WorldWideScience

Sample records for harm reduction 2002-2009

  1. The Global Fund's leadership on harm reduction: 2002-2009.

    Science.gov (United States)

    Atun, Rifat; Kazatchkine, Michel

    2010-03-01

    Injecting drug use is a major driver of the HIV epidemic globally. Whilst robust evidence points to the effectiveness of harm reduction programmes to halt and reverse injecting drug use driven epidemics, uptake of these programmes in developing and transitional countries has been slow. In part, this slow uptake stems from inadequate financial resources for harm reduction; legal, socio-cultural and medical barriers leading to stigmatisation; and weak health systems unequipped to manage marginalized groups. The Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2002, has become the major multilateral source of external funding for harm reduction programmes in countries experiencing concentrated HIV epidemics driven by injecting drug use. Between 2004 to end of 2008, the Global Fund invested around US$180 million in harm reduction programmes in 42 countries. This funding has helped to initiate and scale up harm reduction programmes in settings where domestic funding was lacking. In addition to financing harm reduction programmes globally, the Global Fund has stimulated a strong dialogue between vulnerable groups and governments. Furthermore, the Global Fund has engaged in a dialogue with countries to encourage an evidence-based approach to policy-making that recognizes the immense value of harm reduction in HIV prevention and control. Copyright (c) 2010 Elsevier B.V. All rights reserved.

  2. Harm Reduction Behind Bars

    Directory of Open Access Journals (Sweden)

    Emma R. Miller

    2013-06-01

    Full Text Available We aimed to identify how strategies to reduce the risk of hepatitis C virus (HCV in prisons could be implemented in a way that is acceptable to those with the responsibility for implementing them. Prison officer and nurse perceptions of HCV and attitudes toward a range of harm reduction interventions, including clean needle and bleach provision, were explored. In the context of highly prevalent feelings of resentment, most of the proposed strategies were perceived by all staff as a threat for officers and a privilege for prisoners. Addressing the underlying concerns of prison staff is essential in achieving a fully collaborative harm reduction effort. Ongoing resistance to proposed harm reduction strategies underscores the relevance of these findings for prison settings in Australia and elsewhere.

  3. Harm Reduction Behind Bars

    OpenAIRE

    Emma R. Miller; Jan M. Moore; Peng Bi

    2013-01-01

    We aimed to identify how strategies to reduce the risk of hepatitis C virus (HCV) in prisons could be implemented in a way that is acceptable to those with the responsibility for implementing them. Prison officer and nurse perceptions of HCV and attitudes toward a range of harm reduction interventions, including clean needle and bleach provision, were explored. In the context of highly prevalent feelings of resentment,...

  4. Islam and harm reduction.

    Science.gov (United States)

    Kamarulzaman, A; Saifuddeen, S M

    2010-03-01

    Although drugs are haram and therefore prohibited in Islam, illicit drug use is widespread in many Islamic countries throughout the world. In the last several years increased prevalence of this problem has been observed in many of these countries which has in turn led to increasing injecting drug use driven HIV/AIDS epidemic across the Islamic world. Whilst some countries have recently responded to the threat through the implementation of harm reduction programmes, many others have been slow to respond. In Islam, The Quran and the Prophetic traditions or the Sunnah are the central sources of references for the laws and principles that guide the Muslims' way of life and by which policies and guidelines for responses including that of contemporary social and health problems can be derived. The preservation and protection of the dignity of man, and steering mankind away from harm and destruction are central to the teachings of Islam. When viewed through the Islamic principles of the preservation and protection of the faith, life, intellect, progeny and wealth, harm reduction programmes are permissible and in fact provide a practical solution to a problem that could result in far greater damage to the society at large if left unaddressed. Copyright (c) 2009. Published by Elsevier B.V.

  5. Alcohol harm reduction in Europe

    DEFF Research Database (Denmark)

    Herring, Rachel; Betsy, Thom; Beccaria, Franca

    2010-01-01

    The EMCDDA’s 10th scientific monograph, entitled Harm reduction: evidence, impacts and challenges provides a comprehensive overview of the harm reduction field. Part I of the monograph looks back at the emergence of harm reduction approaches and their diffusion, and explores the concept from diff...

  6. Casting light on harm reduction

    DEFF Research Database (Denmark)

    Jourdan, Michael

    2009-01-01

    Background: Harm reduction is commonly regarded as complementary to other drug problem responses - as the fourth tier. Yet even core examples of harm reduction such as the provision of injection equipment and methadone treatment has over and over encountered considerable opposition, and harm redu...

  7. Tobacco, nicotine and harm reduction.

    Science.gov (United States)

    Le Houezec, Jacques; McNeill, Ann; Britton, John

    2011-03-01

    Tobacco smoking, sustained by nicotine dependence, is a chronic relapsing disorder, which in many cases results in lifelong cigarette use and consequent death of one out of two lifelong smokers from a disease caused by their smoking. Most toxicity due to cigarette smoking is related to the burning process. Models of harm reduction applied to tobacco suggest that use of non-combustible, less toxic, nicotine-containing products as a substitute for cigarette smoking would reduce the death toll arising from tobacco use. Available options include medicinal nicotine and smokeless tobacco products. The potential role of nicotine replacement therapy (NRT) products in a harm reduction strategy is currently severely restricted by strict regulations on dose, safety and potential addictiveness. As a result, NRT products are designed to provide much less nicotine, and deliver it to the brain more slowly, than cigarettes, which are widely accessible and poorly regulated. Smokeless tobacco (snus) has proved to be an acceptable reduced hazard alternative to smoking in Sweden, but supply of snus is illegal elsewhere in the European Union. To increase accessibility and reach more smokers, barriers to the use of NRT use need to be removed and more effective NRTs need urgently to be developed. Smokeless tobacco could also play an important role in harm reduction, but current European Union regulations and concerns over exploitation by tobacco companies currently preclude wider use. To improve public health there is an urgent need for an appropriate regulatory framework and regulatory authority at the European level, controlling both tobacco and nicotine products to ensure that the least harmful products are the most accessible. © 2011 Australasian Professional Society on Alcohol and other Drugs.

  8. Harm reduction principles for healthcare settings.

    Science.gov (United States)

    Hawk, Mary; Coulter, Robert W S; Egan, James E; Fisk, Stuart; Reuel Friedman, M; Tula, Monique; Kinsky, Suzanne

    2017-10-24

    Harm reduction refers to interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely. The vast majority of the harm reduction literature focuses on the harms of drug use and on specific harm reduction strategies, such as syringe exchange, rather than on the harm reduction philosophy as a whole. Given that a harm reduction approach can address other risk behaviors that often occur alongside drug use and that harm reduction principles have been applied to harms such as sex work, eating disorders, and tobacco use, a natural evolution of the harm reduction philosophy is to extend it to other health risk behaviors and to a broader healthcare audience. Building on the extant literature, we used data from in-depth qualitative interviews with 23 patients and 17 staff members from an HIV clinic in the USA to describe harm reduction principles for use in healthcare settings. We defined six principles of harm reduction and generalized them for use in healthcare settings with patients beyond those who use illicit substances. The principles include humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination. For each of these principles, we present a definition, a description of how healthcare providers can deliver interventions informed by the principle, and examples of how each principle may be applied in the healthcare setting. This paper is one of the firsts to provide a comprehensive set of principles for universal harm reduction as a conceptual approach for healthcare provision. Applying harm reduction principles in healthcare settings may improve clinical care outcomes given that the quality of the provider-patient relationship is known to impact health outcomes and treatment adherence. Harm reduction can be a universal precaution applied to all individuals regardless of their disclosure of negative health behaviors, given that health

  9. Harm reduction-the cannabis paradox

    Directory of Open Access Journals (Sweden)

    Melamede Robert

    2005-09-01

    Full Text Available Abstract This article examines harm reduction from a novel perspective. Its central thesis is that harm reduction is not only a social concept, but also a biological one. More specifically, evolution does not make moral distinctions in the selection process, but utilizes a cannabis-based approach to harm reduction in order to promote survival of the fittest. Evidence will be provided from peer-reviewed scientific literature that supports the hypothesis that humans, and all animals, make and use internally produced cannabis-like products (endocannabinoids as part of the evolutionary harm reduction program. More specifically, endocannabinoids homeostatically regulate all body systems (cardiovascular, digestive, endocrine, excretory, immune, nervous, musculo-skeletal, reproductive. Therefore, the health of each individual is dependant on this system working appropriately.

  10. The cost-effectiveness of harm reduction.

    Science.gov (United States)

    Wilson, David P; Donald, Braedon; Shattock, Andrew J; Wilson, David; Fraser-Hurt, Nicole

    2015-02-01

    HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But

  11. Visualizing harm reduction: Methodological and ethical considerations.

    Science.gov (United States)

    Switzer, S; Guta, A; de Prinse, K; Chan Carusone, S; Strike, C

    2015-05-01

    The use of visual methods is becoming increasingly common and accepted in health research. This paper explores the opportunities and constraints of using photo-based methods in the context of a community-based participatory research study on how to engage people living with HIV in conversations about a hospital's recently introduced harm reduction policy. Using a blended approach of photovoice and photo-elicited interviews, we provided participants (n = 16) with cameras and asked them to take a series of photos that "show how you feel about or have experienced harm reduction as a Casey House client." We reflect on methodological insights from the study to think through the process of doing photo-based work on a stigmatized topic in a small hospital setting by foregrounding: 1) how the act of taking photos assisted participants in visualizing connections between space, harm reduction, and substance use; 2) expectations of participation and navigating daily health realities; and 3) issues of confidentiality, anonymity and stigma in clinical settings. These reflections provide a case study on the importance of critically examining the process of engaging with photo-based methods. We conclude the paper by re-thinking issues of context and photo-based methods. Rather than viewing context as a neutral backdrop to apply a method, context should be viewed as an active force in shaping what can or cannot be done or produced within the space. Photo-based methods may offer an effective community-engagement strategy but may require modification for use in a clinical setting when working on a stigmatized topic with individuals with complex health care needs. Given the potential of visual methods as a community engagement strategy, research teams are advised to understand the entire process as a data collection opportunity so that these methods can be further explored in a variety of contexts. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. [Substances considered addictive: prohibition, harm reduction and risk reduction].

    Science.gov (United States)

    Menéndez, Eduardo

    2012-01-01

    Latin America is currently the region with the highest rate of homicides worldwide, and a large part of the killings are linked to so-called organized crime, especially drug trafficking. The trafficking of drugs is a consequence of the illegality of certain substances which - at least presently - is based in and legitimated by biomedical criteria that turns the production, commercialization and often the consumption of certain substances considered addictive into "offenses against health." This text briefly analyzes the two policies formulated and implemented thus far in terms of prohibition and harm reduction, considering the failure of prohibitionism as well as the limitations of harm reduction proposals. The constant and multiple inconsistencies and contradictions of prohibitionism are noted, indicating the necessity of regarding cautiously repeated comments about its "failure." The text proposes the implementation of a policy of risk reduction that includes not only the behavior of individuals and groups, but also the structural dimension, both in economic-political and cultural terms.

  13. Defining and redefining harm reduction in the Lao context

    Directory of Open Access Journals (Sweden)

    Sychareun Vanphanom

    2012-07-01

    Full Text Available Abstract The response to drug use in Laos has focused on reducing opium supply (supply reduction and rates of drug use (demand reduction. However, recently there is increased interest among government counterparts to discuss and develop broader responses to injecting drug use (IDU including the introduction of harm reduction programs. The concept of harm reduction has just been introduced to Lao PDR and as yet there is no agreement on a definition of the concept. We highlight here a range of issues that remain controversial in Lao PDR in the HIV, drug use and harm reduction discourse, the definition of 'harm reduction' and related terms; and the scope of harm reduction. This was a qualitative study, consisting of in-depth interviews with 27 law enforcement and 8 health officers who work in the fields of HIV and/or drug control about their understanding of HIV related to drug use, and concepts of harm reduction. Content analysis was performed to identify the coding, categories and themes. We found that law enforcement officers in particular had limited understanding about harm reduction and the feasibility and appropriateness of harm reduction services in the Lao context. Harm reduction should be a core element of a public health response to HIV where drug use and IDU exists. Recommendations include the necessity of increasing the awareness of harm reduction among law enforcement officers and providing appropriate evidence to support the needs of harm reduction policy and programs. HIV prevention and treatment strategies should be integrated within existing social and cultural frameworks, working with the task force for HIV/IDU and other government counterparts.

  14. [Harm reduction strategy in tobacco control].

    Science.gov (United States)

    Gorini, Giuseppe

    2011-01-01

    .Thus, California Department of Health Services prohibits promotion of snus and medicinal nicotine as a harm reduction strategy. However, the US Federal Family Smoking Prevention and Tobacco Control Act, signed by President Obama in 2009, places tobacco products under FDA jurisdiction: FDA must define criteria for lowering carcinogens and toxicants in tobacco products, making more available medicinal nicotine, evaluating PREPs, creating a federal Tobacco Control Agency.Which approaches is Italy going to follow?

  15. Treating Addictions: Harm Reduction in Clinical Care and Prevention.

    Science.gov (United States)

    Drucker, Ernest; Anderson, Kenneth; Haemmig, Robert; Heimer, Robert; Small, Dan; Walley, Alex; Wood, Evan; van Beek, Ingrid

    2016-06-01

    This paper examines the role of clinical practitioners and clinical researchers internationally in establishing the utility of harm-reduction approaches to substance use. It thus illustrates the potential for clinicians to play a pivotal role in health promoting structural interventions based on harm-reduction goals and public health models. Popular media images of drug use as uniformly damaging, and abstinence as the only acceptable goal of treatment, threaten to distort clinical care away from a basis in evidence, which shows that some ways of using drugs are far more harmful than others and that punitive approaches and insistence on total abstinence as the only goal of treatment often increases the harms of drug use rather than reducing drug use. Therefore the leadership and scientific authority of clinicians who understand the health impact of harm-reduction strategies is needed. Through a review of harm-reduction interventions in Canada, the United Kingdom, the United States, Australia, Switzerland, and the Netherlands, we identify three ways that clinicians have helped to achieve a paradigm shift from punitive approaches to harm-reduction principles in clinical care and in drug policy: (1) through clinical research to provide data establishing the effectiveness and feasibility of harm-reduction approaches, (2) by developing innovative clinical programmes that employ harm reduction, and thereby (3) changing the standard of care to include routine use of these evidence-based (but often misunderstood) approaches in their practices. We argue that through promotion of harm-reduction goals and methods, clinicians have unique opportunities to improve the health outcomes of vulnerable populations.

  16. Overview of harm reduction in prisons in seven European countries.

    Science.gov (United States)

    Sander, Gen; Scandurra, Alessio; Kamenska, Anhelita; MacNamara, Catherine; Kalpaki, Christina; Bessa, Cristina Fernandez; Laso, Gemma Nicolás; Parisi, Grazia; Varley, Lorraine; Wolny, Marcin; Moudatsou, Maria; Pontes, Nuno Henrique; Mannix-McNamara, Patricia; Libianchi, Sandro; Antypas, Tzanetos

    2016-10-07

    While the last decade has seen a growth of support for harm reduction around the world, the availability and accessibility of quality harm reduction services in prison settings is uneven and continues to be inadequate compared to the progress achieved in the broader community. This article provides a brief overview of harm reduction in prisons in Catalonia (Spain), Greece, Ireland, Italy, Latvia, Poland, and Portugal. While each country provides a wide range of harm reduction services in the broader community, the majority fail to provide these same services or the same quality of these services, in prison settings, in clear violation of international human rights law and minimum standards on the treatment of prisoners. Where harm reduction services have been available and easily accessible in prison settings for some time, better health outcomes have been observed, including significantly reduced rates of HIV and HCV incidence. While the provision of harm reduction in each of these countries' prisons varies considerably, certain key themes and lessons can be distilled, including around features of an enabling environment for harm reduction, resource allocation, collection of disaggregated data, and accessibility of services.

  17. HARM REDUCTION IN THE PREVENTION OF DRUG ADDICTIONS

    OpenAIRE

    KALOUSOVÁ, Dita

    2010-01-01

    This dissertation on Harm Reduction approach in the prevention of drug addictions deals with tertiary drug prevention. It aims to show the importance of how much information about this topic students at comprehensive schools get and have. The theoretical part provides some information about the consequences of drug addiction in general, about drug prevention, substitution treatment, Harm Reduction approach and the services involved. The practical part presents the results of a survey which ai...

  18. Harm reduction history, response, and current trends in Asia.

    Science.gov (United States)

    Thomson, Nicholas

    2013-12-01

    HIV epidemics in Asia have been initially driven through injecting drug use and the use of shared needles and syringes. Molecular epidemiological work has shown that where there is heroin trafficking and use, so too is there HIV. Given the often strict enforcement of national anti-narcotic laws, harm reduction responses to HIV infections driven by injecting drug use have been historically slow. As it became clear that preventing HIV meant embracing harm reduction, many countries in the region have adopted harm reduction as part of their national AIDS strategy and increasingly as part of their national drug strategy. Initial successes have proven that harm reduction, as it pertains to HIV among IDUs, can and does work in Asia. These initial successes have led to more comprehensive scale-up of other essential components of HIV prevention among IDUs, including increased availability of opiate substitution programs. Still, multiple challenges remain as overall coverage of services in the region remains poor. Changes in the availability and patterns of use of drugs, including the exponential increase in the use of amphetamine-type stimulants, is providing ongoing challenges to both the law enforcement and public health sectors. This paper reflects on the history of harm reduction in Asia and the shifting trends forcing policy makers to adapt and expand harm reduction strategies to include an ever widening approach to criminal justice, policing, public health, and human rights.

  19. Responsible and controlled use: Older cannabis users and harm reduction.

    Science.gov (United States)

    Lau, Nicholas; Sales, Paloma; Averill, Sheigla; Murphy, Fiona; Sato, Sye-Ok; Murphy, Sheigla

    2015-08-01

    Cannabis use is becoming more accepted in mainstream society. In this paper, we use Zinberg's classic theoretical framework of drug, set, and setting to elucidate how older adult cannabis users managed health, social and legal risks in a context of normalized cannabis use. We present selected findings from our qualitative study of Baby Boomer (born 1946-1964) cannabis users in the San Francisco Bay Area. Data collection consisted of a recorded, in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analyzed to discover the factors of cannabis harm reduction from the users' perspectives. Interviewees made harm reduction choices based on preferred cannabis derivatives and routes of administration, as well as why, when, where, and with whom to use. Most interviewees minimized cannabis-related harms so they could maintain social functioning in their everyday lives. Responsible and controlled use was described as moderation of quantity and frequency of cannabis used, using in appropriate settings, and respect for non-users. Users contributed to the normalization of cannabis use through normification. Participants followed rituals or cultural practices, characterized by sanctions that helped define "normal" or "acceptable" cannabis use. Users contributed to cannabis normalization through their harm reduction methods. These cultural practices may prove to be more effective than formal legal prohibitions in reducing cannabis-related harms. Findings also suggest that users with access to a regulated market (medical cannabis dispensaries) were better equipped to practice harm reduction. More research is needed on both cannabis culture and alternative routes of administration as harm reduction methods. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Responsible and controlled use: Older cannabis users and harm reduction

    Science.gov (United States)

    Lau, Nicholas; Sales, Paloma; Averill, Sheigla; Murphy, Fiona; Sato, Sye-Ok; Murphy, Sheigla

    2015-01-01

    Background Cannabis use is becoming more accepted in mainstream society. In this paper, we use Zinberg’s classic theoretical framework of drug, set, and setting to elucidate how older adult cannabis users managed health, social and legal risks in a context of normalized cannabis use. Methods We present selected findings from our qualitative study of Baby Boomer (born 1946–1964) cannabis users in the San Francisco Bay Area. Data collection consisted of a recorded, in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analyzed to discover the factors of cannabis harm reduction from the users’ perspectives. Results Interviewees made harm reduction choices based on preferred cannabis derivatives and routes of administration, as well as why, when, where, and with whom to use. Most interviewees minimized cannabis-related harms so they could maintain social functioning in their everyday lives. Responsible and controlled use was described as moderation of quantity and frequency of cannabis used, using in appropriate settings, and respect for non-users. Users contributed to the normalization of cannabis use through normification. Conclusion Participants followed rituals or cultural practices, characterized by sanctions that helped define “normal” or “acceptable” cannabis use. Users contributed to cannabis normalization through their harm reduction methods. These cultural practices may prove to be more effective than formal legal prohibitions in reducing cannabis-related harms. Findings also suggest that users with access to a regulated market (medical cannabis dispensaries) were better equipped to practice harm reduction. More research is needed on both cannabis culture and alternative routes of administration as harm reduction methods. PMID:25911027

  1. Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies

    Science.gov (United States)

    Hawk, Kathryn F.; Vaca, Federico E.; D’Onofrio, Gail

    2015-01-01

    The opioid overdose epidemic is a major threat to the public’s health, resulting in the development and implementation of a variety of strategies to reduce fatal overdose [1-3]. Many strategies are focused on primary prevention and increased access to effective treatment, although the past decade has seen an exponential increase in harm reduction initiatives. To maximize identification of opportunities for intervention, initiatives focusing on prevention, access to effective treatment, and harm reduction are examined independently, although considerable overlap exists. Particular attention is given to harm reduction approaches, as increased public and political will have facilitated widespread implementation of several initiatives, including increased distribution of naloxone and policy changes designed to increase bystander assistance during a witnessed overdose [4-7]. PMID:26339206

  2. Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies.

    Science.gov (United States)

    Hawk, Kathryn F; Vaca, Federico E; D'Onofrio, Gail

    2015-09-01

    The opioid overdose epidemic is a major threat to the public's health, resulting in the development and implementation of a variety of strategies to reduce fatal overdose. Many strategies are focused on primary prevention and increased access to effective treatment, although the past decade has seen an exponential increase in harm reduction initiatives. To maximize identification of opportunities for intervention, initiatives focusing on prevention, access to effective treatment, and harm reduction are examined independently, although considerable overlap exists. Particular attention is given to harm reduction approaches, as increased public and political will have facilitated widespread implementation of several initiatives, including increased distribution of naloxone and policy changes designed to increase bystander assistance during a witnessed overdose.

  3. [Harm reduction interventions in drug users: current situation and recommendations].

    Science.gov (United States)

    Bosque-Prous, Marina; Brugal, María Teresa

    2016-11-01

    Harm reduction encompasses interventions, programmes and policies that seek to reduce the negative consequences of the consumption of both legal and illegal drugs on the individual and public health. Harm reduction looks to mitigate the harm suffered by drug users through drug use monitoring and prevention, and promotes initiatives that respect and protect the human rights of this population. The harm reduction policies that have proven effective and efficient are: opioid substitution maintenance therapy (methadone); needle and syringe exchange programmes; supervised drug consumption rooms; and overdose prevention through peer-based naloxone distribution. In order to be effective, these policies must have comprehensive coverage and be implemented in areas where the target population is prevalent. Resident-based opposition to the implementation of these policies is known as the NIMBY (Not In My Back Yard) phenomenon, which is characterised by being against the implementation of new measures in a particular place, but does not question their usefulness. Given that any NIMBY phenomenon is a complex social, cultural and political phenomenon, it is important to conduct a thorough analysis of the situation prior to implementing any of these measures. Harm reduction policies must be extended to other substances such as alcohol and tobacco, as well as to other conditions beyond infectious/contagious diseases and overdose. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Minimizing Harm and Maximizing Pleasure: Considering the Harm Reduction Paradigm for Sexuality Education

    Science.gov (United States)

    Naisteter, Michal A.; Sitron, Justin A.

    2010-01-01

    This article explores the potential for introducing harm reduction into sexuality education. When the goal of sexuality education is on prevention and focuses on risk and public health concerns, a discussion of pleasure is rendered problematic, as many pleasurable behaviors are inherently "unsafe" or "risky" when considered using a safe-sex lens.…

  5. The social context of injection drug use and harm reduction ...

    African Journals Online (AJOL)

    Sub-Saharan Africa has a documented significant burden of heroin and cocaine injection, and HIV transmission. But the region is behind in the implementation and scaling up of harm reduction measures such as syringe exchange programmes and opiate substitution therapy, due to political preference for the control of drug ...

  6. A safer alternative: Cannabis substitution as harm reduction.

    Science.gov (United States)

    Lau, Nicholas; Sales, Paloma; Averill, Sheigla; Murphy, Fiona; Sato, Sye-Ok; Murphy, Sheigla

    2015-11-01

    Substitution is operationalised as a conscious choice made by users to use one drug instead of, or in conjunction with another based on: perceived safety, level of addiction potential, effectiveness in relieving symptoms, access and level of acceptance. Harm reduction is a set of strategies that aim to minimise problems associated with drug use while recognising that for some users, abstinence may be neither a realistic nor a desirable goal. In this paper, we aim for deeper understandings of older adult cannabis users' beliefs and substitution practices as part of the harm reduction framework. We present selected findings from our qualitative study of Baby Boomer (born 1946-1964) marijuana users in the San Francisco Bay Area. Although the sample consisted of primary cannabis users, many had personal experience with other drugs throughout their lifetimes. Data collection consisted of an audio-recorded, semi-structured in-depth life history interview followed by a questionnaire and health survey. Qualitative interviews were analysed to discover users' harm reduction beliefs and cannabis substitution practices. Study participants described using cannabis as a safer alternative for alcohol, illicit drugs and pharmaceuticals based on their perceptions of less adverse side effects, low-risk for addiction and greater effectiveness at relieving symptoms, such as chronic pain. Cannabis substitution can be an effective harm reduction method for those who are unable or unwilling to stop using drugs completely. More research is needed on cannabis as a safer alternative. © 2015 Australasian Professional Society on Alcohol and other Drugs.

  7. Smokeless tobacco as a nicotine delivery device: harm or harm reduction?

    Science.gov (United States)

    Benowitz, N L

    2011-10-01

    Smokeless tobacco (ST) delivers nicotine in doses similar to those received in cigarette smoking but does not expose the user to the toxic combustion gases and particles that are responsible for most tobacco-induced disease. This Opinion piece discusses the controversies pertaining to ST and health, the pros and cons of ST in harm reduction, and progress in treatment for those who would like to quit ST use.

  8. The scientific foundation for tobacco harm reduction, 2006-2011

    OpenAIRE

    Rodu Brad

    2011-01-01

    Abstract Over the past five years there has been exponential expansion of interest in tobacco harm reduction (THR), with a concomitant increase in the number of published studies. The purpose of this manuscript is to review and analyze influential contributions to the scientific and medical literature relating to THR, and to discuss issues that continue to stimulate debate. Numerous epidemiologic studies and subsequent meta-analyses confirm that smokeless tobacco (ST) use is associated with m...

  9. The politics of harm reduction in federal prisons.

    Science.gov (United States)

    Watson, Tara Marie

    2014-09-01

    We need to understand better the political barriers to prison-based harm reduction programs. In this paper, I examine the situation in the Correctional Service of Canada (CSC), a federal prison agency with a zero-tolerance drug policy and general opposition to prison needle and syringe programs (PNSPs) and safer tattooing initiatives. This study draws on 16 interviews with former CSC senior officials, former frontline staff, and external stakeholders; CSC policy and practice documents; and testimony from a House of Commons Standing Committee public study. Thematic coding and comparison of texts were used to examine emergent themes of interest. Four interrelated issues were central for understanding the political barriers: a narrower definition of harm reduction used in corrections, both in principle and practice; the Conservative government's tough-on-crime agenda; strong union opposition; and stakeholder perceptions that political constraints will likely persist, including the view that litigation may offer the only way to introduce PNSPs. The system is at an impasse and key questions remain about the importability of harm reduction services into federal prisons. Despite a highly challenging policy environment, moving forward will demand asking new, critical questions and devising more strategic ways of entering the political-operational dialogue that opposes evidence-based programs. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Tobacco harm reduction: an alternative cessation strategy for inveterate smokers

    Directory of Open Access Journals (Sweden)

    Godshall William T

    2006-12-01

    Full Text Available Abstract According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable – or at least unwilling – to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in

  11. Tobacco harm reduction: an alternative cessation strategy for inveterate smokers.

    Science.gov (United States)

    Rodu, Brad; Godshall, William T

    2006-12-21

    According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable--or at least unwilling--to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist

  12. Tobacco harm reduction: an alternative cessation strategy for inveterate smokers

    Science.gov (United States)

    Rodu, Brad; Godshall, William T

    2006-01-01

    According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases. Many smokers are unable – or at least unwilling – to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die. A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products. This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations. The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist

  13. Love as harm reduction: fighting AIDS and stigma in Vietnam

    Directory of Open Access Journals (Sweden)

    Small Dan

    2009-12-01

    Full Text Available Abstract In the summer of 2009, I visited a humble orphanage for children with HIV/AIDS in Vietnam. Here, like many parts in the world, the very existence of marginalized people with stigmatized illness is hidden away. Relegated to the shadows of society, these children lacked something more fundamental than housing, shelter, nutrition and medications. They lacked families to love and care for them unconditionally. One might think it self-evident that a visit to an orphanage for children with HIV would be profound, but the profundity wasn't where I expected to find it. It was in how the children had created their own family, loving each other like brothers and sisters, and the way the priest who operated the shelters was more than a Father, he was a dad to dozens of children. This is an account of love as harm reduction in the Mai Tam orphanage in Ho Chi Minh City.

  14. The globalization of ayahuasca: harm reduction or benefit maximization?

    Science.gov (United States)

    Tupper, Kenneth W

    2008-08-01

    Ayahuasca is a tea made from two plants native to the Amazon, Banisteriopsis caapi and Psychotria viridis, which, respectively, contain the psychoactive chemicals harmala alkaloids and dimethyltryptamine. The tea has been used by indigenous peoples in countries such as Brazil, Ecuador and Peru for medicinal, spiritual and cultural purposes since pre-Columbian times. In the 20th century, ayahuasca spread beyond its native habitat and has been incorporated into syncretistic practices that are being adopted by non-indigenous peoples in modern Western contexts. Ayahuasca's globalization in the past few decades has led to a number of legal cases which pit religious freedom against national drug control laws. This paper explores some of the philosophical and policy implications of contemporary ayahuasca use. It addresses the issue of the social construction of ayahuasca as a medicine, a sacrament and a "plant teacher." Issues of harm reduction with respect to ayahuasca use are explored, but so too is the corollary notion of "benefit maximization."

  15. Between chaos and care in a harm reduction setting

    DEFF Research Database (Denmark)

    Kappel, Nanna; Tegner, Jette; Toth, Eva Charlotte

    . DCR clients often face stressful living circumstances, like unstable housing as well as physical and mental health issues. Despite this, the staff establish relationships with clients and build bridge to health care facilities, social services and addiction therapy. Aim: The purpose of this study...... relationships and met clients in a non-judgmental, accepting and educational approach. Clients expressed feeling safe, socially accepted and seen as human beings. In this setting, between chaos and care, staff established rapport and positive referrals to both health and social sector as well as addiction...... therapy. Analysis from this study also showed, that DCRs provide a frame for harm reduction services in relation to hygiene, safer injection techniques and prevention of potential overdoses as well as interventions in overdose situations. Furthermore, the clients valued the staff's education and some...

  16. Virtue ethics as an alternative to deontological and consequential reasoning in the harm reduction debate.

    Science.gov (United States)

    Christie, Timothy; Groarke, Louis; Sweet, William

    2008-02-01

    There is strong evidence that harm reduction interventions such as Supervised Injection Sites and Needle Exchange Programs prevent many of the negative consequences of problematic substance use. Yet many governments, including the United States and Canada, still do not endorse these interventions, claiming that they do not get people off of drugs and send a mixed message. This paper will analyze objections to harm reduction in light of the ethical theories of John Stuart Mill, Immanuel Kant and Aristotle. The most important ethical issue in the abstinence vs. harm reduction debate is whether harm reduction - because it does not require individuals to either reduce their consumption of illicit substances or to abstain from illicit substance use - can be ethically justified. Harm reduction interventions are clearly justified on Utilitarian grounds because, based on the evidence, such policies would produce the greatest good for the greatest number. However, Kant would not think that the values guiding harm reduction are ethical because the justification of harm reduction interventions focuses exclusively on examining consequences. Virtue Ethics seeks to find the proper balance between harm reduction and abstinence. We claim that the virtue of compassion would provide a defense of harm reduction.

  17. Two steps forward, one step back: current harm reduction policy and politics in the United States

    National Research Council Canada - National Science Library

    Ethan Nadelmann; Lindsay LaSalle

    2017-01-01

    .... The Obama administration, particularly in its last years, embraced some harm reduction policies that had been rejected by previous administrations but shied away from more cutting edge interventions...

  18. Prospects for a nicotine-reduction strategy in the cigarette endgame: Alternative tobacco harm reduction scenarios.

    Science.gov (United States)

    Kozlowski, Lynn T

    2015-06-01

    Some major national and international tobacco control organisations favour mandating a reduction in nicotine content of cigarettes to non-addictive levels as a tobacco control tool. Reducing nicotine content, it is argued, will make tobacco smoking less attractive. The 2009 U.S. Food and Drug Administration's regulation of cigarettes appears to have the power to reduce nicotine to non-addictive levels provided it is not taken to zero. A consideration of the U.S. context, however, raises doubts about (a) whether this will ever be practicable and (b), if practicable, how long it will take to implement. Current versions of the nicotine-reducing strategy propose the systematic, incentivised use of less harmful nicotine/tobacco products as elements of the mandatory cigarette nicotine-reduction strategy. Time will tell if and when mandatory nicotine reduction in tobacco cigarettes will occur and what impact it might have on smoking prevalence. The question posed here is "Why wait?" Resources used in implementing reduction in nicotine content have an opportunity cost. In the meantime, nicotine-maintaining harm reduction strategies can have nearer term effects on tobacco use as an individual and a public health issue. Copyright © 2015 The Author. Published by Elsevier B.V. All rights reserved.

  19. Ethical considerations of e-cigarette use for tobacco harm reduction

    National Research Council Canada - National Science Library

    Franck, Caroline; Filion, Kristian B; Kimmelman, Jonathan; Grad, Roland; Eisenberg, Mark J

    2016-01-01

    .... We identified the major ethical considerations surrounding the use of e-cigarettes for tobacco harm reduction, including product safety, efficacy for smoking cessation and reduction, use among non...

  20. Beyond human rights and public health: citizenship issues in harm reduction.

    Science.gov (United States)

    Chen, Jia-shin

    2011-05-01

    There have been debates amongst harm reduction practitioners regarding the relationship of universal human rights vis-à-vis public health demands. The ideological debates around these two slippery concepts often obfuscate the important theme of citizenship. The author, therefore, argues for the perspective of citizenship as an alternative to comprehend harm reduction practises more thoroughly. An introduction of the concept of citizenship is followed by a case example of Taiwan's harm reduction policy-making, wherein injection drug users were subjected to various disciplinary actions and made into citizen addicts. It is hoped that more harm reduction researchers will have increased familiarity with the notion of citizenship as a useful tool to examine the power dynamics taking place in the name of harm reduction. Copyright © 2010 Elsevier B.V. All rights reserved.

  1. The scientific foundation for tobacco harm reduction, 2006-2011

    Directory of Open Access Journals (Sweden)

    Rodu Brad

    2011-07-01

    Full Text Available Abstract Over the past five years there has been exponential expansion of interest in tobacco harm reduction (THR, with a concomitant increase in the number of published studies. The purpose of this manuscript is to review and analyze influential contributions to the scientific and medical literature relating to THR, and to discuss issues that continue to stimulate debate. Numerous epidemiologic studies and subsequent meta-analyses confirm that smokeless tobacco (ST use is associated with minimal risks for cancer and for myocardial infarction; a small increased risk for stroke cannot be excluded. Studies from Sweden document that ST use is not associated with benign gastrointestinal disorders and chronic inflammatory diseases. Although any form of nicotine should be avoided during pregnancy, the highest risks for the developing baby are associated with smoking. It is documented that ST use has been a key factor in the declining rates of smoking and of smoking-related diseases in Sweden and Norway. For other countries, the potential population health benefits of ST are far greater than the potential risks. In follow-up studies, dual users of cigarettes and ST are less likely than exclusive smokers to achieve complete tobacco abstinence, but they are also less likely to be smoking. The health risks from dual use are probably lower than those from exclusive smoking. E-cigarette users are not exposed to the many toxicants, carcinogens and abundant free radicals formed when tobacco is burned. Although laboratory studies have detected trace concentrations of some contaminants, it is a small problem amenable to improvements in quality control and manufacturing that are likely with FDA regulation as tobacco products. There is limited evidence from clinical trials that e-cigarettes deliver only small doses of nicotine compared with conventional cigarettes. However, e-cigarette use emulates successfully the cigarette handling rituals and cues of cigarette

  2. The scientific foundation for tobacco harm reduction, 2006-2011.

    Science.gov (United States)

    Rodu, Brad

    2011-07-29

    Over the past five years there has been exponential expansion of interest in tobacco harm reduction (THR), with a concomitant increase in the number of published studies. The purpose of this manuscript is to review and analyze influential contributions to the scientific and medical literature relating to THR, and to discuss issues that continue to stimulate debate. Numerous epidemiologic studies and subsequent meta-analyses confirm that smokeless tobacco (ST) use is associated with minimal risks for cancer and for myocardial infarction; a small increased risk for stroke cannot be excluded. Studies from Sweden document that ST use is not associated with benign gastrointestinal disorders and chronic inflammatory diseases. Although any form of nicotine should be avoided during pregnancy, the highest risks for the developing baby are associated with smoking. It is documented that ST use has been a key factor in the declining rates of smoking and of smoking-related diseases in Sweden and Norway. For other countries, the potential population health benefits of ST are far greater than the potential risks. In follow-up studies, dual users of cigarettes and ST are less likely than exclusive smokers to achieve complete tobacco abstinence, but they are also less likely to be smoking. The health risks from dual use are probably lower than those from exclusive smoking. E-cigarette users are not exposed to the many toxicants, carcinogens and abundant free radicals formed when tobacco is burned. Although laboratory studies have detected trace concentrations of some contaminants, it is a small problem amenable to improvements in quality control and manufacturing that are likely with FDA regulation as tobacco products. There is limited evidence from clinical trials that e-cigarettes deliver only small doses of nicotine compared with conventional cigarettes. However, e-cigarette use emulates successfully the cigarette handling rituals and cues of cigarette smoking, which produces

  3. National Survey on Drug Use and Health: 8-Year R-DAS (NSDUH-2002-2009)

    Data.gov (United States)

    U.S. Department of Health & Human Services — This file includes data from the 2002 through 2009 National Survey on Drug Use and Health (NSDUH) survey. The only variables included in the 8-year 2002-2009 data...

  4. Back to the core: A network approach to bolster harm reduction among persons who inject drugs.

    Science.gov (United States)

    Bouchard, Martin; Hashimi, Sadaf; Tsai, Kristen; Lampkin, Hugh; Jozaghi, Ehsan

    2017-12-08

    Injecting drugs safely almost always includes the presence of one's social network, especially for the prevention of overdose. Yet, the systematic analysis of users' social networks has yet to be established as a focal method in harm reduction research, and interventions. This study draws from 200 interviews with persons who inject drugs recruited from North America's first sanctioned supervised injection facility and a drug user's advocacy group. Respondents were asked about the individuals they personally considered as facilitators of harm reduction, and the relations between them. Collectively, these 200 respondents provided over 900 individuals whom they considered as members of their harm reduction network. The aim was to locate individuals that would potentially make the network denser (harm reduction champions) and users that were situated in the "periphery" of the network, and in practice, further away from the harm reduction core. Of the 1135 network members, 63 individuals formed the "core" of the harm reduction network, collectively reaching approximately 70% of individuals in the network. We also uncovered 31 individuals that acted as "articulation points"- these individuals were not as connected, but were more effective at reaching peripheral individuals. Former or current injecting drug users that were sampled were surrounded by a relatively rich harm reduction network, but the network approach showed that only a minority of individuals were true harm reduction "champions". Recruitment of a combination of well-connected harm reduction champions, and strategically connected articulation points, would be most effective in planning network interventions that encourage harm reduction behaviors among this population. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Harm reduction in U.S. tobacco control: Constructions in textual news media.

    Science.gov (United States)

    Eversman, Michael H

    2015-06-01

    U.S. tobacco control has long emphasized abstinence, yet quitting smoking is hard and cessation rates low. Tobacco harm reduction alternatives espouse substituting cigarettes with safer nicotine and tobacco products. Policy shifts embracing tobacco harm reduction have increased media attention, yet it remains controversial. Discourse theory posits language as fluid, and socially constructed meaning as neither absolute nor neutral, elevating certain views over others while depicting "discursive struggle" between them. While an abstinence-based framework dominates tobacco policy, discourse theory suggests constructions of nicotine and tobacco use can change, for example by positioning tobacco harm reduction more favorably. Textual discourse analysis was used to explore constructions of tobacco harm reduction in 478 (308 original) U.S. textual news media articles spanning 1996-2014. Using keyword database sampling, retrieved articles were analyzed first as discrete recording units and then to identify emergent thematic content. Constructions of tobacco harm reduction shifted over this time, revealing tension among industry and policy interests through competing definitions of tobacco harm reduction, depictions of its underlying science, and accounts of regulatory matters including tobacco industry support for harm reduction and desired marketing and taxation legislation. Heightened salience surrounding tobacco harm reduction and electronic cigarettes suggests their greater acceptance in U.S. tobacco control. Various media depictions construct harm reduction as a temporary means to cessation, and conflict with other constructions of it that place no subjective value on continued "safer" tobacco/nicotine use. Constructions of science largely obscure claims of the veracity of tobacco harm reduction, with conflict surrounding appropriate public health benchmarks for tobacco policy and health risks of nicotine use. Taxation policies and e-cigarette pricing relative to

  6. Harm reduction as a strategy for supporting people who self-harm on mental health wards: the views and experiences of practitioners.

    Science.gov (United States)

    James, Karen; Samuels, Isaac; Moran, Paul; Stewart, Duncan

    2017-05-01

    Harm reduction has had positive outcomes for people using sexual health and substance misuse services. Clinical guidance recommends these approaches may be appropriately adopted by mental health practitioners when managing some people who self-harm. There has, however, been very little research in this area. We explored practitioners' views of harm reduction as a strategy for supporting people who self-harm. The Self Harm Antipathy Scale (SHAS) was administered to a random sample of 395 mental health practitioners working on 31 wards in England, semi-structured interviews were then conducted with 18 survey respondents. Practitioners who had implemented the approach reported positive outcomes including a reduction in incidence and severity of self-harm and a perceived increase in empowerment of service users. Practitioners with no experience of using harm reduction were concerned that self-harm would increase in severity, and were unsure how to assess and manage risk in people under a harm reduction care plan. Some fundamentally disagreed with the principle of harm reduction for self-harm because it challenged their core beliefs about the morality of self-harm, or the ethical and potential legal ramifications of allowing individuals to harm themselves. This study was conducted solely with practitioners working on inpatient units. The majority of staff interviewed had no experience of harm reduction and so their concerns may not reflect challenges encountered by practitioners in clinical practice. Harm reduction is being used to support people who self-harm within inpatient psychiatry and some practitioners report potential benefits of this approach. However, this raises particularly complex practical, ethical and legal issues and further research is needed to assess the safety, acceptability and efficacy of the approach. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  7. Harm reduction-a systematic review on effects of alcohol reduction on physical and mental symptoms.

    Science.gov (United States)

    Charlet, Katrin; Heinz, Andreas

    2017-09-01

    Based on the knowledge that alcohol misuse causes a multitude of diseases and increased mortality, this systematic review examines whether a reduction of the individual alcohol consumption can contribute to a minimization of health risks within a harm reduction approach. In fact, the reviewed 63 studies indicate that interventions aiming at alcohol reduction (including total abstinence as one possible therapeutic aim) indeed resulted in or were associated with positive effects in harmful, hazardous or alcohol-dependent drinkers. Major benefits were observed for reducing alcohol-associated injuries, recovery of ventricular heart function in alcoholic cardiomyopathy, blood pressure lowering, normalization of biochemical parameter, body weight reduction, histological improvement in pre-cirrhotic alcohol-related liver disease and slowed progression of an already existing alcohol-attributable liver fibrosis. Furthermore, reduced withdrawal symptoms, prevalence of psychiatric episodes and duration of in-patient hospital days, improvement of anxiety and depression symptoms, self-confidence, physical and mental quality of life, fewer alcohol-related adverse consequences as well as lower psychosocial stress levels and better social functioning can result from reduced alcohol intake. The reviewed literature demonstrated remarkable socioeconomic cost benefits in areas such as the medical health-care system or workforce productivity. Individuals with heightened vulnerability further benefit significantly from alcohol reduction (e.g. hypertension, hepatitis C, psychiatric co-morbidities, pregnancy, but also among adolescents and young adults). Concluding, the reviewed studies strongly support and emphasize the importance and benefits of early initial screening for problematic alcohol use followed by brief and other interventions in first contact medical health-care facilities to reduce alcohol intake. © 2016 Society for the Study of Addiction.

  8. Mull it over: cannabis vaporizers and harm reduction.

    Science.gov (United States)

    Gartner, Coral E

    2015-11-01

    Legalization of cannabis is likely to lead to greater use. Balanced regulation of potentially less harmful modes of administration, such as vaporizers, is needed. Further research is warranted not only on the direct health effects of vaping cannabis, but also on its potential to decrease co-administration of tobacco with cannabis.

  9. Alcohol Control and Harm Reduction Policies in Lebanon | CRDI ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Alcohol is the world's third largest risk factor for disease and disability and a major contributor to more than 60 diseases. In Lebanon, alcohol use among youth is of particular concern. While local epidemiological data suggest that alcohol use among high school and university students is on the rise, the prevention of harmful ...

  10. The furthest left behind: the urgent need to scale up harm reduction in prisons.

    Science.gov (United States)

    Sander, Gen; Murphy, Fionnuala

    2017-09-11

    Purpose Raise awareness about the disproportionate impact of HIV and hepatitis C (HCV) on prisoners worldwide and the need for key harm reduction services such as needle and syringe programmes and opioid substitution therapy in prisons offer practical recommendations to assist policy makers in implementing or scaling up these services. The paper aims to discuss these issues. Design/methodology/approach This study is a desk review of existing data and evidence on HIV, HCV and harm reduction in prisons, analysis of political barriers and formulation of key policy recommendations. Findings Harm reduction works, yet service provision in prisons remains extremely limited. There is an urgent need for governments to enhance political leadership and funding for harm reduction in prisons. Authorities must also work to remove obstacles to the implementation of harm reduction services in prisons, enhance the monitoring and evaluation of laws, policies and programmes relating to HIV, HCV and drugs in prison settings, and recognise access to harm reduction in prisons as a fundamental human right. Until these obstacles are addressed, the world will not meet the Sustainable Development Goal of eradicating HIV and HCV by 2030. Originality/value More than just a desk review, this policy brief provides a political analysis of the harm reduction crisis in prisons and offers clear-cut recommendations for policy makers.

  11. Harm reduction and law enforcement in Vietnam: influences on street policing

    Directory of Open Access Journals (Sweden)

    Jardine Melissa

    2012-07-01

    Full Text Available Abstract Background and rationale The HIV epidemic in Vietnam has from its start been concentrated among injecting drug users. Vietnam instituted the 2006 HIV/AIDS Law which includes comprehensive harm reduction measures, but these are unevenly accepted and inadequately implemented. Ward police are a major determinant of risk for IDUs, required to participate in drug control practices (especially meeting quotas for detention centres which impede support for harm reduction. We studied influences on ward level police regarding harm reduction in Hanoi to learn how to better target education and structural change. Methods After document review, we interviewed informants from government, NGOs, INGOs, multilateral agencies, and police, using semi-structured guides. Topics covered included perceptions of harm reduction and the police role in drug law enforcement, and harm reduction training and advocacy among police. Results Police perceive conflicting responsibilities, but overwhelmingly see their responsibility as enforcing drug laws, identifying and knowing drug users, and selecting those for compulsory detention. Harm reduction training was very patchy, ward police not being seen as important to it; and understanding of harm reduction was limited, tending to reflect drug control priorities. Justification for methadone was as much crime prevention as HIV prevention. Competing pressures on ward police create much anxiety, with performance measures based around drug control; recourse to detention resolves competing pressures more safely. There is much recognition of the importance of discretion, and much use of it to maintain good social order. Policy dissemination approaches within the law enforcement sector were inconsistent, with little communication about harm reduction programs or approaches, and an unfounded assumption that training at senior levels would naturally reach to the street. Discussion Ward police have not been systematically included

  12. Harm reduction and law enforcement in Vietnam: influences on street policing.

    Science.gov (United States)

    Jardine, Melissa; Crofts, Nick; Monaghan, Geoff; Morrow, Martha

    2012-07-09

    The HIV epidemic in Vietnam has from its start been concentrated among injecting drug users. Vietnam instituted the 2006 HIV/AIDS Law which includes comprehensive harm reduction measures, but these are unevenly accepted and inadequately implemented. Ward police are a major determinant of risk for IDUs, required to participate in drug control practices (especially meeting quotas for detention centres) which impede support for harm reduction. We studied influences on ward level police regarding harm reduction in Hanoi to learn how to better target education and structural change. After document review, we interviewed informants from government, NGOs, INGOs, multilateral agencies, and police, using semi-structured guides. Topics covered included perceptions of harm reduction and the police role in drug law enforcement, and harm reduction training and advocacy among police. Police perceive conflicting responsibilities, but overwhelmingly see their responsibility as enforcing drug laws, identifying and knowing drug users, and selecting those for compulsory detention. Harm reduction training was very patchy, ward police not being seen as important to it; and understanding of harm reduction was limited, tending to reflect drug control priorities. Justification for methadone was as much crime prevention as HIV prevention.Competing pressures on ward police create much anxiety, with performance measures based around drug control; recourse to detention resolves competing pressures more safely. There is much recognition of the importance of discretion, and much use of it to maintain good social order. Policy dissemination approaches within the law enforcement sector were inconsistent, with little communication about harm reduction programs or approaches, and an unfounded assumption that training at senior levels would naturally reach to the street. Ward police have not been systematically included in harm reduction advocacy or training strategies to support or operationalise

  13. Minors, Moral Psychology, and the Harm Reduction Debate: The Case of Tobacco and Nicotine.

    Science.gov (United States)

    Kozlowski, Lynn T

    2017-12-01

    Harm reduction debates are important in health policy. Although it has been established that morality affects policy, this article proposes that perspectives from moral psychology help to explain the challenges of developing evidence-based policy on prohibition-only versus tobacco/nicotine harm reduction for minors. Protecting youth from tobacco is critical, especially since tobacco/nicotine products are legal for adults, who usually begin using when young. Although cigarettes and other combustibles are the deadliest tobacco products, other products such as smokeless tobacco and electronic cigarettes, though unsafe, are upward of 90 percent less harmful than cigarettes. Disgust at contaminating the "purity" of youth, especially "good," low-risk youth, with any tobacco/nicotine products opposes harm reduction, as does contempt for violating so-called community values and disrespecting authority. Support for harm reduction arises from anger at failing to provide reduced harm to "bad," high-risk individuals and denying them the "liberty" to decide. Fast-thinking, moral-emotional intuitions are supported by rationalizations arising from slow-thinking processes. The recognition of such moral psychological influences and the efforts to minimize their impact may help lead to amelioration and compromise. This example from tobacco control, with divided concerns for low-risk and high-risk youth, can be applied to other harm reduction versus prohibition-only policies directed at minors. Copyright © 2017 by Duke University Press.

  14. Ethics of tobacco harm reduction from a liberal perspective.

    Science.gov (United States)

    van der Eijk, Yvette

    2016-05-01

    Mixed evidence on the possible harms, benefits and usage patterns of electronic nicotine delivery systems (ENDS, or 'e-cigarettes'), has led to vigorous and ongoing debates on the issue. The ethical trade-off often represented is that, though smokers should be permitted access to ENDS as a less harmful alternative to smoking, this comes at the expense of non-smokers and children who may experiment with ENDS, become addicted to them, or experience health issues from long-term exposure to passive ENDS vapour. Lacking from many debates is a balanced analysis based on sound ethical reasoning, so this paper aims to examine the issue from a liberal perspective. More specifically, focus is on how ENDS policy can help to promote freedom in a broader sense, with 'freedom' considered as originating from having options and the necessary information and ability to autonomously choose between these options. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  15. Harm reduction measures in prison (Methadone treatment and its effects on quality of life promotion

    Directory of Open Access Journals (Sweden)

    Iraj Esmaili

    2009-02-01

    Conclusion: In a look, it is obvious that the harm reduction measures which have been taken for prisoners under the coverage of Methadone treatment will be effective in improving their quality of life conditions.

  16. Canadian harm reduction policies: A comparative content analysis of provincial and territorial documents, 2000-2015.

    Science.gov (United States)

    Wild, T Cameron; Pauly, Bernie; Belle-Isle, Lynne; Cavalieri, Walter; Elliott, Richard; Strike, Carol; Tupper, Kenneth; Hathaway, Andrew; Dell, Colleen; MacPherson, Donald; Sinclair, Caitlin; Karekezi, Kamagaju; Tan, Benjamin; Hyshka, Elaine

    2017-07-01

    Access to harm reduction interventions among substance users across Canada is highly variable, and largely within the policy jurisdiction of the provinces and territories. This study systematically described variation in policy frameworks guiding harm reduction services among Canadian provinces and territories as part of the first national multimethod case study of harm reduction policy. Systematic and purposive searches identified publicly-accessible policy texts guiding planning and organization of one or more of seven targeted harm reduction services: needle distribution, naloxone, supervised injection/consumption, low-threshold opioid substitution (or maintenance) treatment, buprenorphine/naloxone (suboxone), drug checking, and safer inhalation kits. A corpus of 101 documents written or commissioned by provincial/territorial governments or their regional health authorities from 2000 to 2015 were identified and verified for relevance by a National Reference Committee. Texts were content analyzed using an a priori governance framework assessing managerial roles and functions, structures, interventions endorsed, client characteristics, and environmental variables. Nationally, few (12%) of the documents were written to expressly guide harm reduction services or resources as their primary named purpose; most documents included harm reduction as a component of broader addiction and/or mental health strategies (43%) or blood-borne pathogen strategies (43%). Most documents (72%) identified roles and responsibilities of health service providers, but fewer declared how services would be funded (56%), specified a policy timeline (38%), referenced supporting legislation (26%), or received endorsement from elected members of government (16%). Nonspecific references to 'harm reduction' appeared an average of 12.8 times per document-far more frequently than references to specific harm reduction interventions (needle distribution=4.6 times/document; supervised injection

  17. Harm reduction and “Clean” community: can Viet Nam have both?

    Directory of Open Access Journals (Sweden)

    Khuat Thu

    2012-07-01

    Full Text Available Abstract The findings of our research show that while police play multiple roles in the fight against drug-related crime, they often perceived their tasks – especially preventing and controlling drug use on the one hand, and supporting harm reduction on the other – as contradictory, and this creates tensions in their work and relations with their communities. Although they are leaders and implementers of harm reduction, not all police know about it, and some remain skeptical or perceive it as contradictory to their main task of fighting drugs. Methadone treatment is seen by some as in competition with their main task of coordinating conventional drug treatment in the rehabilitation center. The history of drug use and the evolution of discourses on drug use in Viet Nam have created these conflicting pressures on police, and thus created contradictory expectations and led to different views and attitudes of police regarding various harm reduction measures. This might aid understanding why, despite the comprehensive and progressive policies on HIV/AIDS and harm reduction in Viet Nam, it is not easy for police to actively and effectively support and be involved in harm reduction at the ground level. To promote the wider acceptance of harm reduction the concept of community safety must be expanded to include community health; harm reduction must be integrated into the “new society” movement; and laws and policies need further revision to reduce contradiction between current drug laws and HIV laws. Harm reduction guidelines for police and other actors need to be disseminated and supported, embodying better ways of working between sectors, and all sectors in the partnership require support for building capacity to contribute to the overall goal.

  18. Harm Reduction for the Prevention of Youth Gambling Problems: Lessons Learned From Adolescent High-Risk Behavior Prevention Programs

    Science.gov (United States)

    Dickson, Laurie M.; Derevensky, Jeffrey L.; Gupta, Rina

    2004-01-01

    Despite the growing popularity of the harm reduction approach in the field of adolescent alcohol and substance abuse, a harm reduction approach to prevention and treatment of youth problem gambling remains largely unexplored. This article poses the question of whether the harm reduction paradigm is a promising approach to the prevention of…

  19. Harm reduction approaches to alcohol use: health promotion, prevention, and treatment.

    Science.gov (United States)

    Marlatt, G Alan; Witkiewitz, Katie

    2002-01-01

    Harm reduction approaches to alcohol problems have endured a controversial history in both the research literature and the popular media. Although several studies have demonstrated that controlled drinking is possible and that moderation-based treatments may be preferred over abstinence-only approaches, the public and institutional views of alcohol treatment still support zero-tolerance. After describing the problems with zero-tolerance and the benefits of moderate drinking, the research literature describing prevention and intervention approaches consistent with a harm reduction philosophy are presented. Literature is reviewed on universal prevention programs for young adolescents, selective and indicated prevention for college students, moderation-based self-help approaches, prevention and interventions in primary care settings, pharmacological treatments, and psychosocial approaches with moderation goals. Overall, empirical studies have demonstrated that harm reduction approaches to alcohol problems are at least as effective as abstinence-oriented approaches at reducing alcohol consumption and alcohol-related consequences. Based on these findings, we discuss the importance of individualizing alcohol prevention and intervention to accommodate the preferences and needs of the targeted person or population. In recognizing the multifaceted nature of behavior change, harm reduction efforts seek to meet the individual where he or she is at and assist that person in the direction of positive behavior change, whether that change involves abstinence, moderate drinking, or the reduction of alcohol-related harm. The limitations of harm reduction and recommendations for future research are discussed.

  20. Sheltering risks: Implementation of harm reduction in homeless shelters during an overdose emergency.

    Science.gov (United States)

    Wallace, Bruce; Barber, Katrina; Pauly, Bernadette Bernie

    2017-12-28

    The current opioid overdose crisis in North America is heightening awareness of the need for and the challenges of implementing harm reduction, notably within complex and diverse settings such as homeless shelters. In this paper, we explore the implementation of harm reduction in homeless shelters during an emerging overdose emergency. The objective of this qualitative study was to identify and understand micro-environment level factors within emergency shelters responding to homelessness and substance use, and the macro-level influences that produce and sustain structural vulnerabilities. We conducted eight focus groups with a total of 49 participants during an emerging overdose emergency. These included shelter residents (n = 23), shelter staff (n = 13), and harm reduction workers (n = 13). The findings illustrate the challenges of implementing an overdose response when substance use is prohibited onsite, without an expectation of abstinence, and where harm reduction services are limited to the distribution of supplies. In this context, harm reduction is partially implemented and incomplete. Shelters can be a site of risks and trauma for residents and staff due to experiencing, witnessing, and responding to overdoses. The current overdose crisis heightens the challenges of implementing harm reduction, particularly within complex and diverse settings such as homeless shelters. When harm reduction is limited to the distribution of supplies such as clean equipment and naloxone, important principles of engagement and the development of trust necessary to the provision of services are overlooked with negative implications for service users. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Attitudes toward harm reduction and abstinence-only approaches to alcohol misuse among Alaskan college students

    Directory of Open Access Journals (Sweden)

    Monica C. Skewes

    2013-08-01

    Full Text Available Background. Harm reduction is a public health approach that aims to guide hazardous drinkers to change unsafe drinking and minimize alcohol-related consequences without requiring abstinence. In contrast, abstinence-based interventions are designed for people with more severe alcohol problems and they aim to eliminate consequences via complete abstinence from alcohol. Current best practices for treating college student alcohol misuse involve harm reduction strategies, but no research has been conducted examining students’ perceptions of these strategies. Objective. Understanding attitudes is critical prior to the implementation of an intervention in a new setting, particularly when attitudes may serve as barriers to treatment enrolment and retention. For this reason, we sought to examine attitudes toward contrasting alcohol misuse interventions among college students in two large public universities in the circumpolar north. Design. A web-based survey was conducted with 461 students from two public universities in Alaska. Participants completed questionnaires assessing attitudes toward alcohol treatment, current drinking behaviour, and demographic information. Results. Findings indicated that emerging adult (18–25 years old students who would be targets of future interventions (hazardous drinkers evidenced more positive attitudes toward harm reduction than abstinence-only approaches. Conclusion. This research provides support for the implementation of harm reduction intervention strategies for Alaskan college students who misuse alcohol. It is likely that harm reduction will be acceptable in this population.

  2. Harm reduction and equity of access to care for French prisoners: a review

    Directory of Open Access Journals (Sweden)

    Michel Laurent

    2008-05-01

    Full Text Available Abstract Background Despite France being regarded as a model of efficient harm reduction policy and equity of access to care in the general community, the health of French inmates is a critical issue, as harm reduction measures are either inaccessible or only partially implemented in French prisons. Method Using specific inclusion and exclusion criteria, information was collected and analyzed about HIV, HBV and HCV prevalence, risk practices, mortality, access to harm reduction measures and care for French prison inmates. Results Data about the occurrence of bloodborne diseases, drug use and access to care in prisons remain limited and need urgent updating. Needle exchange programs are not yet available in French prisons and harm reduction interventions and access to OST remain limited or are heterogeneous across prisons. The continuity of care at prison entry and after release remains problematic and should be among the primary public health priorities for French prisoners. Conclusion Preventive and harm reduction measures should be urgently introduced at least as pilot programs. The implementation of such measures, not yet available in French prisons, is not only a human right for prison inmates but can also provide important public health benefits for the general population.

  3. Attitudes toward harm reduction and abstinence-only approaches to alcohol misuse among Alaskan college students.

    Science.gov (United States)

    Skewes, Monica C; Gonzalez, Vivian M

    2013-01-01

    Harm reduction is a public health approach that aims to guide hazardous drinkers to change unsafe drinking and minimize alcohol-related consequences without requiring abstinence. In contrast, abstinence-based interventions are designed for people with more severe alcohol problems and they aim to eliminate consequences via complete abstinence from alcohol. Current best practices for treating college student alcohol misuse involve harm reduction strategies, but no research has been conducted examining students' perceptions of these strategies. Understanding attitudes is critical prior to the implementation of an intervention in a new setting, particularly when attitudes may serve as barriers to treatment enrolment and retention. For this reason, we sought to examine attitudes toward contrasting alcohol misuse interventions among college students in two large public universities in the circumpolar north. A web-based survey was conducted with 461 students from two public universities in Alaska. Participants completed questionnaires assessing attitudes toward alcohol treatment, current drinking behavior, and demographic information. Findings indicated that emerging adult (18-25 years old) students who would be targets of future interventions (hazardous drinkers) evidenced more positive attitudes toward harm reduction than abstinence-only approaches. This research provides support for the implementation of harm reduction intervention strategies for Alaskan college students who misuse alcohol. It is likely that harm reduction will be acceptable in this population.

  4. Innovative Use of the Electronic Health Record to Support Harm Reduction Efforts.

    Science.gov (United States)

    Hyman, Daniel; Neiman, Jenae; Rannie, Michael; Allen, Renee; Swietlik, Marguerite; Balzer, Andrea

    2017-05-01

    Awareness of the impact of preventable harm on patients and families has resulted in extensive efforts to make our health care systems safer. We determined that, in our hospital, patients experienced 1 of 9 types of preventable harm approximately every other day. In an effort to expedite early identification of patients at risk and provide timely intervention, we used the electronic health record's (EHR) documentation to enable decision support, data capture, and auditing and implemented reporting tools to reduce rates of harm. Harm reduction strategies included aggregating data to generate a risk profile for hospital-acquired conditions (HACs) for all inpatients. The profile includes links to prevention bundles and available care guidelines. Additionally, lists of patients at risk for HACs autopopulate electronic audit tools contained within Research Electronic Data Capture, and data from observational audits and EHR documentation populate real-time dashboards of bundle compliance. Patient population summary reports promote the discussion of relevant HAC prevention measures during patient care and unit leadership rounds. The hospital has sustained a >30% reduction in harm for 9 types of HAC since 2012. In 2014, the number of HACs with >80% bundle adherence doubled coincident with the progressive rollout of these EHR-based interventions. Existing EHR documentation and reporting tools may be effective adjuncts to harm reduction initiatives. Additional study should include an evaluation of scalability across organizations, ongoing bundle adherence, and individual tests of change to isolate interventions with the highest impact on our results. Copyright © 2017 by the American Academy of Pediatrics.

  5. Harm reduction theory: users' culture, micro-social indigenous harm reduction, and the self-organization and outside-organizing of users' groups.

    Science.gov (United States)

    Friedman, Samuel R; de Jong, Wouter; Rossi, Diana; Touzé, Graciela; Rockwell, Russell; Des Jarlais, Don C; Elovich, Richard

    2007-03-01

    This paper discusses the user side of harm reduction, focusing to some extent on the early responses to the HIV/AIDS epidemic in each of four sets of localities-New York City, Rotterdam, Buenos Aires, and sites in Central Asia. Using available qualitative and quantitative information, we present a series of vignettes about user activities in four different localities in behalf of reducing drug-related harm. Some of these activities have been micro-social (small group) activities; others have been conducted by formal organizations of users that the users organized at their own initiative. In spite of the limitations of the methodology, the data suggest that users' activities have helped limit HIV spread. These activities are shaped by broader social contexts, such as the extent to which drug scenes are integrated with broader social networks and the way the political and economic systems impinge on drug users' lives. Drug users are active agents in their own individual and collective behalf, and in helping to protect wider communities. Harm reduction activities and research should take note of and draw upon both the micro-social and formal organizations of users. Finally, both researchers and policy makers should help develop ways to enable and support both micro-social and formally organized action by users.

  6. Harm reduction headway and continuing resistance: insights from safe injection in the city of Vancouver.

    Science.gov (United States)

    Hathaway, Andrew D; Tousaw, Kirk I

    2008-02-01

    North America's first official safe injection facility has begun to generate substantial evidence attesting to the harm reduction benefits of supervised injection. Reductions in morbidity, mortality, and crime rates have strengthened the resolve of local advocates and even influenced the views of some original detractors. Many status quo defenders are unwavering, however, in their condemnation of initiatives like InSite. The term 'drug den' has been used in right-wing media and some opponents of the programme say the evidence is biased. In their view, harm reduction advocates are really 'legalisers' in the guise of scientists and public health professionals. Providing services for people with drug problems sends the message that some use of drugs is normal, rather than affirming that drug use is the problem. Abstinence, prevention, and enforcement are the only acceptable and morally legitimate solutions. Harm reduction's muted stance on morals, rights and values prevents proponents from engaging criticisms of this nature in terms other than the evidence or science. The case of InSite in Vancouver, however, the authors argue, demonstrates the value of asserting human rights claims that do not rest on evidence per se. Scientific arguments are insufficient in themselves to move beyond the status quo on drugs. Rights-based moral warrants in support of harm reduction require far more extensive and explicit cultivation if they are to be discursively established and maintained.

  7. Alcohol harm reduction advertisements: a content analysis of topic, objective, emotional tone, execution and target audience.

    Science.gov (United States)

    Dunstone, Kimberley; Brennan, Emily; Slater, Michael D; Dixon, Helen G; Durkin, Sarah J; Pettigrew, Simone; Wakefield, Melanie A

    2017-04-11

    Public health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads). Ads were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded. In total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40%) and the United Kingdom (26%). The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38%) or to behave responsibly and/or not get drunk when drinking (33%). Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults. Some message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of different characteristics of alcohol harm reduction ads. Given

  8. Alcohol harm reduction advertisements: a content analysis of topic, objective, emotional tone, execution and target audience

    Directory of Open Access Journals (Sweden)

    Kimberley Dunstone

    2017-04-01

    Full Text Available Abstract Background Public health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads. Method Ads were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded. Results In total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40% and the United Kingdom (26%. The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38% or to behave responsibly and/or not get drunk when drinking (33%. Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults. Conclusions Some message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of

  9. The impact of harm-reduction-based methadone treatment on mortality among heroin users

    NARCIS (Netherlands)

    Langendam, M. W.; van Brussel, G. H.; Coutinho, R. A.; van Ameijden, E. J.

    2001-01-01

    The purpose of this study was to investigate the impact of harm-reduction-based methadone programs on mortality among heroin users. A prospective cohort investigation was conducted among 827 participants in the Amsterdam Cohort Study. Poisson regression was used to identify methadone maintenance

  10. Alcohol Prevention: What Can Be Expected of a Harm Reduction Focused School Drug Education Programme?

    Science.gov (United States)

    Midford, Richard; Cahill, Helen; Ramsden, Robyn; Davenport, Gillian; Venning, Lynne; Lester, Leanne; Murphy, Bernadette; Pose, Michelle

    2012-01-01

    Aim: This pilot study investigated what alcohol prevention benefits could be achieved by a harm reduction focused school drug education intervention that addressed all drug use, both licit and illicit. Method: The study population comprised a cohort of 225 students in three intervention secondary schools and 93 students in a matched control school…

  11. Should the health community promote smokeless tobacco (snus as a harm reduction measure?

    Directory of Open Access Journals (Sweden)

    Coral E Gartner

    2007-07-01

    Full Text Available BACKGROUND TO THE DEBATE: The tobacco control community is divided on whether or not to inform the public that using oral, smokeless tobacco (Swedish snus is less hazardous to health than smoking tobacco. Proponents of "harm reduction" point to the Swedish experience. Snus seems to be widely used as an alternative to cigarettes in Sweden, say these proponents, contributing to the low overall prevalence of smoking and smoking-related disease. Harm reduction proponents thus argue that the health community should actively inform inveterate cigarette smokers of the benefits of switching to snus. However, critics of harm reduction say that snus has its own risks, that no form of tobacco should ever be promoted, and that Sweden's experience is likely to be specific to that culture and not transferable to other settings. Critics also remain deeply suspicious that the tobacco industry will use snus marketing as a "gateway" to promote cigarettes. In the interests of promoting debate, the authors (who are collaborators on a research project on the future of tobacco control have agreed to outline the strongest arguments for and against promoting Swedish snus as a form of harm reduction.

  12. Select barriers to harm-reduction services for IDUs in eastern Europe

    DEFF Research Database (Denmark)

    Curth, Nadja Kehler; Hansson, Liv Nanna; Storm, Frederikke

    2009-01-01

    In eastern Europe, the high prevalence rates of HIV and the hepatitis C virus (HCV) are concentrated among injecting drug users (IDUs). Harm reduction programmes such as needle and syringe programmes and opioid substitution therapy (OST) have been shown to be effective in preventing...... these infections. However, structural barriers can limit their effectiveness by hindering access....

  13. Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks

    National Research Council Canada - National Science Library

    Elaine Hyshka; Jalene Anderson-Baron; Kamagaju Karekezi; Lynne Belle-Isle; Richard Elliott; Bernie Pauly; Carol Strike; Mark Asbridge; Colleen Dell; Keely McBride; Andrew Hathaway; T Cameron Wild

    2017-01-01

    .... We examined the quality of current provincial and territorial harm reduction policies in Canada, relative to how well official documents reflect internationally recognized principles and attributes...

  14. Harm reduction in the USA: the research perspective and an archive to David Purchase.

    Science.gov (United States)

    Des Jarlais, Don C

    2017-07-26

    The history of harm reduction in the USA has led to the development of some of the most important methods for treating persons for drug use disorders, such as methadone and buprenorphine for opiate use disorder. However, there has been fierce political resistance to implementation and scale-up of harm reduction in the USA. This resistance is rooted in historical demonization of particular psychoactive drugs that were associated with stigmatized racial/ethnic groups.With the discovery of acquired immunodeficiency syndrome (AIDS) in 1981, harm reduction became important not only for treating substance use disorders, but for reducing transmission of blood-borne infection. However, within the context of the crack cocaine epidemic in the 1980s, it was very difficult to implement any programs that appeared to "condone" drug use.It was not until the late 1980s that syringe exchange programs began at the state and local level in the USA. With funding primarily from state and local governments and the support of the North American Syringe Exchange Network (NASEN), there are now approximately 200 programs for syringe exchange in the USA. Research has shown that these programs have been extremely effective in reducing human immunodeficiency virus (HIV) transmission among persons who inject drugs (PWID). The programs in the USA also offer many additional services for drug users, including condom distribution, referrals to substance abuse treatment, HIV, hepatitis C virus (HCV), hepatitis B virus (HBV) counseling and testing, overdose education and naloxone distribution to reverse for overdose.Currently, the USA is experiencing an opioid/heroin epidemic, with significant increases in overdose deaths among drug users. Much of this epidemic is occurring in suburban and rural of the country without harm reduction services. The current challenges for harm reduction and harm reduction research involve expansion of services to suburban and rural areas and implementation science on

  15. Ethics of a relaxed antidoping rule accompanied by harm-reduction measures.

    Science.gov (United States)

    Kayser, Bengt; Tolleneer, Jan

    2017-05-01

    Harm-reduction approaches are used to reduce the burden of risky human behaviour without necessarily aiming to stop the behaviour. We discuss what an introduction of harm reduction for doping in sports would mean in parallel with a relaxation of the antidoping rule. We analyse what is ethically at stake in the following five levels: (1) What would it mean for the athlete (the self)? (2) How would it impact other athletes (the other)? (3) How would it affect the phenomenon of sport as a game and its fair play basis (the play)? (4) What would be the consequences for the spectator and the role of sports in society (the display)? and (5) What would it mean for what some consider as essential to being human (humanity)? For each level, we present arguments for and against doping and then discuss what a harm-reduction approach, within a dynamic regime of a partially relaxed antidoping rule, could imply. We find that a harm-reduction approach is morally defensible and potentially provides a viable escape out of the impasse resulting from the impossibility of attaining the eradication of doping. The following question remains to be answered: Would a more relaxed position, when combined with harm-reduction measures, indeed have less negative consequences for society than today's all-out antidoping efforts that aim for abstinence? We provide an outline of an alternative policy, allowing a cautious step-wise change to answer this question and then discuss the ethical aspects of such a policy change. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. Harm reduction, human rights, and access to information on safer abortion.

    Science.gov (United States)

    Erdman, Joanna N

    2012-07-01

    A harm reduction and human rights approach, grounded in the principles of neutrality, humanism, and pragmatism, supports women's access to information on the safer self- use of misoprostol in diverse legal settings. Neutrality refers to a focus on the risks and harms of abortion rather than its legal or moral status. Humanism refers to the entitlement of all women to care and concern for their lives and health, to be treated with respect, worth, and dignity, and to the empowerment of women to participate in decision-making and political action. Pragmatism accepts the historical reality that women will engage in unsafe abortion, including self-induction, while addressing factors that render them vulnerable to this reality, and requires assessment of interventions to reduce abortion-related harms on evidence of their real rather than intended effect. Criminal law reform is a necessary conclusion to a harm reduction and human rights approach. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  17. Environments, risk and health harms: a qualitative investigation into the illicit use of anabolic steroids among people using harm reduction services in the UK.

    Science.gov (United States)

    Kimergård, Andreas; McVeigh, Jim

    2014-06-04

    The illicit use of anabolic steroids among the gym population continues to rise, along with the number of steroid using clients attending harm reduction services in the UK. This presents serious challenges to public health. Study objectives were to account for the experiences of anabolic steroid users and investigate how 'risk environments' produce harm. Qualitative face-to-face interviews with 24 users of anabolic steroids engaged with harm reduction services in the UK. Body satisfaction was an important factor when deciding to start the use of anabolic steroids. Many users were unaware of the potential dangers of using drugs from the illicit market, whereas some had adopted a range of strategies to negotiate the hazards relating to the use of adulterated products, including self-experimentation to gauge the perceived efficacy and unwanted effects of these drugs. Viewpoints, first-hand anecdotes, norms and practices among groups of steroid users created boundaries of 'sensible' drug use, but also promoted practices that may increase the chance of harms occurring. Established users encouraged young users to go to harm reduction services but, at the same time, promoted risky injecting practices in the belief that this would enhance the efficacy of anabolic steroids. Current steroid-related viewpoints and practices contribute to the risk environment surrounding the use of these drugs and may undermine the goal of current public health strategies including harm reduction interventions. The level of harms among anabolic steroid users are determined by multiple and intertwining factors, in addition to the harms caused by the pharmacological action or injury and illness associated with incorrect injecting techniques. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Developing harm reduction in the context of youth substance use: insights from a multi-site qualitative analysis of young people's harm minimization strategies.

    Science.gov (United States)

    Jenkins, Emily K; Slemon, Allie; Haines-Saah, Rebecca J

    2017-07-31

    Youth substance use programming and educational strategies are frequently informed by prevention approaches that emphasize abstinence goals, which often do not resonate with youth in their lack of acknowledgment of young people's social context and how young people perceive positive effects of substance use. Further, approaches to drug prevention have been critiqued as adopting a one-size-fits-all approach and therefore inadequate in addressing substance use in the context of population variation and inequities. In response to the limitations of current approaches to prevention, programming informed by harm reduction principles that aims to minimize harms without requiring abstinence is emergent in school settings. However, youth perspectives informing harm reduction are limited in both research and program development. This paper draws on data from the Researching Adolescent Distress and Resilience (RADAR) study, which utilized an ethnographic approach to bring youth voice to the literature on mental health and substance use. Qualitative data collection included individual interviews (n = 86) with young people aged 13-18 across three communities-representing urban, suburban, and rural geographies-in British Columbia, Canada. A multi-site qualitative analysis of interview data was conducted to identify themes across and within each research site. Across all three sites, young people's individual experiences of substance use were shaped by geographic, socio-cultural, and political contexts, with youth describing their use in relation to the nature of substance use in peer groups and in the broader community. To manage their own substance use and reduce related harms, youth employed a variety of ad hoc harm minimization strategies that were reflective of their respective contexts. The findings from this study suggest the importance of harm reduction approaches that are contextually relevant and responsive to the lived experiences of youth. Youth perspectives in the

  19. Harm reduction interventions in HIV care: a qualitative exploration of patient and provider perspectives

    Directory of Open Access Journals (Sweden)

    Suzanne Carlberg-Racich

    2016-04-01

    Full Text Available Background. A culture of stringent drug policy, one-size-fits-all treatment approaches, and drug-related stigma has clouded clinical HIV practice in the United States. The result is a series of missed opportunities in the HIV care environment. An approach which may address the broken relationship between patient and provider is harm reduction—which removes judgment and operates at the patient’s stage of readiness. Harm reduction is not a routine part of care; rather, it exists outside clinic walls, exacerbating the divide between compassionate, stigma-free services and the medical system. Methods. Qualitative, phenomenological, semi-structured, individual interviews with patients and providers were conducted in three publicly-funded clinics in Chicago, located in areas of high HIV prevalence and drug use and serving African-American patients (N = 38. A deductive thematic analysis guided the process, including: the creation of an index code list, transcription and verification of interviews, manual coding, notation of emerging themes and refinement of code definitions, two more rounds of coding within AtlasTi, calculation of Cohen’s Kappa for interrater reliability, queries of major codes and analysis of additional common themes. Results. Thematic analysis of findings indicated that the majority of patients felt receptive to harm reduction interventions (safer injection counseling, safer stimulant use counseling, overdose prevention information, supply provision from their provider, and expressed anticipated gratitude for harm reduction information and/or supplies within the HIV care visit, although some were reluctant to talk openly about their drug use. Provider results were mixed, with more receptivity reported by advanced practice nurses, and more barriers cited by physicians. Notable barriers included: role-perceptions, limited time, inadequate training, and the patients themselves. Discussion. Patients are willing to receive harm

  20. Harm Reduction or Psychedelic Support? Caring for Drug-Related Crises at Transformational Festivals

    Directory of Open Access Journals (Sweden)

    Deirdre Ruane

    2015-06-01

    Full Text Available Many of the EDM events known as “transformational festivals” provide psychedelic support spaces: volunteer projects caring for festivalgoers undergoing difficult drug experiences. Mostly drawn from the festival community, many volunteer carers (“sitters” subscribe to psychedelic culture discourse which frames these substances as aids to personal growth if handled appropriately. However, within the dominant paradigm of international drug prohibition, support projects must employ the contrasting discourse of harm reduction in order to gain access to events, visibility to festivalgoers, and integration with other support staff. Harm reduction, a paradigm for the care of drug users which began as a grassroots heroin addict advocacy movement, has since become associated with neoliberal, medicalised views of drugs, drug users and the self. This article considers how psychedelic support workers negotiate this discourse dichotomy in the course of caregiving, within differing national and local drug policy climates. Early findings are presented from ethnographic fieldwork as a psychedelic support volunteer with three organisations at seven festivals, combining participant observation and in-depth interviews with nineteen support workers. Events in the UK, the US and Portugal were studied due to these countries’ contrasting policy regimes. Points of conflict between the psychedelic and harm reduction discourses were found to create tensions both within the support organisations and in their relations with on-site medics, security guards, festival organisers and police. The findings suggest that mainstream harm reduction discourses may be a poor fit for psychedelics and that risks inhere in their adoption by festival support spaces, such as abjection of drug users in difficulty which may create a trust-damaging divide between users and workers.

  1. Review of epidemiologic data on the debate over smokeless tobacco's role in harm reduction.

    Science.gov (United States)

    Timberlake, David S; Zell, Jason A

    2009-10-19

    Some tobacco researchers have argued that the European Union should remove its ban on a form of low-nitrosamine smokeless tobacco referred to as Swedish 'snus'. This argument has developed in to an international debate over the use of smokeless tobacco as a measure of harm reduction for smokers. Leading authorities in the USA have firmly stated that there is no safe tobacco - a message which does not allow for any discussion of comparative tobacco risks. This commentary is intended to review the origin of the controversy over Swedish 'snus', to examine briefly the meta-analysis on cancer risks by Peter Lee and Jan Hamling (published in July in BMC Medicine) and to discuss the anticipated direction of the debate on tobacco-harm reduction in the USA. We anticipate that much of the debate will shift from the discussion of epidemiologic data to the discussion of the marketing, health communication and economics of smokeless tobacco. While the Food and Drug Administration's newly approved authority over tobacco will undoubtedly affect the smokeless products, it may not be the sole determinant of harm reduction's fate in the USA. See associated research article by Lee and Hamling: http://www.biomedcentral.com/1741-7015/7/36.

  2. Review of epidemiologic data on the debate over smokeless tobacco's role in harm reduction

    Directory of Open Access Journals (Sweden)

    Timberlake David S

    2009-10-01

    Full Text Available Abstract Some tobacco researchers have argued that the European Union should remove its ban on a form of low-nitrosamine smokeless tobacco referred to as Swedish 'snus'. This argument has developed in to an international debate over the use of smokeless tobacco as a measure of harm reduction for smokers. Leading authorities in the USA have firmly stated that there is no safe tobacco - a message which does not allow for any discussion of comparative tobacco risks. This commentary is intended to review the origin of the controversy over Swedish 'snus', to examine briefly the meta-analysis on cancer risks by Peter Lee and Jan Hamling (published in July in BMC Medicine and to discuss the anticipated direction of the debate on tobacco-harm reduction in the USA. We anticipate that much of the debate will shift from the discussion of epidemiologic data to the discussion of the marketing, health communication and economics of smokeless tobacco. While the Food and Drug Administration's newly approved authority over tobacco will undoubtedly affect the smokeless products, it may not be the sole determinant of harm reduction's fate in the USA. See associated research article by Lee and Hamling: http://www.biomedcentral.com/1741-7015/7/36

  3. The social logic of naloxone: Peer administration, harm reduction, and the transformation of social policy.

    Science.gov (United States)

    Faulkner-Gurstein, Rachel

    2017-05-01

    This paper examines overdose prevention programs based on peer administration of the opioid antagonist naloxone. The data for this study consist of 40 interviews and participant observation of 10 overdose prevention training sessions at harm reduction agencies in the Bronx, New York, conducted between 2010 and 2012. This paper contends that the social logic of peer administration is as central to the success of overdose prevention as is naloxone's pharmacological potency. Whereas prohibitionist drug policies seek to isolate drug users from the spaces and cultures of drug use, harm reduction strategies like peer-administered naloxone treat the social contexts of drug use as crucial resources for intervention. Such programs utilize the expertise, experience, and social connections gained by users in their careers as users. In revaluing the experience of drug users, naloxone facilitates a number of harm reduction goals. But it also raises complex questions about responsibility and risk. This paper concludes with a discussion of how naloxone's social logic illustrates the contradictions within broader neoliberal trends in social policy. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Harm Reduction and Tensions in Trust and Distrust in a Mental Health Service: A Qualitative Approach.

    Science.gov (United States)

    Lago, Rozilaine Redi; Peter, Elizabeth; Bógus, Cláudia Maria

    2017-03-08

    People seeking care for substance use (PSCSU) experience deep social and health inequities. Harm reduction can be a moral imperative to approach these persons. The purpose of this study was to explore relationships among users, health care providers, relatives, and society regarding harm reduction in mental health care, using a trust approach rooted in feminist ethics. A qualitative study was conducted in a mental health service for PSCSU, and included fifteen participants who were health care providers, users, and their relatives. Individual in-depth and group interviews, participant observation, and a review of patients' records and service reports were conducted. Three nested levels of (dis)trust were identified: (dis)trust in the treatment, (dis)trust in the user, and self-(dis)trust of the user, revealing the interconnections among different layers of trust. (Dis)trust at each level can amplify or decrease the potential for a positive therapeutic response in users, their relatives' support, and how professionals act and build innovations in care. Distrust was more abundant than trust in participants' reports, revealing the fragility of trust and the focus on abstinence within this setting. The mismatch between wants and needs of users and the expectations and requirements of a society and mental health care system based on a logic of "fixing" has contributed to distrust and stigma. Therefore, we recommend policies that increase the investment in harm reduction education and practice that target service providers, PSCSU, and society to change the context of distrust identified.

  5. [Harm reduction policies in Brazil: contributions of a North American program].

    Science.gov (United States)

    Inglez-Dias, Aline; Ribeiro, José Mendes; Bastos, Francisco I; Page, Kimberly

    2014-01-01

    Given the rapid spread of the HIV epidemic and the need to control its transmission among intravenous drug users (IDU), harm reduction strategies have been incorporated in many countries, including Brazil. Considering these aspects and taking into account the emergence of drugs as a core concern on the government's agenda, especially crack cocaine, this article presents some of the contributions acquired from observing and recording the practices of an American model of research and care for IDUs, namely the UFO (You Find Out) Study. Issues such as participants' access and adherence, financing difficulties, sustainability and outcome evaluation were considered. The study involved documental research, systematic observation and interviews with key informants. Some of the UFO features that could contribute to the formulation of harm reduction policies in Brazil are highlighted. The UFO appears to be a successful example of harm reduction initiatives that successfully contact and guarantee the commitment of that risk group, ensuring its access to health services and reducing risks associated with drug use.

  6. Violence against female sex workers in Cameroon: accounts of violence, harm reduction, and potential solutions.

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    Lim, Sahnah; Peitzmeier, Sarah; Cange, Charles; Papworth, Erin; LeBreton, Matthew; Tamoufe, Ubald; Kamla, Aristide; Billong, Serge; Fokam, Pamella; Njindam, Iliassou; Decker, Michele R; Sherman, Susan G; Baral, Stefan

    2015-03-01

    Female sex workers (FSWs) in Cameroon, and West Africa generally, suffer a disproportionate burden of HIV. Although violence against FSWs has been documented extensively in other parts of the world, data on violence from West African countries are lacking. The aim of this study was to qualitatively document violence and harm reduction strategies from the perspective of FSWs in Cameroon as well as to understand how experiences of violence may increase FSWs' HIV risk. FSWs from 7 major cities in Cameroon (Douala, Yaounde, Bamenda, Bertoua, Nagoundere, Kribi, and Bafoussam) were purposively recruited. Data from 31 in-depth interviews and 7 focus groups (n = 70; with some overlapping participants from in-depth interviews) conducted with these FSWs in 6 of these 7 cities (excluding Kribi) were analyzed using a grounded theory approach. Transcripts revealed 3 primary themes related to violence: (1) sources and types of violence, including sexual, physical, and financial violence perpetrated by clients and police, (2) harm reduction strategies, including screening clients and safe work locations, receipt of payment before sexual act, and formation of an informal security network, and (3) recommendations on structural changes to reduce violence that emphasized sex work decriminalization and increased police accountability. As in other parts of the world, violence against FSWs is pervasive in Cameroon. Interventions targeting violence and HIV must address the forms of violence cited locally by FSWs and can build on FSWs' existing strengths and harm reduction strategies. Structural changes are needed to ensure access to justice for this population.

  7. "Trip-Sitting" in the Black Hole: A Netnographic Study of Dissociation and Indigenous Harm Reduction.

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    Hearne, Evelyn; Van Hout, Marie Claire

    2016-01-01

    An array of dissociative novel psychoactive substances, including "methoxetamine," "3-MeO-PCP," and "methoxphenidine," have emerged as substitutes for the illicit substance "ketamine." A netographic research methodology aimed to describe online, dissociative novel psychoactive substance users' perceptions of risk, informed knowledge around use, and indigenous harm-reduction practices as advocated within online drug fora, so as to provide credible information which can be used to inform public online health education and drug prevention. Systematic Internet searches were performed using the terms "synthetic dissociative," "methoxetamine," "methoxphenidine," "diphenidine," "3-MeO-PCP," "4-MeO-PCP," "2-MDP," and "dissociative research chemical" in combination with "forum." Following screening of 3,476 forum threads with removal of duplicates and exclusion criteria, 90 user trip reports and 115 fora threads from seven drug fora websites were analyzed by conducting content analysis. Five themes emerged with 43 categories. The findings illustrated how forum activity within the cyber drug user community disseminated and exchanged "communal folk pharmacology" relating to the use of dissociative novel psychoactive substances. Further research and consistent monitoring of Internet drug fora are advised to explore variations in harm-reduction tactics throughout dissociative NPS populations, and to consider how existing harm-reduction initiatives are influencing these hard-to-reach groups.

  8. Assessing the feasibility of harm reduction services for MSM: the late night breakfast buffet study

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    Kellogg Timothy A

    2006-10-01

    Full Text Available Abstract Background Despite the leveling off in new HIV infections among men who have sex with men (MSM in San Francisco, new evidence suggests that many recent HIV infections are linked with the use of Methamphetamine (MA. Among anonymous HIV testers in San Francisco, HIV incidence among MA users was 6.3% compared to 2.1% among non-MA users. Of particular concern for prevention programs are frequent users and HIV positive men who use MA. These MSM pose a particular challenge to HIV prevention efforts due to the need to reach them during very late night hours. Methods The purpose of the Late Night Breakfast Buffet (LNBB was to determine the feasibility and uptake of harm reduction services by a late night population of MSM. The "buffet" of services included: needle exchange, harm reduction information, oral HIV testing, and urine based sexually transmitted infection (STI testing accompanied by counseling and consent procedures. The study had two components: harm reduction outreach and a behavioral survey. For 4 months during 2004, we provided van-based harm reduction services in three neighborhoods in San Francisco from 1 – 5 a.m. for anyone out late at night. We also administered a behavioral risk and service utilization survey among MSM. Results We exchanged 2000 needles in 233 needle exchange visits, distributed 4500 condoms/lubricants and provided 21 HIV tests and 12 STI tests. Fifty-five MSM enrolled in the study component. The study population of MSM was characterized by low levels of income and education whose ages ranged from 18 – 55. Seventy-eight percent used MA in the last 3 months; almost 25% used MA every day in the same time frame. Of the 65% who ever injected, 97% injected MA and 13% injected it several times a day. MA and alcohol were strong influences in the majority of unprotected sexual encounters among both HIV negative and HIV positive MSM. Conclusion We reached a disenfranchised population of MA-using MSM who are at

  9. The transition to harm reduction: understanding the role of non-governmental organisations in Malaysia.

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    Narayanan, Suresh; Vicknasingam, Balasingam; Robson, Noorzurani Md Haris

    2011-07-01

    The transition of drug policy from prohibition to harm reduction has never been easy. The deeply entrenched belief in prohibition shared by policy makers and religious leaders provided little room for alternatives, and change came only slowly. The non-governmental organisations (NGOs) in Malaysia played a pivotal role in effecting such a change. Understanding how they did so may be instructive for other similarly placed countries. Data collected via reviews of published secondary sources, media reports and in-depth interviews with pioneers of harm reduction drawn from NGOs, medical practitioners and the police were analysed to construct the paper. The policy change was the outcome of competition between three groups in the drug policy subsystem--the state, the Muslim religious lobby and the NGOs. Developments such as the poor outcomes from the prohibition programmes and the outbreak of HIV/AIDS did not change policy but did lead to a rethink of core beliefs in the state alliance and spawned a state-NGO partnership. The subsequent failure to meet the Millennium Development Goal with respect to HIV/AIDS in 2005 was seen as a failure of the Health Ministry which then led the final charge for a policy change arguing that a health crisis was imminent. The NGOs played a pivotal role in this process by educating their partners in the state coalition, by drawing academics and medical practitioners into advocacy and by engaging the religious lobby (albeit with varying success). They were also frontline players in implementing harm reduction programmes and successfully deflected criticisms from unconvinced Islamic groups away from the state. Given their central role in the needle-syringe exchange programme, the NGOs are well positioned to convince injecting drug users to opt for voluntary medical treatment. This can potentially reduce both the harm from drug use and the prevalence of it. Copyright © 2011 Elsevier B.V. All rights reserved.

  10. Variability and dilemmas in harm reduction for anabolic steroid users in the UK: a multi-area interview study

    Science.gov (United States)

    2014-01-01

    Background The UK continues to experience a rise in the number of anabolic steroid-using clients attending harm reduction services such as needle and syringe programmes. Methods The present study uses interviews conducted with harm reduction service providers as well as illicit users of anabolic steroids from different areas of England and Wales to explore harm reduction for this group of drug users, focussing on needle distribution policies and harm reduction interventions developed specifically for this population of drug users. Results The article addresses the complexity of harm reduction service delivery, highlighting different models of needle distribution, such as peer-led distribution networks, as well as interventions available in steroid clinics, including liver function testing of anabolic steroid users. Aside from providing insights into the function of interventions available to steroid users, along with principles adopted by service providers, the study found significant tensions and dilemmas in policy implementation due to differing perspectives between service providers and service users relating to practices, risks and effective interventions. Conclusion The overarching finding of the study was the tremendous variability across harm reduction delivery sites in terms of available measures and mode of operation. Further research into the effectiveness of different policies directed towards people who use anabolic steroids is critical to the development of harm reduction. PMID:24986546

  11. Between harm reduction, loss and wellness: on the occupational hazards of work.

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    Shepard, Benjamin C

    2013-04-01

    Those working in the fields of harm reduction, healthcare, and human services must cope with a range of stresses, including post traumatic stress and vicarious trauma. Pain and loss are just a part of the job. So is dealing with premature death as a result of HIV, hypertension, and even overdose. Faced with a range of challenges, some workers in the field even turn to self-medication. For some, it is about pleasure; for others it is about alleviating suffering. In recent years, several leaders in the AIDS and harm reduction fields have died ahead of their time. Some stopped taking their medications; others overdosed. Rather than weakness or pathology, French sociologist Emile Durkheim saw self-destructive behavior as a byproduct of social disorganization and isolation, as a way of contending with a breakdown of social bonds and alienation. There are any number of reasons why such behavior becomes part of work for those involved with battling the dueling epidemics of Hepatitis C, HIV, and related concerns. Forms of stress related to this work include secondary trauma, compassion fatigue, organizational conflict, burnout, complications of direct services, and lack of funding. Faced with day-to- day struggles over poverty, punitive welfare systems, drug use, the war on drugs, high risk behavior, structural violence, and illness, many in the field are left to wonder how to strive for wellness when taking on so much pain. For some, self-injury and self-medication are ways of responding. Building on ethnographic methods, this reflective analysis considers the stories of those who have suffered, as well as a few of the ways those in the field cope with harm and pain. The work considers the moral questions we face when we see our friends and colleagues suffer. It asks how we as practitioners strive to create a culture of wellness and support in the fields of harm reduction, healthcare, and human services. Through a brief review of losses and literature thereof, the essay

  12. Assessing the impact of harm reduction programs on law enforcement in Southeast Asia: a description of a regional research methodology

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    Thomson Nick

    2012-07-01

    Full Text Available Abstract For over 15 years the Australian Agency for International Development (AusAID has been a leading donor for harm reduction projects in Southeast Asia. The recent AusAID-supported harm reduction projects of greatest significance have included the Asia Regional HIV/AIDS Project (AHRP, from 2002 until 2007,1 and the HIV/AIDS Asia Regional Program (HAARP, from 2007 until 2015.2 Both projects included in their design specific strategies for engaging with law enforcement agencies at country level. The main focus of these strategies has been to develop law enforcement harm reduction policy and curriculum, and the design and implementation of specific harm reduction training for law enforcement officers. In July 2008, the Australian Development Research Awards (ADRA funded the Nossal Institute for Global Health at the University of Melbourne to establish a research project created to assess the influence of harm reduction programs on the policy and operational practices of law enforcement agencies in Southeast Asia, known as the LEHRN Project (Law Enforcement, Harm Reduction, Nossal Institute Project. The ADRA is a unique grant research mechanism that specifically funds development research to improve the understanding and informed decision making of the implementation of Australian aid effectiveness. While the need to engage law enforcement when establishing harm reduction programs was well documented, little was known about the impact or influence of harm reduction programs on policy and practices of law enforcement agencies. The LEHRN Project provided the opportunity to assess the impact of harm reduction programs on law enforcement in Southeast Asia, with a focus on Vietnam, Cambodia and Lao PDR.

  13. Harm Reduction as “Continuum Care” in Alcohol Abuse Disorder

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    Icro Maremmani

    2015-11-01

    Full Text Available Alcohol abuse is one of the most important risk factors for health and is a major cause of death and morbidity. Despite this, only about one-tenth of individuals with alcohol abuse disorders receive therapeutic intervention and specific rehabilitation. Among the various dichotomies that limit an effective approach to the problem of alcohol use disorder treatment, one of the most prominent is integrated treatment versus harm reduction. For years, these two divergent strategies have been considered to be opposite poles of different philosophies of intervention. One is bound to the search for methods that aim to lead the subject to complete abstinence; the other prioritizes a progressive decline in substance use, with maximum reduction in the damage that is correlated with curtailing that use. Reduction of alcohol intake does not require any particular setting, but does require close collaboration between the general practitioner, specialized services for addiction, alcohology services and psychiatry. In patients who reach that target, significant savings in terms of health and social costs can be achieved. Harm reduction is a desirable target, even from an economic point of view. At the present state of neuroscientific knowledge, it is possible to go one step further in the logic that led to the integration of psychosocial and pharmacological approaches, by attempting to remove the shadows of social judgment that, at present, are aiming for a course of treatment that is directed towards absolute abstention.

  14. Harm reduction in name, but not substance: a comparative analysis of current Canadian provincial and territorial policy frameworks.

    Science.gov (United States)

    Hyshka, Elaine; Anderson-Baron, Jalene; Karekezi, Kamagaju; Belle-Isle, Lynne; Elliott, Richard; Pauly, Bernie; Strike, Carol; Asbridge, Mark; Dell, Colleen; McBride, Keely; Hathaway, Andrew; Wild, T Cameron

    2017-07-26

    In Canada, funding, administration, and delivery of health services-including those targeting people who use drugs-are primarily the responsibility of the provinces and territories. Access to harm reduction services varies across jurisdictions, possibly reflecting differences in provincial and territorial policy commitments. We examined the quality of current provincial and territorial harm reduction policies in Canada, relative to how well official documents reflect internationally recognized principles and attributes of a harm reduction approach. We employed an iterative search and screening process to generate a corpus of 54 provincial and territorial harm reduction policy documents that were current to the end of 2015. Documents were content-analyzed using a deductive coding framework comprised of 17 indicators that assessed the quality of policies relative to how well they described key population and program aspects of a harm reduction approach. Only two jurisdictions had current provincial-level, stand-alone harm reduction policies; all other documents were focused on either substance use, addiction and/or mental health, or sexually transmitted and/or blood-borne infections. Policies rarely named specific harm reduction interventions and more frequently referred to generic harm reduction programs or services. Only one document met all 17 indicators. Very few documents acknowledged that stigma and discrimination are issues faced by people who use drugs, that not all substance use is problematic, or that people who use drugs are legitimate participants in policymaking. A minority of documents recognized that abstaining from substance use is not required to receive services. Just over a quarter addressed the risk of drug overdose, and even fewer acknowledged the need to apply harm reduction approaches to an array of drugs and modes of use. Current provincial and territorial policies offer few robust characterizations of harm reduction or go beyond rhetorical or

  15. Expanding conceptualizations of harm reduction: results from a qualitative community-based participatory research study with people who inject drugs.

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    Boucher, L M; Marshall, Z; Martin, A; Larose-Hébert, K; Flynn, J V; Lalonde, C; Pineau, D; Bigelow, J; Rose, T; Chase, R; Boyd, R; Tyndall, M; Kendall, C

    2017-05-12

    The perspectives of people who use drugs are critical in understanding why people choose to reduce harm in relation to drug use, what practices are considered or preferred in conceptualizations of harm reduction, and which environmental factors interfere with or support the use of harm reduction strategies. This study explores how people who inject drugs (PWID) think about harm reduction and considers the critical imperative of equity in health and social services delivery for this community. This community-based participatory research study was conducted in a Canadian urban centre. Using a peer-based recruitment and interviewing strategy, semi-structured qualitative interviews were conducted by and with PWID. The Vidaview Life Story Board, an innovative tool where interviewers and participant co-construct a visual "life-scape" using a board, markers, and customized picture magnets, was used to facilitate the interviews. The topics explored included injection drug use and harm reduction histories, facilitators and barriers to using harm reduction strategies, and suggestions for improving services and supports. Twenty-three interviews with PWID (14 men and 9 women) were analysed, with a median age of 50. Results highlighted an expanded conceptualization of harm reduction from the perspectives of PWID, including motivations for adopting harm reduction strategies and a description of harm reduction practices that went beyond conventional health-focused concerns. The most common personal practices that PWID used included working toward moderation, employing various cognitive strategies, and engaging in community activities. The importance of social or peer support and improving self-efficacy was also evident. Further, there was a call for less rigid eligibility criteria and procedures in health and social services, and the need to more adequately address the stigmatization of drug users. These findings demonstrated that PWID incorporate many personal harm reduction

  16. Calculation of electric conductivity of water of the Aral Sea and correction of the sound salinity of 2002-2009

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    Stunzhas, P. A.

    2016-11-01

    The Aral Sea is an important water area both for monitoring and oceanological studies, because its salinity and salt composition strongly differ from the oceanic. We offer a semiempiric calculation method of electric conductivity and the coefficient of its temperature dependence k judging from the ionic composition of water. The properties of the solution are considered as the sum of properties of seven binary salts taken based on the ionic composition of the solution. The MgSO4 concentration is thought to be the highest possible, which makes the salt concentration nearly unambiguous. In a salinity range of 46-120‰ and temperature range of 5-25°C (2002-2009), the standard deviation of the calculated and measured electric conductivity was 2.9%. To refine the calculation of salinity from electric conductivity measurements using the "oceanic" formula, we suggest its preliminary reduction to a constant temperature (20°C) using the measured or calculated coefficient k.

  17. From risk and harm reduction to decriminalizing abortion: The Uruguayan model for women's rights.

    Science.gov (United States)

    Briozzo, Leonel

    2016-08-01

    To describe public policies, social actions, particularly those of obstetricians/gynecologists, and changes in abortion-related legislation in the different historical periods between 1990 and 2015, and to analyze temporal correlations with a reduction in maternal mortality. The 1990-2015 period was divided into three different stages to permit evaluation of the legislation, health regulations, healthcare system, and professional practices related to the care provided in cases of unsafe abortion: 1990-2001, characterized by illegality and the healthcare system's denial of abortion; 2001-2012, when the model for reducing the risk and harm of unsafe abortions was developed; and 2012-2015, when abortion was finally decriminalized. Changes in public policies and expansion of the risk reduction model coincided with changes in the social perception of abortion and a decrease in maternal mortality and abortion rates, probably due to a set of public policies that led to the decriminalization of abortion in 2012. Changes in public policies and health actions such as the model for reducing the risk and harm of unsafe abortions coincided with a marked reduction in abortion-related maternal mortality. The challenges still to be faced include managing second trimester abortions, ensuring the creation of multidisciplinary teams, and offering postabortion contraception. Copyright © 2016. Published by Elsevier Ireland Ltd.

  18. Provision of harm-reduction services to limit unsafe abortion in Tanzania.

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    Kahabuka, Catherine; Pembe, Andrea; Meglioli, Alejandra

    2017-02-01

    To investigate the feasibility of providing harm-reduction services to reduce unsafe abortion in Tanzania. A cross-sectional study was conducted among 110 women who received harm-reduction counseling at a public health center in Dar es Salaam between February 10 and October 10, 2014. Background and clinical information was collected for all women; a subgroup (n=50) undertook a semi-structured survey that measured the type of services women received, women's perception of the services, and pregnancy outcome. The main study outcomes were attendance at the follow-up visit, type and quality of information women received on both visits, and misoprostol use for pregnancy termination. Overall, 55 (50.0%) women attended follow-up services. Misoprostol was used for induced abortion among 54 (98.2%); 38 (70.4%) of these women had obtained contraception at the follow-up visit. Likelihood of attendance for follow-up was increased among women who were older than 34 years (odds ratio [OR] 2.2, 95% confidence interval [CI] 0.1-35.8), were married (OR 2.1, 95% CI 0.8-5.7), and had a post-primary education level (OR 2.0, 95% CI 0.8-5.3). On average, 44 (87.0%) women received all required information at the initial counseling session and none reported major complications that required hospitalization. Harm-reduction services for unsafe abortion are feasible and acceptable, and could provide an excellent opportunity to fight abortion-related morbidity and mortality in Tanzania. © 2016 CSK Research Solutions Limited.International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

  19. Australian urban Indigenous smokers' perspectives on nicotine products and tobacco harm reduction.

    Science.gov (United States)

    Yuke, Kym; Ford, Pauline; Foley, Wendy; Mutch, Allyson; Fitzgerald, Lisa; Gartner, Coral

    2017-05-10

    Indigenous Australians experience a significant gap in life expectancy compared with non-Indigenous Australians. Indigenous communities have high-smoking prevalence and low engagement with cessation therapies. This qualitative research, conducted in an urban Australian Indigenous community, explored smokers' views on smoking, quitting and engagement with current nicotine replacement therapies. Opinions on acceptability of tobacco harm reduction were sought. We explored the acceptability of novel nicotine products, that is, new or unfamiliar products, including non-therapeutic options, such as e-cigarettes. Focus groups and individual interviews with adult Indigenous daily smokers (n = 27) were used. Current and novel nicotine products were displayed and demonstrated. Discussions were audio-recorded, transcribed and analysed thematically. Participants expressed interest in trying existing and novel nicotine products. Short-to-medium term use of nicotine replacement therapy for quitting was generally acceptable; views on long-term use were mixed. Interest in use of tobacco substitutes depended on their perceived effectiveness, providing a 'kick' and 'relieving stress'. Desirable qualities for tobacco substitutes were identified with gender differences and product preferences noted. The unpleasant taste of existing products is a barrier to both short-term and long-term use. We found substantial interest in trying some existing and novel nicotine products, mostly for short-term use. A number of attributes were identified that would make nicotine products potentially acceptable as a long-term substitute. Some participants were interested in long-term substitution if acceptable products were available. Improvements in current products and access to novel products are needed if tobacco harm reduction is to be acceptable. [Yuke K, Ford P, Foley W, Mutch A, Fitzgerald L, Gartner C. Australian urban Indigenous smokers' perspectives on nicotine products and tobacco harm

  20. Barriers to the dissemination of four harm reduction strategies: a survey of addiction treatment providers in Ontario

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    Cunningham John A

    2006-12-01

    Full Text Available Abstract A sample of service providers at addictions agencies' in Ontario were interviewed by telephone to assess attitudes toward, anticipated internal and external barriers to implementing, and expected benefits of four harm reduction strategies: needle exchange, moderate drinking goals, methadone treatment, and provision of free condoms to clients. Respondents were also asked to define harm reduction, list its most important elements, and describe what they find most troubling and most appealing about harm reduction. Attitudes toward harm reduction in general and the services provided at each agency were also assessed. Results indicated that the service providers surveyed had positive attitudes toward each of the four harm reduction strategies and harm reduction in general, and the majority of respondents were aware of the benefits associated with each strategy. Almost all of the agencies surveyed allowed for moderate drinking outcomes in the treatment of alcohol problems, and most agencies provided free condoms to clients. In terms of barriers, anticipated negative community reaction to needle exchange, methadone treatment, and free condoms was a major concern for the majority of respondents. Lack of staff, of funding, or anticipated staff resistance were also cited as potential barriers to introducing these strategies. In the case of methadone maintenance, the unavailability of a qualified physician was listed as the primary constraint. Implications for future efforts directed at encouraging the adoption of these strategies and suggestions for future research are discussed.

  1. Public attitudes towards gambling product harm and harm reduction strategies: an online study of 16-88 year olds in Victoria, Australia.

    Science.gov (United States)

    Thomas, Samantha L; Randle, Melanie; Bestman, Amy; Pitt, Hannah; Bowe, Steven J; Cowlishaw, Sean; Daube, Mike

    2017-07-25

    Gambling has quickly emerged as an important global public health issue. With new technologies used to develop high intensity gambling products and promotions aimed at driving consumption, public health organisations and researchers, community groups, and politicians have argued for a range of regulatory and education measures aimed at reducing gambling harm. However, there has been limited research seeking to understand community perceptions of the harms associated with gambling products and environments, and the level of community support for strategies designed to prevent and reduce gambling harm. An online study of 500 adolescents and adults (aged 16 and over) was conducted with a representative sample (by age and gender) of individuals who were current residents in the state of Victoria, Australia. Participants were asked a range of questions about their own gambling behaviours, with the Problem Gambling Severity Index (PGSI) used as a measure of problem gambling. Participants were asked about their perceptions of harms associated with electronic gambling machines (EGMs), sports betting, horse betting, and casino gambling. They were also asked about the extent to which they agreed or disagreed with gambling harm reduction strategies related to marketing and promotions, restrictions on gambling products and venues, and public education campaigns. Quantitative data were analysed using descriptive statistics and paired t tests, with thematic analysis used to interpret qualitative responses to open-ended questionnaire items. More than one third (n = 201, 40.2%) of participants were at risk of experiencing some level of harm from gambling (PGSI ≥ 1), with 83 participants (16.6%) recording scores that indicated problem gambling (PGSI ≥ 8). One in five participants gambled on EGMs at least monthly (n = 100, 20.0%). Those who gambled on sports did so frequently, with nearly 1 in 5 gambling on sport at least once a month (n = 87, 17.4%). Over

  2. Cultural Approach to HIV/AIDS Harm Reduction in Muslim Countries

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    Hasnain Memoona

    2005-10-01

    Full Text Available Abstract Muslim countries, previously considered protected from HIV/AIDS due to religious and cultural norms, are facing a rapidly rising threat. Despite the evidence of an advancing epidemic, the usual response from the policy makers in Muslim countries, for protection against HIV infection, is a major focus on propagating abstention from illicit drug and sexual practices. Sexuality, considered a private matter, is a taboo topic for discussion. Harm reduction, a pragmatic approach for HIV prevention, is underutilized. The social stigma attached to HIV/AIDS, that exists in all societies is much more pronounced in Muslim cultures. This stigma prevents those at risk from coming forward for appropriate counseling, testing, and treatment, as it involves disclosure of risky practices. The purpose of this paper is to define the extent of the HIV/AIDS problem in Muslim countries, outline the major challenges to HIV/AIDS prevention and treatment, and discuss the concept of harm reduction, with a cultural approach, as a strategy to prevent further spread of the disease. Recommendations include integrating HIV prevention and treatment strategies within existing social, cultural and religious frameworks, working with religious leaders as key collaborators, and provision of appropriate healthcare resources and infrastructure for successful HIV prevention and treatment programs in Muslim countries.

  3. The Case in Favor of E-Cigarettes for Tobacco Harm Reduction

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    Joel L. Nitzkin

    2014-06-01

    Full Text Available A carefully structured Tobacco Harm Reduction (THR initiative, with e-cigarettes as a prominent THR modality, added to current tobacco control programming, is the most feasible policy option likely to substantially reduce tobacco-attributable illness and death in the United States over the next 20 years. E-cigarettes and related vapor products are the most promising harm reduction modalities because of their acceptability to smokers. There are about 46 million smokers in the United States, and an estimated 480,000 deaths per year attributed to cigarette smoking. These numbers have been essentially stable since 2004. Currently recommended pharmaceutical smoking cessation protocols fail in about 90% of smokers who use them as directed, even under the best of study conditions, when results are measured at six to twelve months. E-cigarettes have not been attractive to non-smoking teens or adults. Limited numbers non-smokers have experimented with them, but hardly any have continued their use. The vast majority of e-cigarette use is by current smokers using them to cut down or quit cigarettes. E-cigarettes, even when used in no-smoking areas, pose no discernable risk to bystanders. Finally, addition of a THR component to current tobacco control programming will likely reduce costs by reducing the need for counseling and drugs.

  4. "Word of mouse": indigenous harm reduction and online consumerism of the synthetic compound methoxphenidine.

    Science.gov (United States)

    Van Hout, Marie Claire; Hearne, Evelyn

    2015-01-01

    Methoxphenidine (MXP) was one of several NMDA antagonists marketed in 2013 to replace the recently controlled compound Methoxetamine (MXE). A steep rise in user interest was recorded, despite vendor cautioning of limited user feedback. The study presented a phenomenological analysis of MXP experiences amongst recreational drug users as posted on public Internet fora. Internet searches were carried out using specific key words; "methoxphenidine," "MXP" and in combination with "experience," "report," "forum," and "trip." Seven self-reported experiences and 28 thread discussions relating sole use of MXP were analyzed using the Empirical Phenomenological Psychological method. Five themes and 61 categories emerged. MXP is marketed as a legal replacement for MXE, diphenidine, and ketamine, with a dissociative and stimulant wave outcome often lasting for days. Harm reduction tactics, awareness of prior tolerance to dissociative and optimal settings for use are discussed. Acute side-effects relate to hypertension and seizures. Chronic long-term memory loss and limb numbness is reported. Sense of empowerment occurs in the afterglow experience. Internet drug fora fuel information exchange and informed consumerism of synthetic compounds, and offer viable mechanisms for pre- and post-purchase decision making and indigenous harm reduction. Continued surveillance of synthetic market entries and user trends is warranted.

  5. An epidemiologic review of smokeless tobacco health effects and harm reduction potential.

    Science.gov (United States)

    Colilla, Susan A

    2010-03-01

    A systematic review of the epidemiologic literature on the health effects of smokeless tobacco (ST) and its relevance to the harm reduction model for smoking was undertaken. Published epidemiologic studies, from the US and European countries, meeting defined inclusion criteria and assessing the health effects of smokeless tobacco products were examined. ST use showed evidence of a slightly increased risk for all-cause mortality. Little evidence was found to support a causal relationship between ST use and risk of oral, pancreatic or lung cancer. ST use was not associated with an increased risk of cardiovascular disease or stroke incidence, but evidence suggested ST use was associated with increased mortality from these diseases. Clinical trials evaluating the effectiveness of ST products in smoking cessation have been sparse, and no standardized method for measuring ST dependence has been used, limiting the assessment of their relationship to ST use. Several studies have examined if ST use increases the risk of smoking initiation, but few have modeled this complex behavior appropriately. Overall, epidemiologic studies have not shown strong evidence of elevated tobacco-related disease risks with ST use. More research is necessary to assess the smoking behavioral consequences of ST use prior to its consideration as a harm reduction tool. (c) 2009 Elsevier Inc. All rights reserved.

  6. Alcohol abstinence or harm-reduction? Parental messages for college-bound light drinkers.

    Science.gov (United States)

    LaBrie, Joseph W; Boyle, Sarah C; Napper, Lucy E

    2015-07-01

    Parental communications about alcohol can have a significant impact on college students' alcohol use; however, it is unclear what types of communication may be most beneficial for reducing alcohol risk, particularly among students who have already initiated alcohol use. The present research examines differences in alcohol use and employment of drinking protective behavioral strategies between pre-college matriculation high school seniors receiving predominantly abstinence parent messaging and students primarily receiving harm-reduction parent messaging. Students who identified as light drinkers were recruited during their last month in high school and completed an online assessment of alcohol use and parent alcohol communication. Analyses revealed that, in comparison to light drinkers who primarily received harm-reduction messaging from parents, light drinkers who received more abstinence messaging reported less frequent alcohol use, lower peak alcohol consumption, and greater use of protective drinking strategies aimed at changing the way they drank and avoiding serious hazards associated with drinking. Findings from this study underscore the utility of messages related to abstinence even for parents who are aware that their children have had previous experiences with alcohol and highlight the need for longitudinal research assessing additional mechanisms associated with message efficacy among light, moderate and heavy drinking students transitioning to college. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Contested space in the pharmacy: public attitudes to pharmacy harm reduction services in the West of Scotland.

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    Gidman, Wendy; Coomber, Ross

    2014-01-01

    Internationally, community pharmacies have become increasingly involved in providing harm reduction services and health advice to people who use illicit drugs. This paper considers public opinion of community pharmacy services. It discusses attitudes to harm reduction services in the context of stigmatization of addiction and people who use drugs. This exploratory study involved twenty-six purposively sampled members of the public, from the West of Scotland, participating in one of 5 focus groups. The groups were composed to represent known groups of users and non-users of community pharmacy, none of whom were problem drug users. Three thematic categories were identified: methadone service users in community pharmacies; attitudes to harm reduction policies; contested space. Harm reduction service expansion has resulted in a high volume of drug users in and around some Scottish pharmacies. Even if harm reduction services are provided discretely users' behavior can differentiate them from other pharmacy users. Drug users' behavior in this setting is commonly perceived to be unacceptable and can deter other consumers from using pharmacy services. The results of this study infer that negative public opinion is highly suggestive of stereotyping and stigmatization of people who use drugs. Participants considered that (1) community pharmacies were unsuitable environments for harm reduction service provision, as they are used by older people and those with children; (2) current drug policy is perceived as ineffective, as abstinence is seldom achieved and methadone was reported to be re-sold; (3) people who use drugs were avoided where possible in community pharmacies. Community pharmacy harm reduction services increasingly bring together the public and drug users. Study participants were reluctant to share pharmacy facilities with drug users. This paper concludes by suggesting mechanisms to minimize stigmatization. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Incarceration, addiction and harm reduction: inmates experience injecting drugs in prison.

    Science.gov (United States)

    Small, Will; Kain, S; Laliberte, Nancy; Schechter, Martin T; O'Shaughnessy, Michael V; Spittal, Patricia M

    2005-01-01

    Within Canadian prisons HIV/AIDS is becoming more common among inmates. While injection drug use in correctional facilities is documented to be a problem, qualitative research into the HIV risks faced by inmates is lacking. The goal of this research was to qualitatively examine HIV risk associated with injecting inside British Columbia prisons. A sample of 26 former male inmates who had recently used drugs within correctional facilities were recruited from a ongoing cohort study of injection drug users in Vancouver, Canada. Data for this study were collected through in-depth interviews conducted in 2001/2002. Analysis of these data involved identifying emergent themes and then exploring these central concepts in further interviews to confirm the accuracy of interpretation. The harms normally associated with drug addiction, and injection drug use are exacerbated in prison. Interpersonal relationships and the possession of exchangeable resources determine access to scarce syringes. The scarcity of syringes has resulted in patterns of sharing amongst large numbers of persons. Continual reuse of scarce syringes poses serious health hazards and bleach distribution is an inadequate solution. The findings of this study emphasize the need for effective harm reduction programs that provide an appropriate response to the problem of injection drug use among inmates.

  9. Evaluation of the Overdose Education and Naloxone Distribution Program of the Baltimore Student Harm Reduction Coalition.

    Science.gov (United States)

    Lewis, Dinah A; Park, Ju Nyeong; Vail, Laura; Sine, Mark; Welsh, Christopher; Sherman, Susan G

    2016-07-01

    Although historically the majority of overdose education and naloxone distribution (OEND) programs have targeted opioid users, states are increasingly passing laws that enable third-party prescriptions of naloxone to individuals who may be able to respond to an overdose, including friends and family members of individuals who use opioids. In this report, we discuss the Baltimore Student Harm Reduction Coalition (BSHRC) OEND program, Maryland's first community-based, state-authorized training program under a new law allowing third-party naloxone prescription. In an 8-month pilot period, 250 free naloxone kits were distributed, and 3 overdose reversals were reported to BSHRC. Trainings were effective in increasing self-efficacy surrounding overdose prevention and response, which appears to persist at up to 12 months following the training.

  10. Supply-side harm reduction strategies: Bolivia's experiment with social control.

    Science.gov (United States)

    Farthing, Linda; Kohl, Benjamin

    2012-11-01

    Harm reduction approaches to drug control have almost exclusively focussed on consumers in northern countries. This article supports recent analysis that indicates that such policies also hold relevance for producer countries by drawing on recent policy innovations in Bolivia. When Evo Morales, the president of the national coca grower confederation, was elected the country's first indigenous president in 2005, he promised to fundamentally change 25 years of the U.S.-funded "drug war" that had generated repeated human rights violations. The new policy, which implicitly incorporates harm reduction principles combined with respect for human rights, recognizes coca leaf's traditional use and cultural importance and relies on vigorous local organizations to implement a community-based programme called social control. Results to date indicate that Bolivia's social control experience has reduced violence in coca growing communities, ensured small farmers a subsistence income from coca and increased sovereignty, while making a modest contribution to containing expansion of coca cultivation. The programme has registered 50,000 farmers who are allowed to cultivate limited quantities of coca to supply traditional users and helped them gain secure title to their land. This registration is combined with satellite surveillance to guarantee that farmers do not exceed limits established by law. To date, the programme's reach is incomplete and coca is still diverted to the drug trade. Nonetheless, the approach may offer lessons for other drug producer countries, particularly where strong socio-political organizations are found in combination with closeknit communities holding shared cultural values. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Effectiveness of Culturally Appropriate Initiative on Drug-Related Harm Reduction for Sex Workers on the Thai/Malaysian Border.

    Science.gov (United States)

    Nunun, Worapol; Kanato, Manop

    2015-07-01

    Drug use can harm to sex workers. Abstinence intervention, however, may not be appropriate since drug use fosters their career performance. The objective was to develop the culturally appropriate model for sex workers participation on drug demand reduction at the Thailand/Malaysian border This study was a pre-post quasi-experimental design. Tripartite participation was used to develop the model aiming to reduce harm regarding drug use. The study carried out during June 2010-May 2011. Data were collected from 150 key informant interviews, 56 focus group discussions, 22 participant observations in various situations, and numerous related materials. Descriptive statistics, survival analysis and 95% confidence interval were utilizedfor quantitative data. Qualitative data were analyzed by content analysis. Drug related harm reduction was evaluated at two-week time along implementation period of 12 months. 89.5% of all sessions introduced could decrease drug related harm. Of all sex workers participated in the study, intended to treat analysis showed 86.9% success rate (95% CI; 77.1, 96.7). Of these, 32.6% became abstinence, 39.1% reduced most of drug related harm. 13.0% reduced partial drug related harm either lessfrequency, less quantity, less concentration, decrease types of drugs/switch to safe drugs or safer method of administration. 2.2% was infancy stage, which needed further support. Key success ofthe model was tripartite participation. With active leaders and strong support, sex workers were continually motivated to reduce harm regarding drug use.

  12. The Effectiveness of Harm Reduction Programs in Seven Prisons of Iran

    Science.gov (United States)

    ROSHANFEKR, Payam; FARNIA, Marziyeh; DEJMAN, Masoumeh

    2013-01-01

    Abstract Background Starting in 1990 many programs were initiated to prevent and control the spread of HIV/AIDS in prisons in accordance with the policies of the Ministry of Health. This study attempts to evaluate the effectiveness of harm reduction programs vis-à-vis drug abuse and dependency in 7 prisons in Iran. Methods The methodology used is Before-After testing and the sample population is incarcerated prisoners in 7 large prisons in 7 provinces with diverse geographical, criminal, and numerical factors and the population sample is estimated at 2,200 inmates. Results Findings show that Drug addiction tests conducted on prisoners, right after their admittance indicated that 57% used at least one of the three drugs of morphine, amphetamines, and hashish (52% morphine, 4.5% ampheta-mines, and 3.9% hashish). Two months later, on the 2nd phase of the study, test results indicated that only 10% of subjects continued using drugs (P=0.05). Heroin and opium were the two most prevalent drugs. Smoking, oral in-take, and sniffing were the three most popular methods. Of those who continued to use drugs in prison, 95% admitted to drug use records. Conclusion Intervention policies in prisons resulted in reduction of drug consumption, from 57% of the newly admitted inmates to 10% after two months of incarceration. PMID:26060645

  13. The Effectiveness of Harm Reduction Programs in Seven Prisons of Iran.

    Science.gov (United States)

    Roshanfekr, Payam; Farnia, Marziyeh; Dejman, Masoumeh

    2013-12-01

    Starting in 1990 many programs were initiated to prevent and control the spread of HIV/AIDS in prisons in accordance with the policies of the Ministry of Health. This study attempts to evaluate the effectiveness of harm reduction programs vis-à-vis drug abuse and dependency in 7 prisons in Iran. The methodology used is Before-After testing and the sample population is incarcerated prisoners in 7 large prisons in 7 provinces with diverse geographical, criminal, and numerical factors and the population sample is estimated at 2,200 inmates. Findings show that Drug addiction tests conducted on prisoners, right after their admittance indicated that 57% used at least one of the three drugs of morphine, amphetamines, and hashish (52% morphine, 4.5% ampheta-mines, and 3.9% hashish). Two months later, on the 2nd phase of the study, test results indicated that only 10% of subjects continued using drugs (P =0.05). Heroin and opium were the two most prevalent drugs. Smoking, oral in-take, and sniffing were the three most popular methods. Of those who continued to use drugs in prison, 95% admitted to drug use records. Intervention policies in prisons resulted in reduction of drug consumption, from 57% of the newly admitted inmates to 10% after two months of incarceration.

  14. Is harm reduction profitable? An analytical framework for corporate social responsibility based on an epidemic model of addictive consumption.

    Science.gov (United States)

    Massin, Sophie

    2012-06-01

    This article aims to help resolve the apparent paradox of producers of addictive goods who claim to be socially responsible while marketing a product clearly identified as harmful. It advances that reputation effects are crucial in this issue and that determining whether harm reduction practices are costly or profitable for the producers can help to assess the sincerity of their discourse. An analytical framework based on an epidemic model of addictive consumption that includes a deterrent effect of heavy use on initiation is developed. This framework enables us to establish a clear distinction between a simple responsible discourse and genuine harm reduction practices and, among harm reduction practices, between use reduction practices and micro harm reduction practices. Using simulations based on tobacco sales in France from 1950 to 2008, we explore the impact of three corresponding types of actions: communication on damage, restraining selling practices and development of safer products on total sales and on the social cost. We notably find that restraining selling practices toward light users, that is, preventing light users from escalating to heavy use, can be profitable for the producer, especially at early stages of the epidemic, but that such practices also contribute to increase the social cost. These results suggest that the existence of a deterrent effect of heavy use on the initiation of the consumption of an addictive good can shed new light on important issues, such as the motivations for corporate social responsibility and the definition of responsible actions in the particular case of harm reduction. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Harm reduction and knowledge exchange-a qualitative analysis of drug-related Internet discussion forums.

    Science.gov (United States)

    Soussan, Christophe; Kjellgren, Anette

    2014-09-08

    and how to use them safely. Although this publicly available knowledge could entail an increase in drug use, the main characteristics of the discussions in general were a concern for safety and harm reduction, not for recruiting new users. Drug-related Internet forums could be used as a location for drug prevention, as well as a source of information for further research about NPS.

  16. The state of harm reduction in the Middle East and North Africa: A focus on Iran and Morocco.

    Science.gov (United States)

    Himmich, Hakima; Madani, Navid

    2016-05-01

    HIV/AIDS and hepatitis C among people who inject drugs are on the rise in the Middle East and North Africa (MENA) region. But the regional response to the epidemic falls short both in terms of the quality and scale of response. From the threat of the death sentence for drug offenses to the burden of refugees fleeing conflict, there are many legal, political and social barriers that hinder the introduction and expansion of harm reduction in the region. However Iran and Morocco are two pioneering countries and over the last decade they have been providing evidence that harm reduction is feasible and acceptable in MENA. Using different approaches, these two countries have overcome various obstacles and encouraged discussion and collaboration among stakeholders, including government, health professionals, civil society and community-based organizations. In so doing they have created an enabling environment to endorse a national harm strategy. Copyright © 2016 Elsevier B.V. All rights reserved.

  17. Hepatitis B vaccination: an unmet challenge in the era of harm reduction programs.

    Science.gov (United States)

    Vallejo, Fernando; Toro, Carlos; de la Fuente, Luis; Brugal, M Teresa; Barrio, Gregorio; Soriano, Vicente; Ballesta, Rosario; Bravo, María J

    2008-06-01

    The prevalence of vaccination against hepatitis B virus (HBV), factors associated with vaccination, and missed opportunities for vaccination were assessed among 949 street-recruited young injecting heroin users (IHUs) and noninjecting HUs (NIHUs). A cross-sectional study was carried out in Madrid, Barcelona, and Seville. Face-to-face interviews were held using a structured questionnaire with computer-assisted personal interviewing. Dried blood spot samples were tested for anti-HBV core antigen and HBV surface antigen. Bivariate and logistic regression analyses were performed. The prevalence of HBV vaccination was 21.7%, with significant differences among the cities (13.3% in Madrid, 18.4% in Seville, and 33.2% in Barcelona) and between IHUs (23.8%) and NIHUs (17.9%). In the logistic regression analysis, living in Barcelona and being aged 25 years or younger were associated with HBV vaccination in IHUs and NIHUs; in IHUs, vaccination was also associated with living in the street or in institutions for most of the last 12 months. Practically all those susceptible to HBV infection had missed at least one opportunity for vaccination, and most of them had missed such an opportunity in the last year. The proportion of vaccinated HUs remains very low despite efforts to set up harm reduction programs. New and more active strategies must be incorporated in these programs.

  18. Spontaneous harm reduction: a barrier for substance-dependent individuals seeking treatment?

    Directory of Open Access Journals (Sweden)

    Fontanella Bruno José Barcellos

    2005-01-01

    Full Text Available OBJETIVE: Greater information regarding motivations and treatment barriers faced by substance-dependent individuals has clinical and public health implications. This study aimed to formulate hypotheses regarding psychological, social and family variables that can be constructed as motivations or subjective barriers for the early seeking of formal treatment. METHODS: A qualitative study was conducted in an intentional sample (selected through saturation and variety of types of 13 substance-dependent individuals who sought treatment. In-depth, semi-structured interviews were conducted using open questions, and the transcribed data were subjected to qualitative analysis. RESULTS: Four types of spontaneous harm reduction measures were identified, according to the subjective logic of each participant: having some periods at rest (not using and recovering from adverse effects; caretaking by close acquaintances (relatives, partners, drug dealers and alcoholic beverage sellers; selectivity regarding substance source, type and means of administration; establishing "healthy" limits of ingestion. CONCLUSIONS: The measures identified might represent barriers to the early seeking of treatment but might also represent spontaneous learning of abilities beneficial to future treatment. Health care professionals should take into consideration their existence and should address them in clinical settings. Issues representative of the formulated categories should be presented in structured questionnaires used in future quantitative studies of barriers to treatment in this population.

  19. Venous access and care: harnessing pragmatics in harm reduction for people who inject drugs.

    Science.gov (United States)

    Harris, Magdalena; Rhodes, Tim

    2012-06-01

    To explore the facilitators of long-term hepatitis C avoidance among people who inject drugs. We employed a qualitative life history design. Recruitment took place through low-threshold drug services and drug user networks in South East and North London. Participants were interviewed at the recruitment services or in their homes. The sample comprised 35 people who inject drugs, 20 of whom were hepatitis C antibody-negative. Participants' average injecting trajectory was 19 years (6-33), with 66% primarily injecting heroin, and 34% a crack and heroin mix. Nine (26%) of the sample were female and the average age was 39 years (23-53). Two interviews were conducted with each participant, with the second interview incorporating reference to a computer-constructed life history time-line. Interview accounts were audiorecorded, transcribed verbatim and analysed thematically. Hepatitis C risk awareness was recent and deprioritized by the majority of participants. The facilitation of venous access and care was an initial and enduring rationale for safe injecting practices. Difficult venous access resulted in increased contamination of injecting environments and transitions to femoral injecting. Participants expressed an unmet desire for non-judgemental venous access information and advice. Harm reduction interventions which attend to the immediate priorities of people who inject drugs, such as venous access and care, have the potential to re-engage individuals who are jaded or confused by hepatitis C prevention messages. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

  20. What Goes Around: the process of building a community-based harm reduction research project.

    Science.gov (United States)

    Jalloh, Chelsea; Illsley, Shohan; Wylie, John; Migliardi, Paula; West, Ethan; Stewart, Debbie; Mignone, Javier

    2017-11-16

    Often, research takes place on underserved populations rather than with underserved populations. This approach can further isolate and stigmatize groups that are already made marginalized. What Goes Around is a community-based research project that was led by community members themselves (Peers). This research aimed to implement a community-based research methodology grounded in the leadership and growing research capacity of community researchers and to investigate a topic which community members identified as important and meaningful. Chosen by community members, this project explored how safer sex and safer drug use information is shared informally among Peers. Seventeen community members actively engaged as both community researchers and research participants throughout all facets of the project: inception, implementation, analysis, and dissemination of results. Effective collaboration between community researchers, a community organization, and academics facilitated a research process in which community members actively guided the project from beginning to end. The methods used in What Goes Around demonstrated that it is not only possible, but advantageous, to draw from community members' involvement and direction in all stages of a community-based research project. This is particularly important when working with a historically underserved population. Purposeful and regular communication among collaborators, ongoing capacity building, and a commitment to respect the experience and expertise of community members were essential to the project's success. This project demonstrated that community members are highly invested in both informally sharing information about safer sex and safer drug use and taking leadership roles in directing research that prioritizes harm reduction in their communities.

  1. Transdisciplinarity among tobacco harm-reduction researchers: a network analytic approach.

    Science.gov (United States)

    Provan, Keith G; Clark, Pamela I; Huerta, Timothy

    2008-08-01

    Progress in tobacco control and other areas of health research is thought to be heavily influenced by the extent to which researchers are able to work with each other not only within, but also across disciplines. This study provides an examination of the extent to which researchers in the area of tobacco harm reduction work together. Specifically, data were collected in 2005 from a national group of 67 top tobacco-control researchers from eight broadly defined disciplines representing 17 areas of expertise. Network analysis was utilized to examine the extent to which these researchers were engaged in research that was interdisciplinary or transdisciplinary, based on the outcome or product attained. Findings revealed that interdisciplinary network ties were much denser than transdisciplinary ties, but researchers in some disciplines were more likely to work across disciplines than others, especially when synergistic outcomes resulted. The study demonstrates for the first time how tobacco-control researchers work together, providing direction for policy officials seeking to encourage greater transdisciplinarity. The study also demonstrates the value of network-analysis methods for understanding research relationships in one important area of health care.

  2. [Efficacy and security of electronic cigarette for tobacco harm reduction: Systematic review and meta-analysis].

    Science.gov (United States)

    Vanderkam, Paul; Boussageon, Rémy; Underner, Michel; Langbourg, Nicolas; Brabant, Yann; Binder, Philippe; Freche, Bernard; Jaafari, Nematollah

    2016-11-01

    Smoking is the first cause of preventable death in France and in the world. Without help, it was shown that 80 % of smokers who try to quit smoking relapse after one month with a low long-term success rate. Smoking reduction can concern smokers who did not want to quit or failed in their attempt to weaning. The final aim is to increase attractiveness of drug therapies by developing new products, such as electronic cigarettes, that can compete cigarette without reproducing its harmful effects. Assess the capacity of electronic cigarettes to reduce or stop tobacco use among regular smokers. Consultations MEDLINE and COCHRANE databases. e-cigarette; electronic cigarettes; ENDD (electronic nicotine delivery system); ENDS (electronic nicotine delivery device); vaping were used. Randomized controlled trials (RCTs) comparing the electronic cigarette with nicotine versus placebo device. Two randomized controlled trials were included in the quantitative analysis. The nicotine electronic cigarette users have tobacco consumption significantly decreased compared to the placebo group (RR: 1.30, 95 % CI [1.02 to 1.66]) at 6 months. Smoking cessation rate at 3 months was greater with the electronic cigarette contains nicotine (RR: 2.55, 95 % CI [1.31 to 4.98]). The small number of RCTs included does not allow definitive conclusions about the effectiveness of electronic cigarettes, especially in the medium to long term. The use of electronic cigarette with nicotine decreases tobacco consumption among regular smokers. Further studies are needed to specify electronic cigarettes safety profile and its ability to cause a reduction in consumption and a long-term cessation in smokers. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  3. Using SMS as a Harm Reduction Strategy: An Evaluation of the RAGE (Register and Get Educated) Project

    Science.gov (United States)

    Crockett, Belinda; Keleher, Helen; Rudd, Annette; Klein, Ruth; Locke, Beth; Roussy, Véronique

    2013-01-01

    The RAGE (Register And Get Educated) project explored the feasibility of SMS (Short Messaging Service) as a means for communicating harm reduction messages in relation to alcohol and other drugs to young people residing in the City of Knox, Victoria. Almost 700 young people aged 12-26 years registered their mobile phone numbers to receive a series…

  4. Putting at risk what we know: reflecting on the drug-using subject in harm reduction and its political implications.

    Science.gov (United States)

    Moore, David; Fraser, Suzanne

    2006-06-01

    This paper provides a poststructuralist analysis of the cultural inscription of drug-using subjects in the neo-liberal discourses of contemporary harm reduction. We argue that although neo-liberal discourses downplay material constraints on individual human agency, divert policy and practice away from structural issues, limit the conception of effective strategies for harm reduction and ignore alternative formulations of the subject, they are also potentially empowering for drug users. Approximating the neo-liberal subject offers political benefits in terms of recognition, trust and legitimation, even as those values assume and reproduce understandings of behaviour, thought and sociality that fit only poorly the realities faced by many drug users. We explore this dilemma and consider three available directions in formulating the subject of harm reduction: (1) embracing the neo-liberal subject; (2) employing a more contextualised version of the neo-liberal subject; and (3) adopting alternative notions of subjectivity, extending the critique of the neo-liberal subject to all citizens, not solely drug users. To clarify some of these issues surrounding this strategic process, the paper considers another field in which struggles over the nature of the subject have been conducted--feminism. The intention is not to resolve the question of the most appropriate subject for harm reduction, but to sketch the political consequences of adopting particular models of the subject as a stimulus to further discussion and debate.

  5. Maximising harm reduction in early specialty training for general practice: validation of a safety checklist

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    Bowie Paul

    2012-06-01

    Full Text Available Abstract Background Making health care safer is a key policy priority worldwide. In specialty training, medical educators may unintentionally impact on patient safety e.g. through failures of supervision; providing limited feedback on performance; and letting poorly developed behaviours continue unchecked. Doctors-in-training are also known to be susceptible to medical error. Ensuring that all essential educational issues are addressed during training is problematic given the scale of the tasks to be undertaken. Human error and the reliability of local systems may increase the risk of safety-critical topics being inadequately covered. However adherence to a checklist reminder may improve the reliability of task delivery and maximise harm reduction. We aimed to prioritise the most safety-critical issues to be addressed in the first 12-weeks of specialty training in the general practice environment and validate a related checklist reminder. Methods We used mixed methods with different groups of GP educators (n = 127 and specialty trainees (n = 9 in two Scottish regions to prioritise, develop and validate checklist content. Generation and refinement of checklist themes and items were undertaken on an iterative basis using a range of methods including small group work in dedicated workshops; a modified-Delphi process; and telephone interviews. The relevance of potential checklist items was rated using a 4-point scale content validity index to inform final inclusion. Results 14 themes (e.g. prescribing safely; dealing with medical emergency; implications of poor record keeping; and effective & safe communication and 47 related items (e.g. how to safety-net face-to-face or over the telephone; knowledge of practice systems for results handling; recognition of harm in children were judged to be essential safety-critical educational issues to be covered. The mean content validity index ratio was 0.98. Conclusion A checklist was developed and

  6. Characteristics of tuberculosis in the state of Minas Gerais, Brazil: 2002-2009

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    Claudio Jose Augusto

    2013-06-01

    Full Text Available OBJECTIVE: To analyze the profile of tuberculosis cases reported between 2002 and 2009 in the state of Minas Gerais, Brazil, according to sociodemographic, clinical, and laboratory characteristics, as well as to comorbidities and mortality. METHODS: This was a descriptive, epidemiological study based on data obtained from the Brazilian Case Registry Database and the Brazilian Mortality Database for the 2002-2009 period. RESULTS: There were 47,285 reported cases of tuberculosis, corresponding to a mean incidence of 22.3/100,000 population. The individuals diagnosed with tuberculosis were predominantly in the 20- to 49-year age bracket and male (62.4% and 67.0%, respectively. Individuals with a low level of education accounted for 18.5% of the cases. New cases, cases of recurrence, and cases of retreatment accounted for 83.7%, 5.7%, 5.7%, respectively. The rates of cure and treatment noncompliance were 66.2% and 11.2%, respectively; multidrug-resistant tuberculosis was identified in 0.2% of the cases; and the mortality rate was 12.9%. The directly observed treatment, short-course (DOTS strategy was applied in 21.8% of the cases. Sputum smear microscopy and culture were performed in only 73.9% and 12.9% of the cases, respectively. Chest X-rays were performed in 90.5% of the cases. Pulmonary tuberculosis was the predominant form (in 83.9%. Comorbidity with alcoholism, HIV infection, and diabetes mellitus were identified in 17.2%, 8.3%, and 3.8%, respectively. CONCLUSIONS: During the study period, the numbers of new cases, cases of treatment noncompliance, and deaths were high, comorbidities were common, and there was a failure to perform adequately basic tests for the diagnosis of tuberculosis. Multidisciplinary approaches, expanded use of the DOTS strategy, better knowledge of the distribution of tuberculosis, and improvements in the databases are needed in order to achieve better control of the disease in the state of Minas Gerais.

  7. Preventing HIV transmission among Iranian prisoners: Initial support for providing education on the benefits of harm reduction practices

    Science.gov (United States)

    Eshrati, Babak; Asl, Rahim Taghizadeh; Dell, Colleen Anne; Afshar, Parviz; Millson, Peggy Margaret E; Kamali, Mohammad; Weekes, John

    2008-01-01

    Background Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison. Methods A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM) and prisoners' risky HIV-related behaviors was examined. Results Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors. Conclusion Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices. PMID:18541032

  8. Preventing HIV transmission among Iranian prisoners: Initial support for providing education on the benefits of harm reduction practices

    Directory of Open Access Journals (Sweden)

    Millson Peggy

    2008-06-01

    Full Text Available Abstract Background Harm reduction is a health-centred approach that seeks to reduce the health and social harms associated with high-risk behaviors, such as illicit drug use. The objective of this study is to determine the association between the beliefs of a group of adult, male prisoners in Iran about the transmission of HIV and their high-risk practices while in prison. Methods A cross-sectional study was conducted in 2004. The study population was a random selection of 100 men incarcerated at Rajaei-Shahr prison. The data were collected through a self-administered questionnaire. Focus group discussions were held at the prison to guide the design of the questionnaire. The relationship between components of the Health Belief Model (HBM and prisoners' risky HIV-related behaviors was examined. Results Calculating Pearson's correlation coefficient, a significant, positive association was found between the benefit component of the HBM and prisoners not engaging in HIV high-risk behaviors. Conclusion Educational harm reduction initiatives that promote the effectiveness of strategies designed to reduce the risk of HIV transmission may decrease prisoners' high-risk behaviors. This finding provides initial support for the Iran prison system's current offering of HIV/AIDS harm reduction programming and suggests the need to offer increased education about the effectiveness of HIV prevention practices.

  9. Cocaine and stimulants, the challenge of self-regulation in a harm reduction perspective

    Directory of Open Access Journals (Sweden)

    Grazia Zuffa

    2015-03-01

    Full Text Available A significant body of research on cocaine users recruited outside the “captive” populations (i.e. studies from samples of users who have not been enrolled through drug addiction services has been carried out in many European countries and outside Europe. These studies show a variety of patterns and trajectories of use other than “addictive” use. The reason of most “controlled” use lies in a wide set of self-regulation “rules” users “naturally” apply to keep drug use at bay and prevent the disruption of everyday life. Not only is this perspective at odds with the “pathological” perspective of professionals, focused as this is on “addiction” originated from the chemical properties of drugs and individual psychological deficit; it also challenges the social representation of drugs as intrinsically “out of control” substances and of drug users’ helplessness under the influence of drugs.The paper describes the workstream Innovative cocaine and poly-drug abuse prevention programme, developed in 2013 by the Italian NGO Forum Droghe within the European project New Approaches in Drug Policy &Interventions (NADPI, aimed at linking findings from research on “controls” to operational models in drug addiction services. Through a critical overview of the disease model and taking cues from users’ self regulation strategies, a new “self regulation” operational model has been developed, focused on users’ control abilities; and on social context and setting of use, following the drug/set/setting paradigm. The self regulation model may be seen as a development of the Harm Reduction approach to drug policies, aimed at decreasing the negative consequences of drug use without necessarily reducing the consumption of drugs.

  10. Aiming at Tobacco Harm Reduction: A survey comparing smokers differing in readiness to quit

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    Sarafidou Jasmin-Olga

    2006-03-01

    Full Text Available Abstract Background Greece has the highest smoking rates (in the 15-nation bloc in Europe. The purpose of this study was to investigate Greek smokers' intention and appraisal of capability to quit employing the theoretical frameworks of Decisional Balance (DB and Cognitive Dissonance (CD. Methods A cross-sectional study including 401 Greek habitual smokers (205 men and 195 women, falling into four groups according to their intention and self-appraised capability to quit smoking was carried out. Participants completed a questionnaire recording their attitude towards smoking, intention and self appraised capability to quit smoking, socio-demographic information, as well as a DB and a CD scale. Results The most numerous group of smokers (38% consisted of those who neither intended nor felt capable to quit and these smokers perceived more benefits of smoking than negatives. DB changed gradually according to smokers' "readiness" to quit: the more ready they felt to quit the less the pros of smoking outnumbered the cons. Regarding relief of CD, smokers who intended but did not feel capable to quit employed more "excuses" compared to those who felt capable. Additionally smokers with a past history of unsuccessful quit attempts employed fewer "excuses" even though they were more frequently found among those who intended but did not feel capable to quit. Conclusion Findings provide support for the DB theory. On the other hand, "excuses" do not appear to be extensively employed to reduce the conflict between smoking and concern for health. There is much heterogeneity regarding smokers' intention and appraised capability to quit, reflecting theoretical and methodological problems with the distinction among stages of change. Harm reduction programs and interventions designed to increase the implementation of smoking cessation should take into account the detrimental effect of past unsuccessful quit attempts.

  11. Harm reduction program use, psychopathology and medical severity in patients with methadone maintenance treatment.

    Science.gov (United States)

    Martínez-Luna, Nieves Gudelia; Rodríguez-Cintas, Laia; Esojo, Abderraman; Palma-Álvarez, Raúl Felipe; Robles-Martínez, María; Grau-López, Lara; Perea, Marta; Roncero, Carlos

    2018-01-15

    Methadone maintenance programs (MMP) for opioid dependence treatment have been widely used due to their effective therapeutic outcomes. Harm reduction programs (HRP) are complementary programs for severe patients with high risk behaviors and when abstinence is not possible. This study aims to compare patients in MMP that use HRP (MMP-HRP) and patients in MMP who do not use HRP (MMP-NO HRP). The sample was composed of 143 patients (MMP-HRP = 42 vs. MMP-NO HRP = 101). An additional subanalysis was performed with patients under 45 years of age (n = 116; MMP-HRP = 38 vs. MMP-NO HRP = 78). All patients were assessed with an ad hoc socio-demographic questionnaire, EuropASI, SCID-I, and SCID-II. Results show that MMP-HRP patients were younger with more frequent use of intravenous drugs and with a high prevalence of Cluster B personality disorders. MMP-NO HRP patients had lower methadone doses compared to MMP-HRP patients and preferred to use drugs by smoked route more frequently. In the subanalysis of patients under 45, MMP-HRP patients were younger, had a higher prevalence of liver diseases, more intravenous drug use, greater severity on the drug use scale, less social and family support in the suescales of EUROP-ASI than compared to patients under 45 years in the group MMP-NO HRP. In conclusion, MMP-HRP patients are younger compared to MMP-NO HRP patients, they also receive higher doses of methadone and had more intravenous use. The above findings imply that the early onset of high risk drug use and long-term exposure to heroin have more severe outcomes such as higher comorbidities (e.g. infectious diseases, medical and psychiatric disorders), and consequently, these patients are a more vulnerable group with a worse prognosis.

  12. Retailers' knowledge of tobacco harm reduction following the introduction of a new brand of smokeless tobacco.

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    Heavner, Karyn K; Rosenberg, Zale; Tenorio, Francis; Phillips, Carl V

    2010-07-29

    Tobacco retailers are potential public health partners for tobacco harm reduction (THR). THR is the substitution of highly reduced-risk nicotine products, such as smokeless tobacco (ST) or pharmaceutical nicotine, for cigarettes. The introduction of a Swedish-style ST product, du Maurier snus (dMS) (Imperial Tobacco Canada Limited), which was marketed as a THR product, provided a unique opportunity to assess retailers' knowledge. This study examined retailers' knowledge of THR and compliance with recommendations regarding tobacco sales to young adults. Male researchers, who may have looked younger than 18 years old, visited 60 stores in Edmonton that sold dMS. The researchers asked the retailers questions about dMS and its health risks relative to those from other tobacco products. They also attempted to purchase dMS to ascertain whether retailers would ask for identification to verify that they were at least 18 years old. Overall, the retailers were only moderately knowledgeable about THR and the differences between dMS and other tobacco products. About half of the retailers correctly indicated that snus is safer than cigarettes; half of whom knew it is safer because it is smoke-free. Fifty percent incorrectly believed that snus causes oral cancer. Less than fifty percent indicated that dMS differs from chewing tobacco because it is in pouches and is used without spitting or chewing (making it more promising for THR). Most (90%) of the retailers asked the researchers for identification when selling dMS. Tobacco retailers are potentially important sources of information about THR, particularly since there are restrictions on the promotion of all tobacco products (regardless of the actual health risks) in Canada. This study found that many retailers in Edmonton do not know the relative health risks of different tobacco products and are therefore unable to pass on accurate information to smokers.

  13. Monitoring quality and coverage of harm reduction services for people who use drugs : A consensus study

    National Research Council Canada - National Science Library

    Wiessing, Lucas; Ferri, Marica; Běláčková, Vendula; Carrieri, Patrizia; Friedman, Samuel R; Folch, Cinta; Dolan, Kate; Galvin, Brian; Vickerman, Peter; Lazarus, Jeffrey V; Mravčík, Viktor; Kretzschmar, Mirjam|info:eu-repo/dai/nl/075187981; Sypsa, Vana; Sarasa-Renedo, Ana; Uusküla, Anneli; Paraskevis, Dimitrios; Mendão, Luis; Rossi, Diana; van Gelder, Nadine; Mitcheson, Luke; Paoli, Letizia; Gomez, Cristina Diaz; Milhet, Maitena; Dascalu, Nicoleta; Knight, Jonathan; Hay, Gordon; Kalamara, Eleni; Simon, Roland; Comiskey, Catherine; Rossi, Carla; Griffiths, Paul; Molinaro, Sabrina; Franchini, Michela; Siciliano, Valeria; Benedetti, Elisa; Perduca, Marco; Ylli, Alban; Anta, Gregorio Barrio; Bravo Portela, Maria José; Indave, Iciar; Rácz, József; Zábranskỳ, Tomáš; Štefunková, Michaela; Dávila, Percy Fernandez; Salekesin, Maris; Vorobjov, Sigrid; Dan, Monica; Fierbinteanu, Cristina; Popescu, Dan; Verdes, Ludmila; Abagiu, Aian Octavian; Hatzakis, Angelos; Moudatsou, Maria; Antypas, Tzanetos; Cadet-Tairou, Agnes; Collins, Anne Marie; Liddell, David

    2017-01-01

    .... This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm...

  14. Harm Reduction Unit of the City of Santo André, São Paulo State, Brazil: An Evaluation

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    Silvia Moreira da Silva

    2010-12-01

    Full Text Available The Harm Reduction Unit (HRU in Santo André (São Paulo State was created to improve the health of people who either live or work on the streets: drug users, commercial sex workers (male and female, men who have sex with men, sexually exploited adolescents, transsexuals, transvestites, lesbians, and women working in brothels. This project was undertaken to evaluate the HRU from the perspective of its users. A semi-structured interview was administered to nineteen users from different segments of the populations served by the unit. The major weaknesses of the HRU were felt to be its inconsistent presence in some areas and the absence of psychologists to provide follow-up care. The unit was seen as promoting better health, increased use of condoms, reduction in drug usage, increased access and use of health care services, and less sharing of equipment used in drug consumption. Users see the HRU as a sympathetic presence whose ongoing work provides them with a sense of security and protection. The impact of the HRU went beyond harm reduction; users reported transformative changes such as increased awareness of their social rights and knowledge about how those rights can be demanded. Users had been given new tools to face their problems and seek access to education, work, and housing. Key words: harm reduction, illegal drugs, health service evaluation, social problems

  15. High risk behaviors of injection drug users registered with harm reduction programme in Karachi, Pakistan

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    Memon Ashraf

    2007-02-01

    Full Text Available Abstract Background Surveillance data of Sindh AIDS Control Programme, Pakistan suggest that HIV infection is rapidly increasing among IDUs in Karachi and has reached 9% in 2004–5 indicating that the country has progressed from nascent to concentrated level of HIV epidemic. Findings of 2nd generation surveillance in 2004–5 also indicate 104/395 (26.3% IDUs HIV positive in the city. Methods We conducted a cross sectional study among registered IDUs of a needle exchange and harm reduction programme in Karachi, Pakistan. A total of 161 IDUs were included in the study between October–November 2003. A detailed questionnaire was implemented and blood samples were collected for HIV, hepatitis B & C and syphilis. HIV, hepatitis B and C antibody tests were performed using Enzyme Linked Immunosorbent Assay (ELISA method. Syphilis tests (RPR & TPHA were performed on Randox kit. Besides calculating frequencies univariate analysis was performed using t tests for continuous variables as age, age at first intercourse and average age of initiation of addiction and chi square for categorical variables like paid for sex or not to identify risk factors for hepatitis B and C and syphilis. Results Average age of IDU was 35.9 years and average age of initiation of drugs was 15.9 years. Number of drug injections per day was 2.3. Shooting drugs in group sharing syringes was reported by 128 (79.5% IDUs. Over half 94 (58.3% reported paying for sex and 64% reported never using a condom. Commercial selling of blood was reported by 44 (28%. 1 of 161 was HIV positive (0.6%. The prevalence of hepatitis B was 12 (7.5%, hepatitis C 151 (94.3% and syphilis 21 (13.1%. IDUs who were hepatitis C positive were more likely to start sexual activity at an earlier age and had never used condoms. Similarly IDUs who were hepatitis B positive were more likely to belong to a younger age group. Syphilis positive IDUs were more likely to have paid for sex and had never used a condom

  16. Spore forming bacteria infections and people who inject drugs: Implications for harm reduction.

    Science.gov (United States)

    Dunleavy, Karen; Munro, Alison; Roy, Kirsty; Hutchinson, Sharon; Palmateer, Norah; Knox, Tony; Goldberg, David; Hope, Vivian; Campbell, John; Hamilton, Emma; Liddell, David; Penrice, Gillian; Taylor, Avril

    2017-12-24

    There is no research on public health interventions that alert people who inject drugs (PWID) to clusters/outbreaks of severe bacterial infections. In Scotland, during the botulism cluster/outbreak of Dec 2014-July 2015 harm reduction (HR) messages detailed on a postcard (Botulism Postcard) were distributed to PWID between Feb-April 2015. We examined the impact of the Botulism Postcard on cluster/outbreak awareness, healthcare seeking and HR behaviours among PWID; and their views on such clusters/outbreaks. The Botulism Postcard questionnaire survey was undertaken with 288 PWID recruited in Greater Glasgow and Clyde between May-August 2015. Multivariate logistic regression was undertaken. Between Oct 2015-January 2016 22 in-depth interviews were conducted with PWID in Glasgow and Edinburgh, these underwent thematic analysis. 38% (108/284) had never seen the postcard, 14% (40/284) had only seen it, 34% (98/284) read but not discussed it and 13% (38/284) had discussed it with service staff. Cluster/outbreak awareness was higher among those who had read (adjusted odds ratio (aOR) = 5.374, CI 2.394-11.349, p < 0.001) or discussed the postcard (aOR = 25.114, CI 3.188-190.550, p < 0.001); and symptom awareness was higher among those who had read (aOR = 2.664, CI 1.322-4.890, p < 0.001) or discussed the postcard (aOR = 6.707, CI 2.744 16.252, p < 0.001) than among those who had never seen it. The odds of introducing HR was higher among those who had discussed the postcard (AOR = 3.304 CI 1.425 7.660, p < 0.01) than those who had only read it. PWID learnt about clusters/outbreaks from several sources and despite concerns they continued to inject during such events. More widespread exposure to the Botulism Postcard during the outbreak/cluster was needed. The Botulism Postcard distributed to PWID may raise awareness of such events, the symptoms, and may encourage HR particularly when used as a tool by frontline staff to initiate

  17. Contingencies of the will: Uses of harm reduction and the disease model of addiction among health care practitioners.

    Science.gov (United States)

    Szott, Kelly

    2015-09-01

    The concept of addiction as a disease is becoming firmly established in medical knowledge and practice at the same time as the logics of the harm reduction approach are gaining broader acceptance. How health care practitioners understand and intervene upon drug use among their patients is complicated by these two models. While harm reduction can be understood as a form of governmentality wherein drug-taking individuals express their regulated autonomy through self-governance, the notion of addiction as a disease removes the option of self-governance through negating the will of the individual. Through analysis of qualitative interviews conducted with 13 health care practitioners who provide care for economically marginalized people who use drugs in New York City, it was found that the absence of will articulated in constructions of addiction as disease offered a gateway through which health care practitioners could bring in ideological commitments associated with harm reduction, such as the de-stigmatization of drug use. Despite differences in the attribution of agency, sewing together these two approaches allowed health care practitioners to work with drug-using patients in practical and compassionate ways. This resembles the strategic deployment of diverse subjectivities found in feminist, post-structural liberatory projects wherein differential subjectification proves tactical and productive. Although drug-using patients may enjoy the benefits of practical and compassionate health care, the conjoint facilitation and denouncement of their will occasioned by the use of both harm reduction and the disease model of addiction imply their management by both pastoral and disciplinary technologies of power. © The Author(s) 2014.

  18. Harm reduction as a complex adaptive system: A dynamic framework for analyzing Tanzanian policies concerning heroin use.

    Science.gov (United States)

    Ratliff, Eric A; Kaduri, Pamela; Masao, Frank; Mbwambo, Jessie K K; McCurdy, Sheryl A

    2016-04-01

    Contrary to popular belief, policies on drug use are not always based on scientific evidence or composed in a rational manner. Rather, decisions concerning drug policies reflect the negotiation of actors' ambitions, values, and facts as they organize in different ways around the perceived problems associated with illicit drug use. Drug policy is thus best represented as a complex adaptive system (CAS) that is dynamic, self-organizing, and coevolving. In this analysis, we use a CAS framework to examine how harm reduction emerged around heroin trafficking and use in Tanzania over the past thirty years (1985-present). This account is an organizational ethnography based on of the observant participation of the authors as actors within this system. We review the dynamic history and self-organizing nature of harm reduction, noting how interactions among system actors and components have coevolved with patterns of heroin us, policing, and treatment activities over time. Using a CAS framework, we describe harm reduction as a complex process where ambitions, values, facts, and technologies interact in the Tanzanian sociopolitical environment. We review the dynamic history and self-organizing nature of heroin policies, noting how the interactions within and between competing prohibitionist and harm reduction policies have changed with patterns of heroin use, policing, and treatment activities over time. Actors learn from their experiences to organize with other actors, align their values and facts, and implement new policies. Using a CAS approach provides researchers and policy actors a better understanding of patterns and intricacies in drug policy. This knowledge of how the system works can help improve the policy process through adaptive action to introduce new actors, different ideas, and avenues for communication into the system. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Influence of Qigong training on reduction of harmful computer habits and their danger for students with weak health

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    M.D. Kudryavtsev

    2017-10-01

    Full Text Available Purpose: to show influence of health related Qigong training of reduction of harmful computer habit and their danger for students with weak health. Material: 1st-3rd year students of Krasnoyarsk were the object of the research (n=1158. Students were trained by discipline “Physical culture” for main health group (no health problems. Students with weak health were trained by Qigong program (n=129. Results: Qigong training reduces total time of students, which they spent for computer habits. The most frequent of all students is internet. The spread of this habit in students of all tested groups does not change noticeably in the course of study. Qigong training reduces the quantity of students, who spend dangerously much time every of three computer habits. Conclusions: Qigong training of reduction of harmful computer habit and their danger for students with weak health. It is more effective in reduction of time, spent for all harmful habits than typical physical culture trainings.

  20. An overview of forensic drug testing methods and their suitability for harm reduction point-of-care services.

    Science.gov (United States)

    Harper, Lane; Powell, Jeff; Pijl, Em M

    2017-07-31

    Given the current opioid crisis around the world, harm reduction agencies are seeking to help people who use drugs to do so more safely. Many harm reduction agencies are exploring techniques to test illicit drugs to identify and, where possible, quantify their constituents allowing their users to make informed decisions. While these technologies have been used for years in Europe (Nightlife Empowerment & Well-being Implementation Project, Drug Checking Service: Good Practice Standards; Trans European Drugs Information (TEDI) Workgroup, Factsheet on Drug Checking in Europe, 2011; European Monitoring Centre for Drugs and Drug Addiction, An Inventory of On-site Pill-Testing Interventions in the EU: Fact Files, 2001), they are only now starting to be utilized in this context in North America. The goal of this paper is to describe the most common methods for testing illicit substances and then, based on this broad, encompassing review, recommend the most appropriate methods for testing at point of care.Based on our review, the best methods for point-of-care drug testing are handheld infrared spectroscopy, Raman spectroscopy, and ion mobility spectrometry; mass spectrometry is the current gold standard in forensic drug analysis. It would be prudent for agencies or clinics that can obtain the funding to contact the companies who produce these devices to discuss possible usage in a harm reduction setting. Lower tech options, such as spot/color tests and immunoassays, are limited in their use but affordable and easy to use.

  1. Access to harm reduction and HIV-related treatment services inside Indian prisons: experiences of formerly incarcerated injecting drug users.

    Science.gov (United States)

    Chakrapani, Venkatesan; Kamei, Ram; Kipgen, Hoineilam; Kh, Jayanta Kumar

    2013-01-01

    The authors aimed to examine the incarceration experiences of injecting drug users in accessing harm reduction, and HIV-related services inside prisons in India. The authors conducted three focus groups with a purposive sample of 23 formerly incarcerated male IDUs and four key informant interviews with a former police official, a drug dealer and service providers. Data were analyzed using a constant comparative method. Participants reported availability of alcohol and injectable or oral drugs such as heroin, dextropropoxyphene, and marijuana inside prisons. Inmates obtained drugs and clean syringes (one syringe bought for 2.5-4 USD) through prison staff, and collected used syringes and needles from the dustbins in prison sickrooms. Needles and syringes were reused and shared. Prisons did not have needle and syringe programmes, detoxification, overdose management or opioid substitution treatment. Drug-using prison inmates faced several challenges in accessing antiretroviral treatment and HIV testing. The authors' findings emphasize the need to protect the health of injection drug-using inmates by introducing harm reduction programmes and removing barriers to HIV testing and antiretroviral treatment. This study illustrates, for the first time, the contexts behind high risk injecting drug use behaviours among prison inmates in India. It also highlights the lack of availability of harm reduction services such as needle and syringe programmes, drug detoxification and opioid substitution treatment inside prisons. Further, it demonstrates the difficulties faced by HIV-positive prison inmates in getting timely and uninterrupted antiretroviral treatment.

  2. Deconstructing anti-harm-reduction metaphors; mortality risk from falls and other traumatic injuries compared to smokeless tobacco use

    Directory of Open Access Journals (Sweden)

    Bergen Paul

    2006-04-01

    Full Text Available Abstract Anti-harm-reduction advocates sometimes resort to pseudo-analogies to ridicule harm reduction. Those opposed to the use of smokeless tobacco as an alternative to smoking sometimes suggest that the substitution would be like jumping from a 3 story building rather than 10 story, or like shooting yourself in the foot rather than the head. These metaphors are grossly inappropriate for several reasons, notably including the fact that they are misleading about the actual risk levels. Based on the available literature on mortality from falls, we estimate that smoking presents a mortality risk similar to a fall of about 4 stories, while mortality risk from smokeless tobacco is no worse than that from an almost certainly non-fatal fall from less than 2 stories. Other metaphors are similarly misleading. These metaphors, like other false and misleading anti-harm-reduction statements are inherently unethical attempts to prevent people from learning accurate health information. Moreover, they implicitly provide bad advice about health behavior priorities and are intended to persuade people to stick with a behavior that is more dangerous than an available alternative. Finally, the metaphors exhibit a flippant tone that seems inappropriate for a serious discussion of health science.

  3. Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: An intersectional lens in the Canadian context.

    Science.gov (United States)

    Smye, Victoria; Browne, Annette J; Varcoe, Colleen; Josewski, Viviane

    2011-06-30

    Using our research findings, we explore Harm Reduction and Methadone Maintenance Treatment (MMT) using an intersectional lens to provide a more complex understanding of Harm Reduction and MMT, particularly how Harm Reduction and MMT are experienced differently by people dependent on how they are positioned. Using the lens of intersectionality, we refine the notion of Harm Reduction by specifying the conditions in which both harm and benefit arise and how experiences of harm are continuous with wider experiences of domination and oppression; A qualitative design that uses ethnographic methods of in-depth individual and focus group interviews and naturalistic observation was conducted in a large city in Canada. Participants included Aboriginal clients accessing mainstream mental health and addictions care and primary health care settings and healthcare providers; All client-participants had profound histories of abuse and violence, most often connected to the legacy of colonialism (e.g., residential schooling) and ongoing colonial practices (e.g., stigma & everyday racism). Participants lived with co-occurring illness (e.g., HIV/AIDS, Hepatitis C, PTSD, depression, diabetes and substance use) and most lived in poverty. Many participants expressed mistrust with the healthcare system due to everyday experiences both within and outside the system that further marginalize them. In this paper, we focus on three intersecting issues that impact access to MMT: stigma and prejudice, social and structural constraints influencing enactment of peoples' agency, and homelessness; Harm reduction must move beyond a narrow concern with the harms directly related to drugs and drug use practices to address the harms associated with the determinants of drug use and drug and health policy. An intersectional lens elucidates the need for harm reduction approaches that reflect an understanding of and commitment to addressing the historical, socio-cultural and political forces that shape

  4. Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: An intersectional lens in the Canadian context

    Directory of Open Access Journals (Sweden)

    Varcoe Colleen

    2011-06-01

    Full Text Available Abstract Background Using our research findings, we explore Harm Reduction and Methadone Maintenance Treatment (MMT using an intersectional lens to provide a more complex understanding of Harm Reduction and MMT, particularly how Harm Reduction and MMT are experienced differently by people dependent on how they are positioned. Using the lens of intersectionality, we refine the notion of Harm Reduction by specifying the conditions in which both harm and benefit arise and how experiences of harm are continuous with wider experiences of domination and oppression; Methods A qualitative design that uses ethnographic methods of in-depth individual and focus group interviews and naturalistic observation was conducted in a large city in Canada. Participants included Aboriginal clients accessing mainstream mental health and addictions care and primary health care settings and healthcare providers; Results All client-participants had profound histories of abuse and violence, most often connected to the legacy of colonialism (e.g., residential schooling and ongoing colonial practices (e.g., stigma & everyday racism. Participants lived with co-occurring illness (e.g., HIV/AIDS, Hepatitis C, PTSD, depression, diabetes and substance use and most lived in poverty. Many participants expressed mistrust with the healthcare system due to everyday experiences both within and outside the system that further marginalize them. In this paper, we focus on three intersecting issues that impact access to MMT: stigma and prejudice, social and structural constraints influencing enactment of peoples' agency, and homelessness; Conclusions Harm reduction must move beyond a narrow concern with the harms directly related to drugs and drug use practices to address the harms associated with the determinants of drug use and drug and health policy. An intersectional lens elucidates the need for harm reduction approaches that reflect an understanding of and commitment to addressing

  5. DINAMICA POPULAŢIEI ŢĂRII AMLAŞULUI ÎN PERIOADA 2002-2009

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    Ion-Horaţiu PAVEL

    2011-04-01

    Full Text Available The Dynamics of the Population of Amlaş Land between 2002-2009. By analyzing the natural and migratory dynamics of the population of the region we could draw a general demographic balance for this period that tells us that the number of people in this region decreased slightly by 1.4‰. The only localities with a positive population balance are Orlat and Sălişte, poles of attraction in the region, particularly through their superior superior public facilities an industrial production units, although with the highly manufacturing profile.

  6. How understanding and application of drug-related legal instruments affects harm reduction interventions in Cambodia: a qualitative study.

    Science.gov (United States)

    Tuot, Sovannary; Ngin, Chanrith; Pal, Khuondyla; Sou, Sochenda; Sawez, Ghazal; Morgan, Phylicia; Srey, Mony; Chan, Tola; Chhoun, Pheak; Golichenko, Olga; Choub, Sok Chamreun; Yi, Siyan

    2017-06-19

    Harm reduction interventions in Cambodia face numerous obstacles because of conflicting understanding and interests and inconsistencies in the implementation by law enforcement officials. This study aims to examine how understanding and application of Drug Control Law (DCL) and Village/Commune Safety Policy (VCSP) affects harm reduction interventions in Cambodia from the standpoints of law enforcement officials, people who inject drugs and people who use drugs (PWID/PWUD), as well as other key stakeholders. This qualitative study was conducted in the capital city of Phnom Penh in 2015. We held five focus group discussions (FGDs) with groups of PWID/PWUD, police officers, Sangkat/commune officers, and local non-governmental organization (NGO) field staff. We also conducted ten key informant interviews (KIIs) with representatives from government agencies, donor agencies, and NGOs. FGDs and KIIs with Cambodian participants were transcribed in Khmer and translated into English. KIIs with foreign participants were transcribed in English. Transcripts were read and re-read to identify emerging themes, which were reviewed and refined to develop common and divergent patterns. There was a huge gap between what the DCL and VCSP say and how law enforcement officers and PWID/PWUD understood them. The gap was also evident in how law enforcement officers implemented the DCL and VCSP. Harm reduction services, including health- and non-health-related interventions, were limited and challenged by unsupportive attitudes, misinterpretation of the DCL and VCSP, and the lack of full engagement with NGOs in the development of these instruments. The needs of PWID/PWUD in accessing health care services were not met due to misconduct of authorities while practicing the DCL and VCSP. Further, the misconduct and enforcement of the law and policy lead to increased social discrimination and physical abuses against PWID/PWUD. There is a lack of common understanding of the drug-related law and

  7. Drug policy and harm reduction in the Middle East and North Africa: The role of civil society.

    Science.gov (United States)

    Aaraj, Elie; Jreij Abou Chrouch, Micheline

    2016-05-01

    Civil society organizations (CSOs) in Middle East and North Africa (MENA) are the principal partners of government in scaling up the response to HIV and in implementing national policies. In return, CSOs expect endorsement of their work by the governments. Some CSOs face weaknesses and need capacity-building in order for them to reach the level of response required for reducing drug-related harm in this region. Substance use and the transmission of HIV are increasing in the MENA region. The limited data available on drug use show that there are approximately 630,000 people who inject drugs (PWID) across the region. The HIV epidemic remains concentrated among PWID and other key populations in the region. Comprehensive harm reduction programs which include prevention, care, and HIV treatment for PWID are being implemented by CSOs. This could not happen without the presence of a conducive environment which has been facilitated by the CSOs, and which aims to lead to a positive response in health policies, and thus to harm reduction programs in some countries in the region. However, based on the international data, antiretroviral therapy (ART) coverage remains low in these countries, even if the number of people living with HIV (PLHIV) receiving ART is increasing. This increase can sometimes mask important challenges in equity: in several countries PWID are the most likely to be infected with HIV while being the least likely to be receiving care and ART. Therefore, concentrated efforts need to continue toward the goal of having mainstream harm reduction approaches in region. Copyright © 2016. Published by Elsevier B.V.

  8. Establishments licensed to serve alcohol and their contribution to police-recorded crime in Australia: further opportunities for harm reduction.

    Science.gov (United States)

    Rowe, Shelley C; Wiggers, John H; Wolfenden, Luke; Francis, J Lynn

    2010-11-01

    Although strategies exist to minimize alcohol-related harms associated with establishments licensed to serve alcohol, such establishments are associated with a disproportionate level of harm. To date, understanding the association between such establishments and alcohol-related harms, and hence the opportunities for reducing harm, has been limited by inadequate information regarding incidents of alcohol-related crime. To address this deficiency, this study was undertaken to describe the association between such establishments and incidents of crime using enhanced police-recorded, alcohol-related crime intelligence. A descriptive analysis was undertaken of intoxicated people who had last consumed alcohol in establishments licensed to serve alcohol (841 bars, 551 licensed social clubs, 11 nightclubs, and 18 other locations) preceding their involvement in police-recorded incidents of violence, disorder, or motor vehicle crashes. The study area encompassed 21 nonmetropolitan police commands in the state of New South Wales, Australia. Among intoxicated persons involved in incidents of violence, disorder, or motor vehicle crashes, the risk of being recorded as having last consumed alcohol in a bar or nightclub before the incident was at least twice that of licensed social clubs and other establishments. Approximately 20% of establishments accounted for 80% of intoxicated persons involved in such incidents, and 6% of establishments were in the top 20% of establishments for all three offense types. The disproportionate burden of alcohol-related crime associated with establishments licensed to serve alcohol may be reduced if harm-reduction strategies address the specific risks posed by bars and nightclubs, and individual high-risk establishments.

  9. E-Cigarette as a Harm Reduction Approach among Tobacco Smoking Khat Chewers: A Promising Bullet of Multiple Gains

    Directory of Open Access Journals (Sweden)

    Saba Kassim

    2016-02-01

    Full Text Available Khat chewing/use, a green leaf with amphetamine-like effects is socially integrated in the Middle East and Africa. Khat chewing is often associated with tobacco smoking and occurs in closed places, such as a family home setting where the smoke-free laws cannot be implemented. Tobacco cigarette smoking among khat chewers is a significant concern, but there is also second-hand exposure to smoke at home or in places where khat users gather. Evidence suggests that e-cigarettes represent a significantly less harmful form of nicotine intake. Evaluating the effects of e-cigarettes among khat chewers could be important in understanding the impact of e-cigarettes as a harm reduction approach, with the potential to reduce the health risk associated with smoking.

  10. E-Cigarette as a Harm Reduction Approach among Tobacco Smoking Khat Chewers: A Promising Bullet of Multiple Gains.

    Science.gov (United States)

    Kassim, Saba; Farsalinos, Konstantinos E

    2016-02-19

    Khat chewing/use, a green leaf with amphetamine-like effects is socially integrated in the Middle East and Africa. Khat chewing is often associated with tobacco smoking and occurs in closed places, such as a family home setting where the smoke-free laws cannot be implemented. Tobacco cigarette smoking among khat chewers is a significant concern, but there is also second-hand exposure to smoke at home or in places where khat users gather. Evidence suggests that e-cigarettes represent a significantly less harmful form of nicotine intake. Evaluating the effects of e-cigarettes among khat chewers could be important in understanding the impact of e-cigarettes as a harm reduction approach, with the potential to reduce the health risk associated with smoking.

  11. "It's not rocket science, what I do": Self-directed harm reduction strategies among drug using ethno-racially diverse gay and bisexual men.

    Science.gov (United States)

    Greenspan, Nicole R; Aguinaldo, Jeffrey P; Husbands, Winston; Murray, James; Ho, Peter; Sutdhibhasilp, Noulmook; Cedano, José; Lau, Chris; Gray, Trevor; Maharaj, Rajendra

    2011-01-01

    Research on harm reduction has typically focused on broad-based or organisational strategies such as needle exchange and opiate substitute programmes. Less attention has been paid to the self-directed harm reduction practices of substance users themselves. Few studies have focused on sexual minority populations such as gay and bisexual men and fewer still on the marginalised groups that constitute these populations. This paper identifies self-directed harm reduction strategies among substance using ethno-racially diverse gay and bisexual men. This article presents findings from the Party Drugs Study in Toronto's gay dance club scene, a community-based qualitative study in Toronto, Canada. We present a thematic analysis of interviews with 43 gay and bisexual men from diverse ethno-racial backgrounds about their substance use in the gay dance club scene. We identify five self-directed harm reduction strategies: rationing, controlling or avoiding mixing, controlling quality, maintaining a healthy lifestyle, and following guidelines during substance use. We discuss our findings in relation to prior research and to critical theory. We suggest that drug users' awareness of possible harm, and their personal investment in harm reduction, constitute a viable platform from which community-based and public health organisations may promote and strengthen harm reduction among gay and bisexual men from ethno-racially diverse backgrounds. Copyright © 2010 Elsevier B.V. All rights reserved.

  12. Features of alcohol harm reduction advertisements that most motivate reduced drinking among adults: an advertisement response study.

    Science.gov (United States)

    Wakefield, Melanie A; Brennan, Emily; Dunstone, Kimberley; Durkin, Sarah J; Dixon, Helen G; Pettigrew, Simone; Slater, Michael D

    2017-04-20

    To improve the effectiveness of alcohol harm reduction mass media campaigns, this study aimed to (1) identify existing advertisements (ads) with greatest potential to motivate reduced alcohol consumption, (2) assess consistency across audience subgroups in ad effectiveness and (3) identify ad features associated with effectiveness. Cross-sectional online ad response study with random assignment to view ads. 2174 Australian adult weekly drinkers recruited from an online panel. Participants were randomly assigned to view three of 83 English-language alcohol harm reduction ads. Each ad was viewed and rated by a mean of 79 participants. After viewing each ad, participants reported the extent to which they felt motivated to reduce their drinking. Ads were ranked from most to least motivating using predicted means adjusted for demographic characteristics and alcohol consumption. We compared the characteristics of the top-ranked 15% of ads (most motivating) with the middle 70% and bottom 15%. An ad about the link between alcohol and cancer (' Spread ') was most motivating, whereas an ad that encouraged drinking water instead of beer (' Add nothing ') was least motivating. Top-ranked ads were more likely than other ads to feature a 'why change' message and less likely to carry a 'how to change' message; more likely to address long-term harms; more likely to be aimed at the general adult drinking population and more likely to include drinking guidelines. There was substantial overlap in top-ranked ads for younger versus older adults, men versus women and high-risk versus low-risk drinker subgroups. The effectiveness of alcohol harm reduction campaigns may be improved by directly communicating alcohol's long-term harms to the general adult population of drinkers along with drinking guidelines. By doing so, campaigns can also efficiently influence high-risk drinkers and key demographic subgroups. Published by the BMJ Publishing Group Limited. For permission to use (where not

  13. Understanding the emergence of the tobacco industry's use of the term tobacco harm reduction in order to inform public health policy.

    Science.gov (United States)

    Peeters, Silvy; Gilmore, Anna B

    2015-03-01

    To explore the history of transnational tobacco companies' use of the term, approach to and perceived benefits of 'harm reduction'. Analysis of internal tobacco industry documents, contemporary tobacco industry literature and 6 semistructured interviews. The 2001 Institute of Medicine report on tobacco harm reduction appears to have been pivotal in shaping industry discourse. Documents suggest British American Tobacco and Philip Morris International adopted the term 'harm reduction' from Institute of Medicine, then proceeded to heavily emphasise the term in their corporate messaging. Documents and interviews suggest harm reduction offered the tobacco industry two main benefits: an opportunity to (re-) establish dialogue with and access to policy makers, scientists and public health groups and to secure reputational benefits via an emerging corporate social responsibility agenda. Transnational tobacco companies' harm reduction discourse should be seen as opportunistic tactical adaptation to policy change rather than a genuine commitment to harm reduction. Care should be taken that this does not undermine gains hitherto secured in efforts to reduce the ability of the tobacco industry to inappropriately influence policy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. A qualitative assessment of stakeholder perceptions and socio-cultural influences on the acceptability of harm reduction programs in Tijuana, Mexico

    Directory of Open Access Journals (Sweden)

    Magis-Rodriguez Carlos

    2008-11-01

    Full Text Available Abstract Background The Mexico-U.S. border region is experiencing rising rates of blood-borne infections among injection drug users (IDUs, emphasizing the need for harm reduction interventions. Methods We assessed the religious and cultural factors affecting the acceptability and feasibility of three harm reduction interventions – Needle exchange programs (NEPs, syringe vending machines, and safer injection facilities (SIFs – in Tijuana, Mexico. In-depth qualitative interviews were conducted with 40 community stakeholders to explore cultural and societal-related themes. Results Themes that emerged included Tijuana's location as a border city, family values, and culture as a mediator of social stigma and empathy towards IDUs. Perception of low levels of both awareness and socio-cultural readiness for harm reduction interventions was noted. Religious culture emerged as a theme, highlighting the important role religious leaders play in determining community responses to harm reduction and rehabilitation strategies for IDUs. The influence of religious culture on stakeholders' opinions concerning harm reduction interventions was evidenced by discussions of family and social values, stigma, and resulting policies. Conclusion Religion and politics were described as both a perceived benefit and deterrent, highlighting the need to further explore the overall influences of culture on the acceptability and implementation of harm reduction programs for drug users.

  15. [Productivity, visibility and citation analysis of the Revista Peruana de Medicina Experimental y Salud Pública, 2002-2009].

    Science.gov (United States)

    Huamaní, Charles

    2010-09-01

    Biomedical journals are the most used and important venue to disseminate and interchange scientific information, and evaluation is an important component. A bibliometric study was conducted on the productivity, visibility and citation analysis of the Revista Peruana de Medicina Experimental y Salud Pública (RPMESP), from 2002 to 2009. During this period, the RPMESP published about 62 documents per year, 55.3% were research articles. The visibility of RPMESP, determined among three databases (SISBIB-UNMSM, SciELO-Peru, and REDALYC), was irregular, increasing on July 2006, with the highest access on October 2009 (117,618 hits). 43.0% of publications were cited. The calculated impact factor in ISI journals was 0.04 in 2009. In conclusion, the citation of RPMESP shows a slowly growing during the period 2002-2009. It is hoped that the RPMESP increase its visibility and impact after its inclusion in MEDLINE.

  16. HIV, Hepatitis C, TB, Harm Reduction, and Persons Deprived of Liberty: What Standards Does International Human Rights Law Establish?

    Science.gov (United States)

    Sander, Gen; Lines, Rick

    2016-12-01

    HIV, hepatitis C virus (HCV), and TB in prisons and other places of detention are serious public health concerns, with prevalence and incidence considerably higher than in the general community because of the overrepresentation of risky behavior, substandard conditions, overcrowding, people who inject drugs, and the wholly inadequate prevention, care, and treatment of these conditions, including the denial of harm reduction services. This is not only a severe public health crisis but also a serious human rights concern. This article works to clarify the standards established by human rights law with regards to HIV, HCV, TB, and harm reduction in prisons by examining international and regional case law, minimum standards on the treatment of prisoners and public health, as well as the work of UN treaty bodies, Special Rapporteurs, and prison monitoring bodies. It is imperative that urgent steps are taken to close the gap between human rights and public health standards on the one hand, and effective implementation in prison settings on the other.

  17. More than just needles: An evidence-informed approach to enhancing harm reduction supply distribution in British Columbia

    Directory of Open Access Journals (Sweden)

    Mak Sunny

    2008-12-01

    Full Text Available Abstract Background The BC Harm Reduction Strategies and Services (HRSS policy states that each health authority (HA and their community partners will provide a full range of harm reduction (HR services to their jurisdictions and these HR products should be available to all who need them regardless of where they live and choice of drug. Preliminary analysis revealed wide variations between and within HAs. Methods The objective of this study is to analyze distribution of HR products by site using Geographic Information Systems (GIS and to investigate the range, adequacy and methods of HR product distribution using qualitative interviews. The BC Centre for Disease Control pharmacy database tracks HR supplies distributed to health units and community agencies. Additionally, eleven face-to-face interviews were conducted in eight mainland BC communities using an open-ended questionnaire. Results There is evidence in BC that HR supplies are not equally available throughout the province. There are variations within jurisdictions in how HR supplies are distributed, adequacy of current HR products, collection of used needles, alternative uses of supplies and community attitudes towards HR. GIS illustrates where HR supplies are ordered but with secondary distribution, true reach and availability of supplies cannot be determined. Conclusion Currently, a consultant is employed to develop a 'best practice' document; relevant health files, standard training and protocols within HAs are also being developed. There is a need to enhance the profile and availability of culturally appropriate HR services for Aboriginal populations. Distribution of crackpipe mouthpieces is being investigated.

  18. Substance use management: a harm reduction-principled approach to assisting the relief of drug-related problems.

    Science.gov (United States)

    Bigg, D

    2001-01-01

    Disease (particularly HIV) has increased our motivation to reconsider how the current help system deals with drug-related problems. A more concrete focus on disease prevention as an additional goal has, for many, lead to a reevaluation of the goals of drug help work. Such a critical examination shows how much there is to improve within the system even in the absence of blood borne disease. Integrating the heart of harm reduction--respecting work on any positive change as a person defines it for his/herself--into treatment fashions a health sensitive alternative to the predominant practice of abstinence-only assistance for the relief of drug problems. This new approach is called substance use management (SUM), as it no longer requires abstinence but instead focuses on a range of options for improvements while still including abstinence among the possible self-selected outcomes. SUM is suggested as a framework for change within the treatment system that would maximize treatment's constructive impact, cost-effectiveness and maturation as a distinct discipline that can appropriately attract support and gain stature for making society healthier. This article describes a formalized system for applying some of the main principles of harm reduction within the treatment system. Viable options for a SUM treatment focus are suggested herein as well as a critical process, based on respect and collaboration, for use with these options.

  19. If supply-oriented drug policy is broken, can harm reduction help fix it? Melding disciplines and methods to advance international drug-control policy.

    Science.gov (United States)

    Greenfield, Victoria A; Paoli, Letizia

    2012-01-01

    Critics of the international drug-control regime contend that supply-oriented policy interventions are not just ineffective, but, in focusing almost exclusively on supply reduction, they also produce unintended adverse consequences. Evidence from the world heroin market supports their claims. The balance of the effects of policy is yet unknown, but the prospect of adverse consequences underlies a central paradox of contemporary supply-oriented policy. In this paper, we evaluate whether harm reduction, a subject of intense debate in the demand-oriented drug-policy community, can provide a unifying foundation for supply-oriented drug policy and speak more directly to policy goals. Our analysis rests on an extensive review of the literature on harm reduction and draws insight from other policy communities' disciplines and methods. First, we explore the paradoxes of supply-oriented policy that initially motivated our interest in harm reduction; second, we consider the conceptual and technical challenges that have contributed to the debate on harm reduction and assess their relevance to a supply-oriented application; third, we examine responses to those challenges, i.e., various tools (taxonomies, models, and measurement strategies), that can be used to identify, categorize, and assess harms. Despite substantial conceptual and technical challenges, we find that harm reduction can provide a basis for assessing the net consequences of supply-oriented drug policy, choosing more rigorously amongst policy options, and identifying new options. In addition, we outline a practical path forward for assessing harms and policy options. On the basis of our analysis, we suggest pursuing a harm-based approach and making a clearer distinction between supply-oriented and supply-reduction policy. Published by Elsevier B.V.

  20. Virtual harm reduction efforts for Internet gambling: effects of deposit limits on actual Internet sports gambling behavior

    Directory of Open Access Journals (Sweden)

    Nelson Sarah E

    2008-08-01

    Full Text Available Abstract Background In an attempt to reduce harm related to gambling problems, an Internet sports betting service provider, bwin Interactive Entertainment, AG (bwin, imposes limits on the amount of money that users can deposit into their online gambling accounts. We examined the effects of these limits on gambling behavior. Methods We compared (1 gambling behavior of those who exceeded deposit limits with those who did not, and (2 gambling behavior before and after exceeding deposit limits. We analyzed 2 years of the actual sports gambling behavior records of 47000 subscribers to bwin. Results Only 160 (0.3% exceeded deposit limits at least once. Gamblers who exceeded deposit limits evidenced higher average number of bets per active betting day and higher average size of bets than gamblers who did not exceed deposit limits. Comparing the gambling behavior before and after exceeding deposit limits revealed slightly more unfavorable gambling behavior after exceeding deposit limits. Conclusion Our findings indicate that Internet gamblers who exceed deposit limits constitute a group of bettors willing to take high risks; yet, surprisingly, they appear to do this rather successfully because their percentage of losses is lower than others in the sample. However, some of these gamblers exhibit some poor outcomes. Deposit limits might be necessary harm reduction measures to prevent the loss of extremely large amounts of money and cases of bankruptcy. We discuss how these limits might be modified based on our findings.

  1. Effects of academic service learning in drug misuse and addiction on students' learning preferences and attitudes toward harm reduction.

    Science.gov (United States)

    Kabli, Noufissa; Liu, Ben; Seifert, Tricia; Arnot, Michelle I

    2013-04-12

    OBJECTIVE. To examine academic service-learning pedagogy on student learning and perceptions of drug misuse and addiction. DESIGN. Third- and fourth-year pharmacology students were exposed to an academic service-learning pedagogy that integrated a community service experience with lectures, in-class discussions and debates, group projects, a final paper, and an examination. Reflective writing assignments throughout the course required students to assimilate and apply what they had learned in the classroom to what they learned in their community placement. ASSESSMENT. Changes in students' responses on pre- and post-course survey instruments reflected shifts toward higher-order thinking. Also, subjective student-learning modalities shifted toward learning by writing. Students' perspectives and attitudes allowed improved context of issues associated with drug misuse and harm reduction models. CONCLUSION. Academic service-learning pedagogy contributes to developing adaptable, well-rounded, engaged learners who become more compassionate and pragmatic in addressing scientific and social questions relating to drug addiction.

  2. Unpacking commercial sector opposition to European smoke-free policy: lack of unity, 'fear of association' and harm reduction debates.

    Science.gov (United States)

    Weishaar, Heide; Amos, Amanda; Collin, Jeff

    2016-07-01

    Tobacco companies have made extensive efforts to build alliances against comprehensive smoke-free legislation. This article analyses the interaction between actors who opposed the development of the European Council Recommendation on smoke-free environments. Drawing on data from 200 policy documents and 32 semistructured interviews and using qualitative textual analysis and organisational network analysis, opponents' positions on, and responses to, the policy initiative, strategies to oppose the policy, and efforts to build alliances were investigated. The non-binding nature of the policy, scientific evidence and clear political will to adopt EU-wide measures combined to limit the intensity of commercial sector opposition to the comprehensive EU smoke-free policy. Most tobacco companies, led by the Confederation of European Community Cigarette Manufacturers (CECCM), voiced reservations against the proposal, criticised the policy process and fought flanking measures on product regulation. However, some companies focused on instigating harm reduction debates. These divergent approaches and the reluctance of other commercial actors to demonstrate solidarity with the tobacco sector prevented the establishment of a cohesive commercial sector alliance. The comparatively limited opposition to EU smoke-free policy contrasts with previous accounts of tobacco industry resistance to tobacco control. While context-specific factors can partially explain these differences, the paper indicates that the sector's diminished credibility and lack of unity hampered political engagement and alliance building. Industry efforts to emphasise the benefits of smokeless tobacco during smoke-free policy debates highlight the potential of harm reduction as a gateway for tobacco companies to re-enter the political arena. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Injecting drug use, sexual risk, HIV knowledge and harm reduction uptake in a large prison in Bali, Indonesia.

    Science.gov (United States)

    Sawitri, Anak Agung Sagung; Hartawan, Anak Agung Gede; Craine, Noel; Sari, Ayu Kartika; Septarini, Ni Wayan; Wirawan, Dewa Nyoman

    2016-01-01

    The purpose of this paper is to describe HIV-related risk behavior and knowledge of HIV among inmates of Kerobokan prison Bali, Indonesia. A cross-sectional survey of inmates of using a structured questionnaire and sample framework to reflect narcotic use among inmates and the prison gender mix. Among 230 inmates recruited to the study self-reported prevalence of injecting drug use was 7.4 percent (95 percent CI 4.0-10.8 percent). Respondents who participated in a prison based methadone treatment program were all still injecting drugs, these made up 13/17 of the IDU. In total, 47 percent (95 percent CIs 45-55 percent) of respondents who reported injecting also reported sharing needles within the last week. Sexual intercourse while in prison was reported by 3.0 percent (95 percent CI 0.82-5.26 percent) of study respondents. One-third of non-injectors were unaware of the preventative role of condom use. This study suggests that despite harm reduction initiatives within Kerobokan prison HIV risk behavior continues and there is a considerable lack of awareness of the importance of condom use in preventing HIV. The authors relied on self-reported risk behavior that may be subject to reporting bias. The sampling strategy may not reflect the true ratio inmates using or not using narcotics. The current harm reduction approach, including methadone substitution treatment should be optimized within the Indonesian prison setting. This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.

  4. "Just Advil": Harm reduction and identity construction in the consumption of over-the-counter medication for chronic pain.

    Science.gov (United States)

    Eaves, Emery R

    2015-12-01

    Direct-to-consumer marketing has sparked ongoing debate concerning whether ads empower consumers to be agents of their own care or shift greater control to the pharmaceutical industry. Ads for over-the-counter (OTC) medications in particular portend to offer simple, harmless solutions for meeting the demands of social life. Rather than join the longstanding debate between consumer agency and social control in pharmaceutical advertising, I approach self-medication with over-the-counter (OTC) analgesics using Harm Reduction as a framework. From this perspective, consumption of OTC analgesics by chronic pain sufferers is a means of seeking some level of relief while also avoiding the stigma associated with prescription pain medication. Qualitative methods are used to analyze data from two sources: (1) semi-structured qualitative interviews with 95 participants in a trial examining the effectiveness of Traditional Chinese Medicine for Temporomandibular Disorders (TMD) from 2006 to 2011 in Tucson, AZ and Portland, OR; and (2) print, online, and television advertisements for three major brands of OTC pain medication. Participants described their use of OTC medications as minimal, responsible, and justified by the severity of their pain. OTC medication advertising, while ostensibly ambiguous and targeting all forms of pain, effectively lends support to the consumption of these medications as part of the self-projects of chronic pain sufferers, allowing them to reconcile conflicting demands for pain relief while being stoic and maintaining a positive moral identity. Describing OTC medication as "just over-the-counter" or "not real pain medication," sufferers engage in ideological harm reduction, distinguishing themselves from "those people who like taking pain medication" while still seeking relief. Justifying one's use of OTC medication as minimal and "normal," regardless of intake, avoids association with the addictive potential of prescription pain medications and

  5. Factors associated with alcohol reduction in harmful and hazardous drinkers following alcohol brief intervention in Scotland: a qualitative enquiry.

    Science.gov (United States)

    McQueen, Jean M; Ballinger, Claire; Howe, Tracey E

    2017-03-08

    Alcohol Brief Intervention (ABI) uses a motivational counselling approach to support individuals to reduce excessive alcohol consumption. There is growing evidence on ABI's use within various health care settings, although how they work and which components enhance success is largely unknown. This paper reports on the qualitative part of a mixed methods study. It explores enablers and barriers associated with alcohol reduction following an ABI. It focuses on alcohol's place within participants' lives and their personal perspectives on reducing consumption. There are a number of randomised controlled trials in this field though few ABI studies have addressed the experiences of hazardous/harmful drinkers. This study examines factors associated with alcohol reduction in harmful/hazardous drinkers following ABI. This qualitative study was underpinned by a realist evaluation approach and involved semi-structured interviews with ten harmful or hazardous alcohol drinkers. Participants (n = 10) were from the intervention arm of a randomised controlled trial (n = 124). All had received ABI, a 20 min motivational counselling interview, six months previously, and had reduced their alcohol consumption. Interviews were recorded, transcribed verbatim and thematically analysed. Participants described their views on alcohol, its' place in their lives, their personal perspectives on reducing their consumption and future aspirations. The findings provide an insight into participants' views on alcohol, ABI, and the barriers and enablers to change. Participants described a cost benefit analysis, with some conscious consideration of the advantages and disadvantages of reducing intake or abstaining from alcohol. Findings suggest that, whilst hospital admission can act as a catalyst, encouraging individuals to reflect on their alcohol consumption through ABI may consolidate this, turning this reflective moment into action. Sustainability may be enhanced by the presence of a

  6. The Global Fund to Fight AIDS, Tuberculosis and Malaria's investments in harm reduction through the rounds-based funding model (2002-2014)

    DEFF Research Database (Denmark)

    Bridge, Jamie; Hunter, Benjamin M; Albers, Eliot

    2016-01-01

    and inequitable access to these services and face widespread stigma and discrimination. In 2013, the Global Fund launched a new funding model-signalling the end of the previous rounds-based model that had operated since its founding in 2002. This study updates previous analyses to assess Global Fund investments...... investment of US$ 620. million. Two-thirds of this budgeted amount was for interventions in the "comprehensive package" defined by the United Nations. 91% of the identified amount was for Eastern Europe and Asia. Conclusion: This study represents an updated, comprehensive assessment of Global Fund...... investments in harm reduction from its founding (2002) until the start of the new funding model (2014). It also highlights the overall shortfall of harm reduction funding, with the estimated global need being US$ 2.3. billion for harm reduction in 2015 alone. Using this baseline, the Global Fund must...

  7. Outcome assessment of a triangular clinic as a harm reduction intervention in Rajaee-Shahr Prison, Iran.

    Science.gov (United States)

    Asl, Rahim Taghizadeh; Eshrati, Babak; Dell, Colleen Anne; Taylor, Kelli; Afshar, Parviz; Kamali, Mohammad; Mirzazadeh, Ali

    2013-12-26

    Transmission of the human immunodeficiency virus (HIV) among incarcerated injection drug users (IDU) is a health epidemic in the Islamic Republic of Iran. Triangular clinics (TCs) were established in prisons as a harm reduction measure to decrease the risk of HIV transmission and other blood-borne infections. The objective of this study was to assess the immediate outcomes of one TC among male IDUs in Iran's Rajaee-Shahr prison. This study was conducted in two stages between 2003 and 2005. In the preparatory stage, focus group data was collected to update the prison's TC education and medical interventions and construct the self-report questionnaire. In stage two, 150 male IDUs were recruited in a closed cohort study design to assess the immediate outcome of the TC. Participants were measured at baseline and followed up to six months to measure their drug use, attitude toward and knowledge of high risk behaviours, serological conversion for HIV, HBV and HCV, and engagement in risky behaviors. The TC outcomes were determined through random urine analysis testing, a self-administered questionnaire and behaviour report cards, and viral infection testing. The findings of the urine analyses indicated a minimal yet consistent decrease in drug use over the six months. The pre and post- self-administered questionnaire data relayed a modest change in IDU risky behaviours associated with sexual practices; this was greater in comparison to the knowledge and attitude measures. It was determined that age may have a detrimental effect as may viral infections (HIV and HBV) on knowledge, attitude and behavior change. Both education and employment may have a protective effect. Data collected from the self-report behaviour cards similarly showed a modest reduction in high risk practices. At the six month follow-up, only one case became HIV positive, 9 HCV and 17 HBV. Considering that HIV is concentrated among Iranian prisoners who inject drugs at a high level, the results of this

  8. Impact of alcohol harm reduction strategies in community sports clubs: pilot evaluation of the Good Sports program.

    Science.gov (United States)

    Rowland, Bosco; Allen, Felicity; Toumbourou, John W

    2012-05-01

    Approximately 4.5 million Australians are involved in community sports clubs. A high level of alcohol consumption tends to be commonplace in this setting. The only program of its type in the world, the Good Sports program was designed to reduce harmful alcohol consumption in these Australian community sports clubs. The program offers a staged accreditation process to encourage the implementation of alcohol harm-reduction strategies. We conducted a postintervention adoption study to evaluate whether community sports club accreditation through the Good Sports program was associated with lower rates of alcohol consumption. We examined alcohol consumption rates in 113 clubs (N = 1,968 participants) and compared these to consumption rates in the general community. We hypothesized that members of clubs with more advanced implementation of the Good Sports accreditation program (Stage Two) would consume less alcohol than those with less advanced implementation (Stage One). Multilevel modeling (MLM) indicated that on days when teams competed, Stage Two club members consumed 19% less alcohol than Stage One club members. MLM also indicated that the length of time a club had been in the Good Sports program was associated with reduced rates of weekly drinking that exceeded Australian short-term risky drinking guidelines. However consumption rates for all clubs were still higher than the general community. Higher accreditation stage also predicted reduced long-term risky drinking by club members. Our findings suggest that community sports clubs show evidence of higher levels of alcohol consumption and higher rates of risky consumption than the general community. Implementation of the Good Sports accreditation strategy was associated with lower alcohol consumption in these settings.

  9. Nitrogen and Phosphorus Loads in an Agricultural Watershed Affected by Poultry Litter Application and Wastewater Effluent, Northeastern Oklahoma and Northwestern Arkansas, 2002-2009

    Science.gov (United States)

    Esralew, R.; Tortorelli, R. L.

    2010-12-01

    The Eucha-Spavinaw Basin in Northeastern Oklahoma and Northwestern Arkansas is the source of water for Lake Eucha and Spavinaw Lake, which are part of the water supply for the city of Tulsa, Oklahoma. Lake Eucha and Spavinaw Lakes have experienced deteriorating water quality largely due to growth of algae, notably cyanobacteria, from the excess input of nutrients. As a result, the city of Tulsa has spent millions of dollars to eliminate taste and odor problems resulting from production of algal and bacterial byproducts. To evaluate changes in nutrient loading resulting from a reduction in land application of poultry litter, installation of best management practices, and reductions in the phosphorus concentrations in wastewater effluent, the U.S. Geological Survey investigated nitrogen and phosphorus concentrations from samples collected during baseflow and runoff and used regression models to estimate nitrogen and phosphorus loads, yields, and flow-weighted concentrations in two major tributaries to Lake Eucha, Spavinaw and Beaty Creeks, for the period 2002-2009. Estimated mean flow-weighted total unfiltered nitrogen and phosphorus concentrations in the basin were about 5 to 10 times greater than the 75th percentile of flow-weighted nutrient concentrations in other mostly undeveloped basins of the United States. Spavinaw and Beaty Creeks contributed an estimated mean annual total load of about 762,500 kilograms of nitrogen and 49,200 kilograms of phosphorus per year, 76 to 91 percent of which was transported to Lake Eucha by runoff. Thirty-four percent of the nitrogen load and 48 percent of the phosphorus load to Lake Eucha occurred during the year 2008 which was the wettest year on record for the Eucha-Spavinaw Basin. The results of this analysis indicate that although efforts were made to control nutrient loading, nutrient concentrations, especially phosphorus, were substantially augmented by non-point sources and that most loading occurs during runoff events

  10. The Global Fund to Fight AIDS, Tuberculosis and Malaria's investments in harm reduction through the rounds-based funding model (2002-2014).

    Science.gov (United States)

    Bridge, Jamie; Hunter, Benjamin M; Albers, Eliot; Cook, Catherine; Guarinieri, Mauro; Lazarus, Jeffrey V; MacAllister, Jack; McLean, Susie; Wolfe, Daniel

    2016-01-01

    Harm reduction is an evidence-based, effective response to HIV transmission and other harms faced by people who inject drugs, and is explicitly supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria. In spite of this, people who inject drugs continue to have poor and inequitable access to these services and face widespread stigma and discrimination. In 2013, the Global Fund launched a new funding model-signalling the end of the previous rounds-based model that had operated since its founding in 2002. This study updates previous analyses to assess Global Fund investments in harm reduction interventions for the duration of the rounds-based model, from 2002 to 2014. Global Fund HIV and TB/HIV grant documents from 2002 to 2014 were reviewed to identify grants that contained activities for people who inject drugs. Data were collected from detailed grant budgets, and relevant budget lines were recorded and analysed to determine the resources allocated to different interventions that were specifically targeted at people who inject drugs. 151 grants for 58 countries, plus one regional proposal, contained activities targeting people who inject drugs-for a total investment of US$ 620 million. Two-thirds of this budgeted amount was for interventions in the "comprehensive package" defined by the United Nations. 91% of the identified amount was for Eastern Europe and Asia. This study represents an updated, comprehensive assessment of Global Fund investments in harm reduction from its founding (2002) until the start of the new funding model (2014). It also highlights the overall shortfall of harm reduction funding, with the estimated global need being US$ 2.3 billion for harm reduction in 2015 alone. Using this baseline, the Global Fund must carefully monitor its new funding model and ensure that investments in harm reduction are maintained or scaled-up. There are widespread concerns regarding the withdrawal from middle-income countries where harm reduction remains

  11. Harm reduction or women's rights? Debating access to emergency contraceptive pills in Canada and the United States.

    Science.gov (United States)

    Wynn, L L; Erdman, Joanna N; Foster, Angel M; Trussell, James

    2007-12-01

    This article compares the ethical pivot points in debates over nonprescription access to emergency contraceptive pills in Canada and the United States. These include women's right to be informed about the contraceptive method and its mechanism of action, pharmacists' conscientious objection concerning the dispensing of emergency contraceptive pills, and rights and equality of access to the method, especially for poor women and minorities. In both countries, arguments in support of expanding access to the pills were shaped by two competing orientations toward health and sexuality. The first, "harm reduction," promotes emergency contraception as attenuating the public health risks entailed in sex. The second orientation regards access to pills as a question of women's right to engage in nonprocreative sex and to choose from among all reproductive health-care options. The authors contend that arguments for expanding access to emergency contraceptive pills that frame issues in terms of health and science are insufficient bases for drug regulation; ultimately, women's health is also a matter of women's rights.

  12. Motivations for Using MDMA (Ecstasy/Molly) among African Americans: Implications for Prevention and Harm-Reduction Programs.

    Science.gov (United States)

    Rigg, Khary K

    2017-01-01

    Despite the growing popularity of MDMA (ecstasy/molly) among African Americans, their motives for using the drug are still largely unknown. The purpose of this study was to identify and describe the most salient motivations for using MDMA among this understudied population. In-depth interviews (n = 15) were conducted with a sample of African American young adults in Southwest Florida between August 2014 and November 2015. The primary motivations for using MDMA included: (1) altering the effects of marijuana and alcohol; (2) lasting longer sexually; (3) enhancing sexual pleasure; and (4) facilitating "freaky" sexual experiences. This is the first study to directly examine MDMA motivations specifically among African American drug users, and findings shed light on why some African Americans use MDMA. A better understanding of why African Americans use this drug should help to inform prevention and harm-reduction efforts. Study findings show the need for health messages that include the potential consequences of mixing MDMA with other drugs, and engaging in high-risk sexual behaviors after taking MDMA. These data contrast with motivations (e.g., introspection, self-enlightenment, getting into the music) commonly reported among groups of largely White MDMA users, suggesting that interventions tailored specifically for African American users are needed.

  13. Canada’s highest court unchains injection drug users; implications for harm reduction as standard of healthcare

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    Small Dan

    2012-07-01

    Full Text Available Abstract North America’s only supervised injection facility, Insite, opened its doors in September of 2003 with a federal exemption as a three-year scientific study. The results of the study, evaluated by an independent research team, showed it to be successful in engaging the target group in healthcare, preventing overdose death and HIV infections while increasing uptake and retention in detox and treatment. The research, published in peer-reviewed medical and scientific journals, also showed that the program did not increase public disorder, crime or drug use. Despite the substantial evidence showing the effectiveness of the program, the future of Insite came under threat with the election of a conservative federal government in 2006. As a result, the PHS Community Services Society (PHS, the non-profit organization that operates Insite, launched a legal case to protect the program. On 30 September 2011, Supreme Court of Canada ruled in favour of Insite and underscored the rights of people with addictions to the security of their person under section 7 of the Charter of Rights and Freedoms (Charter of Rights. The decision clears the ground for other jurisdictions in Canada, and perhaps North America, to implement supervised injection and harm reduction where it is epidemiologically indicated. The legal case validates the personhood of people with addictions while metaphorically unchaining them from the criminal justice system.

  14. Social control as supplyside harm reduction strategy The case of an indigenous coca growing community in Peru

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    GARCIA-YI, Jaqueline

    2014-05-01

    Full Text Available Traditional coca uses have taken place in Peru and Bolivia from three thousand years. International organizations have urged the implementation of “zero-coca” growing policies in those countries, although without tangible results. Supply-side harm reduction strategies are currently being implemented in Bolivia, which rely on social control to limit, although not totally abolish coca growing. In this article, the different motivations for traditional coca growing are extensively reviewed, and the data from a survey conducted with 496 farmers in an indigenous community is examined, in order to provide a comprehensive overview of the coca-growing problem and to evaluate if social control could potentially influence the scale of coca growing in Peru. The results suggest that social control variables, such as attachment, involvement, and beliefs, seem to limit coca-growing areas. Those factors have been largely overlooked and may offer an opportunity to reduce coca areas if explicitly considered in anti-drug policy design.

  15. Effects of Academic Service Learning in Drug Misuse and Addiction on Students’ Learning Preferences and Attitudes Toward Harm Reduction

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    Kabli, Noufissa; Liu, Ben; Seifert, Tricia

    2013-01-01

    Objective. To examine academic service-learning pedagogy on student learning and perceptions of drug misuse and addiction. Design. Third- and fourth-year pharmacology students were exposed to an academic service-learning pedagogy that integrated a community service experience with lectures, in-class discussions and debates, group projects, a final paper, and an examination. Reflective writing assignments throughout the course required students to assimilate and apply what they had learned in the classroom to what they learned in their community placement. Assessment. Changes in students’ responses on pre- and post-course survey instruments reflected shifts toward higher-order thinking. Also, subjective student-learning modalities shifted toward learning by writing. Students’ perspectives and attitudes allowed improved context of issues associated with drug misuse and harm reduction models. Conclusion. Academic service-learning pedagogy contributes to developing adaptable, well-rounded, engaged learners who become more compassionate and pragmatic in addressing scientific and social questions relating to drug addiction. PMID:23610481

  16. Effect of Smoking Abstinence and Reduction in Asthmatic Smokers Switching to Electronic Cigarettes: Evidence for Harm Reversal

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    Riccardo Polosa

    2014-05-01

    Full Text Available Electronic cigarettes (e-cigs are marketed as safer alternatives to tobacco cigarettes and have shown to reduce their consumption. Here we report for the first time the effects of e-cigs on subjective and objective asthma parameters as well as tolerability in asthmatic smokers who quit or reduced their tobacco consumption by switching to these products. We retrospectively reviewed changes in spirometry data, airway hyper-responsiveness (AHR, asthma exacerbations and subjective asthma control in smoking asthmatics who switched to regular e-cig use. Measurements were taken prior to switching (baseline and at two consecutive visits (Follow-up/1 at 6 (±1 and Follow-up/2 at 12 (±2 months. Eighteen smoking asthmatics (10 single users, eight dual users were identified. Overall there were significant improvements in spirometry data, asthma control and AHR. These positive outcomes were noted in single and dual users. Reduction in exacerbation rates was reported, but was not significant. No severe adverse events were noted. This small retrospective study indicates that regular use of e-cigs to substitute smoking is associated with objective and subjective improvements in asthma outcomes. Considering that e-cig use is reportedly less harmful than conventional smoking and can lead to reduced cigarette consumption with subsequent improvements in asthma outcomes, this study shows that e-cigs can be a valid option for asthmatic patients who cannot quit smoking by other methods.

  17. Community pharmacy harm reduction services for drug misusers: national service delivery and professional attitude development over a decade in Scotland.

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    Matheson, Catriona; Bond, Christine M; Tinelli, Michela

    2007-12-01

    Community pharmacy contributes to drug misuse management and reduced spread of blood-borne disease through distributing clean needles and substitute drug dispensing. This paper reports a third Scotland-wide survey of pharmacies enabling service delivery to be charted over a decade. A cross-sectional postal questionnaire of all Scottish pharmacies (n=1166) was undertaken. Descriptive data were collected on services provided, attitudes, training and demography. Data were compared with data from 1995 and 2000. Needle exchange provision increased slightly to 12.5% from 9.7% (2000) and 8.6% (1995). The mean number of needle exchange clients increased significantly to 37.7 from 20.3 (2000) and 12.5 (1995). Methadone was dispensed by 79.1% of respondents, and 90.9% of those supervised self-administration. The total number of methadone patients increased to 12 400 from 8809 in 2000 and 3387 in 1995. Of those taking methadone, 57% have supervised self-administration. A quarter dispensed buprenorphine to 190 patients. Attitudes improved significantly but training levels have not changed since 2000. More commitment to harm reduction was evident through improved attitudes and increased services. Service delivery has increased more for dispensing services than for needle exchange. Strategies for delivering future needle exchange and substitute dispensing services are required if demand approaches capacity.

  18. Who is 'Molly'? MDMA adulterants by product name and the impact of harm-reduction services at raves.

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    Saleemi, Sarah; Pennybaker, Steven J; Wooldridge, Missi; Johnson, Matthew W

    2017-08-01

    Methylenedioxymethamphetamine (MDMA), often sold as 'Ecstasy' or 'Molly', is commonly used at music festivals and reported to be responsible for an increase in deaths over the last decade. Ecstasy is often adulterated and contains compounds that increase morbidity and mortality. While users and clinicians commonly assume that products sold as Molly are less-adulterated MDMA products, this has not been tested. Additionally, while pill-testing services are sometimes available at raves, the assumption that these services decrease risky drug use has not been studied. This study analyzed data collected by the pill-testing organization, DanceSafe, from events across the United States from 2010 to 2015. Colorimetric reagent assays identified MDMA in only 60% of the 529 samples collected. No significant difference in the percentage of samples testing positive for MDMA was determined between Ecstasy and Molly. Individuals were significantly less likely to report intent to use a product if testing did not identify MDMA (relative risk (RR) = 0.56, p = 0.01). Results suggest that Molly is not a less-adulterated substance, and that pill-testing services are a legitimate harm-reduction service that decreases intent to consume potentially dangerous substances and may warrant consideration by legislators for legal protection. Future research should further examine the direct effects of pill-testing services and include more extensive pill-testing methods.

  19. Tuberculosis and HIV in people who inject drugs: evidence for action for tuberculosis, HIV, prison and harm reduction services.

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    Getahun, Haileyesus; Gunneberg, Christian; Sculier, Delphine; Verster, Annette; Raviglione, Mario

    2012-07-01

    To provide a comprehensive summary of the prevention, diagnosis and treatment of HIV-related tuberculosis (TB) in people who inject drugs (PWIDs), and recommend actions to enhance the clinical and programmatic responses to the epidemic. People who live with HIV and inject drugs have a 2-6-fold increased risk of developing TB compared with noninjectors, and commonly have comorbidities with hepatitis B (HBV) and C viral (HCV) infection. Among PWIDs who develop TB, at least one in three will also have HIV and two out of three will have HCV antibodies. They are also at increased risk of criminalization and incarceration. The risk of TB disease in prisons is on average 23 times higher than the level in the general population. Key recent developments to address HIV-related TB among PWIDs include the use of simplified symptom-based algorithm to provide isoniazid-preventive therapy, molecular DNA detection methods for Mycobacterium tuberculosis and the immediate provision of antiretroviral therapy within the first 2 weeks of initiation of anti-TB treatment. Addressing the challenge posed by HIV-associated TB among PWIDs requires a systematic and integrated response to viral hepatitis and incarceration-related health issues, in addition to ensuring HIV and TB prevention, diagnosis and treatment as core components of harm reduction services. Regionally tailored measures, taking into consideration the epidemiology of these comorbidities, the policy and programmatic environment, and the infrastructure of the health system are needed.

  20. Community attitudes towards harm reduction services and a newly established needle and syringe automatic dispensing machine in an inner-city area of Sydney, Australia.

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    White, Bethany; Haber, Paul S; Day, Carolyn A

    2016-01-01

    Automatic dispensing machines (ADMs) are an inexpensive method of increasing needle and syringe distribution to people who inject drugs but widespread implementation has been limited. The operation of ADMs in Australia has been met with apparent community opposition despite national data indicating support for harm reduction. Key community concerns include perceived increases in crime and drug use. This study aimed to examine community-level support for a newly implemented ADM in an inner-city Sydney area known for high levels of drug use. Attitudes to harm reduction and ADMs were assessed via a brief face-to-face survey of local residents (n=118) and businesses (n=35) located within the vicinity of needle and syringe program (NSP) services including the ADM. Participation was voluntary and no reimbursement was provided. Univariate analysis assessed statistically significant differences between residents' and businesses' knowledge of, and support for, a range of harm reduction initiatives, both generally and in the local area. Univariate logistic regression models were used to determine factors associated with indicating support for an ADM locally. The response rate was higher among businesses (60%) compared to residents living in street-accessible dwellings (42%). Participants indicated support for fixed-site NSPs in general (83%) and locally (77%). Support for ADMs was slightly lower - 67% indicated support for ADMs generally and 60% locally. Negative opinions regarding ADMs (believing that they encourage drug use, attract drug users to the area and increase drug-related crime) were found to be significantly associated with a lower likelihood of indicating support for ADMs locally. Despite media reports suggesting widespread community concern, there was general community support for harm reduction, including ADMs. While it is important that harm reduction services are aware of community concerns and respond appropriately, such responses should be considered and

  1. Exploring social work student education: The effect of a harm reduction curriculum on student knowledge and attitudes regarding opioid use disorders.

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    Estreet, Anthony; Archibald, Paul; Tirmazi, M Taqi; Goodman, Sapphire; Cudjoe, Tracy

    2017-01-01

    This study evaluates the degree to which a harm reduction intervention course module impacted Master of Social Work (MSW) students' knowledge and attitudes towards addressing opioid use disorder issues and clients. Using a mixed-methods approach, data from 124 MSW students were collected between 2011 and 2015. Students completed a 3-hour course module that focused on harm reduction philosophy and interventions specifically for opioid use disorders. Students completed pre- and posttest of the Harm Reduction Attitude Scale. Students were also engaged in focus groups to gain a better understanding of how and if their knowledge and attitudes changed. Results: Overall, attitudes towards harm reduction approaches for opioid use disorder shifted favorably following the course module. Paired t-test results show a statistically significant difference in the mean scores for pretest attitudes (M = 2.64, SD = 0.16) and posttest attitudes (M = 2.86, SD = 0.12) among social work students. This trend remained consistent despite treatment orientation and having a family history of substance use. Conclusion: Given the increased capacity for social work students to encounter clients with opioid use disorders, it is important to ensure that students are provided with relevant and accurate information related to client-centered approaches such as the harm reduction model to address opioid use disorders. Moreover, given the dearth of social work programs that have and required substance use disorder courses, it is imperative for schools of social work to ensure that students are provided with more than practical information, which is often gained during field placement.

  2. Reductions in biomarkers of exposure (BoE) to harmful or potentially harmful constituents (HPHCs) following partial or complete substitution of cigarettes with electronic cigarettes in adult smokers.

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    O'Connell, Grant; Graff, Donald W; D'Ruiz, Carl D

    2016-07-01

    Changes in fifteen urine, blood and exhaled breath BoEs of HPHCs representing classes of compounds reported by FDA to be significant contributors to smoking-associated disease risks were measured in 105 clinical-confined subjects following randomization and a five-day forced-switch from usual brand conventional combustible cigarettes to: (i) exclusive commercial e-cigarette use; (ii) dual-use of commercial e-cigarettes and the subject's usual cigarette brand; or (iii) discontinued use of all tobacco or nicotine products. Levels of urinary biomarkers in subjects that completely substituted their usual cigarette with e-cigarettes were significantly lower (29-95%) after 5 days. Percent reductions in eight of nine urinary BoEs were indistinguishable to smokers who had quit smoking, except for nicotine equivalents, which declined by 25-40%. Dual users who halved self-reported daily cigarette consumption with e-cigarettes exhibited reductions (7-38%) in eight of nine urinary biomarkers, but had increase (1-20%) in nicotine equivalents. Reductions were broadly proportional to the reduced numbers of cigarettes smoked. Dual user urinary nicotine equivalents were slightly higher, but not statistically significant. After 5 days, blood nicotine biomarker levels were lower in the cessation (75-96%) and exclusive use groups (11-83%); with dual users experiencing no significant reductions. All subjects experienced significant decreases in exhaled CO. Decreases in the cessation and exclusive groups ranged from 88-89% and 27-32% in dual users. Exhaled NO increased in the cessation and exclusive groups (46-63% respectively), whereas the dual users experienced minimal changes. Overall, smokers who completely or partially substituted conventional cigarettes with e-cigarettes over five days, experienced reductions in HPHCs.

  3. Implementation and evaluation of a harm-reduction model for clinical care of substance using pregnant women.

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    Wright, Tricia E; Schuetter, Renee; Fombonne, Eric; Stephenson, Jessica; Haning, William F

    2012-01-19

    Methamphetamine (MA) use during pregnancy is associated with many pregnancy complications, including preterm birth, small for gestational age, preeclampsia, and abruption. Hawaii has lead the nation in MA use for many years, yet prior to 2007, did not have a comprehensive plan to care for pregnant substance-using women. In 2006, the Hawaii State Legislature funded a pilot perinatal addiction clinic. The Perinatal Addiction Treatment Clinic of Hawaii was built on a harm-reduction model, encompassing perinatal care, transportation, child-care, social services, family planning, motivational incentives, and addiction medicine. We present the implementation model and results from our first one hundred three infants (103) seen over 3 years of operation of the program. Referrals came from community health centers, hospitals, addiction treatment facilities, private physician offices, homeless outreach services and self-referral through word-of-mouth and bus ads. Data to describe sample characteristics and outcome was obtained prospectively and retrospectively from chart abstraction and delivery data. Drug use data was obtained from the women's self-report and random urine toxicology during the pregnancy, as well as urine toxicology at the time of birth on mothers, and urine and meconium toxicology on the infants. Post-partum depression was measured in mothers with the Edinburgh Post-Partum depression scale. Data from Path clinic patients were compared with a representative cohort of women delivering at Kapiolani Medical Center for Women and Children during the same time frame, who were enrolled in another study of pregnancy outcomes. Ethical approval for this study was obtained through the University of Hawaii Committee for Human Studies. Between April 2007 and August 2010, 213 women with a past or present history of addiction were seen, 132 were pregnant and 97 delivered during that time. 103 live-born infants were delivered. There were 3 first-trimester Spontaneous

  4. Implementation and evaluation of a harm-reduction model for clinical care of substance using pregnant women

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    Wright Tricia E

    2012-01-01

    Full Text Available Abstract Background Methamphetamine (MA use during pregnancy is associated with many pregnancy complications, including preterm birth, small for gestational age, preeclampsia, and abruption. Hawaii has lead the nation in MA use for many years, yet prior to 2007, did not have a comprehensive plan to care for pregnant substance-using women. In 2006, the Hawaii State Legislature funded a pilot perinatal addiction clinic. The Perinatal Addiction Treatment Clinic of Hawaii was built on a harm-reduction model, encompassing perinatal care, transportation, child-care, social services, family planning, motivational incentives, and addiction medicine. We present the implementation model and results from our first one hundred three infants (103 seen over 3 years of operation of the program. Methods Referrals came from community health centers, hospitals, addiction treatment facilities, private physician offices, homeless outreach services and self-referral through word-of-mouth and bus ads. Data to describe sample characteristics and outcome was obtained prospectively and retrospectively from chart abstraction and delivery data. Drug use data was obtained from the women's self-report and random urine toxicology during the pregnancy, as well as urine toxicology at the time of birth on mothers, and urine and meconium toxicology on the infants. Post-partum depression was measured in mothers with the Edinburgh Post-Partum depression scale. Data from Path clinic patients were compared with a representative cohort of women delivering at Kapiolani Medical Center for Women and Children during the same time frame, who were enrolled in another study of pregnancy outcomes. Ethical approval for this study was obtained through the University of Hawaii Committee for Human Studies. Results Between April 2007 and August 2010, 213 women with a past or present history of addiction were seen, 132 were pregnant and 97 delivered during that time. 103 live-born infants were

  5. The Effectiveness of Group Family Training About the Principles of Harm Reduction Approach on Marital Satisfaction of Spouses of Patients Under Methadone Maintenance Treatment.

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    Hojjat, Seyed Kaveh; Rezaei, Mahdi; Hatami, Seyed Esmaeil; Kohestani, Mina; Norozi Khalili, Mina

    2017-01-02

    One of the most important problems in treatment of drug dependence is the cooperation of the patient's family. Many families do not look at drug dependence as a chronic and relapsing disorder and expect a quick and definite recovery of the disease. These families, including wives, are unfamiliar with the concept of harm reduction as a realistic approach. The aim of this study was to educate the spouses of patients undergoing methadone maintenance treatment (MMT) on the different aspects of harm reduction approach and assess the impact of this training on marital satisfaction and relapse rate. This study was a pretest-posttest study with control group. The sample consisted of 50 MMT patients and their wives in private methadone maintenance treatment clinics in the city of Bojnurd, located in the northeastern region of Iran. The experimental group received eight group training sessions run by a psychiatrist. The content of the training sessions was based on harm reduction programs for families of patients with high-risk behaviors. Two groups are compared in terms of marital satisfaction and relapse rate. A paired t test was used to compare changes before and after the training. The results of this study showed that harm reduction education and efforts for changing wives' views toward MMT are effective in increasing their marital satisfaction. However, the conducted training showed no effect on relapse rate in the six-month follow-up. Regarding the fact that this type of training has not been paid enough attention in the national protocol, the proposed training program of this research can be considered in MMT clinics.

  6. Results of a participatory needs assessment demonstrate an opportunity to involve people who use alcohol in drug user activism and harm reduction.

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    Crabtree, Alexis; Latham, Nicole; Bird, Lorna; Buxton, Jane

    2016-12-09

    Drug users' organizations have made progress in recent years in advocating for the health and human rights of people who use illicit drugs but have historically not emphasized the needs of people who drink alcohol. This paper reports on a qualitative participatory needs assessment with people who use illicit substances in British Columbia, Canada. We held workshops in 17 communities; these were facilitated by people who use illicit drugs, recorded with ethnographic fieldnotes, and analyzed using critical theory. Although the workshops were targeted to people who use illicit drugs, people who primarily consume alcohol also attended. An unexpected finding was the potential for drug users' organizations and other harm reduction programs to involve "illicit drinkers": people who drink non-beverage alcohol (e.g. mouthwash, rubbing alcohol) and those who drink beverage alcohol in criminalized ways (e.g., homeless drinkers). Potential points of alliance between these groups are common priorities (specifically, improving treatment by health professionals and the police, expanding housing options, and implementing harm reduction services), common values (reducing surveillance and improving accountability of services), and polysubstance use. Despite these potential points of alliance, there has historically been limited involvement of illicit drinkers in drug users' activism. Possible barriers to involvement of illicit drinkers in drug users' organizations include racism (as discourses around alcohol use are highly racialized), horizontal violence, the extreme marginalization of illicit drinkers, and knowledge gaps around harm reduction for alcohol. Understanding the commonalities between people who use drugs and people who use alcohol, as well as the potential barriers to alliance between them, may facilitate the greater involvement of illicit drinkers in drug users' organizations and harm reduction services.

  7. HIV, Syphilis, and Behavioral Risk Factors among Female Sex Workers before and after Implementation of Harm Reduction Programs in a High Drug-Using Area of China

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    Pan, Stephen W.; Song, Benli; Liu, Qianping; Xu, Yunan; Dong, Hui; Xing, Hui; Shao, Yiming; Ruan, Yuhua

    2014-01-01

    Objective To evaluate the impact of harm reduction programs on HIV and syphilis infection and related risk behaviors among female sex workers (FSWs) in a drug trafficking city in Southwest China. Design Before and after harm reduction program study. Methods Two cross-sectional surveys were conducted among FSWs before and after harm reduction programs were launched in Xichang city, Sichuan province. The first and second cross-sectional surveys were conducted in 2004 and 2010, respectively. Temporal changes in odds of HIV, syphilis, and behavioral risk factors were assessed by multivariable logistic regression while controlling for socio-demographics. Results The 2004 and 2010 cross-sectional surveys recruited 343 and 404 FSWs, respectively. From 2004 to 2010, the odds of syphilis infection decreased by 35% and was of borderline statistical significance (AOR: 0.65, 95% CI: 0.41–1.03), while odds of HIV infection rose, but not significantly (AOR: 4.12, 95% CI: 0.76–22.45). Although odds of unprotected sex with primary sex partners did not significantly change over time (AOR: 0.96; 95% CI: 0.61–1.50), odds of unprotected sex with clients declined significantly and remarkably (AOR: 0.14, 95% CI: 0.09–0.21). Notably, the odds of reporting ≥10 new sex partners in the previous month increased by 37% (AOR: 1.37; 95% CI: 0.98–1.90). Conclusions Harm reduction strategies may be an effective means of reducing unprotected sex with clients among FSWs. Future research is needed to better target both FSWs and IDUs and interrupt bridging networks for HIV transmission in high drug-using areas of China. PMID:24416319

  8. HIV, syphilis, and behavioral risk factors among female sex workers before and after implementation of harm reduction programs in a high drug-using area of China.

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    Li Zhang

    Full Text Available To evaluate the impact of harm reduction programs on HIV and syphilis infection and related risk behaviors among female sex workers (FSWs in a drug trafficking city in Southwest China.Before and after harm reduction program study.Two cross-sectional surveys were conducted among FSWs before and after harm reduction programs were launched in Xichang city, Sichuan province. The first and second cross-sectional surveys were conducted in 2004 and 2010, respectively. Temporal changes in odds of HIV, syphilis, and behavioral risk factors were assessed by multivariable logistic regression while controlling for socio-demographics.The 2004 and 2010 cross-sectional surveys recruited 343 and 404 FSWs, respectively. From 2004 to 2010, the odds of syphilis infection decreased by 35% and was of borderline statistical significance (AOR: 0.65, 95% CI: 0.41-1.03, while odds of HIV infection rose, but not significantly (AOR: 4.12, 95% CI: 0.76-22.45. Although odds of unprotected sex with primary sex partners did not significantly change over time (AOR: 0.96; 95% CI: 0.61-1.50, odds of unprotected sex with clients declined significantly and remarkably (AOR: 0.14, 95% CI: 0.09-0.21. Notably, the odds of reporting ≥10 new sex partners in the previous month increased by 37% (AOR: 1.37; 95% CI: 0.98-1.90.Harm reduction strategies may be an effective means of reducing unprotected sex with clients among FSWs. Future research is needed to better target both FSWs and IDUs and interrupt bridging networks for HIV transmission in high drug-using areas of China.

  9. Changes in HIV incidence among people who inject drugs in Taiwan following introduction of a harm reduction program: a study of two cohorts.

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    Yen-Fang Huang

    2014-04-01

    Full Text Available Harm reduction strategies for combating HIV epidemics among people who inject drugs (PWID have been implemented in several countries. However, large-scale studies using sensitive measurements of HIV incidence and intervention exposures in defined cohorts are rare. The aim of this study was to determine the association between harm reduction programs and HIV incidence among PWID.The study included two populations. For 3,851 PWID who entered prison between 2004 and 2010 and tested HIV positive upon incarceration, we tested their sera using a BED HIV-1 capture enzyme immunoassay to estimate HIV incidence. Also, we enrolled in a prospective study a cohort of 4,357 individuals who were released from prison via an amnesty on July 16, 2007. We followed them with interviews at intervals of 6-12 mo and by linking several databases. A total of 2,473 participants who were HIV negative in January 2006 had interviews between then and 2010 to evaluate the association between use of harm reduction programs and HIV incidence. We used survival methods with attendance at methadone clinics as a time-varying covariate to measure the association with HIV incidence. We used a Poisson regression model and calculated the HIV incidence rate to evaluate the association between needle/syringe program use and HIV incidence. Among the population of PWID who were imprisoned, the implementation of comprehensive harm reduction programs and a lower mean community HIV viral load were associated with a reduced HIV incidence among PWID. The HIV incidence in this population of PWID decreased from 18.2% in 2005 to 0.3% in 2010. In an individual-level analysis of the amnesty cohort, attendance at methadone clinics was associated with a significantly lower HIV incidence (adjusted hazard ratio: 0.20, 95% CI: 0.06-0.67, and frequent users of needle/syringe program services had lower HIV incidence (0% in high NSP users, 0.5% in non NSP users. In addition, no HIV seroconversions were

  10. Australian mental health care practitioners' practices and attitudes for encouraging smoking cessation and tobacco harm reduction in smokers with severe mental illness.

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    Sharma, Ratika; Meurk, Carla; Bell, Stephanie; Ford, Pauline; Gartner, Coral

    2018-02-01

    Reducing the burden of physical illness among people living with severe mental illnesses (SMI) is a key priority. Smoking is strongly associated with SMIs resulting in excessive smoking related morbidity and mortality in smokers with SMI. Smoking cessation advice and assistance from mental health practitioners would assist with reducing smoking and smoking-related harms in this group. This study examined the attitudes and practices of Australian mental health practitioners towards smoking cessation and tobacco harm reduction for smokers with SMI, including adherence to the 5As (ask, assess, advise, assist and arrange follow up) of smoking cessation. We surveyed 267 Australian mental health practitioners using a cross-sectional, online survey. Most practitioners (77.5%) asked their clients about smoking and provided health education (66.7%) but fewer provided direct assistance (31.1-39.7%). Most believed that tobacco harm reduction strategies are effective for reducing smoking related risks (88.4%) and that abstinence from all nicotine should not be the only goal discussed with smokers with SMI (77.9%). Many respondents were unsure about the safety (56.9%) and efficacy (39.3%) of e-cigarettes. Practitioners trained in smoking cessation were more likely (OR: 2.9, CI: 1.5-5.9) to help their clients to stop smoking. Community mental health practitioners (OR: 0.3, CI: 0.1-0.9) and practitioners who were current smokers (OR: 0.3, CI: 0.1-0.9) were less likely to adhere to the 5As of smoking cessation intervention. The results of this study emphasize the importance and need for providing smoking cessation training to mental health practitioners especially community mental health practitioners. © 2017 Australian College of Mental Health Nurses Inc.

  11. Obsolete tobacco control themes can be hazardous to public health: the need for updating views on absolute product risks and harm reduction

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    Lynn T. Kozlowski

    2016-05-01

    Full Text Available Abstract Background Leading themes have guided tobacco control efforts, and these themes have changed over the decades. When questions arose about health risks of tobacco, they focused on two key themes: 1 how bad is the problem (i.e., absolute risk and 2 what can be done to reduce the risk without cessation (i.e., prospects for harm reduction. Using the United States since 1964 as an example, we outline the leading themes that have arisen in response to these two questions. Initially, there was the recognition that “cigarettes are hazardous to health” and an acceptance of safer alternative tobacco products (cigars, pipes, light/lower-tar cigarettes. In the 1980s there was the creation of the seminal theme that “Cigarettes are lethal when used as intended and kill more people than heroin, cocaine, alcohol, AIDS, fires, homicide, suicide, and automobile crashes combined.” By around 2000, support for a less-dangerous light/lower tar cigarette was gone, and harm reduction claims were avoided for products like cigars and even for smokeless tobacco which were summarized as “unsafe” or “not a safe alternative to cigarettes.” Discussion The Surgeon General in 2014 concluded that by far the greatest danger to public health was from cigarettes and other combusted products. At the same time the evidence base for smokeless tobacco and alternative nicotine delivery systems (ANDS had grown. Product innovation and tobacco/nicotine bio-behavioral, epidemiological and public health sciences demonstrate that low nitrosamine smokeless tobacco (e.g., Swedish snus, and ANDS have substantially lower harms than cigarettes. Going forward, it is important to sharpen themes and key messages of tobacco control, while continuing to emphasize the extreme lethality of the inhaled smoke from cigarettes or from use of any combusting tobacco product. Summary Implications of updating the leading themes for regulation, policymaking and advocacy in tobacco control

  12. Obsolete tobacco control themes can be hazardous to public health: the need for updating views on absolute product risks and harm reduction.

    Science.gov (United States)

    Kozlowski, Lynn T; Abrams, David B

    2016-05-24

    Leading themes have guided tobacco control efforts, and these themes have changed over the decades. When questions arose about health risks of tobacco, they focused on two key themes: 1) how bad is the problem (i.e., absolute risk) and 2) what can be done to reduce the risk without cessation (i.e., prospects for harm reduction). Using the United States since 1964 as an example, we outline the leading themes that have arisen in response to these two questions. Initially, there was the recognition that "cigarettes are hazardous to health" and an acceptance of safer alternative tobacco products (cigars, pipes, light/lower-tar cigarettes). In the 1980s there was the creation of the seminal theme that "Cigarettes are lethal when used as intended and kill more people than heroin, cocaine, alcohol, AIDS, fires, homicide, suicide, and automobile crashes combined." By around 2000, support for a less-dangerous light/lower tar cigarette was gone, and harm reduction claims were avoided for products like cigars and even for smokeless tobacco which were summarized as "unsafe" or "not a safe alternative to cigarettes." The Surgeon General in 2014 concluded that by far the greatest danger to public health was from cigarettes and other combusted products. At the same time the evidence base for smokeless tobacco and alternative nicotine delivery systems (ANDS) had grown. Product innovation and tobacco/nicotine bio-behavioral, epidemiological and public health sciences demonstrate that low nitrosamine smokeless tobacco (e.g., Swedish snus), and ANDS have substantially lower harms than cigarettes. Going forward, it is important to sharpen themes and key messages of tobacco control, while continuing to emphasize the extreme lethality of the inhaled smoke from cigarettes or from use of any combusting tobacco product. Implications of updating the leading themes for regulation, policymaking and advocacy in tobacco control are proposed as an important next step. A new reframing can align

  13. Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs: a qualitative analysis

    Directory of Open Access Journals (Sweden)

    McNeil Ryan

    2012-05-01

    Full Text Available Abstract Background Homeless and marginally housed persons who use alcohol and/or illicit drugs often have end-of-life care needs that go unmet due to barriers that they face to accessing end-of-life care services. Many homeless and marginally housed persons who use these substances must therefore rely upon alternate sources of end-of-life care and support. This article explores the role of harm reduction services in end-of-life care services delivery to homeless and marginally housed persons who use alcohol and/or illicit drugs. Methods A qualitative case study design was used to explore end-of-life care services delivery to homeless and marginally housed persons in six Canadian cities. A key objective was to explore the role of harm reduction services. 54 health and social services professionals participated in semi-structured qualitative interviews. All participants reported that they provided care and support to this population at end-of-life. Results Harm reduction services (e.g., syringe exchange programs, managed alcohol programs, etc. were identified as a critical point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs. Where possible, harm reduction services facilitated referrals to end-of-life care services for this population. Harm reduction services also provided end-of-life care and support when members of this population were unable or unwilling to access end-of-life care services, thereby improving quality-of-life and increasing self-determination regarding place-of-death. Conclusions While partnerships between harm reduction programs and end-of-life care services are identified as one way to improve access, it is noted that more comprehensive harm reduction services might be needed in end-of-life care settings if they are to engage this underserved population.

  14. Factors associated with alcohol reduction in harmful and hazardous drinkers following alcohol brief intervention in Scotland: a qualitative enquiry

    OpenAIRE

    McQueen, Jean M.; Ballinger, Claire; Howe, Tracey E.

    2017-01-01

    Background: Alcohol Brief Intervention (ABI) uses a motivational counselling approach to support individuals to\\ud reduce excessive alcohol consumption. There is growing evidence on ABI’s use within various health care settings,\\ud although how they work and which components enhance success is largely unknown. This paper reports on the\\ud qualitative part of a mixed methods study. It explores enablers and barriers associated with alcohol reduction\\ud following an ABI. It focuses on alcohol’s ...

  15. Mitigating risks of students use of study drugs through understanding motivations for use and applying harm reduction theory: a literature review.

    Science.gov (United States)

    Abelman, Dor David

    2017-10-06

    As postsecondary students' use of "study drugs" becomes more popular with increasingly reported negative effects on health and academic performance, failing prohibitionist policies to reduce consumption, and ambiguity in literature towards best practices to address this population, we present a literature review that seeks effective solutions educational institutions can apply to improve outcomes for students who use drugs. Motivations for use, effects of the substances, an analysis of efforts to control use from educational institutions, and suggestions on promoting most effective outcomes based on harm reduction, are described. Theory, quantitative, and qualitative works from systematic reviews, cohort studies, and epidemiological assessments are examined on the "study drugs" methylphenidate, dextroamphetamine, and amphetamine, also known as Adderall, Ritalin, Focalin, and Concerta. There is a focus on postsecondary students ages 18-25 in North America. Results show important risk factors for drug use including low perceived self-efficacy or enjoyment in courses, poor accommodation of special needs, reliance on external validation, having a low GPA, and experiencing a mental health issue. There is much misconception on the health and academic effects of these drugs in literature, among students, and on online knowledge sources. We suggest these drugs do not improve GPA and learning, while they might temporarily increase memory, but with detrimental negative health effects. Campaigns that address underlying factors of use can be most successful in mitigating harms.

  16. Reduction of emission of harmful substances from high speed Diesel engines; Verringerung der Schadstoffemissionen bei schnellaufenden Dieselmotoren

    Energy Technology Data Exchange (ETDEWEB)

    Bach, E.; Budack, R.; Sandig, R.; Enke, W.; Hofmann [Motoren- und Turbinen-Union GmbH, Friedrichshafen (Germany); Velji, A.; Danckert, B.; Breidenbach, U.; Rauscher, M.; Schmidt, G. [Hochschule fuer Technik und Wirtschaft Dresden (Germany). Forschungsinstitut fuer Fahrzeugtechnik

    1996-12-31

    The aim of the combined project was, starting from the state of technology (EURO II technology for heavy commercial vehicles), to determine the potential of new technologies for complying with future exhaust gas emission limits (EURO III). It is well known that the most severe requirements in reducing harmful emission arise form the conflict between NO{sub x} and particle emission. Measures inside the engine for complying with future emission limits (EURO III) lead to an unacceptable increase in fuel consumption with conventional injection systems. If one still wants to fall below future emission limits (EURO III) with a high efficiency by measures inside the engine, a new injection technique is required. For this reason, the common rail injection system (CRE) was selected and the CRE was developed further from a laboratory model to a model which can be used on the engine. Summarising, one can say that by changing the injection technique from conventional systems driven by the cam to the common rail injection system (CRE), a potential was obtained for reducing the NO{sub x} and particle emission with a favourable efficiency. (orig./AKF) [Deutsch] Ziel des Verbundvorhabens war es, ausgehend vom Stand der Technik (EURO II-Technologie fuer schwere Nutzfahrzeuge), das Potential neuer Technologien zur Einhaltung zukuenftiger Abgasemissionsgrenzwerte (EURO III) zu ermitteln. Es ist bekannt, dass bei der Schadstoffminderung der Konflikt zwischen NO{sub x}- und Partikelemission die schaerfsten Anforderungen darstellt. Innermotorische Massnahmen zur Erfuellung zukuenftiger Emissionsgrenzwerte (EURO III) haben mit herkoemmlichen Einspritzsystemen eine nicht akzeptable Zunahme des Kraftstoffverbrauches zur Folge. Will man trotzdem mit innermotorischen Massnahmen zukuenftige Emissionsgrenzwerte (EURO III) bei noch gutem Wirkungsgrad unterschreiten, so ist eine neue Einspritztechnologie erforderlich. Aus diesem Grunde wurde ein geeignetes Einspritzsystem, das Common

  17. Unpacking commercial sector opposition to European smoke-free policy: lack of unity, ‘fear of association’ and harm reduction debates

    Science.gov (United States)

    Weishaar, Heide; Amos, Amanda; Collin, Jeff

    2016-01-01

    Objective Tobacco companies have made extensive efforts to build alliances against comprehensive smoke-free legislation. This article analyses the interaction between actors who opposed the development of the European Council Recommendation on smoke-free environments. Methods Drawing on data from 200 policy documents and 32 semistructured interviews and using qualitative textual analysis and organisational network analysis, opponents’ positions on, and responses to, the policy initiative, strategies to oppose the policy, and efforts to build alliances were investigated. Results The non-binding nature of the policy, scientific evidence and clear political will to adopt EU-wide measures combined to limit the intensity of commercial sector opposition to the comprehensive EU smoke-free policy. Most tobacco companies, led by the Confederation of European Community Cigarette Manufacturers (CECCM), voiced reservations against the proposal, criticised the policy process and fought flanking measures on product regulation. However, some companies focused on instigating harm reduction debates. These divergent approaches and the reluctance of other commercial actors to demonstrate solidarity with the tobacco sector prevented the establishment of a cohesive commercial sector alliance. Conclusions The comparatively limited opposition to EU smoke-free policy contrasts with previous accounts of tobacco industry resistance to tobacco control. While context-specific factors can partially explain these differences, the paper indicates that the sector's diminished credibility and lack of unity hampered political engagement and alliance building. Industry efforts to emphasise the benefits of smokeless tobacco during smoke-free policy debates highlight the potential of harm reduction as a gateway for tobacco companies to re-enter the political arena. PMID:26055268

  18. Rapid decline in HCV incidence among people who inject drugs associated with national scale-up in coverage of a combination of harm reduction interventions.

    Science.gov (United States)

    Palmateer, Norah E; Taylor, Avril; Goldberg, David J; Munro, Alison; Aitken, Celia; Shepherd, Samantha J; McAllister, Georgina; Gunson, Rory; Hutchinson, Sharon J

    2014-01-01

    Government policy has precipitated recent changes in the provision of harm reduction interventions - injecting equipment provision (IEP) and opiate substitution therapy (OST) - for people who inject drugs (PWID) in Scotland. We sought to examine the potential impact of these changes on hepatitis C virus (HCV) transmission among PWID. We used a framework to triangulate different types of evidence: 'group-level/ecological' and 'individual-level'. Evidence was primarily generated from bio-behavioural cross-sectional surveys of PWID, undertaken during 2008-2012. Individuals in the window period (1-2 months) where the virus is present, but antibodies have not yet been formed, were considered to have recent infection. The survey data were supplemented with service data on the provision of injecting equipment and OST. Ecological analyses examined changes in intervention provision, self-reported intervention uptake, self-reported risk behaviour and HCV incidence; individual-level analyses investigated relationships within the pooled survey data. Nearly 8,000 PWID were recruited in the surveys. We observed a decline in HCV incidence, per 100 person-years, from 13.6 (95% CI: 8.1-20.1) in 2008-09 to 7.3 (3.0-12.9) in 2011-12; a period during which increases in the coverage of OST and IEP, and decreases in the frequency of injecting and sharing of injecting equipment, were observed. Individual-level evidence demonstrated that combined high coverage of needles/syringes and OST were associated with reduced risk of recent HCV in analyses that were unweighted (AOR 0.29, 95%CI 0.11-0.74) and weighted for frequency of injecting (AORw 0.05, 95%CI 0.01-0.18). We estimate the combination of harm reduction interventions may have averted 1400 new HCV infections during 2008-2012. This is the first study to demonstrate that impressive reductions in HCV incidence can be achieved among PWID over a relatively short time period through high coverage of a combination of interventions.

  19. Rapid decline in HCV incidence among people who inject drugs associated with national scale-up in coverage of a combination of harm reduction interventions.

    Directory of Open Access Journals (Sweden)

    Norah E Palmateer

    Full Text Available BACKGROUND: Government policy has precipitated recent changes in the provision of harm reduction interventions - injecting equipment provision (IEP and opiate substitution therapy (OST - for people who inject drugs (PWID in Scotland. We sought to examine the potential impact of these changes on hepatitis C virus (HCV transmission among PWID. METHODS AND FINDINGS: We used a framework to triangulate different types of evidence: 'group-level/ecological' and 'individual-level'. Evidence was primarily generated from bio-behavioural cross-sectional surveys of PWID, undertaken during 2008-2012. Individuals in the window period (1-2 months where the virus is present, but antibodies have not yet been formed, were considered to have recent infection. The survey data were supplemented with service data on the provision of injecting equipment and OST. Ecological analyses examined changes in intervention provision, self-reported intervention uptake, self-reported risk behaviour and HCV incidence; individual-level analyses investigated relationships within the pooled survey data. Nearly 8,000 PWID were recruited in the surveys. We observed a decline in HCV incidence, per 100 person-years, from 13.6 (95% CI: 8.1-20.1 in 2008-09 to 7.3 (3.0-12.9 in 2011-12; a period during which increases in the coverage of OST and IEP, and decreases in the frequency of injecting and sharing of injecting equipment, were observed. Individual-level evidence demonstrated that combined high coverage of needles/syringes and OST were associated with reduced risk of recent HCV in analyses that were unweighted (AOR 0.29, 95%CI 0.11-0.74 and weighted for frequency of injecting (AORw 0.05, 95%CI 0.01-0.18. We estimate the combination of harm reduction interventions may have averted 1400 new HCV infections during 2008-2012. CONCLUSIONS: This is the first study to demonstrate that impressive reductions in HCV incidence can be achieved among PWID over a relatively short time period through

  20. The Role of Physical Activity in Harm Reduction among Betel Quid Chewers from a Prospective Cohort of 419,378 Individuals.

    Directory of Open Access Journals (Sweden)

    Feng En Lo

    Full Text Available To assess the benefits of regular exercise in reducing harms associated with betel quid (BQ chewing.The study cohort, 419,378 individuals, participated in a medical screening program between 1994 and 2008, with 38,324 male and 1,495 female chewers, who consumed 5-15 quids of BQ a day. Physical activity of each individual, based on "MET-hour/week", was classified as "inactive" or "active", where activity started from a daily 15 minutes/day or more of brisk walking (≥3.75 MET-hour/week. Hazard ratios for mortality and remaining years in life expectancy were calculated.Nearly one fifth (18.7% of men, but only 0.7% of women were chewers. Chewers had a 10-fold increase in oral cancer risk; and a 2-3-fold increase in mortality from lung, esophagus and liver cancer, cardiovascular disease, and diabetes, with doubling of all-cause mortality. More than half of chewers were physically inactive (59%. Physical activity was beneficial for chewers, with a reduction of all-cause mortality by 19%. Inactive chewers had their lifespan shortened by 6.3 years, compared to non-chewers, but being active, chewers improved their health by gaining 2.5 years. The improvement, however, fell short of offsetting the harms from chewing.Chewers had serious health consequences, but being physically active, chewers could mitigate some of these adverse effects, and extend life expectancy by 2.5 years and reduce mortality by one fifth. Encouraging exercise, in addition to quitting chewing, remains the best advice for 1.5 million chewers in Taiwan.

  1. “We don’t need services. We have no problems”: exploring the experiences of young people who inject drugs in accessing harm reduction services

    Directory of Open Access Journals (Sweden)

    Anita Krug

    2015-02-01

    Full Text Available Introduction: Evidence suggests that people who inject drugs often begin their drug use and injecting practices in adolescence, yet there are limited data available on the HIV epidemic and the responses for this population. The comprehensive package of interventions for the prevention, treatment and care of HIV infection among people who inject drugs first laid out in 2009 (revised in 2012 by World Health Organization, United Nations Office of Drugs and Crime and Joint United Nations Programme on HIV/AIDS, does not consider the unique needs of adolescent and young people. In order to better understand the values and preferences of young people who inject drugs in accessing harm reduction services and support, we undertook a series of community consultations with young people with experience of injecting drugs during adolescence. Methods: Community consultations (4–14 persons were held in 14 countries. Participants were recruited using a combined criterion and maximum variation sampling strategy. Data were analyzed using collaborative qualitative data analysis. Frequency analysis of themes was conducted. Results: Nineteen community consultations were organized with a total of 132 participants. All participants had experienced injecting drugs before the age of 18. They had the following age distribution: 18–20 (37%, 21–25 (48% and 26–30 (15%. Of the participants, 73.5% were male while 25.7% were female, with one transgender participant. Barriers to accessing the comprehensive package included: lack of information and knowledge of services, age restrictions on services, belief that services were not needed, fear of law enforcement, fear of stigma, lack of concern, high cost, lack of outreach, lack of knowledge of HCV/TB and lack of youth friendly services. Conclusions: The consultations provide a rare insight into the lived experiences of adolescents who inject drugs and highlight the dissonance between their reality and current policy and

  2. Observed Benefits to On-site Medical Services during an Annual 5-day Electronic Dance Music Event with Harm Reduction Services.

    Science.gov (United States)

    Munn, Matthew Brendan; Lund, Adam; Golby, Riley; Turris, Sheila A

    2016-04-01

    With increasing attendance and media attention, large-scale electronic dance music events (EDMEs) are a subset of mass gatherings that have a unique risk profile for attendees and promoters. Shambhala Music Festival (Canada) is a multi-day event in a rural setting with a recognized history of providing harm reduction (HR) services alongside medical care. Study/Objective This manuscript describes the medical response at a multi-day electronic music festival where on-site HR interventions and dedicated medical care are delivered as parallel public health measures. This study was a descriptive case report. Medical encounters and event-related data were documented prospectively using an established event registry database. In 2014, Shambhala Music Festival had 67,120 cumulative attendees over a 7-day period, with a peak daily attendance of 15,380 people. There were 1,393 patient encounters and the patient presentation rate (PPR) was 20.8 per one thousand. The majority of these (90.9%) were for non-urgent complaints. The ambulance transfer rate (ATR) was 0.194 per one thousand and 0.93% of patient encounters were transferred by ambulance. No patients required intubation and there were no fatalities. Harm reduction services included mobile outreach teams, distribution of educational materials, pill checking facilities, a dedicated women's space, and a "Sanctuary" area that provided non-medical peer support for overwhelmed guests. More than 10,000 encounters were recorded by mobile and booth-based preventive and educational services, and 2,786 pills were checked on-site with a seven percent discard rate. Dedicated medical and HR services represent two complementary public health strategies to minimize risk at a multi-day electronic music festival. The specific extent to which HR strategies reduce the need for medical care is not well understood. Incorporation of HR practices when planning on-site medical care has the potential to inform patient management, reduce

  3. The Significance of Harm Reduction as a Social and Health Care Intervention for Injecting Drug Users: An Exploratory Study of a Needle Exchange Program in Fresno, California.

    Science.gov (United States)

    Clarke, Kris; Harris, Debra; Zweifler, John A; Lasher, Marc; Mortimer, Roger B; Hughes, Susan

    2016-01-01

    Infectious disease remains a significant social and health concern in the United States. Preventing more people from contracting HIV/AIDS or Hepatitis C (HCV), requires a complex understanding of the interconnection between the biomedical and social dimensions of infectious disease. Opiate addiction in the US has skyrocketed in recent years. Preventing more cases of HIV/AIDS and HCV will require dealing with the social determinants of health. Needle exchange programs (NEPs) are based on a harm reduction approach that seeks to minimize the risk of infection and damage to the user and community. This article presents an exploratory small-scale quantitative study of the injection drug using habits of a group of injection drug users (IDUs) at a needle exchange program in Fresno, California. Respondents reported significant decreases in high risk IDU behaviors, including sharing of needles and to a lesser extent re-using of needles. They also reported frequent use of clean paraphernalia. Greater collaboration between social and health outreach professionals at NEPs could provide important frontline assistance to people excluded from mainstream office-based services and enhance efforts to reduce HIV/AIDS or HCV infection.

  4. Implementation of the risk and harm reduction strategy against unsafe abortion in Uruguay: From a university hospital to the entire country.

    Science.gov (United States)

    Labandera, Ana; Gorgoroso, Monica; Briozzo, Leonel

    2016-08-01

    The history of the creation of the risk and harm reduction model applied to unsafe abortion is reviewed, from its initial implementation by a small group of gynecologists at the Pereira Rossell Hospital Center in Uruguay to its spread to the rest of the country. Its ethical rationale, its successful application in the hospital, the decision to disseminate it with the cooperation of the International Federation of Gynecology and Obstetrics (FIGO), and the intervention procedures are explained. It was evaluated from the epidemiological and anthropological viewpoints, from the changes in professionals' and users' perception of the care offered and its impact on complications and maternal deaths. A very favorable change was seen in the number and quality of the services, the providers' attitude, and maternal morbidity and mortality were reduced. It also brought visibility to women with unplanned and unwanted pregnancies and an improved understanding of their problems, which contributed to the legislative changes that were made subsequently. Copyright © 2016. Published by Elsevier Ireland Ltd.

  5. Mapeando Programas de Redução de Danos da Região Metropolitana de Porto Alegre / Mapping harm reduction programs in the metropolitan region of Porto Alegre

    NARCIS (Netherlands)

    R. Quadros Rigoni (Rafaela); H.C. Nardi (Henrique)

    2009-01-01

    textabstractThis study mapped and described 11 harm reduction interventions/programs in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil, in 2004-2006. Mapping was based on interviews and analysis of available documents and comparison with a previous study with data from 2003. We

  6. The Effects of the 2004 Reduction in the Price of Alcohol on Alcohol-Related Harm in Finland – a Natural Experiment Based on Register Data

    Directory of Open Access Journals (Sweden)

    Kimmo Herttua

    2010-01-01

    disadvantage on the area level and interpersonal violence, although the differences in the effects of the price reduction between the different areas were small.  The findings of the present study suggest that that a reduction in alcohol prices may lead to a substantial increase in alcohol-related mortality and morbidity. However, large population group differences were observed regarding responsiveness to the price changes. In particular, the less privileged, such as the unemployed, were most sensitive. In contrast, at least in the Finnish context, the younger generations and the employed do not appear to be adversely affected, and those in the older age groups may even benefit from cheaper alcohol in terms of decreased rates of CVD mortality. The results also suggest that reductions in alcohol prices do not necessarily affect interpersonal violence. The population group differences in the effects of the price changes on alcohol-related harm should be acknowledged, and therefore the policy actions should focus on the population subgroups that are primarily responsive to the price reduction.

  7. Injecting and HIV prevalence among young heroin users in three Spanish cities and their association with the delayed implementation of harm reduction programmes

    Science.gov (United States)

    de la Fuente, Luis; Bravo, María José; Toro, Carlos; Brugal, M Teresa; Barrio, Gregorio; Soriano, Vicente; Vallejo, Fernando

    2006-01-01

    Objectives To evaluate changes in the prevalence of HIV infection among young heroin users in three Spanish cities, and their association with harm reduction programmes (HRPs). Methods Two cross sectional studies. The 1995 study included 596 users; half were street recruited and half were recruited at drug treatment centres. The 2001–03 study included 981 street recruited users. Face to face interviews were conducted using a structured questionnaire. Samples for HIV testing (saliva in 1995 and dried blood spot in 2001–03) were collected. Results The proportion who had ever injected (IDUs) decreased in all three cities. HIV prevalence in IDUs decreased by half in Barcelona (44.1% to 20.8%) and Seville (44.2% to 22.2%), but remained constant in Madrid (36.8% and 34.9%). This difference was attributable to a decrease in HIV prevalence in long term IDUs in Barcelona and Seville, but not in Madrid. The crude odds ratio for HIV prevalence in Madrid compared with Barcelona in long term IDUs was 2.3 (95%CI 1.4 to 3.7), increasing to 3.1 (95%CI 1.5 to 6.2) after adjusting for sociodemographic and risk factors. HIV prevalence in short term IDUs was similar in all cities. In 1992 Barcelona already had 20 heroin users in methadone maintenance programmes (MMPs) per 10 000 population aged 15–49 years; Seville reached this rate in 1994, and Madrid, not until 1998. Conclusions The prevalence of HIV infection did not decrease in long term injectors in Madrid. The delayed implementation of HRPs, especially MMPs, may be the most plausible hypothesis. This finding should shed light on decision making in countries in a similar epidemiological and sociological situation. PMID:16698987

  8. Debunking the claim that abstinence is usually healthier for smokers than switching to a low-risk alternative, and other observations about anti-tobacco-harm-reduction arguments

    Directory of Open Access Journals (Sweden)

    Phillips Carl V

    2009-11-01

    Full Text Available Abstract Nicotine is so desirable to many people that when they are given only the options of consuming nicotine by smoking, with its high health costs, and not consuming nicotine at all, many opt for the former. Few smokers realize that there is a third choice: non-combustion nicotine sources, such as smokeless tobacco, electronic cigarettes, or pharmaceutical nicotine, which eliminate almost all the risk while still allowing consumption of nicotine. Widespread dissemination of misleading health claims is used to prevent smokers from learning about this lifesaving option, and to discourage opinion leaders from telling smokers the truth. One common misleading claim is a risk-risk comparison that has not before been quantified: A smoker who would have eventually quit nicotine entirely, but learns the truth about low-risk alternatives, might switch to an alternative instead of quitting entirely, and thus might suffer a net increase in health risk. While this has mathematical face validity, a simple calculation of the tradeoff -- switching to lifelong low-risk nicotine use versus continuing to smoke until quitting -- shows that such net health costs are extremely unlikely and of trivial maximum magnitude. In particular, for the average smoker, smoking for just one more month before quitting causes greater health risk than switching to a low-risk nicotine source and never quitting it. Thus, discouraging a smoker, even one who would have quit entirely, from switching to a low-risk alternative is almost certainly more likely to kill him than it is to save him. Similarly, a strategy of waiting for better anti-smoking tools to be developed, rather than encouraging immediate tobacco harm reduction using current options, kills more smokers every month than it could possibly ever save.

  9. EFFECTIVENESS OF DIALECTICAL BEHAVIOR THERAPY VERSUS COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY TREATMENT FOR REDUCTION OF SELF-HARM IN ADULTS WITH BORDERLINE PERSONALITY TRAITS AND DISORDER

    DEFF Research Database (Denmark)

    Andreasson, Kate; Krogh, Jesper; Wenneberg, Christina

    2016-01-01

    were: severity of borderline symptoms, depressive symptoms, hopelessness, suicide ideation, and self-esteem. RESULTS: At 28 weeks, the number of participants with new self-harm in the DBT group was 21 of 57 (36.8%) versus 12 of 51 (23.5%) in the CAMS treatment (OR: 1.90; 95% CI: 0.80-4.40; P = .14......BACKGROUND: Many psychological treatments have shown effect on reducing self-harm in adults with borderline personality disorder. There is a need of brief psychotherapeutical treatment alternative for suicide prevention in specialized outpatient clinics. METHODS/DESIGN: The DiaS trial was designed...... behavior therapy (DBT) versus up to 16 weeks of collaborative assessment and management of suicidality (CAMS) treatment. The primary composite outcome was the number of participants with a new self-harm (nonsuicidal self-injury [NSSI] or suicide attempt) at week 28 from baseline. Other exploratory outcomes...

  10. The influence of marketing on the sports betting attitudes and consumption behaviours of young men: implications for harm reduction and prevention strategies.

    Science.gov (United States)

    Deans, Emily G; Thomas, Samantha L; Derevensky, Jeffrey; Daube, Mike

    2017-01-19

    Gambling can cause significant health and social harms for individuals, their families, and communities. While many studies have explored the individual factors that may lead to and minimise harmful gambling, there is still limited knowledge about the broader range of factors that may contribute to gambling harm. There are significant regulations to prevent the marketing of some forms of gambling but comparatively limited regulations relating to the marketing of newer forms of online gambling such as sports betting. There is a need for better information about how marketing strategies may be shaping betting attitudes and behaviours and the range of policy and regulatory responses that may help to prevent the risky or harmful consumption of these products. We conducted qualitative, semi-structured interviews with 50 Australian men (aged 20-37 years) who gambled on sports. We explored their attitudes and opinions regarding sports betting marketing, the embedding of marketing within sports and other non-gambling community environments, and the implications this had for the normalisation of betting. Our findings indicate that most of the environments in which participants reported seeing or hearing betting advertisements were not in environments specifically designed for betting. Participants described that the saturation of marketing for betting products, including through sports-based commentary and sports programming, normalised betting. Participants described that the inducements offered by the industry were effective marketing strategies in getting themselves and other young men to bet on sports. Inducements were also linked with feelings of greater control over betting outcomes and stimulated some individuals to sign up with more than one betting provider. This research suggests that marketing plays a strong role in the normalisation of gambling in sports. This has the potential to increase the risks and subsequent harms associated with these products

  11. The impact of an alcohol harm reduction intervention on interpersonal violence and engagement in sex work among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial.

    Science.gov (United States)

    Parcesepe, Angela M; L Engle, Kelly L; Martin, Sandra L; Green, Sherri; Sinkele, William; Suchindran, Chirayath; Speizer, Ilene S; Mwarogo, Peter; Kingola, Nzioki

    2016-04-01

    To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya. Randomized controlled trial. HIV prevention drop-in centers in Mombasa, Kenya. 818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively). 6 session alcohol harm reduction intervention. 6 session non-alcohol related nutrition intervention. In-person interviews were conducted at enrollment, immediately post-intervention and 6-months post-intervention. General linear mixed models examined associations between intervention assignment and recent violence (physical violence, verbal abuse, and being robbed in the past 30 days) from paying and non-paying sex partners and engagement in sex work in the past 30 days. The alcohol intervention was associated with statistically significant decreases in physical violence from paying partners at 6 months post-intervention and verbal abuse from paying partners immediately post-intervention and 6-months post-intervention. Those assigned to the alcohol intervention had significantly reduced odds of engaging in sex work immediately post-intervention and 6-months post-intervention. The alcohol intervention was associated with reductions in some forms of violence and with reductions in engagement in sex work among FSWs in Mombasa, Kenya. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. The impact of an alcohol harm reduction intervention on interpersonal violence and engagement in sex work among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial*

    Science.gov (United States)

    Parcesepe, Angela M.; L'Engle, Kelly L.; Martin, Sandra L.; Green, Sherri; Sinkele, William; Suchindran, Chirayath; Speizer, Ilene S.; Mwarogo, Peter; Kingola, Nzioki

    2016-01-01

    Aims To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya. Design Randomized controlled trial. Setting HIV prevention drop-in centers in Mombasa, Kenya. Participants 818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively). Intervention 6 session alcohol harm reduction intervention. Comparator 6 session non-alcohol related nutrition intervention. Measurements In-person interviews were conducted at enrollment, immediately post-intervention and 6-months post-intervention. General linear mixed models examined associations between intervention assignment and recent violence (physical violence, verbal abuse, and being robbed in the past 30 days) from paying and non-paying sex partners and engagement in sex work in the past 30 days. Findings The alcohol intervention was associated with statistically significant decreases in physical violence from paying partners at 6 months post-intervention and verbal abuse from paying partners immediately post-intervention and 6-months post-intervention. Those assigned to the alcohol intervention had significantly reduced odds of engaging in sex work immediately post-intervention and 6-months post-intervention. Conclusions The alcohol intervention was associated with reductions in some forms of violence and with reductions in engagement in sex work among FSWs in Mombasa, Kenya. PMID:26872880

  13. Self-harm

    Science.gov (United States)

    Self-harm refers to a person's harming their own body on purpose. About 1 in 100 people hurts ... females hurt themselves than males. A person who self-harms usually does not mean to kill himself or ...

  14. EFFECTIVENESS OF DIALECTICAL BEHAVIOR THERAPY VERSUS COLLABORATIVE ASSESSMENT AND MANAGEMENT OF SUICIDALITY TREATMENT FOR REDUCTION OF SELF-HARM IN ADULTS WITH BORDERLINE PERSONALITY TRAITS AND DISORDER-A RANDOMIZED OBSERVER-BLINDED CLINICAL TRIAL.

    Science.gov (United States)

    Andreasson, Kate; Krogh, Jesper; Wenneberg, Christina; Jessen, Helle K L; Krakauer, Kristine; Gluud, Christian; Thomsen, Rasmus R; Randers, Lasse; Nordentoft, Merete

    2016-06-01

    Many psychological treatments have shown effect on reducing self-harm in adults with borderline personality disorder. There is a need of brief psychotherapeutical treatment alternative for suicide prevention in specialized outpatient clinics. The DiaS trial was designed as a pragmatic single-center, two-armed, parallel-group observer-blinded, randomized clinical superiority trial. The participants had at least two criteria from the borderline personality disorder diagnosis and a recent suicide attempt (within a month). The participants were offered 16 weeks of dialectical behavior therapy (DBT) versus up to 16 weeks of collaborative assessment and management of suicidality (CAMS) treatment. The primary composite outcome was the number of participants with a new self-harm (nonsuicidal self-injury [NSSI] or suicide attempt) at week 28 from baseline. Other exploratory outcomes were: severity of borderline symptoms, depressive symptoms, hopelessness, suicide ideation, and self-esteem. At 28 weeks, the number of participants with new self-harm in the DBT group was 21 of 57 (36.8%) versus 12 of 51 (23.5%) in the CAMS treatment (OR: 1.90; 95% CI: 0.80-4.40; P = .14). When assessing the effect of DBT versus CAMS treatment on the individual components of the primary outcome, we observed no significant differences in the number of NSSI (OR: 1.60; 95% CI: 0.70-3.90; P = .31) or number of attempted suicides (OR: 2.24; 95% CI: 0.80-7.50; P = .12). In adults with borderline personality traits and disorder and a recent suicide attempt, DBT does not seem superior compared with CAMS for reduction of number of self-harm or suicide attempts. However, further randomized clinical trials may be needed. © 2016 Wiley Periodicals, Inc.

  15. Exploring the relationship between treatment satisfaction, perceived improvements in functioning and well-being and gambling harm reduction among clients of pathological gambling treatment programs.

    Science.gov (United States)

    Monnat, Shannon M; Bernhard, Bo; Abarbanel, Brett L L; St John, Sarah; Kalina, Ashlee

    2014-08-01

    The objective of this study was to evaluate the relationship between treatment service quality, perceived improvement in social, functional, and material well-being and reduction in gambling behaviors among clients of Nevada state-funded pathological gambling treatment programs. Utilizing survey data from 361 clients from 2009 to 2010, analyses revealed that client satisfaction with treatment services is positively associated with perceived improvements in social, functional, and material well-being, abstinence from gambling, reduction in gambling thoughts and reduction in problems associated with gambling, even after controlling for various respondent characteristics. These findings can be useful to treatment program staff in managing program development and allocating resources.

  16. Cigarette users' interest in using or switching to electronic nicotine delivery systems for smokeless tobacco for harm reduction, cessation, or novelty: a cross-sectional survey of US adults.

    Science.gov (United States)

    Berg, Carla J; Haardoerfer, Regine; Escoffery, Cam; Zheng, Pinpin; Kegler, Michelle

    2015-02-01

    We examined: (a) current (past 30-day) smokers' interest in using or switching to electronic nicotine delivery systems (ENDS) or smokeless tobacco for various reasons; (b) correlates of interest in these products; and (c) subgroups of current smokers in relation to interest in these products. We conducted a cross-sectional survey assessing sociodemographics, tobacco use, interest in ENDS and smokeless tobacco among smokers, and knowledge about ENDS among 2,501 US adults recruited through an online consumer panel. We oversampled tobacco users (36.7% current cigarette smokers), ethnic minorities, and southeastern US state residents. On average, participants were more interested in ENDS than smokeless tobacco across all reasons provided. Additionally, they were less interested in either product because of their potential use in places prohibiting smoking or due to curiosity and more interested in reducing health risk or cigarette consumption or to aid in cessation. We documented high rates (27.9%) of misbeliefs about Food and Drug Administration approval of ENDS for cessation, particularly among current smokers (38.5%). Also, 27.2% of current smokers had talked with a health care provider about ENDS, with 18.0% reporting that their provider endorsed ENDS use for cessation. Furthermore, cluster analyses revealed 3 groups distinct in their interest in the products, sociodemographics, and smoking-related characteristics. This study highlights higher interest in ENDS versus smokeless tobacco and greater interest in both for harm reduction and cessation than due to novelty or smoking restrictions. Developing educational campaigns and informing practitioners about caveats around ENDS as cessation or harm reduction aids are critical. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  17. Self Harm - Cutting

    Science.gov (United States)

    ... Wellness Emotional Well-Being Mental Health Self Harm — Cutting Self Harm — Cutting Share Print It’s difficult to watch your child ... their pain, such as in the case of cutting. Cutting (sometimes called self harm) is the act ...

  18. Deliberate Self Harm Behavior

    Directory of Open Access Journals (Sweden)

    Fatma Gul Helvaci Celik

    2017-06-01

    Full Text Available The deliberate self-harm behaviour which defined as attempting to own body resulting in tisue damage without conscious desire of peolple to die, is a major public health problem worldwide. The causes of deliberate self- harm, risk factors, the relationship between mental disorders and treatment strategies are not fully known. Deliberate self- harm can be observed together with psychiatric disorders such as borderline personality disorder, histrionic personality disorder, eating disorders and mood disorders. Also, deliberate self-harm must be distinguished from suicidal behavior. Psychologi-cal trauma has been suggested as a risk factor for deliberate self- harm behavior. Trauma and traumatic events have long been associated with deliberate self- harm behavior. The aim of this review article is to investigate the etiology and epidemiology of deliberate self-harm behaviour and relationship between psychiatric disorders. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2017; 9(2.000: 209-226

  19. DETECÇÃO E QUANTIFICAÇÃO DE AFLATOXINAS EM AMOSTRAS DE GRÃOS DE AMENDOIM E DERIVADOS COMERCIALIZADOS NA REGIÃO DE MARÍLIA – SP, 2002-2009

    Directory of Open Access Journals (Sweden)

    Rosângela Aguilar da SILVA

    2013-01-01

    Full Text Available O objetivo do trabalho foi analisar retrospectivamente a ocorrência e a quantidade de aflatoxinas B1 , B2 , G1 e G2 em amostras de grãos de amendoim e derivados coletadas em estabelecimentos comerciais da região de Marília, Estado de São Paulo, no período 2002-2009. Entre as 75 amostras analisadas, 12 (16% continham ní- veis detectáveis de aflatoxinas (≥ 2 μg/Kg pelo método de cromatografia em camada delgada, sendo 4 amostras de amendoim e 8 amostras de paçoca. A aflatoxina do tipo B1 foi detectada em todas estas amostras isoladamente ou em combinação com os tipos B2 , G1 , e G2. Embora a frequência de detecção de aflatoxinas em amendoim e derivados no presente estudo tenha sido relativamente baixa, a continuidade e a otimização do controle de qualidade pela cadeia produtiva e das ações governamentais para avaliação da qualidade destes produtos são essenciais para evitar riscos à saúde do consumidor e prejuízos econômicos.

  20. Self-Harm

    Science.gov (United States)

    ... find treatment for the underlying emotions. Treatment and Coping There are effective treatments for self-harm that ... a Member Create an Account Donate Take the stigma free Pledge What Can I Do? Share Your ...

  1. Harmful Algal Bloom Webinar

    Science.gov (United States)

    The problem is complex. Excessive nitrogen and phosphorous levels can cause harmful algal blooms. Different algal/cyanobacteria strains bloom under different conditions. Different strains produce different toxins at varying amounts.

  2. Cutting and Self-Harm

    Science.gov (United States)

    ... Your feelings Feeling sad Cutting and self-harm Cutting and self-harm Self-harm, sometimes called self- ... There are many types of self-injury, and cutting is one type that you may have heard ...

  3. Mitigating the Harmful Effects of Violent Television

    Science.gov (United States)

    Rosenkoetter, Lawrence I.; Rosenkoetter, Sharon E.; Ozretich, Rachel A.; Acock, Alan C.

    2004-01-01

    In an effort to minimize the harmful effects of violent TV, a yearlong intervention was undertaken with children in Grades 1 through 3 (N = 177). The classroom-based intervention consisted of 31 brief lessons that emphasized the many ways in which television distorts violence. As hypothesized, the intervention resulted in a reduction in children's…

  4. Cutting Class Harms Grades

    Science.gov (United States)

    Taylor, Lewis A., III

    2012-01-01

    An accessible business school population of undergraduate students was investigated in three independent, but related studies to determine effects on grades due to cutting class and failing to take advantage of optional reviews and study quizzes. It was hypothesized that cutting classes harms exam scores, attending preexam reviews helps exam…

  5. The effect of paranoia on the judging of harmful events.

    Science.gov (United States)

    Freeman, Daniel; Evans, Nicole; Černis, Emma; Lister, Rachel; Dunn, Graham

    2015-01-01

    Social psychological research has indicated that intentional harm may be perceived as causing greater damage than unintentional harm. It has been proposed that this harm magnification is a consequence of a need to blame, condemn and punish ("blame motivation"). The objective of the current study was to replicate these findings and to test whether such judgements about harmful events are associated with the level of an individual's paranoia. Three hundred adults read a scenario in which a head of a company causes a reduction in employees' pay. Participants were randomly allocated to versions in which the outcome of the executive's action was intended or unintended. Ratings were made of intent, harm caused and blame motivation. Participants also completed assessments of paranoia and anxiety. Intentional harm was judged as causing worse outcomes than unintentional harm, explaining a small amount of variance in harm scores. Paranoia moderated judgements of intent and blame motivation but not the degree of harm caused; high paranoia, relative to low paranoia, was associated with the unintentional scenario generating higher attributions of intent and blame and the intentional scenario generating lower attributions of intent and blame. Anxiety levels did not affect judgements. The study supports the theory that there is a reasoning bias that magnifies the consequences of intentional harm relative to unintentional harm. In the initial judgement about intent, people with paranoia are less accurate in their use of contextual information.

  6. Environmentally harmful subventions in the Federal Republic of Germany. Updating for the year 2016; Umweltschaedliche Subventionen in Deutschland. Aktualisierte Ausgabe 2016

    Energy Technology Data Exchange (ETDEWEB)

    Koeder, Lea; Burger, Andreas

    2016-12-15

    The contribution on environmentally harmful subventions in the Federal Republic of Germany (Updating for the year 2016) includes the following issues: Why the reduction of environmentally harmful subventions is necessary; subventions and related processes; international initiatives for the reduction of environmentally harmful subventions, routes for the reduction of environmentally harmful subventions.

  7. A computerized harm minimization prevention program for alcohol misuse and related harms: randomized controlled trial.

    Science.gov (United States)

    Vogl, Laura; Teesson, Maree; Andrews, Gavin; Bird, Kevin; Steadman, Bronwyn; Dillon, Paul

    2009-04-01

    Hazardous alcohol use is a leading cause of death among adolescents and young adults world-wide, yet few effective prevention interventions exist. This study was the first to examine a computerized harm minimization intervention to reduce alcohol misuse and related harms in adolescents. Cluster randomized controlled trial of a six-session curriculum-integrated harm minimization prevention program. The intervention was delivered by computer in the form of a teenage drama, which provided education through alcohol-related scenarios to which young people could relate. Schools in Australia. A total of 1466 year 8 students (13 years) from 16 high schools in Australia were allocated randomly to a computerized prevention program (n = 611, eight schools) or usual classes (n = 855, eight schools). Change in knowledge, alcohol use, alcohol-related harms and alcohol expectancies. A computerized prevention program was more effective than usual classes in increasing alcohol-related knowledge of facts that would inform safer drinking choices and decreasing the positive social expectations which students believed alcohol may afford. For females it was effective in decreasing average alcohol consumption, alcohol-related harms and the frequency of drinking to excess (more than four standard drinks; 10 g ethanol). For males the behavioural effects were not significant. A harm minimization approach is effective in educating young people about alcohol-related risks and is effective in reducing risky drinking and harms among girls. Reduction of problems among boys remains a challenge.

  8. Is incest harmful?

    Science.gov (United States)

    Henderson, J

    1983-02-01

    Classically, incest has been considered from both a psychological and sociological point of view to have harmful consequences. Genetic research, though by no means lacking controversy of its own, generally supports the notion that inbreeding has untoward genetic consequences. The psychodynamics of all three parties to father-daughter incest seem to indicate that people who become involved in incestuous behaviour are often psychologically damaged before the fact, so that if they show subsequent evidence of psychological impairment the incestuous behaviour can be as plausibly viewed as a dysfunctional attempt at solving problems as it can a cause of subsequent psychopathology. Girls involved in the father-daughter incest present in one of half a dozen frequent clinical syndromes. The presentation is influenced by the degree to which the girl may have participated in ongoing incestuous behaviour as opposed to being the presumed victim of an older adult's coercive actions or her own temporary suspension of a behavioural taboo. Research is inconclusive as to the psychological harmfulness of incestuous behaviour, and evidence is reviewed on both sides of this complicated and controversial question. Quite apart from the general issue of the harmfulness of incest, a number of indicators can be derived from the nature of the incestuous episode and the early response to therapeutic assessment which aid in the clinical forecasting of probable outcome.

  9. Total Liability for Excessive Harm

    OpenAIRE

    Cooter, Robert; Porat, Ariel

    2005-01-01

    The harm that each individual causes others is unverifiable in some circumstances where the total harm caused by everyone is verifiable. For example, the environmental agency can often measure the total harm caused by pollution much easier than it can measure the harm caused by each individual polluter. In these circumstances, implementing the usual liability rules or externality taxes is impossible. We propose a novel solution: Hold each participant in the activity responsible for all of the...

  10. European rating of drug harms.

    Science.gov (United States)

    van Amsterdam, Jan; Nutt, David; Phillips, Lawrence; van den Brink, Wim

    2015-06-01

    The present paper describes the results of a rating study performed by a group of European Union (EU) drug experts using the multi-criteria decision analysis model for evaluating drug harms. Forty drug experts from throughout the EU scored 20 drugs on 16 harm criteria. The expert group also assessed criteria weights that would apply, on average, across the EU. Weighted averages of the scores provided a single, overall weighted harm score (range: 0-100) for each drug. Alcohol, heroin and crack emerged as the most harmful drugs (overall weighted harm score 72, 55 and 50, respectively). The remaining drugs had an overall weighted harm score of 38 or less, making them much less harmful than alcohol. The overall weighted harm scores of the EU experts correlated well with those previously given by the UK panel. The outcome of this study shows that the previous national rankings based on the relative harms of different drugs are endorsed throughout the EU. The results indicates that EU and national drug policy measures should focus on drugs with the highest overall harm, including alcohol and tobacco, whereas drugs such as cannabis and ecstasy should be given lower priority including a lower legal classification. © The Author(s) 2015.

  11. [What is self-harm?].

    Science.gov (United States)

    Sommerfeldt, Bente; Skårderud, Finn

    2009-04-16

    The aim with this article is to provide an introduction to self-harm as a clinical phenomenon, with phenomenological descriptions and definitions, and by presenting risk factors, epidemiological data and functions of self-harm. The basis for the article is a non-systematic literature search of the electronic databases Medline, PsychInfo and EMBASE (1985 - 2008). and our own archive of literature on self-harm. There is some evidence for an increase in the prevalence of self-harm. Among possible risk factors are childhood abuse, abandonment, neglect, trauma and separation, and the affective quality of the attachment bonds in childhood. A common factor is self-harm as a bodily practice for affect regulation, and as such, it can be understood as a dysfunctional competence. To search for understanding of self-harm in individual, familiar and cultural contexts contributes to meet individuals with such tendencies with empathy and beneficial interventions.

  12. Smokeless tobacco: the epidemiology and politics of harm.

    Science.gov (United States)

    Phillips, Carl V; Heavner, Karyn K

    2009-07-01

    The health burden from tobacco smoking results almost entirely from inhalation of the components of smoke, although this is not widely known. The primary benefit of smoking is nicotine delivery, but nicotine can be obtained without combustion. Thus there is potential for tobacco harm reduction (THR), the substitution of lower-risk nicotine products for smoking. Epidemiological evidence suggests that smokeless tobacco causes about one one-hundredth the health risk of smoking. Despite the practice of harm reduction being widely accepted in public health, however, THR has faced fierce opposition from antitobacco activists. These activists have effectively misled the public about what aspect of smoking cigarettes causes the harm, convincing them that nicotine and tobacco themselves are harmful, ignoring the smoke. In the interests of promoting public health and rescuing science from politics, experts on inhalation hazards and health could play an important role in educating the public and policy makers about THR.

  13. Harmful Materials and Residential Demolition

    Science.gov (United States)

    Certain harmful or problematic materials present in residential buildings may need to be handled differently from general demolition debris. Here is a list of several specific types of materials that may be present in residential buildings.

  14. Harm expectancy violation during exposure therapy for posttraumatic stress disorder.

    Science.gov (United States)

    de Kleine, Rianne A; Hendriks, Lotte; Becker, Eni S; Broekman, Theo G; van Minnen, Agnes

    2017-06-01

    Exposure therapy has proven efficacy in the treatment of posttraumatic stress disorder (PTSD). Emotional processing theory proposes that fear habituation is a central mechanism in symptom reduction, but the empirical evidence supporting this is mixed. Recently it has been proposed that violation of harm expectancies is a crucial mechanism of action in exposure therapy. But to date, changes in harm expectancies have not been examined during exposure therapy in PTSD. The goal of the current study was to examine harm expectancy violation as mechanism of change in exposure therapy for posttraumatic stress disorder (PTSD). Patients (N=50, 44 female) with a primary diagnosis of chronic PTSD received intensive exposure therapy. Harm expectancies, harm experiences and subjective units of distress (SUDs) were assessed at each imaginal exposure session, and PTSD symptoms were assessed pre- and posttreatment with the Clinician Administered PTSD Scale (CAPS). Results showed that harm expectancies were violated within and strongly declined in-between exposure therapy sessions. However, expectancy violation was not related to PTSD symptom change. Fear habituation measures were moderately related to PTSD symptom reductions. In line with theory, exposure therapy promotes expectancy violation in PTSD patients, but this is not related to exposure therapy outcome. More work is warranted to investigate mechanisms of change during exposure therapy in PTSD. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Vulnerability to self-harm in autism

    National Research Council Canada - National Science Library

    Paula-Perez, I; Artigas-Pallares, J

    2016-01-01

    ... lead persons with autism to harm themselves. In this article a distinction is drawn, first of all, between self-harm related to neurodevelopmental disorders, such as autism, and self-harm linked to other psychiatric conditions...

  16. 2011 John M. Eisenberg Patient Safety and Quality Awards. The Henry Ford Health System No Harm Campaign: a comprehensive model to reduce harm and save lives. innovation in patient safety and quality at the local level.

    Science.gov (United States)

    Conway, William A; Hawkins, Susan; Jordan, Jack; Voutt-Goos, Mary J

    2012-07-01

    In 2008 Henry Ford Health System launched its "No Harm Campaign," designed to integrate harm-reduction interventions into a systemwide initiative and, ultimately, to eliminate harm from the health care experience. The No Harm Campaign aims to decrease harm events through enhancing the system's culture of safety by reporting and studying harm events, researching causality, identifying priorities, and redesigning care to eliminate harm. The campaign uses a comprehensive set of 27 measures for harm reduction, covering infection-, medication-, and procedure-related harm, as well as other types of harm, all of which are combined to comprise a unique global harm score. The campaign's objective is to reduce all-cause harm events systemwide by 50% by 2013. A wide range of communication processes, from systemwide leadership retreats to daily e-mail news sent to all employees and physicians, is used to promote the campaign. In addition, the campaign is on the intranet "Knowledge Wall," where monthly dashboards, meeting minutes, and best practices and the work of our teams and collaboratives are documented and shared. From 2008 through 2011, a 31% reduction in harm events and an 18% reduction in inpatient mortality occurred systemwide. Building infrastructure, creating a culture of safety, providing employee training and education, and improving work process design are critical to systemwide implementation of harm-reduction efforts. Key actions for ongoing success focus on leadership, disseminating performance, putting everyone to work, and stealing ideas through national and local collaborations. A financial model was created to assess cost-savings of reducing harm events; early results total nearly $10 million in four years.

  17. Managing Product-Harm Crises

    NARCIS (Netherlands)

    H.J. van Heerde (Harald); K. Helsen; M.G. Dekimpe (Marnik)

    2005-01-01

    textabstractProduct-harm crises are among a firm’s worst nightmares. Since marketing investments may be instrumental to convince consumers to purchase the firm's products again, it is important to provide an adequate measurement of the effectiveness of these investments, especially after the crisis.

  18. Harm minimization among teenage drinkers

    DEFF Research Database (Denmark)

    Jørgensen, Morten Hulvej; Curtis, Tine; Christensen, Pia Haudrup

    2007-01-01

    . In regulating the social context of drinking they relied on their personal experiences more than on formalized knowledge about alcohol and harm, which they had learned from prevention campaigns and educational programmes. CONCLUSIONS: In this study we found that teenagers may help each other to minimize alcohol...

  19. Vaccinations given during pregnancy, 2002-2009: a descriptive study.

    Science.gov (United States)

    Naleway, Allison L; Kurosky, Samantha; Henninger, Michelle L; Gold, Rachel; Nordin, James D; Kharbanda, Elyse O; Irving, Stephanie; Craig Cheetham, T; Nakasato, Cynthia; Glanz, Jason M; Hambidge, Simon J; Davis, Robert L; Klein, Nicola P; McCarthy, Natalie L; Weintraub, Eric

    2014-02-01

    A number of studies have described influenza vaccination coverage during pregnancy but few publications have described rates of other vaccinations. To describe vaccination rates during pregnancy in the Vaccine Safety Datalink (VSD), with particular focus on vaccinations contraindicated during pregnancy. Pregnancies ending in 2002 through 2009 and vaccinations administered during these pregnancies were identified in the VSD. Vaccination rates per 1000 pregnancies during the study period were calculated by vaccine type, recommendation category, pregnancy year, maternal age, and trimester. Analyses were conducted in 2012-2013. In the VSD, 669,695 pregnancies and 141,389 vaccinations were identified. Trivalent inactivated influenza (TIV) was the most commonly administered vaccination (174.1 doses per 1000 pregnancies) and was most often administered during the 2nd and 3rd trimesters. The most common vaccines in the "consider if indicated" category were tetanus-diphtheria (6.1 per 1000) and hepatitis B (3.7 per 1000). Contraindicated vaccination was infrequent, and the majority of these were measles-mumps-rubella (MMR) (1.2 per 1000); varicella (1.0 per 1000); and live-attenuated influenza vaccine (LAIV) (0.3 per 1000). Both "consider if indicated" and contraindicated vaccines were more frequently administered during early pregnancy. TIV was the most commonly administered vaccine. With the exception of TIV, other vaccines were most frequently administered during early pregnancy and among younger women, suggesting that vaccination may occur when the woman and/or provider are unaware of the pregnancy. Contraindicated vaccines were infrequently administered during pregnancy; however, given that some women received contraindicated vaccines later in pregnancy, clearer recommendations and improved provider education may be needed. © 2013 American Journal of Preventive Medicine Published by American Journal of Preventive Medicine All rights reserved.

  20. Injection of Pharmaceuticals Designed for Oral Use: Harms Experienced and Effective Harm Reduction Through Filtration.

    Science.gov (United States)

    McLean, Stuart; Patel, Rahul; Bruno, Raimondo

    Several pharmaceutical products are liable to 'abuse' or use outside their prescription, which frequently involves their injection. Examples are slow-release forms of morphine and oxycodone, and sublingual buprenorphine. During injection preparation, the drug is extracted into water, after crushing and heating the tablet if considered necessary. Since these products are designed for oral administration, they can contain excipients (ingredients other than the drug) which are poorly soluble, resulting in suspension of particles in the injection solution. Injected particles are able to produce medical complications such as the blockage of small blood vessels leading to ischaemia (inadequate blood flow) and tissue damage. Filtration can be used to remove particles from the suspension; including bacteria if the porosity is small enough (0.2 μm). However, filters are liable to blockage when overloaded, especially if the pore size is small. This problem can be minimised by using a larger pore size (e.g. 5-10 μm), but the resulting filtrate will contain many residual small particles. The use of two filters, coarse and fine, either sequentially or in a double membrane device, enables removal of the majority of particles as well as bacteria, although not quite meeting pharmaceutical standards for safe injection. Although not yet evaluated by a clinical trial, this highly effective filtration process would be expected to greatly reduce the risk of vascular and related complications, as well as non-viral infections. Careful technique ensures that drug is not lost by filtration, a priority for most drug consumers. Practical issues that affect acceptability of filtration by injecting drug users, including ease of use and cost, will need to be considered. However, given the laboratory evidence demonstrating the effectiveness of filters it is time to consider these tools as essential for safe injection as sterile needles/syringes for the world's approximately 16 million people who inject drugs.

  1. Alcohol Control and Harm Reduction Policies in Lebanon | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Findings will document the current national alcohol policy and identify the direct and indirect influences of policy-relevant factors and psychosocial mediators on alcohol consumption and purchasing. Researchers will also assess the potential impact of specific alcohol-control policy packages. The results should help to ...

  2. Condomless Sex: Gay Men, Barebacking, and Harm Reduction

    Science.gov (United States)

    Shernoff, Michael

    2006-01-01

    Social science research as well as a rise in sexually transmitted diseases and new HIV infections among men who have sex with men point to increasing numbers of gay men engaging in unprotected anal intercourse without condoms, a practice called "barebacking." There is some evidence that barebacking is linked to the rise of crystal methamphetamine…

  3. The fast and furious : Cocaine, amphetamines and harm reduction

    NARCIS (Netherlands)

    J-P.C. Grund (Jean-Paul); P. Coffin (Philip); M. Jauffret-Roustide (Marie); M. Dijkstra (Minke); D. de Bruin (Dick); P. Blanken (Peter)

    2010-01-01

    textabstractCocaine and amphetamines (‘stimulants’) are distinct central nervous system stimulants with similar effects (Pleuvry, 2009; Holman, 1994). Cocaine is a crystalline tropane alkaloid extracted from coca leaves. Amphetamines are a subclass of phenylethylamines with primarily stimulant

  4. Monitoring harm reduction in European prisons via the Dublin Declaration.

    Science.gov (United States)

    Lines, Rick; Stöver, Heino; Donochoe, Martin C; Lazarus, Jeffrey V

    2009-01-01

    The Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia is the key policy document on HIV/AIDS in the European Region as a whole Among the Declaration's 33 actions for governments are many that apply to prison populations. Based upon an analysis of these commitments, and a review of the current status of states in meeting those targets, it is clear that the scale-up of HIV/AIDS prevention and treatment programmes and services in prisons lags far behind what is needed, what is available outside of prisons, and what is mandated within the Declaration itself.

  5. Global Fund investments in harm reduction from 2002 to 2009

    DEFF Research Database (Denmark)

    Bridge, Jamie; Hunter, Benjamin M; Atun, Rifat

    2012-01-01

    Injecting drug use has been documented in 158 countries and is a major contributor to HIV epidemics. People who inject drugs have poor and inequitable access to HIV services. The Global Fund to Fight AIDS, Tuberculosis and Malaria is the leading multilateral donor for HIV programmes and encourages...

  6. Benefits and harms of endoscopic screening for gastric cancer.

    Science.gov (United States)

    Hamashima, Chisato

    2016-07-28

    Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries except in South Korea and Japan. Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated, such evidence remains weak because it is based on results from studies other than randomized controlled trials. Specifically, evidence was mostly based on the results of cohort and case-control studies mainly conducted in South Korea and Japan. However, the consistent positive results from these studies suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. The major harms of endoscopic screening include infection, adverse effects, false-positive results, and overdiagnosis. Despite the possible harms of endoscopic screening, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered when cancer screening is introduced as a public policy. Quality assurance is very important for the implementation of cancer screening to provide high-quality and safe screening and minimize harms. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further evaluation to reliably establish its effectiveness and optimal use.

  7. Balancing harms in support of recovery.

    Science.gov (United States)

    Sykes, Michael J; Brabban, Alison; Reilly, Joe

    2015-06-01

    Harm in mental health has traditionally been viewed as "unambiguous" and measured in terms of suicide, self-harm, self-neglect and violence. In order to develop an organisational patient safety strategy, one Trust engaged with service users, carers and senior clinicians and managers in order to understand how they define harm. To explore the meaning of harm in a mental health and learning disabilities setting. This paper describes the outcome of service improvement work with service users, carers, senior clinicians and managers at one Trust to determine what harm meant to them. Harm is a concept which is broader than elements currently seen within organisational patient safety metrics and clinical risk assessments. Taking into account the diverse feedback received about what constitutes harm, a more inclusive definition emerges which could be incorporated into a new framework for risk management, balancing risk of harms across multiple dimensions. This approach has the potential to bring together consideration of the risk and recovery agendas.

  8. Pregnancy Cravings Can Harm Your Oral Health

    Science.gov (United States)

    ... About | Contact InfoBites Quick Reference Learn more Children's Oral Health How Do I Care for My Child's Baby ... your desktop! more... Pregnancy Cravings Can Harm Your Oral Health Article Chapters Pregnancy Cravings Can Harm Your Oral ...

  9. Secondary harm mitigation: A more humanitarian framework for international drug law enforcement.

    Science.gov (United States)

    Blaustein, Jarrett; McLay, Miki; McCulloch, Jude

    2017-08-01

    This article introduces the concept of 'secondary harm mitigation' as a framework for improving the humanitarian credentials of international drug law enforcement agencies. The concept is rooted in a critical analysis of the compatibility of the harm reduction philosophy with Australia's international drug law enforcement practices. On a utilitarian level, the net benefits of international drug law enforcement are determined to be, at best inconclusive, arguably counterproductive and in most cases, incalculable. On a humanitarian level, international drug law enforcement is also determined to be problematic from a criminological standpoint because it generates secondary harms and it is indifferent to the vulnerability of individuals who participate in illicit drug trafficking. Accordingly, the article concludes that a philosophy of harm reduction grounded in the public health perspective is inadequate for mitigating secondary harms arising from Australia's efforts to combat international illicit drug trafficking. A tentative list of secondary harm mitigation principles is presented and the article argues that secondary harm mitigation should replace supply reduction as a core tenet of Australia's National Drug Strategy. The article also concludes that secondary harm mitigation may provide a viable framework for stimulating a productive dialogue between those who advocate prohibition and those who call for decriminalisation at the global level. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Gambling-related harms among adolescents: a population-based study.

    Science.gov (United States)

    Raisamo, Susanna; Halme, Jukka; Murto, Antti; Lintonen, Tomi

    2013-03-01

    Internationally, and also in Europe, adolescent gambling is increasingly recognized as an important public health issue. Most research on adolescent gambling, however, is prevalence-focused and population-based studies are scarce. Few studies have examined gambling-related harms among adolescents. In a national sample, we examined self-experienced harms related to gambling and the relationship between reported harms and gambling behavior among Finnish adolescents. A national survey of 12-18-year-olds was conducted in Finland in 2011 (N = 4,566). Main measures were frequency of gambling and gambling-related harms reported during the past 6 months. The relationship between reported harms and gambling behavior was assessed using logistic regression analysis. Overall, 44% had gambled during the past 6 months. Of the sample, 12% were frequent gamblers (at least weekly) and 32% were occasional gamblers (monthly or less often). Compared to occasional gamblers, frequent gamblers were more likely to experience harms. The most commonly reported harms among frequent gamblers were "felt guilty or shameful due to gambling" (17%) followed by "problems with relationships" (13%) and "disruptions of daily rhythm" (10%). In age and gender-adjusted analysis, daily gamblers were significantly more likely to report all different types of harms when compared to other groups. These findings suggest that when planning and targeting youth gambling prevention and harm reduction strategies the nature and extent to which gambling may contribute to the different types of harms are important to consider.

  11. Increasing the benefits and reducing the harms of prescription opioid analgesics.

    Science.gov (United States)

    Hallinan, Richard; Osborn, Mary; Cohen, Milton; Dobbin, Malcolm; Wodak, Alex

    2011-05-01

    Consumption of prescription opioid analgesics (POAs) in Australia has increased steadily in recent years, raising concerns of increasing harms including overdose and dependence, as has occurred in the USA. Exposition of the Royal Australasian College of Physicians Prescription Opioid Policy with reference to the published literature, drawing out principles for harm reduction for psychoactive pharmaceutical drugs. Complex professional, patient, regulatory and market factors influence health professionals balancing the benefits and harms of POAs. Owing to the potential for diversion, overlapping markets probably exist for pharmaceutical opioids used for populations with cancer pain, chronic non-cancer pain, and people dependent on pharmaceutical and illicit opioids (including those needing opioid substitution treatment). Attempts to reduce or restrict supply in one area may increase demand in others. There is a need to consider new harm reduction strategies for people with problematic pharmaceutical opioid use. These people are demographically not well characterised, and may be distinct from the more familiar population of injection drug users. Harm reduction is a valid approach for POAs. However, the role of health professionals as gatekeepers of opioid supply, the need to optimise health benefits of POAs, and the likely interplay of complex market forces among populations consuming opioids have no close parallel in harm reduction for other substances. This poses fundamentally different challenges. Reducing inappropriate supply and demand for POAs while maximising their benefits and minimising their harms may improve health outcomes. © 2011 Australasian Professional Society on Alcohol and other Drugs.

  12. Number needed to treat (or harm).

    Science.gov (United States)

    Tramèr, Martin R; Walder, Bernhard

    2005-05-01

    The effect of a treatment versus controls may be expressed in relative or absolute terms. For rational decision-making, absolute measures are more meaningful. The number needed to treat, the reciprocal of the absolute risk reduction, is a powerful estimate of the effect of a treatment. It is particularly useful because it takes into account the underlying risk (what would happen without the intervention?). The number needed to treat tells us not only whether a treatment works but how well it works. Thus, it informs health care professionals about the effort needed to achieve a particular outcome. A number needed to treat should be accompanied by information about the experimental intervention, the control intervention against which the experimental intervention has been tested, the length of the observation period, the underlying risk of the study population, and an exact definition of the endpoint. A 95% confidence interval around the point estimate should be calculated. An isolated number needed to treat is rarely appropriate to summarize the usefulness of an intervention; multiple numbers needed to treat for benefit and harm are more helpful. Absolute risk reduction and number needed to treat should become standard summary estimates in randomized controlled trials.

  13. Nonsuicidal Self-Harm among Community Adolescents: Understanding the "Whats" and "Whys" of Self-Harm

    Science.gov (United States)

    Laye-Gindhu, Aviva; Schonert-Reichl, Kimberly A.

    2005-01-01

    This study examines self-harm in a community sample of adolescents. More specifically, the study identifies the prevalence and types of self-harm, elucidates the nature and underlying function of self-harm, and evaluates the relation of psychological adjustment, sociodemographic, and health-risk variables to self-harm. Self-report questionnaires…

  14. What's the Harm? Harms in Research with Adults with Intellectual Disability

    Science.gov (United States)

    McDonald, Katherine E.; Conroy, Nicole E.; Olick, Robert S.

    2017-01-01

    Scientific advances can improve the lives of adults with intellectual disability, yet concerns that research participation may impose harm impede scientific progress. What counts as harmful can be subjective and perceptions of harm may vary among stakeholders. We studied perspectives on the harmfulness of research events among adults with…

  15. Benzodiazepine harm: how can it be reduced?

    Science.gov (United States)

    Lader, Malcolm

    2014-02-01

    The benzodiazepines (BZDs) are anxiolytics, hypnotics, anticonvulsants, muscle-relaxants and induce anaesthesia. Adverse effects comprise sedation subjectively and cognitive and psychomotor impairment objectively. Complex skills such as driving can be compromised. Paradoxical excitement can have forensic implications. Long term use beyond the licensed durations is common but both efficacy and adverse effects associated with this have been poorly documented. Withdrawal and dependence have excited particular concern, and even polemic. Perhaps a third of long term (beyond 6  months) users experience symptoms and signs on attempting to withdraw - anxiety, insomnia, muscle spasms and tension and perceptual hypersensitivity. Uncommonly, fits or a psychosis may supervene. The patterns following withdrawal vary widely. The usual method of withdrawal is slow tapering but it may not obviate the problems completely. BZDs are also drugs of abuse either on their own or in conjunction with opioids and stimulants. Claims have been made that the use of BZDs is associated with increased mortality. This is a concern in view of the widespread usage of these drugs, particularly in the elderly. All of these factors impinge on the risk : benefit ratio and the severity of the indications. Harm reduction should focus on choice of alternative treatments both psychological and pharmacological. Guidelines emphasise that BZDs are not drugs of first choice and should only be used short term. Schedules are available to educate about methods of withdrawal in current users, emphasising the slow rate of taper. General principles of harm minimization in the addiction field are appropriate to BZD abuse. © 2012 The Author. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  16. Students as effective harm reductionists and needle exchange organizers.

    Science.gov (United States)

    Barbour, Kyle; McQuade, Miriam; Brown, Brandon

    2017-03-17

    Needle exchange programs are safe, highly effective programs for promoting health among people who inject drugs. However, they remain poorly funded, and often illegal, in many places worldwide due to fear and stigma surrounding drug use. Continued advocacy, education, and implementation of new needle exchanges are thus essential to improve public health and reduce structural inequality. We argue that students, and especially professional and graduate students, have the potential to play an important role in advancing harm reduction. Students benefit from the respect given to the professions they are training to enter, which gives them leverage to navigate the political hurdles often faced by needle exchange organizers, especially in areas that presently lack services. In addition, due to their relative simplicity, needle exchanges do not require much of the licensing, clinical knowledge, and infrastructure associated with more traditional student programs, such as student-run free medical clinics. Students are capable of learning harm reduction cultural approaches and techniques if they remain humble, open-minded, and seek the help of the harm reduction community. Consequently, students can generate tremendous benefits to their community without performing beyond their appropriate clinical limitations. Students benefit from organizing needle exchanges by gaining applied experience in advocacy, organization-building, and political finesse. Working in a needle exchange significantly helps erode stigma against multiple marginalized populations. Students in health-related professions additionally learn clinically-relevant knowledge that is often lacking from their formal training, such as an understanding of structural violence and inequality, root causes of substance use, client-centered approaches to health services, and interacting with clients as peers, rather than through the standard hierarchical medical interaction. We therefore encourage students to learn about

  17. What is the harm in harmful conception? On threshold harms in non-identity cases.

    Science.gov (United States)

    Williams, Nicola J; Harris, John

    2014-10-01

    Has the time come to put to bed the concept of a harm threshold when discussing the ethics of reproductive decision making and the legal limits that should be placed upon it? In this commentary, we defend the claim that there exist good moral reasons, despite the conclusions of the non-identity problem, based on the interests of those we might create, to refrain from bringing to birth individuals whose lives are often described in the philosophical literature as 'less than worth living'.

  18. Valoración de los usuarios de un programa de reducción de daños integrado en un ambulatorio de drogodependencias Users´ perception of a harm reduction program in an outpatient drug dependency treatment center

    Directory of Open Access Journals (Sweden)

    Constanza Daigre

    2010-12-01

    Full Text Available Objetivos: Explorar la perspectiva de los usuarios y analizar los factores que influyen en su vinculación en un programa de reducción de daños (REDAN que presta los siguientes servicios: intercambio de jeringuillas, espacio educativo de calor y café, programa de mantenimiento con metadona, sala de consumo higiénico supervisado, espacio para la higiene personal y seguimiento sanitario y psicosocial. Este programa presenta la particularidad de estar integrado en un ambulatorio de drogodependencias situado en un recinto hospitalario. Métodos: Estudio descriptivo realizado con metodología cualitativa. Se realizó un muestreo teórico. Se saturaron los contenidos mediante 12 entrevistas en profundidad y un grupo focal con ocho participantes. El análisis de la información se basó en la Grounded Theory. Las transcripciones literales fueron codificadas descriptivamente y luego se generaron categorías amplias. Este procedimiento se realizó en un principio por tres investigadores y finalmente un cuarto investigador trianguló la información. Resultados: Emergen cinco dimensiones (accesibilidad, servicios, relación, localización e identidad compuestas por diferentes temas valorados desde las expectativas y experiencias de los usuarios. La dimensión «identidad» otorga un elemento distintivo respecto a la vinculación con el programa. Conclusión: En general, los usuarios valoran positivamente el programa REDAN. Respecto a la vinculación, describen aspectos facilitadores y otros deficitarios que pueden suponer barreras, frente a las cuales realizan sugerencias. Aspectos como la convivencia entre los usuarios del programa REDAN y los pacientes en tratamiento orientado a la abstinencia generan ambivalencia, pero se identifica que la gestión por parte del equipo minimiza estas dificultades.Objectives: We analyzed the perspective of users enrolled in a harm reduction program that provides syringe exchange, an educational room for «warmth and

  19. Perceiving the agency of harmful agents: A test of dehumanization versus moral typecasting accounts.

    Science.gov (United States)

    Khamitov, Mansur; Rotman, Jeff D; Piazza, Jared

    2016-01-01

    It is clear that harmful agents are targets of severe condemnation, but it is much less clear how perceivers conceptualize the agency of harmful agents. The current studies tested two competing predictions made by moral typecasting theory and the dehumanization literature. Across six studies, harmful agents were perceived to possess less agency than neutral (non-offending) and benevolent agents, consistent with a dehumanization perspective but inconsistent with the assumptions of moral typecasting theory. This was observed for human targets (Studies 1-2b and 4-5) and corporations (Study 3), and across various gradations of harmfulness (Studies 3 and 4). Importantly, denial of agency to harmful agents occurred even when controlling for perceptions of the agent's likeability (Studies 2a and 2b) and while using two different operationalizations of agency (Study 2a). Study 5 showed that harmful agents are denied agency primarily through an inferential process, and less through motivations to see the agent punished. Across all six studies, harmful agents were deemed less worthy of moral standing as a consequence of their harmful conduct and this reduction in moral standing was mediated through reductions in agency. Our findings clarify a current tension in the moral cognition literature, which have direct implications for the moral typecasting framework. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Risk of harm: inmates who harm themselves while in prison psychiatric treatment.

    Science.gov (United States)

    Young, Myla H; Justice, Jerald V; Erdberg, Philip

    2006-01-01

    In this study, 242 randomly selected male offenders who were receiving psychiatric treatment in prison were administered psychological and neuropsychological evaluations and were followed during their treatment in a prison psychiatric hospital. Offenders who harmed themselves in treatment were compared to those who did not harm themselves. Eighteen percent of offenders harmed themselves, the severity of which required medical intervention. Young age, drug abuse, absence of Axis I mental disorder but presence of Axis II borderline personality disorder identified offenders who harmed themselves. Psychopathy checklist-revised (PCL-R) total rating > or = 30 and PCL-R Factor 2 (antisocial lifestyle) rating also identified offenders who harmed themselves. Additionally, offenders who harmed themselves also were 8.36 times more likely than their cohorts to harm treatment staff. Theoretical understanding of offenders who harm themselves, the importance of considering the environmental context in identifying risk factors for self-harm, and implications for treatment are suggested.

  1. The OECD's Report on Harmful Tax Competition

    OpenAIRE

    Weiner, JoAnn M.; Hugh J. Ault

    1998-01-01

    In response to pressures created by the increasing globalization of the world economy, the OECD has issued a report titled "Harmful Tax Competition: An Emerging Global Issue" that provides an analysis of the phenomenon known as harmful tax competition. The Report identifies factors that characterize tax havens and harmful preferential tax regimes and recommends numerous measures in the areas of domestic legislation, tax treaties, and international cooperation, that countries may pursue to cou...

  2. Profissionais do sexo: perfil socioepidemiológico e medidas de redução de danos Profesionales del sexo: perfil socioepidemiológico y medidas de reducción de daños Sex workers: socioepidemiologic profile and measurements of harm reduction

    Directory of Open Access Journals (Sweden)

    Neiva de Alencar Salmeron

    2012-01-01

    estas mujeres tengan perspectivas de mejoría de vida, valorizando y respetando la individualidad.OBJECTIVES: To identify the socioepidemiologic profile of sex workers and to establish measures to reduce harm. METHODS: A descriptive, exploratory study, conducted with 50 sex workers from five nightclubs in São Paulo, with the use of a questionnaire. The data were presented in the form of tables and figures. During data collection, measures of harm reduction were adopted. RESULTS: The results showed that the age ranged between 21 and 41 years, the subject received between R $ 1,001.00 and R $ 3,000.00. Regarding personal history, 28% resulted in at least one abortion, and had, on average, 15 weekly programs. It was observed that 68% used some type of drug, and 86% had used the morning after pill. CONCLUSIONS: A behavioral change can be influenced by the environment, by information, but this was not sufficient to change their attitudes. It is necessary that these women have perspectives of a better life, valuing and respecting their individuality.

  3. The Scientometric Bubble Considered Harmful.

    Science.gov (United States)

    Génova, Gonzalo; Astudillo, Hernán; Fraga, Anabel

    2016-02-01

    This article deals with a modern disease of academic science that consists of an enormous increase in the number of scientific publications without a corresponding advance of knowledge. Findings are sliced as thin as salami and submitted to different journals to produce more papers. If we consider academic papers as a kind of scientific 'currency' that is backed by gold bullion in the central bank of 'true' science, then we are witnessing an article-inflation phenomenon, a scientometric bubble that is most harmful for science and promotes an unethical and antiscientific culture among researchers. The main problem behind the scenes is that the impact factor is used as a proxy for quality. Therefore, not only for convenience, but also based on ethical principles of scientific research, we adhere to the San Francisco Declaration on Research Assessment when it emphasizes "the need to eliminate the use of journal-based metrics in funding, appointment and promotion considerations; and the need to assess research on its own merits rather on the journal in which the research is published". Our message is mainly addressed to the funding agencies and universities that award tenures or grants and manage research programmes, especially in developing countries. The message is also addressed to well-established scientists who have the power to change things when they participate in committees for grants and jobs.

  4. Gambling Harm and Crime Careers.

    Science.gov (United States)

    May-Chahal, Corinne; Humphreys, Leslie; Clifton, Alison; Francis, Brian; Reith, Gerda

    2017-03-01

    Incarcerated populations across the world have been found to be consistently and significantly more vulnerable to problem gambling than general populations in the same countries. In an effort to gain a more specific understanding of this vulnerability the present study applied latent class analysis and criminal career theory to gambling data collected from a sample of English and Scottish, male and female prisoners (N = 1057). Theoretical links between gambling and crime were tested through three hypotheses: (1) that prisoners in the UK would have higher rates of problem gambling behaviour than the national population; (2) that if the link between gambling and crime is coincidental, gambling behaviour would be highly prevalent in an offending population, and (3) if connections between gambling behaviour and offending are co-symptomatic a mediating factor would show a strong association. The first of these was supported, the second was not supported and the third was partially supported. Latent class analysis found six gambling behaviour clusters measured by responses to the Problem Gambling Severity Index, primarily distinguished by loss chasing behaviour. Longitudinal offending data drawn from the Police National Computer database found four criminal career types, distinguished by frequency and persistence over time. A significant association was found between higher level loss chasing and high rate offending in criminal careers suggesting that impulse control may be a mediating factor for both gambling harm and criminal careers.

  5. Adolescent self-harm and risk factors.

    Science.gov (United States)

    Zhang, Jixiang; Song, Jianwei; Wang, Jing

    2016-12-01

    This study aims to define the characteristics of adolescents who have engaged in self-harm behavior and ascertain the risk factors. From January 2013 to January 2014, 4,176 adolescents from senior middle schools in Linyi, China, were administered four questionnaire surveys to ascertain the following: incidence of self-harm behavior regarding the frequency of different self-harm behaviors by group (never/one to five times/greater than five times in the last 6 months) and then comparing the self-harm behavior of the different subgroups; symptom self-check, comparing the differences between the adolescents with self-harm behavior and without in nine subscales (somatization, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, hostility, fear, paranoid, and psychosis); Adolescent Self-Rating Life Events Check List scores; and Egna Minnenav Barndoms Uppfostran (EMBU) scores. Multivariate logistic regression analysis was used to determine the risk factors of self-harm in adolescents. The incidence of adolescent self-harm was 27.60%; the occurrence of adolescent self-harm was closely related to their mental health status, stressful life events, and EMBU. Being female, an urban student, or an only child; having poor school performance or experiences of stressful life events, harsh parenting styles, or excessive interference; and poor mental health were the risk factors for adolescent self-harm. The incidence of adolescent self-harm was high, and their mental health status, stressful life events, and EMBU affected the occurrence of adolescent self-harm, which is an issue that needs greater attention. © 2016 John Wiley & Sons Australia, Ltd.

  6. What’s the Harm? Harms in Research with Adults with Intellectual Disability

    Science.gov (United States)

    McDonald, Katherine E.; Conroy, Nicole E.; Olick, Robert S.

    2017-01-01

    Scientific advances can improve the lives of adults with intellectual disability, yet concerns that research participation may impose harm impede scientific progress. What counts as harmful can be subjective and perceptions of harm may vary among stakeholders. We studied perspectives on the harmfulness of research events among adults with intellectual disability, family members and friends, disability service providers, researchers, and Institutional Review Board members. We found considerable variance. For example, adults with intellectual disability see exclusion from research as more harmful, but most psychosocial harms as less significant than others. All stakeholders agree that having someone else make the participation decision is harmful. Findings provide insights into the concept of harm and ethical research with adults with intellectual disability. PMID:28095059

  7. What's the Harm? Harms in Research With Adults With Intellectual Disability.

    Science.gov (United States)

    McDonald, Katherine E; Conroy, Nicole E; Olick, Robert S; Panel, The Project Ethics Expert

    2017-01-01

    Scientific advances can improve the lives of adults with intellectual disability, yet concerns that research participation may impose harm impede scientific progress. What counts as harmful can be subjective and perceptions of harm may vary among stakeholders. We studied perspectives on the harmfulness of research events among adults with intellectual disability, family members and friends, disability service providers, researchers, and Institutional Review Board members. We found considerable variance. For example, adults with intellectual disability see exclusion from research as more harmful, but most psychosocial harms as less significant than others. All stakeholders agree that having someone else make the participation decision is harmful. Findings provide insights into the concept of harm and ethical research with adults with intellectual disability.

  8. Competing for space in an already crowded market: a mixed methods study of why an online community of practice (CoP) for alcohol harm reduction failed to generate interest amongst the group of public health professionals at which it was aimed.

    Science.gov (United States)

    Ponsford, Ruth; Ford, Jennifer; Korjonen, Helena; Hughes, Emma; Keswani, Asha; Pliakas, Triantafyllos; Egan, Matt

    2017-07-21

    Improving mechanisms for knowledge translation (KT) and connecting decision-makers to each other and the information and evidence they consider relevant to their work remains a priority for public health. Virtual communities of practices (CoPs) potentially offer an affordable and flexible means of encouraging connection and sharing of evidence, information and learning among the public health community in ways that transgress traditional geographical, professional, institutional and time boundaries. The suitability of online CoPs in public health, however, has rarely been tested. This paper explores the reasons why particular online CoP for alcohol harm reduction hosted by the UK Health Forum failed to generate sufficient interest from the group of public health professionals at which it was aimed. The study utilises online web-metrics demonstrating a lack of online activity on the CoP. One hundred and twenty seven responses to an online questionnaire were used to explore whether the lack of activity could be explained by the target audience's existing information and evidence practices and needs. Qualitative interviews with 10 members describe in more detail the factors that shape and inhibit use of the virtual CoP by those at which it was targeted. Quantitative and qualitative data confirm that the target audience had an interest in the kind of information and evidence the CoP was set up to share and generate discussion about, but also that participants considered themselves to already have relatively good access to the information and evidence they needed to inform their work. Qualitative data revealed that the main barriers to using the CoP were a proliferation of information sources meaning that participants preferred to utilise trusted sources that were already established within their daily routines and a lack of time to engage with new online tools that required any significant commitment. Specialist online CoPs are competing for space in an already crowded

  9. Redução de danos e saúde pública: construções alternativas à política global de "guerra às drogas" Harm reduction and public health: building alternatives to global policy of "war on drugs"

    Directory of Open Access Journals (Sweden)

    Eduardo Henrique Passos

    2011-04-01

    Full Text Available A Redução de Danos (RD vem se consolidando como um importante movimento nacional, impulsionando a construção de uma política de drogas democrática. Neste artigo destacaremos o modo como a RD se constituiu frente aos embates com as forças totalitárias da política global de "guerra às drogas". Enfocaremos tanto aspectos internacionais quanto aspectos nacionais que confluíram para a construção de uma política antidrogas. É dentro desse cenário político que a RD vem se consolidando como uma outra política de drogas possível. Analisaremos como a inclusão dos usuários de drogas em arranjos coletivos de gestão é uma importante direção clínica e política do movimento da RD, definindo uma nova proposta de atenção em saúde. A partir desses espaços coletivos de cuidado, os usuários de drogas puderam tecer uma rede nacional de cooperação e de produção de uma luta comum.Harm Reduction (HR has been consolidated as an important national movement, promoting the building of a democratic drug policy. In this article we will highlight how HR has been shaped in the face of clashes with totalitarian forces of the "war on drugs" global policy. We will focus on both international and national aspects that came together to build an anti-drug policy. It is within this political scenario that HR is consolidating itself as a different and feasible drug policy. We intend to show the extent to which the inclusion of drug users in collective arrangements of management is an important clinical and political direction of the HD movement, defining a new proposal for health care. From these collective spaces of care, drug users have been able to weave a national network of cooperation and production of a common struggle.

  10. Harm and benefits of short-term pre-operative radiotherapy in patients with resectable rectal carcinomas

    NARCIS (Netherlands)

    Bakx, R.; Emous, M.; Legemate, D. A.; Zoetmulder, F. A. N.; van Tienhoven, G.; Bemelman, W. A.; van Lanschot, J. J. B.

    2006-01-01

    AIM: To weigh the harms and benefits of short-term pre-operative radiotherapy in the treatment of resectable rectal cancer. METHODS: The benefits (reduction of local recurrence) and harm (increase of short-term complications) of short-term pre-operative radiotherapy are balanced using a model which

  11. Physical harm due to chronic substance use

    NARCIS (Netherlands)

    van Amsterdam, Jan; Pennings, Ed; Brunt, Tibor; van den Brink, Wim

    2013-01-01

    Chronic use at high dose of illicit drugs, alcohol and tobacco is associated with physical disease. The relative physical harm of these substances has not been described before, but will benefit the guiding of policy measures about licit and illicit substances. The physical harm of 19 addictive

  12. Practitioner Review: Self-Harm in Adolescents

    Science.gov (United States)

    Ougrin, Dennis; Tranah, Troy; Leigh, Eleanor; Taylor, Lucy; Asarnow, Joan Rosenbaum

    2012-01-01

    Background: Repeated self-harm in adolescents is common and associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm there have been few systematic reviews of the topic. Aims: The main aim of this article is to review randomised controlled…

  13. Why Do Adolescents Self-Harm?

    Science.gov (United States)

    Rasmussen, Susan; Hawton, Keith; Philpott-Morgan, Sion; O'Connor, Rory C

    2016-05-01

    Given the high rates of self-harm among adolescents, recent research has focused on a better understanding of the motives for the behavior. The present study had three aims: to investigate (a) which motives are most frequently endorsed by adolescents who report self-harm; (b) whether motives reported at baseline predict repetition of self-harm over a 6-month period; and (c) whether self-harm motives differ between boys and girls. In all, 987 school pupils aged 14-16 years completed a lifestyle and coping questionnaire at two time points 6 months apart that recorded self-harm and the associated motives. The motive "to get relief from a terrible state of mind" was the most commonly endorsed reason for self-harm (in boys and girls). Interpersonal reasons (e.g., "to frighten someone") were least commonly endorsed. Regression analyses showed that adolescents who endorsed wanting to get relief from a terrible state of mind at baseline were significantly more likely to repeat self-harm at follow-up than those adolescents who did not cite this motive. The results highlight the complex nature of self-harm. They have implications for mental health provision in educational settings, especially in relation to encouraging regulation of emotions and help-seeking.

  14. Violent Self-Harm in Schizophrenia

    Science.gov (United States)

    Symonds, Catherine S.; Taylor, Steve; Tippins, Val; Turkington, Douglas

    2006-01-01

    Patients with schizophrenia have a substantial lifetime suicide risk, especially by violent means. Little published work exists on self-harm (SH) in this population. The goal of this study was to examine whether patients with schizophrenia were also more likely to self-harm in a violent manner. A retrospective analysis performed on method, motive,…

  15. Alcohol and self-harm in Anuradhapura

    DEFF Research Database (Denmark)

    Sørensen, Jane Brandt; Jayasena, Chandima; Agampodi, Thilini Chanchala

    the personal network of the drinker and lead to secondary traumatization. This can appear as emotional distress, financial difficulties and lead to domestic violence and in some cases self-harm and suicide. This interplay between alcohol and self-harm was investigated in individuals, families and communities...... in the Anuradhapura area. Objectives: The objective of this study was to explore alcohol’s role in cases of self-harm in individuals, families and communities. Methods: A qualitative, exploratory study, was conducted utilizing: (i) serial, narrative, life-story interviews with 19 individuals (12 men and 7 women...... drinking to social, occasional and even first time drinking. All women had alcohol indirectly involved in their case of self-harm through the negative effects of a relative’s drinking. Findings indicate that two categories of the alcohol-self-harm complex exist, with different characteristics for men...

  16. Deprivation as un-experienced harm?

    DEFF Research Database (Denmark)

    Keerus, Külli; Gjerris, Mickey; Röcklinsberg, Helena

    2017-01-01

    Tom Regan encapsulated his principle of harm as a prima facie direct duty not to harm experiencing subjects of a life. However, his consideration of harm as deprivation, one example of which is loss of freedom, can easily be interpreted as a harm, which may not be experienced by its subject....... This creates a gap between Regan’s criterion for moral status and his account of what our duties are. However, in comparison with three basic paradigms of welfare known in nonhuman animal welfare science, Regan’s understanding coheres with a modified version of a feelings-based paradigm: not only the immediate...... feelings of satisfaction, but also future opportunities to have such feelings, must be taken into account. Such an interpretation is compatible with Regan’s understanding of harm as deprivation. The potential source of confusion, however, lies in Regan’s own possible argumentative mistakes....

  17. Alcohol's Harm to Children: Findings from the 2015 United States National Alcohol's Harm to Others Survey.

    Science.gov (United States)

    Kaplan, Lauren M; Nayak, Madhabika B; Greenfield, Thomas K; Karriker-Jaffe, Katherine J

    2017-05-01

    To examine the prevalence and severity of alcohol's harm to children in the US and the relationship of the harmer to the child, and to examine caregivers' sociodemographic characteristics, alcohol use, and exposure to harm due to a drinking spouse/partner or other family member as risk factors for alcohol's harm to children. We report data on 764 caregivers (defined as persons with parental responsibility for at least 1 child aged ≤17 years) from the 2015 National Alcohol's Harm to Others Survey, a dual-frame national sample of US adults. Overall 7.4% of caregivers reported alcohol's harm to children in the past year. Risk factors for alcohol's harm to children included the caregiver's own experience of alcohol's harm from a spouse/partner or other family member. Caregivers with a heavy drinker in the household were significantly more likely to report harm to children. A caregiver's own heavy drinking was not a significant risk factor for children in his or her care. Alcohol places a substantial burden on children in the US. Although a caregiver's own drinking can harm children, other drinkers also increase the risk of alcohol's harm to children. Screening caregivers to determine whether there is a heavy drinker in the household may help reduce alcohol's harm in the family without stigmatizing caregivers, who themselves may not be heavy drinkers. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. [Vulnerability to self-harm in autism].

    Science.gov (United States)

    Paula-Perez, I; Artigas-Pallares, J

    2016-01-01

    The reasons underlying self-harm in persons with autism do not appear to have a single, straightforward and simple explanation. Biological predisposition, certain psychological states involving stress, atypical sensory processing, communication disorders, medical problems, and limited emotional regulation, among others, can lead persons with autism to harm themselves. In this article a distinction is drawn, first of all, between self-harm related to neurodevelopmental disorders, such as autism, and self-harm linked to other psychiatric conditions. Second, a preliminary approach to an integrated model for the understanding of self-harm in autism is proposed. Some of the hypotheses put forward to account for self-harm in autism are focused on atypical sensory processing, on communication disorders and medical problems, and on emotional dysregulation. The limited number of studies conducted in this area and the inconsistency of the data resulting from them have led to great efforts being made to separate the facts from the suppositions in this subject. This modest initial proposal makes it possible to draw up a roadmap to guide and help persons with autism, their families and professionals in the process of reducing or eliminating this behaviour. It is suggested that self-harm should no longer be considered a disruptive behaviour and that it should be interpreted instead as an (inadequate) self-regulatory response to stress.

  19. Digital Self-Harm Among Adolescents.

    Science.gov (United States)

    Patchin, Justin W; Hinduja, Sameer

    2017-12-01

    Despite increased media and scholarly attention to digital forms of aggression directed toward adolescents by their peers (e.g., cyberbullying), very little research has explored digital aggression directed toward oneself. "Digital self-harm" is the anonymous online posting, sending, or otherwise sharing of hurtful content about oneself. The current study examined the extent of digital self-harm among adolescents. Survey data were obtained in 2016 from a nationally representative sample of 5,593 American middle and high school students (12-17 years old). Logistic regression analysis was used to identify correlates of participation in digital self-harm. Qualitative responses were also reviewed to better understand motivations for digital self-harm. About 6% of students have anonymously posted something online about themselves that was mean. Males were significantly more likely to report participation (7.1% compared to 5.3%). Several statistically significant correlates of involvement in digital self-harm were identified, including sexual orientation, experience with school bullying and cyberbullying, drug use, participation in various forms of adolescent deviance, and depressive symptoms. Digital self-harm is a new problem that demands additional scholarly attention. A deeper inquiry as to the motivations behind this behavior, and how it correlates to offline self-harm and suicidal ideation, can help direct mental health professionals toward informed prevention approaches. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  20. Efficient emissions reduction

    OpenAIRE

    Roussillon, Beatrice; Schweinzer, Paul

    2010-01-01

    We propose a simple mechanism capable of achieving international agreement on the reduction of harmful emissions to their efficient level. It employs a contest creating incentives among participating nations to simultaneously exert efficient productive and efficient abatement efforts. Participation in the most stylised formulation of the scheme is voluntary and individually rational. All rules are mutually agreeable and are unanimously adopted if proposed. The scheme balances its budget and r...

  1. Mammography screening. Benefits, harms, and informed choice

    DEFF Research Database (Denmark)

    Jørgensen, Karsten Juhl

    2013-01-01

    that would otherwise never have been detected because they grow very slowly or not at all and would not have been detected in the woman's lifetime in the absence of screening. Screening therefore turns women into cancer patients unnecessarily, with life-long physical and psychological harms. The debate about...... exaggerates benefits, participation is directly recommended, and the harms are downplayed or left out, despite agreement that the objective is informed choice. This raises an ethical discussion concerning autonomy versus paternalism, and the difficulty in weighing benefits against harms. Finally, financial......, political, and professional conflicts of interest are discussed, as well as health economics....

  2. [Self-harm in fiction literature].

    Science.gov (United States)

    Skårderud, Finn

    2009-04-16

    European literature contains fictional descriptions of self-harm and self-punishment over a time span of almost 2 500 years. This article presents such descriptions, from Sofocles' tragedy about King Oedipus to contemporary literature. Particular interest is dedicated to the Austrian Nobel prize laureate Elfriede Jelinek and the Norwegian author Karl Ove Knausgård. In Jelinek's fictional universe, self-harm is particularly related to the topic of autonomy in a family context; while Knausgård describes the role of shame in triggering and sustaining self-harming behaviour.

  3. Suicide Following Deliberate Self-Harm.

    Science.gov (United States)

    Olfson, Mark; Wall, Melanie; Wang, Shuai; Crystal, Stephen; Gerhard, Tobias; Blanco, Carlos

    2017-08-01

    The authors sought to identify risk factors for repeat self-harm and completed suicide over the following year among adults with deliberate self-harm. A national cohort of Medicaid-financed adults clinically diagnosed with deliberate self-harm (N=61,297) was followed for up to 1 year. Repeat self-harm per 1,000 person-years and suicide rates per 100,000 person-years (based on cause of death information from the National Death Index) were determined. Hazard ratios of repeat self-harm and suicide were estimated by Cox proportional hazard models. During the 12 months after nonfatal self-harm, the rate of repeat self-harm was 263.2 per 1,000 person-years and the rate of completed suicide was 439.1 per 100,000 person-years, or 37.2 times higher than in a matched general population cohort. The hazard of suicide was higher after initial self-harm events involving violent as compared with nonviolent methods (hazard ratio=7.5, 95% CI=5.5-10.1), especially firearms (hazard ratio=15.86, 95% CI=10.7-23.4; computed with poisoning as reference), and to a lesser extent after events of patients who had recently received outpatient mental health care (hazard ratio=1.6, 95% CI=1.2-2.0). Compared with self-harm patients using nonviolent methods, those who used violent methods were at significantly increased risk of suicide during the first 30 days after the initial event (hazard ratio=17.5, 95% CI=11.2-27.3), but not during the following 335 days. Adults treated for deliberate self-harm frequently repeat self-harm in the following year. Patients who use a violent method for their initial self-harm, especially firearms, have an exceptionally high risk of suicide, particularly right after the initial event, which highlights the importance of careful assessment and close follow-up of this group.

  4. Perioperative glucocorticoids in hip and knee surgery - benefit vs. harm?

    DEFF Research Database (Denmark)

    Lunn, T H; Kehlet, H

    2013-01-01

    Glucocorticoids are frequently used to prevent post-operative nausea and vomiting (PONV), and may be part of multimodal analgesic regimes. The objective of this review was to evaluate the overall benefit vs. harm of perioperative glucocorticoids in patients undergoing hip or knee surgery. A wide......-analysis was performed. In conclusion, in addition to PONV reduction with low-dose systemic glucocorticoid, this review supports high-dose systemic glucocorticoid to ameliorate post-operative pain after hip and knee surgery. However, large-scale safety and dose-finding studies are warranted before final recommendations....

  5. Impact of Inpatient Harms on Hospital Finances and Patient Clinical Outcomes.

    Science.gov (United States)

    Adler, Lee; Yi, David; Li, Michael; McBroom, Barry; Hauck, Loran; Sammer, Christine; Jones, Cason; Shaw, Terry; Classen, David

    2015-03-23

    The aim of this study was to determine the impact of all-cause inpatient harms on hospital finances and patient clinical outcomes. A retrospective analysis of inpatient harm from 24 hospitals in a large multistate health system was conducted during 2009 to 2012 using the Institute of Healthcare Improvement Global Trigger Tool for Measuring Adverse Events. Inpatient harms were detected and categorized into harm (F-I), temporary harm (E), and no harm. Of the 21,007 inpatients in this study, 15,610 (74.3%) experienced no harm, 2818 (13.4%) experienced temporary harm, and 2579 (12.3%) experienced harm. A patient with harm was estimated to have higher total cost ($4617 [95% confidence interval (CI), $4364 to 4871]), higher variable cost ($1774 [95% CI, $1648 to $1900]), lower contribution margin (-$1112 [95% CI, -$1378 to -$847]), longer length of stay (2.6 d [95% CI, 2.5 to 2.8]), higher mortality probability (59%; odds ratio, 1.4 [95% CI, 1.0 to 2.0]), and higher 30-day readmission probability (74.4%; odds ratio, 2.9 [95% CI, 2.6 to 3.2]). A patient with temporary harm was estimated to have higher total cost ($2187 [95% CI, $2008 to $2366]), higher variable cost ($800 [95% CI, $709 to $892]), lower contribution margin (-$669 [95% CI, -$891 to -$446]), longer length of stay (1.3 d [95% CI, 1.2 to 1.4]), mortality probability not statistically different, and higher 30-day readmission probability (54.6%; odds ratio, 1.2 [95% CI, 1.1 to 1.4]). Total health system reduction of harm was associated with a decrease of $108 million in total cost, $48 million in variable cost, an increase of contribution margin by $18 million, and savings of 60,000 inpatient care days. This all-cause harm safety study indicates that inpatient harm has negative financial outcomes for hospitals and negative clinical outcomes for patients.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible

  6. Thalassiosira mala (Bacillariophyta), a potentially harmful, marine ...

    Indian Academy of Sciences (India)

    Thalassiosira malaitalic> (Bacillariophyta), a potentially harmful, marine diatom from Chilka Lake and other coastal localities of Odisha, India: Nomenclature, ... Department of Biological Science, Florida State University, Tallahassee, FL 32306–4370, USA; Department of Biology, Valdosta State University, Valdosta, GA ...

  7. Hurtful Emotions: Understanding Self-Harm

    Science.gov (United States)

    ... Issues Subscribe September 2017 Print this issue Hurtful Emotions Understanding Self-Harm En español Send us your ... help you learn new ways to cope with emotion. See the Wise Choices box for tips on ...

  8. Vision Problems Can Harm Kids' Development, Grades

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_167475.html Vision Problems Can Harm Kids' Development, Grades Eye experts ... toll on children's school performance and well-being, vision experts say. If left untreated, certain eye-related ...

  9. Climate Adaptation and Harmful Algal Blooms

    Science.gov (United States)

    EPA supports local, state and tribal efforts to maintain water quality. A key element of its efforts is to reduce excess nutrient pollution and the resulting adverse impacts, including harmful algal blooms.

  10. Some Prostate Drugs May Do Harm

    Science.gov (United States)

    ... https://medlineplus.gov/news/fullstory_166950.html Some Prostate Drugs May Do Harm Hormone-based meds linked ... Popular hormone-based drugs for treating an enlarged prostate could increase men's risk of type 2 diabetes, ...

  11. Factsheet: Climate Change and Harmful Algal Blooms

    Science.gov (United States)

    Climate change is predicted to change many environmental conditions that could affect the properties of fresh and marine waters. These changes could favor the growth of harmful algal blooms and habitat changes.

  12. Executive Compensation and Misconduct: Environmental Harm

    OpenAIRE

    Minor, Dylan Blu

    2016-01-01

    We explore the relationship between managerial incentives and misconduct using the setting of environmental harm. We find that high powered executive compensation can increase the odds of environmental law-breaking by 40-60% and the magnitude of environmental harm by over 100%. We document similar results for the setting of executive compensation and illegal financial accounting. Finally, we outline some managerial and policy implications to blunt these adverse incentive effects.

  13. Deliberate self-harm (and attempted suicide)

    OpenAIRE

    Soomro, G Mustafa

    2008-01-01

    Deliberate self-harm involves acts such as self-cutting or self-poisoning, carried out deliberately, with or without the intention of committing suicide. Lifetime prevalence of deliberate self-harm in Europe and the USA is about 3% to 5% of the population, and is increasing.Familial, biological and psychosocial factors may contribute. Risks are higher in women and young adults, in people who are socially isolated or deprived, and those with psychiatric or personality disorders.

  14. Deliberate self-harm (and attempted suicide)

    OpenAIRE

    Soomro, G. Mustafa; Kakhi, Sara

    2015-01-01

    Deliberate self-harm involves acts such as self-cutting or self-poisoning, carried out deliberately, with or without the intention of suicide. Lifetime prevalence of deliberate self-harm in Europe and the US is about 3% to 5% of the population, and has been increasing.Familial, biological, and psychosocial factors may contribute. Risks are higher in women and young adults, in people who are socially isolated or deprived, and in those with psychiatric or personality disorders.

  15. Self-harm and suicide in adolescents.

    Science.gov (United States)

    Hawton, Keith; Saunders, Kate E A; O'Connor, Rory C

    2012-06-23

    Self-harm and suicide are major public health problems in adolescents, with rates of self-harm being high in the teenage years and suicide being the second most common cause of death in young people worldwide. Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social, and cultural factors. The effects of media and contagion are also important, with the internet having an important contemporary role. Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted initiatives focused on high-risk groups. There is little evidence of effectiveness of either psychosocial or pharmacological treatment, with particular controversy surrounding the usefulness of antidepressants. Restriction of access to means for suicide is important. Major challenges include the development of greater understanding of the factors that contribute to self-harm and suicide in young people, especially mechanisms underlying contagion and the effect of new media. The identification of successful prevention initiatives aimed at young people and those at especially high risk, and the establishment of effective treatments for those who self-harm, are paramount needs. Copyright © 2012 Elsevier Ltd. All rights reserved.

  16. Authority dependence and judgments of utilitarian harm.

    Science.gov (United States)

    Piazza, Jared; Sousa, Paulo; Holbrook, Colin

    2013-09-01

    Three studies tested the conditions under which people judge utilitarian harm to be authority dependent (i.e., whether its right or wrongness depends on the ruling of an authority). In Study 1, participants judged the right or wrongness of physical abuse when used as an interrogation method anticipated to yield useful information for preventing future terrorist attacks. The ruling of the military authority towards the harm was manipulated (prohibited vs. prescribed) and found to significantly influence judgments of the right or wrongness of inflicting harm. Study 2 established a boundary condition with regards to the influence of authority, which was eliminated when the utility of the harm was definitely obtained rather than forecasted. Finally, Study 3 replicated the findings of Studies 1-2 in a completely different context-an expert committee's ruling about the harming of chimpanzees for biomedical research. These results are discussed as they inform ongoing debates regarding the role of authority in moderating judgments of complex and simple harm. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. 47 CFR 68.108 - Incidence of harm.

    Science.gov (United States)

    2010-10-01

    ... harm. Should terminal equipment, inside wiring, plugs and jacks, or protective circuitry cause harm to the public switched telephone network, or should the provider of wireline telecommunications...

  18. Advocacy and coverage of needle exchange programs: results of a comparative study of harm reduction programs in Brazil, Bangladesh, Belarus, Ukraine, Russian Federation, and China Advocacy e cobertura de projetos de troca de agulhas: resultados de um estudo comparativo sobre programas de redução de danos no Brasil, Bangladesh, Belarus, Ucrânia, Federação Russa e China

    Directory of Open Access Journals (Sweden)

    Dave Burrows

    2006-04-01

    Full Text Available To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs, effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex. Recent work by UNAIDS on "high coverage sites", adopting the above strategies, has shown that one of the key elements in achieving high coverage is ongoing and sophisticated advocacy. High coverage harm reduction sites were studied through literature search and site visits, including key informant interviews, review of service statistics, and data analysis, in order to document the steps that led to scaling up, the way coverage was defined in these sites, and the lessons learned from their efforts. Syringe-exchange programs can achieve high coverage of IDUs. Monitoring to determine regular reach (those who are in regular contact with harm reduction services should be added to uniform data collection carried out by harm reduction programs. Advocacy is crucial to achieving high coverage.Para prevenir ou mitigar uma epidemia de AIDS entre usuários de drogas injetáveis (UDI, atividades eficazes devem ser implementadas numa escala suficiente para atingir e ajudar um número suficiente de usuários e, portanto, modificar seus comportamentos de risco em relação ao uso de drogas e práticas sexuais. Um estudo recente do UNAIDS sobre "locais de cobertura alta", ao adotar as estratégias propostas acima, demonstrou que um dos elementos centrais para atingir uma cobertura alta é a advocacy permanente e bem-elaborada. Locais de redução de danos que apresentavam altas taxas de cobertura foram estudados através de uma revisão bibliográfica e visitas aos locais de maior cobertura, incluindo entrevistas com informantes principais, revisão de dados estatísticos dos serviços e análise de dados para poder documentar os passos que levaram à ampliação do alcance dos projetos, à defini

  19. Minimising the harm from nicotine use: finding the right regulatory framework.

    Science.gov (United States)

    Borland, Ron

    2013-05-01

    The tobacco problem can be usefully conceptualised as two problems: eliminating the most harmful forms of nicotine use (certainly cigarettes, and probably all smoked tobacco), and minimising the use and/or harms from use of lower-harm, but addictive forms of nicotine. A possible target would be to effectively eliminate use of the most harmful forms of nicotine within the next decade and then turn our focus to a long-term strategy for the low-harm forms. This paper focuses on the administrative framework(s) needed to accomplish these twin tasks. For a phase-out taking a long time and/or for dealing with residually net harmful and addictive products, there are severe limitations to allowing for-profit marketing of tobacco because such an arrangement (the current one in most countries) can markedly slow down progress and because of the difficulty of constraining marketing in ways that minimise undesirable use. A harm reduction model where the marketing is under the control of a non-profit entity (a regulated market) is required to curtail the incredible power of for-profit marketing and to allow tobacco marketing to be done in ways that further the goal of minimising tobacco-related harm. Countries with a nationalised industry can move their industry onto a harm minimisation framework if they have the political will. Countries with a for-profit industry should consider whether the time and effort required to reconstruct the market may, in the longer term, facilitate achieving their policy goals.

  20. Developing, implementing and evaluating a model for an outpatient self-harm service.

    Science.gov (United States)

    Brand, Fiona; Lascelles, Karen

    2017-05-10

    Aim To reduce the incidence of self-harming behaviour and improve well-being and experience of care for individuals who present regularly to the emergency department in one hospital following self-harm, by providing outpatient care. Method This was a 12-month nurse-led practice development project to develop, implement and evaluate a brief-intervention outpatient service for individuals who presented to the emergency department following self-harm and who were identified as being at risk of further self-harm. The service improvement was informed by an action research process and the principles of appreciative inquiry. Findings The project provided a short-term outpatient follow-up service, known as Brief Interventions in Repeat Self Harm (BIRSH), to patients who presented to the emergency department following self-harm, and who were considered at risk of further self-harm. The intervention enabled the clinician to validate the patient's distress and offer them short-term outpatient follow-up care. The BIRSH sessions were offered to 38 patients. A total of 26 patients attended one or more BIRSH session, and all of these individuals showed a reduction in the number of presentations to the emergency department following self-harm in the six months following the intervention, compared to the six months before the intervention. Conclusion The BIRSH outpatient service appears to have been a contributory factor in reducing self-harm for patients who engaged with the service. The service improvement was informed by an action research process and the principles of appreciative inquiry, which provided a positive, focused approach to the practice development project.

  1. Validation of the Short Gambling Harm Screen (SGHS): A Tool for Assessment of Harms from Gambling.

    Science.gov (United States)

    Browne, Matthew; Goodwin, Belinda C; Rockloff, Matthew J

    2017-06-03

    It is common for jurisdictions tasked with minimising gambling-related harm to conduct problem gambling prevalence studies for the purpose of monitoring the impact of gambling on the community. However, given that both public health theory and empirical findings suggest that harms can occur without individuals satisfying clinical criteria of addiction, there is a recognized conceptual disconnect between the prevalence of clinical problem gamblers, and aggregate harm to the community. Starting with an initial item pool of 72 specific harms caused by problematic gambling, our aim was to develop a short gambling harms scale (SGHS) to screen for the presence and degree of harm caused by gambling. An Internet panel of 1524 individuals who had gambled in the last year completed a 72-item checklist, along with the Personal Wellbeing Index, the PGSI, and other measures. We selected 10 items for the SGHS, with the goals of maximising sensitivity and construct coverage. Psychometric analysis suggests very strong reliability, homogeneity and unidimensionality. Non-zero responses on the SGHS were associated with a large decrease in personal wellbeing, with wellbeing decreasing linearly with the number of harms indicated. We conclude that weighted SGHS scores can be aggregated at the population level to yield a sensitive and valid measure of gambling harm.

  2. Risico meten met HARM 2.0: Harm voor belastende hand-armtaken

    NARCIS (Netherlands)

    Douwes, M.; Kraker, H. de; Bosch, T.

    2016-01-01

    Een derde van de Nederlandse werknemers voert met regelmaat herhalende bewegingen uit in het werk. Wanneer zorgt dit voor een risico op gezondheidsklachten? Bedrijven konden dat al zelf nagaan met de Hand-Arm Risicobeoordelingsmethode (HARM). Deze methode is nu verbeterd: HARM 2.0. Vakmedia

  3. Characteristics of Self-Harm Behaviour among Identified Self-Harming Youth in Care

    Science.gov (United States)

    Grenville, Jeffrey; Goodman, Deborah; Macpherson, Alison K.

    2012-01-01

    The objective of this study was to describe deliberate self-harming (DSH) characteristics in a child-welfare population identified as having threatened or completed self-harm. Secondary data from 621 serious occurrence reports (SOR) that documented 2004-2007 DSH incidents and DSH threats with 252 Canadian youth in care (Y-INC) of the Children's…

  4. Subjective Probability of Receiving Harm as a Function of Attraction and Harm Delivered.

    Science.gov (United States)

    Schlenker, Barry R.; And Others

    It was hypothesized that subjects who liked a source of potential harm would estimate the probability of receiving harm mediated by him as lower than would subjects who disliked the source. To test the hypothesis, subjects were asked to estimate the probability that a liked or disliked confederate would deliver an electric shock on each of 10…

  5. Regulating Emotion and Identity by Narrating Harm.

    Science.gov (United States)

    Pasupathi, Monisha; Billitteri, Jacob; Mansfield, Cade D; Wainryb, Cecilia; Hanley, Grace E; Taheri, Kiana

    2015-10-01

    This study examined how narration of harm experiences can regulate self and emotions in ways relevant to well-being. Participants (n = 88, 65% female) were asked to provide 6 narratives about instances when they were victims of harm and 6 narratives about instances when they were perpetrators of harm. Narratives were coded for extent of exploration, growth, damage conclusions and resolution. Participants drew damage conclusions more frequently in victim narratives and growth conclusions more frequently in perpetrator narratives. Both the type of experience (victim or perpetrator) and the way the experience was narrated (references to damage conclusions and resolution) predicted emotion and identity implications, which were, in turn, related to well-being. Implications for narrative approaches to self-regulation are discussed.

  6. Biomanipulation with quagga mussels (Dreissena rostriformis bugensis) to control harmful algal blooms in eutrophic urban ponds

    NARCIS (Netherlands)

    Waajen, Guido W. A. M.; Van Bruggen, Niek C. B.; Pires, L. Miguel Dionisio; Lengkeek, Wouter; Lurling, Miquel

    Many urban ponds in The Netherlands and other countries suffer from eutrophication, resulting in harmful algal blooms which are often dominated by cyanobacteria. A sufficient reduction of nutrients, as prerequisite to mitigate cyanobacterial blooms in urban ponds, is not always feasible. Water

  7. Biomanipulation with quagga mussels (Dreissena rostriformis bugensis) to control harmful algal blooms in eutrophic urban ponds

    NARCIS (Netherlands)

    Waajen, Guido W.A.M.; Bruggen, Van Niek C.B.; Pires, Miguel Dionisio L.; Lengkeek, Wouter; Lurling, Miguel

    2016-01-01

    Many urban ponds in The Netherlands and other countries suffer from eutrophication, resulting in harmful algal blooms which are often dominated by cyanobacteria. A sufficient reduction of nutrients, as prerequisite to mitigate cyanobacterial blooms in urban ponds, is not always feasible. Water

  8. European breast cancer service screening outcomes: a first balance sheet of the benefits and harms

    NARCIS (Netherlands)

    Paci, E.; Broeders, M.J.M.; Hofvind, S.; Puliti, D.; Duffy, S.W.

    2014-01-01

    A recent comprehensive review has been carried out to quantify the benefits and harms of the European population-based mammographic screening programs. Five literature reviews were conducted on the basis of the observational published studies evaluating breast cancer mortality reduction, breast

  9. The relationship between Australian harm minimisation alcohol education and student uptake, consumption and harm.

    Science.gov (United States)

    Midford, Richard; Lester, Leanne; Williams, Tahlia; White, Victoria

    2017-12-08

    Alcohol use by young people is a public health concern in Australia because of the disproportionate harm they experience. Accordingly, governments have sought to protect young people, with school identified as an appropriate site for drug, including alcohol, prevention through education. School-based drug education programmes, however, have not been particularly effective, and even when individual programs report prevention benefits they can be criticised for being developed and evaluated by the same group. This study involved secondary analysis of alcohol data from the 2011 and 2014 Australian Secondary Students Alcohol and Drug (ASSAD) surveys, to examine the relationship between the amount of alcohol education students reported receiving and their patterns of use and harm. Associations between the amount of alcohol education remembered and alcohol uptake, consumption, risky consumption and alcohol-related harm were measured using Logistic and Tobit regression techniques. As most alcohol education in Australia reflects harm minimisation aims, this research provides an independent, proxy assessment of the effect of harm minimisation education. In the 12- to 17-year-old student group, as a whole, there was a significant positive association between having tried alcohol and the level of alcohol education recalled. There were significant negative associations between the amount of alcohol consumed and the level of alcohol education recalled for drinkers and risky drinkers. There were no significant associations between alcohol-related harm and the level of alcohol education recalled for drinkers and risky drinkers. Providing more harm minimisation alcohol education did not persuade students to abstain from alcohol, but rather the reverse. Providing more harm minimisation education was influential in reducing consumption by students, particularly those drinking at risky levels. This should be considered indirectly beneficial in terms of minimising harm. However, the

  10. Risk prediction of product-harm events using rough sets and multiple classifier fusion : an experimental study of listed companies in China

    OpenAIRE

    Wang, Delu; Zheng, Jianping; Ma, Gang; Song, Xuefeng; Liu, Yun

    2016-01-01

    With the increasing of frequency and destructiveness of product-harm events, study on enterprise crisis management becomes essentially important, but little literature thoroughly explores the risk prediction method of product-harm event. In this study, an initial index system for risk prediction was built based on the analysis of the key drivers of the product-harm event's evolution; ultimately, nine risk-forecasting indexes were obtained using rough set attribute reduction. With the four ind...

  11. Moral Distress, Workplace Health, and Intrinsic Harm.

    Science.gov (United States)

    Weber, Elijah

    2016-05-01

    Moral distress is now being recognized as a frequent experience for many health care providers, and there's good evidence that it has a negative impact on the health care work environment. However, contemporary discussions of moral distress have several problems. First, they tend to rely on inadequate characterizations of moral distress. As a result, subsequent investigations regarding the frequency and consequences of moral distress often proceed without a clear understanding of the phenomenon being discussed, and thereby risk substantially misrepresenting the nature, frequency, and possible consequences of moral distress. These discussions also minimize the intrinsically harmful aspects of moral distress. This is a serious omission. Moral distress doesn't just have a negative impact on the health care work environment; it also directly harms the one who experiences it. In this paper, I claim that these problems can be addressed by first clarifying our understanding of moral distress, and then identifying what makes moral distress intrinsically harmful. I begin by identifying three common mistakes that characterizations of moral distress tend to make, and explaining why these mistakes are problematic. Next, I offer an account of moral distress that avoids these mistakes. Then, I defend the claim that moral distress is intrinsically harmful to the subject who experiences it. I conclude by explaining how acknowledging this aspect of moral distress should reshape our discussions about how best to deal with this phenomenon. © 2015 John Wiley & Sons Ltd.

  12. Harmful traditional practices in a newborn

    African Journals Online (AJOL)

    PROF. EZECHUKWU

    2014-11-17

    Nov 17, 2014 ... Osogbo, Western Nigeria, reported harmful cord care practices to include fomentation with hot water, lantern, and knife as well as application of menthol containing creams. Thakur and Kumar1 also reported that 74% of mothers in Ganda community, India applied paste of mustard oil and turmeric powder ...

  13. Must losing taxes on saving be harmful?

    DEFF Research Database (Denmark)

    Huizinga, Harry; Nielsen, Søren Bo

    2004-01-01

    Internationalization offers enhanced opportunities for individuals to place savingsabroad and evade domestic saving taxation. This paper asks whether the concomi-tant loss of saving taxation necessarily is harmful. To this end we construct a modelof many symmetric countries in which public goods ...

  14. Mayan Morality: An Exploration of Permissible Harms

    Science.gov (United States)

    Abarbanell, Linda; Hauser, Marc D.

    2010-01-01

    Anthropologists have provided rich field descriptions of the norms and conventions governing behavior and interactions in small-scale societies. Here, we add a further dimension to this work by presenting hypothetical moral dilemmas involving harm, to a small-scale, agrarian Mayan population, with the specific goal of exploring the hypothesis that…

  15. Hazardous, harmful and dependent drinking in hosteldwelling ...

    African Journals Online (AJOL)

    Objective: This study was conducted to determine the prevalence of hazardous, harmful and dependent drinking among hostel-dwelling students on the main campus of the University of the Free State (UFS), and the influence of sex and academic year on the habit. Method: A quarter of all hostel-dwelling students of UFS ...

  16. Summer heatwaves promote blooms of harmful cyanobacteria

    NARCIS (Netherlands)

    Jöhnk, K.D.; Huisman, J.; Sharples, J.; Sommeijer, B.; Visser, P.M.; Stroom, J.M.

    2008-01-01

    Dense surface blooms of toxic cyanobacteria in eutrophic lakes may lead to mass mortalities of fish and birds, and provide a serious health threat for cattle, pets, and humans. It has been argued that global warming may increase the incidence of harmful algal blooms. Here, we report on a lake

  17. Summer heatwaves promote blooms of harmful cyanobacteria

    NARCIS (Netherlands)

    K.D Joehnk; J. Huisman; J. Sharples; B.P. Sommeijer (Ben); P.M. Visser (Petra); J.M. Stroom

    2008-01-01

    htmlabstractDense surface blooms of toxic cyanobacteria in eutrophic lakes may lead to mass mortalities of fish and birds, and provide a serious health threat for cattle, pets, and humans. It has been argued that global warming may increase the incidence of harmful algal blooms. Here, we report on a

  18. Examination of associations between early life victimisation and alcohol's harm from others.

    Science.gov (United States)

    Kaplan, Lauren M; Greenfield, Thomas K; Karriker-Jaffe, Katherine J

    2017-08-21

    Study aims were to examine: (i) how physical and sexual victimisation in early life are associated with alcohol's harm from others; and (ii) whether respondents' current drinking is a mediator of the association between early life victimisation and alcohol's harm from others among men and women. Data were from national computer-assisted telephone interviews, using the landline sample (3335 men and 3520 women ages ≥18) from the 2010 US National Alcohol Survey. Harms from someone else's drinking included family/marital problems, financial troubles, assault and vandalism in the past 12 months. Victimisation was measured with severe physical abuse or sexual assault before age 18. Severe physical or sexual victimisation before age 18 was reported by 3.4% of men and 8.1% of women. Significantly more men (5.2%) than women (2.4%) reported assault by other drinkers, and significantly more women reported family/marital (5.3%) and financial problems (2.8%) than did men (2.6 and 1% respectively). Severe early life victimisation was robustly associated with a greater likelihood of experiencing past-year harms from other drinkers for both men and women. Men's drinking partially mediated associations between early life victimisation and recent assaults and vandalism by other drinkers. Early life victimisation may increase risk of harms from someone else's drinking. Health services and interventions that screen for histories of victimisation may help decrease risk of later harms from others' drinking. Reductions in drinking among men with histories of victimisation also could help reduce their exposure to such harms. [Kaplan LM, Greenfield TK, Karriker-Jaffe KJ. Examination of associations between early life victimisation and alcohol's harm from others. Drug Alcohol Rev 2017;00:000-000]. © 2017 Australasian Professional Society on Alcohol and other Drugs.

  19. Exploring the use and effects of deliberate self-harm websites: an Internet-based study.

    Science.gov (United States)

    Harris, Isobel Marion; Roberts, Lesley Martine

    2013-12-20

    In the United Kingdom, rates of deliberate self-harm (DSH) are rising. Alongside this, there has been an increase in the number of websites available with DSH content, and the Internet is known as a valuable resource for those who feel isolated by their condition(s). However, there is little and contradictory evidence available on the effects of using such websites. Further research is therefore required to examine the use and effects of DSH websites. Our objectives were to explore (1) the reasons people engage in the use of self-harm forums/websites, (2) the beliefs of users of self-harm forums regarding the role of such websites, (3) how the use of self-harm forums/websites modulates self-harm behaviors, and (4) other ways that self-harm forums affect the lives of individuals who use them. Data were collected by a questionnaire hosted on 20 websites with self-harm content. Participants were self-selected from users of these sites. Results were analyzed using descriptive statistics and simple thematic analysis. In total, 329 responses were received with 91.8% (302/329) from female site users. The majority of participants (65.6%, 187/285) visited these sites at least twice per week, and most participants used the sites to find information (78.2%, 223/285) or participate in the forums (68.4%, 195/285). Positive effects of website use such as gaining help and support, isolation reduction, and a reduction in self-harm behaviors were reported by a large number of participants. However, smaller but important numbers reported negative effects including worsened self-harm, being triggered to self-harm, and additional negative physical and psychological effects. This is the first multisite study to explore DSH website use in depth. There are clear and important benefits to engaging in website use for many individuals; however, these are not experienced by all website users. Negative effects were experienced by moderate numbers following website use, and clinicians should

  20. Associations between self-harm and distinct types of impulsivity.

    Science.gov (United States)

    Chamberlain, Samuel R; Redden, Sarah A; Grant, Jon E

    2017-04-01

    There is an ongoing debate regarding how self-harm should be classified. The aim of this study was to characterize associations between self-harm and impulsivity. Total 333 adults (mean [SD] age 22.6 (3.6) years, 61% male) were recruited from the general community. History of self-harm was quantified using the Self-Harm Inventory (SHI), which asks about 22 self-harm behaviors. Principal components analysis was used to identify latent dimensions of self-harming behaviors. Relationships between self-harm dimensions and other measures were characterized using ordinary least squares regression. Principal Components Analysis yielded a three factor solution, corresponding to self-injurious self-harm (e.g. cutting, overdoses, burning), interpersonal related self-harm (e.g. engaging in emotionally or sexually abusive relationships), and reckless self-harm (e.g. losing one's job deliberately, driving recklessly, abusing alcohol). Regression modelling showed that all three dimensions of self-harm were associated with lower quality of life. This study suggests the existence of three distinct subtypes or 'latent factors' of self-harm: all three appear clinically important in that they are linked with worse quality of life. Clinicians should screen for impulse control disorders in people with self-harm, especially when it is self-injurious or involves interpersonal harm. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  1. Protection of atmosphere from harmful emissions of stationary fuelburn installations

    Directory of Open Access Journals (Sweden)

    Lebedeva Еvgeniya А.

    2013-01-01

    Full Text Available The article analyzes domestic and foreign researches in the field of combustion gas cleaning from harmful matters. The drawbacks of the existing methods of cleaning emissions of small-capacity boilers are revealed. The results of the researches conducted by the authors are presented. Complex schemes of cleaning emissions of the industrial boilers of the DKVR series are considered. The results of the tests of afterburning devices installed in the industrial boilers are presented. The simplest design of an afterburning device by the example of an industrial boiler of the DKVR series is considered. It is shown that the application of the afterburning devices prevents emissions of the incomplete burning products (CO, carbon black, benzpyrene and reduces the nitric oxide content by (50-80%, depending on the scheme of cleaning. The usage of the afterburning devices improves boiler performance owing to the increase of the radiant component in a furnace chamber, reduction of heat losses, increase of efficiency.

  2. Harmful organisms in urban green areas

    Czech Academy of Sciences Publication Activity Database

    Hanousková, Irena; Boháč, Jaroslav; Sedláček, František; Šerá, Božena; Lepšová, A.; Zacharda, Miloslav

    -, č. 23 (2004), s. 58-68 ISSN 1335-342X R&D Projects: GA MŠk(CZ) OC C11.001 Grant - others:ÚEK AV ČR(CZ) OC C11.001 Program:OC Institutional research plan: CEZ:AV0Z6087904 Keywords : urban green areas, harmful organisms, management, * planning Subject RIV: AP - Urban , Regional and Transport Planning

  3. On the evolution of harming and recognition in finite panmictic and infinite structured populations

    Science.gov (United States)

    Lehmann, Laurent; Feldman, Marcus W.; Rousset, François

    2010-01-01

    Natural selection may favor two very different types of social behaviors that have costs in vital rates (fecundity and/or survival) to the actor: helping behaviors, which increase the vital rates of recipients, and harming behaviors, which reduce the vital rates of recipients. While social evolutionary theory has mainly dealt with helping behaviors, competition for limited resources creates ecological conditions where an actor may benefit from expressing behaviors that reduce the vital rates of neighbours. This may occur if the reduction in vital rates decreases the intensity of competition experienced by the actor or that experienced by its offspring. Here, we explore the joint evolution of neutral recognition markers and marker-based costly conditional harming whereby actors express harming, conditional on actor and recipient bearing different conspicuous markers. We do so for two complementary demographic scenarios: finite panmictic and infinite structured populations. We find that marker-based conditional harming can evolve under a large range of recombination rates and group sizes under both finite panmictic and infinite structured populations. Direct comparison with results for the evolution of marker-based conditional helping reveals that, if everything else is equal, marker-based conditional harming is often more likely to evolve than marker-based conditional. PMID:19624725

  4. The cost of harmful alcohol use in South Africa

    African Journals Online (AJOL)

    spending on mitigating the impact of alcohol abuse incurs significant opportunity costs .... Alcohol, the most widespread drug of abuse in SA, is the most harmful drug at a ...... Drug harms in the UK: A multicriteria decision analysis. Lancet. 2010 ...

  5. How Well Do Survey Studies Capture Alcohol's Harm to Others?

    Science.gov (United States)

    Rossow, Ingeborg

    2015-01-01

    Empirical studies assessing alcohol's harm to others very often rely on population survey data. This study addresses some of the problems and challenges in using survey data for this purpose. Such problems include the limited capacity of population surveys in identifying infrequent harm and long-term consequences of drinking. Moreover, the drinker may report the alcohol-related harm or the person being harmed may report the damage. However, irrespective of who reports the harm, causal attribution to drinking is problematic. Challenges for future population surveys to address alcohol's harm to others include the need for improved models and understanding of complex mechanisms to guide empirical studies within the broad range of harm. Study designs other than cross-sectional surveys, such as longitudinal study designs and combinations of population surveys and other data sources, are likely to overcome some of the identified problems in current population surveys of alcohol's harm to others.

  6. Doctors Who 'Fat-Shame' Patients Can Cause Real Harm

    Science.gov (United States)

    ... gov/news/fullstory_167589.html Doctors Who 'Fat-Shame' Patients Can Cause Real Harm Many patients respond ... Aug. 3, 2017 (HealthDay News) -- Doctors who "fat shame" patients do more harm than good, new research ...

  7. On Recent Developments in Fighting Harmful Tax Practices

    National Research Council Canada - National Science Library

    Gaëtan Nicodème

    2009-01-01

    ... of international standards on information exchange. This paper reviews the theoretical and empirical literature on harmful tax practices and information exchange on the size and consequences of the existence of tax havens and harmful tax regimes...

  8. prevalence of major depression in deliberate self~harm individuals

    African Journals Online (AJOL)

    2002-05-05

    harm individuals. Design. A cross sectional descriptive study. Setting. Three tertiary health care centres in Harare, Zimbabwe. Subjects: Three hundred and eighty seven deliberate self-harm consecutive subjects were recruited ...

  9. Harmful Algal Blooms – Special Sampling and Response Actions

    Science.gov (United States)

    The Harmful Algal Blooms – Special Sampling and Response Actions webpage contains information about Background on Harmful Algae in Surface Waters and What to Do if Your System Has Indicators of an Algal Bloom.

  10. Bodywork: Self-Harm, Trauma, and Embodied Expressions of Pain

    Science.gov (United States)

    Gurung, Kesherie

    2018-01-01

    Self-harm, or self-mutilation, is generally viewed in academic literature as a pathological act, usually born out of trauma and/or a psychological and personality defect. Individuals who engage in self-harm are usually seen as damaged, destructive, and pathological. While self-harm is not a desirable act, this paper argues through the narratives…

  11. Moral Complexity in Middle Childhood: Children's Evaluations of Necessary Harm

    Science.gov (United States)

    Jambon, Marc; Smetana, Judith G.

    2014-01-01

    We assessed 5-to 11-year-olds' (N = 76) judgments of straightforward moral transgressions (prototypical harm) as well as their evaluations of complex, hypothetical scenarios in which an actor transgresses in order to prevent injury (necessary harm). The nature of the actor's transgression (psychological or physical harm) varied across…

  12. Medical Harm: Patient Perceptions and Follow-up Actions.

    Science.gov (United States)

    Lyu, Heather G; Cooper, Michol A; Mayer-Blackwell, Brandan; Jiam, Nicole; Hechenbleikner, Elizabeth M; Wick, Elizabeth C; Berenholtz, Sean M; Makary, Martin A

    2017-12-01

    Much research has been conducted to describe medical mistakes resulting in patient harm using databases that capture these events for medical organizations. The objective of this study was to describe patients' perceptions regarding disclosure and their actions after harm. We analyzed a patient harm survey database composed of responses from a voluntary online survey administered to patients by ProPublica, an independent nonprofit news organization, during a 1-year period (May 2012 to May 2013). We collected data on patient demographics and characteristics related to the acknowledgment of patient harms, the reporting of patient harm to an oversight agency, whether the patient or the family obtained the harm-associated medical records, as well as the presence of a malpractice claim. There were 236 respondents reporting a patient harm (mean age, 49.1 y). In 11.4% (27/236) of harms, an apology by the medical organization or the clinician was made. In 42.8% (101/236) of harms, a complaint was filed with an oversight agency. In 66.5% (157/236) of harms, the patient or the family member obtained a copy of the pertinent medical records. A malpractice claim was reported in 19.9% (47/236) of events. In this sample of self-reported patient harms, we found a perception of inadequate apology. Nearly half of patient harm events are reported to an oversight agency, and roughly one-fifth result in a malpractice claim.

  13. Purple coneflower viruses: species diversity and harmfulness

    Directory of Open Access Journals (Sweden)

    Dunich A. A.

    2015-02-01

    Full Text Available Viral diseases became an actual problem in medicinal plants cultivation. The number of viruses known to infect purple coneflower increased significantly in the last years in many countries. However, there is no any review about the viral diseases of this valuable medicinal crop. Therefore, the aim of this article is to summarize the main information about the viruses affecting purple coneflower plants (Echinacea purpurea L. Moench.. An analysis of the literature data showed that purple coneflower could be infected by 10 viruses. These viruses belong to the families Bromoviridae, Bunyaviridae, Secoviridae, Potyviridae, Vir­ga­vi­ri­dae, and almost all of them are considered to be highly harmful plant viruses. Additionally, four of them (TMV, TSWV, CMV, PVY are in the top 10 of the most economically important plant viruses in the world and occupy the first places. Such distribution and harmfulness of these viruses are explained by a wide range of sensitive host-plants, wild plants and weeds – reservoirs of an infection, and also a large number of vectors. The data from a few countries show that the viral diseases of purple coneflower are becoming more severe from year to year. The appearance of new viruses is registered on coneflower every year that complicates prognosis and risk estimation of epiphytoties in these regions which, for example, were revealed in Bulgaria, Lithuania and Ukraine. This review presents the detailed symptoms of the viral diseases in purple coneflower, the main properties of each virus and data about their harmful effect on the quality of raw material (the concentration of biologically active substances and heavy metals in plants.

  14. Produção científica no contexto psicanalítico (2002-2009 Scientific production in the psychoanalytic context (2002-2009

    Directory of Open Access Journals (Sweden)

    Rosane Zétola Lustoza

    2010-08-01

    Full Text Available Esta pesquisa teve por objetivo analisar a produção científica no contexto psicanalítico em 229 artigos (2002 a 2009, seis periódicos científicos indexados. A análise baseou-se em alguns critérios da metaciência, a saber, autoria, temática, discurso e análise dos tipos de recursos. Os resultados evidenciaram que em alguns periódicos há maior concentração de publicações sobre a temática, acentuada nos últimos anos. A participação feminina foi predominante na autoria dos artigos, e detectou-se ampla diversificação nos propósitos e contextos nos quais a psicanálise tem sido aplicada. Conclui-se que a produção divulgada no período revela o amadurecimento da área, mas aponta para alguns aspectos que poderão ser mais explorados em futuras publicações. Sugere-se que outros estudos similares sejam realizados, visando monitorar a expansão da área no Brasil.This paper analyzes the scientific production in the psychoanalytic context published in 229 articles (2002 to 2009 from six scientific indexed periodicals. The analysis was carried out according to some metascientific criteria such as: authorship, thematic, discourse, and exam of the different types of resources. Results evinced not only a greater concentration of publications regarding psychoanalysis in certain journals, but also an increase of these types of studies recently. It was also found that most of the authors were females and the psychoanalysis were used both in a variety of contexts and with diverse purposes. It was concluded that the divulged production in the period reveals the matureness of the area, but points out some aspects that might be explored in future publications. It is recommended that similar studies be conducted in order to better monitor the expanding area in Brazil.

  15. Measuring emergency department nurses' attitudes towards deliberate self-harm using the Self-Harm Antipathy Scale.

    LENUS (Irish Health Repository)

    Conlon, Mary

    2012-01-31

    The emergency department is an important gateway for the treatment of self-harm patients. Nurses\\' attitudes towards patients who self-harm can be negative and often nurses experience frustration, helplessness, ambivalence and antipathy. Patients are often dissatisfied with the care provided, and meeting with positive or negative attitudes greatly influences whether they seek additional help. A quantitative design was utilised to measure emergency department nurses\\' attitudes towards deliberate self-harm. The \\'Self-Harm Antipathy Scale\\

  16. Does Foreign Aid Harm Political Institutions?

    DEFF Research Database (Denmark)

    Jones, Edward Samuel; Tarp, Finn

    2016-01-01

    The notion that foreign aid harms the institutions of recipient governments remains prevalent. We combine new disaggregated aid data and various metrics of political institutions to re-examine this relationship. Long run cross-section and alternative dynamic panel estimators show a small positive...... net effect of total aid on political institutions. Distinguishing between types of aid according to their frequency domain and stated objectives, we find that this aggregate net effect is driven primarily by the positive contribution of more stable inflows of ‘governance aid’. We conclude...... that the data do not support the view that aid has had a systematic negative effect on political institutions....

  17. Does foreign aid harm political institutions?

    DEFF Research Database (Denmark)

    Jones, Edward Samuel; Tarp, Finn

    The notion that foreign aid harms the institutions of recipient governments remains prevalent. We combine new disaggregated aid data and various metrics of political institutions to re-examine this relationship. Long-run cross-section and alternative dynamic panel estimators show a small positive...... net effect of total aid on political institutions. Distinguishing between types of aid according to their frequency domain and stated objectives, we find this aggregate net effect is driven primarily by the positive contribution of more stable inflows of ‘governance aid’. We conclude the data do...... not support the view that aid has had a systematic negative effect on political institutions....

  18. Brief Report: The Self Harm Questionnaire--A New Tool Designed to Improve Identification of Self Harm in Adolescents

    Science.gov (United States)

    Ougrin, Dennis; Boege, Isabel

    2013-01-01

    The Self Harm Questionnaire (SHQ) aiming at identification of self-harm in adolescents has been developed and piloted in a sample of 12-17 year olds (n = 100). The adolescents were recruited from both in- and outpatient psychiatric services. Concurrent validity of the SHQ was evaluated by comparing the SHQ results with recorded self harm in the…

  19. Breaking Bad: Comparing Gambling Harms Among Gamblers and Affected Others.

    Science.gov (United States)

    Li, En; Browne, Matthew; Rawat, Vijay; Langham, Erika; Rockloff, Matthew

    2017-03-01

    This article examines gambling harms from both gamblers and affected others' perspectives. Participants (3076 gamblers and 2129 affected others) completed a retrospective survey that elicited information on harms they experienced from gambling across their lifetime. Their responses were analyzed through testing measurement invariance, estimating item-response theoretic parameters, calculating percentages, confidence intervals, and correlations, as well as regressions. The results indicated large commonalities in the experience of harms reported by gamblers and affected others. Further, gamblers appeared to 'export' about half of the harms they experienced to those around them. The findings also provided detailed profiles of evolving harms as problem gambling severity varies.

  20. Perception of e-cigarette harm and its correlation with use among U.S. adolescents.

    Science.gov (United States)

    Amrock, Stephen M; Zakhar, Joseph; Zhou, Sherry; Weitzman, Michael

    2015-03-01

    U.S. adolescents increasingly use e-cigarettes. The perceived harm of e-cigarettes has not been described, nor has the correlation between harm perception and e-cigarette use been assessed. This study examines correlates of e-cigarette harm perception and use of e-cigarettes in a national survey. We used cross-sectional nationally representative data from the 2012 National Youth Tobacco Survey (n = 24,658). Cross-tabulations and multivariate ordered probit and logistic regression models were employed to assess relative harm perception and e-cigarette use. Half of U.S. adolescents had heard of e-cigarettes. Of these, 13.2% (95% confidence interval [CI] = 11.7-14.9) and 4.0% (95% CI = 3.4-4.7) reported ever or currently using e-cigarettes, respectively. Of those aware of e-cigarettes, 34.2% (95% CI = 32.8-35.6) believed e-cigarettes were less harmful than cigarettes. Among those trying e-cigarettes, 71.8% (95% CI = 69.0-74.5) believed e-cigarettes were comparatively less harmful. Females and those ≥ 17 years old were more likely to perceive e-cigarettes as more harmful relative to cigarettes, while on average Whites, users of other tobacco products, and those with family members who used tobacco were more likely to perceive e-cigarettes as comparatively safer. Among cigarette-naive e-cigarette users, use of other tobacco products and perceived harm reduction by e-cigarettes were, respectively, on average associated with 1.6 and 4.1 percentage-point increases in e-cigarette use. Perception of e-cigarettes as less harmful than conventional cigarettes was associated with increased e-cigarette use, including among cigarette-naive e-cigarette users. These findings should prompt further scientific investigation and merit attention from regulators. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Drug harms in the UK: a multicriteria decision analysis.

    Science.gov (United States)

    Nutt, David J; King, Leslie A; Phillips, Lawrence D

    2010-11-06

    Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK. Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm. Centre for Crime and Justice Studies (UK). Copyright © 2010 Elsevier Ltd. All rights reserved.

  2. Perceived harmfulness of substance use: A pilot study

    Directory of Open Access Journals (Sweden)

    Siddharth Sarkar

    2014-01-01

    Full Text Available Background: Harm ratings of substances help in understanding the perception toward substance use and formulating policies. Evidence of such harm ratings by substance users and their caregivers provides a clearer perspective of those who experience and observe such harm closely. Materials and Methods: Substance users and their caregivers were recruited from the Drug De-addiction and Treatment Centre of PGIMER, Chandigarh. Sociodemographic details of the subjects were noted. The subjects were then asked to rate a list of psychoactive preparations according to the harms they thought the preparation caused. The list of substances was developed taking into consideration substance commonly encountered in the geographical area. The harm ratings were transformed on a scale of 0-100. Results: All subjects were males and majority of them were educated above 10 th standard, were not employed and belonged to urban background. Most of them had taken psychoactive substances in their lifetimes but were currently abstinent. Most of the subjects endorsed intravenous drugs as the most harmful, followed by heroin. Beer and chewable tobacco considered the least harmful substances. Greater degree of education was associated with lower harm rankings for heroin, cannabis, dextropropoxyphene, and raw opium; while urban residence was associated with greater harm ratings for cannabis and raw opium. Differences in the harms were perceived for different preparations of the same active compound for alcohol and nicotine. Conclusion: Harm ratings of substances can be a useful guide while formulating policies and allocating resources. Need for further research extending this pilot study is emphasized.

  3. Harmfulness of smoking among high school students

    Directory of Open Access Journals (Sweden)

    Iwona Rotter

    2013-03-01

    Full Text Available Introduction: The aim of the study was to assess the level of awareness of smoking and non smoking students on harmful impact of nicotine and cigarette smoke on human body. Material and methods: The study was carried out in March 2011 in high schools in Szczecin. Own elaborated questionnaire was used. 288 students from high school, technical college and vocational school were tested. Results: The majority of responders (95,1% claimed that cigarette smoke is harmful both for passive and active smokers. They most often pinpoint the direct cause connected with smoking to pulmonary diseases (264 persons and cancers (240 persons. Almost 90% of students found negative impact of tobacco products on development of fetus of pregnant women. Overwhelming majority of respondents (83,2% feels anxious if it comes to stay in a room filled with smoke. Conclusions: The awareness of high school students on negative influence of smoking on human body is quite satisfactory, but there is still a need for more education in the range of diseases and symptoms connected with smoking.

  4. Trichloroacetic Acid Ingestion: Self-Harm Attempt

    Directory of Open Access Journals (Sweden)

    E. R. Black

    2017-01-01

    Full Text Available Objective. Trichloroacetic acid (TCAA, or trichloroethanoic acid, is a chemical analogue of acetic acid where three methyl group hydrogen atoms are replaced by chlorine. TCAAs are also abbreviated and referred to as TCAs, causing confusion with the psychiatric antidepressant drug class, especially among patients. TCAAs exist in dermatological treatments such as chemical peels or wart chemoablation medication. TCAA ingestion or overdose can cause gastric irritation symptoms including vomiting, diarrhea, or lassitude. This symptomatology is less severe than TCA overdose, where symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. Owing to the vast difference in symptoms, the need for clinical intervention differs greatly. While overdose of either in a self-harm attempt can warrant psychiatric hospital admission, the risk of death in TCAA ingestion is far less. Case Report. A patient ingested TCAA in the form of a commercially available dermatological chemical peel as a self-harm attempt, thinking that it was a more injurious TCA. Conclusion. Awareness among physicians, particularly psychiatrists, regarding this relatively obscure chemical compound (TCAA and its use by suicidal patients mistakenly believing it to be a substance that can be significantly more lethal (TCA, is imperative.

  5. Reducing harm from alcohol: call to action.

    Science.gov (United States)

    Casswell, Sally; Thamarangsi, Thaksaphon

    2009-06-27

    Despite clear evidence of the major contribution alcohol makes to the global burden of disease and to substantial economic costs, focus on alcohol control is inadequate internationally and in most countries. Expansion of industrial production and marketing of alcohol is driving alcohol use to rise, both in emerging markets and in young people in mature alcohol markets. Cost-effective and affordable interventions to restrict harm exist, and are in urgent need of scaling up. Most countries do not have adequate policies in place. Factors impeding progress include a failure of political will, unhelpful participation of the alcohol industry in the policy process, and increasing difficulty in free-trade environments to respond adequately at a national level. An effective national and international response will need not only governments, but also non-governmental organisations to support and hold government agencies to account. International health policy, in the form of a Framework Convention on Alcohol Control, is needed to counterbalance the global conditions promoting alcohol-related harm and to support and encourage national action.

  6. FACEBOOK AND WHATSAPP: BENEFICIAL OR HARMFUL?

    Directory of Open Access Journals (Sweden)

    Sankalp Raj

    2015-04-01

    Full Text Available New innovations and advances in science and technology in the present day have made considerable and significant changes in the lifestyle of people all around the globe. Communication from one part of the world to another is possible at the hit of a button . Social networking is being rampantly used everywhere and by everybody, be it youngsters or the older generation. Facebook and Whatsapp are the most commonly used means of communication in social networking at present. Smart phones functioning as minicomp uters with fast internet connectivity in the pockets of today’s technosavy generation have made them create and spend most of their time interacting with people in a virtual world. There is an urgent need to understand the dynamics of social media and its effects on the lifestyle of people. Studies documenting the same have been very few. This study was conducted to understand the benefits and harms towards health and academics of MBBS students. This cross - sectional study on 147 MBBS students revealed inter esting findings and opinions of the students. Effects of Facebook and What Sapp on productivity and sleep disturbances due to it were the significant findings of the study. Facebook and Whatsapp can be considered both beneficial and harmful and it solely d epends on how it is being put to use

  7. Can harmful tax competition be curbed at the international level?

    Energy Technology Data Exchange (ETDEWEB)

    Gjersti, Per O. [Finans- og Tolldepartementet, Oslo (Norway)

    1998-07-01

    This presentation discusses the following issues: (1) Good vs harmful tax competition?, (2) How to identify harmful competition?, (3) What is the economic and social impact of harmful tax competition?, (4) What can be done about harmful tax competition? There are three levels, the EU level, the OECD level and the global level. Existing measures to counteract harmful tax practices are insufficient because action by one country merely shifts activity to another country and puts its tax payers at a competitive disadvantage and because coordination action eases political pressure. The EU code of good conduct and the OECD guidelines for dealing with harmful preferential tax regimes are compared, with respect to general features, with respect to key factors to identify harmful measures, and with respect to general scope.

  8. Characterizing use patterns and perceptions of relative harm in dual users of electronic and tobacco cigarettes

    OpenAIRE

    Rass, Olga; Pacek, Lauren R.; Johnson, Patrick S.; Johnson, Matthew W.

    2015-01-01

    Awareness and use of electronic cigarettes (e-cigarettes) is increasing. Questions regarding positive (e.g., smoking reduction/cessation) and negative (e.g., delay of cessation) potential public health consequences of e-cigarettes may be informed by studying dual users of e-cigarettes and tobacco cigarettes. A cross-sectional online survey assessed demographics, product use patterns, and beliefs about relative product benefits and harms among dual users (n = 350) in the United States using th...

  9. 77 FR 20034 - Harmful and Potentially Harmful Constituents in Tobacco Products and Tobacco Smoke; Established List

    Science.gov (United States)

    2012-04-03

    ... in each tobacco product by brand and by quantity in each brand and subbrand.'' The Agency has... On January 31, 2011, FDA announced the availability of a guidance entitled `` `Harmful and... contain quantities of the HPHCs by brand and subbrand. Beginning June 22, 2012, sections 904(a)(3) and 904...

  10. 76 FR 50226 - Harmful and Potentially Harmful Constituents in Tobacco Products and Tobacco Smoke; Request for...

    Science.gov (United States)

    2011-08-12

    ... harmful constituents, including smoke constituents, to health in each tobacco product by brand and by quantity in each brand and subbrand.'' Section 904(e) of the FD&C Act also requires that FDA ``publish a... remove constituents. On June 10, 2010, FDA announced the availability for public comment of a draft...

  11. Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis.

    Science.gov (United States)

    Ougrin, Dennis; Tranah, Troy; Stahl, Daniel; Moran, Paul; Asarnow, Joan Rosenbaum

    2015-02-01

    Suicidal behavior and self-harm are common in adolescents and are associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm and links between self-harm and suicide and risk of suicide attempt, progress in reducing suicide death rates has been elusive, with no substantive reduction in suicide death rates over the past 60 years. Extending prior reviews of the literature on treatments for suicidal behavior and repetitive self-harm in youth, this article provides a meta-analysis of randomized controlled trials (RCTs) reporting efficacy of specific pharmacological, social, or psychological therapeutic interventions (TIs) in reducing both suicidal and nonsuicidal self-harm in adolescents. Data sources were identified by searching the Cochrane, Medline, PsychINFO, EMBASE, and PubMed databases as of May 2014. RCTs comparing specific therapeutic interventions versus treatment as usual (TAU) or placebo in adolescents (through age 18 years) with self-harm were included. Nineteen RCTs including 2,176 youth were analyzed. TIs included psychological and social interventions and no pharmacological interventions. The proportion of the adolescents who self-harmed over the follow-up period was lower in the intervention groups (28%) than in controls (33%) (test for overall effect z = 2.31; p = .02). TIs with the largest effect sizes were dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), and mentalization-based therapy (MBT). There were no independent replications of efficacy of any TI. The pooled risk difference between TIs and TAU for suicide attempts and nonsuicidal self-harm considered separately was not statistically significant. TIs to prevent self-harm appear to be effective. Independent replication of the results achieved by DBT, MBT, and CBT is a research priority. Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by

  12. Effects of the Campus Watch intervention on alcohol consumption and related harm in a university population.

    Science.gov (United States)

    Cousins, Kimberly; Connor, Jennie L; Kypri, Kypros

    2014-10-01

    High levels of drinking and alcohol-related problems are pervasive among university students in New Zealand and other high-income countries, where controls on alcohol availability and promotion are typically weak. Environmental interventions to reduce hazardous drinking and harm have shown promise in general populations, but require further evidence of effectiveness in university settings. The aim of this study was to estimate the effect of a community liaison and security program, Campus Watch, on drinking patterns and alcohol-related harm among university students. The study used a quasi-experimental design with non-equivalent control sites using before (2005) and after (2009) observations. Participants were full-time students aged 17-25 years selected randomly from the enrolment lists of six New Zealand universities. Changes in scores on the alcohol use disorders identification consumption scale (AUDIT-C) and alcohol-related harms at the intervention campus were compared with those at control campuses using linear and logistic regression models. Compared to control campuses, AUDIT-C scores decreased in students at the intervention campus (β=-0.5, 95% CI: -0.6 to -0.3). Campus Watch was associated with reductions in some harms (independent of its effect on drinking), such as aggression (aOR 0.66, 95% CI: 0.46 to 0.94), but not other harms, e.g., blackouts (aOR 1.06, 95% CI: 0.89 to 1.27). While not being focused on alcohol per se, Campus Watch reduced alcohol consumption and some related harms. Such programs may be useful in similar environments where controls on alcohol availability and promotion cannot be affected and where informal controls are weak. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  13. Estimates of benefits and harms of prophylactic use of aspirin in the general population

    Science.gov (United States)

    Cuzick, J.; Thorat, M. A.; Bosetti, C.; Brown, P. H.; Burn, J.; Cook, N. R.; Ford, L. G.; Jacobs, E. J.; Jankowski, J. A.; La Vecchia, C.; Law, M.; Meyskens, F.; Rothwell, P. M.; Senn, H. J.; Umar, A.

    2015-01-01

    Background Accumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current data and assessed the benefits and harms of prophylactic use of aspirin in the general population. Methods The effect of aspirin for site-specific cancer incidence and mortality, cardiovascular events was collated from the most recent systematic reviews. Studies identified through systematic Medline search provided data regarding harmful effects of aspirin and baseline rates of harms like gastrointestinal bleeding and peptic ulcer. Results The effects of aspirin on cancer are not apparent until at least 3 years after the start of use, and some benefits are sustained for several years after cessation in long-term users. No differences between low and standard doses of aspirin are observed, but there were no direct comparisons. Higher doses do not appear to confer additional benefit but increase toxicities. Excess bleeding is the most important harm associated with aspirin use, and its risk and fatality rate increases with age. For average-risk individuals aged 50–65 years taking aspirin for 10 years, there would be a relative reduction of between 7% (women) and 9% (men) in the number of cancer, myocardial infarction or stroke events over a 15-year period and an overall 4% relative reduction in all deaths over a 20-year period. Conclusions Prophylactic aspirin use for a minimum of 5 years at doses between 75 and 325 mg/day appears to have favourable benefit–harm profile; longer use is likely to have greater benefits. Further research is needed to determine the optimum dose and duration of use, to identify individuals at increased risk of bleeding, and to test effectiveness of Helicobacter pylori screening–eradication before starting aspirin prophylaxis. PMID:25096604

  14. Dealing with Alcohol-related problems in the Night-Time Economy: A Study Protocol for Mapping trends in harm and stakeholder views surrounding local community level interventions.

    Science.gov (United States)

    Miller, Peter; Palmer, Darren; Droste, Nicolas; Tindall, Jenny; Gillham, Karen; Sonderlund, Anders; McFarlane, Emma; de Groot, Florentine; Sawyer, Amy; Groombridge, Daniel; Lecathelinais, Christophe; Wiggers, John

    2011-06-18

    This project will provide a comprehensive investigation into the prevalence of alcohol-related harms and community attitudes in the context of community-based interventions being implemented to reduce harm in two regional centres of Australia. While considerable experimentation and innovation to address these harms has occurred in both Geelong and Newcastle, only limited ad-hoc documentation and analysis has been conducted on changes in the prevalence of harm as a consequence, leaving a considerable gap in terms of a systematic, evidence-based analysis of changes in harm over time and the need for further intervention. Similarly, little evidence has been reported regarding the views of key stakeholder groups, industry, government agencies, patrons or community regarding the need for, and the acceptability of, interventions to reduce harms. This project will aim to provide evidence regarding the impact and acceptability of local initiatives aimed at reducing alcohol-related harms. This study will gather existing police data (assault, property damage and drink driving offences), Emergency Department presentations and Ambulance attendance data. Further, the research team will conduct interviews with licensed venue patrons and collect observational data of licensed venues. Key informant interviews will assess expert knowledge from key industry and government stakeholders, and a community survey will assess community experiences and attitudes towards alcohol-related harm and harm-reduction strategies. Overall, the project will assess: the extent of alcohol-related harm in the context of harm-reduction interventions, and the need for and acceptability of further intervention. These findings will be used to improve evidence-based practice both nationally and internationally. This project has been approved by Deakin University HREC.

  15. Dealing with Alcohol-related problems in the Night-Time Economy: A Study Protocol for Mapping trends in harm and stakeholder views surrounding local community level interventions

    Directory of Open Access Journals (Sweden)

    de Groot Florentine

    2011-06-01

    Full Text Available Abstract Background This project will provide a comprehensive investigation into the prevalence of alcohol-related harms and community attitudes in the context of community-based interventions being implemented to reduce harm in two regional centres of Australia. While considerable experimentation and innovation to address these harms has occurred in both Geelong and Newcastle, only limited ad-hoc documentation and analysis has been conducted on changes in the prevalence of harm as a consequence, leaving a considerable gap in terms of a systematic, evidence-based analysis of changes in harm over time and the need for further intervention. Similarly, little evidence has been reported regarding the views of key stakeholder groups, industry, government agencies, patrons or community regarding the need for, and the acceptability of, interventions to reduce harms. This project will aim to provide evidence regarding the impact and acceptability of local initiatives aimed at reducing alcohol-related harms. Methods/Design This study will gather existing police data (assault, property damage and drink driving offences, Emergency Department presentations and Ambulance attendance data. Further, the research team will conduct interviews with licensed venue patrons and collect observational data of licensed venues. Key informant interviews will assess expert knowledge from key industry and government stakeholders, and a community survey will assess community experiences and attitudes towards alcohol-related harm and harm-reduction strategies. Overall, the project will assess: the extent of alcohol-related harm in the context of harm-reduction interventions, and the need for and acceptability of further intervention. Discussion These findings will be used to improve evidence-based practice both nationally and internationally. Ethical Approval This project has been approved by Deakin University HREC.

  16. Exploring Thematic Nightmare Content and Associated Self-Harm Risk.

    Science.gov (United States)

    Hochard, Kevin D; Ashcroft, Sam; Carroll, Janine; Heym, Nadja; Townsend, Ellen

    2017-09-28

    Nightmares have been shown to be robust predictors of self-harm risk, beyond depressive symptoms and hopelessness at times. However, few studies have investigated associations between nightmare content and increased self-harm risk. This study explored associations of thematic nightmare content with history of self-harm, and risk of self-harm phenomena the morning following a nightmare. A mixed-method diary study was performed. Prospective nightmare reports were obtained from 72 participants. A total of 47 nightmare reports met inclusion criteria and were analyzed for themes using inductive thematic analysis. Chi-square and bootstrap Pearson's correlation tests were performed to assess the associations between nightmare themes and self-harm history, and risk of self-harm phenomena following a nightmare. "Powerlessness to Change Behavior" was associated with a history of self-harm engagement, whereas "Financial Hardship" indicated reduced risk. Themes were not significantly associated with increased risk of self-harm phenomena following a nightmare. Content may be of use in detecting lifetime history of self-harm engagement, particularly in populations where disclosure is seen as taboo. However, nightmare symptom severity remains a better indicator of risk. Evidence for the utility of nightmare content in assessing immediate self-harm risk is presently lacking. Replication with increased power is recommended. © 2017 The American Association of Suicidology.

  17. Self-harm in nurses: prevalence and correlates.

    Science.gov (United States)

    Cheung, Teris; Yip, Paul S F

    2016-09-01

    The aim of this study was to examine the weighed prevalence of self-harm and its correlates among Hong Kong nurses. Recent epidemiological data suggest that the weighted prevalence of past-year suicidality among Hong Kong nurses was found to be 14·9%. Deliberate self-harm was a significant correlate of suicidality. Nonetheless, there are few population-based studies exploring the prevalence of self-harm and its correlates among medical occupational groups in Asia. The study uses a cross-sectional survey design. Data were collected in Hong Kong over a four-week period from October-November 2013. Statistical methods, including binary and multivariate logistic regression models, were used to examine the weighted prevalence of self-harm and its associated factors in nurses. A total of 850 nurses participated in the study. Seventy-nine participants (9·3%) reported self-harm in the past year. Nurses aged between 25-44 were at especially high risk of self-harm. Female nurses reported self-harm more than male nurses. The most common forms of self-harm were self-cutting, striking oneself and poisoning oneself. Clinical experience, chronic illness, relationship crises with family members, a family history of self-harm, smoking, symptoms of stress and psychiatric disorder were significantly associated with nurses' self-harm. The positive correlation between psychiatric disorder and self-harm was confirmed. There is a need for a raft of self-harm prevention strategies, including a continuous monitoring system in the healthcare setting detecting and managing the risks of self-harm in nurses as part of the ordinary provision for their well-being. © 2016 John Wiley & Sons Ltd.

  18. [Overmedicalization: When too much medicine harms].

    Science.gov (United States)

    Hanslik, T; Flahault, A

    2016-03-01

    Overmedicalization refers to non-validated medical practices, with no clear benefits, potentially harmful and therefore unnecessarily costly. Awareness is growing with respect to this serious public health problem. Permanent expansion of diagnostic or therapeutic interventions, disease mongering, inadequate management of diagnostic uncertainty, conflict of interest or lack of commitment by physicians and patients in shared decision making. Overmedicalization is made possible by a lack of training of health professionals and users on medical decision process. Only a multidisciplinary research program, involving medical and non-medical worlds, will allow the implementation of corrective actions. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  19. Harmful Effects of Nanoparticles on Animals

    Directory of Open Access Journals (Sweden)

    Jean-Marie Exbrayat

    2015-01-01

    Full Text Available Since several years nanoparticles (NPs are produced by industries and used in several fields of activities. They are finally found in aquatic and terrestrial environments, where they are ingested by living organisms in which they accumulate, before being eliminated. In organisms, NPs represent foreign elements with their own physicochemical properties due to their small size. So NPs may interfere with the normal physiological mechanisms of the embryos, growing animals, and adults, and it is indispensable to understand their potentially direct or indirect harmful effects on living organisms. It has been already shown that NPs could be toxic to bacteria, algae, invertebrates, and vertebrates. In this review, several examples of recent studies are given. We will examine successively the effects of NPs on terrestrial and semiaquatic and aquatic vertebrate and invertebrate animals.

  20. Harmful Algal Blooms and Public Health.

    Science.gov (United States)

    Grattan, Lynn M; Holobaugh, Sailor; Morris, J Glenn

    2016-07-01

    The five most commonly recognized Harmful Algal Bloom related illnesses include Ciguatera poisoning, Paralytic Shellfish poisoning, Neurotoxin Shellfish poisoning, Diarrheic Shellfish Poisoning and Amnesic Shellfish poisoning. Although they are each the product of different toxins, toxin assemblages or HAB precursors these clinical syndromes have much in common. Exposure occurs through the consumption of fish or shellfish; routine clinical tests are not available for diagnosis; there is no known antidote for exposure; and the risk of these illnesses can negatively impact local fishing and tourism industries. Thus, illness prevention is of paramount importance to minimize human and public health risks. To accomplish this, close communication and collaboration is needed among HAB scientists, public health researchers and local, state and tribal health departments at academic, community outreach, and policy levels.

  1. Geoengineering, Climate Harm, and Business as Usual

    Science.gov (United States)

    Jankunis, F. J.; Peacock, K.

    2014-12-01

    We define geoengineering (GE) as the intentional use of technology to change the planet's climate. Many people believe GE is different in kind rather than degree from any other organized activity in human history. In fact, humans caused changes in the planet's climate long before the industrial age, and all organisms engineer their environments directly or indirectly. The relevant difference between this cumulative and generally inadvertent activity and GE is the presence of intention. Now that science has revealed the extent to which humans can change the climate, however, even the continuance of Business as Usual (BAU) is, in effect, a form of intentional GE, albeit one that will cause significant climate harm, defined as effects such as sea level rise that will impact human well-being. But as with all forms of engineering, the devil is in the details: what forms of GE should be tried first? Some methods, such as large-scale afforestation, are low risk but have long-term payoffs; others, such as aerosol injection into the stratosphere, could help buy time in a warming crisis but have unknown side-effects and little long-term future. Climate change is a world-wide, inter-generational tragedy of the commons. Rational choice theory, the spatial and temporal extension of the problem, poorly fitted moral frameworks, and political maneuvering are all factors that inhibit solutions to the climate tragedy of the commons. The longer that such factors are allowed to dominate decision-making (or the lack thereof) the more likely it is that humanity will be forced to resort to riskier and more drastic forms of GE. We argue that this fact brings an additional measure of urgency to the search for ways to engineer the climate differently so as to avoid climate harm in the most lasting and least risky way.

  2. [Harmful biological agents at museum workposts].

    Science.gov (United States)

    Skóra, Justyna; Zduniak, Katarzyna; Gutarowska, Beata; Rembisz, Daria

    2012-01-01

    The aim of the studies was to determine the level and kind of microbiological contamination of air and surfaces in museum premises with various collection specificities. In addition, the criteria for selecting indicators of contamination with harmful biological agents at museum workposts are proposed. The analysis of microbial contamination was carried out in 14 museum premises (storehouses, restoration workshops, exhibition hall). Microbiological air purity was measured with a MAS-100 Eco Air Sampler. Surface samples were collected using contact plates RODAC Envirocheck. Biochemical API tests were used to identify bacteria and yeasts. Fungi were diagnosed with taxonomic keys, based on macro- and microscopic mycelia assessment. The levels of microbiological contamination in museums varied and ranged from 2.1 x 10(2) to 7.0 x 10(3) cfu/m3 in the air and from 1.4 x 10(2) to 1.7 x 10(4) cfu/100 cm2 on surfaces. The dominant microorganisms were fungi, which accounted respectively for 18-98% and 23-100% of all isolates from tested sites and surfaces. It was found that the amount of fungi in the indoor air of the Museum of Archeology and Ethnography and the Museum of Independence Traditions equaled respectively 4.2 x 10(2) cfu/m3 and 1.4 x 10(4) cfu/m3, which means that they exceeded the recommended reference value of 2.0 x 10(2) cfu/m3. Having analyzed the frequency of strain isolation, the source of microorganisms and the hazard to human health, 10 fungal species were isolated, which may be regarded as indicators of contamination with harmful biological agents at museum workposts. They are: Aspergillus (A. niger, A. versicolor), Cladosporium (C. herbarum, C. macrocarpum), Penicillium (P. carneum, P. digitatum, P. italicum, P. paneum, P. polonicum), Rhizopus nigricans.

  3. Harmful Freshwater Algal Blooms, With an Emphasis on Cyanobacteria

    Directory of Open Access Journals (Sweden)

    Hans W. Paerl

    2001-01-01

    zooplankton to further up the food chain. Both N2- and non-N2-fixing genera participate in mutualistic and symbiotic associations with microorganisms, higher plants, and animals. These associations appear to be of great benefit to their survival and periodic dominance. In this review, we address the ecological impacts and environmental controls of harmful blooms, with an emphasis on the ecology, physiology, and management of cyanobacterial bloom taxa. Combinations of physical, chemical, and biotic features of natural waters function in a synergistic fashion to determine the sensitivity of water bodies. In waters susceptible to blooms, human activities in water- and airsheds have been linked to the extent and magnitudes of blooms. Control and management of cyanobacterial and other phytoplankton blooms invariably includes nutrient input constraints, most often focused on nitrogen (N and/or phosphorus (P. The types and amount of nutrient input constraints depend on hydrologic, climatic, geographic, and geologic factors, which interact with anthropogenic and natural nutrient input regimes. While single nutrient input constraints may be effective in some water bodies, dual N and P input reductions are usually required for effective long-term control and management of harmful blooms. In some systems where hydrologic manipulations (i.e., plentiful water supplies are possible, reducing the water residence time by enhanced flushing and artificial mixing (in conjunction with nutrient input constraints can be particularly effective alternatives. Implications of various management strategies, based on combined ecophysiological and environmental considerations, are discussed.

  4. Harmful freshwater algal blooms, with an emphasis on cyanobacteria.

    Science.gov (United States)

    Paerl, H W; Fulton, R S; Moisander, P H; Dyble, J

    2001-04-04

    to further up the food chain. Both N2- and non-N2-fixing genera participate in mutualistic and symbiotic associations with microorganisms, higher plants, and animals. These associations appear to be of great benefit to their survival and periodic dominance. In this review, we address the ecological impacts and environmental controls of harmful blooms, with an emphasis on the ecology, physiology, and management of cyanobacterial bloom taxa. Combinations of physical, chemical, and biotic features of natural waters function in a synergistic fashion to determine the sensitivity of water bodies. In waters susceptible to blooms, human activities in water- and airsheds have been linked to the extent and magnitudes of blooms. Control and management of cyanobacterial and other phytoplankton blooms invariably includes nutrient input constraints, most often focused on nitrogen (N) and/or phosphorus (P). The types and amount of nutrient input constraints depend on hydrologic, climatic, geographic, and geologic factors, which interact with anthropogenic and natural nutrient input regimes. While single nutrient input constraints may be effective in some water bodies, dual N and P input reductions are usually required for effective long-term control and management of harmful blooms. In some systems where hydrologic manipulations (i.e., plentiful water supplies) are possible, reducing the water residence time by enhanced flushing and artificial mixing (in conjunction with nutrient input constraints) can be particularly effective alternatives. Implications of various management strategies, based on combined ecophysiological and environmental considerations, are discussed.

  5. A systematic and extensive literature search on crop production of host plants of seven organisms harmful to horticulture

    NARCIS (Netherlands)

    Derkx, M.P.M.; Brouwer, J.H.D.; Breda, van P.J.M.; Helm, van der F.P.M.; Hop, M.E.C.M.; Landzaat, K.M.; Wubben, C.F.M.

    2012-01-01

    The European Commission is currently seeking advice from EFSA, on the risk to plant health for the EU territory including the evaluation of the effectiveness of risk reduction options of seven organisms harmful to horticulture (both food- and non food) plants: Liriomyza trifolii, Liriomyza

  6. Characterizing use patterns and perceptions of relative harm in dual users of electronic and tobacco cigarettes.

    Science.gov (United States)

    Rass, Olga; Pacek, Lauren R; Johnson, Patrick S; Johnson, Matthew W

    2015-12-01

    Awareness and use of electronic cigarettes (e-cigarettes) is increasing. Questions regarding positive (e.g., smoking reduction/cessation) and negative (e.g., delay of cessation) potential public health consequences of e-cigarettes may be informed by studying dual users of e-cigarettes and tobacco cigarettes. A cross-sectional online survey assessed demographics, product use patterns, and beliefs about relative product benefits and harms among dual users (n = 350) in the United States using the website Amazon Mechanical Turk. Compared to tobacco cigarettes, e-cigarettes were used less often and were associated with lower dependence. Participants reported a 30% reduction in self-reported tobacco cigarette smoking since beginning to use e-cigarettes. Reported primary reasons for e-cigarette use were harm reduction and smoking cessation. E-cigarette use was reported as more likely in settings with smoking restrictions and when others' health could be adversely affected. Conversely, participants reported having used tobacco cigarettes more often than e-cigarettes in hedonic situations (e.g., after eating, drinking coffee or alcohol, or having sex), outdoors, or when stressed. Participants were twice as likely to report wanting to quit tobacco cigarettes compared to e-cigarettes in the next year and intended to quit tobacco cigarettes sooner. Tobacco cigarettes were described as more harmful and addictive, but also as more enjoyable than e-cigarettes. Participants provided evidence consistent with both positive and negative public health consequences of e-cigarettes, highlighting the need for experimental research, including laboratory studies and clinical trials. Policies should consider potential public health benefits of e-cigarettes, in addition to potential harms. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  7. Characterizing use patterns and perceptions of relative harm in dual users of electronic and tobacco cigarettes

    Science.gov (United States)

    Rass, Olga; Pacek, Lauren R.; Johnson, Patrick S.; Johnson, Matthew W.

    2015-01-01

    Awareness and use of electronic cigarettes (e-cigarettes) is increasing. Questions regarding positive (e.g., smoking reduction/cessation) and negative (e.g., delay of cessation) potential public health consequences of e-cigarettes may be informed by studying dual users of e-cigarettes and tobacco cigarettes. A cross-sectional online survey assessed demographics, product use patterns, and beliefs about relative product benefits and harms among dual users (n = 350) in the United States using the website Amazon Mechanical Turk (MTurk). Compared to tobacco cigarettes, e-cigarettes were used less often and were associated with lower dependence. Participants reported a 30% reduction in self-reported tobacco cigarette smoking since beginning to use e-cigarettes. Reported primary reasons for e-cigarette use were harm reduction and smoking cessation. E-cigarette use was reported as more likely in settings with smoking restrictions and when others’ health could be adversely affected. Conversely, participants reported having used tobacco cigarettes more often than e-cigarettes in hedonic situations (e.g., after eating, drinking coffee or alcohol, or having sex), outdoors, or when stressed. Participants were twice as likely to report wanting to quit tobacco cigarettes compared to e-cigarettes in the next year and intended to quit tobacco cigarettes sooner. Tobacco cigarettes were described as more harmful and addictive, but also more enjoyable than e-cigarettes. Participants provided evidence consistent with both positive and negative public health consequences of e-cigarettes, highlighting the need for experimental research, including laboratory studies and clinical trials. Policies should consider potential public health benefits of e-cigarettes, in addition to potential harms. PMID:26389638

  8. High rates of alcohol consumption and related harm at schoolies week: a portal study.

    Science.gov (United States)

    Lubman, Dan I; Droste, Nic; Pennay, Amy; Hyder, Shannon; Miller, Peter

    2014-12-01

    To investigate alcohol consumption, substance use and risky and harmful behaviour among young people attending 'schoolies' week in Victoria. Breathalyser tests and brief surveys (n=558) measuring alcohol, energy drink and illicit drug use, and experience of aggressive incidents, alcohol-related injury and unprotected sex, were undertaken with young people attending schoolies week in Lorne and Torquay. Schoolies reported consuming a mean of 8.8 drinks in the current session, with a mean blood alcohol count (BAC) of 0.05; 18.3% recorded a BAC of greater than 0.08. One in six participants had consumed alcohol with energy drinks; 7.7% reported using illicit substances. Participants who co-consumed alcohol and energy drinks recorded a higher BAC than alcohol-only users. One in five participants had experienced alcohol-related harm at schoolies week, including aggressive incidents, alcohol-related injury and engagement in unprotected sex. Each alcoholic drink consumed increased the potential for involvement in aggressive incidents by 8% and alcohol-related accidents/injuries by 5%; illicit drug use was associated with six times the likelihood of engaging in unprotected sex with a non-partner. Excessive alcohol consumption and experience of related harms are common among young people attending schoolies week. Harm reduction initiatives targeting schoolies week should focus on the consequences of excessive alcohol consumption, illicit drugs and the co-consumption of alcohol and energy drinks. © 2014 Public Health Association of Australia.

  9. Potentially Harmful Therapy and Multicultural Counseling: Bridging Two Disciplinary Discourses

    Science.gov (United States)

    Wendt, Dennis C.; Gone, Joseph P.; Nagata, Donna K.

    2015-01-01

    In recent years psychologists have been increasingly concerned about potentially harmful therapy, yet this recent discourse has not addressed issues that have long been voiced by the multicultural counseling and psychotherapy movement. We aim to begin to bring these seemingly disparate discourses of harm into greater conversation with one another, in the service of placing the discipline on a firmer foothold in its considerations of potentially harmful therapy. After reviewing the two discourses and exploring reasons for their divergence, we argue that they operate according to differing assumptions pertaining to the sources, objects, and scope of harm. We then argue that these differences reveal the discipline’s need to better appreciate that harm is a social construct, that psychotherapy may be inherently ethnocentric, and that strategies for collecting evidence of harm should be integrated with a social justice agenda. PMID:26339075

  10. Predictors for repeat self-harm and suicide among older people within 12 months of a self-harm presentation.

    Science.gov (United States)

    Cheung, Gary; Foster, Gisele; de Beer, Wayne; Gee, Susan; Hawkes, Tracey; Rimkeit, Sally; Tan, Yu Mwee; Merry, Sally; Sundram, Frederick

    2017-08-01

    A past history of self-harm is a significant risk factor for suicide in older people. The aims of this study are to (i) characterize older people who present with self-harm to emergency departments (EDs); and (ii) determine the predictors for repeat self-harm and suicide. Demographic and clinical data were retrospectively collected on older people (age 65+ years), who presented to seven EDs in New Zealand following an episode of self-harm between 1st July 2010 and 30th June 2013. In addition, 12-month follow-up information on repeat self-harm and suicide was collected. The sample included 339 older people (55.2% female) with an age range of 65-96 years (mean age = 75.0; SD = 7.6). Overdose (68.7%) was the most common method of self-harm. 76.4% of the self-harm cases were classified as suicide attempts. Perceived physical illness (47.8%) and family discord (34.5%) were the most common stressors. 12.7% of older people repeated self-harm and 2.1% died by suicide within 12 months. Older people who had a positive blood alcohol reading (OR = 3.87, 95% Cl = 1.35-11.12, p = 0.012) and were already with mental health services at the index self-harm (OR = 2.73, 95% Cl = 1.20-6.25, p = 0.047) were more likely to repeat self-harm/suicide within 12 months. Older people who self-harm are at very high risk of repeat self-harm and suicide. Screening and assessment for alcohol use disorders should be routinely performed following a self-harm presentation, along with providing structured psychological treatment as an adjunct to pharmacological treatment for depression and interventions to improve the person's resilience resources.

  11. Psychosocial interventions following self-harm in adults: a systematic review and meta-analysis.

    Science.gov (United States)

    Hawton, Keith; Witt, Katrina G; Salisbury, Tatiana L Taylor; Arensman, Ella; Gunnell, David; Hazell, Philip; Townsend, Ellen; van Heeringen, Kees

    2016-08-01

    months (0·36, 0·05-2·47; n=172, two trials). However, the secondary endpoint of frequency of self-harm was associated with a significant reduction with use of dialectical behaviour therapy (mean difference -18·82, 95% CI -36·68 to -0·95). Four trials each of case management (OR 0·78, 95% CI 0·47-1·30; n=1608) and sending regular postcards (OR 0·87, 95% CI 0·62-1·23; n=3277) did not reduce repetition of self-harm. CBT seems to be effective in patients after self-harm. Dialectical behaviour therapy did not reduce the proportion of patients repeating self-harm but did reduce the frequency of self-harm. However, aside from CBT, there were few trials of other promising interventions, precluding firm conclusions as to their effectiveness. National Institute for Health Research. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Assessing the harms of cannabis cultivation in Belgium.

    Science.gov (United States)

    Paoli, Letizia; Decorte, Tom; Kersten, Loes

    2015-03-01

    Since the 1990s, a shift from the importation of foreign cannabis to domestic cultivation has taken place in Belgium, as it has in many other countries. This shift has prompted Belgian policy-making bodies to prioritize the repression of cannabis cultivation. Against this background, the article aims to systematically map and assess for the first time ever the harms associated with cannabis cultivation, covering the whole spectrum of growers. This study is based on a web survey primarily targeting small-scale growers (N=1293) and on three interconnected sets of qualitative data on large-scale growers and traffickers (34 closed criminal proceedings, interviews with 32 criminal justice experts, and with 17 large-scale cannabis growers and three traffickers). The study relied on Greenfield and Paoli's (2013) harm assessment framework to identify the harms associated with cannabis cultivation and to assess the incidence, severity and causes of such harms. Cannabis cultivation has become endemic in Belgium. Despite that, it generates, for Belgium, limited harms of medium-low or medium priority. Large-scale growers tend to produce more harms than the small-scale ones. Virtually all the harms associated with cannabis cultivation are the result of the current criminalizing policies. Given the spread of cannabis cultivation and Belgium's position in Europe, reducing the supply of cannabis does not appear to be a realistic policy objective. Given the limited harms generated, there is scarce scientific justification to prioritize cannabis cultivation in Belgian law enforcement strategies. As most harms are generated by large-scale growers, it is this category of cultivator, if any, which should be the focus of law enforcement repression. Given the policy origin of most harms, policy-makers should seek to develop policies likely to reduce such harms. At the same time, further research is needed to comparatively assess the harms associated with cannabis cultivation (and

  13. Impulsivity and self-harm in adolescence: a systematic review.

    Science.gov (United States)

    Lockwood, Joanna; Daley, David; Townsend, Ellen; Sayal, Kapil

    2017-04-01

    Research supports an association between impulsivity and self-harm, yet inconsistencies in methodology across studies have complicated understanding of this relationship. This systematic review examines the association between impulsivity and self-harm in community-based adolescents aged 11-25 years and aims to integrate findings according to differing concepts and methods. Electronic searches of EMBASE, MEDLINE, PsychINFO, CINAHL, PubMed and The Cochrane Library, and manual searches of reference lists of relevant reviews identified 4496 articles published up to July 2015, of which 28 met inclusion criteria. Twenty-four of the studies reported an association between broadly specified impulsivity and self-harm. However, findings varied according to the conception and measurement of impulsivity and the precision with which self-harm behaviours were specified. Specifically, lifetime non-suicidal self-injury was most consistently associated with mood-based impulsivity-related traits. However, cognitive facets of impulsivity (relating to difficulties maintaining focus or acting without forethought) differentiated current self-harm from past self-harm. These facets also distinguished those with thoughts of self-harm (ideation) from those who acted on thoughts (enaction). The findings suggested that mood-based impulsivity is related to the initiation of self-harm, while cognitive facets of impulsivity are associated with the maintenance of self-harm. In addition, behavioural impulsivity is most relevant to self-harm under conditions of negative affect. Collectively, the findings indicate that distinct impulsivity facets confer unique risks across the life-course of self-harm. From a clinical perspective, the review suggests that interventions focusing on reducing rash reactivity to emotions or improving self-regulation and decision making may offer most benefit in supporting those who self-harm.

  14. Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Anthony Charles Ruocco

    2016-05-01

    Full Text Available Self-harm is a potentially lethal symptom of borderline personality disorder (BPD that often improves with dialectical behavior therapy (DBT. While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, twenty-nine actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex during impulse control prior to beginning DBT and after seven months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex prior to beginning treatment, and they showed the greatest increases in activity within this region after seven months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial prefrontal cortex and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right dorsolateral prefrontal cortex even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the prefrontal cortex underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT.

  15. Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study

    Science.gov (United States)

    Ruocco, Anthony C.; Rodrigo, Achala H.; McMain, Shelley F.; Page-Gould, Elizabeth; Ayaz, Hasan; Links, Paul S.

    2016-01-01

    Self-harm is a potentially lethal symptom of borderline personality disorder (BPD) that often improves with dialectical behavior therapy (DBT). While DBT is effective for reducing self-harm in many patients with BPD, a small but significant number of patients either does not improve in treatment or ends treatment prematurely. Accordingly, it is crucial to identify factors that may prospectively predict which patients are most likely to benefit from and remain in treatment. In the present preliminary study, 29 actively self-harming patients with BPD completed brain-imaging procedures probing activation of the prefrontal cortex (PFC) during impulse control prior to beginning DBT and after 7 months of treatment. Patients that reduced their frequency of self-harm the most over treatment displayed lower levels of neural activation in the bilateral dorsolateral prefrontal cortex (DLPFC) prior to beginning treatment, and they showed the greatest increases in activity within this region after 7 months of treatment. Prior to starting DBT, treatment non-completers demonstrated greater activation than treatment-completers in the medial PFC and right inferior frontal gyrus. Reductions in self-harm over the treatment period were associated with increases in activity in right DLPFC even after accounting for improvements in depression, mania, and BPD symptom severity. These findings suggest that pre-treatment patterns of activation in the PFC underlying impulse control may be prospectively associated with improvements in self-harm and treatment attrition for patients with BPD treated with DBT. PMID:27242484

  16. Repeated self-harm in young people: a review.

    Science.gov (United States)

    Robinson, Jo

    2017-04-01

    This paper provides a review of the rates of self-harm and repeated self-harm among young people. It describes some of the risk factors associated with these behaviours and summarises some of the barriers to delivering optimal treatment. The review concludes that there is an urgent need for the delivery of respectful and evidence-based practice to all young people who present with self-harm. In addition, improved monitoring of self-harm presentations to hospitals across Australia is required in order that robust data are collected and the impact of practice change can be reliably assessed.

  17. Initial skill assessment of the California Harmful Algae Risk Mapping (C-HARM) system.

    Science.gov (United States)

    Anderson, Clarissa R; Kudela, Raphael M; Kahru, Mati; Chao, Yi; Rosenfeld, Leslie K; Bahr, Frederick L; Anderson, David M; Norris, Tenaya A

    2016-11-01

    Toxic algal events are an annual burden on aquaculture and coastal ecosystems of California. The threat of domoic acid (DA) toxicity to human and wildlife health is the dominant harmful algal bloom (HAB) concern for the region, leading to a strong focus on prediction and mitigation of these blooms and their toxic effects. This paper describes the initial development of the California Harmful Algae Risk Mapping (C-HARM) system that predicts the spatial likelihood of blooms and dangerous levels of DA using a unique blend of numerical models, ecological forecast models of the target group, Pseudo-nitzschia, and satellite ocean color imagery. Data interpolating empirical orthogonal functions (DINEOF) are applied to ocean color imagery to fill in missing data and then used in a multivariate mode with other modeled variables to forecast biogeochemical parameters. Daily predictions (nowcast and forecast maps) are run routinely at the Central and Northern California Ocean Observing System (CeNCOOS) and posted on its public website. Skill assessment of model output for the nowcast data is restricted to nearshore pixels that overlap with routine pier monitoring of HABs in California from 2014 to 2015. Model lead times are best correlated with DA measured with solid phase adsorption toxin tracking (SPATT) and marine mammal strandings from DA toxicosis, suggesting long-term benefits of the HAB predictions to decision-making. Over the next three years, the C-HARM application system will be incorporated into the NOAA operational HAB forecasting system and HAB Bulletin. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Self-harm and life problems: findings from the Multicentre Study of Self-harm in England.

    Science.gov (United States)

    Townsend, Ellen; Ness, Jennifer; Waters, Keith; Kapur, Navneet; Turnbull, Pauline; Cooper, Jayne; Bergen, Helen; Hawton, Keith

    2016-02-01

    Self-harm is a major clinical problem and is strongly linked to suicide. It is important to understand the problems faced by those who self-harm to design effective clinical services and suicide prevention strategies. We investigated the life problems experienced by patients presenting to general hospitals for self-harm. Data for 2000-2010 from the Multicentre Study of Self-harm in England were used to investigate life problems associated with self-harm and their relationship to patient and clinical characteristics, including age, gender, repeat self-harm and employment status. Of 24,598 patients (36,431 assessed episodes), 57% were female and with a mean age of 33.1 years (SD 14.0 years), 92.6% were identified as having at least one contributing life problem. The most frequently reported problems at first episode of self-harm within the study period were relationship difficulties (especially with partners). Mental health issues and problems with alcohol were also very common (especially in those aged 35-54 years, and those who repeated self-harm). Those who repeated self-harm were more likely to report problems with housing, mental health and dealing with the consequences of abuse. Self-harm usually occurs in the context of multiple life problems. Clinical services for self-harm patients should have access to appropriate care for provision of help for relationship difficulties and problems concerning alcohol and mental health issues. Individualised clinical support (e.g. psychological therapy, interventions for alcohol problems and relationship counselling) for self-harm patients facing these life problems may play a crucial role in suicide prevention.

  19. Effects of benefits and harms on older persons' willingness to take medication for primary cardiovascular prevention.

    Science.gov (United States)

    Fried, Terri R; Tinetti, Mary E; Towle, Virginia; O'Leary, John R; Iannone, Lynne

    2011-05-23

    Quality-assurance initiatives encourage adherence to evidenced-based guidelines based on a consideration of treatment benefit. We examined older persons' willingness to take medication for primary cardiovascular disease prevention according to benefits and harms. In-person interviews were performed with 356 community-living older persons. Participants were asked about their willingness to take medication for primary prevention of myocardial infarction (MI) with varying benefits in terms of absolute 5-year risk reduction and varying harms in terms of type and severity of adverse effects. Most (88%) would take medication, providing an absolute benefit of 6 fewer persons with MI out of 100, approximating the average risk reduction of currently available medications. Of participants who would not take it, 17% changed their preference if the absolute benefit was increased to 10 fewer persons with MI, and, of participants who would take it, 82% remained willing if the absolute benefit was decreased to 3 fewer persons with MI. In contrast, large proportions (48%-69%) were unwilling or uncertain about taking medication with average benefit causing mild fatigue, nausea, or fuzzy thinking, and only 3% would take medication with adverse effects severe enough to affect functioning. Older persons' willingness to take medication for primary cardiovascular disease prevention is relatively insensitive to its benefit but highly sensitive to its adverse effects. These results suggest that clinical guidelines and decisions about prescribing these medications to older persons need to place emphasis on both benefits and harms.

  20. DDT, epigenetic harm, and transgenerational environmental justice

    Science.gov (United States)

    2014-01-01

    Although the environmentally harmful effects of widespread dichlorodiphenyltrichloroethane (DDT) use became well-known following Rachel Carson’s Silent Spring (1962), its human health effects have more recently become clearer. A ban on the use of DDT has been in place for over 30 years, but recently DDT has been used for malaria control in areas such as Africa. Recent work shows that DDT has transgenerational effects in progeny and generations never directly exposed to DDT. These effects have health implications for individuals who are not able to have any voice in the decision to use the pesticide. The transgenerational effects of DDT are considered in light of some widely accepted ethical principles. We argue that this reframes the decision to use DDT, requiring us to incorporate new considerations, and new kinds of decision making, into the deliberative process that determines its ongoing use. Ethical considerations for intergenerational environmental justice are presented that include concern and respect for autonomy, nonmaleficence, and justice. Here, we offer a characterization of the kinds of ethical considerations that must be taken into account in any satisfactory decisions to use DDT. PMID:25086599

  1. Energy drinks and adolescents: what's the harm?

    Science.gov (United States)

    Harris, Jennifer L; Munsell, Christina R

    2015-04-01

    Concerns about potential dangers from energy drink consumption by youth have been raised by health experts, whereas energy drink manufacturers claim these products are safe and suitable for marketing to teens. This review summarizes the evidence used to support both sides of the debate. Unlike most beverage categories, sales of energy drinks and other highly caffeinated products continue to grow, and marketing is often targeted to youth under the age of 18 years. These products pose a risk of caffeine toxicity when consumed by some young people, and there is evidence of other troubling physiological and behavioral effects associated with their consumption by youth. The US Food and Drug Administration has indicated it will reexamine the safety of caffeine in the food supply; however, more research is needed to better understand youth consumption of energy drinks and caffeine in general, as well as the long-term effects on health. Meanwhile, policymakers and physician groups have called on energy drink manufacturers to take voluntary action to reduce the potential harm of their products, including placing restrictions on marketing to youth under the age of 18 years. Additional regulatory and legislative options are also being discussed. © The Author(s) 2015. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  2. Satellite monitoring of cyanobacterial harmful algal bloom ...

    Science.gov (United States)

    Cyanobacterial harmful algal blooms (cyanoHABs) cause extensive problems in lakes worldwide, including human and ecological health risks, anoxia and fish kills, and taste and odor problems. CyanoHABs are a particular concern because of their dense biomass and the risk of exposure to toxins in both recreational waters and drinking source waters. Successful cyanoHAB assessment by satellites may provide a first-line of defense indicator for human and ecological health protection. In this study, assessment methods were developed to determine the utility of satellite technology for detecting cyanoHAB occurrence frequency at locations of potential management interest. The European Space Agency's MEdium Resolution Imaging Spectrometer (MERIS) was evaluated to prepare for the equivalent Sentinel-3 Ocean and Land Colour Imager (OLCI) launched in 2016. Based on the 2012 National Lakes Assessment site evaluation guidelines and National Hydrography Dataset, there were 275,897 lakes and reservoirs greater than 1 hectare in the 48 U.S. states. Results from this evaluation show that 5.6 % of waterbodies were resolvable by satellites with 300 m single pixel resolution and 0.7 % of waterbodies were resolvable when a 3x3 pixel array was applied based on minimum Euclidian distance from shore. Satellite data was also spatially joined to US public water surface intake (PWSI) locations, where single pixel resolution resolved 57% of PWSI and a 3x3 pixel array resolved 33% of

  3. Benefit-to-harm ratio of the Danish breast cancer screening programme.

    Science.gov (United States)

    Beau, Anna-Belle; Lynge, Elsebeth; Njor, Sisse Helle; Vejborg, Ilse; Lophaven, Søren Nymand

    2017-08-01

    The primary aim of breast cancer screening is to reduce breast cancer mortality, but screening also has negative side-effects as overdiagnosis. To evaluate a screening programme, both benefits and harms should be considered. Published estimates of the benefit-to-harm ratio, the number of breast cancer deaths prevented divided by the number of overdiagnosed breast cancer cases, varied considerably. The objective of the study was to estimate the benefit-to-harm ratio of breast cancer screening in Denmark. The numbers of breast cancer deaths prevented and overdiagnosed cases [invasive and ductal carcinoma in situ (DCIS)] were estimated per 1,000 women aged 50-79, using national published estimates for breast cancer mortality and overdiagnosis, and national incidence and mortality rates. Estimations were made for both invited and screened women. Among 1,000 women invited to screening from age 50 to age 69 and followed until age 79, we estimated that 5.4 breast cancer deaths would be prevented and 2.1 cases overdiagnosed, under the observed scenario in Denmark of a breast cancer mortality reduction of 23.4% and 2.3% of the breast cancer cases being overdiagnosed. The estimated benefit-to-harm ratio was 2.6 for invited women and 2.5 for screened women. Hence, 2-3 women would be prevented from dying from breast cancer for every woman overdiagnosed with invasive breast cancer or DCIS. The difference between the previous published ratios and 2.6 for Denmark is probably more a reflection of the accuracy of the underlying estimates than of the actual screening programmes. Therefore, benefit-to-harm ratios should be used cautiously. © 2017 The Authors International Journal of Cancer published by John Wiley & Sons Ltd on behalf of UICC.

  4. Predictive validity of the Hand Arm Risk assessment Method (HARM)

    NARCIS (Netherlands)

    Douwes, M.; Boocock, M.; Coenen, P.; Heuvel, S. van den; Bosch, T.

    2014-01-01

    The Hand Arm Risk assessment Method (HARM) is a simplified risk assessment method for determining musculoskeletal symptoms to the arm, neck and/or shoulder posed by hand-arm tasks of the upper body. The purpose of this study was to evaluate the predictive validity of HARM using data collected from a

  5. Monitoring of harmful algal blooms along the Norwegian coast using ...

    African Journals Online (AJOL)

    A Norwegian monitoring system for harmful algal blooms, consisting of an Observer Network, the State Food Hygiene Control Agency, the Oceanographic Company of Norway, the Institute of Marine Research and the Directorate for Fisheries, is reviewed. Potentially harmful algae on the Norwegian coast are found primarily ...

  6. Doing Harm: An Unintended Consequence of Qualitative Inquiry?

    Science.gov (United States)

    Magolda, Peter; Weems, Lisa

    2002-01-01

    Explores ethical issues related to doing qualitative research and examines harm as it is conceptualized within the qualitative inquiry literature. Serves as an examination of professional standards, administrative practices, and methodological procedures that reveal the different kinds of harm that are inevitable outcomes of qualitative inquiry.…

  7. Nurses' attitudes towards self-harm: a literature review

    NARCIS (Netherlands)

    Karman, P.; Kool, N.; Poslawsky, I.E.; van Meijel, B.

    2015-01-01

    Accessible summary: People who self-harm experience many problems and needs related to management of emotional and practical stress. A positive attitude among nurses is especially important given the close contact they have with people who self-harm. This article is based on a review of the

  8. Marine harmful algal blooms, human health and wellbeing

    DEFF Research Database (Denmark)

    Berdalet, Elisa; Fleming, Lora E.; Gowen, Richard

    2016-01-01

    cause harm to humans and other organisms. These harmful algal blooms (HABs) have direct impacts on human health and negative influences on human wellbeing, mainly through their consequences to coastal ecosystem services (fisheries, tourism and recreation) and other marine organisms and environments...

  9. Population dynamics of potentially harmful algal blooms in Bizerte ...

    African Journals Online (AJOL)

    The population dynamics of potentially harmful phytoplankton in the semi-closed, coastal Bizerte Lagoon, Tunisia, in the south-western Mediterranean, were examined from November 2007 to February 2009 at six sampling stations, three situated in areas of mussel and oyster farming. The harmful species monitored ...

  10. Nurses’ attitudes towards self-harm: a literature review

    NARCIS (Netherlands)

    I.E. Poslawsky; P. Karman; Nienke Kool; prof Berno van Meijel

    2014-01-01

    Self-harm is a growing health problem. Nurses in a variety of healthcare settings play a central role in the care of people who self-harm. Their professional attitudes towards these people are essential for high-quality care. This review aims to develop insight into nurses’ attitudes towards

  11. Self-Harm and Conventional Gender Roles in Women

    Science.gov (United States)

    Straiton, Melanie L.; Hjelmeland, Heidi; Grimholt, Tine K.; Dieserud, Gudrun

    2013-01-01

    A total of thirty-two women admitted to a general hospital for medical treatment after self-harming completed measures of conventional positive and negative masculinity and femininity. Comparisons were made with two control groups with no self-harm history; 33 women receiving psychiatric outpatient treatment and a nonclinical sample of 206 women.…

  12. Biological control of Microcystis dominated harmful algal blooms

    African Journals Online (AJOL)

    STORAGESEVER

    2008-12-29

    Dec 29, 2008 ... Key words: Biological control, Microcystis aeruginosa, harmful algal blooms, predatory bacteria. INTRODUCTION. Harmful algal ... duces water quality with adverse effects on lake ecology, livestock, human water supply and .... more suitable than viruses as biocontrol agents because bacteria can survive on ...

  13. Training Implications of Harmful Effects of Psychological Treatments

    Science.gov (United States)

    Castonguay, Louis G.; Boswell, James F.; Constantino, Michael J.; Goldfried, Marvin R.; Hill, Clara E.

    2010-01-01

    The goal of this article is to delineate training implications regarding harmful effects associated with psychotherapy. The authors strongly recommend that trainees be made aware of (and encouraged to examine carefully) the potentially harmful treatments that have been recently identified (Lilienfeld, 2007). Consistent with a broad perspective on…

  14. Benefits and Harms of Breast Cancer Screening: A Systematic Review.

    Science.gov (United States)

    Myers, Evan R; Moorman, Patricia; Gierisch, Jennifer M; Havrilesky, Laura J; Grimm, Lars J; Ghate, Sujata; Davidson, Brittany; Mongtomery, Ranee Chatterjee; Crowley, Matthew J; McCrory, Douglas C; Kendrick, Amy; Sanders, Gillian D

    2015-10-20

    Patients need to consider both benefits and harms of breast cancer screening. To systematically synthesize available evidence on the association of mammographic screening and clinical breast examination (CBE) at different ages and intervals with breast cancer mortality, overdiagnosis, false-positive biopsy findings, life expectancy, and quality-adjusted life expectancy. We searched PubMed (to March 6, 2014), CINAHL (to September 10, 2013), and PsycINFO (to September 10, 2013) for systematic reviews, randomized clinical trials (RCTs) (with no limit to publication date), and observational and modeling studies published after January 1, 2000, as well as systematic reviews of all study designs. Included studies (7 reviews, 10 RCTs, 72 observational, 1 modeling) provided evidence on the association between screening with mammography, CBE, or both and prespecified critical outcomes among women at average risk of breast cancer (no known genetic susceptibility, family history, previous breast neoplasia, or chest irradiation). We used summary estimates from existing reviews, supplemented by qualitative synthesis of studies not included in those reviews. Across all ages of women at average risk, pooled estimates of association between mammography screening and mortality reduction after 13 years of follow-up were similar for 3 meta-analyses of clinical trials (UK Independent Panel: relative risk [RR], 0.80 [95% CI, 0.73-0.89]; Canadian Task Force: RR, 0.82 [95% CI, 0.74-0.94]; Cochrane: RR, 0.81 [95% CI, 0.74-0.87]); were greater in a meta-analysis of cohort studies (RR, 0.75 [95% CI, 0.69 to 0.81]); and were comparable in a modeling study (CISNET; median RR equivalent among 7 models, 0.85 [range, 0.77-0.93]). Uncertainty remains about the magnitude of associated mortality reduction in the entire US population, among women 40 to 49 years, and with annual screening compared with biennial screening. There is uncertainty about the magnitude of overdiagnosis associated with

  15. A new green approach for the reduction of graphene oxide ...

    Indian Academy of Sciences (India)

    A simple and green chemistry approach for the preparation of reduced graphene oxide nanosheets was successfully demonstrated through the reduction of graphene oxide (GO) using caffeine as the reductant. Without using toxic and harmful chemicals, this method is environmentally friendly and suitable for the large-scale ...

  16. What's the Harm? The Coverage of Ethics and Harm Avoidance in Research Methods Textbooks

    Science.gov (United States)

    Dixon, Shane; Quirke, Linda

    2018-01-01

    Methods textbooks play a role in socializing a new generation of researchers about ethical research. How do undergraduate social research methods textbooks portray harm, its prevalence, and ways to mitigate harm to participants? We conducted a content analysis of ethics chapters in the 18 highest-selling undergraduate textbooks used in sociology…

  17. Paediatric endocrine disorders at the university college hospital, ibadan: 2002 - 2009.

    Science.gov (United States)

    Jarrett, O O; Ogunbosi, B O; Ayoola, O O

    2013-12-01

    Until recently, most published research focus more on infectious diseases and malnutrition giving the impression that endocrine disorders are uncommon. Reports on endocrine disorders in children in developing countries are few compared to developed countries reflecting the different level of prevalence in the different geographical locations and or level of awareness and availability of facilities for proper diagnosis. This study aims at defining the burden of paediatric endocrine disorders in Ibadan. A review of records of children who presented at University College Hospital, Ibadan with paediatric endocrine disorders from 2002 to 2009 was carried out. During the eight-year period, a total of 110 children presented with various endocrine disorders but only 94 had complete data for this study. There were 47(50%) males and 37(39.4%) females, and in 10(10.6%) of them, had genital ambiguity at presentation. Patients' ages ranged from 2 weeks to 15 years with a median of 3 years. Many (35%) patients were malnourished with weight less than 80% of the expected weight for age and only 9% were overweight. Yearly distribution of cases showed a steady increase in number of cases from 2005. Rickets and metabolic disorders constituted 56.4% of patients; Diabetes mellitus was diagnosed in 12.8%, adrenal disoders in 10.6%, pubertal disorders in 5.3% and growth disorders in 4.3% of the patients. Thyroid disorders were present in 6.4%, obesity in 3.2% while the least common disorder was Diabetes insipidus (1%). About 58% of the children had parents in the low socioeconomic status and the management of the cases were severely hampered by lack of funds. About 60.6% of these patients were lost to follow up, during the period. Paediatric endocrine disorders are associated with a high incidence of malnutrition. Most patients presented with rickets which is a preventable condition.

  18. Publishing in "SERJ": An Analysis of Papers from 2002-2009

    Science.gov (United States)

    Zieffler, Andrew; Garfield, Joan; delMas, Robert C.; Le, Laura; Isaak, Rebekah; Bjornsdottir, Audbjorg; Park, Jiyoon

    2011-01-01

    "SERJ" has provided a high quality professional publication venue for researchers in statistics education for close to a decade. This paper presents a review of the articles published to explore what they suggest about the field of statistics education, the researchers, the questions addressed, and the growing knowledge base on teaching and…

  19. Income Inequality, Economic Growth and Stroke Mortality in Brazil: Longitudinal and Regional Analysis 2002-2009.

    Science.gov (United States)

    Vincens, Natalia; Stafström, Martin

    2015-01-01

    Stroke accounts for more than 10% of all deaths globally and most of it occurs in low- and middle-income countries (LMIC). Income inequality and gross domestic product (GDP) per capita has been associated to stroke mortality in developed countries. In LMIC, GDP per capita is considered to be a more relevant health determinant than income inequality. This study aims to investigate if income inequality is associated to stroke mortality in Brazil at large, but also on regional and state levels, and whether GDP per capita modulates the impact of this association. Stroke mortality rates, Gini index and GDP per capita data were pooled for the 2002 to 2009 period from public available databases. Random effects models were fitted, controlling for GDP per capita and other covariates. Income inequality was independently associated to stroke mortality rates, even after controlling for GDP per capita and other covariates. GDP per capita reduced only partially the impact of income inequality on stroke mortality. A decrease in 10 points in the Gini index was associated with 18% decrease in the stroke mortality rate in Brazil. Income inequality was independently associated to stroke mortality in Brazil.

  20. Antibiotic susceptibility of bacteria isolated from infections in cats and dogs throughout Europe (2002-2009).

    Science.gov (United States)

    Kroemer, Stéphane; El Garch, Farid; Galland, Delphine; Petit, Jean-Luc; Woehrle, Frédérique; Boulouis, Henri-Jean

    2014-03-01

    A monitoring program of the pre-treatment susceptibility of clinical isolates of bacteria from diseased dogs and cats was active between the years 2002 and 2009. Susceptibility of each isolated strain to a panel of nine antibiotics (amoxicillin/clavulanic acid, ampicillin, penicillin, clindamycin, doxycycline, enrofloxacin, marbofloxacin, trimethoprim and trimethoprim/sulfamethoxazole) was assessed. The Minimum Inhibitory Concentration (MIC) of marbofloxacin was also determined by a standardized microdilution technique following CLSI recommendations. In total, 1857 bacterial strains were collected throughout Europe from cases of otitis, respiratory, urinary and dermatological infections. Although bacterial susceptibility varied for each of the antibiotics within the panel, patterns of susceptibility were similar to those described in the literature for comparable time periods and geographical areas. With a clinical resistance varying from 0 to 14.48% against the isolated strains, marbofloxacin susceptibility was very high and remains an effective antibiotic for the treatment of otitis, urinary, respiratory and dermatological infections in companion animals. Copyright © 2014. Published by Elsevier Ltd.

  1. Trends in the use of standardized tools for developmental screening in early childhood: 2002-2009.

    Science.gov (United States)

    Radecki, Linda; Sand-Loud, Nina; O'Connor, Karen G; Sharp, Sanford; Olson, Lynn M

    2011-07-01

    Early identification of developmental delays is essential for optimal early intervention. An American Academy of Pediatrics (AAP) 2002 Periodic Survey of Fellows found education programs promoted screening implementation. In 2006, the AAP issued a revised policy statement with a detailed algorithm. Since the 2002 Periodic Survey, no national surveys have examined the effectiveness of policy, programmatic, and educational enhancements. The goal of this study was to compare pediatricians' use of standardized screening tools from 2002 to 2009. A national, random sample of nonretired US AAP members were mailed Periodic Surveys (2002: N=1617, response rate: 55%; 2009: N=1620, response rate: 57%). χ(2) analyses were used to examine responses across survey years; a multivariate logistic regression model was developed to compare differences in using ≥1 formal screening tools across survey years while controlling for various individual and practice characteristics. Pediatricians' use of standardized screening tools increased significantly between 2002 and 2009. The percentage of those who self-reported always/almost always using ≥1 screening tools increased over time (23.0%-47.7%), as did use of specific instruments (eg, Ages & Stages Questionnaire, Parents' Evaluation of Developmental Status). No differences were noted on the basis of physician or practice characteristics. The percentage of pediatricians who reported using ≥1 formal screening tools more than doubled between 2002 and 2009. Despite greater attention to consistent use of appropriate tools, the percentage remains less than half of respondents providing care to patients younger than 36 months. Given the critical importance of developmental screening in early identification, evaluation, and intervention, additional research is needed to identify barriers to greater use of standardized tools in practice. Copyright © 2011 by the American Academy of Pediatrics.

  2. Spatial surveillance during control of infectious diseases – Salmonella Dublin in Denmark 2002-2009

    DEFF Research Database (Denmark)

    Ersbøll, Annette Kjær; Nielsen, Liza Rosenbaum

    2010-01-01

    estimated risk maps. In 2002, herd-level prevalence of Salmonella was 8% among all cattle herds (24% among dairy herds). It decreased to 4% among all cattle herds and 11% among dairy herds in 2009. Differences were seen in progress of the control among dairy herds between regions during the years...

  3. Proton pump inhibitor use in the U.S. ambulatory setting, 2002-2009.

    Directory of Open Access Journals (Sweden)

    Stephen R Rotman

    Full Text Available BACKGROUND AND AIMS: Anecdotal reports and studies of select populations suggest that the use of proton pump inhibitors (PPIs has increased since their introduction. We sought to determine recent trends in PPI use in the U.S. outpatient setting and characteristics of patients and physicians that may predict their use. METHODS: We used data from the National Ambulatory Medical Care Survey (NAMCS and the National Hospital Ambulatory Medical Care Survey (NHAMCS to estimate the prevalence of visits in which patients used PPIs from 2002 to 2009. We tested for associations between PPI use and patient, physician, and practice characteristics using data from 2009. We also estimated the prevalence of visits in which PPIs were used by patients without gastrointestinal complaints, diagnoses, or other indications for their use and tested for associations between patient and physician characteristics and PPI use in patients with no documented indication. RESULTS: PPIs were used in 4.0% of visits in 2002 and 9.2% in 2009 (p<0.001 for trend across years. The use of omeprazole (0.9% in 2002 to 3.9% in 2009, p<0.001, esomeprazole (0.9% in 2002 to 2.3% in 2009, p<0.001, and pantoprazole (0.6% in 2002 to 1.6% in 2009, p<0.001 increased significantly over the study period. Among visits by patients using PPIs, 62.9% documented no gastrointestinal complaints, gastrointestinal diagnoses, or other indicated reason for their use. CONCLUSIONS: We found that PPI use increased significantly from 2002 to 2009 as did documented indications for their use. Newly-prescribed PPI use did not change from 2006 to 2009. More research is needed to determine whether PPIs are overused in the U.S. outpatient setting.

  4. Unveiling self-harm behaviour: what can social media site Twitter tell us about self-harm? A qualitative exploration.

    Science.gov (United States)

    Emma Hilton, Charlotte

    2017-06-01

    To report the findings from a unique analysis of naturally occurring data regarding self-harm behaviour generated through the global social media site, Twitter. Self-harm behaviours are of global concern for health and social care practice. However, little is known about the experiences of those who harm and the attitudes of the general public towards such behaviours. A deeper, richer and more organic understanding of this is vital to informing global approaches to supporting individuals through treatment and recovery. Exploratory, qualitative design. Three hundred and sixty-two Twitter messages were subject to inductive thematic analysis. Five themes were identified: (1) celebrity influence, (2) self-harm is not a joke (with subthemes of you wouldn't laugh if you loved me and you think it's funny, I think it's cruel), (3) support for and from others, (4) eating disorders and self-harm and (5) videos and personal stories. The findings indicate that self-harm behaviour continues to be largely misunderstood by the general public and is often the source of ridicule which may contribute to delays in accessing treatment. Whilst Twitter may also provide a source of valuable support for those who self-harm, the sense of community, relatedness and understanding generated by such support may contribute to normalising self-harm and perpetuating the behaviours. Our understanding of the complexity of and aetiology and most effective treatment options for self-harm behaviours is still unclear. The findings demonstrate that there is a critical opportunity to conduct further qualitative research to better understand self-harm and to use these valuable and internationally relevant data to support the development of effective public education campaigns and personally tailored treatment options. © 2016 John Wiley & Sons Ltd.

  5. MELDI2 Do No Harm Test Series

    Science.gov (United States)

    Swanson, G. T.; Santos, J. A.; White, T. R.; Bruce, W. E.; Kuhl, C. A.; Wright, H. S.

    2017-01-01

    Mars 2020 will fly the Mars Entry, Descent, and Landing Instrumentation II (MEDLI2) sensor suite consisting of a total of seventeen instrumented thermal sensor plugs, eight pressure transducers, two heat flux sensors, and one radiometer embedded in the thermal protection system (TPS). Of the MEDLI2 instrumentation, eleven instrumented thermal plugs and seven pressure transducers will be installed on the heatshield of the Mars 2020 vehicle while the rest will be installed on the backshell. The goal of the MEDLI2 instrumentation is to directly inform the large performance uncertainties that contribute to the design and validation of a Mars entry system. A better understanding of the entry environment and TPS performance could lead to reduced design margins enabling a greater payload mass-fraction and smaller landing ellipses. To prove that the MEDLI2 system will not degrade the performance of the Mars 2020 TPS, an Aerothermal Do No Harm (DNH) test series was designed and conducted. Like Mars 2020's predecessor, Mars Science Laboratory (MSL), the heatshield material will be Phenolic Impregnated Carbon Ablator (PICA); the Mars 2020 entry conditions are enveloped by the MSL design environments, therefore the development and qualification testing performed during MEDLI is sufficient to show that the similar MEDLI2 heatshield instrumentation will not degrade PICA performance. However, given that MEDLI did not include any backshell instrumentation, the MEDLI2 team was required to design and execute a DNH test series utilizing the backshell TPS material (SLA-561V) with the intended flight sensor suite. To meet the requirements handed down from Mars 2020, the MEDLI2 DNH test series emphasized the interaction between the MEDLI2 sensors and sensing locations with the surrounding backshell TPS and substrucutre. These interactions were characterized by performing environmental testing of four 12" by 12" test panels, which mimicked the construction of the backshell TPS and the

  6. Alcohol Involvement in Suicide and Self-Harm.

    Science.gov (United States)

    Larkin, Celine; Griffin, Eve; Corcoran, Paul; McAuliffe, Carmel; Perry, Ivan J; Arensman, Ella

    2017-11-01

    Alcohol misuse and alcohol consumption are significant risk factors for suicidal behavior. This study sought to identify factors associated with alcohol consumption in cases of suicide and nonfatal self-harm presentations. Suicide cases in Cork, Ireland, from September 2008 to June 2012 were identified through the Suicide Support and Information System. Emergency department presentations of self-harm in the years 2007-2013 were obtained from the National Self-Harm Registry Ireland. Alcohol consumption was detected in the toxicology of 44% out of 307 suicide cases. Only younger age was significantly associated with having consumed alcohol among suicides. Alcohol consumption was noted in the case notes in 21% out of 8,145 self-harm presentations. Logistic regression analyses indicated that variables associated with having consumed alcohol in a self-harm presentation included male gender, older age, overdose as a method, not being admitted to a psychiatric ward, and presenting out-of-hours. Data was limited to routinely collected variables by the two different monitoring systems. Alcohol consumption commonly precedes suicidal behavior, and several factors differentiated alcohol-related suicidal acts. Self-harm cases, in particular, differ in profile when alcohol is consumed and may require a tailored clinical approach to minimize risk of further nonfatal or fatal self-harm.

  7. Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm.

    Science.gov (United States)

    van de Plas, Afke; Slikkerveer, Mariëlle; Hoen, Saskia; Schrijnemakers, Rick; Driessen, Johanna; de Vries, Frank; van den Bemt, Patricia

    2017-01-01

    In this controlled before-after study the effect of improvements, derived from Lean Six Sigma strategy, on parenteral medication administration errors and the potential risk of harm was determined. During baseline measurement, on control versus intervention ward, at least one administration error occurred in 14 (74%) and 6 (46%) administrations with potential risk of harm in 6 (32%) and 1 (8%) administrations. Most administration errors with high potential risk of harm occurred in bolus injections: 8 (57%) versus 2 (67%) bolus injections were injected too fast with a potential risk of harm in 6 (43%) and 1 (33%) bolus injections on control and intervention ward. Implemented improvement strategies, based on major causes of too fast administration of bolus injections, were: Substitution of bolus injections by infusions, education, availability of administration information and drug round tabards. Post intervention, on the control ward in 76 (76%) administrations at least one error was made (RR 1.03; CI95:0.77-1.38), with a potential risk of harm in 14 (14%) administrations (RR 0.45; CI95:0.20-1.02). In 40 (68%) administrations on the intervention ward at least one error occurred (RR 1.47; CI95:0.80-2.71) but no administrations were associated with a potential risk of harm. A shift in wrong duration administration errors from bolus injections to infusions, with a reduction of potential risk of harm, seems to have occurred on the intervention ward. Although data are insufficient to prove an effect, Lean Six Sigma was experienced as a suitable strategy to select tailored improvements. Further studies are required to prove the effect of the strategy on parenteral medication administration errors.

  8. Alcohol-related harm among university students in Hanoi, Vietnam

    Directory of Open Access Journals (Sweden)

    Pham Bich Diep

    2013-02-01

    Full Text Available Introduction and Aim: This study examines the prevalence of and risk factors for alcohol-related harm and types of harm among medical students from Hanoi Medical University (Vietnam. Risk factors include aspects of drinking patterns and relevant socio-demographic variables. Study Design and Methods: A cross-sectional study involving 1st to 6th year students (N=1216; response rate 96.5%. Of these, 210 students from each academic year were randomly selected from a sampling frame covering all students from each academic year. Data were collected using a questionnaire distributed in class by researchers. Drinkers completed 23 questions on alcohol-related harm categorized into: 1 ‘negative influence on daily activities’; 2 ‘social conflict’; 3 ‘loss of control, acute consequences, and withdrawal’; 4 ‘mental health conditions’; and 5 ‘physical and medical health problems’. Logistic and Poisson regression models were used to identify the predictors of alcohol-related harm and the amount of harm, respectively. Results: The prevalence of alcohol use associated with at least one or more of the five types of harm was higher in men (81.8% than in women (60.4%. In female and male students, the most common harm category was ‘loss of control, acute consequences, and withdrawal’ (51.8 and 75.6%, respectively, followed by ‘negative influence on daily activities’ (29.4 and 55.8%, respectively. Age, living away from home, and average number of standard drinks per occasion among male drinkers, and age and frequency of drinking per week among female drinkers were associated with alcohol-related harm. Conclusions: These data suggest that alcohol-related harm represents a serious public health problem among young educated individuals in Vietnam. The risk factors indicate that prevention should be aimed at aspects of drinking patterns and specific subpopulations defined by gender, age, and (for men only type of living situation.

  9. Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Carter, Emily; Bryce, Jennifer; Perin, Jamie; Newby, Holly

    2015-08-18

    correct management of diarrheal disease in children and result in treatment failure, sustained nutritional deficits, and increased diarrhea mortality. The lack of consistency in sampling, measurement, and reporting identified in this literature review highlights the need to document harmful practices using standard methods of measurement and reporting for the continued reduction of diarrhea mortality.

  10. Public Perceptions of Self-Harm: Perceived Motivations of (and Willingness to Help in Response to) Adolescent Self-Harm.

    Science.gov (United States)

    Nielsen, Emma; Townsend, Ellen

    2017-10-05

    We investigated public perceptions of, and responses to, adolescent self-harm-an under-researched topic, given that the majority of self-harm in this group is not disclosed to formal support services. Participants (N = 355, aged 18-67 years) were presented with 1 of 10 vignettes and completed self-report measures assessing perceived motivations for self-harm and helping/rejecting responses. Vignettes were manipulated across conditions for stated motivation, controllability of stated cause, and presentation format. Results indicate that stated motivation for self-harm, controllability of stated cause, and presentation format affect perceived motivations. Further, participants demonstrate an understanding of the complex nature of self-harm, indicating an appreciation that an individual may hold multiple motivations simultaneously. Perceived motivations for self-harm are associated with the endorsement of helping/rejecting behaviors. These relationships are important to explore, given the critical importance of initial responses to self-harm on subsequent disclosures and help-seeking.

  11. Cocaine and stimulants, the challenge of self-regulation in a harm reduction perspective

    OpenAIRE

    Grazia Zuffa; Susanna Ronconi

    2015-01-01

    A significant body of research on cocaine users recruited outside the “captive” populations (i.e. studies from samples of users who have not been enrolled through drug addiction services) has been carried out in many European countries and outside Europe. These studies show a variety of patterns and trajectories of use other than “addictive” use. The reason of most “controlled” use lies in a wide set of self-regulation “rules” users “naturally” apply to keep drug use at bay and prevent the di...

  12. Harm-reduction activism: a case study of an unsanctioned user-run safe injection site.

    Science.gov (United States)

    Kerr, Thomas; Oleson, Megan; Wood, Evan

    2004-08-01

    Due to the ongoing health crisis among injection drug users in Vancouver, Canada, there have been repeated calls for the establishment of safe injection sites (SISs) since the early 1990s. In April 2003, in response to a large-scale police crackdown and government inaction, a group of activists opened an unsanctioned SIS in Vancouver's Downtown Eastside (DTES). The 327 Carrall Street SIS operated for 181 days despite considerable police harassment and limited financial support. During the operation of the SIS, volunteers supervised over 3000 injections and demonstrated the feasibility of a user-run low-threshold SIS. The experience of the SIS provides valuable lessons for those seeking to advance the interests of injection drug users through community mobilization and direct action approaches. In this article, Thomas Kerr, Megan Oleson, and Evan Wood describe the events surrounding the establishment, operation, and closing of the unsanctioned SIS, and outline the lessons learned.

  13. Monitoring quality and coverage of harm reduction services for people who use drugs

    DEFF Research Database (Denmark)

    Wiessing, Lucas; Ferri, Marica; Běláčková, Vendula

    2017-01-01

    among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS: The framework was developed collaboratively using consensus methods involving nominal group...... meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators...

  14. Sexual Agreement Classifications for Gay and Bisexual Men and Implications for Harm Reduction HIV Prevention

    Science.gov (United States)

    Wilkerson, J. Michael; Smolenski, Derek J.; Morgan, Richard; Rosser, B. R. Simon

    2012-01-01

    HIV prevention educators frequently encourage gay and bisexual men (GBM) to negotiate condom use prior to sexual engagement. Identifying groups of GBM based on their presexual agreements can aid efforts to tailor interventions. Using cross-sectional data from 1,188 GBM who reported having sex with a nonprimary sex partner in the 90 days prior to…

  15. Monitoring quality and coverage of harm reduction services for people who use drugs : A consensus study

    NARCIS (Netherlands)

    Wiessing, Lucas; Ferri, Marica; Běláčková, Vendula; Carrieri, Patrizia; Friedman, Samuel R.; Folch, Cinta; Dolan, Kate; Galvin, Brian; Vickerman, Peter; Lazarus, Jeffrey V.; Mravčík, Viktor; Kretzschmar, Mirjam; Sypsa, Vana; Sarasa-Renedo, Ana; Uusküla, Anneli; Paraskevis, Dimitrios; Mendão, Luis; Rossi, Diana; van Gelder, Nadine; Mitcheson, Luke; Paoli, Letizia; Gomez, Cristina Diaz; Milhet, Maitena; Dascalu, Nicoleta; Knight, Jonathan; Hay, Gordon; Kalamara, Eleni; Simon, Roland; Comiskey, Catherine; Rossi, Carla; Griffiths, Paul; Molinaro, Sabrina; Franchini, Michela; Siciliano, Valeria; Benedetti, Elisa; Perduca, Marco; Ylli, Alban; Anta, Gregorio Barrio; Bravo Portela, Maria José; Indave, Iciar; Rácz, József; Zábranskỳ, Tomáš; Štefunková, Michaela; Dávila, Percy Fernandez; Salekesin, Maris; Vorobjov, Sigrid; Dan, Monica; Fierbinteanu, Cristina; Popescu, Dan; Verdes, Ludmila; Abagiu, Adrian Octavian; Hatzakis, Angelos; Moudatsou, Maria; Antypas, Tzanetos; Cadet-Tairou, Agnes; Collins, Anne Marie; Liddell, David

    2017-01-01

    Background and aims: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological

  16. Reduction of harmful nitrogen oxide emission from low heat rejection diesel engine using carbon nanotubes

    Directory of Open Access Journals (Sweden)

    Thulasi Gopinathan

    2016-01-01

    Full Text Available In this study, lanthanum aluminate is used as thermal barrier coating material for the first time in the internal combustion engine to convert the standard engine into low heat rejection engine. Initially, the biodiesel is prepared from sunflower oil by using trans-esterification process. The piton crown, cylinder head and valves of the engine is coated with lanthanum aluminate for a thickness of around 200 microns. However, the analysis of performance and emission characteristics of a standard diesel is carried out with diesel/biodiesel to compare with the low heat rejection engine. The lanthanum aluminate coated engine fueled with sunflower methyl ester shows better performance and emission. But the emission of NOx founds to be higher in the coated engine. Further, a small quantity of carbon nanotubes is added onto the biodiesel to carry out the experiments. Based on the results, the carbon nanotubes are added with the biodiesel to reduce the emission of NOx.

  17. Assessing University Students' Self-Efficacy to Employ Alcohol-Related Harm Reduction Strategies

    Science.gov (United States)

    Rosenberg, Harold; Bonar, Erin E.; Hoffmann, Erica; Kryszak, Elizabeth; Young, Kathleen M.; Kraus, Shane W.; Ashrafioun, Lisham; Bannon, Erin E.; Pavlick, Michelle

    2011-01-01

    Objective: Develop and evaluate key psychometric properties of a self-report questionnaire specifically designed to assess student drinkers' self-confidence to employ a variety of strategies intended to reduce unhealthy consequences of high-risk drinking. Methods: Four hundred ninety-eight participants rated their confidence (from "not at all…

  18. Maximising harm reduction in early specialty training for general practice: validation of a safety checklist

    National Research Council Canada - National Science Library

    Bowie, Paul; McKay, John; Kelly, Moya

    2012-01-01

    .... Doctors-in-training are also known to be susceptible to medical error. Ensuring that all essential educational issues are addressed during training is problematic given the scale of the tasks to be undertaken...

  19. A Premiere example of the illusion of harm reduction cigarettes in the 1990s

    OpenAIRE

    Pollay, R; Dewhirst, T

    2003-01-01

    Objective: To use the product launch of Player's Premiere as a case study for understanding the new cigarette product development process during the 1990s. We determine the (in)validity of industry claims that: (1) development of the physical product preceded the promotional promise of "less irritation"; (2) "less irritation" was actually realised; (3) advertising informed consumers; and (4) advertising regulations caused the product's failure in the marketplace.

  20. Harm reduction and knowledge exchange—a qualitative analysis of drug-related Internet discussion forums

    OpenAIRE

    Kjellgren, Anette; Soussan, Christophe

    2014-01-01

    Background: Novel psychoactive substances (NPS) are continuously and increasingly appearing on the international drug market. Global Internet forums are a publicly available reality where users anonymously discuss and share information about NPS. The aim of this study was to explore and characterize the discussions about NPS on international Internet forums. Methods: The most post-frequent NPS discussions were collected from three “leading edge” international Internet forums. A total of 13,08...

  1. Alcohol Abstinence or Harm-Reduction? Parental Messages for College-Bound Light Drinkers

    OpenAIRE

    LaBRIE, JOSEPH W.; Boyle, Sarah C.; Napper, Lucy E.

    2015-01-01

    Parental communications about alcohol can have a significant impact on college students’ alcohol use; however, it is unclear what types of communication may be most beneficial for reducing alcohol risk, particularly among students who have already initiated alcohol use. The present research examines differences in alcohol use and employment of drinking protective behavioral strategies between pre-college matriculation high school seniors receiving predominantly abstinence parent messaging and...

  2. Harm Reduction or Psychedelic Support? Caring for Drug-Related Crises at Transformational Festivals

    OpenAIRE

    Deirdre Ruane

    2015-01-01

    Many of the EDM events known as “transformational festivals” provide psychedelic support spaces: volunteer projects caring for festivalgoers undergoing difficult drug experiences. Mostly drawn from the festival community, many volunteer carers (“sitters”) subscribe to psychedelic culture discourse which frames these substances as aids to personal growth if handled appropriately. However, within the dominant paradigm of international drug prohibition, support projects must employ the contrasti...

  3. Less Invasive Procedure May Treat Fibroids without Harming Fertility

    Science.gov (United States)

    ... Less Invasive Procedure May Treat Fibroids Without Harming Fertility Study found blocking blood flow to growths worked ... are suffering from fibroids without jeopardizing their future fertility, a new study suggests. Uterine fibroid embolization (UFE) ...

  4. Mental health nurses' attitudes toward self-harm: Curricular implications

    Directory of Open Access Journals (Sweden)

    David G. Shaw

    2016-12-01

    Conclusion: The FASH Model may inform future curriculum innovation. Adopting a holistic approach to education of nurses about self-harm may assist in developing attitudes and skills to make care provision more effective in secure mental health settings.

  5. Airborne Monitoring of Harmful Algal Blooms over Lake Erie

    Science.gov (United States)

    Tokars, Roger; Lekki, John

    2013-01-01

    The Hyperspectral Imager mounted to an aircraft was used to develop a remote sensing capability to detect the pigment Phycocyanin, an indicator of Microcystis, in low concentration as an early indicator of harmful algal bloom prediction.

  6. Learning-Based Detection of Harmful Data in Mobile Devices

    Directory of Open Access Journals (Sweden)

    Seok-Woo Jang

    2016-01-01

    Full Text Available The Internet has supported diverse types of multimedia content flowing freely on smart phones and tablet PCs based on its easy accessibility. However, multimedia content that can be emotionally harmful for children is also easily spread, causing many social problems. This paper proposes a method to assess the harmfulness of input images automatically based on an artificial neural network. The proposed method first detects human face areas based on the MCT features from the input images. Next, based on color characteristics, this study identifies human skin color areas along with the candidate areas of nipples, one of the human body parts representing harmfulness. Finally, the method removes nonnipple areas among the detected candidate areas using the artificial neural network. The experimental results show that the suggested neural network learning-based method can determine the harmfulness of various types of images more effectively by detecting nipple regions from input images robustly.

  7. Problems of harmful habits and dependences of students.

    Directory of Open Access Journals (Sweden)

    Gorobey Nikolaj Petrovich

    2011-11-01

    Full Text Available The analysis of data of modern scientific literature is conducted on issue of harmful habits and dependences of students. It is shown that considerable part of student young people have harmful habits and dependences. Negative influence of harmful habits and dependences of students is exposed on the state of their health. Importance of delivering is well-proven from addiction behavior in practice of healthy way of life of students. It is set that one of foreground jobs of present time there is an increase of level of education of student young people on questions abandonment from harmful habits and dependences. The ways of decision of problem of addiction behavior of students are offered as an effective condition of improvement of the state of their health.

  8. Evolution of helping and harming in heterogeneous populations.

    Science.gov (United States)

    Rodrigues, António M M; Gardner, Andy

    2012-07-01

    There has been much interest in understanding how demographic factors can mediate social evolution in viscous populations. Here, we examine the impact of heterogeneity in patch quality--that is, the availability of reproductive resources for each breeder--upon the evolution of helping and harming behaviors. We find that, owing to a cancellation of relatedness and kin competition effects, the evolution of obligate and facultative helping and harming is not influenced by the degree of viscosity in populations characterized by either spatial or temporal heterogeneity in patch quality. However, facultative helping and harming may be favored when there is both spatial and temporal heterogeneity in patch quality, with helping and harming being favored in both high-quality and low-quality patches. We highlight the prospect for using kin selection theory to explain within-population variation in social behavior, and point to the need for further theoretical and empirical investigation of this topic. © 2012 The Author(s).

  9. Identity, harm, and the ethics of reproductive technology.

    Science.gov (United States)

    Malek, Janet

    2006-02-01

    The controversial question of whether a future child can be harmed by the use of reproductive technology turns on the way that the future child's identity is understood. As a result, analysis of the ethical and legal obligations to the children of reproductive technology that are based upon the possibility of such harm depends upon the conception of identity that is used. This paper reviews the contributions of two recent books, David DeGrazia's Human Identity and Bioethics (2005) and Philip Peters' How Safe is Safe Enough? (2004) to this area of inquiry. It suggests that the use of a narrative rather than numerical conception of identity makes it possible to coherently claim that future children can be harmed by the use of reproductive technologies and that, as a result, potential parents can have obligations regarding the use of those technologies based upon that possibility of harm.

  10. Just 10 Cigarettes During Pregnancy Can Harm Kids

    Science.gov (United States)

    ... medlineplus.gov/news/fullstory_166312.html Just 10 Cigarettes During Pregnancy Can Harm Kids Teens whose mothers ... to women who smoked as few as 10 cigarettes are more apt to have thinking and learning ...

  11. Mental health nurses' attitudes toward self-harm: Curricular implications

    National Research Council Canada - National Science Library

    David G. Shaw; Peter Thomas Sandy

    2016-01-01

    .... The literature also neglects secure mental health settings. Methods: The study aimed to explore the attitudes of mental health nurses toward service users who self-harm in secure environments, and to inform mental health curriculum development...

  12. Harmful situations, impure people: an attribution asymmetry across moral domains.

    Science.gov (United States)

    Chakroff, Alek; Young, Liane

    2015-03-01

    People make inferences about the actions of others, assessing whether an act is best explained by person-based versus situation-based accounts. Here we examine people's explanations for norm violations in different domains: harmful acts (e.g., assault) and impure acts (e.g., incest). Across four studies, we find evidence for an attribution asymmetry: people endorse more person-based attributions for impure versus harmful acts. This attribution asymmetry is partly explained by the abnormality of impure versus harmful acts, but not by differences in the moral wrongness or the statistical frequency of these acts. Finally, this asymmetry persists even when the situational factors that lead an agent to act impurely are stipulated. These results suggest that, relative to harmful acts, impure acts are linked to person-based attributions. Copyright © 2014 Elsevier B.V. All rights reserved.

  13. Sexual Orientation and Self-Harm in Men and Women

    National Research Council Canada - National Science Library

    Skegg, Keren; Nada-Raja, Shyamala; Dickson, Nigel; Paul, Charlotte; Williams, Sheila

    2003-01-01

    .... The purpose of this study was to determine associations between self-harm and sexual orientation for men and women separately, defining sexual orientation by sexual attraction rather than by behavior. METHOD...

  14. Beneficial and Harmful Addictions: Two sides of the same coin

    National Research Council Canada - National Science Library

    Rafael López

    2016-01-01

    ...) as two sides of the same coin. Besides the theoretical insight it provides, this dualism is also particularly useful because it readily allows for the translation of the results obtained in the domain of harmful addictions...

  15. Risk Talk : On Communicating Benefits and Harms in Health Care

    OpenAIRE

    Hoffmann, Mikael

    2006-01-01

    One of the most critical elements in empowering the patient, and ensuring concordance, is communication of the possible benefits and harms of different actions in health care. Risk assessment is a complex task due both to the different interpretations of the concept of risk, and the common lack of hard facts. Hormone, or hormone replacement, therapy (HT) is used by many women in, and after, the menopause. The benefits and possible harms associated with short and long term treatment with HT ha...

  16. Coastal engineering and Harmful Algal Blooms along Alexandria coast, Egypt

    Directory of Open Access Journals (Sweden)

    Amany A. Ismael

    2014-01-01

    The phytoplankton composition and its standing crop became totally different during the two periods. The most important bloom was caused by Micromonas pusilla forming a heavy green tide accompanied by a bloom of Peridinium quinquecorne. Although there were no fish or invertebrate mortality, this bloom caused economic losses to internal tourism. In the absence of any Environmental Assessment, the coastal engineering works increased the harmful algal blooms in Alexandria coastal waters, even after corrective steps were taken to mitigate the harmful effects.

  17. Learning-Based Detection of Harmful Data in Mobile Devices

    OpenAIRE

    Seok-Woo Jang; Gye-Young Kim

    2016-01-01

    The Internet has supported diverse types of multimedia content flowing freely on smart phones and tablet PCs based on its easy accessibility. However, multimedia content that can be emotionally harmful for children is also easily spread, causing many social problems. This paper proposes a method to assess the harmfulness of input images automatically based on an artificial neural network. The proposed method first detects human face areas based on the MCT features from the input images. Next,...

  18. Deliberate Self-Harm in Adolescence: A Challenge for Schools

    Science.gov (United States)

    Best, Ron

    2006-01-01

    Acts of deliberate self-harm (DSH) by adolescents are thought to be on the increase. Many of those who self-harm are of school age and it is to be expected that schools (and their teachers) will be aware of the problem and will respond appropriately as part of their pastoral-care provision. However, a recent survey of research in pastoral care and…

  19. Self-harm by severe glossal injury in schizophrenia

    Science.gov (United States)

    Bhat, Pookala S.; Pardal, P. K.; Diwakar, M.

    2011-01-01

    Self-mutilation, the deliberate destruction occurs in a variety of psychiatric disorders.Many methods of self-destructive behavior have been described in literature. Patients of schizophrenia are known to attempt self-harm due to command hallucination, catatonic excitement or because of associated depression, however severe glossal injury by biting has not been reported so far.Authors report case of self-harm of glossal injury by biting in schizophrenia. Treatment and management issues are discussed. PMID:23271870

  20. Do no harm: a defense of markets in healthcare.

    Science.gov (United States)

    Kline, William

    2010-09-01

    This paper argues that the rules that constitute a market protect autonomy and increase welfare in healthcare. Markets do the former through protecting rights to self-ownership and a cluster of rights that protect its exercise. Markets protect welfare by organizing and protecting trades. In contrast, prohibition destroys legitimate markets, giving rise to so-called black markets that harm both the autonomy and well-being of agents. For example, a fee-for-service medical system is a highly developed and specialized market. It is individuals working together, through the division of labor, to provide mutual insurance. This coordination, and the benefits it makes possible, is not possible without injunctions against harm. Prohibitions on harm are not mere ethical niceties, they are practice rules for both healthcare and markets. Placing the doctor within a healthcare market actually reinforces the doctor's moral obligation, and the legal enforcement of that obligation, not to harm. Similarly, markets reinforce patient rights to self-determination through legal and institutional enforcement of the harm principle in the form of the protection of certain basic welfare rights to life, bodily integrity, property, trade, and contract. Since the establishment of markets protects agent autonomy and welfare, and prohibition directly harms the same, there are strong reasons for establishing markets to protect trade in precisely those areas where autonomy and well-being are most vulnerable to exploitation, for example, the trade in human kidneys.

  1. High-Volume Repeaters of Self-Harm.

    Science.gov (United States)

    Ness, Jennifer; Hawton, Keith; Bergen, Helen; Waters, Keith; Kapur, Navneet; Cooper, Jayne; Steeg, Sarah; Clarke, Martin

    2016-11-01

    Repetition of self-harm is common and is strongly associated with suicide. Despite this, there is limited research on high-volume repetition. To investigate individuals with high-volume repeat self-harm attendances to the emergency department (ED), including their patterns of attendance and mortality. Data from the Multicentre Study of Self-Harm in England were used. High-volume repetition was defined as ⩾15 attendances within 4 years. An attendance timeline was constructed for each high-volume repeater (HVR) and the different patterns of attendance were explored using an executive sorting task and hierarchical cluster analysis. A small proportion of self-harm patients are HVRs (0.6%) but they account for a large percentage of self-harm attendances (10%). In this study, the new methodological approach resulted in three types of attendance patterns. All of the HVRs had clusters of attendance and a greater proportion died from external causes compared with non-HVRs. The approach used in this study offers a new method for investigating this problem that could have both clinical and research benefits. The need for early intervention is highlighted by the large number of self-harm episodes per patient, the clustered nature of attendances, and the higher prevalence of death from external causes.

  2. Drug policy, harm and human rights: a rationalist approach.

    Science.gov (United States)

    Stevens, Alex

    2011-05-01

    It has recently been argued that drug-related harms cannot be compared, so making it impossible to choose rationally between various drug policy options. Attempts to apply international human rights law to this area are valid, but have found it difficult to overcome the problems in applying codified human rights to issues of drug policy. This article applies the rationalist ethical argument of Gewirth (1978) to this issue. It outlines his argument to the 'principle of generic consistency' and the hierarchy of basic, nonsubtractive and additive rights that it entails. It then applies these ideas to drug policy issues, such as whether there is a right to use drugs, whether the rights of drug 'addicts' can be limited, and how different harms can be compared in choosing between policies. There is an additive right to use drugs, but only insofar as this right does not conflict with the basic and nonsubtractive rights of others. People whose freedom to choose whether to use drugs is compromised by compulsion have a right to receive treatment. They retain enforceable duties not to inflict harms on others. Policies which reduce harms to basic and nonsubtractive rights should be pursued, even if they lead to harms to additive rights. There exists a sound, rational, extra-legal basis for the discussion of drug policy and related harms which enables commensurable discussion of drug policy options. Copyright © 2011 Elsevier B.V. All rights reserved.

  3. Why Suicide? The Analysis of Motives for Self-Harm.

    Science.gov (United States)

    Abbas, Mohammed J; Mohanna, Mostafa A; Diab, Tarig A; Chikoore, Millicent; Wang, Michael

    2017-06-19

    There is a gap in understanding the meaning and motives behind suicidal behaviour. Using the Ideal Type methodology, Jean Baechler systematically examined the internal logic of suicidal and self-harming behaviours. He developed a typology of eleven typical meanings/motives: Flight, Grief, Self-punishment, Vengeance, Crime, Blackmail, Appeal, Sacrifice, Transfiguration, Ordeal and Game. To develop and validate a standardized instrument to measure the motives/meanings of suicidal and self-harming behaviours, using Baechler's typology. We developed a self-fill Likert questionnaire (Ideal Typical Meaning Questionnaire, ITMQ) covering ten of Baechler's eleven types. The questionnaire was completed by 147 patients within four weeks of attempting suicide or self-harm. The Death Attitude Profile-Revised (DAP-R) questionnaire was used to examine the concurrent validity of the Flight and the Transfiguration types and to explore the association between suicidal/self-harming motives and views about death. The final 25-item ITMQ has an eight-factor structure (Appeal/Blackmail, Ordeal/Game, Vengeance, Self-punishment, Sacrifice, Flight, Grief and Transfiguration) supporting Baechler's theory. The types have adequate reliability. Correlations with the DAP-R gave some support for the concurrent validity of the Flight and Transfiguration types. The ITMQ is a measure of suicidal and self-harming motives/meanings based on a sound conceptual framework and could significantly contribute to the understanding of suicidal and self-harming behaviour in research and clinical settings.

  4. Serotonin selectively influences moral judgment and behavior through effects on harm aversion

    National Research Council Canada - National Science Library

    Molly J. Crockett; Luke Clark; Marc D. Hauser; Trevor W. Robbins

    2010-01-01

    ...) against highly aversive harmful actions (e.g., killing an innocent person). Enhancing serotonin made subjects more likely to judge harmful actions as forbidden, but only in cases where harms were emotionally salient...

  5. Harmful algal bloom smart device application: using image analysis and machine learning techniques for early classification of harmful algal blooms

    Science.gov (United States)

    The Ecological Stewardship Institute at Northern Kentucky University and the U.S. Environmental Protection Agency are collaborating to optimize a harmful algal bloom detection algorithm that estimates the presence and count of cyanobacteria in freshwater systems by image analysis...

  6. A method for examining temporal changes in cyanobacterial harmful algal bloom spatial extent using satellite remote sensing (Harmful Algae)

    Science.gov (United States)

    Cyanobacterial harmful algal blooms (CyanoHAB) are thought to be increasing globally over the past few decades, but relatively little quantitative information is available about the spatial extent of blooms. Satellite remote sensing provides a potential technology for identifying...

  7. Nitrate reduction

    Science.gov (United States)

    Dziewinski, Jacek J.; Marczak, Stanislaw

    2000-01-01

    Nitrates are reduced to nitrogen gas by contacting the nitrates with a metal to reduce the nitrates to nitrites which are then contacted with an amide to produce nitrogen and carbon dioxide or acid anions which can be released to the atmosphere. Minor amounts of metal catalysts can be useful in the reduction of the nitrates to nitrites. Metal salts which are formed can be treated electrochemically to recover the metals.

  8. Nurses' attitudes towards self-harm: a literature review.

    Science.gov (United States)

    Karman, P; Kool, N; Poslawsky, I E; van Meijel, B

    2015-02-01

    People who self-harm experience many problems and needs related to management of emotional and practical stress. A positive attitude among nurses is especially important given the close contact they have with people who self-harm. This article is based on a review of the literature. It includes articles that concern both general and mental health nurses who work in various healthcare settings (e.g. acute inpatients wards, community mental health, emergency departments and medical admission units). The literature shows that negative attitudes towards self-harm are common among nurses. It remains unclear how nurses' age, work experience and gender influence their attitudes. The setting in which nurses work appears to influence their attitude, as does their level of qualification. For example, mental health nurses appear to have more positive attitudes than general nurses. Nurses' attitudes can be improved with the help of education comprising reflective and interactive elements. Supervision and support from colleagues appear to be especially important for mental health nurses. Self-harm is a growing health problem. Nurses in a variety of healthcare settings play a central role in the care of people who self-harm. Their professional attitudes towards these people are essential for high-quality care. This review aims to develop insight into nurses' attitudes towards self-harm as they exist in contemporary nursing practice. A literature search was conducted in four databases, and a total of 15 relevant articles were found. This review indicates that negative attitudes towards self-harm are common among nurses. The influence of nurses' age, gender and work experience remains unclear. Healthcare setting and qualification level appear to be influencing factors. Education can have a positive influence on nurses' attitudes towards self-harm, especially when it includes reflective and interactive components. It is demonstrated in this review that a major change is needed

  9. Future Climate Impacts on Harmful Algal Blooms in an Agriculturally Dominated Ecosystem

    Science.gov (United States)

    Aloysius, N. R.; Martin, J.; Ludsin, S.; Stumpf, R. P.

    2015-12-01

    Cyanobacteria blooms have become a major problem worldwide in aquatic ecosystems that receive excessive runoff of limiting nutrients from terrestrial drainage. Such blooms often are considered harmful because they degrade ecosystem services, threaten public health, and burden local economies. Owing to changing agricultural land-use practices, Lake Erie, the most biologically productive of the North American Great Lakes, has begun to undergo a re-eutrophication in which the frequency and extent of harmful algal blooms (HABs) has increased. Continued climate change has been hypothesized to magnify the HAB problem in Lake Erie in the absence of new agricultural management practices, although this hypothesis has yet to be formally tested empirically. Herein, we tested this hypothesis by predicting how the frequency and extent of potentially harmful cyanobacteria blooms will change in Lake Erie during the 21st century under the Intergovernmental Panel on Climate Change Fifth Assessment climate projections in the region. To do so, we used 80 ensembles of climate projections from 20 Global Climate Models (GCMs) and two greenhouse gas emission scenarios (moderate reduction, RCP4.5; business-as-usual, RCP8.5) to drive a spatiotemporally explicit watershed-hydrology model that was linked to several statistical predictive models of annual cyanobacteria blooms in Lake Erie. Owing to anticipated increases in precipitation during spring and warmer temperatures during summer, our ensemble of predictions revealed that, if current land-management practices continue, the frequency of severe HABs in Lake Erie will increase during the 21st century. These findings identify a real need to consider future climate projections when developing nutrient reduction strategies in the short term, with adaptation also needing to be encouraged under both greenhouse gas emissions scenarios in the absence of effective nutrient mitigation strategies.

  10. Effect of smoking reduction on lung cancer risk

    DEFF Research Database (Denmark)

    Godtfredsen, Nina S; Prescott, Eva; Osler, Merete

    2005-01-01

    Many smokers are unable or unwilling to completely quit smoking. A proposed means of harm reduction is to reduce the number of cigarettes smoked per day. However, it is not clear whether this strategy decreases the risk for tobacco-related diseases.......Many smokers are unable or unwilling to completely quit smoking. A proposed means of harm reduction is to reduce the number of cigarettes smoked per day. However, it is not clear whether this strategy decreases the risk for tobacco-related diseases....

  11. Cost-Effectiveness and Harm-Benefit Analyses of Risk-Based Screening Strategies for Breast Cancer

    Science.gov (United States)

    Carles, Misericordia; Sala, Maria; Pla, Roger; Castells, Xavier; Domingo, Laia; Rue, Montserrat

    2014-01-01

    The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies. PMID:24498285

  12. PREP advertisement features affect smokers' beliefs regarding potential harm.

    Science.gov (United States)

    Strasser, A A; Tang, K Z; Tuller, M D; Cappella, J N

    2008-09-01

    The Institute of Medicine report on potential reduced exposure products (PREPs) recommends that advertising and labelling be regulated to prevent explicitly or implicitly false or misleading claims. Belief that a product is less harmful may increase use or prevent smoking cessation. To determine the effect of altering advertisement features on smokers' beliefs of the harm exposure from a PREP. A Quest advertisement was digitally altered using computer software and presented to participants using web-based television recruitment contracted through a survey company. 500 current smokers completed demographic and smoking history questions, were randomised to view one of three advertisement conditions, then completed eight items assessing their beliefs of the harmfulness of the product. Advertisement conditions included the original, unaltered advertisement; a "red" condition where the cigarette packages were digitally altered to the colour red, implying increased harm potential; and a "no text" condition where all text was removed to reduce explicit product information. Polytomous logistic regression, using "incorrect," "unsure" and "correct" as outcomes, and advertisement type and covariates as predictors, was used for analyses. Participants randomised to the "no text" advertisement were less likely to be incorrect in their beliefs that Quest cigarettes are lower in tar, less addictive, less likely to cause cancer, have fewer chemicals, are healthier and make smoking safer. Smokers can form false beliefs about the harmfulness of PREP products based on how the PREPs are marketed. Careful examination must be undertaken to provide empirical evidence to better formulate regulatory principles of PREP advertising.

  13. Harmful Algal in Banyuasin Coastal Waters, South Sumatera

    Directory of Open Access Journals (Sweden)

    Riris Aryawati

    2016-09-01

    Full Text Available Phytoplankton have important as food-chain major component and primary production of marine environment. However, high abundance of phytoplankton could give harmful effects toward water ecosystem. Moreover, they could produce toxic substances that will be accumulated within their consumer. This accumulation could be dangerous for human or animals.This research were aimed to determine and calculatespecies of harmful algae in Banyuasin coastal waters. The study was conducted on April, June, August, October and December of 2013, and in February 2014, at ten stations. Phytoplankton samples were taken vertically using plankton nets. In the form of cone-shaped with a diameter of 30 cm, length 100 cm and mesh size 30 μm.The result showed that there are 35 genera of phytoplankton. That have been found and consisted of four groups; Bacillariophyceae, Dinophyceae, Cyanophyceae and Chlorophyceae. 13 species were identified as Harmful Algal (Chaetoceros, Coscinodiscus, Nitzschia, Skeletonema, Thalassiosira, Alexandrium, Ceratium, Dinophysis, Noctiluca, Protoperidinium, Prorocentrum, Anabaena dan Oscillatoria, with seven of them were known for having toxin (Nitzschia, Alexandrium, Dinophysis, Protoperidinium Prorocentrum, Anabaena and Oscillatoria. Monitoring result showed that the highest number of species of potential harmful algal blooms (HABs occured in June and the highest abundance occured in August, especially Chaetoceros and Skeletonema.How to CiteAryawati, R., Bengen, D. G., Prartono, T., & Zulkifli, H. (2016. Harmful Algal in Banyuasin Coastal Waters, South Sumatera. Biosaintifika: Journal of Biology & Biology Education, 8(2, 231-239.

  14. Harmful Tax Competition in the EU with Reference to Croatia

    Directory of Open Access Journals (Sweden)

    Saša Drezgić

    2005-08-01

    Full Text Available The process of globalisation has led, among other things, to harmful tax competition. This paper considers the efforts within the EU in combating harmful tax competition (Code of Conduct on Business Taxation and their effects when taking into account the EU regulations in relation to state aids. Considering a number of problems in the implementation of the Code, and the numerous criticisms with regard to the validity of the combat against harmful tax competition – it is difficult to give a final answer about its success. Croatian tax system, and the corporation tax in particular, are analysed in the light of the aforementioned problems. The advantages of the equal treatment of domestic and foreign investors, as well as the certain elements of state aids in tax benefits, are pointed out.

  15. Harmful Gas Recognition Exploiting a CTL Sensor Array

    Directory of Open Access Journals (Sweden)

    Yao Zheng

    2013-10-01

    Full Text Available In this paper, a novel cataluminescence (CTL-based sensor array consisting of nine types of catalytic materials is developed for the recognition of several harmful gases, namely carbon monoxide, acetone, chloroform and toluene. First, the experimental setup is constructed by using sensing nanomaterials, a heating plate, a pneumatic pump, a gas flow meter, a digital temperature device, a camera and a BPCL Ultra Weak Chemiluminescence Analyzer. Then, unique CTL patterns for the four types of harmful gas are obtained from the sensor array. The harmful gases are successful recognized by the PCA method. The optimal conditions are also investigated. Finally, experimental results show high sensitivity, long-term stability and good linearity of the sensor array, which combined with simplicity, make our system a promising application in this field.

  16. Rich Reduction

    DEFF Research Database (Denmark)

    Niebuhr, Oliver

    2016-01-01

    Managing and, ideally, explaining phonetic variation has ever since been a key issue in the speech sciences. In this context, the major contribution of Lindblom's H&H theory was to replace the futile search for invariance by an explainable variance based on the tug-of-war metaphor. Recent empirical...... evidence on articulatory prosodies and the involvement of reduction in conveying communication functions both suggest the next steps along the line of argument opened up by Lindblom. Specifically, we need to supplement Lindblom's explanatory framework and revise the speaker-listener conflict that lies...... at the heart of the tug-of-war metaphor. The author's suggestion would be to "offshore" the tug-of-war metaphor and replace it by the ocean metaphor of Bolinger (1964), with the ups and downs at the surface of the ocean representing the speaker's variation along the hypo-hyper scale and wavelength...

  17. Perceptions of Harm and Addiction of Snus: An Exploratory Study

    Science.gov (United States)

    Kaufman, Annette R.; Grenen, Emily; Grady, Meredith; Leyva, Bryan; Ferrer, Rebecca A.

    2017-01-01

    Tobacco companies in the United States are prohibited from making reduced harm claims without filing a modified risk tobacco product application with the Food and Drug Administration and obtaining an order to market as such. However, it is possible that product marketing may suggest reduced risk to individuals. This study examines perceptions, in particular those related to harm and addiction, of snus print advertisements using a combination of eye-tracking, survey, and semistructured interviews. Participants were 22 male smokers ages 19–29 (M = 26.64, SD = 2.92). Five snus advertisements were each displayed for 20 s and eye movements were tracked. Participants responded to questions about harm and addiction after each advertisement and interviews were conducted after seeing all advertisements. For each advertisement, descriptive statistics were calculated and regression analyses predicted harm and addiction perceptions from eye tracking areas of interest (e.g., warning label). Qualitative data were analyzed using inductive/deductive thematic analysis. For certain advertisements, areas of interest were significantly associated with harm and/or addiction perceptions. For example, higher total fixation duration on the graphic in the Smokeless for Smokers advertisement was associated with decreased perceptions of addiction (B = −.360, p = .048). Qualitative themes emerged and in many instances corroborated quantitative results. This study indicates that for some advertisements, attention on certain areas (measured through eye tracking) is associated with perceptions among young male smokers. Understanding how smokers perceive and understand products after viewing advertisements may inform regulations regarding claims about product harm and addiction and may guide public health efforts to educate smokers on the risks of emerging products. PMID:28068113

  18. Perceptions of harm and addiction of snus: An exploratory study.

    Science.gov (United States)

    Kaufman, Annette R; Grenen, Emily; Grady, Meredith; Leyva, Bryan; Ferrer, Rebecca A

    2016-12-01

    Tobacco companies in the United States are prohibited from making reduced harm claims without filing a modified risk tobacco product application with the Food and Drug Administration and obtaining an order to market as such. However, it is possible that product marketing may suggest reduced risk to individuals. This study examines perceptions, in particular those related to harm and addiction, of snus print advertisements using a combination of eye-tracking, survey, and semistructured interviews. Participants were 22 male smokers ages 19-29 (M = 26.64, SD = 2.92). Five snus advertisements were each displayed for 20 s and eye movements were tracked. Participants responded to questions about harm and addiction after each advertisement and interviews were conducted after seeing all advertisements. For each advertisement, descriptive statistics were calculated and regression analyses predicted harm and addiction perceptions from eye tracking areas of interest (e.g., warning label). Qualitative data were analyzed using inductive/deductive thematic analysis. For certain advertisements, areas of interest were significantly associated with harm and/or addiction perceptions. For example, higher total fixation duration on the graphic in the Smokeless for Smokers advertisement was associated with decreased perceptions of addiction (B = -.360, p = .048). Qualitative themes emerged and in many instances corroborated quantitative results. This study indicates that for some advertisements, attention on certain areas (measured through eye tracking) is associated with perceptions among young male smokers. Understanding how smokers perceive and understand products after viewing advertisements may inform regulations regarding claims about product harm and addiction and may guide public health efforts to educate smokers on the risks of emerging products. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  19. Fasting: Benefits and probable health harmfulness from the Islamic perspective

    Directory of Open Access Journals (Sweden)

    Mahdi Ebrahimi

    2015-06-01

    Medical science can determine the effects and consequences of thirst and hunger during the month of Ramadan. In the religious perspective, it has been emphasized that fasting is for achieving the divine virtue, and this shouldn’t be in conflict with maintaining man’s health. Therefore, the conditions in which there is the probability of harmfulness to man’s health due to fasting, man shouldn’t fast. As a result, medical science could recognize the conditions in which there is probable harmfulness to man’s health.

  20. Do Psychiatric Medications Cause More Harm Than Good?

    Science.gov (United States)

    Howland, Robert H

    2015-07-01

    A head-to-head debate published in The BMJ was centered on the question "Does long-term use of psychiatric drugs cause more harm than good?" One of the debaters stated that virtually all psychotropic drug use could be stopped without deleterious effects, claiming that these drugs have minimal benefits, are immensely harmful, and cause more than 500,000 deaths each year. In the current article, this conclusion is disputed by the discussion of the history of psychiatric therapeutics, limitations of research investigations, inherent morbidity and mortality associated with mental disorders, and importance of direct care experience with psychiatric patients and their families. Copyright 2015, SLACK Incorporated.

  1. Embodied harms: gender, shame, and technology-facilitated sexual violence.

    Science.gov (United States)

    Henry, Nicola; Powell, Anastasia

    2015-06-01

    Criminality in cyberspace has been the subject of much debate since the 1990s, yet comparatively little attention has been paid to technology-facilitated sexual violence and harassment (TFSV). The aim of this article is to explore the ways in which retraditionalized gender hierarchies and inequalities are manifested in online contexts, and to conceptualize the cause and effects of TFSV as "embodied harms." We argue that problematic mind/body and online/off-line dualisms result in a failure to grasp the unique nature of embodied harms, precluding an adequate understanding and theorization of TFSV. © The Author(s) 2015.

  2. Double Jeopardy: Insurance, Animal Harm, and Domestic Violence.

    Science.gov (United States)

    Signal, Tania; Taylor, Nik; Burke, Karena J; Brownlow, Luke

    2017-06-01

    Although the role of companion animals within the dynamic of domestic violence (DV) is increasingly recognized, the overlap of animal harm and insurance discrimination for victims/survivors of DV has not been considered. Prompted by a case study presented in a National Link Coalition LINK-Letter, this research note examines "Pet Insurance" policies available in Australia and whether nonaccidental injury caused by an intimate partner would be covered. We discuss the implications of exclusion criteria for victims/survivors of DV, shelters providing places for animals within a DV dynamic, and, more broadly, for cross- or mandatory-reporting (of animal harm) initiatives.

  3. On strategic ignorance of environmental harm and social norms

    DEFF Research Database (Denmark)

    Thunström, Linda; van’t Veld, Klaas; Shogren, Jason. F.

    2014-01-01

    on their harm to the environment, and that they use ignorance as an excuse to engage in less pro-environmental behavior. It also predicts that the cost of ignorance increases if people can learn about the social norm from the information. We test the model predictions empirically using an experiment combined...... people feel internal pressure (“guilt”) from causing harm to the environment (e.g., emitting carbon dioxide) as well as external pressure to conform to the social norm for pro-environmental behavior (e.g., offsetting carbon emissions). Our model predicts that people may benefit from avoiding information...

  4. Self-harm by severe glossal injury in schizophrenia

    Directory of Open Access Journals (Sweden)

    Pookala S Bhat

    2011-01-01

    Full Text Available Self-mutilation, the deliberate destruction occurs in a variety of psychiatric disorders.Many methods of self-destructive behavior have been described in literature. Patients of schizophrenia are known to attempt self-harm due to command hallucination, catatonic excitement or because of associated depression, however severe glossal injury by biting has not been reported so far.Authors report case of self-harm of glossal injury by biting in schizophrenia.Treatment and management issues are discussed.

  5. The multifactorial role of the 3Rs in shifting the harm-benefit analysis in animal models of disease

    Science.gov (United States)

    Graham, Melanie L.; Prescott, Mark J.

    2015-01-01

    Ethics on animal use in science in Western society is based on utilitarianism, weighing the harms and benefits to the animals involved against those of the intended human beneficiaries. The 3Rs concept (Replacement, Reduction, Refinement) is both a robust framework for minimizing animal use and suffering (addressing the harms to animals) and a means of supporting high quality science and translation (addressing the benefits). The ambiguity of basic research performed early in the research continuum can sometimes make harm-benefit analysis more difficult since anticipated benefit is often an incremental contribution to a field of knowledge. On the other hand, benefit is much more evident in translational research aimed at developing treatments for direct application in humans or animals suffering from disease. Though benefit may be easier to define, it should certainly not be considered automatic. Issues related to model validity seriously compromise experiments and have been implicated as a major impediment in translation, especially in complex disease models where harms to animals can be intensified. Increased investment and activity in the 3Rs is delivering new research models, tools and approaches with reduced reliance on animal use, improved animal welfare, and improved scientific and predictive value. PMID:25823812

  6. The Effectiveness of Training on Awareness and Attitude of Young Slummer Boys about Harms of Opium Consumption

    Directory of Open Access Journals (Sweden)

    Heyran Pornajaf

    2010-02-01

    Full Text Available Objective: The consumption of opium is a universal phenomenon which has plentiful bodily, psychic, family, social, and economic harms. It can be produced serious reduction of individual and social functions in an aimed person. Preventive activities have significant role in immunity of persons on mentioned harms. These preventive activities can be held on the basis of training and awareness. Method: The current research done on 1388 among slummer young of Ilam city in a range of 15-25 years old. The selected sample by evoke manner for participation in educational classes. Each class included of 60-70 persons who trained in a 2 training sessions of introduction of opium and its harms for 4 hours. Results: The results showed that training was increased the young’s awareness. Conclusion: The training can be enhanced the young persons’ awareness and can be modified their attitudes towards harms of opium consumption, also it’s can be affected on their buffering against opium.

  7. Minor Self-Harm and Psychiatric Disorder: A Population-Based Study

    Science.gov (United States)

    Skegg, Keren; Nada-Raja, Shyamala; Moffit, Terrie E.

    2004-01-01

    Little is known about the extent to which minor self-harm in the general population is associated with psychiatric disorder. A population-based sample of 980 young adults was interviewed independently about past-year suicidal and self-harm behavior and thoughts, and psychiatric disorders. Self-harm included self-harmful behaviors such as…

  8. Reducing harm from HIV/AIDS misconceptions among female sex workers in Tijuana and Ciudad Juarez, Mexico: A cross sectional analysis

    Directory of Open Access Journals (Sweden)

    Robertson Angela M

    2012-08-01

    Full Text Available Abstract Background HIV prevalence is increasing among female sex workers (FSWs in Mexico’s Northern border region, who experience multiple occupational risks. Improving vulnerable populations’ education, empowerment, and access to preventive services are important components of harm reduction strategies. Given the increasing interest in adapting harm reduction principles from drug use to sex work and other public health responses to the HIV epidemic, we used a sex work harm reduction framework to guide our investigation of FSWs’ HIV knowledge. Methods From 2004–2006, FSWs aged ≥18 years in Tijuana and Ciudad Juarez participated in a behavioral intervention study and completed structured interviews. Measures included HIV knowledge assessment and factors within each domain of our theoretical framework for sex work harms: (1 socio-demographic factors that may lead to sex work, (2 sex work characteristics and behaviors that may lead to harm, and (3 mutually reinforcing harms that lead to sex work and result from it (e.g., drug abuse. Negative binomial regression identified factors independently associated with suboptimal HIV knowledge (i.e., incorrect responses during the HIV knowledge assessment. Results Among 924 FSWs, the median proportion of incorrect responses was nearly one third (28% incorrect. Examination of item responses revealed misconceptions regarding specific transmission and prevention mechanisms, including prevention of mother to child transmission. Suboptimal HIV knowledge was independently associated with older age, lower education, living in Tijuana (vs. Ciudad Juarez, inconsistent condom use for vaginal sex with male clients, and lacking prior HIV testing. Conclusions Our application of a sex work harm reduction framework to the study of FSWs’ HIV knowledge is an important first step in enhancing HIV prevention efforts in Northern Mexican border cities. Our findings imply that interventions should identify and

  9. Reducing harm from HIV/AIDS misconceptions among female sex workers in Tijuana and Ciudad Juarez, Mexico: A cross sectional analysis.

    Science.gov (United States)

    Robertson, Angela M; Ojeda, Victoria D; Nguyen, Lucie; Lozada, Remedios; Martínez, Gustavo A; Strathdee, Steffanie A; Patterson, Thomas L

    2012-08-06

    HIV prevalence is increasing among female sex workers (FSWs) in Mexico's Northern border region, who experience multiple occupational risks. Improving vulnerable populations' education, empowerment, and access to preventive services are important components of harm reduction strategies. Given the increasing interest in adapting harm reduction principles from drug use to sex work and other public health responses to the HIV epidemic, we used a sex work harm reduction framework to guide our investigation of FSWs' HIV knowledge. From 2004-2006, FSWs aged ≥18 years in Tijuana and Ciudad Juarez participated in a behavioral intervention study and completed structured interviews. Measures included HIV knowledge assessment and factors within each domain of our theoretical framework for sex work harms: (1) socio-demographic factors that may lead to sex work, (2) sex work characteristics and behaviors that may lead to harm, and (3) mutually reinforcing harms that lead to sex work and result from it (e.g., drug abuse). Negative binomial regression identified factors independently associated with suboptimal HIV knowledge (i.e., incorrect responses during the HIV knowledge assessment). Among 924 FSWs, the median proportion of incorrect responses was nearly one third (28% incorrect). Examination of item responses revealed misconceptions regarding specific transmission and prevention mechanisms, including prevention of mother to child transmission. Suboptimal HIV knowledge was independently associated with older age, lower education, living in Tijuana (vs. Ciudad Juarez), inconsistent condom use for vaginal sex with male clients, and lacking prior HIV testing. Our application of a sex work harm reduction framework to the study of FSWs' HIV knowledge is an important first step in enhancing HIV prevention efforts in Northern Mexican border cities. Our findings imply that interventions should identify and discredit local HIV misconceptions to improve knowledge of specific HIV

  10. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms.

    Science.gov (United States)

    Mandelblatt, Jeanne S; Cronin, Kathleen A; Bailey, Stephanie; Berry, Donald A; de Koning, Harry J; Draisma, Gerrit; Huang, Hui; Lee, Sandra J; Munsell, Mark; Plevritis, Sylvia K; Ravdin, Peter; Schechter, Clyde B; Sigal, Bronislava; Stoto, Michael A; Stout, Natasha K; van Ravesteyn, Nicolien T; Venier, John; Zelen, Marvin; Feuer, Eric J

    2009-11-17

    Despite trials of mammography and widespread use, optimal screening policy is controversial. To evaluate U.S. breast cancer screening strategies. 6 models using common data elements. National data on age-specific incidence, competing mortality, mammography characteristics, and treatment effects. A contemporary population cohort. Lifetime. Societal. 20 screening strategies with varying initiation and cessation ages applied annually or biennially. Number of mammograms, reduction in deaths from breast cancer or life-years gained (vs. no screening), false-positive results, unnecessary biopsies, and overdiagnosis. The 6 models produced consistent rankings of screening strategies. Screening biennially maintained an average of 81% (range across strategies and models, 67% to 99%) of the benefit of annual screening with almost half the number of false-positive results. Screening biennially from ages 50 to 69 years achieved a median 16.5% (range, 15% to 23%) reduction in breast cancer deaths versus no screening. Initiating biennial screening at age 40 years (vs. 50 years) reduced mortality by an additional 3% (range, 1% to 6%), consumed more resources, and yielded more false-positive results. Biennial screening after age 69 years yielded some additional mortality reduction in all models, but overdiagnosis increased most substantially at older ages. Varying test sensitivity or treatment patterns did not change conclusions. Results do not include morbidity from false-positive results, patient knowledge of earlier diagnosis, or unnecessary treatment. Biennial screening achieves most of the benefit of annual screening with less harm. Decisions about the best strategy depend on program and individual objectives and the weight placed on benefits, harms, and resource considerations. National Cancer Institute.

  11. EFFECTS OF MAMMOGRAPHY SCREENING UNDER DIFFERENT SCREENING SCHEDULES: MODEL ESTIMATES OF POTENTIAL BENEFITS AND HARMS

    Science.gov (United States)

    Mandelblatt, Jeanne S.; Cronin, Kathleen A.; Bailey, Stephanie; Berry, Donald A.; de Koning, Harry J.; Draisma, Gerrit; Huang, Hui; Lee, Sandra J.; Munsell, Mark; Plevritis, Sylvia K.; Ravdin, Peter; Schechter, Clyde B.; Sigal, Bronislava; Stoto, Michael A.; Stout, Natasha K.; van Ravesteyn, Nicolien T; Venier, John; Zelen, Marvin; Feuer, Eric J.

    2012-01-01

    Background Despite trials of mammography and widespread use, optimal screening policy is controversial. Design and Objective Six models use common data elements to evaluate US screening strategies. Data Sources The models use national data on age-specific incidence, competing mortality, mammography characteristics and treatment effects. Target Population and Time Horizon A contemporary population cohort followed over their lifetimes. Perspective We use a societal perspective for analysis. Interventions We evaluate 20 screening strategies with varying initiation and cessation ages applied annually or biennially. Outcome Measures Number of mammograms, breast cancer mortality reduction or life years gained [LYG] (vs. no screening), false positives, unnecessary biopsies and over-diagnosis. Results of Base Case The 6 models produce consistent rankings of screening strategies. Screening biennially maintains an average of 81% (range across strategies and models 67–99%) of the benefit of annual screening with almost half the number of false positives. Screening biennially from ages 50 to 69 achieves a median 16.5% (range 15%–23%) breast cancer mortality reduction vs. no screening. Initiating biennial screening at age 40 (vs. 50) reduces mortality by an additional 3% (range 1%–6%), consumes more resources and yields more false positives. Biennial screening after age 69 yields some additional mortality reduction in all models but over-diagnosis increases most substantially at older ages. Sensitivity Analysis Results Varying test sensitivity or treatment patterns do not change conclusions. Limitations Results do not include morbidity from false positives, knowledge of earlier diagnosis or under-going unnecessary treatment. Conclusion Biennial screening achieves most of the benefit of annual screening with less harm. Decisions about the best strategy depend on program and individual objectives and the weight placed on benefits, harms and resource considerations. PMID

  12. Exceptional Reductions

    CERN Document Server

    Marrani, Alessio; Riccioni, Fabio

    2011-01-01

    Starting from basic identities of the group E8, we perform progressive reductions, namely decompositions with respect to the maximal and symmetric embeddings of E7xSU(2) and then of E6xU(1). This procedure provides a systematic approach to the basic identities involving invariant primitive tensor structures of various irreprs. of finite-dimensional exceptional Lie groups. We derive novel identities for E7 and E6, highlighting the E8 origin of some well known ones. In order to elucidate the connections of this formalism to four-dimensional Maxwell-Einstein supergravity theories based on symmetric scalar manifolds (and related to irreducible Euclidean Jordan algebras, the unique exception being the triality-symmetric N = 2 stu model), we then derive a fundamental identity involving the unique rank-4 symmetric invariant tensor of the 0-brane charge symplectic irrepr. of U-duality groups, with potential applications in the quantization of the charge orbits of supergravity theories, as well as in the study of mult...

  13. Primary School Children and Self Harm: The Emotional Impact upon Education Professionals, and Their Understandings of Why Children Self Harm and How This Is Managed

    Science.gov (United States)

    Simm, Rebecca; Roen, Katrina; Daiches, Anna

    2010-01-01

    There is evidence suggesting that self harm among young people is beginning earlier, in childhood and adolescent years. This paper reports on a qualitative study of primary school staff responses to self harm among children. Some studies with adolescents show self harm presents challenges to education professionals who may lack training or…

  14. First episode of self-harm in older age: a report from the 10-year prospective Manchester Self-Harm project

    NARCIS (Netherlands)

    Oude Voshaar, R.C.; Cooper, J.; Murphy, E.; Steeg, S.; Kapur, N.; Purandare, N.B.

    2011-01-01

    OBJECTIVE: Self-harm is closely related to completed suicide, especially in older age. As empirical research of self-harm in older age is scarce, with no studies confined to first-ever episodes in older age, we examined the clinical characteristics and the risk of repetition in first-ever self-harm

  15. First Episode of Self-Harm in Older Age : A Report From the 10-Year Prospective Manchester Self-Harm Project

    NARCIS (Netherlands)

    Voshaar, Richard C. Oude; Cooper, Jayne; Murphy, Elizabeth; Steeg, Sarah; Kapur, Nay; Purandare, Nitin B.

    Objective: Self-harm is closely related to completed suicide, especially in older age. As empirical research of self-harm in older age is scarce, with no studies confined to first-ever episodes in older age, we examined the clinical characteristics and the risk of repetition in first-ever self-harm

  16. Information on existing monitoring practices for Harmful Algal ...

    African Journals Online (AJOL)

    spamer

    Food Hygiene Control Agency, the Oceanographic Company of Norway, the Institute of Marine Research and the Directorate for Fisheries, is reviewed. Potentially harmful algae on the Norwegian coast are found primarily in four classes of phytoplankton, dinoflagellates, prymnesiophytes, diatoms and raphidophytes.

  17. Effects of rising CO₂ on the harmful cyanobacterium Microcystis

    NARCIS (Netherlands)

    Sandrini, G.

    2016-01-01

    The waters of our planet are full with cyanobacteria that use CO₂, water and light for photosynthesis. Cyanobacteria form the base of the food web and have a strong impact on all life on Earth. Yet, not all cyanobacteria are beneficial. Harmful cyanobacteria (also known as ‘blue-green algae’) can

  18. Synthesis of Porous Inorganic Hollow Fibers without Harmful Solvents

    NARCIS (Netherlands)

    Shukla, Sushumna; de Wit, Patrick; Luiten-Olieman, Maria W.J.; Kappert, Emiel; Nijmeijer, Arian; Benes, Nieck Edwin

    2015-01-01

    A route for the fabrication of porous inorganic hollow fibers with high surface-area-to-volume ratio that avoids harmful solvents is presented. The approach is based on bio-ionic gelation of an aqueous mixture of inorganic particles and sodium alginate during wet spinning. In a subsequent thermal

  19. Harm to patients and others caused by impaired junior doctors ...

    African Journals Online (AJOL)

    Public health officials may be held directly liable for the harm caused to patients, third parties or the junior doctors themselves, if it can be shown that they are at fault and are acting unlawfully in violation of the Constitution. Where officials carry out the unlawful orders of senior officials, including the minister of health and ...

  20. Will the new Consumer Protection Act prevent harm to nutritional ...

    African Journals Online (AJOL)

    Will the new Consumer Protection Act prevent harm to nutritional supplement users? Gary Gabriels, Mike Lambert, Pete Smith, Donavon Hiss. Background. There is no clear distinction between the regulation of food, supplements and medicines in South Africa. Consequently, grey areas exist in implementing the legislation, ...

  1. Harmful cyanobacteria and their cyanotoxins in Egyptian fresh waters

    African Journals Online (AJOL)

    Cyanobacterial blooms have increased in freshwater ecosystems worldwide in the last century, mostly resulting from eutrophication and climate change. These blooms represent serious threats to environmental and human health because of the production of harmful metabolites, called cyanotoxins. Like many countries ...

  2. Doing Harm While Doing Good: The Child Protection Paradox

    Science.gov (United States)

    Ainsworth, Frank; Hansen, Patricia

    2012-01-01

    Every Australian citizen expects state and territory governments to protect children from child abuse and neglect. Protecting children from harm is seen as good. This however is not a simple matter. The ultimate act in protecting children is to remove them from parental care. This causes trauma for the child and pain and distress for parents no…

  3. Knowledge, Attitudes and Practices involved in Harmful Health ...

    African Journals Online (AJOL)

    ... attitude and practice of the population of Dembia District towards traditional harmful health practices. Methods: A cross-sectional study was conducted in Dembia district, northwest Ethiopia, in May 2001. Data were collected from 1181 households using a pre-tested questionnaire. Results: Uvulectomy, milk teeth extraction ...

  4. Cognitive-behavioural therapy for deliberate self-harm

    NARCIS (Netherlands)

    Slee, Nadja

    2008-01-01

    This thesis describes the outcomes of a randomized controlled trial of a Cognitive Behavioural Therapy (CBT) intervention for patients who engage in Deliberate Self-Harm (DSH). The CBT intervention was designed to supplement usual care following an episode of DSH. The study involved 90 people (95%

  5. Mobile phone social harms (mobile phone, communicative device or ...

    African Journals Online (AJOL)

    One of the human inventions created in order to facilitate life but it became scourge for him is mobile phone. Ignorance on quality of using mobile phone and conscious use of it in inappropriate way will have consequences that it seems that it gradually becomes as social problem and harm. Author of this paper aims to warns ...

  6. Mental health nurses' attitudes toward self-harm: Curricular ...

    African Journals Online (AJOL)

    Background: Self-harm is an old problem but increasing in incidence. It has important consequences for the individual concerned, the health care system, and can impact the well-being of staff. Extensive prior research has adopted a quantitative approach, thereby failing to explore in detail the perspective of mental health ...

  7. Harmful algal blooms of the Southern Benguela current: A review ...

    African Journals Online (AJOL)

    The Benguela upwelling system is subjected to blooms of harmful and toxic algae, the incidence and consequences of which are documented here. Red tides are common and usually attributed to members of the Dinophyceae, most of which are non-toxic. The incidence of these blooms varies spatially, with most blooms ...

  8. Strength-Based Efforts for Promoting Recovery from Psychological Harm

    Science.gov (United States)

    De Civita, Mirella

    2006-01-01

    Much resilience research highlights protective factors that prevent risk. Here the author focuses on resilience as the ability to recover from psychological harm. The strength-based view sees resilience as a transformational experience. One applicant of this approach is the Phoenix Intervention Program for Children (PIPC) which combines concepts…

  9. Immigration Enforcement Practices Harm Refugee Children and Citizen-Children

    Science.gov (United States)

    Zayas, Luis H.

    2018-01-01

    Aggressive immigration enforcement hurts the very youngest children. Refugee and U.S.-born children of undocumented immigrants experience many childhood adversities, compromising their development and health. Refugee children flee traumatizing violence in their home countries, face grueling migrations, and are harmed further by being held in…

  10. Health care providers' perceptions on harmful traditional health ...

    African Journals Online (AJOL)

    It includes both paid and unpaid work and activities that are mentally, physically, socially or morally dangerous and harmful to children. However, information on the magnitude of the problem is scarce. Objective: To determine the magnitude of child labor and problems associated with it in Shebe rural town, South West ...

  11. The character of harms: operational challenges in control

    National Research Council Canada - National Science Library

    Sparrow, Malcolm K

    2008-01-01

    ... approach which he terms "the sabotage of harms." The book explores the institutional arrangements and decision-frameworks necessary to support this emerging operational model. Written for reflective practitioners charged with risk-control responsibilities across the public, private, and non-governmental sectors, The Character ...

  12. Revisiting white collar criminality from a social harm perspective

    Directory of Open Access Journals (Sweden)

    Vicky Vasilantonopoulou

    2014-09-01

    Full Text Available Normal 0 MicrosoftInternetExplorer4 Social harm approach seems to be the only promising proposal to deal with white collar crimes. By overwhelming the “crime – schema” an end is straightly put to a long lasting “war” of the white-collar crime criminologists, arguing since the late of ‘40s whether white collar crime is a crime or not, while the harmful results from white collar activities follow an uncontrollable trajectory. A second “end” is destined for the stalemate that critical criminology is remained locked since the deconstruction of crime. The critical arguments about the systemic origins of the crimes of powerful loose not only faith but also validity when the proclaiming solutions end up at the same tools and structures with their very cause. Under this prism, social harm approach does not represent the “anti-paradigm” of critical criminology but a new step beyond. White collar crime may be used as a typical example of the allegation that crime lacks any ontological substance while the reality of its social harms may function as stable basis even for seemingly utopian goals.

  13. Shared Responsibility and Issues of Injustice and Harm within Sport

    Science.gov (United States)

    Sartore-Baldwin, Melanie L.; McCullough, Brian; Quatman-Yates, Catherine

    2017-01-01

    The purpose of this article is to present a conceptual model of shared responsibility within the sport context. Focusing on issues of harm and injustice, this model proposes that organized sport can exist as an oppressive social structure that endorses ignorance through the presence of asymmetrical power relations. This ignorance reinforces…

  14. Biological control of Microcystis dominated harmful algal blooms ...

    African Journals Online (AJOL)

    Freshwater resources are now threatened by the presence and increase of harmful algal blooms (HAB) all over the world. The HABs are sometimes a direct result of anthropogenic pollution entering water bodies, such as partially treated nutrient-rich effluents and the leaching of fertilisers and animal wastes. The impact of ...

  15. correction of tarsal ectropion following harmful eye medication in a

    African Journals Online (AJOL)

    Dr O Babalola

    Keywords: public health education, harmful traditional eye medication, ectropion surgery. INTRODUCTION. Traditional ... ectropion from 'burns' is often reported. Other causes of. 5 ectropion often listed are ageing, ... Siemens syndrome (a rare inherited skin disorder where the skin around hair follicles becomes stiff and the ...

  16. Benefits and harms of perioperative beta-blockade

    DEFF Research Database (Denmark)

    Wetterslev, Jørn; Juul, Anne Benedicte

    2006-01-01

    randomized trials. However, confidence intervals of the intervention effects in the meta-analyses are wide, leaving room for both benefits and harms. The largest observational study performed suggests that perioperative beta-blockade is associated with higher mortality in patients with low cardiac risk...

  17. Evolution of helping and harming in heterogeneous groups.

    Science.gov (United States)

    Rodrigues, António M M; Gardner, Andy

    2013-08-01

    Social groups are often composed of individuals who differ in many respects. Theoretical studies on the evolution of helping and harming behaviors have largely focused upon genetic differences between individuals. However, nongenetic variation between group members is widespread in natural populations, and may mediate differences in individuals' social behavior. Here, we develop a framework to study how variation in individual quality mediates the evolution of unconditional and conditional social traits. We investigate the scope for the evolution of social traits that are conditional on the quality of the actor and/or recipients. We find that asymmetries in individual quality can lead to the evolution of plastic traits with different individuals expressing helping and harming traits within the same group. In this context, population viscosity can mediate the evolution of social traits, and local competition can promote both helping and harming behaviors. Furthermore, asymmetries in individual quality can lead to the evolution of competition-like traits between clonal individuals. Overall, we highlight the importance of asymmetries in individual quality, including differences in reproductive value and the ability to engage in successful social interactions, in mediating the evolution of helping and harming behaviors. © 2013 The Author(s). Evolution © 2013 The Society for the Study of Evolution.

  18. Gendered risk factors associated with self-harm mortality among ...

    African Journals Online (AJOL)

    For this reason, uniform approaches to awareness campaigns need to be altered to address the specific needs of youth. While males have higher rates than females, the prevalence of self-harm mortality in pregnant females is of concern and needs to be addressed specifically, as it relates not only to suicidal ideation and ...

  19. Fasting: Benefits and probable health harmfulness from the Islamic perspective

    National Research Council Canada - National Science Library

    Mahdi Ebrahimi; Saeedeh Behrooznia

    2015-01-01

    ..., and an individual’s health as well as his ill-health. Therefore, it is of utmost importance in the Islamic perspective to weigh the spiritual benefits achieved through fasting against its probable harmfulness to an individual’s health...

  20. Harming ourselves and defiling others: what determines a moral domain?

    Directory of Open Access Journals (Sweden)

    Alek Chakroff

    Full Text Available Recent work has distinguished "harm" from "purity" violations, but how does an act get classified as belonging to a domain in the first place? We demonstrate the impact of not only the kind of action (e.g., harmful versus impure but also its target (e.g., oneself versus another. Across two experiments, common signatures of harm and purity tracked with other-directed and self-directed actions, respectively. First, participants judged self-directed acts as primarily impure and other-directed acts as primarily harmful. Second, conservatism predicted harsher judgments of self-directed but not other-directed acts. Third, while participants delivered harsher judgments of intentional versus accidental acts, this effect was smaller for self-directed than other-directed acts. Finally, participants judged self-directed acts more harshly when focusing on the actor's character versus the action itself; other-directed acts elicited the opposite pattern. These findings suggest that moral domains are defined not only by the kind of action but also by the target of the action.