The 1st results in the realization of the Harm Reduction program for intravenous narcotic users in the city of Penza

To achieve the aims of the project, the following stages were consecutively defined: (1) the exchange of syringes, organized by outreach workers, with the simultaneous popularization of the project, (2) the orientation of intravenous drug users to attending syringe exchange stations and (3) the extension of the area covered by the activities of outreach workers. Our experience showed that outreach workers, especially those working in the street, were the main force to count on for achieving success in the work of the projects. The budget of the project should provide for the publication of information material. Special assignments for outreach workers to study some concrete problem (drug service, the use of blood, etc.) can be useful. It is expedient to raise the status of syringe exchange stations by turning them into multi-purpose consultation centers.     

The realization of the concept of Harm Reduction in Russia

By the present moment cases of HIV infection among injecting narcotic users (INU) have been registered in more than 100 countries. To prevent HIV infection, the program "Harm Reduction" has been developed in Britain; the program states that the prevention of HIV infection must be considered more important than the prevention of the use of narcotic drugs, as this infection is a growing danger for both drug users and public health in general. Breaking drug dependence must not be the only aim of services working with drug addicts, because this will exclude persons decisively disposed to the mode of life including the prolonged use of drugs from the sphere of their activity. Active INU having no contacts with organizations which must give them treatment and assistance find themselves in dangerous situations more often than INU maintaining contacts with such organizations. Penetration into such hidden group and its education must be the primary task. Propaganda plays a decisive role in this process, as the only way to penetrate into such group is to develop work in its territory, so that drug addicts, supplied with the necessary means could change their behavior in the desired direction. In the Russian Federation work on the project "Harm Reduction" has been carried out in 50 regions. This work has contributed to conducting teaching seminars, working out teaching programs, as well as to augmenting the interest among specialists of different professions to the problem of decreasing the spread of HIV infection. The importance of information distributed by the narcological service and the probability that very responsible persons take correct decisions on the basis of their understanding the situation have increased. The rating of public organization has risen.     

Experience in realizing the Harm Reduction program in Moscow

The data on the realization of the program of the prevention of HIV infection among intravenously injecting drug users in the South-Western administrative district of Moscow are presented. In the course of the realization of the project drawn up in accordance with this program the information package permitting the collection, analysis and transmission of the necessary information on the epidemic situation and leading risk factors in the zone of the action of the project has been compiled, and on the basis of this information the tactics and strategy of preventive measures have been worked out. The main advantage of the information system thus developed is the possibility of its use in computers of any class, in any operational system, as well as its use in Internet.     

The introduction of the concept of Harm Reduction in the city of Cherkassy

The introduction of the concept of Harm Reduction into the practical work of the narcological survive confidence relations with injecting drug users were established, which resulted in the possibility to carry out information and educational, as well as preventive work. In addition, there occurred changes in public opinion with respect to the problems of drug addiction (a drug addict was now regarded as a sick person) and AIDS (HIV infection was considered to be a problem, topical for wide strata of the population). The creation of a dedicated team comprising medical personnel, psychologists, representatives of the clergy, volunteers from drug addicts contributed to successes in this work. The work on the correction of negative manifestations, carried out by the organs of law protection, also contributed to the creation of balance between the strategy of Harm Reduction and the strategy of the reduction of need in narcotic drugs.     

The prevention of HIV infection and other blood-contact diseases among intravenous narcotic users in Nizhniy Novgorod within the framework of the Harm Reduction program

The results of the development and realization principles of the project on the decrease of harm, envisaging work in three directions (the determination of the technology of using drugs, the exchange of syringes/needles and other accessories, as well as laboratory examination for the presence of antibodies to HIV, hepatitis B and hepatitis C viruses and consultations of narcologists). 1075 injecting drug users took part in this project. Out of 611 participants filling-in the questionnaires, 338 persons underwent tests for HIV and 3 of them were found to be HIV-infected; out of 305 persons screened for the presence of markers of hepatitis B virus, positive results were obtained in 98 (32% of cases); in 218 (65%) out of 335 persons antibodies to hepatitis C virus were found (49 persons, i.e. 14%, had hepatitis C registered in the medical history and in the rest antibodies were detected for the first time). The preventive program of the decrease of harm was assessed as effective.     

Treating Addictions: Harm Reduction in Clinical Care and Prevention

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.     

潍坊市儿童11种国家免疫规划疫苗接种率抽样调查

目的了解潍坊市11种国家免疫规划疫苗的接种状况,比较常住儿童与流动儿童的接种率水平。方法采用分层随机抽样方法对2005年1月1日—2010年12月31日出生的儿童进行抽样调查。结果调查的常住和流动儿童2 160名,建卡、建证、卡证相符率均>95%,差异无统计学意义(P>0.05);BCG、HepB、OPV123、DPT123、MV或MR、MenA、JE-I 1、MMR、DPT4、HepA-I、JE-I 2、OPV4、MenAC1的接种率,常住儿童为95.63%～99.44%,流动儿童为93.89%～98.89%,差异无统计学意义(P>0.05);HepB首针、MV初种及时率常住和流动儿童均>95%,差异无统计学意义(P>0.05);6岁年龄组MenAC2、DT、MV3常住儿童分别为92.15%、91.11%、93.33%;流动儿童分别为86.25%、85.00%、87.08%,差异有统计学意义(χ2=18.89、18.42、23.48,P<0.01)。结论潍坊市4岁以下常住和流动儿童疫苗各剂次接种率差异无统计学意义,6岁年龄组MenAC2、DT、MV3疫苗接种率常住儿童高于流动儿童,差异有统计学意义(P<0.01)。     

The comparison of two different embryo culture methods in the course of in vitro fertilization program

The objective of the study was to compare two different embryo culture methods in the course of in vitro fertilization program by means of fertilization rate, embryo development, total time and cost. 98 patients undergoing assisted reproduction procedures due to infertility were analyzed. The inclusion criteria for the study: first IVF-ET program, at least 10 MII oocytes, no indications for ICSI. Oocytes were divided into two study groups: group A- open culture (oocytes placed in four-well dishes together, then inseminated and cultured in successive wells) and group B - a closed culture (oocytes placed in microdroplets, each embryo cultured separately). The fertilization rate was assessed around 18 hours from insemination. The embryos were classified into four classes. The best embryos were chosen for transfer. In the group A the fertilization rate obtained was lower than in group B (68% vs. 78%, respectively). The microdroplet culture required more time on the insemination day and on the second day of culture, while the four-well dish method required more time on the first day of culture and on the day of transfer. On analyzing the total cost of the above procedures (MI medium and oil costs) it occurred that the microdroplet culture was more expensive than the four-well dish method (due to the intake of paraffin oil). However, the difference was of no practical importance. In the conclusion, microdroplet culture gives a higher fertilization rate than four-well dish culture, probably due to a homogenous sperm distribution. Despite the differences in time outside the incubator and laboratory expenses (which are after all insignificant) microdroplet culture allows a better control over the embryo development. The embryos of best developmental potential can therefore be chosen for ET.     

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

ObjectiveTo assess the benefits of regular exercise in reducing harms associated with betel quid (BQ) chewing.MethodsThe 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.ResultsNearly 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.ConclusionsChewers 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.     

Efficacy of a complex program for controlling influenza in a large industrial city

The epidemiological and economic effectiveness of the realization of the complex three-year (1980-1982) program for the control of influenza in Perm is shown. The coverage of 46-51% of the city population, including working people, pensioners and children, with immunization carried out with the use of live and inactivated vaccines made it possible to decrease morbidity rate 2.12 times in comparison with the average data for many years. The greatest effect was achieved at large industrial enterprises where, simultaneously with vaccination covering 90% of the employees, urgent prophylaxis with remantadin and the early treatment of influenza patients were carried out. Due to these measures the morbidity rate and the number of disability days per 100 employees decreased 3-6 times.     

The effect of a syringe-exchange program on a decrease in the risk of HIV infection among intravenous narcotic abusers in the city of Rostov-on-Don

The necessity and effectiveness of introducing the program of the exchange of syringes for intravenous drug users as a preventive and antiepidemic measure are discussed. Preventive and antiepidemic measures within the concept of harm reduction are described. The comparative analysis of materials obtained as a result of two sociological questionings, carried out in 1997-1998 among the representatives of the community (random nonrepeating choice) and in the middle of 1999 among the participants of the program revealed that the participants of the program had statistically significant changes in risky behavior patterns during the use of injection drugs.     

The case for multiple realization in biology

Polger and Shapiro argue that their official recipe, a criterion for judging when the phenomenon of multiple realization (MR) exists, renders MR less widespread than its proponents have assumed. I argue that, although Polger and Shapiro’s criterion is a useful contribution, they arrive at their conclusion too hastily. Contrary to Polger and Shapiro, I claim that the phenomenon of multiple realization in the biological world, judged by their criterion, is not as scarce as they suggest. To show this, an updated official recipe, namely a multiple mechanistic realization thesis, integrating Polger and Shapiro’s criterion with a compositional conception of realization, is developed. Then, three examples of varied kinds are examined, showing that cases of MR are not so hard to find in the biological world.     

The origin of the myelination program in vertebrates

The myelin sheath was a transformative vertebrate acquisition, enabling great increases in impulse propagation velocity along axons. Not all vertebrates possess myelinated axons, however, and when myelin first appeared in the vertebrate lineage is an important open question. It has been suggested that the dual, apparently unrelated acquisitions of myelin and the hinged jaw were actually coupled in evolution [1,2]. If so, it would be expected that myelin was first acquired during the Devonian period by the oldest jawed fish, the placoderms [3]. Although myelin itself is not retained in the fossil record, within the skulls of fossilized Paleozoic vertebrate fish are exquisitely preserved imprints of cranial nerves and the foramina they traversed. Examination of these structures now suggests how the nerves functioned in vivo. In placoderms, the first hinge-jawed fish, oculomotor nerve diameters remained constant, but nerve lengths were ten times longer than in the jawless osteostraci. We infer that to accommodate this ten-fold increase in length, while maintaining a constant diameter, the oculomotor system in placoderms must have been myelinated to function as a rapidly conducting motor pathway. Placoderms were the first fish with hinged jaws and some can grow to formidable lengths, requiring a rapid conduction system, so it is highly likely that they were the first organisms with myelinated axons in the craniate lineage.