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Remarkable influence of surface composition and structure of oxidized iron layer on orange I decomposition mechanisms.

Although the decomposition of water pollutants in the presence of metallic iron is known, the reaction pathways and mechanisms of the decomposition of azo-dyes have been meagerly investigated. The interface phenomena taking place during orange I decomposition have been investigated with the use of infrared external reflection spectroscopy, X-ray photoelectron spectroscopy, and scanning electron microscopy. The studies presented in this paper establish that there are close relationships between the composition and structure of the iron surface oxidized layers and the kinetics and reaction pathway of orange decomposition. The influence of the molecular structure of azo-dye on the produced intermediates was also studied. There are remarkable differences in orange I decomposition between pH 3 and pH 5 at 30 degrees C. Decomposition at pH 3 is very fast with pseudo-first-order kinetics, whereas at pH 5 the reaction is slower with pseudo-zero-order kinetics. At pH 3, only one amine, namely 1-amino-4-naphthol, was identified as an intermediate that undergoes future decomposition. Sulfanilic acid, the second harmful reduction product, was not found in our studies. At pH 3, the iron surface is covered only by a very thin layer of polymeric Fe(OH)(2) mixed with FeO that ensures orange reduction by a combination of an electron transfer reaction and a catalytic hydrogenation reaction. At pH 5, the iron surface is covered up to a few micrometers thick, with a very spongy and porous layer of lepidocrocite enriched in Fe(2+) ions, which slows the electron transfer process. The fastest decomposition reaction was found at a potential near -300 mV (standard hydrogen electrode). An addition of Fe(2+) ions to solution, iron preoxidation in water, or an increase of temperature all result in an increasing decomposition rate. There is no single surface product that would inhibit the decomposition of orange. This information is crucial to perform efficient, clean and low cost waste water treatment. The findings presented here make the treatment of wastewater in the presence of metallic iron a very promising solution.

Azo Compounds↗

Methylenedioxymethamphetamine (ecstasy)-related hyperthermia.

MDMA (or 3, 4 methylenedioxymethamphetamine) was first manufactured in the 1920s and found to have structural similarities to both mescaline and amphetamines. Used briefly by some therapists in the 1970s and early 1980s as an adjunct to psychotherapy, it is now primarily abused by teenagers and young adults as an illicit recreational drug known as "ecstasy." As its popularity has increased, so have the number of fatalities and adverse events related to its use. We report six patients suffering fatal or life-threatening hyperthermia after MDMA use. These cases illustrate that hyperthermia associated with MDMA use cannot be solely attributed to rave parties (high ambient temperatures, excessive dancing, dehydration, and overcrowded conditions), drug contaminants, or co-ingestants. A better understanding of the etiology of hyperthermia after MDMA use is needed so that appropriate harm-reduction measures can be developed and instituted.

Adolescent↗

Prevention of viral hepatitis in HIV co-infection.

Co-infection of HIV-positive patients with hepatitis viruses worsens the long-term prognosis and this is summative for each new infection in any individual. Vaccination against hepatitis A or B may be effective but response rates are reduced in HIV infected patients. Improvement in response can be induced through extra doses, higher doses and HAART-induced increase in the CD4 count. Hepatitis B and C may also be prevented through counselling about safer sex, particularly condom use. In intravenous drug users, harm reduction, counselling and the use of needle/syringe exchange schemes may be helpful.

HIV↗

A nested-epidemic model for the spread of hepatitis C among injecting drug users.

Injecting drug users (IDUs) are the largest risk group for HCV infection. Studying injecting by classical epidemiological methods is no easy task, largely due to its hidden nature and low prevalence in general population terms. Thus, mathematical modelling can be of major help in performing a qualitative and quantitative evaluation of the costs and possible impact of the various interventions and to produce forecasts of both injecting drug use and HCV spread among IDUs. In the present paper an epidemic Mover-Stayer model for the spread of drug use, which has been recently proposed, is extended to mirror the spread of an infectious disease, in particular hepatitis C, among the injecting drug user population. In order to model the spread of a disease (HCV) among a population evolving following a different epidemic (injecting drug use) all the compartments of the 'external epidemic' (injecting drug use) are subdivided into two sub-compartments: the first one comprising individuals who are not affected by HCV and the second one comprising individuals affected. The resulting model may be defined the 'two epidemics' or, better, the 'nested epidemics' model. The model is a Mover-Stayer model for what concerns the 'external epidemic' (injecting drug use) but is a homogeneous epidemic model for HCV (all individuals are at risk of HCV the same). In the following, the dynamic equations are derived. Some qualitative analysis is performed in order to evaluate the asymptotic behaviour and the impact of possible prevention or harm reduction interventions. The results of a scenario analysis are also presented. The model, though simple, seems to be a very valuable tool for policy makers.

Disease Outbreaks↗

Heroin epidemics, treatment and ODE modelling.

The UN [United Nations Office on Drugs and Crime (UNODC): World Drug Report, 2005, vol. 1: Analysis. UNODC, 2005.], EU [European Monitoring Centre for Drugs and Drug Addiction (EMCDDA): Annual Report, 2005.http://annualreport.emcdda.eu.int/en/home-en.html.] and WHO [World Health Organisation (WHO): Biregional Strategy for Harm Reduction, 2005-2009. HIV and Injecting Drug Use. WHO, 2005.] have consistently highlighted in recent years the ongoing and persistent nature of opiate and particularly heroin use on a global scale. While this is a global phenomenon, authors have emphasised the significant impact such an epidemic has on individual lives and on society. National prevalence studies have indicated the scale of the problem, but the drug-using career, typically consisting of initiation, habitual use, a treatment-relapse cycle and eventual recovery, is not well understood. This paper presents one of the first ODE models of opiate addiction, based on the principles of mathematical epidemiology. The aim of this model is to identify parameters of interest for further study, with a view to informing and assisting policy-makers in targeting prevention and treatment resources for maximum effectiveness. An epidemic threshold value, R(0), is proposed for the drug-using career. Sensitivity analysis is performed on R(0) and it is then used to examine the stability of the system. A condition under which a backward bifurcation may exist is found, as are conditions that permit the existence of one or more endemic equilibria. A key result arising from this model is that prevention is indeed better than cure.

Adolescent↗

Are there sex differences associated with the effects of ecstasy/3,4-methylenedioxymethamphetamine (MDMA)?

Sex has been identified as an important factor in moderating the effects of several drugs of abuse. Given the increasing popularity of ecstasy (3,4-methylenedioxymethamphetamine [MDMA]) use, it is important for researchers and clinicians to understand the factors that may influence its pharmacological actions to improve education, harm reduction and treatment efforts. This review focuses on preclinical and clinical research that examines the role of sex as an independent variable in the effects of ecstasy/MDMA. A systematic search of PsycINFO and MEDLINE electronic databases from 1966 to April 2006 was conducted. Both preclinical and clinical studies show a sexually dimorphic pattern in the acute, subacute and possibly long-term effects of ecstasy/MDMA. Specifically, adult females are more sensitive than males to the acute and subacute physical and psychological effects of ecstasy/MDMA and long-term alterations in aspects of 5-HT functioning. Conversely, males are more sensitive to the acute physiological effects of ecstasy/MDMA. These findings are consistent with research outcomes reported for other substances such as amphetamines and cocaine. Potential reasons for these sex differences and directions for future research are discussed.

Animals↗

Drugs on the web; the Psychonaut 2002 EU project.

PURPOSE: Only a few formal assessments of websites with drug-related contents have been carried out. We aimed here at fostering collection and analysis of data from web pages related to information on consumption, manufacture and sales of psychoactive substances. GENERAL METHODS: An 8-language, two-engine, assessment of the information available in a purposeful sample of 1633 unique websites was carried out. FINDINGS: A pro-drug and a harm reduction approach were evident, respectively, in 18% and 10% of websites accessed. About 1 in 10 websites offered either psychoactive compounds for sale or detailed data on drugs' synthesis/extraction procedures. Information on a number of psychoactive substances and on unusual drugs' combinations not found in the Medline was elicited. CONCLUSIONS: This represents the first review which is both comprehensive and multilingual of the online available information on psychoactive compounds. Health professionals may need to be aware of the web being a new drug resource for information and possibly purchase.

Analysis of Variance↗

Pushing the boundaries of outreach work: the case of needle exchange outreach programs in Canada.

In this paper, we examine the challenges of defining the boundaries of outreach work using the example of needle exchange programs. In particular, we examine the multiple and inter-related factors that extend needle exchange outreach work beyond its official mandate. Using semi-structured interviews, 59 workers at 15 programs in Ontario, Canada were asked questions about operational policies and routines. An iterative and inductive analytic process was used. Over time, most outreach workers develop a well-defined sense of the activities they consider to be consistent with a harm reduction approach and the types of conduct that are considered to be acceptable and professional. Workers conceptualize their roles to encompass education and support but are reluctant to impose a rigid definition of their roles. A pragmatic and humble stance combined with strong beliefs in social justice encourages workers to find informal solutions to meet client needs that extend beyond the program mandate. As a result, doing 'extra' is the norm. These extra efforts are informal, but often regular, expansions of the service complement. Construction of flexible boundaries provides opportunities to meet many client needs and unexpected situations; however, going the extra-mile strains resources. A minority of workers blur the boundaries between private and professional lives. Further, a variety of personal, social and socio-political forces encourage outreach workers to continually redefine the boundaries of their roles and service complements.

Canada↗

Knowledge, attitudes and experiences of sex trafficking by young women in Benin City, South-South Nigeria.

Benin City, the headquarters of Edo State, is known to have one of the highest rates of international sex trafficking of young women in Nigeria. This study was designed to determine the knowledge, attitudes and experiences of young women in Benin City, towards international sex trafficking. A random household sample of 1456 women aged 15-25 years was interviewed with a structured questionnaire that elicited information on women's experiences of, and attitudes towards international sex trafficking. The results indicate that 97.4% of the women have heard of international sex trafficking; 70% had female relatives who lived in the receiving countries of Italy, Spain, and the Netherlands; while 44.0% knew of someone who was currently engaged in sex work abroad. Up to 32% of the women reported that they had been approached by someone offering to assist them to travel abroad. Women of poorer socio-economic status (being out-of-school, unemployed, parents uneducated and unemployed) were more likely to report having been offered assistance to travel abroad. Up to 81.5% of the women supported the notion that sex trafficking should be stopped, while 18.5% felt it should be allowed to continue. The perception that sex trafficking leads to wealth creation and economic gains for women was the most common reason proffered by those wanting the practice to continue. By contrast, the fear of adverse health consequences and the need to maintain social and religious morals were the reasons given by those wanting the practice to discontinue. These results suggest that programs that promote the economic well being of women, and social advocacy focusing on harm reduction will be most helpful in reducing the rate of sex trafficking in Benin City.

Adolescent↗

Expansion of HIV/AIDS in China: lessons from Yunnan Province.

In this article we systematically and critically review the Chinese and English language literature on human immunodeficiency virus (HIV)-related studies in Yunnan Province, Southwestern China. Yunnan Province had the first Chinese HIV outbreak and is still the worst affected area in the nation. Since 1989, HIV infection has extended from injecting drug users into the general population through sexual transmission. Since the economic reform of the 1980s, changed social norms and increased migration have spawned increases in HIV-related risk behaviors such as drug use and commercial sex work. A smaller size of "bridge" populations and lower sexual contact rates between persons in "bridge" and general populations may explain the slower expansion of the HIV epidemic in Yunnan compared to nearby Southeast Asian nations. In 2004, women in antenatal care had a 0.38% HIV prevalence province wide, although >1% infection rates are seen in those counties with high injection drug rates. Patterns of drug trafficking have spread the unusual recombinant HIV subtypes first seen in Yunnan to far-flung regions of China. Increased efforts of Yunnan's HIV control program are correlated with an improved general HIV awareness, but risk behaviors continue at worrisome rates. Future efforts should focus on changing risk behaviors, including harm reduction and condom promotion, especially among the "bridge" groups. The resurgence of commercial sex work in Yunnan, and the high frequency of workers migrating into provinces far from home and family are all sociocultural factors of considerable importance for future HIV and sexually transmitted disease control in China.

China↗

Psychologists and tobacco: attitudes to cessation counseling and patterns of use.

BACKGROUND: Psychologists can play an important role in helping their clients stop using tobacco. The extent to which they do so, or quit themselves, has not been reported previously. The utility of snus in reducing smoking prevalence is also questioned and merits study. METHOD: A 36-item self-completion questionnaire was mailed to a random sample of 1000 Swedish psychologists. RESULTS: The response rate was 85%. Very few psychologists (1%) 'often' helped clients to stop using tobacco. While a majority (72%) believed that quitting tobacco use would improve their client's quality of life, most (75%) thought that it was not their responsibility to help clients stop and 74% felt they lacked the necessary skills. About 8% of psychologists smoked cigarettes daily. Use of snus as an aid to cigarette cessation was common in men, but not women, although overall, the percentage of smokers who had quit smoking (72%) did not differ by gender. CONCLUSIONS: Most Swedish psychologists have stopped smoking, but very few help their clients to quit. Targeted campaigns aimed at encouraging and supporting psychologists to treat nicotine dependence are needed. This could increase cessation rates in the population. Snus helped reduce smoking prevalence among men and is a potentially useful harm reduction tool.

Age Factors↗

A pilot study of smokeless tobacco in smoking cessation.

PURPOSE: The substitution of smokeless tobacco for cigarette smoking is a harm reduction alternative for inveterate smokers and reduces others' passive exposure to smoke. Two million smokers have used smokeless tobacco to quit on their own, but no formal program has employed this method of smoking cessation. We conducted a pilot study to determine if smokeless tobacco could be successfully employed in a smoking cessation program. PATIENTS AND METHODS: Subjects attended a lecture about the health effects of all forms of tobacco use and about the use of smokeless tobacco as an aid to quit smoking. The study population consisted of 63 evaluable subjects. Follow-up was accomplished by quarterly telephone interviews. Smoking abstinence was confirmed at 1 year by measurement of expired air carbon monoxide. RESULTS: At 1 year, 31% of men and 19% of women had attained smoking cessation, for an overall success rate of 25%. An additional 7% of subjects had reduced their cigarette consumption by at least 50%. CONCLUSION: This study suggests that the use of smokeless tobacco warrants evaluation as a potential smoking cessation strategy.

Adult↗

Incidence of heroin use in Zurich, Switzerland: a treatment case register analysis.

BACKGROUND: Switzerland has been criticised for its liberal drug policy, which could attract new users and lengthen periods of heroin addiction. We sought to estimate incidence trends and prevalence of problem heroin use in Switzerland. METHODS: We obtained information about first year of regular heroin use from the case register of substitution treatments in the canton of Zurich for 7256 patients (76% of those treated between 1991 and March, 2005). We estimated the proportion of heroin users not yet in substitution treatment programmes using the conditional lag-time distribution. Cessation rate was the proportion of individuals leaving substitution treatment programmes and not re-entering within the subsequent 10 years. Overall prevalence of problematic heroin use was modelled as a function of incidence and cessation rate. FINDINGS: Every second person began their first substitution treatment within 2 years of starting to use heroin regularly. Incidence of heroin use rose steeply, starting with about 80 people in 1975, culminating in 1990 with 850 new users, and declining substantially to about 150 users in 2002. Two-thirds of those who had left substitution treatment programmes re-entered within the next 10 years. The population of problematic heroin users declined by 4% a year. The cessation rate in Switzerland was low, and therefore, the prevalence rate declined slowly. Our prevalence model accords with data generated by different approaches. INTERPRETATION: The harm reduction policy of Switzerland and its emphasis on the medicalisation of the heroin problem seems to have contributed to the image of heroin as unattractive for young people. Our model could enable the study of incidence trends across different countries and thus urgently needed assessments of the effect of different drug policies.

Adult↗

[Social characteristics and risk behaviors for HIV in a group of transvestites and male transsexuals engaging in street prostitution].

OBJECTIVE: To describe life and work conditions, practices associated with HIV transmission, self-informed HIV status and HIV test coverage in a group of male transgender street prostitutes. METHODS: Case descriptive study of male transgender street prostitutes who attended a mobile unit of a harm reduction programme in 1998 in Madrid, Spain Information on sociodemographic characteristics, work conditions, illegal drug use, sexual behaviours and self-informed HIV status was collected. RESULTS: 132 male transgenders were interviewed, of which 56% were Spanish. Median age was 30 years. 50% had primary school education or less. 11% had injected drugs sometime in their lives. Median time in prostitution was 8 years and 66% had worked only in the streets. In the last month, all of them said to use condoms in insertive anal sex with clients, 98% in receptive sex and 49% always used it with their partners in the previous year. 39% referred accidents with condoms within the previous month. 73% had had an HIV test, of which 22% said to be HIV positive (16% in those who had never injected drugs and 58% in the ones who had). CONCLUSIONS: HIV seroprevalence in male transgender street prostitutes is high, even in non-intravenous drug users. They nearly always use condoms with clients but have a high level of accidents. HIV prevention programmes in prostitution should be more specifically adapted to the different groups of commercial sex workers.

Adult↗

Risking risk: the influence of types of capital and social networks on the injection practices of drug users.

Although syringe exchange and other harm reduction interventions have generally been effective in reducing bloodborne pathogen incidence among injection drug users (IDUs), in some cases a minority of IDUs continues to engage in risky injection behavior. Building on emerging perspectives in social epidemiology and research on drug use in anthropology that point to the importance of examining fundamental social causes of risk behavior, or what puts individuals at risk for risk, this study used a multilevel perspective to explore whether forms of capital, social network characteristics, and other contextual factors influence continued risky injection behavior. Quantitative and qualitative data were collected on IDUs in the city of Marseilles, France, where sterile injection equipment has been legal and officially promoted since 1995. In multivariate analysis on data concerning active users, location in the densest part of a large, interconnected network of IDUs greatly increased the likelihood of risky injection practices, while there was a non-significant tendency for low Acquired Cultural and Economic Capital to predict this behavior. Among the strongest individual-level characteristics to predict this outcome were illicit use of prescribed medication, generally high dose buprenorphine, and unprotected sex. Parental abuse of psychoactive drugs during the subject's childhood, on the other hand, greatly decreased the chances of engaging in risky injection behavior. Additionally, qualitative data analysis suggests that risky injection may be linked to lack of resources to procure drugs, and not simply to inadequate sterile injection equipment. Further research, including ecological models, is needed to better understand how fundamental social conditions are related to "risk for risk". However, public health interventions can already address the need for community-level interventions, while rethinking the consequences of inaccessible drugs and unintended "leakage" from the introduction of buprenorphine and other medicalized treatments for opiate dependency.

Adult↗

Causal webs, preventive brooms, and housekeepers.

The concept of causal webs, which emphasises complex multiple causation of disease and injury, diverts attention and resources from preventive brooms that can sweep away the webs to reduce harm despite multiple causation. Epidemiologists who focus primarily on specification of causal paths in webs may overlook the modifiable necessary conditions for disease and injury. Necessary causes for disease and injury and necessary conditions for prevention are not always the same. Corporations and governments have the opportunity and means to reduce or eliminate many hazards to human health by changing products and processes that are hazardous. The arguments used to avoid doing so are often flawed and sometimes false. Public health scientists who focus on the behavior of corporations and government agencies that fail to employ preventive brooms of known effectiveness are more likely to contribute to harm reduction than those who focus on causal webs.

Accidents, Traffic↗

Characteristics of highly physically active smokers in a population of young adult military recruits.

A substantial number of cigarette smokers are thought to engage in regular exercise. It is unclear why individuals who engage in a health-promoting activity such as exercising would simultaneously engage in a health-damaging behavior like smoking. Two possibilities are that (1) exercise serves as a "harm reduction" strategy to lessen the negative effects of smoking, or (2) that among weight conscious individuals, exercise and smoking are both used as weight control strategies. To examine these issues, smoking status, physical activity level, weight concerns, and several additional health behaviors and attitudes were assessed by questionnaire in a population of United States Air Force recruits (n=32,144). Multiple logistic regression analyses were used to compare characteristics of highly physically active smokers with both highly physically active never-smokers, and less active smokers. A substantial proportion of smokers reported being highly physically active (15.8%), although this proportion was significantly higher for never-smokers (22.7%). Active smokers were similar to active never-smokers across several health behaviors and attitudes, including diet, seatbelt use, and attitudes toward illegal drugs and condom use. Compared to less active smokers, active smokers consumed more fruits and vegetables, worried less about their weight, were less nicotine dependent, and had greater previous success at quitting smoking. These findings indicate that a substantial proportion of highly physically active young adults are regular cigarette smokers. Based on findings regarding general health behaviors and smoking history, this group may be particularly amenable to smoking cessation efforts.

Adolescent↗

Correlates of occasional cigarette and marijuana use: are teens harm reducing?

This paper examines characteristics that distinguish heavy and occasional cigarette and marijuana use among U.S. high school seniors. High school seniors who completed the 1994 Monitoring the Future survey (N = 15,929) were classified as nonusers, occasional users, and heavy users of cigarettes and marijuana. Level of use was examined with regard to degree of perceived risk of regular use, perceived risk of occasional use as well as several psychosocial factors previously shown to be associated with use (e.g., peer use, close friends' approval of use, and self-esteem). Involvement with other drugs and high-risk behaviors across levels of use was also examined. Heavy users of cigarettes or marijuana reported significantly lower perceived risk of regular use of each substance compared to occasional users. Heavy and occasional users did not generally differ with regard to perceived risk of occasional use. Compared to heavy users, occasional cigarette or marijuana users reported significantly lower rates of illicit drug use, heavy alcohol use, and high-risk driving behaviors as well as fewer problem behaviors and higher grades. Some adolescents may moderate their cigarette and marijuana use to minimize harmful effects they associate with heavier use (i.e., they may be practicing harm reduction). Additional research is needed to better understand controlled substance use, and incorporate this information into prevention and cessation programs.

Adolescent↗