Sample records for accelerating harm reduction

  1. Defining harm reduction.

    PubMed

    Single, E

    1995-01-01

    Harm reduction attempts to reduce the adverse consequences of drug use among persons who continue to use drugs. It developed in response to the excesses of a "zero tolerance approach". Harm reduction emphasizes practical rather than idealized goals. It has been expanded from illicit drugs to legal drugs and is grounded in the evolving public health and advocacy movements. Harm reduction has proved to be effective and it has gained increasing official acceptance; for example, it is now the basis of Canada's Drug Strategy. However, the concept is still poorly defined, as virtually any drug policy or programme, even abstinence-oriented programmes, attempt to reduce drug-related harm. The principle feature of harm reduction is the acceptance of the fact that some drug users cannot be expected to cease their drug use at the present time. Harm reduction is neutral about the long term goals of intervention while according a high priority to short-term realizable goals. Harm reduction should be neutral about legalization. The essence of the concept is to ameliorate adverse consequences of drug use while, at least in the short term, drug use continues.

  2. Sex-work harm reduction.

    PubMed

    Rekart, Michael L

    2005-12-17

    Sex work is an extremely dangerous profession. The use of harm-reduction principles can help to safeguard sex workers' lives in the same way that drug users have benefited from drug-use harm reduction. Sex workers are exposed to serious harms: drug use, disease, violence, discrimination, debt, criminalisation, and exploitation (child prostitution, trafficking for sex work, and exploitation of migrants). Successful and promising harm-reduction strategies are available: education, empowerment, prevention, care, occupational health and safety, decriminalisation of sex workers, and human-rights-based approaches. Successful interventions include peer education, training in condom-negotiating skills, safety tips for street-based sex workers, male and female condoms, the prevention-care synergy, occupational health and safety guidelines for brothels, self-help organisations, and community-based child protection networks. Straightforward and achievable steps are available to improve the day-to-day lives of sex workers while they continue to work. Conceptualising and debating sex-work harm reduction as a new paradigm can hasten this process.

  3. Harm reduction principles for healthcare settings.

    PubMed

    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

  4. Defining and redefining harm reduction in the Lao context

    PubMed Central

    2012-01-01

    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. PMID:22769736

  5. Alcohol policy and harm reduction in Australia.

    PubMed

    Loxley, Wendy; Gray, Dennis; Wilkinson, Celia; Chikritzhs, Tanya; Midford, Richard; Moore, David

    2005-11-01

    With consultations having been held across Australia this year as part of the process of developing a new National Alcohol Strategy, it seemed timely to invite my colleagues from the National Drug Research Institute who are experts in the alcohol field to write this Harm Reduction Digest. The authors have canvassed a range of alcohol policy options and discussed their effectiveness in reducing harm for what is arguably Australia's number one drug problem. Australia's response to alcohol and other drug problems has, historically, been based on 'harm minimization--incorporating supply reduction, demand reduction and harm reduction'. At this time where the policy options for alcohol are being set for the next 5 years in a climate of 'small government', removing restrictions of 'fair competition' in business and a belief in the free market, what does the research have to say about recommended policies and strategies to reduce alcohol-related harm?

  6. The cost-effectiveness of harm reduction.

    PubMed

    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

  7. Harm Reduction Agencies as a Potential Site for Buprenorphine Treatment.

    PubMed

    Fox, Aaron D; Chamberlain, Adam; Frost, Taeko; Cunningham, Chinazo O

    2015-01-01

    Harm reduction agencies complement addiction treatment by providing diverse services that improve the health of people who use drugs. Buprenorphine maintenance treatment (BMT) is an effective opioid addiction treatment that may be provided from flexible settings, potentially including harm reduction agencies. This study investigated attitudes toward different potential sites for BMT (harm reduction agencies, general medical clinics, and drug treatment programs) among harm reduction clients. Using computer-based interviews, participants indicated preferred potential site for BMT (harm reduction agency, drug treatment program, or general medical clinic), interest in BMT by potential site, motivation for treatment, and barriers to BMT. Multivariable logistic regression was used to determine factors associated with harm reduction agency preference. Of 102 opioid users, the most preferred potential site for BMT was a harm reduction agency (51%), whereas fewer preferred general medical clinics (13%), drug treatment programs (12%), or were not interested in BMT (25%). In multivariable analysis, experiencing ≥1 barrier to BMT was strongly associated with preferring harm reduction agencies (adjusted odds ratio [aOR] = 3.39, 95% confidence interval [CI]: 1.00-11.43). The potential to initiate BMT at harm reduction agencies is highly favorable among harm reduction clients, especially among those experiencing barriers to BMT. Offering BMT at harm reduction agencies could improve access to treatment, but studies are needed to determine safety and efficacy of this approach.

  8. Harm Reduction in MSW Substance Abuse Courses

    ERIC Educational Resources Information Center

    Eversman, Michael H.

    2012-01-01

    Professional social work largely has endorsed the empirically supported paradigm of harm reduction in relation to substance abuse issues. Despite literature detailing similarities between social work and harm reduction, little is known about its presence in MSW substance abuse coursework. A purposive sample of 133 social work faculty from…

  9. Harm Reduction From Below

    PubMed Central

    Van Schipstal, Inge; Berning, Moritz; Murray, Hayley

    2016-01-01

    This article focuses on how recreational drug users in the Netherlands and in online communities navigate the risks and reduce the harms they associate with psychoactive drug use. To do so, we examined the protective practices they invent, use, and share with their immediate peers and with larger drug experimenting communities online. The labor involved in protective practices and that which ultimately informs harm reduction from below follows three interrelated trajectories: (1) the handling and sharing of drugs to facilitate hassle-free drug use, (2) creating pleasant and friendly spaces that we highlight under the practices of drug use attunements, and (3) the seeking and sharing of information in practices to spread the good high. We focus not only on users’ concerns but also on how these concerns shape their approach to drugs, what young people do to navigate uncertainties, and how they reach out to and create different sources of knowledge to minimize adversities and to improve highs. Harm reduction from below, we argue, can best be seen in the practices of sharing around drug use and in the caring for the larger community of drug-using peers. PMID:27721525

  10. Islam and harm reduction.

    PubMed

    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.

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

    PubMed

    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.

  12. A new empiricism for harm reduction.

    PubMed

    Duff, Cameron

    2018-03-23

    This commentary reflects on the key methodological innovations presented in Nicole Vitellone's recent book Social Science of the Syringe (Vitellone, 2017). Vitellone's book offers a critical account of harm reduction steeped in the material practices of empirical inquiry. In Vitellone's hands, harm reduction becomes a "matter of care"; a means of thinking, feeling and knowing the life-worlds of people who inject drugs, such that these worlds may be encountered differently. Vitellone couches this analysis in terms of a novel social science of the syringe. Throughout her analysis, Vitellone asks us to reimagine the syringe, not as a fixed technical object, but as a dense point of capacities and affects around which certain forms of sociality become possible. The book follows the implications of this logic for scholars interested in the social and political contexts - the situated materialities - of injection drug use. I will close with some brief reflections on Vitellone's book in relation to broader efforts to advance a novel social science for harm reduction. Copyright © 2018 Elsevier B.V. All rights reserved.

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

    PubMed Central

    2012-01-01

    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 in harm reduction advocacy

  14. Harm reduction in Cambodia: a disconnect between policy and practice

    PubMed Central

    2012-01-01

    In 2003 the Government of Cambodia officially began to recognise that harm reduction was an essential approach to preventing HIV among people who use drugs and their sexual partners. Several programs aiming to control and prevent HIV among drug users have been implemented in Cambodia, mostly in the capital, Phnom Penh. However, there have been ongoing tensions between law enforcement and harm reduction actors, despite several advocacy efforts targeting law enforcement. This study attempts to better understand the implementation of harm reduction in Cambodia and how the policy environment and harm reduction program implementation has intersected with the role of law enforcement officials in Cambodia. PMID:22770124

  15. Harm reduction psychotherapy: extending the reach of traditional substance use treatment.

    PubMed

    Tatarsky, Andrew

    2003-12-01

    Harm reduction is a paradigm-shifting idea that has the potential to significantly improve the treatment of problem substance users. The essence of harm reduction is the recognition that treatment must start from the client's needs and personal goals and that all change that reduces the harms associated with substance use can be regarded as valuable. The paper presents harm reduction's rationale, principles, treatment implications, and application to psychotherapy. The author describes his model of Integrative Harm Reduction Psychotherapy, an approach that integrates a strategic skills-building focus with an exploration of the multiple meanings of substance use and the importance of the therapeutic alliance.

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

    PubMed

    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.

  17. Tobacco use harm reduction, elimination, and escalation in a large military cohort.

    PubMed

    Klesges, Robert C; Sherrill-Mittleman, Deborah; Ebbert, Jon O; Talcott, G Wayne; Debon, Margaret

    2010-12-01

    We evaluated changing patterns of tobacco use following a period of forced tobacco abstinence in a US military cohort to determine rates of harm elimination (e.g., tobacco cessation), harm reduction (e.g., from smoking to smokeless tobacco use), and harm escalation (e.g., from smoking to dual use or from smokeless tobacco use to smoking or dual use). Participants were 5225 Air Force airmen assigned to the health education control condition in a smoking cessation and prevention trial. Tobacco use was assessed by self-report at baseline and 12 months. Among 114 baseline smokers initiating smokeless tobacco use after basic military training, most demonstrated harm escalation (87%), which was 5.4 times more likely to occur than was harm reduction (e.g., smoking to smokeless tobacco use). Harm reduction was predicted, in part, by higher family income and belief that switching from cigarettes to smokeless tobacco is beneficial to health. Harm escalation predictors included younger age, alcohol use, longer smoking history, and risk-taking. When considering a harm reduction strategy with smokeless tobacco, the tobacco control community should balance anticipated benefits of harm reduction with the risk of harm escalation and the potential for adversely affecting public health.

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

    PubMed

    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

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

    PubMed Central

    2012-01-01

    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. PMID:22769430

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

    PubMed

    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.

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

    PubMed Central

    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

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

    PubMed

    Bridge, Jamie; Hunter, Benjamin M; Atun, Rifat; Lazarus, Jeffrey V

    2012-07-01

    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 applicants to include harm reduction interventions in their proposals. This study is the first detailed analysis of Global Fund investments in harm reduction interventions. The full list of more than 1000 Global Fund grants was analysed to identify HIV grants that contain activities for people who inject drugs. Data were collected from the detailed budgets agreed between the Global Fund and grant recipients. Relevant budget lines were recorded and analysed in terms of the resources allocated to different interventions. 120 grants from 55 countries and territories contained activities for people who inject drugs worth a total of US$ 361 million, increasing to US$ 430 million after projections were made for grants that had yet to enter their final phase of funding. Two-thirds of the budgeted US$ 361 million was allocated to core harm reduction activities as defined by the United Nations. Thirty-nine of the 55 countries were in Eastern Europe and Asia. Only three countries with generalised HIV epidemics had grants that included harm reduction activities. This study represents the most comprehensive assessment of Global Fund investments in harm reduction. This funding, while substantial, falls short of the estimated needs. Investments in harm reduction must increase if HIV transmission among people who inject drugs is to be halved by 2015. Copyright © 2012 Elsevier B.V. All rights reserved.

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

    PubMed

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

    2016-05-17

    Due to their similarity to tobacco cigarettes, electronic cigarettes (e-cigarettes) could play an important role in tobacco harm reduction. However, the public health community remains divided concerning the appropriateness of endorsing a device whose safety and efficacy for smoking cessation remain unclear. 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-smokers, use among youth, marketing and advertisement, use in public places, renormalization of a smoking culture, and market ownership. Overall, the safety profile of e-cigarettes is unlikely to warrant serious public health concerns, particularly given the known adverse health effects associated with tobacco cigarettes. As a result, it is unlikely that the population-level harms resulting from e-cigarette uptake among non-smokers would overshadow the public health gains obtained from tobacco harm reduction among current smokers. While the existence of a gateway effect for youth remains uncertain, e-cigarette use in this population should be discouraged. Similarly, marketing and advertisement should remain aligned with the degree of known product risk and should be targeted to current smokers. Overall, the available evidence supports the cautionary implementation of harm reduction interventions aimed at promoting e-cigarettes as attractive and competitive alternatives to cigarette smoking, while taking measures to protect vulnerable groups and individuals.

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

    PubMed

    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.

  5. E-cigarette Regulation and Harm Reduction: The Case of Hong Kong.

    PubMed

    Churk, Shue Sing

    Harm reduction is an internationally recognized tobacco control strategy. E-cigarettes, being a less harmful alternative to smoking, have the potential to achieve harm reduction. Within this context, this article critiques Hong Kong’s legal regime governing e-cigarettes and the proposed prohibition of the product. It is argued that the current law is uncertain and inadequate. Although a reform of laws relating to e-cigarettes is needed, it is argued that banning the product altogether as a means to reducing the harm of tobacco use is unsupported by evidence.

  6. Harm reduction at the crossroads: the case of e-cigarettes.

    PubMed

    Maziak, Wasim

    2014-10-01

    The recent popularity of electronic (e)-cigarettes and their rapid uptake by youth has ignited the debate about their role as a harm-reduction strategy. Harm reduction in the context of tobacco control contends that in societies that have achieved considerable success in curbing smoking, leaving the remaining hard-to-quit smokers with an abstinence-only option is unfair, especially when less-harmful choices are available. On one side of the debate are those who call for caution in endorsing such products until critical pieces of evidence about their safety and potential become available, whereas the other side argues that waiting until all questions about e-cigarettes are answered is dogma driven. In this piece, I try to discuss the unresolvable contention between harm-reduction goals of offering safer options to smokers, and those of e-cigarette makers of being commercially viable and profitable. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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

    PubMed Central

    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

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

    PubMed

    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.

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

    PubMed

    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.

  10. Harm reduction programmes in the Asia--Pacific Region.

    PubMed

    Reid, Gary; Devaney, Madonna L; Baldwin, Simon

    2008-01-01

    This paper reports on the public health intervention of harm reduction to address drug use issues in the Asia-Pacific region. It is based on the report 'Situational analysis of illicit drug issues and responses in Asia and the Pacific', commissioned by the Australian National Council on Drugs Asia Pacific Drug Issues Committee. A comprehensive desk-based review based on published and unpublished literature and key informant data. Drug use in the Asia--Pacific region is widespread, resulting in serious adverse health consequences. Needle and syringe programmes are found in some parts of Asia, but not in the six Pacific Island countries reviewed. Outreach and peer education programmes are implemented, but overall appear minor in size and scope. Substitution therapy programmes appear to be entering a new era of acceptance in some parts of Asia. Primary health care specifically for drug users overall is limited. Harm reduction programmes in the Asia--Pacific region are either small in scale or do not exist. Most programmes lack the technical capacity, human resources and a limited scope of operations to respond effectively to the needs of drug users. Governments in this region should be encouraged to endorse evidence-based harm reduction programmes.

  11. Online drug user-led harm reduction in Hungary: a review of “Daath”

    PubMed Central

    2013-01-01

    Harm reduction has been increasingly finding its way into public drug policies and healthcare practices worldwide, with successful intervention measures justifiably focussing on the highest-risk groups, such as injecting drug users. However, there are also other types of drug users in need for harm reduction, even though they pose less, low, or no public health risk. Occasionally, drug users may autonomously organise themselves into groups to provide advocacy, harm reduction, and peer-help services, sometimes online. The http://www.daath.hu website has been operated since 2001 by the “Hungarian Psychedelic Community”, an unorganised drug user group with a special interest in hallucinogenic and related substances. As of today, the website serves about 1200 visitors daily, and the online community comprises of more than 8000 registered members. The Daath community is driven by a strong commitment to the policy of harm reduction in the form of various peer-help activities that aim to expand harm reduction without promoting drug use. Our review comprehensively summarises Daath’s user-led harm reduction services and activities from the last ten years, firstly outlining the history and growth phases of Daath, along with its self-set guidelines and policies. Online services (such as a discussion board, and an Ecstasy pill database) and offline activities (such as Ecstasy pill field testing, and a documentary film about psychedelics) are described. In order to extend its harm reduction services and activities in the future, Daath has several social, commercial, and legislative challenges to face. Starting with a need to realign its focus, outlooks for the upcoming operation of Daath are pondered. Future trends in harm reduction, such as separating harm-decreasing from benefit-increasing, are also discussed. We aim to share these innovative harm reduction measures and good practices in order to be critically assessed, and – if found useful – adapted and applied

  12. Partners in treatment: relational psychoanalysis and harm reduction therapy.

    PubMed

    Rothschild, Debra

    2010-02-01

    A relational psychoanalytic harm reduction orientation to the treatment of substance misusers is presented and illustrated with a clinical example. Both harm reduction therapy and relational psychoanalysis rely on a two-person model in which the therapist and client are collaborators in the treatment. In both, substance use is seen in the context of the user's internal psychodynamics and external environment, and there is an emphasis on treating the person as a whole individual whose substance use is one aspect of life, rather than focusing on the substance use itself as was often done in the past. Historically, psychoanalysis and substance abuse treatment were so different from each other that their paths rarely crossed. The introduction of harm reduction therapy to substance abuse and the relational orientation in psychoanalysis have brought the fields closer together such that the valuable contributions that each can make to the other can now be appreciated. (c) 2010 Wiley Periodicals, Inc.

  13. Integrative harm reduction psychotherapy: a case of substance use, multiple trauma, and suicidality.

    PubMed

    Tatarsky, Andrew; Kellogg, Scott

    2010-02-01

    Harm reduction is a new paradigm that seeks to reduce the harmful consequences of substance use and other risky behaviors without requiring abstinence. This article discusses integrative harm reduction psychotherapy, one application of harm reduction principles to psychotherapy. Seven therapeutic tasks are described with attention to clinical process, skills, and strategies. A case is presented that illustrates the application of this approach with life-threatening substance use that was related to multiple trauma and suicidal depression. (c) 2010 Wiley Periodicals, Inc.

  14. The development of peer educator-based harm reduction programmes in Northern Vietnam.

    PubMed

    Walsh, Nick; Gibbie, Tania M; Higgs, Peter

    2008-03-01

    Injecting drug use remains an important risk factor for transmission in Vietnam, with an estimated 50% of the 290 000 people living with HIV/AIDS reporting injecting drug use as a risk factor. Despite this, effective harm reduction interventions are generally lacking. This paper describes the implementation of peer-based harm reduction programmes in two rural provinces of Vietnam. Peer educators were trained in basic HIV prevention, including harm reduction. After significant preparation work with the Provincial AIDS Committees of Bac Giang and Thanh Hoa and other relevant national, provincial and local authorities, the interventions were commenced. Harm reduction interventions were delivered through outreach as well as on-site. This included needle and syringe distribution and collection. Community advocacy occurred throughout the life of the project. Local authorities and peers believed that while there was a general reduction in stigma and discrimination, legal barriers associated particularly with the carrying of injecting equipment remained. This impacted upon the ability of peer educators to work with their clients. Peer-based delivery of harm reduction intervention is acceptable. Harm reduction interventions, including needle and syringe programmes, are feasible and acceptable in these two rural Vietnamese provinces. Community acceptance and uptake of these interventions is key to successful expansion across the region. Active participation by families of drug users seems crucial. This initiative demonstrates that despite a difficult policy environment, peer-delivered needle and syringe programmes are feasible within a rural Asian environment as long as there is adequate local political and community support.

  15. The Olympics and harm reduction?

    PubMed Central

    2012-01-01

    The current anti-doping policy (‘war on doping’) resembles the ‘war on drugs’ in several aspects, including a zero-tolerance approach, ideology encroaching on human rights and public health principles, high cost using public money for repression and control, and attempts to shape internationally harmonized legal frameworks to attain its aim. Furthermore, even if for different reasons, both wars seem not to be able to attain their objectives, and possibly lead to more harm to society than they can prevent. The Olympic buzz is mounting and we can expect multiple headlines in the media on doping and anti-doping stories related to this event. In this article we describe current anti-doping policy, reflect on its multiple unplanned consequences, and end with a discussion, if lessons learned from harm reduction experiences in the illicit drugs field could be applied to anti-doping. PMID:22788912

  16. Party drugs - use and harm reduction.

    PubMed

    Frei, Matthew

    2010-08-01

    Party drug use, the intermittent use of stimulants, ecstasy and so-called 'designer drugs' at dance parties or 'raves', is now part of the culture of many young Australians. This article discusses the risks associated with the use of 'party drugs' and describes an useful approach to general practitioner assessment and management of patients who may be using party drugs. Party drug use is associated with a range of harms, including risks associated with behaviour while drug affected, toxicity and overdose, mental health complications and physical morbidity. Multiple substance use, particularly combining sedatives, further amplifies risk. If GPs have some understanding of these drugs and their effects, they are well placed to provide an effective intervention in party drug users by supporting the reduction of harm.

  17. Assessing university students' self-efficacy to employ alcohol-related harm reduction strategies.

    PubMed

    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

    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. Four hundred ninety-eight participants rated their confidence (from "not at all confident" to "completely confident") to employ 17 harm reduction strategies when drinking. Factor analysis and internal consistency reliability analyses indicated that the 17 items constitute a single scale with good test-retest reliability. Consistent with other research examining previous use of such strategies, women in our sample reported significantly higher harm reduction self-efficacy than did men. Harm reduction self-efficacy was also associated with reported number of high-risk drinking episodes in the previous 2 weeks. This brief and easily administered questionnaire holds promise as a clinical tool to identify individuals with low harm reduction self-efficacy and as an outcome measure for health promotion and educational interventions.

  18. Harm reduction with pharmacotherapy for homeless people with alcohol dependence: Protocol for a randomized controlled trial

    PubMed Central

    Collins, Susan E.; Saxon, Andrew J.; Duncan, Mark H.; Smart, Brian F.; Merrill, Joseph O.; Malone, Daniel K.; Jackson, T. Ron; Clifasefi, Seema L.; Joesch, Jutta; Ries, Richard K.

    2014-01-01

    Background Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. Aims Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. Methods This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4 weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. Discussion If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among

  19. Harm reduction with pharmacotherapy for homeless people with alcohol dependence: protocol for a randomized controlled trial.

    PubMed

    Collins, Susan E; Saxon, Andrew J; Duncan, Mark H; Smart, Brian F; Merrill, Joseph O; Malone, Daniel K; Jackson, T Ron; Clifasefi, Seema L; Joesch, Jutta; Ries, Richard K

    2014-07-01

    Interventions requiring abstinence from alcohol are neither preferred by nor shown to be highly effective with many homeless individuals with alcohol dependence. It is therefore important to develop lower-threshold, patient-centered interventions for this multimorbid and high-utilizing population. Harm-reduction counseling requires neither abstinence nor use reduction and pairs a compassionate style with patient-driven goal-setting. Extended-release naltrexone (XR-NTX), a monthly injectable formulation of an opioid receptor antagonist, reduces craving and may support achievement of harm-reduction goals. Together, harm-reduction counseling and XR-NTX may support alcohol harm reduction and quality-of-life improvement. Study aims include testing: a) the relative efficacy of XR-NTX and harm-reduction counseling compared to a community-based, supportive-services-as-usual control, b) theory-based mediators of treatment effects, and c) treatment effects on publicly funded service costs. This RCT involves four arms: a) XR-NTX+harm-reduction counseling, b) placebo+harm-reduction counseling, c) harm-reduction counseling only, and d) community-based, supportive-services-as-usual control conditions. Participants are currently/formerly homeless, alcohol dependent individuals (N=300). Outcomes include alcohol variables (i.e., craving, quantity/frequency, problems and biomarkers), health-related quality of life, and publicly funded service utilization and associated costs. Mediators include 10-point motivation rulers and the Penn Alcohol Craving Scale. XR-NTX and harm-reduction counseling are administered every 4weeks over the 12-week treatment course. Follow-up assessments are conducted at weeks 24 and 36. If found efficacious, XR-NTX and harm-reduction counseling will be well-positioned to support reductions in alcohol-related harm, decreases in costs associated with publicly funded service utilization, and increases in quality of life among homeless, alcohol

  20. Is groin injecting an ethical boundary for harm reduction?

    PubMed

    Miller, Peter G; Lintzeris, Nick; Forzisi, Luciana

    2008-12-01

    Femoral vein (or groin) injecting by street drug users is an emerging public health issue in the UK. It has been proposed that groin injecting is becoming normalised among UK injecting drug users (IDUs), yet harm reduction strategies are currently piecemeal and some may be crossing the boundary of responsible provision of information. This paper discusses the interventions available to service providers dealing with groin injecting and explores the utility of ethical frameworks for informing service provider decisions. Methods analysis of possible service provider responses using White and Popovits' ethical decision-making framework. The use of ethical frameworks suggest that different types of groin injectors should receive different interventions. Injectors for whom the groin is a site of 'last resort' should be given information about how to inject there less dangerously, whereas 'convenience' groin injectors should be actively encouraged to inject elsewhere. Groin injecting is a behaviour which represents a boundary for some harm reduction practices (such as providing 'how to' booklets to all injectors) as well as being an argument for more complex and environmentally appropriate harm reduction responses such as drug consumption rooms and training IDUs to maintain healthier injecting sites.

  1. Harm reduction and women in the Canadian national prison system: policy or practice?

    PubMed

    Rehman, Laurene; Gahagan, Jacqueline; DiCenso, Anne Marie; Dias, Giselle

    2004-01-01

    Applying the principles of harm reduction within the context of incarcerated populations raises a number of challenges. Although some access to harm reduction strategies has been promoted in general society, a divide between what is available and what is advocated continues to exist within the prison system. This paper explores the perceptions and lived experiences of a sample of nationally incarcerated women in Canada regarding their perceptions and experiences in accessing HIV and Hepatitis C prevention, care, treatment and support. In-depth interviews were conducted with 156 women in Canadian national prisons. Q.S.R. Nudist was used to assist with data management. A constant comparison method was used to derive categories, patterns, and themes. Emergent themes highlighted a gap between access to harm reduction in policy and in practice. Despite the implementation of some harm reduction techniques, women in Canadian prisons reported variable access to both education and methods of reducing HIV/HCV transmission. Concerns were also raised about pre-and post-test counseling for HIV/HCV testing. Best practices are suggested for implementing harm reduction strategies within prisons for women in Canada.

  2. Little cigars, big cigars: omissions and commissions of harm and harm reduction information on the Internet.

    PubMed

    Dollar, Katherine M; Mix, Jacqueline M; Kozlowski, Lynn T

    2008-05-01

    We conducted a comparative analysis of "harm," "harm reduction," and "little cigar" information about cigars on 10 major English-language health Web sites. The sites were from governmental and nongovernmental organizations based in seven different countries and included "harm" and "harm reduction" information, discussions of little cigars, quantitative estimates of health risks, and qualifying behavioral characteristics (inhalation, number per day). Of the 10 Web sites, 7 offered statements explicitly indicating that cigars may be safer than cigarettes. None of the Web sites reviewed described that little cigars are likely as dangerous as cigarettes. Some Web sites provided quantitative estimates of health risks and extensive discussions of qualifying factors. Reading grade levels were higher than desirable. Extensive and complex information on the reduced risks of cigars compared with cigarettes is available on Web sites affiliated with prominent health organizations. Yet these sites fail to warn consumers that popular cigarette-like little cigars and cigarillos are likely to be just as dangerous as cigarettes, even for those who have never smoked cigarettes. Improvement of these Web sites is urgently needed to provide the public with high-quality health information.

  3. A qualitative analysis of case managers' use of harm reduction in practice.

    PubMed

    Tiderington, Emmy; Stanhope, Victoria; Henwood, Benjamin F

    2013-01-01

    The harm reduction approach has become a viable framework within the field of addictions, yet there is limited understanding about how this approach is implemented in practice. For people who are homeless and have co-occurring psychiatric and substance use disorders, the Housing First model has shown promising results in employing such an approach. This qualitative study utilizes ethnographic methods to explore case managers' use of harm reduction within Housing First with a specific focus on the consumer-provider relationship. Analysis of observational data and in-depth interviews with providers and consumers revealed how communication between the two regarding the consumer's substance use interacted with the consumer-provider relationship. From these findings emerged a heuristic model of harm reduction practice that highlighted the profound influence of relationship quality on the paths of communication regarding substance use. This study provides valuable insight into how harm reduction is implemented in clinical practice that ultimately has public health implications in terms of more effectively addressing high rates of addiction that contribute to homelessness and health disparities. Copyright © 2013 Elsevier Inc. All rights reserved.

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

    PubMed Central

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

    2007-01-01

    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 organised 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 PMID:17689353

  5. Substance abuse and developments in harm reduction.

    PubMed

    Cheung, Y W

    2000-06-13

    A drug is a substance that produces a psychoactive, chemical or medicinal effect on the user. The psychoactive effect of mood-altering drugs is modulated by the user's perception of the risks of drug use, his or her ability to control drug use and the demographic, socioeconomic and cultural context. The ability to control drug use may vary along a continuum from compulsive use at one end to controlled use at the other. The "drug problem" has been socially constructed, and the presence of a moral panic has led to public support for the prohibitionist approach. The legalization approach has severely attacked the dominant prohibitionist approach but has failed to gain much support in society because of its extreme libertarian views. The harm reduction approach, which is based on public health principles, avoids the extremes of value-loaded judgements on drug use and focuses on the reduction of drug-related harm through pragmatic and low-threshold programs. This approach is likely to be important in tackling the drug problem in the 21st century.

  6. Substance abuse and developments in harm reduction

    PubMed Central

    Cheung, Y W

    2000-01-01

    A drug is a substance that produces a psychoactive, chemical or medicinal effect on the user. The psychoactive effect of mood-altering drugs is modulated by the user's perception of the risks of drug use, his or her ability to control drug use and the demographic, socioeconomic and cultural context. The ability to control drug use may vary along a continuum from compulsive use at one end to controlled use at the other. The "drug problem" has been socially constructed, and the presence of a moral panic has led to public support for the prohibitionist approach. The legalization approach has severely attacked the dominant prohibitionist approach but has failed to gain much support in society because of its extreme libertarian views. The harm reduction approach, which is based on public health principles, avoids the extremes of value-loaded judgements on drug use and focuses on the reduction of drug-related harm through pragmatic and low-threshold programs. This approach is likely to be important in tackling the drug problem in the 21st century. PMID:10870502

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

    PubMed

    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.

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

    ERIC Educational Resources Information Center

    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.…

  9. Developing an Effective Intervention for IDU Women: A Harm Reduction Approach to Collaboration

    ERIC Educational Resources Information Center

    Brown, Nancy L.; Luna, Veronica; Ramirez, M. Heliana; Vail, Kenneth A.; Williams, Clark A.

    2005-01-01

    Harm reduction is fundamentally a movement intended to empower the patient and consumer of health services. This project applied harm reduction theory as a strategy to empower collaborating community partners and researchers to overcome their preconceptions about each other in order to create a successful HIV prevention intervention and evaluation…

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

    PubMed

    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.

  11. Scale-up of a comprehensive harm reduction programme for people injecting opioids: lessons from north-eastern India

    PubMed Central

    Lalmuanpuii, Melody; Biangtung, Langkham; Mishra, Ritu Kumar; Reeve, Matthew J; Tzudier, Sentimoa; Singh, Angom L; Sinate, Rebecca

    2013-01-01

    Abstract Problem Harm reduction packages for people who inject illicit drugs, including those infected with human immunodeficiency virus (HIV), are cost-effective but have not been scaled up globally. In the north-eastern Indian states of Manipur and Nagaland, the epidemic of HIV infection is driven by the injection of illicit drugs, especially opioids. These states needed to scale up harm reduction programmes but faced difficulty doing so. Approach In 2004, the Bill & Melinda Gates Foundation funded Project ORCHID to scale up a harm reduction programme in Manipur and Nagaland. Local setting In 2003, an estimated 10 000 and 16 000 people were injecting drugs in Manipur and Nagaland, respectively. The prevalence of HIV infection among people injecting drugs was 24.5% in Manipur and 8.4% in Nagaland. Relevant changes By 2012, the harm reduction programme had been scaled up to an average of 9011 monthly contacts outside clinics (80% of target); an average of 1709 monthly clinic visits (15% of target, well above the 5% monthly goal) and an average monthly distribution of needles and syringes of 16 each per programme participant. Opioid agonist maintenance treatment coverage was 13.7% and retention 6 months after enrolment was 63%. Antiretroviral treatment coverage for HIV-positive participants was 81%. Lessons learnt A harm reduction model consisting of community-owned, locally relevant innovations and business approaches can result in good harm reduction programme scale-up and influence harm reduction policy. Project ORCHID has influenced national harm reduction policy in India and contributed to the development of harm reduction guidelines. PMID:23599555

  12. Research on the Ordered Mesoporous Silica for Tobacco Harm Reduction

    NASA Astrophysics Data System (ADS)

    Wang, Y.; Y Li, Z.; Ding, J. X.; Hu, Z. J.; Liu, Z.; Zhou, G.; Huang, T. H.

    2017-12-01

    For reducting tobacco harm, this paper prepared an ordered mesoporous silica by using triblock copolymer Pluronic P123 as template. The property of this material was characterized by the X-ray scattering spectrum(XRD), Transmission electron microscopy(TEM), Scanning electron microscopy (SEM) and Nitrogen adsorption/desorption. Then this ordered mesoporous silica was added into the cigarette filter in order to researching its effect of cigarette harm index. The result shows that the feature of SBA-15 was grain morphology, ordered arrangement, tubular porous 2-D hexagonal structure. The application of SBA-15 in cigarette filter can selectively reduce harmful components in cigarette smoke such as crotonaldehyde, hydrogen cyanide, benzo pyrene and tar. The synthesized SBA-15 could properly reduce cigarette harm index.

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

    PubMed

    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

  14. Harm reduction in the US: a movement for change.

    PubMed

    Greig, A

    The War on Drugs in the United States has polarized the debate on how to deal effectively with drug use and prevention and makes it difficult to form an agenda to address the harm of drug use. Harm-reduction activists and drug-user groups need to establish common ground to develop programs acceptable to all parties. The harm-reduction approach is based on the premise that adverse consequences of a harmful act, drug use in this case, can be mitigated without necessarily reducing consumption. Needle exchange programs are a good example of this approach. There are 100 such programs in the United States, and the programs are seen as an effective means of reducing HIV transmission. However, the programs remain politically sensitive and Federal funding is outlawed. The War on Drugs programs can conflict with HIV prevention programs; programs that might reduce the incidence of HIV infection but do not criminalize or stigmatize drug use are rarely socially acceptable. In the U.S., about half of all new HIV cases can be attributed to drug use. One-third of the increase in prison populations since 1980 is a consequence of the number of drug-law violators in the prison system. The impact of moral conservatism and how the drug laws are affected by class, race, and gender are discussed. Groups involved with combating drug use and preventing HIV transmission will need to form alliances to develop programs mutually beneficial to their audiences.

  15. Harm reduction for young people who use prescription opioids extra-medically: Obstacles and opportunities

    PubMed Central

    Marshall, Brandon D.L.; Green, Traci C.; Yedinak, Jesse L.; Hadland, Scott E.

    2016-01-01

    Extra-medical prescription opioid (EMPO) use—intentional use without a prescription or outside of prescribed parameters—is a public health crisis in the United States and around the world. Epidemiological evidence suggests that the prevalence of EMPO use and adverse sequelae, including opioid overdose and hepatitis C infection, are elevated among people aged 18 to 25. Despite these preventable health risks, many harm reduction interventions are underutilized by, or inaccessible to, EMPO-using youth. In this commentary, we describe key harm reduction strategies for young people who use prescription opioids. We examine individual, social, and policy-level barriers to the implementation of evidence-based approaches that address EMPO use and related harms among young people. We highlight the need for expanded services and new interventions to engage this diverse and heterogeneous at-risk population. A combination of medical, social, and structural harm reduction interventions are recommended. Furthermore, research to inform strategies that mitigate particularly high-risk practices (e.g., polysubstance use) is warranted. Finally, we discuss how the meaningful involvement of youth in the implementation of harm reduction strategies is a critical component of the public health response to the prescription opioid epidemic. PMID:26919826

  16. The Social Practice of Harm Reduction in Argentina: A “Latin” Kind of Intervention

    PubMed Central

    Harris, Shana

    2016-01-01

    Harm reduction” is a public health model that places emphasis on reducing the negative effects of drug use rather than on eliminating drug use or ensuring abstinence. Based on sixteen months of ethnographic research, this article examines how harm reduction in Argentina is both envisioned and observed as a social practice by analyzing how local harm reductionists position their work in relation to “social context.” My informants consider this social emphasis to be characteristic of a “Latin” kind of intervention, which they differentiate from an “Anglo-Saxon” approach focused on individual behavior change. Differentiating between these “cultural” models of intervention helps Argentine harm reductionists guide their social orientation to drug use, risk, and harm by situating interventions in the contexts in which users live and operate. It also allows them to distinguish their social form of harm reduction from a neoliberal one that they associate with the global north. The construction of these distinct cultural models of intervention is a means of critiquing neoliberal approaches to health that advocate technical solutions to changing individual behavior. Ultimately, this construct acts as a political commentary on the limits of an individual-oriented harm reduction project when applied to the “Argentine context.” PMID:27182076

  17. Accelerating harm reduction interventions to confront the HIV epidemic in the Western Pacific and Asia: the role of WHO (WPRO)

    PubMed Central

    Mesquita, Fabio; Jacka, David; Ricard, Dominique; Shaw, Graham; Tieru, Han; Yifei, Hu; Poundstone, Katharine; Salva, Madeline; Fujita, Masami; Singh, Nirmal

    2008-01-01

    The epidemic of HIV/AIDS linked to injecting drug usage is one of the most explosive in recent years. After a historical epicentre in Europe, South and North America, at present it is clearly the main cause of dissemination of the epidemic in Eastern Europe and some key Asian countries. Recently, 10 African countries reported the spread of HIV through people who inject drugs (PWID), breaking one of the final geographical barriers to the globalization of the epidemic of HIV among and from PWID. Several countries of the Asia and Pacific Region have HIV epidemics that are driven by injecting drug usage. Harm reduction interventions have been implemented in many countries and potential barriers to implementation are being overcome. Harm reduction is no longer a marginal approach in the Region; instead, it is the core tool for responding to the HIV/AIDS epidemic among PWID. The development of a comprehensive response in the Region has been remarkable, including scaling up of needle and syringe programmes (NSPs), methadone maintenance treatment (MMT), and care, support and treatment for PWID. This development is being followed up by strong ongoing changes in policies and legislations. The main issue now is to enhance interventions to a level that can impact the epidemic. The World Health Organization (WHO) is one of the leading UN agencies promoting harm reduction. Since the establishment of the Global Programme on AIDS, WHO has been working towards an effective response to the HIV epidemic among PWID. WHO's work is organized into a number of components: establishing an evidence base; advocacy; development of normative standards, tools and guidelines; providing technical support to countries; ensuring access to essential medicines, diagnostics and commodities; and mobilizing resources. In this paper, we trace the course of development of the HIV/AIDS epidemic among and from PWID in the Western Pacific and Asia Region (WPRO) as well as WHO's role in supporting the

  18. Injection Drug Users' Perceived Barriers to Using Self-Initiated Harm Reduction Strategies.

    PubMed

    Bonar, Erin E; Rosenberg, Harold

    2014-08-01

    Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs' perceived barriers to engaging in these behaviors. We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one's drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants' most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated.

  19. Reviewing harm reduction for people who inject drugs in Asia: the necessity for growth.

    PubMed

    Stone, Katie Alexandra

    2015-10-16

    There is an estimate of three to five million people who inject drugs living in Asia. Unsafe injecting drug use is a major driver of both the HIV and hepatitis C (HCV) epidemic in this region, and an increase in incidence among people who inject drugs continues. Although harm reduction is becoming increasingly accepted, a largely punitive policy remains firmly in place, undermining access to life-saving programmes. The aim of this study is to present an overview of key findings on harm reduction in Asia based on data collected for the Global State of Harm Reduction 2014. A review of international scientific and grey literature was undertaken between May and September 2014, including reports from multilateral agencies and international non-governmental organisations. A qualitative survey comprising open-ended questions was also administered to civil society, harm reduction networks, and organisations of people who use drugs to obtain national and regional information on key developments in harm reduction. Expert consultation from academics and key thinkers on HIV, drug use, and harm reduction was used to verify findings. In 2014, 17 countries in Asia provide needle and syringe programmes (NSP) provision and 15 opioid substitution therapy (OST). It is estimated that between 60 and 90 % of people who use drugs in Asia have HCV; however, treatment still remains out of reach due to cost barriers. TB testing and treatment services are yet to be established for key populations, yet nearly 15 % of the global burden of new cases of HIV-TB co-infection are attributed to southeast Asia. Eighteen percent of the total number of people living with HIV eligible for antiretroviral treatment (ART) accessed treatment. Only Malaysia and Indonesia provide OST in prison, with no NSP provision in prisons in the region. To reduce HIV and viral hepatitis risk among people who inject drugs, there is a necessity to significantly increase harm reduction service provision in Asia. Although

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

    PubMed

    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

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

    PubMed Central

    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

  2. Public health implications of smokeless tobacco use as a harm reduction strategy.

    PubMed

    Savitz, David A; Meyer, Roger E; Tanzer, Jason M; Mirvish, Sidney S; Lewin, Freddi

    2006-11-01

    Harm reduction strategies involve promoting a product that has adverse health consequences as a substitute for one that has more severe adverse health consequences. Smokeless tobacco low in nitrosamine content offers potential benefits in reducing smoking prevalence rates. Possible harm arises from the potential for such products to serve as a gateway to more harmful tobacco products, public misinterpretation of "less harmful" as "safe," distraction from the public health goal of tobacco elimination, and ethical issues involved in advising those marketing these harmful products. We offer a research agenda to provide a stronger basis for evaluating the risks and benefits of smokeless tobacco as a means of reducing the adverse health effects of tobacco.

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

    ERIC Educational Resources Information Center

    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…

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

    PubMed

    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.

  5. Injection Drug Users’ Perceived Barriers to Using Self-Initiated Harm Reduction Strategies

    PubMed Central

    Rosenberg, Harold

    2014-01-01

    Introduction and Aims Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs’ perceived barriers to engaging in these behaviors. Method We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. Results The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one’s drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants’ most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. Discussion and Conclusions Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated. PMID:25419201

  6. Articulating Connections between the Harm-Reduction Paradigm and the Marginalisation of People Who Use Illicit Drugs

    PubMed Central

    Souleymanov, Rusty; Allman, Dan

    2016-01-01

    In this paper, we argue for the importance of unsettling dominant narratives in the current terrain of harm-reduction policy, practice and research. To accomplish this, we trace the historical developments regarding the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and harm-reduction policies and practice. We argue that multiple historical junctures rather than single causes of social exclusion engender the processes of marginalisation, propelled by social movements, institutional interests, state legislation, community practices, neo-liberalism and governmentality techniques. We analyse interests (activist, lay expert, institutional and state) in the harm-reduction field, and consider conceptualisations of risk, pleasure, stigma, social control and exclusionary moral identities. Based on our review of the literature, this paper provides recommendations for social workers and others delivering health and social care interested in the fields of substance use, HIV prevention and harm reduction. PMID:27559236

  7. Articulating Connections between the Harm-Reduction Paradigm and the Marginalisation of People Who Use Illicit Drugs.

    PubMed

    Souleymanov, Rusty; Allman, Dan

    2016-07-01

    In this paper, we argue for the importance of unsettling dominant narratives in the current terrain of harm-reduction policy, practice and research. To accomplish this, we trace the historical developments regarding the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and harm-reduction policies and practice. We argue that multiple historical junctures rather than single causes of social exclusion engender the processes of marginalisation, propelled by social movements, institutional interests, state legislation, community practices, neo-liberalism and governmentality techniques. We analyse interests (activist, lay expert, institutional and state) in the harm-reduction field, and consider conceptualisations of risk, pleasure, stigma, social control and exclusionary moral identities. Based on our review of the literature, this paper provides recommendations for social workers and others delivering health and social care interested in the fields of substance use, HIV prevention and harm reduction.

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

    PubMed Central

    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

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

    PubMed

    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

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

    PubMed

    Thomson, Nick; Moore, Tim; Crofts, Nick

    2012-07-09

    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.

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

    PubMed Central

    2016-01-01

    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 reduction

  12. Community-based harm reduction substance abuse treatment with methamphetamine-using men who have sex with men.

    PubMed

    Carrico, Adam W; Flentje, Annesa; Gruber, Valerie A; Woods, William J; Discepola, Michael V; Dilworth, Samantha E; Neilands, Torsten B; Jain, Jennifer; Siever, Michael D

    2014-06-01

    Harm reduction approaches endeavor to assist individuals with avoiding the most detrimental consequences of risk taking behaviors, but limited research has documented the outcomes of harm reduction substance abuse treatment. In total, 211 methamphetamine-using men who have sex with men (MSM) enrolled in two outcome studies of substance abuse treatment programs that were implementing an evidence-based, cognitive-behavioral intervention (i.e., the Matrix Model) from a harm reduction perspective. Study 1 (N = 123) examined changes in self-reported substance use, Addiction Severity Index (ASI) composite scores, and HIV care indicators over a 12-month follow-up. Study 2 (N = 88) assessed changes in substance use, sexual risk taking, and HIV care indicators over a 6-month follow-up. Participants in study 1 reported reductions in cocaine/crack use as well as decreases in the ASI drug and employment composite scores. Among HIV-positive participants in study 1 (n = 75), 47 % initiated or consistently utilized anti-retroviral therapy and this was paralleled by significant increases in self-reported undetectable HIV viral load. Study 2 participants reported reductions in methamphetamine use, erectile dysfunction medication use in combination with other substances, and sexual risk-taking behavior while using methamphetamine. Participants in both studies reported concurrent increases in marijuana use. Taken together, these studies are among the first to observe that clients may reduce stimulant use and concomitant sexual risk-taking behavior during harm reduction substance abuse treatment. Randomized controlled trials are needed to examine the differential effectiveness of harm reduction and abstinence-based approaches to substance abuse treatment.

  13. Deficiencies in public understanding about tobacco harm reduction: results from a United States national survey.

    PubMed

    Kiviniemi, Marc T; Kozlowski, Lynn T

    2015-07-02

    Tobacco products differ in their relative health harms. The need for educating consumers about such harms is growing as different tobacco products enter the marketplace and as the FDA moves to regulate and educate the public about different products. However, little is known about the patterns of the public's knowledge of relative harms. Data were analyzed from the Health Information National Trends Survey (HINTS) 4 Cycle 2, a population-representative survey of US adults conducted between October 2012 and January 2013 (N = 3630). Participants reported their perceptions of the relative risks of e-cigarettes, smokeless tobacco, and different types of cigarettes compared to "traditional" cigarettes. Relative risk perceptions for each product type, as well as the consistency and accuracy of harm reduction beliefs, were analyzed. About 65% of the respondents accurately reported that no cigarettes were less harmful than any others. Slightly more than half of U.S. adults perceived e-cigarettes to be safer than regular cigarettes, a belief in line with current scientific evidence. By contrast, only 9% of respondents perceived some smokeless tobacco products to be safer, a belief strongly supported by the evidence. Only 3.5% of respondents had patterns of relative risk perceptions in line with current scientific evidence for all three modalities. The discrepancy between current evidence and public perceptions of relative risk of various tobacco/nicotine products was marked; for most tobacco types, a large proportion of the population held inaccurate harm reduction beliefs. Although there was substantial awareness that no cigarettes were safer than any other cigarettes, there could be benefits from increasing the percentage of the public that appreciates this fact, especially among current smokers. Given the potential benefits of tobacco risk reduction strategies, public health education efforts to increase understanding of basic harm reduction principles are needed to

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

    PubMed Central

    2012-01-01

    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. PMID:22769050

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

    PubMed Central

    2013-01-01

    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

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

    PubMed Central

    Maremmani, Icro; Cibin, Mauro; Pani, Pier Paolo; Rossi, Alessandro; Turchetti, Giuseppe

    2015-01-01

    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. PMID:26610535

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

    PubMed

    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.

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

    PubMed

    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

  19. Education as networking: Rethinking the success of the harm reduction policy of Taiwan.

    PubMed

    Chen, Jia-shin

    2015-05-01

    The harm reduction policy of Taiwan has been considered a success. However, the HIV incidence among injection drug users declined before the nationwide needle and syringe program and drug substitution treatments were implemented. Thus, other factors in the policy might have contributed to its success. Some authors have suggested that education may have played a pivotal part. In this research, the purported significance of education in the success of the policy is conceptualized by reviewing the studies on harm reduction in Taiwan and reflecting upon my own fieldwork. Moreover, relevant literature is used as reference to reformulate this notion of education. This article shows that harm reduction education may be conducted in numerous forms, most of which are non-formal, improvisational, and contingent. Non-governmental organizations may play a role, but more actors, strategies, infrastructures, and interactions should be considered. This article draws from actor-network theory and refines the current thesis that attributes the policy success to education by utilizing three reflections, namely, appreciating materiality and spatiality, recognizing covert actors in the networking, and treating education as an outcome rather than a means. In conclusion, looking at education as a form of networking offers theoretical insight that increases understanding of its participants, mechanisms, processes, and permutations. © The Author(s) 2014.

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

    PubMed Central

    Philbin, Morgan M; Lozada, Remedios; Zúñiga, María Luisa; Mantsios, Andrea; Case, Patricia; Magis-Rodriguez, Carlos; Latkin, Carl A; Strathdee, Steffanie A

    2008-01-01

    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. PMID:19021899

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

    PubMed

    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.

  2. Moving from a project to programmatic response: scaling up harm reduction in Asia.

    PubMed

    Chatterjee, Anindya; Sharma, Mukta

    2010-03-01

    The response to the HIV epidemics among people who inject drugs in Asia began to emerge in the early to mid 1990s, with the rather hesitant implementation of small-scale needle syringe programmes and community care initiatives aiming to support those who were already living with the virus. Since then Asia has seen a significant scaling up of harm reduction, despite very limited resources and difficult policy and legislative environments. One of the major reasons this has happened, is the utilisation of programme based approaches and the firm entrenchment of harm reduction thinking within national HIV/AIDS programmes and strategic plans--in most cases aided by multilateral and bilateral donors. Several models of scale up have been noted in Asia. The transition away from project based approaches, while on the whole positive, can also have a negative impact if the involvement of civil society and a client focussed approach is not protected. Also there are implications for which models of capacity building can be systematised for ongoing scale up. Most crucially, the tensions between drug policy, human rights and public health policies need to be resolved if harm reduction services are to be made available to the millions in Asia who are still unable to access these services. Copyright (c) 2010 Elsevier B.V. All rights reserved.

  3. HIV, Hepatitis C, TB, Harm Reduction, and Persons Deprived of Liberty

    PubMed Central

    Lines, Rick

    2016-01-01

    Abstract 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. PMID:28559684

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

    PubMed

    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.

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

    PubMed

    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

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

    PubMed Central

    Peeters, Silvy; Gilmore, Anna B

    2015-01-01

    Objectives To explore the history of transnational tobacco companies’ use of the term, approach to and perceived benefits of ‘harm reduction’. Methods Analysis of internal tobacco industry documents, contemporary tobacco industry literature and 6 semistructured interviews. Results 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. Conclusions 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. PMID:24457543

  7. Maximising the Highs and Minimising the Lows: Harm Reduction Guidance within Ecstasy Distribution Networks

    PubMed Central

    Duterte, Micheline; Sales, Paloma; Murphy, Sheigla

    2008-01-01

    Background Little is known about how users build and share knowledge concerning the highs and lows of Ecstasy and the role that Ecstasy sellers play in the exchange of this information. Methods These findings are based on a National Institute on Drug Abuse-funded project, “An Exploratory Study of Ecstasy Distribution,” conducted between 2003 and 2006. We completed in-depth interviews with 120 men and women in the San Francisco Bay Area who had sold 5 or more doses 5 or more times in the 6 months prior to the interview. The research focused on buyer-seller relationships and the influence of these relationships on users’ health. Results Users constructed harm reduction strategies in attempts to maximise the Ecstasy high and minimise the risks. The social context of Ecstasy use allowed for the exchange of harm reduction information and advice on how to maximise the pleasurable aspects of Ecstasy. Some participants served as “guides” to ensure that their customers had safe and enjoyable experiences while using Ecstasy. Conclusion These findings suggest that Ecstasy sellers are important points of intervention for the dissemination of harm reduction information as friendship networks were the primary link in creating awareness of safer Ecstasy use. PMID:17964771

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

    PubMed

    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.

  9. The Strategic Dialogue on Tobacco Harm Reduction: a vision and blueprint for action in the US

    PubMed Central

    Zeller, Mitchell; Hatsukami, Dorothy

    2016-01-01

    The issues related to tobacco harm reduction continue to challenge the tobacco control research and policy communities. The potential for combusting tobacco products to reduce exposure and risk remains largely unknown, but this has not stopped manufacturers from offering such products making these claims. The role of oral tobacco products in a harm reduction regimen has also been a source of dialogue and debate. Within the last few years, major cigarette manufacturing companies have begun selling smokeless products for the first time, claiming to target current cigarette smokers. Other cigarette manufacturers are also offering smokeless products in markets around the world. The harm reduction debate has at times been divisive. There has been no unifying set of principles or goals articulated to guide tobacco control efforts. In particular, the research needs are extraordinarily high in order to drive evidence-based policy in this area and avoid the mistakes made with “light” cigarettes. This paper discusses recommendations from a strategic dialogue held with key, mostly US-based tobacco control researchers and policy makers to develop a strategic vision and blueprint for research, policy and communications to reduce the harm from tobacco for the US. Short-term and long-term objectives are described. PMID:19240228

  10. Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996-2013: a modelling study.

    PubMed

    Nosyk, Bohdan; Zang, Xiao; Min, Jeong E; Krebs, Emanuel; Lima, Viviane D; Milloy, M-J; Shoveller, Jean; Barrios, Rolando; Harrigan, P Richard; Kerr, Thomas; Wood, Evan; Montaner, Julio S G

    2017-07-01

    Antiretroviral therapy (ART) and harm reduction services have been cited as key contributors to control of HIV epidemics; however, the specific contribution of ART has been questioned due to uncertainty of its true efficacy on HIV transmission through needle sharing. We aimed to isolate the independent effects of harm reduction services (opioid agonist treatment uptake and needle distribution volumes) and ART on HIV transmission via needle sharing in British Columbia, Canada, from 1996 to 2013. We used comprehensive linked individual health administrative and registry data for the population of diagnosed people living with HIV in British Columbia to populate a dynamic, compartmental transmission model to simulate the HIV/AIDS epidemic in British Columbia from 1996 to 2013. We estimated HIV incidence, mortality, and quality-adjusted life-years (QALYs). We also estimated scenarios designed to isolate the independent effects of harm reduction services and ART, assuming 50% (10-90%) efficacy, in reducing HIV incidence through needle sharing, and we investigated structural and parameter uncertainty. We estimate that 3204 (upper bound-lower bound 2402-4589) incident HIV cases were averted between 1996 and 2013 as a result of the combined effect of the expansion of harm reduction services and ART coverage on HIV transmission via needle sharing. In a hypothetical scenario assuming ART had zero effect on transmission through needle sharing, we estimated harm reduction services alone would have accounted for 77% (upper bound-lower bound 62-95%) of averted HIV incidence. In a separate hypothetical scenario where harm reduction services remained at 1996 levels, we estimated ART alone would have accounted for 44% (10-67%) of averted HIV incidence. As a result of high distribution volumes, needle distribution predominantly accounted for incidence reductions attributable to harm reduction but opioid agonist treatment provided substantially greater QALY gains. If the true efficacy

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

    PubMed Central

    Rose, Valerie J; Raymond, H Fisher; Kellogg, Timothy A; McFarland, Willi

    2006-01-01

    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 risk for acquiring or

  12. Harm reduction and viral hepatitis C in European prisons: a cross-sectional survey of 25 countries.

    PubMed

    Bielen, Rob; Stumo, Samya R; Halford, Rachel; Werling, Klára; Reic, Tatjana; Stöver, Heino; Robaeys, Geert; Lazarus, Jeffrey V

    2018-05-11

    Current estimates suggest that 15% of all prisoners worldwide are chronically infected with the hepatitis C virus (HCV), and this number is even higher in regions with high rates of injecting drug use. Although harm reduction services such as opioid substitution therapy (OST) and needle and syringe programs (NSPs) are effective in preventing the further spread of HCV and HIV, the extent to which these are available in prisons varies significantly across countries. The Hep-CORE study surveyed liver patient groups from 25 European countries in 2016 and mid-2017 on national policies related to harm reduction, testing/screening, and treatment for HCV in prison settings. Results from the cross-sectional survey were compared to the data from available reports and the peer-reviewed literature to determine the overall degree to which European countries implement evidence-based HCV recommendations in prison settings. Patient groups in nine countries (36%) identified prisoners as a high-risk population target for HCV testing/screening. Twenty-one countries (84%) provide HCV treatment in prisons. However, the extent of coverage of these treatment programs varies widely. Two countries (8%) have NSPs officially available in prisons in all parts of the country. Eleven countries (44%) provide OST in prisons in all parts of the country without additional requirements. Despite the existence of evidence-based recommendations, infectious disease prevention measures such as harm reduction programs are inadequate in European prison settings. Harm reduction, HCV testing/screening, and treatment should be scaled up in prison settings in order to progress towards eliminating HCV as a public health threat.

  13. Does harm reduction programming make a difference in the lives of highly marginalized, at-risk drug users?

    PubMed Central

    Rogers, Susan J; Ruefli, Terry

    2004-01-01

    Harm reduction is a controversial model for treating drug users, with little formal research available on its operation and effectiveness. In order to advance the field, we first conducted participatory research of harm reduction with 120 clients using nominal-group technique to develop culturally relevant outcomes to measure progress. Second, we conducted focus group interviews with a different group of clients to help validate the outcomes. Third, we used the outcomes in an evaluation of the largest harm reduction program in New York City, which involved a representative sample of 261 and entailed baseline, post, and six follow-up assessments. The participatory research resulted in outcomes of 10 life areas important to drug users. Evaluation results showed that program participants made positive improvements across most outcomes, with the most substantial progress made in how clients dealt with drug-use problems. Along with their participation in the program, progress in some outcomes was also associated with clients' type of drug use (i.e., stable vs. chaotic), where more stable drug use was associated with better ways of making an income and types of housing. Surprisingly, progress was not associated with the kinds or numbers of services received or the length of time in the program. This was attributed to the service delivery model of harm reduction, in which clients are less inclined to associate their success with a single staff person or with a single service or intervention received than with the program as a whole. PMID:15171790

  14. Condomless sex: gay men, barebacking, and harm reduction.

    PubMed

    Shernoff, Michael

    2006-04-01

    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 use (by men of all races and socioeconomic groups) and surfing the Internet to locate sex partners, although these are not the only factors contributing to this phenomenon. This article summarizes current research findings on sexual risk taking among gay men, discusses psychosocial issues that contribute to barebacking, and suggests a harm-reduction approach to clinical work with gay men who bareback as an effective method of addressing the behavior.

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

    PubMed

    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

  16. The children of mama coca: coca, cocaine and the fate of harm reduction in South America.

    PubMed

    Bastos, Francisco I; Caiaffa, Waleska; Rossi, Diana; Vila, Marcelo; Malta, Monica

    2007-03-01

    The paper reviews the main findings from substance misuse research carried out over the last two decades in South America looking at the main initiatives aimed at reducing drug related harm and curbing the spread of HIV/AIDS and other sexually transmitted and blood-borne diseases. The current challenges faced by harm reduction in the region are analysed from the perspective of the history of coca and its different uses in South America. Except in Brazil and Argentina, the implementation of initiatives to reduce drug related harm in South America has been very cautious. The paper aims to link the analysis of harms associated with the use of illicit substances, with the often paradoxically harmful effects of supply-side drug policies in the world's largest coca/cocaine producing area. Despite the undeniable success of many initiatives, the broader context of harm maximization through structural violence and entrenched corruption acts as a major disincentive for the comprehensive adoption of sound public health policies.

  17. Still "at risk": An examination of how street-involved young people understand, experience, and engage with "harm reduction" in Vancouver's inner city.

    PubMed

    Bozinoff, Nikki; Small, Will; Long, Cathy; DeBeck, Kora; Fast, Danya

    2017-07-01

    Vancouver is an international leader in implementing interventions to reduce harms related to drug use. However, street-involved young people who use drugs continue to be vulnerable to overdose death, hepatitis C (HCV) infection, and high rates of syringe sharing. To better understand this in the context of the intensive public health response, we examined how young people, who are involved in the 'street drug scene', understood, experienced and engaged with harm reduction. Twelve semi-structured interviews were conducted in 2013 with 13 young people (ages 17-28) recruited from the At-Risk Youth Study, a prospective cohort of street-involved and drug-using young people. These interviews were embedded within a larger, eight-year program of ethnographic research and explored participants' understandings of harm reduction, their use of specific services, and their ideas about improving their day-to-day lives. Interviews were transcribed verbatim and a thematic analysis was performed. Young peoples' ideas about harm reduction were diverse and expansive. They articulated the limitations of existing programs, indicating that while they are positioned to reduce the risk of HIV and HCV transmission, they offer little meaningful support to improve young peoples' broader life chances. Young people described strategies to mitigate risk and harm in their own lives, including transitioning to drugs deemed less harmful and attempting to gain access to drug treatment. Finally, young people indicated that spatial considerations (e.g., distance from Vancouver's Downtown Eastside) strongly determined access to services. In Vancouver, a large, well established harm reduction infrastructure seeks to reduce HIV and HCV transmission among street-involved young people. However, young peoples' multiple understandings, experiences and engagements with harm reduction in this setting illustrate the limitations of the existing infrastructure in improving their broader life chances. Copyright

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

    PubMed Central

    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

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

    PubMed

    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.

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

    PubMed

    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.

  1. How do drug users define their progress in harm reduction programs? Qualitative research to develop user-generated outcomes

    PubMed Central

    Ruefli, Terry; Rogers, Susan J

    2004-01-01

    Background Harm reduction is a relatively new and controversial model for treating drug users, with little formal research on its operation and effectiveness. In order to advance the study of harm reduction programs and our understanding of how drug users define their progress, qualitative research was conducted to develop outcomes of harm reduction programming that are culturally relevant, incremental, (i.e., capable of measuring change), and hierarchical (i.e., capable of showing how clients improve over time). Methods The study used nominal group technique (NGT) to develop the outcomes (phase 1) and focus group interviews to help validate the findings (phase 2). Study participants were recruited from a large harm-reduction program in New York City and involved approximately 120 clients in 10 groups in phase 1 and 120 clients in 10 focus groups in phase 2. Results Outcomes of 10 life areas important to drug users were developed that included between 10 to 15 incremental measures per outcome. The outcomes included ways of 1) making money; 2) getting something good to eat; 3) being housed/homeless; 4) relating to families; 5) getting needed programs/benefits/services; 6) handling health problems; 7) handling negative emotions; 8) handling legal problems; 9) improving oneself; and 10) handling drug-use problems. Findings also provided insights into drug users' lives and values, as well as a window into understanding how this population envisions a better quality of life. Results challenged traditional ways of measuring drug users based solely on quantity used and frequency of use. They suggest that more appropriate measures are based on the extent to which drug users organize their lives around drug use and how much drug use is integrated into their lives and negatively impacts other aspects of their lives. Conclusions Harm reduction and other programs serving active drug users and other marginalized people should not rely on institutionalized, provider

  2. "We want a living solution": views of harm reduction programs in black US Communities.

    PubMed

    Eversman, Michael H

    2015-01-01

    Illicit drug use in the US remains concerning, with injection drug use linked to transmission of blood-borne diseases as HIV/AIDS; persons of color, including Black Americans, experience disproportionately higher transmission rates. Harm reduction programs such as methadone and needle- and syringe-exchange (NEP/SEP) are empirically demonstrated to reduce HIV transmission, yet are believed largely opposed by Black communities. Using interview data from 21 service providers of substance abuse and related service organizations located in and/or serving predominantly populations of color, this study explored perceptions of harm reduction programming for illicit drugs and race in the US. Criticizing each program for unique reasons, respondents deemed them largely inadequate and inappropriate responses to community drug problems. While some believed these programs worsen Black communities, others believed they are becoming more accepted there. Views were informed by racial dynamics surrounding drugs in society, burdens borne by program host communities, and racialized stereotypes of drug use.

  3. The incentives created by a harm reduction approach to smoking cessation: Snus and smoking in Sweden and Finland.

    PubMed

    Maki, Jennifer

    2015-06-01

    Tobacco harm reduction involves advocating the use of a less harmful alternative to smoking for those users who are unwilling or unable to quit. The net effect of such an approach is unclear as it may create opposing incentives. Although some smokers may substitute toward this less harmful alternative, it may reduce the incentive to quit by undermining public health efforts and may act as a gateway to smoking. This research paper aims to answer the question: Does the availability of a less harmful alternative to smoking lead to cessation? To explore the opposing incentives created by a harm reduction approach to smoking cessation, I focus on the role of snus, a popular smokeless tobacco product in Scandinavia that is widely used in Sweden. This paper exploits a quasi-natural experiment to examine the net effect resulting from these opposing incentives. While two Scandinavian countries, Sweden and Finland, joined the European Union (EU) in 1995, Finland was subject to a pre-existing EU ban on oral tobacco products while Sweden received an exemption. A difference in differences framework is used to estimate the change in the smoking rate in Finland due to the implementation of the ban. A secondary analysis uses Finnish smoking data to test for a structural break in trend. In the post-ban period, smoking was 3.47 percentage points higher in Finland relative to what it would have been in the absence of the ban. The availability of snus, a less harmful alternative to smoking, appears to have had a positive impact (reduction) on the smoking rate. Offering acceptable alternatives to cigarettes is critical in reducing smoking prevalence. Copyright © 2014 Elsevier B.V. All rights reserved.

  4. Development of a residual acceleration data reduction and dissemination plan

    NASA Technical Reports Server (NTRS)

    Rogers, Melissa J. B.

    1992-01-01

    A major obstacle in evaluating the residual acceleration environment in an orbiting space laboratory is the amount of data collected during a given mission: gigabytes of data will be available as SAMS units begin to fly regularly. Investigators taking advantage of the reduced gravity conditions of space should not be overwhelmed by the accelerometer data which describe these conditions. We are therefore developing a data reduction and analysis plan that will allow principal investigators of low-g experiments to create experiment-specific residual acceleration data bases for post-flight analysis. The basic aspects of the plan can also be used to characterize the acceleration environment of earth orbiting laboratories. Our development of the reduction plan is based on the following program of research: the identification of experiment sensitivities by order of magnitude estimates and numerical modelling; evaluation of various signal processing techniques appropriate for the reduction, supplementation, and dissemination of residual acceleration data; and testing and implementation of the plan on existing acceleration data bases. The orientation of the residual acceleration vector with respect to some set of coordinate axes is important for experiments with known directional sensitivity. Orientation information can be obtained from the evaluation of direction cosines. Fourier analysis is commonly used to transform time history data into the frequency domain. Common spectral representations are the amplitude spectrum which gives the average of the components of the time series at each frequency and the power spectral density which indicates the power or energy present in the series per unit frequency interval. The data reduction and analysis scheme developed involves a two tiered structure to: (1) identify experiment characteristics and mission events that can be used to limit the amount of accelerator data an investigator should be interested in; and (2) process the

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

    PubMed Central

    Szott, Kelly

    2015-01-01

    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. PMID:25394654

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

    PubMed Central

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

    2017-01-01

    Objectives 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. Design Cross-sectional online ad response study with random assignment to view ads. Participants 2174 Australian adult weekly drinkers recruited from an online panel. Procedure 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. Outcome measure 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%. Results 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. Conclusions 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

  7. Participatory research with an online drug forum: a survey of user characteristics, information sharing, and harm reduction views.

    PubMed

    Chiauzzi, Emil; Dasmahapatra, Pronabesh; Lobo, Kimberly; Barratt, Monica J

    2013-06-01

    Visitors to a popular online drug forum completed an online survey between November 2011 and January 2012, which covered (1) demographic characteristics, (2) substance use (including nonmedical prescription opioid use), (3) forum activity, and (4) harm reduction beliefs. The study sample (N = 897) primarily included Caucasian males in their twenties from the United States, the United Kingdom, Australia, and Canada. The practice of harm reduction was overwhelmingly endorsed by participants. Current nonmedical prescription opioid users reported more activity in forums and past substance abuse treatment. The study's implications and limitations are noted and future research is suggested.

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

    PubMed

    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.

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

    PubMed Central

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

    2016-01-01

    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 socio-political 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. PMID:26790689

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

    PubMed

    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.

  11. A fresh look at tobacco harm reduction: the case for the electronic cigarette

    PubMed Central

    2013-01-01

    Smokers of any age can reap substantial health benefits by quitting. In fact, no other single public health effort is likely to achieve a benefit comparable to large-scale smoking cessation. Surveys document that most smokers would like to quit, and many have made repeated efforts to do so. However, conventional smoking cessation approaches require nicotine addicted smokers to abstain from tobacco and nicotine entirely. Many smokers are unable – or at least unwilling – to achieve this goal, and so they continue smoking in the face of impending adverse health consequences. In effect, the status quo in smoking cessation presents smokers with just two unpleasant alternatives: quit or suffer the harmful effects of continuing smoking. But, there is a third choice for smokers: tobacco harm reduction. It involves the use of alternative sources of nicotine, including modern smokeless tobacco products like snus and the electronic cigarette (E-cig), or even pharmaceutical nicotine products, as a replacement for smoking. E-cigs might be the most promising product for tobacco harm reduction to date, because, besides delivering nicotine vapour without the combustion products that are responsible for nearly all of smoking’s damaging effect, they also replace some of the rituals associated with smoking behaviour. Thus it is likely that smokers who switch to E-cigs will achieve large health gains. The focus of this article is on the health effects of using an E-cig, with consideration given to the acceptability, safety and effectiveness of this product as a long-term substitute for smoking. PMID:24090432

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

    PubMed

    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.

  13. Failure to treat tobacco use in mental health and addiction treatment settings: a form of harm reduction?

    PubMed

    Prochaska, Judith J

    2010-08-01

    In mental health and addiction treatment settings, failure to treat tobacco dependence has been rationalized by some as a clinical approach to harm reduction. That is, tobacco use is viewed as a less harmful alternative to alcohol or illicit drug use and/or other self-harm behaviors. This paper examines the impact of providers' failure to treat tobacco use on patients' alcohol and illicit drug use and associated high-risk behaviors. The weight of the evidence in the literature indicates: (1) tobacco use is a leading cause of death in patients with psychiatric illness or addictive disorders; (2) tobacco use is associated with worsened substance abuse treatment outcomes, whereas treatment of tobacco dependence supports long-term sobriety; (3) tobacco use is associated with increased (not decreased) depressive symptoms and suicidal risk behavior; (4) tobacco use adversely impacts psychiatric treatment; (5) tobacco use is a lethal and ineffective long-term coping strategy for managing stress, and (6) treatment of tobacco use does not harm mental health recovery. Failure to treat tobacco dependence in mental health and addiction treatment settings is not consistent with a harm reduction model. In contrast, emerging evidence indicates treatment of tobacco dependence may even improve addiction treatment and mental health outcomes. Providers in mental health and addiction treatment settings have an ethical duty to intervene on patients' tobacco use and provide available evidence-based treatments. Copyright (c) 2010. Published by Elsevier Ireland Ltd.

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

    PubMed

    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.

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

    PubMed

    Phillips, Carl V; Guenzel, Brian; Bergen, Paul

    2006-04-18

    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.

  16. Addressing excess risk of overdose among recently incarcerated people in the USA: harm reduction interventions in correctional settings.

    PubMed

    Brinkley-Rubinstein, Lauren; Cloud, David H; Davis, Chelsea; Zaller, Nickolas; Delany-Brumsey, Ayesha; Pope, Leah; Martino, Sarah; Bouvier, Benjamin; Rich, Josiah

    2017-03-13

    Purpose The purpose of this paper is to discuss overdose among those with criminal justice experience and recommend harm reduction strategies to lessen overdose risk among this vulnerable population. Design/methodology/approach Strategies are needed to reduce overdose deaths among those with recent incarceration. Jails and prisons are at the epicenter of the opioid epidemic but are a largely untapped setting for implementing overdose education, risk assessment, medication assisted treatment, and naloxone distribution programs. Federal, state, and local plans commonly lack corrections as an ingredient in combating overdose. Harm reduction strategies are vital for reducing the risk of overdose in the post-release community. Findings Therefore, the authors recommend that the following be implemented in correctional settings: expansion of overdose education and naloxone programs; establishment of comprehensive medication assisted treatment programs as standard of care; development of corrections-specific overdose risk assessment tools; and increased collaboration between corrections entities and community-based organizations. Originality/value In this policy brief the authors provide recommendations for implementing harm reduction approaches in criminal justice settings. Adoption of these strategies could reduce the number of overdoses among those with recent criminal justice involvement.

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

    PubMed

    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.

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

    PubMed

    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.

  19. 'Social evils' and harm reduction: the evolving policy environment for human immunodeficiency virus prevention among injection drug users in China and Vietnam.

    PubMed

    Hammett, Theodore M; Wu, Zunyou; Duc, Tran Tien; Stephens, David; Sullivan, Sheena; Liu, Wei; Chen, Yi; Ngu, Doan; Des Jarlais, Don C

    2008-01-01

    This paper reviews the evolution of government policies in China and Vietnam regarding harm reduction interventions for human immunodeficiency virus (HIV) prevention, such as needle/syringe provision and opioid substitution treatment. The work is based upon the authors' experiences in and observations of these policy developments, as well as relevant government policy documents and legislation. Both countries are experiencing HIV epidemics driven by injection drug use and have maintained generally severe policies towards injection drug users (IDUs). In recent years, however, they have also officially endorsed harm reduction. We sought to understand how and why this apparently surprising policy evolution took place. Factors associated with growing support for harm reduction were similar but not identical in China and Vietnam. These included the emergence of effective 'champions' for such policies, an ethos of pragmatism and receptivity to evidence, growing collaboration across public health, police and other sectors, the influence of contingent events such as the severe acute respiratory syndrome (SARS) epidemic and pressure from donors and international organizations to adopt best practice in HIV prevention. Ongoing challenges and lessons learned include the persistence of tensions between drug control and harm reduction that may have negative effects on programs until a fully harmonized policy environment is established. Excessive reliance on law enforcement and forced detoxification will not solve the problems of substance abuse or of HIV among drug users. Ongoing evaluation of harm reduction programs, as well as increased levels of multi-sectoral training, collaboration and support are also needed.

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

    PubMed

    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

  1. White slavery, whorehouse riots, venereal disease, and saving women: historical context of prostitution interventions and harm reduction in New York City during the Progressive Era.

    PubMed

    Smolak, Alex

    2013-01-01

    Harm reduction and structural approaches to reduce HIV risk among sex workers face several barriers. One such barrier is based on moral arguments, and it has a rich historical context. This article examines the historical context of interventions with sex workers in New York City during the Progressive Era (1890-1920). Present at the time, though under a different name, the harm reduction approach was largely dismissed. These same moral underpinnings may be active today in driving interventions and policy toward those that are morally focused and away from those that focus on harm reduction and structural change.

  2. White Slavery, Whorehouse Riots, Venereal Disease, and Saving Women: Historical Context of Prostitution Interventions and Harm Reduction in New York City during the Progressive Era

    PubMed Central

    Smolak, Alex

    2013-01-01

    Harm reduction and structural approaches to reduce HIV risk among sex workers face several barriers. One such barrier is based on moral argument, and it has a rich historical context. This paper will examine the historical context of interventions with sex workers in New York City during the Progressive Era (1890–1920). Present at the time, though under a different name, the harm reduction approach was largely dismissed. These same moral underpinnings may be active today in driving interventions and policy toward those that are morally focused and away from those that focus on harm reduction and structural change. PMID:23805804

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

    PubMed

    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.

  4. [Harm reduction strategy in tobacco control].

    PubMed

    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?

  5. Stigmatizing harm reduction through language: a case study into the use of "addict" and opposition to supervised injection sites in Canada.

    PubMed

    Cortina, Sandra C

    2013-01-01

    Stigma continues to be the largest barrier for accessing treatment among people experiencing drug addiction. The dominant portrayals that exist about people who use drugs are often damaging and act to dehumanize the group as a whole. When left unchallenged, stereotypes can act as truthful depictions and facilitate the resistance against harm reduction services that are based on a human rights model. The use of labels is one way stigma is perpetuated by eliciting the label's stereotyped narratives onto an individual or group. Within harm reduction discourse, the word "addict" can have detrimental effects on how the public perceives people experiencing addiction and their deservingness of pragmatic services. This article aims to draw attention to the inattention we give "addict" in language and explain how its routine use in society acts to perpetuate addiction stigma. Using the example of supervised injection site opposition in Canada, the use of "addict" is used as a way to understand how stigma through language works to impede the expansion of harm reduction initiatives.

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

    PubMed

    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.

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

    PubMed

    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."

  8. Using the Theory of Planned Behavior to predict implementation of harm reduction strategies among MDMA/ecstasy users.

    PubMed

    Davis, Alan K; Rosenberg, Harold

    2016-06-01

    This prospective study was designed to test whether the variables proposed by the Theory of Planned Behavior (TPB) were associated with baseline intention to implement and subsequent use of 2 MDMA/ecstasy-specific harm reduction interventions: preloading/postloading and pill testing/pill checking. Using targeted Facebook advertisements, an international sample of 391 recreational ecstasy users were recruited to complete questionnaires assessing their ecstasy consumption history, and their attitudes, subjective norms, perceived behavioral control, habit strength (past strategy use), and intention to use these two strategies. Attitudes, subjective norms, and perceived behavioral control were significantly associated with baseline intention to preload/postload and pill test/pill check. Out of the 391 baseline participants, 100 completed the two-month follow-up assessment. Baseline habit strength and frequency of ecstasy consumption during the three months prior to baseline were the only significant predictors of how often participants used the preloading/postloading strategy during the follow-up. Baseline intention to pill test/pill check was the only significant predictor of how often participants used this strategy during the follow-up. These findings provide partial support for TPB variables as both correlates of baseline intention to implement and predictors of subsequent use of these two strategies. Future investigations could assess whether factors related to ecstasy consumption (e.g., subjective level of intoxication, craving, negative consequences following consumption), and environmental factors (e.g., accessibility and availability of harm reduction resources) improve the prediction of how often ecstasy users employ these and other harm reduction strategies. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  9. Malaysia and harm reduction: the challenges and responses.

    PubMed

    Reid, Gary; Kamarulzaman, Adeeba; Sran, Sangeeta Kaur

    2007-03-01

    In Malaysia the response to illicit drug use has been largely punitive with the current goal of the Malaysian government being to achieve a drug-free society by 2015. This paper outlines the results of a desk-based situation assessment conducted over a 3-week period in 2004. Additional events, examined in 2005, were also included to describe more recent policy developments and examine how these came about. Despite punitive drug policy there has been a substantial rise in the number of drug users in the country. Over two-thirds of HIV/AIDS cases are among injecting drug users (IDUs) and there has been an exponential rise in the number of cases reported. Further, data suggest high risk drug use practices are widespread. Harm reduction initiatives have only recently been introduced in Malaysia. The successful piloting of substitution therapies, in particular methadone and buprenorphine, is cause for genuine hope for the rapid development of such interventions. In 2005 the government announced it will allow methadone maintenance programmes to operate beyond the pilot phase and needle and syringe exchange programmes will be established to serve the needs of IDUs.

  10. Strategies for an effective tobacco harm reduction policy in Indonesia

    PubMed Central

    Nurwidya, Fariz; Takahashi, Fumiyuki; Baskoro, Hario; Hidayat, Moulid; Yunus, Faisal; Takahashi, Kazuhisa

    2014-01-01

    Tobacco consumption is a major causative agent for various deadly diseases such as coronary artery disease and cancer. It is the largest avoidable health risk in the world, causing more problems than alcohol, drug use, high blood pressure, excess body weight or high cholesterol. As countries like Indonesia prepare to develop national policy guidelines for tobacco harm reduction, the scientific community can help by providing continuous ideas and a forum for sharing and distributing information, drafting guidelines, reviewing best practices, raising funds, and establishing partnerships. We propose several strategies for reducing tobacco consumption, including advertisement interference, cigarette pricing policy, adolescent smoking prevention policy, support for smoking cessation therapy, special informed consent for smokers, smoking prohibition in public spaces, career incentives, economic incentives, and advertisement incentives. We hope that these strategies would assist people to avoid starting smoking or in smoking cessation. PMID:25518881

  11. Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation.

    PubMed

    Parsons, Jeffrey T; Schrimshaw, Eric W; Wolitski, Richard J; Halkitis, Perry N; Purcell, David W; Hoff, Colleen C; Gómez, Cynthia A

    2005-04-01

    This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk. The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques. City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco. Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.

  12. Prevention and harm reduction for chemical dependency: a process perspective.

    PubMed

    DiClemente, C C

    1999-06-01

    Clinical psychology is often on the periphery of treatment and prevention efforts to stop substance abuse and dependence. This article describes the current status of prevention research and practice, outlines a process perspective on the initiation and cessation of drug use and abuse, and offers some new ideas about how psychology can and should become involved in the prevention of chemical dependency. Psychologists are faced with the precursors and consequences of chemical dependency on a daily basis. With improved training and increased awareness, and aided by a process perspective, psychology and psychologists can play an important role in preventing the onset of chemical dependency, creating early interventions to stop the process of initiation, and becoming more involved in treatment and harm-reduction efforts. Psychologists have the basic training and the biopsychosocial orientation that could make them effective agents for primary, secondary, and tertiary prevention of chemical dependency.

  13. Change in attitudes and knowledge of problem drug use and harm reduction among a community cohort in Kabul, Afghanistan.

    PubMed

    Todd, C S; Stanekzai, M R; Nasir, A; Fiekert, K; Orr, M G; Strathdee, S A; Vlahov, D

    2016-06-15

    This pre-post evaluation aimed to measure changes in knowledge and attitudes towards drug users among community representatives in Kabul, Afghanistan, over a period of expansion of harm reduction and drug dependence programming. A convenience sample of 160 professionals aged 18+ years completed interview questionnaires in 2007 and 2009. Views endorsing programme quality and the provision of condoms, infection counselling/testing and needle/syringe distribution increased significantly over the 2-year period. In 13 of 38 statements, there was a substantial (> 10%) change in agreement level, most commonly among men and medical professionals. Attitudes concerning support of drug users remained largely positive, with substantial attitude changes in some subgroups of the population. Further community education through the media and a more cohesive government drug policy may be needed to strengthen community support for harm reduction/drug treatment in Afghanistan.

  14. Access to harm reduction programs among persons who inject drugs: findings from a respondent-driven sampling survey in Tehran, Iran.

    PubMed

    Rahnama, Ruyan; Mohraz, Minoo; Mirzazadeh, Ali; Rutherford, George; McFarland, Willi; Akbari, Gholamreza; Malekinejad, Mohsen

    2014-07-01

    Over the past two decades, drug injection-related risk behaviors have been the major drivers of the HIV epidemic in Iran. This study assesses the access of people who injected drugs (PWID) to harm reduction services (needle-exchange programs [NEP] and methadone maintenance treatment [MMT]) in Tehran, Iran in 2007, almost five years after the large-scale implementation of these programs. 572 consenting PWID (>18 years old, ever injected in the past month, lived in Tehran or its suburbs) were recruited (24 seeds) into a sero-behavioral survey using respondent-driven sampling method. Participants completed a face-to-face interview about HIV-related risk behaviors and access to harm reduction services. We calculated adjusted population estimates using RDSAT. Overall, 99.2% of the participants were male, 41.6% aged between 30 and 39 years old, 55.4% lived alone in the past year, 83.2% were ever incarcerated, and 88.8% lived in the southern areas of Tehran. In terms of "awareness" and "use" of services among PWID, 62.8% and 54.8% reported for NEP (respectively) and 19.7% and 9.1% for drug treatment services (respectively). PWID who lived in Northwest and South-central Tehran were more likely to be aware (85.0% and 82.8%, respectively) of one or more services than PWID who lived elsewhere. Similarly, PWID who lived with friends were more likely to be aware of (88.6%) and use (85.9%) services (vs. other living partners). Overall, 11% of the participants were aware of but had not used any harm reduction services. Despite a relatively high level of access to NEP among PWID in Tehran, a sizable fraction of the population remains without access to other services five years after their implementation. The use of harm reduction may be affected by certain PWID characteristics (e.g., living partners and geographical location). Ongoing surveillance activities are necessary to track change in access over time. Copyright © 2014 Elsevier B.V. All rights reserved.

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

    ERIC Educational Resources Information Center

    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…

  16. Emerging HIV epidemics in Muslim countries: assessment of different cultural responses to harm reduction and implications for HIV control.

    PubMed

    Todd, Catherine S; Nassiramanesh, Bijan; Stanekzai, Mohammad Raza; Kamarulzaman, Adeeba

    2007-12-01

    Harm reduction, including needle exchange and opioid substitution therapy, has been demonstrated to reduce high-risk behavior and HIV infection among injection drug users. An increasing number of countries in the Middle East, North Africa, and Asia, including those with Muslim majorities, have experienced or are at risk for HIV epidemics initiated by burgeoning injection drug use. Although use of intoxicants is expressly forbidden within Islam, the local culture impacts the interpretation of Islamic law and influences the response to drug misuse, whether punitive or therapeutic. Harm reduction programming has received varying acceptance within this global region, which may be reflected by national trends in HIV prevalence. The purpose of this paper is to examine cultural and religious response to injecting drug use and associated HIV prevalence trends in Malaysia and Iran, with possible application of lessons learned to an emerging situation in Afghanistan.

  17. Patterns of harm reduction service utilization and HIV incidence among people who inject drugs in Ukraine: A two-part latent profile analysis.

    PubMed

    Ompad, Danielle C; Wang, Jiayu; Dumchev, Konstantin; Barska, Julia; Samko, Maria; Zeziulin, Oleksandr; Saliuk, Tetiana; Varetska, Olga; DeHovitz, Jack

    2017-05-01

    Program utilization patterns are described within a large network of harm reduction service providers in Ukraine. The relationship between utilization patterns and HIV incidence is determined among people who inject drugs (PWID) controlling for oblast-level HIV incidence and treatment/syringe coverage. Data were extracted from the network's monitoring and evaluation database (January 2011-September 2014, n=327,758 clients). Latent profile analysis was used to determine harm reduction utilization patterns using the number of HIV tests received annually and the number of condoms, syringes, and services (i.e., information and counseling sessions) received monthly over a year. Cox proportional hazards regression determined the relations between HIV seroconversion and utilization class membership. In the final 4-class model, class 1 (34.0% of clients) received 0.1 HIV tests, 1.3 syringes, 0.6 condom and minimal counseling and information sessions per month; class 2 (33.6%) received 8.6 syringes, 3.2 condoms, and 0.5 HIV tests and counseling and information sessions; class 3 (19.1%) received 1 HIV test, 11.9 syringes, 4.3 condoms, and 0.7 information and counseling sessions; class 4 (13.3%) received 1 HIV test, 26.1 syringes, 10.3 condoms, and 1.8 information and 1.9 counseling sessions. Class 4 clients had significantly decreased risk for HIV seroconversion as compared to those in class 1 after controlling for oblast-level characteristics. Injection drug use continues to be a major mode of HIV transmission in Ukraine, making evaluation of harm reduction efforts in reducing HIV incidence among PWID critical. These analyses suggest that receiving more syringes and condoms decreased risk of HIV. Scaling up HIV testing and harm reduction services is warranted. Copyright © 2016. Published by Elsevier B.V.

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

    PubMed

    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.

  19. [Self-harm vs. harming others: the lived experiences of a dysfunctional family].

    PubMed

    Wu, Hsiu-Chin; Lin, Mei-Feng; Yu, Shu-Hua

    2007-10-01

    The purpose of this study was to explore the lived experiences of self-harm and harm to others from the perspective of two adult offspring and a father, the latter of whom was prone to alcohol abuse and domestic violence and had attempted suicide. Written informed consents were obtained from the subjects after a detailed explanation of the research aims and procedures. A qualitative, phenomenological method was applied for the study. Three subjects were interviewed using a semi-structured interview guide designed by the researchers and based on the aims of the study over a six-month period of home care. A qualitative content analysis based on a phenomenological method was used to identify themes in the data. Two main categories emerged: (1) the mutual harm to the couple subsystem, (2) the misplaced parental-child subsystem. Subsequently, two to four themes were identified from each category. These results provide a better analysis and understanding of the perceived experiences of the harm to the spouse, parental, and sibling subsystems. They should also help health professionals to improve awareness of the lived experiences associated with the issues of self-harm and threats of harm to others. This study could serve as a valuable reference in promoting possible prevention strategies aiming at the reduction of self-harm and harm to others in dysfunctional families within the community.

  20. Are Australian smokers interested in using low-nitrosamine smokeless tobacco for harm reduction?

    PubMed

    Gartner, C E; Jimenez-Soto, E V; Borland, R; O'Connor, R J; Hall, W D

    2010-12-01

    To determine (1) whether Australian smokers are aware of low-nitrosamine smokeless tobacco (LNSLT) products and (2) whether they would be interested in using LNSLT either as a long-term substitute for smoking or as an aid to quitting, if these products were to become legally available. 401 daily smokers were recruited by a market research company to complete an internet questionnaire about their smoking history, knowledge of smokeless tobacco and intentions to purchase LNSLT under different scenarios. Just under half (48%) indicated they were willing to buy an LNSLT product. Predictors of an interest in purchasing LNSLT were low income, poorer health, prior SLT use, belief that SLT is less harmful than cigarettes, switching to a lower tar cigarette in the past year, ever using nicotine replacement therapy products for quitting or other reasons, having made a failed cessation attempt in the previous year and not planning to quit smoking. Analysis of quitting and LNSLT purchasing intentions under different scenarios suggest that making LNSLT available at a much lower cost than smoked cigarettes while increasing taxes on cigarettes could provide a greater reduction in the number of smokers than the same tax increase alone. These results support further examination of the potential for LNSLT to reduce smoking-related harm in Australia.

  1. Quantifying the effects of promoting smokeless tobacco as a harm reduction strategy in the USA.

    PubMed

    Mejia, Adrienne B; Ling, Pamela M; Glantz, Stanton A

    2010-08-01

    Snus (a form of smokeless tobacco) is less dangerous than cigarettes. Some health professionals argue that snus should be promoted as a component of a harm reduction strategy, while others oppose this approach. Major US tobacco companies (RJ Reynolds and Philip Morris) are marketing snus products as cigarette brand line extensions. The population effects of smokeless tobacco promotion will depend on the combined effects of changes in individual risk with population changes in tobacco use patterns. To quantitatively evaluate the health impact of smokeless tobacco promotion as part of a harm reduction strategy in the US. A Monte Carlo simulation of a decision tree model of tobacco initiation and use was used to estimate the health effects associated with five different patterns of increased smokeless tobacco use. With cigarette smoking having a health effect of 100, the base case scenario (based on current US prevalence rates) yields a total health effect of 24.2 (5% to 95% interval 21.7 to 26.5) and the aggressive smokeless promotion (less cigarette use and increased smokeless, health-concerned smokers switching to snus, smokers in smokefree environments switching to snus) was associated with a health effect of 30.4 (5% to 95% interval 25.9 to 35.2). The anticipated health effects for additional scenarios with lower rates of smokeless uptake also overlapped with the base case. Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level.

  2. Fe(III) oxides accelerate microbial nitrate reduction and electricity generation by Klebsiella pneumoniae L17.

    PubMed

    Liu, Tongxu; Li, Xiaomin; Zhang, Wei; Hu, Min; Li, Fangbai

    2014-06-01

    Klebsiella pneumoniae L17 is a fermentative bacterium that can reduce iron oxide and generate electricity under anoxic conditions, as previously reported. This study reveals that K. pneumoniae L17 is also capable of dissimilatory nitrate reduction, producing NO2(-), NH4(+), NO and N2O under anoxic conditions. The presence of Fe(III) oxides (i.e., α-FeOOH, γ-FeOOH, α-Fe2O3 and γ-Fe2O3) significantly accelerates the reduction of nitrate and generation of electricity by K. pneumoniae L17, which is similar to a previous report regarding another fermentative bacterium, Bacillus. No significant nitrate reduction was observed upon treatment with Fe(2+) or α-FeOOH+Fe(2+), but a slight facilitation of nitrate reduction and electricity generation was observed upon treatment with L17+Fe(2+). This result suggests that aqueous Fe(II) or mineral-adsorbed Fe(II) cannot reduce nitrate abiotically but that L17 can catalyze the reduction of nitrate and generation of electricity in the presence of Fe(II) (which might exist as cell surface-bound Fe(II)). To rule out the potential effect of Fe(II) produced by L17 during microbial iron reduction, treatments with the addition of TiO2 or Al2O3 instead of Fe(III) oxides also exhibited accelerated microbial nitrate reduction and electricity generation, indicating that cell-mineral sorption did account for the acceleration effect. However, the acceleration caused by Fe(III) oxides is only partially attributed to the cell surface-bound Fe(II) and cell-mineral sorption but may be driven by the iron oxide conduction band-mediated electron transfer from L17 to nitrate or an electrode, as proposed previously. The current study extends the diversity of bacteria of which nitrate reduction and electricity generation can be facilitated by the presence of iron oxides and confirms the positive role of Fe(III) oxides on microbial nitrate reduction and electricity generation by particular fermentative bacteria in anoxic environments. Copyright

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

    PubMed Central

    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

  4. The complexity of 'harm reduction' with smokeless tobacco as an approach to tobacco control in low-income and middle-income countries.

    PubMed

    Ayo-Yusuf, Olalekan A; Burns, David M

    2012-03-01

    To review the implications of recommending smokeless tobacco (ST) use as a harm reduction approach for low-income and middle-income countries (LMICs). Narrative review of published papers and other data sources (including conference abstracts and internet-based information) on the health risks posed by the use of ST products for individual smokers and for the population with a focus on their implications for LMICs. Swedish snus has a relatively lower toxicity profile than ST products available in other markets, including older products used in the US and products used in Africa and Asia. The experience with snus in Sweden provides information on the effects of snus use in a population where cigarette smoking was already culturally ingrained. However, population effects are likely to be different in those LMICs where smoking is not yet the dominant culturally accepted form of tobacco use. The total effect may be negative in countries where locally-popular ST products have substantially higher disease risks than Swedish snus and where there is limited regulatory and tobacco use surveillance capacity. Issues relating to how populations in LMICs respond to marketing efforts, the risks of the dual use of ST and smoking, and the capacity to regulate ST products need to be considered in making decisions about harm reduction strategies in LMICs. The public health effects of supporting ST as a harm reduction strategy may vary substantively in countries with different pre-existing tobacco use patterns.

  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.

    PubMed

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

    PubMed

    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.

  7. Residual acceleration data on IML-1: Development of a data reduction and dissemination plan

    NASA Technical Reports Server (NTRS)

    Rogers, Melissa J. B.; Alexander, J. Iwan D.

    1993-01-01

    The research performed consisted of three stages: (1) identification of sensitive IML-1 experiments and sensitivity ranges by order of magnitude estimates, numerical modeling, and investigator input; (2) research and development towards reduction, supplementation, and dissemination of residual acceleration data; and (3) implementation of the plan on existing acceleration databases.

  8. A harm-reduction model of abortion counseling about misoprostol use in Peru with telephone and in-person follow-up: A cohort study.

    PubMed

    Grossman, Daniel; Baum, Sarah E; Andjelic, Denitza; Tatum, Carrie; Torres, Guadalupe; Fuentes, Liza; Friedman, Jennifer

    2018-01-01

    In Peru, abortion is legal only to preserve the life and health of the woman. A non-profit clinic system in Peru implemented a harm-reduction model for women with unwanted pregnancy that included pre-abortion care with instructions about misoprostol use and post-abortion care; they started offering telephone follow-up for clients in 2011. This study aimed to evaluate the effectiveness and safety of the harm-reduction model, and to compare outcomes by type of follow-up obtained. Between January 2012 and March 2013, 500 adult women seeking harm-reduction services were recruited into the study. Telephone surveys were conducted approximately four weeks after their initial harm-reduction counseling session with 262 women (response rate 52%); 9 participants were excluded. The survey focused on whether women pursued an abortion, and if so, what their experience was. Demographic and clinical data were also extracted from clinic records. Eighty-six percent of participants took misoprostol; among those taking misoprostol, 89% reported a complete abortion at the time of the survey. Twenty-two percent obtained an aspiration after taking misoprostol and 8% self-reported adverse events including hemorrhage without transfusion, infection, or severe pain. Among women who took misoprostol, 46% reported receiving in-person follow-up (in some cases both telephone and in-person), 34% received telephone only, and 20% did not report receiving any form of follow-up. Those who had in-person follow-up with the counselor were most likely to report a complete abortion (<0.001). Satisfaction with both types of follow-up was very high, with 81%-89% reporting being very satisfied. Liberalization of restrictive abortion laws is associated with improvements in health outcomes, but the process of legal reform is often lengthy. In the interim, giving women information about evidence-based regimens of misoprostol, as well as offering a range of follow-up options to ensure high quality post

  9. A harm-reduction model of abortion counseling about misoprostol use in Peru with telephone and in-person follow-up: A cohort study

    PubMed Central

    Baum, Sarah E.; Andjelic, Denitza; Tatum, Carrie; Torres, Guadalupe; Fuentes, Liza; Friedman, Jennifer

    2018-01-01

    Background In Peru, abortion is legal only to preserve the life and health of the woman. A non-profit clinic system in Peru implemented a harm-reduction model for women with unwanted pregnancy that included pre-abortion care with instructions about misoprostol use and post-abortion care; they started offering telephone follow-up for clients in 2011. This study aimed to evaluate the effectiveness and safety of the harm-reduction model, and to compare outcomes by type of follow-up obtained. Methods Between January 2012 and March 2013, 500 adult women seeking harm-reduction services were recruited into the study. Telephone surveys were conducted approximately four weeks after their initial harm-reduction counseling session with 262 women (response rate 52%); 9 participants were excluded. The survey focused on whether women pursued an abortion, and if so, what their experience was. Demographic and clinical data were also extracted from clinic records. Results Eighty-six percent of participants took misoprostol; among those taking misoprostol, 89% reported a complete abortion at the time of the survey. Twenty-two percent obtained an aspiration after taking misoprostol and 8% self-reported adverse events including hemorrhage without transfusion, infection, or severe pain. Among women who took misoprostol, 46% reported receiving in-person follow-up (in some cases both telephone and in-person), 34% received telephone only, and 20% did not report receiving any form of follow-up. Those who had in-person follow-up with the counselor were most likely to report a complete abortion (<0.001). Satisfaction with both types of follow-up was very high, with 81%-89% reporting being very satisfied. Conclusions Liberalization of restrictive abortion laws is associated with improvements in health outcomes, but the process of legal reform is often lengthy. In the interim, giving women information about evidence-based regimens of misoprostol, as well as offering a range of follow

  10. Drug education in Victorian schools (DEVS): the study protocol for a harm reduction focused school drug education trial.

    PubMed

    Midford, Richard; Cahill, Helen; Foxcroft, David; Lester, Leanne; Venning, Lynne; Ramsden, Robyn; Pose, Michelle

    2012-02-10

    This study seeks to extend earlier Australian school drug education research by developing and measuring the effectiveness of a comprehensive, evidence-based, harm reduction focused school drug education program for junior secondary students aged 13 to 15 years. The intervention draws on the recent literature as to the common elements in effective school curriculum. It seeks to incorporate the social influence of parents through home activities. It also emphasises the use of appropriate pedagogy in the delivery of classroom lessons. A cluster randomised school drug education trial will be conducted with 1746 junior high school students in 21 Victorian secondary schools over a period of three years. Both the schools and students have actively consented to participate in the study. The education program comprises ten lessons in year eight (13-14 year olds) and eight in year nine (14-15 year olds) that address issues around the use of alcohol, tobacco, cannabis and other illicit drugs. Control students will receive the drug education normally provided in their schools. Students will be tested at baseline, at the end of each intervention year and also at the end of year ten. A self completion questionnaire will be used to collect information on knowledge, patterns and context of use, attitudes and harms experienced in relation to alcohol, tobacco, cannabis and other illicit drug use. Multi-level modelling will be the method of analysis because it can best accommodate hierarchically structured data. All analyses will be conducted on an Intent-to-Treat basis. In addition, focus groups will be conducted with teachers and students in five of the 14 intervention schools, subsequent to delivery of the year eight and nine programs. This will provide qualitative data about the effectiveness of the lessons and the relevance of the materials. The benefits of this drug education study derive both from the knowledge gained by trialling an optimum combination of innovative, harm

  11. 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.

    PubMed

    McNeil, Ryan; Guirguis-Younger, Manal; Dilley, Laura B; Aubry, Tim D; Turnbull, Jeffrey; Hwang, Stephen W

    2012-05-17

    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. 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. 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. 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.

  12. Prevention, early intervention, harm reduction, and treatment of substance use in young people.

    PubMed

    Stockings, Emily; Hall, Wayne D; Lynskey, Michael; Morley, Katherine I; Reavley, Nicola; Strang, John; Patton, George; Degenhardt, Louisa

    2016-03-01

    We did a systematic review of reviews with evidence on the effectiveness of prevention, early intervention, harm reduction, and treatment of problem use in young people for tobacco, alcohol, and illicit drugs (eg, cannabis, opioids, amphetamines, or cocaine). Taxation, public consumption bans, advertising restrictions, and minimum legal age are effective measures to reduce alcohol and tobacco use, but are not available to target illicit drugs. Interpretation of the available evidence for school-based prevention is affected by methodological issues; interventions that incorporate skills training are more likely to be effective than information provision-which is ineffective. Social norms and brief interventions to reduce substance use in young people do not have strong evidence of effectiveness. Roadside drug testing and interventions to reduce injection-related harms have a moderate-to-large effect, but additional research with young people is needed. Scarce availability of research on interventions for problematic substance use in young people indicates the need to test interventions that are effective with adults in young people. Existing evidence is from high-income countries, with uncertain applicability in other countries and cultures and in subpopulations differing in sex, age, and risk status. Concerted efforts are needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependence

    PubMed Central

    Collins, Susan E.; Grazioli, Véronique S.; Torres, Nicole I.; Taylor, Emily M.; Jones, Connor B.; Hoffman, Gail E.; Haelsig, Laura; Zhu, Mengdan D.; Hatsukami, Alyssa S.; Koker, Molly J.; Herndon, Patrick; Greenleaf, Shawna M.; Dean, Parker E.

    2015-01-01

    Most treatment programs for alcohol dependence have prioritized alcohol abstinence as the primary treatment goal. However, abstinence-based goals are not always considered desirable or attainable by more severely affected populations, such as chronically homeless people with alcohol dependence. Because these individuals comprise a multimorbid and high-utilizing population, they are in need of more focused research attention that elucidates their preferred treatment goals. The aim of this secondary study was therefore to qualitatively and quantitatively document participant-generated treatment goals. Participants were currently or formerly chronically homeless individuals (N=31) with alcohol dependence who participated in a pilot of extended-release naltrexone and harm-reduction counseling. Throughout the treatment period, study interventionists elicited participants’ goals and recorded them on an open-ended grid. In subsequent weeks, progress towards and achievement of goals was obtained via self-report and recorded by study interventionists. Conventional content analysis was performed to classify participant-generated treatment goals. Representation of the three top categories remained stable over the course of treatment. In the order of their frequency, they included drinking-related goals, quality-of-life goals and health-related goals. Within the category of drinking-related goals, participants consistently endorsed reducing drinking and alcohol-related consequences ahead of abstinence-based goals. Quantitative analyses indicated participants generated an increasing number of goals over the course of treatment. Proportions of goals achieved and progressed toward kept pace with this increase. Findings confirmed hypotheses that chronically homeless people with alcohol dependence can independently generate and achieve treatment goals toward alcohol harm reduction and quality-of-life improvement. PMID:25697724

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

    PubMed

    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.

  15. Impacts of licensed premises trading hour policies on alcohol-related harms.

    PubMed

    Atkinson, Jo-An; Prodan, Ante; Livingston, Michael; Knowles, Dylan; O'Donnell, Eloise; Room, Robin; Indig, Devon; Page, Andrew; McDonnell, Geoff; Wiggers, John

    2018-07-01

    Evaluations of alcohol policy changes demonstrate that restriction of trading hours of both 'on'- and 'off'-licence venues can be an effective means of reducing rates of alcohol-related harm. Despite this, the effects of different trading hour policy options over time, accounting for different contexts and demographic characteristics, and the common co-occurrence of other harm reduction strategies in trading hour policy initiatives, are difficult to estimate. The aim of this study was to use dynamic simulation modelling to compare estimated impacts over time of a range of trading hour policy options on various indicators of acute alcohol-related harm. An agent-based model of alcohol consumption in New South Wales, Australia was developed using existing research evidence, analysis of available data and a structured approach to incorporating expert opinion. Five policy scenarios were simulated, including restrictions to trading hours of on-licence venues and extensions to trading hours of bottle shops. The impact of the scenarios on four measures of alcohol-related harm were considered: total acute harms, alcohol-related violence, emergency department (ED) presentations and hospitalizations. Simulation of a 3 a.m. (rather than 5 a.m.) closing time resulted in an estimated 12.3 ± 2.4% reduction in total acute alcohol-related harms, a 7.9 ± 0.8% reduction in violence, an 11.9 ± 2.1% reduction in ED presentations and a 9.5 ± 1.8% reduction in hospitalizations. Further reductions were achieved simulating a 1 a.m. closing time, including a 17.5 ± 1.1% reduction in alcohol-related violence. Simulated extensions to bottle shop trading hours resulted in increases in rates of all four measures of harm, although most of the effects came from increasing operating hours from 10 p.m. to 11 p.m. An agent-based simulation model suggests that restricting trading hours of licensed venues reduces rates of alcohol-related harm and extending trading hours of bottle

  16. 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.

    PubMed

    Zhang, Li; Liang, Shu; Lu, Weixia; Pan, Stephen W; Song, Benli; Liu, Qianping; Xu, Yunan; Dong, Hui; Xing, Hui; Shao, Yiming; Ruan, Yuhua

    2014-01-01

    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.

  17. The Australian tar derby: the origins and fate of a low tar harm reduction programme

    PubMed Central

    King, W; Carter, S; Borland, R; Chapman, S; Gray, N

    2003-01-01

    Objective: To document the development of the low tar harm reduction programme in Australia, including tobacco industry responses. Data sources: Tobacco industry documents, retail tobacco journals, newspapers, medical journals, and Anti-Cancer Council of Victoria (ACCV) newsletters and archival records. Study selection: Documents on the strategies and knowledge bases of the ACCV, other Australian health authorities, and the tobacco industry. Results: The ACCV built a durable system for measuring and publicising the tar and nicotine yields of Australian cigarettes and influencing their development. The tobacco industry initially sought to block the development of this system but later appeared to cooperate with it, as is evidenced by the current market dominance of low tar brands. However, behind the scenes, the industry used its substantial knowledge advantage regarding compensatory smoking and its ability to re-engineer cigarettes to gain effective control of the system and subvert the ACCV's objectives. Conclusions: Replacement of the low tar programme with new means of minimising the harms from cigarette smoking should be a policy priority for the Australian government. This will require regulation, rather than further voluntary agreements, and stringent monitoring of successor programmes will be necessary. PMID:14645950

  18. Can screening and brief intervention lead to population-level reductions in alcohol-related harm?

    PubMed Central

    2012-01-01

    A distinction is made between the clinical and public health justifications for screening and brief intervention (SBI) against hazardous and harmful alcohol consumption. Early claims for a public health benefit of SBI derived from research on general medical practitioners’ (GPs’) advice on smoking cessation, but these claims have not been realized, mainly because GPs have not incorporated SBI into their routine practice. A recent modeling exercise estimated that, if all GPs in England screened every patient at their next consultation, 96% of the general population would be screened over 10 years, with 70-79% of excessive drinkers receiving brief interventions (BI); assuming a 10% success rate, this would probably amount to a population-level effect of SBI. Thus, a public health benefit for SBI presupposes widespread screening; but recent government policy in England favors targeted versus universal screening, and in Scotland screening is based on new registrations and clinical presentation. A recent proposal for a national screening program was rejected by the UK National Health Service’s National Screening Committee because 1) there was no good evidence that SBI led to reductions in mortality or morbidity, and 2) a safe, simple, precise, and validated screening test was not available. Even in countries like Sweden and Finland, where expensive national programs to disseminate SBI have been implemented, only a minority of the population has been asked about drinking during health-care visits, and a minority of excessive drinkers has been advised to cut down. Although there has been research on the relationship between treatment for alcohol problems and population-level effects, there has been no such research for SBI, nor have there been experimental investigations of its relationship with population-level measures of alcohol-related harm. These are strongly recommended. In this article, conditions that would allow a population-level effect of SBI to occur are

  19. Analysis of ballistic transport in nanoscale devices by using an accelerated finite element contact block reduction approach

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Li, H.; Li, G., E-mail: gli@clemson.edu

    2014-08-28

    An accelerated Finite Element Contact Block Reduction (FECBR) approach is presented for computational analysis of ballistic transport in nanoscale electronic devices with arbitrary geometry and unstructured mesh. Finite element formulation is developed for the theoretical CBR/Poisson model. The FECBR approach is accelerated through eigen-pair reduction, lead mode space projection, and component mode synthesis techniques. The accelerated FECBR is applied to perform quantum mechanical ballistic transport analysis of a DG-MOSFET with taper-shaped extensions and a DG-MOSFET with Si/SiO{sub 2} interface roughness. The computed electrical transport properties of the devices obtained from the accelerated FECBR approach and associated computational cost as amore » function of system degrees of freedom are compared with those obtained from the original CBR and direct inversion methods. The performance of the accelerated FECBR in both its accuracy and efficiency is demonstrated.« less

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

    PubMed

    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.

  1. Drug education in victorian schools (DEVS): the study protocol for a harm reduction focused school drug education trial

    PubMed Central

    2012-01-01

    Background This study seeks to extend earlier Australian school drug education research by developing and measuring the effectiveness of a comprehensive, evidence-based, harm reduction focused school drug education program for junior secondary students aged 13 to 15 years. The intervention draws on the recent literature as to the common elements in effective school curriculum. It seeks to incorporate the social influence of parents through home activities. It also emphasises the use of appropriate pedagogy in the delivery of classroom lessons. Methods/Design A cluster randomised school drug education trial will be conducted with 1746 junior high school students in 21 Victorian secondary schools over a period of three years. Both the schools and students have actively consented to participate in the study. The education program comprises ten lessons in year eight (13-14 year olds) and eight in year nine (14-15 year olds) that address issues around the use of alcohol, tobacco, cannabis and other illicit drugs. Control students will receive the drug education normally provided in their schools. Students will be tested at baseline, at the end of each intervention year and also at the end of year ten. A self completion questionnaire will be used to collect information on knowledge, patterns and context of use, attitudes and harms experienced in relation to alcohol, tobacco, cannabis and other illicit drug use. Multi-level modelling will be the method of analysis because it can best accommodate hierarchically structured data. All analyses will be conducted on an Intent-to-Treat basis. In addition, focus groups will be conducted with teachers and students in five of the 14 intervention schools, subsequent to delivery of the year eight and nine programs. This will provide qualitative data about the effectiveness of the lessons and the relevance of the materials. Discussion The benefits of this drug education study derive both from the knowledge gained by trialling an

  2. The Effectiveness of the Harm Reduction Group Therapy Based on Bandura's Self-Efficacy Theory on Risky Behaviors of Drug-Dependent Sex Worker Women.

    PubMed

    Rabani-Bavojdan, Marjan; Rabani-Bavojdan, Mozhgan; Rajabizadeh, Ghodratollah; Kaviani, Nahid; Bahramnejad, Ali; Ghaffari, Zohreh; Shafiei-Bafti, Mehdi

    2017-07-01

    The aim of this study was to investigate the effectiveness of the harm reduction group therapy based on Bandura's self-efficacy theory on risky behaviors of sex workers in Kerman, Iran. A quasi-experimental two-group design (a random selection with pre-test and post-test) was used. A risky behaviors questionnaire was used to collect. The sample was selected among sex workers referring to drop-in centers in Kerman. Subjects were allocated to two groups and were randomly classified into two experimental and control groups. The sample group consisted of 56 subjects. The experimental design was carried out during 12 sessions, and the post-test was performed one month and two weeks after the completion of the sessions. The results were analyzed statistically. By reducing harm based on Bandura's self-efficacy theory, the risky behaviors of the experimental group, including injection behavior, sexual behavior, violence, and damage to the skin, were significantly reduced in the pre-test compared to the post-test (P < 0.010). The harm reduction group therapy based on Bandura's self-efficacy theory can reduce the risky behaviors of sex workers.

  3. Accelerating oxygen reduction on Pt monolayer via substrate compression

    NASA Astrophysics Data System (ADS)

    Zhang, Xilin; Chen, Yue; Yang, Zongxian; Lu, Zhansheng

    2017-11-01

    Many methods have been proposed to accelerate the oxygen reduction and save the dosage of Pt. Here, we report a promising way in fulfilling these purposes by applying substrate strain on the supported Pt monolayer. The compressive strain would modify the geometric and electronic structures of tungsten carbide (WC) substrate, changing the interaction nature between substrate and Pt monolayer and resulting in a downward shift of the d-band center of surface Pt atoms. The activity of Pt monolayer on the compressed WC is further evaluated from the kinetics of the dissociation and protonation of O2. The dissociation barrier of O2 is increased and the hydrogenation barrier of O atom is decreased, indicating that the recovery of the catalytically active sites is accelerated and the deactivation by oxygen poison is alleviated. The present study provides an effective way in tuning the activity of Pt-based catalysts by applying the substrate strain.

  4. A harm reduction programme for injecting drug users in Nepal.

    PubMed

    Singh, M

    1997-01-01

    The Lifesaving and Lifegiving Society (LALS), a street-based nongovernmental organization established in Nepal in 1991, utilizes a harm-reduction strategy to minimize the spread of HIV among injecting drug users. Community health outreach workers, many of whom are former drug addicts, work in the streets of Kathmandu, educating, counseling, and distributing bleach, sterile water, swabs, and clean needles. They demonstrate how to clean syringes and distribute condoms. LALS also provides primary health care services such as treatment for abscesses. Clients are informed about the limited drug treatment services in Nepal and are offered the option of home detoxification under LALS supervision. LALS promotes the message that drug users should be treated as victims of a disease rather than as criminals. Family involvement, fostered through home visits, is considered important to sustaining behavioral changes and family members are informed about ways of encouraging drug users to give up drug use or at least practice safe injecting techniques. Education of and networking with Narcotics Division and other police officers has been essential to LALS' success. LALS is working with the Nepali Red Cross on integrating HIV prevention into family planning programs. A current priority is to reduce dependence on funding from donor agencies and mobilize support from private businesses.

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

    PubMed

    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.

  6. Developing and Evaluating an Automated All-Cause Harm Trigger System.

    PubMed

    Sammer, Christine; Miller, Susanne; Jones, Cason; Nelson, Antoinette; Garrett, Paul; Classen, David; Stockwell, David

    2017-04-01

    From 2009 through 2012, the Adventist Health System Patient Safety Organization (AHS PSO) used the Global Trigger Tool method for harm identification and demonstrated harm reduction. Although the awareness of harm demonstrated opportunities for improvement across the system, leaders determined that the human and fiscal resources required to continue with a retrospective manual harm identification process were unsustainable. In addition, there was growing concern that the identification of harm after the patient's discharge did not allow for intervention during the hospital stay. Therefore, the AHS PSO decided to seek an alternative method for patient harm identification. The AHS PSO and another PSO jointly developed a novel automated all-cause harm trigger identification system that allowed for real-time bedside intervention, real-time trend analysis affecting patient safety, and continued learning about harm measurement. A sociotechnical approach of people, process, and technology was used at two pilot hospitals sharing the same electronic health record platform. Automated positive harm triggers and work-flow models were developed and evaluated. Combined data from the two hospitals in a period of 11 consecutive months indicated (1) a total of 2,696 harms (combined hospital-acquired and outside-acquired); (2) that hypoglycemia (blood glucose ≤ 40 mg/dL) was the most frequently identified harm; (3) 256 harms related to the Patient Safety Indicator 90 (PSI 90) Composite descriptions versus 77 harms reported to regulatory harm reduction programs; and (4) that almost one third (32%) of total harms were classified as outside-acquired. The automated harm trigger system revealed not only more harm but a broader scope of harm and led to a deeper understanding of patient safety vulnerabilities. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  7. Managed alcohol as a harm reduction intervention for alcohol addiction in populations at high risk for substance abuse.

    PubMed

    Muckle, Wendy; Muckle, Jamie; Welch, Vivian; Tugwell, Peter

    2012-12-12

    Managed alcohol programmes (MAP) are a harm reduction strategy used to minimise the personal harm and adverse societal effects that alcohol dependence can lead to by providing an alternative to zero-tolerance approaches that incorporate drinking goals (abstinence or moderation) that are compatible with the needs of the individual, and promoting access to services by offering low-threshold alternatives. This enables clients to gain access to services despite continued alcohol consumption and works to help the patient understand the risks involved in their behaviour and make decisions about their own treatment goals. To assess the effectiveness of MAP treatment regimens (serving limited quantities of alcohol daily to alcoholics) on their own or as compared to moderate drinking (self-controlled drinking), screening and brief intervention using a harm reduction approach, traditional abstinence-based interventions (12 step programmes) and no intervention. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL and PsycINFO up to March 2012. This search was expanded by handsearching of high-yield journals and conference proceedings that had not already been handsearched on behalf of The Cochrane Collaboration, searching reference lists of all papers and relevant reviews identified, references to ongoing and recently completed clinical trials in the National Research Register and IFPMA Clinical Trials Database (which contains ClinicalTrials.gov, Centerwatch, Current Controlled Trials and ClinicalStudyResults.gov, and Osservatorio Nazionale sulla Sperimentazione Clinica dei Medicinali). Trials registers, grey literature and reference lists were also searched. Individuals, organisations and experts in the field were contacted. Randomised control trials (RCT), controlled clinical trials (CCT), interrupted time series (ITS) studies, and control before and after (CBA) studies involving vulnerable people aged 18 years or older who were

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

    PubMed

    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/

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

    PubMed Central

    Buxton, Jane A; Preston, Emma C; Mak, Sunny; Harvard, Stephanie; Barley, Jenny

    2008-01-01

    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. PMID:19108726

  10. Commentary: Understanding the origins of anger, contempt, and disgust in public health policy disputes: applying moral psychology to harm reduction debates.

    PubMed

    Alderman, Jess; Dollar, Katherine M; Kozlowski, Lynn T

    2010-04-01

    Scientific disputes about public health issues can become emotional battlefields marked by strong emotions like anger, contempt, and disgust. Contemporary work in moral psychology demonstrates that each of these emotions is a reaction to a specific type of moral violation. Applying this work to harm reduction debates, specifically the use of smokeless tobacco to reduce harm from tobacco use, we attempt to explain why some public health disputes have been so heated. Public health ethics tend to emphasize social justice concerns to the exclusion of other moral perspectives that value scientific authority, professional loyalty, and bodily purity. An awareness of their different emotional reactions and underlying moral motivations might help public health professionals better understand each others' viewpoints, ultimately leading to more productive dialogue.

  11. Aqueous Cr(VI) reduction by electrodeposited zero-valent iron at neutral pH: acceleration by organic matters.

    PubMed

    Liu, Junxi; Wang, Chuan; Shi, Jianying; Liu, Hong; Tong, Yexiang

    2009-04-15

    This work investigated the effect of co-existing organic matters on aqueous Cr(VI) reduction by electrodeposited zero-valent iron (ED Fe(0)) at neutral pH. The ED Fe(0) prepared in a solution containing mixture of saccharin, L-ascorbic acid and sodium dodecyl sulfate showed higher activity in reducing the aqueous Cr(VI) at neutral pH than that prepared without any organic presence. XRD and SEM indicated that the structure of ED Fe(0) was significantly improved to nano-scale by the presence of organic mixture in the preparation solution. Further, the ED Fe(0) activity in the Cr(VI) reduction at neutral pH was increased by the co-existence of citric acid or oxalic acid in the chromate solution. Electrochemical impedance spectroscopy (EIS) demonstrated that the corrosive current increased with the concentration of organic matter in the reaction solution. With the co-existing organic matters in the preparation solution, the ED Fe(0) corroded more rapidly due to its nano-size, thus the Cr(VI) reduction by the ferrous iron was accelerated. With the co-existing organic matters in the reaction solution, the Cr(VI) reduction was accelerated by a Fe(II) complex as the main electron donor, and a prevention of the passivation due to the Fe(III) and Cr(III) complexes also accelerated the Cr(VI) reduction.

  12. Information sought, information shared: exploring performance and image enhancing drug user-facilitated harm reduction information in online forums.

    PubMed

    Tighe, Boden; Dunn, Matthew; McKay, Fiona H; Piatkowski, Timothy

    2017-07-21

    There is good evidence to suggest that performance and image enhancing drug (PIED) use is increasing in Australia and that there is an increase in those using PIEDs who have never used another illicit substance. Peers have always been an important source of information in this group, though the rise of the Internet, and the increased use of Internet forums amongst substance consumers to share harm reduction information, means that PIED users may have access to a large array of views and opinions. The aim of this study was to explore the type of information that PIED users seek and share on these forums. An online search was conducted to identify online forums that discussed PIED use. Three discussion forums were included in this study: aussiegymjunkies.com, bodybuildingforums.com.au, and brotherhoodofpain.com. The primary source of data for this study was the 'threads' from the online forums. Threads were thematically analysed for overall content, leading to the identification of themes. One hundred thirty-four threads and 1716 individual posts from 450 unique avatars were included in this analysis. Two themes were identified: (1) personal experiences and advice and (2) referral to services and referral to the scientific literature. Internet forums are an accessible way for members of the PIED community to seek and share information to reduce the harms associated with PIED use. Forum members show concern for both their own and others' use and, where they lack information, will recommend seeking information from medical professionals. Anecdotal evidence is given high credence though the findings from the scientific literature are used to support opinions. The engagement of health professionals within forums could prove a useful strategy for engaging with this population to provide harm reduction interventions, particularly as forum members are clearly seeking further reliable information, and peers may act as a conduit between users and the health and medical

  13. Harmful Algal Blooms

    USGS Publications Warehouse

    Graham, Jennifer L.

    2007-01-01

    What are Harmful Algal Blooms (HABs)? Freshwater and marine harmful algal blooms (HABs) can occur anytime water use is impaired due to excessive accumulations of algae. HAB occurrence is affected by a complex set of physical, chemical, biological, hydrological, and meteorological conditions making it difficult to isolate specific causative environmental factors. Potential impairments include reduction in water quality, accumulation of malodorous scums in beach areas, algal production of toxins potent enough to poison both aquatic and terrestrial organisms, and algal production of taste-and-odor compounds that cause unpalatable drinking water and fish. HABs are a global problem, and toxic freshwater and (or) marine algae have been implicated in human and animal illness and death in over 45 countries worldwide and in at least 27 U.S. States (Yoo and others, 1995; Chorus and Bartram, 1999; Huisman and others, 2005).

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

    PubMed

    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

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

    PubMed Central

    2013-01-01

    Background 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. Methods 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. Results 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. Conclusions Considering that HIV is concentrated among Iranian prisoners who inject

  16. Syringe Decriminalization Advocacy in Red States: Lessons from the North Carolina Harm Reduction Coalition.

    PubMed

    Cloud, David H; Castillo, Tessie; Brinkley-Rubinstein, Lauren; Dubey, Manisha; Childs, Robert

    2018-05-08

    Syringe access programs (SAPs) are cornerstone harm reduction interventions for combatting the national opioid epidemic. The goal of this paper is to describe effective advocacy strategies for enacting syringe decriminalization legislation to foster the expansion of SAPs in high-need areas amidst political opposition. Decades or research shows that SAPs prevent the transmission of HIV among people who inject drugs (PWID) and are a cost-effective tool for linking PWID to medical care, health education, and social services. In the USA, state laws criminalizing distribution and possession of syringes impede the expansion of SAPs into areas where they are sorely needed. In 2016, North Carolina became the first state to legalize SAPs with a Republican super majority. This paper distills strategies for community organizations seeking to advance syringe decriminalization legislation in politically conservative states with histories of prioritizing punitive sanctions over public health responses to drug use.

  17. Assessment of the reduction in levels of exposure to harmful and potentially harmful constituents in Japanese subjects using a novel tobacco heating system compared with conventional cigarettes and smoking abstinence: A randomized controlled study in confinement.

    PubMed

    Haziza, Christelle; de La Bourdonnaye, Guillaume; Merlet, Sarah; Benzimra, Muriel; Ancerewicz, Jacek; Donelli, Andrea; Baker, Gizelle; Picavet, Patrick; Lüdicke, Frank

    2016-11-01

    Smoking conventional cigarettes (CCs) exposes smokers to harmful and potentially harmful constituents (HPHCs). The Tobacco Heating System 2.2 (THS 2.2), a candidate modified risk tobacco product, was developed to reduce or eliminate the formation of HPHCs, while preserving as much as possible the taste, sensory experience, nicotine delivery profile and ritual characteristics of CC. This randomized, controlled, open-label study in confinement for 5 day exposure aimed to demonstrate the reduction in exposure to selected HPHCs, to assess nicotine uptake and subjective effects, in participants switching to THS 2.2 (n = 80) compared to participants continuing smoking CCs (n = 40) and abstaining from smoking (n = 40). The subjects were randomized according to sex and daily CC consumption. The levels of biomarkers of exposure to HPHCs were significantly reduced in participants switching to THS 2.2, compared to CC use. More importantly, the magnitude of exposure reduction observed was close to that which was seen in participants who abstained from smoking for 5 days, while nicotine uptake was maintained. Reduction in urge-to-smoke was comparable between THS and CC groups, however THS 2.2 was slightly less satisfactory than CCs. The new, alternative tobacco product THS 2.2 was well tolerated. Copyright © 2016 Philip Morris Products S.A. Published by Elsevier Inc. All rights reserved.

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

    PubMed

    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.

  19. Evidence of reducing ethanol content in beverages to reduce harmful use of alcohol.

    PubMed

    Rehm, Jürgen; Lachenmeier, Dirk W; Llopis, Eva Jané; Imtiaz, Sameer; Anderson, Peter

    2016-09-01

    Alcohol use is a major contributor to the burden of gastrointestinal disease. WHO's global strategy to reduce harmful use of alcohol encourages the alcohol industry to contribute to this effort. However, evidence that alcohol producers have contributed to the reduction of harmful use of alcohol is scarce. Reduction of alcoholic strength of beer has been proposed and initiated as one potential way forward. We examine the evidence base for the success of such an initiative. Direct evidence from natural experiments or other controlled studies is scarce. We identified three potential mechanisms for how reduction of alcoholic strength could affect harmful use of alcohol: by current drinkers replacing standard alcoholic beverages with similar beverages of lower alcoholic strength, without increasing the quantity of liquid consumed; by current drinkers switching to no alcohol alternatives for part of the time, thereby reducing their average amount of ethanol consumed; and by initiating alcohol use in current abstainers. The first mechanism seems to be the most promising to potentially reduce harm, but much will depend on actual implementation, and only an independent assessment will be able to identify effects on harmful drinking. The potential of alcoholic strength reduction is independent of initiation by law or by self-initiative of the industry. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Young people who use drugs engaged in harm reduction programs in New York City: Overdose and other risks.

    PubMed

    Calvo, Michele; MacFarlane, Jessica; Zaccaro, Heather; Curtis, Matthew; Cabán, María; Favaro, Jamie; Passannante, Marian R; Frost, Taeko

    2017-09-01

    Little is known about the engagement of young people who use drugs (PWUD) in harm reduction programs (HRPs), and few studies have included non-opioid users and non-injectors. While HRPs have effectively engaged PWUD, young people are under-represented in their services. The Injection Drug Users Health Alliance Citywide Study (IDUCS) is the largest community-based study of PWUD in HRPs in the US. From 2014-2015, 2421 HRP participants across New York City (NYC) completed a cross-sectional survey. We investigated differences in socio-demographics, service utilization, and risk behaviors between young (aged 18-30) and older participants and examined factors associated with overdose among young participants. The study included 257 young participants. They were significantly more likely than older participants to be white, educated, uninsured, unstably housed or homeless, and have a history of incarceration and residential drug treatment. They were more likely to report recent overdose but less likely to report knowledge of naloxone. Young participants also had higher rates of alcohol, marijuana, benzodiazepine, and injection drug use, and related risk behaviors such as public injection. Factors associated with past year overdose among young participants included experiencing symptoms of psychological distress (AOR=9.71), being unstably housed or homeless (AOR=4.39), and utilizing detox (AOR=4.20). Young PWUD who access services at HRPs in NYC differ significantly from their older counterparts. New York City and other urban centers that attract young PWUD should consider implementing harm reduction oriented services tailored to the unique needs of young people. Copyright © 2017. Published by Elsevier B.V.

  1. Pulmonary and latent tuberculosis screening in opiate drug users: an essential and neglected approach for harm-reduction facilities.

    PubMed

    Honarvar, Behnam; Lankarani, Kamran Bagheri; Odoomi, Neda; Roudgari, Amir; Moghadami, Mohsen; Kazerooni, Parvin Afsar; Abadi, Alireza Hassan

    2013-01-01

    Opiates drug users are at much higher risk of developing tuberculosis (TB) infection than general population. We conducted this study to determine the susceptibility for pulmonary and latent TB infection in opiates drug users. In this cross-sectional study, all opiates drug users referred to drop-in centers, methadone maintenance clinics, and harm-reduction facilities affiliated with Shiraz University of Medical Sciences in southern Iran were screened for pulmonary and latent TB infection. The participation rate of opiate drug users was 87.66% (263 of 300). Mean age was 37.37 ± 8.33 (range, 20-65) years. Two hundred twenty-six (85.93%) were male and 197 (74.90%) were injection drug users (IDUs). One hundred sixty-three (61.97%) had TB-related symptoms. Culture for TB was positive in 3 patients (1.14%) (2 non-IDUs and 1 IDU). Two patients (0.76%) showed acid-fast bacilli in the direct sputum smear. Eighty-five of 244 patients (34.83%) had a 5- to 10-mm induration in the skin TB test. Twenty-nine of 223 patients (13%) had abnormal findings from chest x-ray films. The prevalence of smear-positive pulmonary TB in opiate drug users is more than 100 times in the general population in Iran. Therefore, active and appropriate screening to detect pulmonary TB infection should be integrated into routine activities at all harm-reduction facilities for drug users, irrespective of their route of drug use or human immunodeficiency virus status, in this country.

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

    PubMed

    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.

  3. Simultaneous removal of NOx and SO2 from flue gas using combined Na2SO3 assisted electrochemical reduction and direct electrochemical reduction.

    PubMed

    Guo, Qingbin; He, Yi; Sun, Tonghua; Wang, Yalin; Jia, Jinping

    2014-07-15

    A method combining Na2SO3 assisted electrochemical reduction and direct electrochemical reduction using Fe(II)(EDTA) solution was proposed to simultaneously remove NOx and SO2 from flue gas. Activated carbon was used as catalyst to accelerate the process. This new system features (a) direct conversion of NOx and SO2 to harmless N2 and SO4(2-); (b) fast regeneration of Fe(II)(EDTA); (c) minimum use of chemical reagents; and (d) recovery of the reduction by-product (Na2SO4). Fe(II)(EDTA) solution was continuously recycled and reused during entire process, and no harmful waste was generated. Approximately 99% NOx and 98% SO2 were removed under the optimal condition. The stability test showed that the system operation was reliable. Copyright © 2014 Elsevier B.V. All rights reserved.

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

    PubMed

    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.

  5. Increasing the intensity of an induction accelerator and reduction of the beam breakup instability

    NASA Astrophysics Data System (ADS)

    Coleman, J. E.; Moir, D. C.; Ekdahl, C. A.; Johnson, J. B.; McCuistian, B. T.; Sullivan, G. W.; Crawford, M. T.

    2014-03-01

    A 7 cm cathode has been deployed for use on a 3.8 MV, 80 ns (FWHM) Blumlein, to increase the extracted electron current from the nominal 1.7 to 2.9 kA. The intense relativistic electron bunch is accelerated and transported through a nested solenoid and ferrite induction core lattice consisting of 64 elements, exiting the accelerator with a nominal energy of 19.8 MeV. The principal objective of these experiments is to quantify the space-charge limitations on the beam quality, its coupling with the beam breakup (BBU) instability, and provide an independent validation of the BBU theory in a higher current regime, I >2 kA. Time resolved centroid measurements indicate a reduction in BBU >10× with simply a 50% increase in the average B-field used to transport the beam through the accelerator. A qualitative comparison of experimental and calculated results are presented, which include time resolved current density distributions, radial BBU amplitude relative to the calculated beam envelope, and frequency analyzed BBU amplitude with different accelerator lattice tunes.

  6. Pricing of alcohol in Canada: A comparison of provincial policies and harm-reduction opportunities.

    PubMed

    Giesbrecht, Norman; Wettlaufer, Ashley; Thomas, Gerald; Stockwell, Tim; Thompson, Kara; April, Nicole; Asbridge, Mark; Cukier, Samantha; Mann, Robert; McAllister, Janet; Murie, Andrew; Pauley, Chris; Plamondon, Laurie; Vallance, Kate

    2016-05-01

    Alcohol pricing is an effective prevention policy. This paper compares the 10 Canadian provinces on three research-based alcohol pricing policies-minimum pricing, pricing by alcohol content and maintaining prices relative to inflation. The selection of these three policies was based on systematic reviews and seminal research papers. Provincial data for 2012 were obtained from Statistics Canada and relevant provincial ministries, subsequently sent to provincial authorities for verification, and then scored by team members. All provinces, except for Alberta, have minimum prices for at least one beverage type sold in off-premise outlets. All provinces, except for British Columbia and Quebec, have separate (and higher) minimum pricing for on-premise establishments. Regarding pricing on alcohol content, western and central provinces typically scored higher than provinces in Eastern Canada. Generally, minimum prices were lower than the recommended $1.50 per standard drink for off-premise outlets and $3.00 per standard drink in on-premise venues. Seven of 10 provinces scored 60% or higher compared to the ideal on indexing prices to inflation. Prices for a representative basket of alcohol products in Ontario and Quebec have lagged significantly behind inflation since 2006. While examples of evidence-based alcohol pricing policies can be found in every jurisdiction in Canada, significant inter-provincial variation leaves substantial unrealised potential for further reducing alcohol-related harm and costs. This comparative assessment of alcohol price policies provides clear indications of how individual provinces could adjust their pricing policies and practices to improve public health and safety. [Giesbrecht N, Wettlaufer A, Thomas G, Stockwell T, Thompson K, April N, Asbridge M, Cukier S, Mann R, McAllister J, Murie A, Pauley C, Plamondon L, Vallance K. Pricing of alcohol in Canada: A comparison of provincial policies and harm-reduction opportunities. Drug Alcohol Rev

  7. [Harmful alcohol consumption: prevalence, trends, health burden, reduction strategy].

    PubMed

    Грузева, Татьяна С; Дуфинец, Василий А; Замкевич, Виктория Б

    2016-01-01

    Harmful alcohol consumption constitutes a significant cause of the global burden of disease, causing more than 200 different diseases, 5.9% of all deaths worldwide, causing substantial medical and social costs, major economic loss, slowing progress towards the strategic goals of human development. to substantiate approaches to the formation of a national strategy to combat the harmful use of alcohol in Ukraine based on the analysis of the prevalence of alcohol consumption and related health and social problems and international experience and recommendations of WHO. The study was based on analysis of the extent and patterns of alcohol consumption in Ukraine, levels, structure and dynamics of morbidity and mortality from diseases associated with alcohol abuse; investigation of preventive activities in primary healthcare, the existing problems and doctors' needs for prevention alcohol abuse, national and international experience on this problem.This work usesbibliosemantic, medical, statistical, sociological, epidemiological methods. The information base are: European Health for All Database (HFA-DB)for 2000-2012,Center of Medical Statistics, Ministry of Health of Ukraine for 2000-2015, questionnaire survey of physicians in primary care, strategic and policy documents of WHO, WHO Regional Office for Europe. In Ukraine, as in most countries in the WHO European Region prevalence of alcohol is high. In the ranking of the WHO European Region Ukraine ranks fifth in alcohol consumption per capita. The structure of consumption of alcoholic drinks is dominated by strong spirits (48%). There has been a negative trend for this indicator from 5.4 liters in 2002 to 15.6 liters in 2012.The dominant pattern of alcohol consumption is characterized by early onset of alcohol consumption, significant frequency, large doses, mostly strong alcohol beverages, with significant share of low-quality alcohol. This factor contributes to high levels of morbidity. A total of546.3 thousandpeople

  8. Quantified, Localized Health Benefits of Accelerated Carbon Dioxide Emissions Reductions.

    PubMed

    Shindell, Drew; Faluvegi, Greg; Seltzer, Karl; Shindell, Cary

    2018-01-01

    Societal risks increase as Earth warms, but also for emissions trajectories accepting relatively high levels of near-term emissions while assuming future negative emissions will compensate even if they lead to identical warming [1]. Accelerating carbon dioxide (CO 2 ) emissions reductions, including as a substitute for negative emissions, hence reduces long-term risks but requires dramatic near-term societal transformations [2]. A major barrier to emissions reductions is the difficulty of reconciling immediate, localized costs with global, long-term benefits [3, 4]. However, 2°C trajectories not relying on negative emissions or 1.5°C trajectories require elimination of most fossil fuel related emissions. This generally reduces co-emissions that cause ambient air pollution, resulting in near-term, localized health benefits. We therefore examine the human health benefits of increasing ambition of 21 st century CO 2 reductions by 180 GtC; an amount that would shift a 'standard' 2°C scenario to 1.5°C or could achieve 2°C without negative emissions. The decreased air pollution leads to 153±43 million fewer premature deaths worldwide, with ~40% occurring during the next 40 years, and minimal climate disbenefits. More than a million premature deaths would be prevented in many metropolitan areas in Asia and Africa, and >200,000 in individual urban areas on every inhabited continent except Australia.

  9. Quantified, localized health benefits of accelerated carbon dioxide emissions reductions

    NASA Astrophysics Data System (ADS)

    Shindell, Drew; Faluvegi, Greg; Seltzer, Karl; Shindell, Cary

    2018-04-01

    Societal risks increase as Earth warms, and increase further for emissions trajectories accepting relatively high levels of near-term emissions while assuming future negative emissions will compensate, even if they lead to identical warming as trajectories with reduced near-term emissions1. Accelerating carbon dioxide (CO2) emissions reductions, including as a substitute for negative emissions, hence reduces long-term risks but requires dramatic near-term societal transformations2. A major barrier to emissions reductions is the difficulty of reconciling immediate, localized costs with global, long-term benefits3,4. However, 2 °C trajectories not relying on negative emissions or 1.5 °C trajectories require elimination of most fossil-fuel-related emissions. This generally reduces co-emissions that cause ambient air pollution, resulting in near-term, localized health benefits. We therefore examine the human health benefits of increasing 21st-century CO2 reductions by 180 GtC, an amount that would shift a `standard' 2 °C scenario to 1.5 °C or could achieve 2 °C without negative emissions. The decreased air pollution leads to 153 ± 43 million fewer premature deaths worldwide, with 40% occurring during the next 40 years, and minimal climate disbenefits. More than a million premature deaths would be prevented in many metropolitan areas in Asia and Africa, and >200,000 in individual urban areas on every inhabited continent except Australia.

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

    PubMed

    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

  11. Supping with the devil? The role of law in promoting tobacco harm reduction using low nitrosamine smokeless tobacco products.

    PubMed

    Hall, W; Gartner, C

    2009-03-01

    In Sweden, male cigarette smoking has declined as snus, a smokeless tobacco product which is low in carcinogenic nitrosamines, has gained popularity among male tobacco users. Epidemiological modelling based on the Swedish experience indicates that there would be major public health gains if a substantial number of current smokers in other countries could also be persuaded to switch to this product. This form of 'tobacco harm reduction' is very controversial in the public health community for many reasons. These include: objections in principle to the use of less harmful but still addictive nicotine products; uncertainties about the long-term effects of these products on health; doubts about the likely interest in and uptake of these products among existing smokers; concerns that increasing the availability of these products will increase the number of new tobacco users and eventually the number of smokers in the population; and anxiety about how the tobacco industry may use these products to undermine current tobacco control policies. This paper concludes with suggestions for a graduated series of policies that may allow exploration of the public health costs and benefits of encouraging smokers to switch to snus.

  12. Effect of smokeless tobacco product marketing and use on population harm from tobacco use policy perspective for tobacco-risk reduction.

    PubMed

    Kozlowski, Lynn T

    2007-12-01

    This article presents policy perspectives on the marketing of smokeless tobacco products to reduce population harm from tobacco use. Despite consensus that smokeless tobacco products as sold in the United States are less dangerous than cigarettes, there is no consensus on how to proceed. Diverse factions have different policy concerns. While the tobacco industry is exempted from U.S. Food and Drug Administration (FDA) oversight, the pharmaceutical industry whose nicotine replacement therapy (NRT) medicines compete with smokeless tobacco as noncombustible nicotine-delivery systems are regulated by the FDA. Some public health experts support smokeless tobacco use to reduce population harm from tobacco; other public health experts oppose promoting smokeless tobacco for harm reduction. Adult consumers can freely purchase currently-marketed smokeless tobacco products and even more-deadly cigarettes. Concerns with and advantages of smokeless tobacco products are discussed. In that noncombustible medicinal nicotine-delivery systems have been proven to be effective smoking-cessation aids, smokeless tobacco, as another source of psychoactive doses of nicotine, could be used similarly, in a dose-response fashion as a smoking-cessation aid (consistent with FDA principles for evaluating generic versions of drugs). Price measures should be used on tobacco products to make costs to consumers proportional to product health risks (which would make smokeless tobacco much cheaper than cigarettes), and smokeless tobacco should be encouraged as an option for smoking cessation in adult smokers, particularly for those who have failed to stop smoking using NRT or other methods.

  13. Is Harm Reduction a Viable Choice for Kids Enchanted with Drugs?

    ERIC Educational Resources Information Center

    Laursen, Erik K.; Brasler, Paul

    2002-01-01

    This article describes a strengths-based alternative to substance abuse treatment. Many contemporary youth are experiencing problems with alcohol or other drugs but reject the message of total abstinence and disease models of treatment. The authors draw from their experience and research to combine a strengths perspective with a harm-reduction…

  14. Harm reduction and cessation efforts and interest in cessation resources among survivors of smoking-related cancers.

    PubMed

    Berg, Carla J; Carpenter, Matthew J; Jardin, Bianca; Ostroff, Jamie S

    2013-03-01

    Despite the well-established risks associated with persistent smoking, many cancer survivors who were active smokers at the time of cancer diagnosis continue to smoke. In order to guide the development of tobacco cessation interventions for cancer survivors, a better understanding is needed regarding post-diagnosis quitting efforts. Thus, we examined quitting and reduction efforts and interest in cessation resources among cancer survivors who self-identified as current smokers at the time of diagnosis. We conducted analyses of survey participants (n = 54) who were current smokers at the time of cancer diagnosis and were continued smokers at the time of assessment. We also conducted semi-structured interviews (n = 21) among a subset of those who either continued to smoke or quit smoking post-cancer diagnosis. Among our survey participants, 22.2 % had ever used behavioral cessation resources and 66.7 % had use pharmacotherapy, while 62.8 % had interest in future use of behavioral cessation resources and 75.0 % had interest in pharmacotherapy. The majority reported some quitting efforts including making quit attempts, using cessation medications, and reducing their daily cigarette consumption. Semi-structured interview data revealed various strategies used to aid in smoking reduction and cessation as well as variability in preferences for cessation resources. Cancer patients who smoke following diagnosis often engage in smoking reduction and cessation-related behaviors, which may reflect their motivation to reduce their smoking-related risks. They also report high interest in cessation resources. Thus, it is important to explore the acceptability and effectiveness of different cessation intervention components among this group. Cancer survivors who smoke demonstrate actions toward harm reduction and cessation. They should inquire about potential resources that might facilitate their efforts among their healthcare providers and enlist support and advice from

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

    PubMed Central

    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

  16. How far will they go? Assessing the travel distance of current and former drug users to access harm reduction services.

    PubMed

    Allen, Sean; Ruiz, Monica; O'Rourke, Allison

    2015-03-01

    Prior research has explored spatial access to syringe exchange programs (SEPs) among people who inject drugs (PWID), but little is known about service utilization by former PWID who continue to access services (e.g., HIV screenings and referrals for social services) at harm reduction providers. The purpose of this research is to examine differences in access to SEPs between current and former PWID seeking services at a mobile SEP in Washington, DC. A geometric point distance estimation technique was applied to data collected as part of a PWID population estimation study that took place in Washington, DC, in March and April 2014. We calculated the walking distance from the centroid point of home residence zip code to the mobile exchange site where PWID presented for services. An independent samples t-test was used to examine differences in walking distance measures between current and former PWID. Differences in mean walking distance were statistically significant with current and former PWID having mean walking distances of 2.75 and 1.80 miles, respectively. The results of this study suggest that former PWID who are engaging with SEPs primarily for non-needle exchange services (e.g., medical or social services) may have decreased access to SEPs than their counterparts who are active injectors. This research provides support for expanding SEP operations such that both active and former PWID have increased access to harm reduction providers and associated health and social services. Increasing service accessibility may help resolve unmet needs among current and former PWID.

  17. Reduction of Harmful Emissions During Start and Warming Up of the Engine

    NASA Astrophysics Data System (ADS)

    Volkov, N.; Chainikov, D.

    2018-01-01

    The question of decrease in harmful emissions when idling of a truck engine in the conditions of low temperatures is considered. The implementation of the thermogenerator for a power supply of electrical elements is offered in a design of the self-powered heater. The principle of the device operation is based on a thermoelectric effect at which there is heat absorption and thermo-EMF emergence. In a consequence of this process electricity is produced. The exhaust gases of the self-powered heater are the source of the absorbed heat and act as fuel for the thermogenerator. It allows developing energy for a power supply of electrical elements of the heater. It gives the chance not to start the engine for warming up during the long parking, thereby reducing harmful emissions.

  18. A cross-sectional study of the feasibility of pharmacy-delivered harm reduction services among people who inject drugs in Xichang, China.

    PubMed

    Yang, Yi; Latkin, Carl A; Luan, Rongsheng; Yang, Cui

    2015-09-14

    HIV prevalence is high in Liangshan, China (1.1 %). In 2012, people who inject drugs (PWID) in Xichang, the capital city, contributed to 60.0 % of the HIV infections. The goal of the current study was to examine the feasibility of implementing pharmacy-delivered harm reduction services (PDHRS) for PWID. Face-to-face structured interviews with 403 PWID included questions on PWID's experiences of syringe services and their specific experiences, acceptance, and potential usage of PDHRS. There were some reports of harassment/bad treatment from pharmacists (12.2 %) and police (17.6 %). Non-prescription syringe sales (NPSS) from pharmacies in single piece were the main source (82.1 %) of syringes. 72.5 % of PWID reported visiting 31.5 % of the identified pharmacies. Most (74.7 %) PWID disposed of their used syringes by throwing them away. Only one PWID brought used syringes back to a pharmacy in the past 30 days. Half of the PDHRS, such as printed materials about HIV, Hepatitis C and STIs; risk reduction services; (16.9 %) and sharps container to dispose of syringes (0.2 %) were offered by a few pharmacies (<20 % for each service). The acceptance rates among PWID toward currently offered services were high (≥91.1 %). All potential PDHRS were acceptable by most (68-95.3 %) PWID, and correspondingly 67-94.5 % of PWID reported they would use each service if offered. NPSS from pharmacies provided many PWID in Liangshan with new syringes. However, disposal of used syringes was problematic. At the time of investigation, half of 16 assessed PDHRS were already available in pharmacies in Xichang. PWID were ready to use all the potential PDHRS and14 of 16 PDHRS were feasible to provide. HIV testing kits may be available in pharmacies in the future. Many pharmacy-delivered harm reduction services are feasible and acceptable among PWID in Xichang, China.

  19. Self-harm.

    PubMed

    Skegg, Keren

    The term self-harm is commonly used to describe a wide range of behaviours and intentions including attempted hanging, impulsive self-poisoning, and superficial cutting in response to intolerable tension. As with suicide, rates of self-harm vary greatly between countries. 5-9% of adolescents in western countries report having self-harmed within the previous year. Risk factors include socioeconomic disadvantage, and psychiatric illness--particularly depression, substance abuse, and anxiety disorders. Cultural aspects of some societies may protect against suicide and self-harm and explain some of the international variation in rates of these events. Risk of repetition of self-harm and of later suicide is high. More than 5% of people who have been seen at a hospital after self-harm will have committed suicide within 9 years. Assessment after self-harm includes careful consideration of the patient's intent and beliefs about the lethality of the method used. Strong suicidal intent, high lethality, precautions against being discovered, and psychiatric illness are indicators of high suicide risk. Management after self-harm includes forming a trusting relationship with the patient, jointly identifying problems, ensuring support is available in a crisis, and treating psychiatric illness vigorously. Family and friends may also provide support. Large-scale studies of treatments for specific subgroups of people who self-harm might help to identify more effective treatments than are currently available. Although risk factors for self-harm are well established, aspects that protect people from engaging in self-harm need to be further explored.

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

    PubMed Central

    Broda, Anja; LaPlante, Debi A; Nelson, Sarah E; LaBrie, Richard A; Bosworth, Leslie B; Shaffer, Howard J

    2008-01-01

    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. PMID:18684323

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

    PubMed

    Broda, Anja; LaPlante, Debi A; Nelson, Sarah E; LaBrie, Richard A; Bosworth, Leslie B; Shaffer, Howard J

    2008-08-06

    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. 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. 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. 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.

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

    PubMed

    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.

  3. Harm reduction for drug abusing ex-offenders: outcome of the California prevention and education project MORE project.

    PubMed

    Bowser, Benjamin P; Jenkins-Barnes, Tazima; Dillard-Smith, Carla; Lockett, Gloria

    2010-01-01

    MORE was a mobile outreach drug abuse prevention and HIV harm reduction program primarily for ex-offenders who are active drug users. Through case management, clients were provided substance abuse education, counseling, and referral. Long term goals of these services were to reduce their drug use and re-incarceration for drug related crimes. From January 2002 to May 2006, 487 unduplicated clients were recruited in year long cohorts and offered services. The program evaluation tool was the Federal Office of Budget and Management Government Performance and Results Act questionnaire. Government Performance and Results Act interviews were conducted at in-take into the program, approximately six months later and again approximately 12 months after their initial in-take. By the six and 12 month follow-up interviews, active drug using clients reported significant reductions in their use of alcohol, cocaine/crack, heroin, and fewer sex partners and crimes. Program completers reported significantly reduced cocaine/crack and heroin use as well as fewer days in jail and crimes than non-completers (p < .01 to .001). Six program components account for these reductions: case management, day-treatment, outpatient services, outreach, HIV/AIDS, and substance abuse education. The differences in program service intensity, income, and employment for program completers and non-completers were analyzed using logistic regression. The intensity of case management and all services received along with having higher income by month six were the most significant predictors of program completion.

  4. Differentiating drugs by harm potential: the rational versus the feasible.

    PubMed

    Kalant, H

    1999-01-01

    In an ideal harm reduction model, drugs would be ranked according to their potential to cause harm, with varying implications for control policies and interventions. In such a public health oriented approach, the maximum protection of the public from harm would be balanced with the least possible restriction of freedom. In reality, however, the accuracy and completeness of the necessary information for such a ranking is highly limited. Many other factors not readily incorporated in a rational model, such as values, beliefs, and traditions, also affect drug policy decisions. Thus, rather than relying on acquisition of the necessary knowledge, it may be preferable to focus efforts on developing effective nonlegal measures to reduce drug use and harm. [Translations are provided in the International Abstracts Section of this issue.

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

    PubMed

    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/

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

    PubMed Central

    2011-01-01

    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

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

    PubMed

    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

  8. Reduction of angular divergence of laser-driven ion beams during their acceleration and transport

    NASA Astrophysics Data System (ADS)

    Zakova, M.; Pšikal, Jan; Margarone, Daniele; Maggiore, Mario; Korn, G.

    2015-05-01

    Laser plasma physics is a field of big interest because of its implications in basic science, fast ignition, medicine (i.e. hadrontherapy), astrophysics, material science, particle acceleration etc. 100-MeV class protons accelerated from the interaction of a short laser pulse with a thin target have been demonstrated. With continuing development of laser technology, greater and greater energies are expected, therefore projects focusing on various applications are being formed, e.g. ELIMAIA (ELI Multidisciplinary Applications of laser-Ion Acceleration). One of the main characteristic and crucial disadvantage of ion beams accelerated by ultra-short intense laser pulses is their large divergence, not suitable for the most of applications. In this paper two ways how to decrease beam divergence are proposed. Firstly, impact of different design of targets on beam divergence is studied by using 2D Particlein-cell simulations (PIC). Namely, various types of targets include at foils, curved foil and foils with diverse microstructures. Obtained results show that well-designed microstructures, i.e. a hole in the center of the target, can produce proton beam with the lowest divergence. Moreover, the particle beam accelerated from a curved foil has lower divergence compared to the beam from a flat foil. Secondly, another proposed method for the divergence reduction is using of a magnetic solenoid. The trajectories of the laser accelerated particles passing through the solenoid are modeled in a simple Matlab program. Results from PIC simulations are used as input in the program. The divergence is controlled by optimizing the magnetic field inside the solenoid and installing an aperture in front of the device.

  9. Algicidal activity of thiazolidinedione derivatives against harmful algal blooming species.

    PubMed

    Kim, Yeon-Mi; Wu, Ying; Duong, Thi Uyen; Jung, Seul-Gi; Kim, Si Wouk; Cho, Hoon; Jin, Eonseon

    2012-06-01

    Thiazolidinedione (TD) derivatives exhibit algicidal activity against harmful algal blooming species such as Chattonella marina, Heterosigma akashiwo, and Cochlodinium polykrikoides, as reported previously. In this study, the efficacies and selectivities of TD derivatives were tested by analyzing the structure-activity relationships of various TD derivatives. To investigate structure-activity relationships for growth inhibition of harmful algae, we added a methylene group between the cyclohexyl ring and oxygen of 5-(3-chloro-4-hydroxybenzylidene)-TD, which decreased the inhibitory potency of compound 17. Interestingly, another addition of a methylene group significantly increased the inhibitory potency against C. polykrikoides. The addition of 1 μM compound 17 resulted in the cell rupture of harmful algae after less than 10 h incubation at 20 °C. Compound 17 was applied to both harmful and non-harmful algae and showed a drastic reduction in the efficiency of photosystem II, resulting in reduced photosynthetic oxygen evolution. Compound 17 at a 5 μM concentration destroyed all of the harmful algae, while algicidal activity against non-harmful algae did not exceed 30% of the control within the concentration range tested. In contrast, a herbicide, 3-(3,4-dichlorophenyl)-1,1-dimethylurea, tested at a 5 μM concentration, exhibited 40-70% algicidal activity relative to that of the control against both harmful and non-harmful algae. Compound 17 is a promising lead compound for the development of algicides to control harmful algal blooming species.

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

    PubMed

    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

  11. Mitigating the Harmful Effects of Violent Television

    ERIC Educational Resources Information Center

    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…

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

    PubMed

    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.

  13. Keeping them connected--reducing drug-related harm in Australian schools from a Catholic perspective.

    PubMed

    Norden, Peter

    2008-07-01

    In this Harm Reduction Digest, Father Peter Norden of Jesuit Social Services (Australia) summarises the findings of a report of a consultation into how Catholic schools in Australia address substance use by school students. The report showed that while in the past the 'zero tolerance' approach had been the norm, more recently there had been a growing awareness in Catholic schools that it is possible to respond to the needs of drug-using students while being respectful of the duty of care to other students. Moreover, harm reduction was accepted as a serious objective for drug policy and practice in Australian Catholic schools. The paper canvases the key issues that emerged from the consultation and suggests what 'good practice' looks like, providing useful guidance for both Catholic and non-Catholic schools alike. For those of us outside the Catholic school system, the paper provides an enlightening read about how substance use can be best addressed within schools. Simon Lenton Editor, Harm Reduction Digest.

  14. Empowerment through agency-promoting dialogue: an explicit application of harm reduction theory to reframe HIV test counseling.

    PubMed

    Mattson, M

    2000-01-01

    The counseling that accompanies HIV testing can be an important prevention tool for encouraging people to practice safer sex to avoid AIDS, but there is scant research about how HIV test counseling operates in practice. This article critiques the current Centers for Disease Control and Prevention (CDC) protocol for HIV test counseling for not being genuinely client centered and ignoring the unique needs of clients and offers an alternative approach that adapts and explicitly applies the tenets of harm reduction theory (HRT). Excerpts from actual HIV test counseling sessions illustrate both the weaknesses in the current approach to HIV test counseling and project how the alternative theoretical perspective offered could provide counseling that encourages agency-promoting and empowering dialogue. The implications for the development of HRT as a health communication heuristic and a practical training and evaluation strategy are discussed along with limitations and future research directions.

  15. Trialability, observability and risk reduction accelerating individual innovation adoption decisions.

    PubMed

    Hayes, Kathryn J; Eljiz, Kathy; Dadich, Ann; Fitzgerald, Janna-Anneke; Sloan, Terry

    2015-01-01

    The purpose of this paper is to provide a retrospective analysis of computer simulation's role in accelerating individual innovation adoption decisions. The process innovation examined is Lean Systems Thinking, and the organizational context is the imaging department of an Australian public hospital. Intrinsic case study methods including observation, interviews with radiology and emergency personnel about scheduling procedures, mapping patient appointment processes and document analysis were used over three years and then complemented with retrospective interviews with key hospital staff. The multiple data sources and methods were combined in a pragmatic and reflexive manner to explore an extreme case that provides potential to act as an instructive template for effective change. Computer simulation of process change ideas offered by staff to improve patient-flow accelerated the adoption of the process changes, largely because animated computer simulation permitted experimentation (trialability), provided observable predictions of change results (observability) and minimized perceived risk. The difficulty of making accurate comparisons between time periods in a health care setting is acknowledged. This work has implications for policy, practice and theory, particularly for inducing the rapid diffusion of process innovations to address challenges facing health service organizations and national health systems. Originality/value - The research demonstrates the value of animated computer simulation in presenting the need for change, identifying options, and predicting change outcomes and is the first work to indicate the importance of trialability, observability and risk reduction in individual adoption decisions in health services.

  16. Reducing Lake Erie's Harmful Algal Blooms: Projection and Adoption of Management Plans

    NASA Astrophysics Data System (ADS)

    Martin, J.; Aloysius, N.; Howard, G.; Kalcic, M. M.; Wilson, R. S.; Scavia, D.; Roe, B.

    2016-12-01

    In early 2016, the United States and Canada formally agreed to reduce phosphorus inputs to Lake Erie by 40% to reduce the severity of annual Harmful Algal Blooms (HABs). These blooms have become more severe, with record events occurring in 2011 and 2015, and have compromised public safety, shut down drinking water supplies, and negatively impacted the economy of the western Lake Erie basin. Now, key questions revolve around the ability to reach the 40% reduction, required management changes, and resources to support these changes. This presentation will highlight interdisciplinary research to compare the amount and types of practices needed for this reduction to the current and projected levels of adoption. Economic resources to support these management changes are also compared with the financial support from the general public to improve Lake Erie water quality. Multiple models of the Maumee watershed identified management plans and adoption rates needed to reach the reduction targets. For example, one successful scenario estimated necessary adoption rates of 50% for subsurface application of fertilizer on row crops, 58% for cover crops, and 78% for buffer strips. Current adoption is below these levels, but future projections based on farmer surveys shows these levels are possible. Public support is necessary to generate the funding to support cost sharing and other programs aimed at increasing adoption of recommended practices. Comparing results from willingness-to-pay surveys of the general public with the estimated need for these management plans shows a gap in resources to support these levels of adoption. In general, these results show that accelerated adoption of management plans is needed compared to past adoption rates, but that these rates are possible based on likely adoption rates. Projected support from the general public indicates it will be challenging to fund these rates of adoption, especially during climate changes that may require even greater

  17. Reduction of Effective Acceleration to Microgravity Levels

    NASA Technical Reports Server (NTRS)

    Downey, James P.

    2000-01-01

    Acceleration due to earth's gravity causes buoyancy driven convection and sedimentation in solutions. In addition. pressure gradients occur as a function of the height within a liquid column. Hence gravity effects both equilbria conditions and phase transitions as a result of hydrostatic pressure gradients. The affect of gravity on the rate of heat and man transfer in solutal processes can be particularly important in polymer processing due to the high sensitivity of polymeric materials to processing conditions. The term microgravity has been coined to describe an environment in which the affects of gravitational acceleration am greatly reduced. It may seem odd to talk in term of reducing the effects of gravitational acceleration since gravitational attraction is a basic property of matter. However, die presence of gravity on in situ processing or measurements can be negated by achieving conditions in which the laboratory, or more specifically the container of the experimental materials, a subjected to the same acceleration as the materials themselves. With regard to the laboratory reference frame, there is virtually no force on the experimental solutions. This is difficult to achieve but can be done. A short review of Newtonian physics provides an explanation on both how processes we affected by gravity and how microgravity conditions are achieved. The fact that fluids deform when subject to a force bid solids do not indicates that solids have a structure able to exert an opposing force that negates an externally applied force. Liquids deform when a force is applied, indicating that a liquid structure cannot completely negate an applied force. Just how easily a liquid resists deformation is related to its viscosity. Spaceflight provides an environment in which the laboratory reference frame i.e. the spacecraft and all the equipment therein an experiencing virtually identical forces. There is no solid foundation underneath such a laboratory, so the laboratory

  18. Early Acceleration of Mathematics Students and its Effect on Growth in Self-esteem: A Longitudinal Study

    NASA Astrophysics Data System (ADS)

    Ma, Xin

    2002-11-01

    The Longitudinal Study of American Youth (LSAY) database was employed to examine the educational practice of early acceleration of students of mathematics on the development of their self-esteem across the entire secondary grade levels. Students were classified into three different academic categories (gifted, honors, and regular). Results indicated that, in terms of the development of their self-esteem, gifted students benefited from early acceleration, honors students neither benefited nor were harmed by early acceleration, and regular students were harmed by early acceleration. Early acceleration in mathematics promoted significant growth in self-esteem among gifted male students and among gifted, honors, and regular minority students. When students were accelerated, schools showed similar average growth in self-esteem among gifted students and regular students and a large effect of general support for mathematics on the average growth in self-esteem among honors students.

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

    ERIC Educational Resources Information Center

    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…

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

    PubMed

    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.

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

    PubMed

    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.

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

    PubMed Central

    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

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

    PubMed

    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.

  4. 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.

    PubMed

    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.

  5. 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*

    PubMed Central

    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

  6. Seeing the "Harm" in "Harmed" and "Harmful": Morphological Processing by Children in Grades 4, 6, and 8

    ERIC Educational Resources Information Center

    Deacon, S. Helene; Campbell, Emily; Tamminga, Meredith; Kirby, John

    2010-01-01

    This study examined morphological processing of inflected and derived words by children in Grades 4, 6, and 8. Participants were shown root forms and inflected, derived, and orthographic control items (e.g., "harm", "harmed", "harmful", or "harmony"), followed by a fragment completion task (e.g., completing "h a_ _"). Participants were equally…

  7. Reducing harm from HIV/AIDS misconceptions among female sex workers in Tijuana and Ciudad Juarez, Mexico: A cross sectional analysis.

    PubMed

    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

  8. Reducing harm from HIV/AIDS misconceptions among female sex workers in Tijuana and Ciudad Juarez, Mexico: A cross sectional analysis

    PubMed Central

    2012-01-01

    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 discredit local HIV

  9. Understanding gambling related harm: a proposed definition, conceptual framework, and taxonomy of harms.

    PubMed

    Langham, Erika; Thorne, Hannah; Browne, Matthew; Donaldson, Phillip; Rose, Judy; Rockloff, Matthew

    2016-01-27

    Harm from gambling is known to impact individuals, families, and communities; and these harms are not restricted to people with a gambling disorder. Currently, there is no robust and inclusive internationally agreed upon definition of gambling harm. In addition, the current landscape of gambling policy and research uses inadequate proxy measures of harm, such as problem gambling symptomology, that contribute to a limited understanding of gambling harms. These issues impede efforts to address gambling from a public health perspective. Data regarding harms from gambling was gathered using four separate methodologies, a literature review, focus groups and interviews with professionals involved in the support and treatment of gambling problems, interviews with people who gamble and their affected others, and an analysis of public forum posts for people experiencing problems with gambling and their affected others. The experience of harm related to gambling was examined to generate a conceptual framework. The catalogue of harms experienced were organised as a taxonomy. The current paper proposes a definition and conceptual framework of gambling related harm that captures the full breadth of harms that gambling can contribute to; as well as a taxonomy of harms to facilitate the development of more appropriate measures of harm. Our aim is to create a dialogue that will lead to a more coherent interpretation of gambling harm across treatment providers, policy makers and researchers.

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

    PubMed

    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

  11. Exploring the Use and Effects of Deliberate Self-Harm Websites: An Internet-Based Study

    PubMed Central

    Harris, Isobel Marion

    2013-01-01

    Background 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. Objective 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. Methods 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. Results 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. Conclusions 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

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

    PubMed Central

    Borland, Ron

    2013-01-01

    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. PMID:23591515

  13. [Self-harming behaviour].

    PubMed

    Kool, Nienke; Pollen, Wim; van Meijel, Berno

    2010-01-01

    To gain a better understanding of self-harm, a 28-year-old female patient and a 19-year-old female patient with self-harming behaviour are presented. The first patient refused treatment of cut wounds when the doctor enquired about the reason for self-harm. The second patient was referred for mental health care. These cases illustrate the complexity of this behaviour for the patient and the caregiver. Self-harm is often a symbol of underlying problems and serves multiple psychological functions. It is mostly used by patients to cope with unbearable emotions for which they have no other solution. The self-harm invokes different feelings in caregivers which tend to influence the attitude of the caregiver towards the patient. It is very important that caregivers are aware of their feelings and use them professionally. People who self-harm should not be judged, but treated respectfully and attention should be paid to their suffering.

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

    PubMed

    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

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

    PubMed

    Bowie, Paul; McKay, John; Kelly, Moya

    2012-06-21

    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. 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. 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. A checklist was developed and validated for educational supervisors to assist in the reliable delivery of

  16. Self-Harm

    MedlinePlus

    ... value. Skipping classes to change bandages or avoiding social occasions to prevent people from seeing your scars is a sign that your habit is negatively affecting work and relationships. Why People Self-harm Self-harm is not a mental illness, but ...

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

    PubMed

    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.

  18. Harm, change, and time.

    PubMed

    Belshaw, Christopher

    2012-10-01

    What is harm? I offer an account that involves the victim's either suffering some adverse intrinsic change or being prevented from enjoying some beneficial intrinsic change. No one is harmed, I claim, in virtue of relational changes alone. Thus (excepting for contrived cases), there are neither posthumous harms nor, in life, harms of the undiscovered betrayal, slander, reputation-damaging variety. Further, two widespread moves in the philosophy of death are rejected. First, death and posthumous are not to be assimilated--death does bring about adverse internal change and harms us straightforwardly. Second, Pitcher-type accounts of posthumous harm are criticized--posthumous events can thwart the satisfaction of my interests, but I am not harmed either just when this occurs or, earlier, when I first acquire or invest in those interests. We have other ways of describing what is going on.

  19. The District Nursing Clinical Error Reduction Programme.

    PubMed

    McGraw, Caroline; Topping, Claire

    2011-01-01

    The District Nursing Clinical Error Reduction (DANCER) Programme was initiated in NHS Islington following an increase in the number of reported medication errors. The objectives were to reduce the actual degree of harm and the potential risk of harm associated with medication errors and to maintain the existing positive reporting culture, while robustly addressing performance issues. One hundred medication errors reported in 2007/08 were analysed using a framework that specifies the factors that predispose to adverse medication events in domiciliary care. Various contributory factors were identified and interventions were subsequently developed to address poor drug calculation and medication problem-solving skills and incorrectly transcribed medication administration record charts. Follow up data were obtained at 12 months and two years. The evaluation has shown that although medication errors do still occur, the programme has resulted in a marked shift towards a reduction in the associated actual degree of harm and the potential risk of harm.

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

    PubMed

    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. Tobacco Harm Reduction with Vaporised Nicotine (THRiVe): The Study Protocol of an Uncontrolled Feasibility Study of Novel Nicotine Replacement Products among People Living with HIV Who Smoke.

    PubMed

    Bell, Stephanie; Dean, Judith; Gilks, Charles; Boyd, Mark A; Fitzgerald, Lisa; Mutch, Allyson; Baker, Peter; Neilsen, Graham; Gartner, Coral E

    2017-07-18

    Smoking is a leading cause of morbidity and premature mortality among people living with HIV (PLHIV), who have high rates of tobacco smoking. Vaporised nicotine products (VNPs) are growing in popularity as a quit aid and harm reduction tool. However, little is known about their acceptability and use among PLHIV. Using a pragmatic, uncontrolled, mixed methods design this exploratory clinical trial aims to examine the feasibility of conducting a powered randomised clinical trial of VNPs as a smoking cessation and harm reduction intervention among vulnerable populations, such as PLHIV who smoke tobacco. Convenience sampling and snowball methods will be used to recruit participants (N = 30) who will receive two VNPs and up to 12 weeks' supply of nicotine e-liquid to use in a quit attempt. Surveys will be completed at weeks 0 (baseline), 4, 8, 12 (end of treatment) and 24 (end of the study) and qualitative interviews at weeks 0 and 12. As far as we are aware, this feasibility study is the first to trial VNPs among PLHIV for smoking cessation. If feasible and effective, this intervention could offer a new approach to reducing the high burden of tobacco-related disease among PLHIV and other vulnerable populations.

  2. Brief psychological intervention after self-harm: randomised controlled trial from Pakistan.

    PubMed

    Husain, Nusrat; Afsar, Salahuddin; Ara, Jamal; Fayyaz, Hina; Rahman, Raza Ur; Tomenson, Barbara; Hamirani, Munir; Chaudhry, Nasim; Fatima, Batool; Husain, Meher; Naeem, Farooq; Chaudhry, Imran B

    2014-06-01

    Self-harm is a major risk factor for completed suicide. To determine the efficacy of a brief psychological intervention - culturally adapted manual-assisted problem-solving training (C-MAP) - delivered following an episode of self-harm compared with treatment as usual (TAU). The study was a randomised controlled assessor-masked clinical trial (trial registration: ClinicalTrials.gov NCT01308151). All patients admitted after an episode of self-harm during the previous 7 days to the participating medical units of three university hospitals in Karachi, Pakistan, were included in the study. A total of 250 patients were screened and 221 were randomly allocated to C-MAP plus treatment as usual (TAU) or to TAU alone. All patients were assessed at baseline, at 3 months (end of intervention) and at 6 months after baseline. The primary outcome measure was reduction in suicidal ideation at 3 months. The secondary outcome measures included hopelessness, depression, coping resources and healthcare utilisation. A total of 108 patients were randomised to the C-MAP group and 113 to the TAU group. Patients in the C-MAP group showed statistically significant improvement on the Beck Scale for Suicide Ideation and Beck Hopelessness Inventory, which was sustained at 3 months after the completion of C-MAP. There was also a significant reduction in symptoms of depression compared with patients receiving TAU. The positive outcomes of this brief psychological intervention in patients attempting self-harm are promising and suggest that C-MAP may have a role in suicide prevention. Royal College of Psychiatrists.

  3. Still “at risk”: An examination of how street-involved young people understand, experience, and engage with “harm reduction” in Vancouver’s inner city

    PubMed Central

    Bozinoff, Nikki; Small, Will; Long, Cathy; DeBeck, Kora; Fast, Danya

    2017-01-01

    Background Vancouver is an international leader in implementing interventions to reduce harms related to drug use. However, street-involved young people who use drugs continue to be vulnerable to overdose death, hepatitis C (HCV) infection, and high rates of syringe sharing. To better understand this in the context of the intensive public health response, we examined how young people, who are involved in the ‘street drug scene’, understood, experienced and engaged with harm reduction. Methods Twelve semi-structured interviews were conducted in 2013 with 13 young people (ages 17–28) recruited from the At-Risk Youth Study, a prospective cohort of street-involved and drug-using young people. These interviews were embedded within a larger, eight-year program of ethnographic research and explored participants’ understandings of harm reduction, their use of specific services, and their ideas about improving their day-to-day lives. Interviews were transcribed verbatim and a thematic analysis was performed. Results Young peoples’ ideas about harm reduction were diverse and expansive. They articulated the limitations of existing programs, indicating that while they are positioned to reduce the risk of HIV and HCV transmission, they offer little meaningful support to improve young peoples’ broader life chances. Young people described strategies to mitigate risk and harm in their own lives, including transitioning to drugs deemed less harmful and attempting to gain access to drug treatment. Finally, young people indicated that spatial considerations (e.g., distance from Vancouver’s Downtown Eastside) strongly determined access to services. Conclusions In Vancouver, a large, well established harm reduction infrastructure seeks to reduce HIV and HCV transmission among street-involved young people. However, young peoples’ multiple understandings, experiences and engagements with harm reduction in this setting illustrate the limitations of the existing

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

    PubMed Central

    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

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

    PubMed

    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.

  6. Social-emotional characteristics of gifted accelerated and non-accelerated students in the Netherlands.

    PubMed

    Hoogeveen, Lianne; van Hell, Janet G; Verhoeven, Ludo

    2012-12-01

    In the studies of acceleration conducted so far a multidimensional perspective has largely been neglected. No attempt has been made to relate social-emotional characteristics of accelerated versus non-accelerated students in perspective of environmental factors. In this study, social-emotional characteristics of accelerated gifted students in the Netherlands were examined in relation to personal and environmental factors. Self-concept and social contacts of accelerated (n = 148) and non-accelerated (n = 55) gifted students, aged 4 to 27 (M = 11.22, SD = 4.27) were measured. Self-concept and social contacts of accelerated and non-accelerated gifted students were measured using a questionnaire and a diary, and parents of these students evaluated their behavioural characteristics. Gender and birth order were studied as personal factors and grade, classroom, teachers' gender, teaching experience, and the quality of parent-school contact as environmental factors. The results showed minimal differences in the social-emotional characteristics of accelerated and non-accelerated gifted students. The few differences we found favoured the accelerated students. We also found that multiple grade skipping does not have negative effects on social-emotional characteristics, and that long-term effects of acceleration tend to be positive. As regards the possible modulation of personal and environmental factors, we merely found an impact of such factors in the non-accelerated group. The results of this study strongly suggest that social-emotional characteristics of accelerated gifted students and non-accelerated gifted students are largely similar. These results thus do not support worries expressed by teachers about the acceleration of gifted students. Our findings parallel the outcomes of earlier studies in the United States and Germany in that we observed that acceleration does not harm gifted students, not even in the case of multiple grade skipping. On the contrary, there is a

  7. Approximate classification of mining tremors harmfulness based on free-field and building foundation vibrations

    NASA Astrophysics Data System (ADS)

    Kuzniar, Krystyna; Stec, Krystyna; Tatara, Tadeusz

    2018-04-01

    The paper compares the results of an approximate evaluation of mining tremors harmfulness performed on the basis of free-field and simultaneously measured building foundation vibrations. The focus is on the office building located in the Upper Silesian Basin (USB). The empirical Mining Intensity Scale GSI-GZWKW-2012 has been applied to classify the harmfulness of the rockbursts. This scale is based on the measurements of free-field vibrations but, for research purposes, it was also used in the cases of building foundation vibrations. The analysis was carried out using the set of 156 pairs ground - foundation of velocity vibration records as well as the set of 156 pairs of acceleration records induced by the same mining tremors.

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

    PubMed Central

    2012-01-01

    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 validated for educational

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

    PubMed

    Lo, Feng En; Lu, Po Jung; Tsai, Min Kuang; Lee, June Han; Wen, Christopher; Wen, Chi Pang; Wai, Jackson Pui Man; Tsao, Chwen Keng; Chiang, Po Huang; Lyu, Shu Yu; Ma, Ko Lu; Chi, Ying-Chen; Li, Chu-Shiu; Liu, Chwen-Chi; Wu, Xifeng

    2016-01-01

    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.

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

    PubMed

    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.

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

    ERIC Educational Resources Information Center

    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…

  12. Assessing seasonality of travel distance to harm reduction service providers among persons who inject drugs.

    PubMed

    Allen, Sean T; Ruiz, Monica S; Roess, Amira; Jones, Jeff

    2015-10-12

    Prior research has examined access to syringe exchange program (SEP) services among persons who inject drugs (PWID), but no research has been conducted to evaluate variations in SEP access based on season. This is an important gap in the literature given that seasonal weather patterns and inclement weather may affect SEP service utilization. The purpose of this research is to examine differences in access to SEPs by season among PWID in the District of Columbia (DC). A geometric point distance estimation technique was applied to records from a DC SEP that operated from 1996 to 2011. We calculated the walking distance (via sidewalks) from the centroid point of zip code of home residence to the exchange site where PWID presented for services. Analysis of variance (ANOVA) was used to examine differences in walking distance measures by season. Differences in mean walking distance measures were statistically significant between winter and spring with PWID traveling approximately 2.88 and 2.77 miles, respectively, to access the SEP during these seasons. The results of this study suggest that seasonal differences in SEP accessibility may exist between winter and spring. PWID may benefit from harm reduction providers adapting their SEP operations to provide a greater diversity of exchange locations during seasons in which inclement weather may negatively influence engagement with SEPs. Increasing the number of exchange locations based on season may help resolve unmet needs among injectors.

  13. Self-harm and life problems: findings from the Multicentre Study of Self-harm in England.

    PubMed

    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.

  14. “Just Advil”: Harm reduction and identity construction in the consumption of Over-The-Counter medication for chronic pain Social Science & Medicine

    PubMed Central

    2015-01-01

    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 medication 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

  15. Suicide Following Deliberate Self-Harm.

    PubMed

    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.

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

    PubMed Central

    2012-01-01

    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. PMID:22817679

  17. Addiction, agency, and the politics of self-control: doing harm reduction in a heroin users' group.

    PubMed

    Gowan, Teresa; Whetstone, Sarah; Andic, Tanja

    2012-04-01

    Our 2007-2009 ethnography describes and analyses the practice of harm reduction in a heroin users' group in the midwestern United States. While dominant addiction interventions conceptualize the addict as powerless - either through moral or physical weakness - this group contested such "commonsense," treating illicit drug use as one of many ways that modern individuals attempt to "fill the void." Insisting on the destigmatization of addiction and the normalization of illicit drug use, the group helped its members work on incremental steps toward self-management. Although "Connection Points" had very limited resources to improve the lives of its members, our work suggests that the users' group did much to restore self-respect, rational subjectivity, and autonomy to a group historically represented as incapable of reason and self-control. As the users cohered as a community, they developed a critique of the oppressions suffered by "junkies," discussed their rights and entitlements, and even planned the occasional political action. Engaging with literature on the cultural construction of agency and responsibility, we consider, but ultimately complicate, the conceptualization of needle exchange as a "neoliberal" form of population management. Within the context of the United States' War on Drugs, the group's work on destigmatization, health education, and the practice of incremental control showed the potential for reassertions of social citizenship within highly marginal spaces. Copyright © 2012 Elsevier Ltd. All rights reserved.

  18. Decreasing Malpractice Claims by Reducing Preventable Perinatal Harm.

    PubMed

    Riley, William; Meredith, Les W; Price, Rebecca; Miller, Kristi K; Begun, James W; McCullough, Mac; Davis, Stanley

    2016-12-01

    To evaluate the association of improved patient safety practices with medical malpractice claims and costs in the perinatal units of acute care hospitals. Malpractice and harm data from participating hospitals; litigation records and medical malpractice claims data from American Excess Insurance Exchange, RRG, whose data are managed by Premier Insurance Management Services, Inc. (owned by Premier Inc., a health care improvement company). A quasi-experimental prospective design to compare baseline and postintervention data. Statistical significance tests for differences were performed using chi-square, Wilcoxon signed-rank test, and t-test. Claims data were collected and evaluated by experienced senior claims managers through on-site claim audits to evaluate claim frequency, severity, and financial information. Data were provided to the analyzing institution through confidentiality contracts. There is a significant reduction in the number of perinatal malpractice claims paid, losses paid, and indemnity payments (43.9 percent, 77.6 percent, and 84.6 percent, respectively) following interventions to improve perinatal patient safety and reduce perinatal harm. This compares with no significant reductions in the nonperinatal claims in the same hospitals during the same time period. The number of perinatal malpractice claims and dollar amount of claims payments decreased significantly in the participating hospitals, while there was no significant decrease in nonperinatal malpractice claims activity in the same hospitals. © Health Research and Educational Trust.

  19. Self-harm history predicts resistance to inpatient treatment of body shape aversion in women with eating disorders: The role of negative affect.

    PubMed

    Olatunji, Bunmi O; Cox, Rebecca; Ebesutani, Chad; Wall, David

    2015-06-01

    Although self-harm has been observed among patients with eating disorders, the effects of such tendencies on treatment outcomes are unclear. The current study employed structural equation modeling to (a) evaluate the relationship between self-harm and changes in body dissatisfaction and drive for thinness in a large sample of patients (n = 2061) who underwent inpatient treatment, and (b) to examine whether the relationship between self-harm and changes in body dissatisfaction and drive for thinness during inpatient treatment remains significant when controlling for change in negative affect during treatment. Results revealed that patients with a history of self-harm reported significantly less reduction in body dissatisfaction and drive for thinness following treatment. Patients experiencing less change in negative affect also reported significantly less reduction in body dissatisfaction and drive for thinness after discharge from treatment. However, the association between history of self-harm and reduction in body dissatisfaction and drive for thinness after treatment became non-significant when controlling for change in negative affect. This pattern of findings was also replicated among patients with a primary diagnosis of anorexia nervosa (n = 845), bulimia nervosa (n = 565), and eating disorder not otherwise specified (n = 651). The implications of these findings for delineating the specific role of self-harm in the nature and treatment of eating disorders are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. The harms of prostitution: critiquing Moen's argument of no-harm.

    PubMed

    Westin, Anna

    2014-02-01

    In this short critical analysis, the author examines the recent argument by Moen in his article 'Is Prostitution Harmful?' In highlighting why prostitution does not cause harm to either member involved in the act, Moen argues that prostitution is not an ethical concern. However, while Moen is able to clearly challenge contemporary objections to prostitution, the author of this review will suggest that Moen's argument is itself incomplete as it does not address essential key ontological issues. This critical analysis will briefly suggest why this omission weakens Moen's argument. Finally, it will conclude with examining why prostitution differs substantially from other professions through the type of harm that it causes to the moral agents involved.

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

    PubMed Central

    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

  2. How an integrated change programme has accelerated the reduction in high hazard nuclear facilities at Sellafield

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Mackintosh, Angela

    For over five decades the Sellafield Site has been central to the UK's nuclear programme. Now operated by Sellafield Ltd, under the management of Parent Body Organisation Nuclear Management Partners (NMP), a consortium of URS Washington Division, AMEC and AREVA is focussed on the decommissioning of historical facilities. When Decommissioning commenced in the late 1980's the site focus at that time was on commercial reprocessing and waste management. Now through the implementation of a company change programme, emphasis has shifted towards accelerated risk and hazard reduction of degraded legacy plants with nuclear inventory whilst ensuring value for money for themore » customer, the Nuclear Decommissioning Authority. This paper will describe the management success by the Site owners in delivering a successful change programme. The paper will explain how the site has transitioned to the INPO Standard Nuclear Performance Model (SNPM) and how through the use of a change maturity matrix has contributed to the accelerated reduction in high risk high hazard nuclear facilities. The paper will explain in detail how the Decommissioning Programme Office has facilitated and coordinated the Governance and assured delivery of the change plan and how successful application of visual management has aided the communication of its progress. Finally, the paper will discuss how the Delivery Schedules have proved critical for presenting the change plan to Key Stakeholders, Government Owners and Powerful Regulators. Overall, this paper provides an insight into how a massive change programme is being managed within one of the world's highest regulated industries. (authors)« less

  3. Immediate effects on adult drinkers of exposure to alcohol harm reduction advertisements with and without drinking guideline messages: experimental study.

    PubMed

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

    2018-06-01

    To compare the immediate effects on drinkers of television advertisements focusing upon short- versus long-term harms with and without low-risk drinking guidelines. Between-participants on-line experiment, with random assignment to view: (a) alcohol product advertisements (ALC control); (b) advertisements unrelated to alcohol (NON-ALC control); (c) advertisements featuring short-term harms (STH) of alcohol; (d) advertisements featuring STH plus a STH guideline (STH+G); (e) advertisements featuring long-term harms (LTH); or (f) advertisements featuring LTH plus a LTH guideline (LTH+G). Australia, 2016. A total of 3718 drinkers aged 18-64 years (48.5% male). Post-exposure likelihood that participants provided a correct estimate of drinking levels associated with short- and long-term harms; post-exposure intentions to avoid alcohol or reduce consumption. After exposure to STH+G or LTH+G advertisements, participants were more likely to estimate correctly rather than overestimate drinking levels associated with harm, compared with those exposed to STH (P < 0.001) and LTH advertisements without guidelines, respectively (P = 0.019) and ALC control (STH+G, P < 0.001; LTH+G, P < 0.001) and NON-ALC control conditions (STH+G, P < 0.001; LTH+G, P = 0.011). Drinkers exposed to STH conditions were more likely to intend to reduce next-week alcohol consumption than those exposed to ALC control (both P < 0.001) and NON-ALC control conditions (STH, P = 0.001; STH+G, P < 0.001); a similar pattern was observed for intentions to avoid alcohol. Drinkers exposed to LTH conditions were also more likely than drinkers exposed to ALC or NON-ALC controls to intend to avoid and reduce alcohol in the next week. Additionally, drinkers exposed to LTH+G were more likely to intend to reduce drinking than those exposed to LTH advertisements without guidelines (P = 0.022). Response patterns for low- and high-risk drinkers by condition were similar. Alcohol harm television

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

    PubMed

    Jørgensen, Karsten Juhl

    2013-04-01

    The rationale for breast cancer screening with mammography is deceptively simple: catch it early and reduce mortality from the disease and the need for mastectomies. But breast cancer is a complex problem, and complex problems rarely have simple solutions. Breast screening brings forward the time of diagnosis only slightly compared to the lifetime of a tumour, and screen-detected tumours have a size where metastases are possible. A key question is if screening can prevent metastases, and if the screen-detected tumours are small enough to allow breast conserving surgery rather than mastectomy. A mortality reduction can never justify a medical intervention in its own right, but must be weighed against the harms. Overdiagnosis is the most important harm of breast screening, but has gained wider recognition only in recent years. Screening leads to the detection and treatment of breast cancers 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 the justification of breast screening is therefore not a simple question of whether screening reduces breast cancer mortality. This dissertation quantifies the primary benefits and harms of screening mammography. Denmark has an unscreened "control group" because only two geographical regions offered screening over a long time-period, which is unique in an international context. This was used to study breast cancer mortality, overdiagnosis, and the use of mastectomies. Also, a systematic review of overdiagnosis in five other countries allowed us to show that about half of the screen-detected breast cancers are overdiagnosed. An effect on breast cancer mortality is doubtful in today's setting, and overdiagnosis causes an increase in the use of mastectomies. These findings are

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

    PubMed

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

    2018-03-01

    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. © 2017 Australasian Professional Society on Alcohol and other Drugs.

  6. Interested consumers' awareness of harmful chemicals in everyday products.

    PubMed

    Hartmann, Sabrina; Klaschka, Ursula

    2017-01-01

    Everyday products can contain a multitude of harmful substances unnoticed by most consumers, because established risk communication channels reach only part of the society. The question is, whether at least interested and informed consumers are able to use risk communication tools and assess harmful chemicals in products. An online survey investigated the awareness of 1030 consumers on harmful substances in everyday items. Participating consumers' education level, knowledge in chemistry, and motivation were above society's average. Although a large number of responses showed that survey participants were familiar with several aspects of the issue, the results revealed that knowledge in chemistry helped, but was not enough. Many participants assumed that products with an eco-label, natural personal care products, products without hazard pictograms or products produced in the European Union would not contain harmful substances. Most participants indicated to use hazard pictograms, information on the packaging, reports in the media, and environmental and consumer organizations as information sources, while information by authorities and manufacturers were not named frequently and did not receive high confidence. Smartphone applications were not indicated by many participants as information sources. The information sources most trusted were environmental and consumer organizations, hazard pictograms, and lists of ingredients on the containers. The declared confidence in certain risk communication instruments did not always correspond to the use frequencies indicated. Nearly all participants considered legislators as responsible for the reduction of harmful substances in consumer products. Misconceptions about harmful substances in products can be dangerous for the personal health and the environment. The survey indicates that motivation, educational level, and chemical expertise do not automatically provide an appropriate understanding of harmful substances in products

  7. Repetition of self-harm and suicide following self-harm in children and adolescents: findings from the Multicentre Study of Self-harm in England.

    PubMed

    Hawton, Keith; Bergen, Helen; Kapur, Navneet; Cooper, Jayne; Steeg, Sarah; Ness, Jennifer; Waters, Keith

    2012-12-01

    Self-harm (intentional self-poisoning and self-injury) in children and adolescents is often repeated and is associated with increased risk of future suicide. We have investigated factors associated with these outcomes. We used data collected in the Multicentre Study of Self-harm in England on all self-harm hospital presentations by individuals aged 10-18 years between 2000 and 2007, and national death information on these individuals to the end of 2010. Cox hazard proportional models were used to identify independent and multivariable predictors of repetition of self-harm and of suicide. Repetition of self-harm occurred in 27.3% of individuals (N = 3920) who presented between 2000 and 2005 and were followed up until 2007. Multivariate analysis showed that repetition was associated with age, self-cutting, and previous self-harm and psychiatric treatment. Of 51 deaths in individuals who presented between 2000 and 2007 and were followed up to 2010 (N = 5133) half (49.0%) were suicides. The method used was usually different to that used for self-harm. Multivariate analysis showed that suicide was associated with male gender [Hazard ratio (HR) = 2.4, 95% CI 1.2-4.8], self-cutting (HR = 2.1, 95% CI 1.1-3.7) and prior psychiatric treatment at initial presentation (HR = 4.2, 95% CI 1.7-10.5). It was also associated with self-cutting and history of psychiatric treatment at the last episode before death, and history of previous self harm. Self-cutting as a method of self-harm in children and adolescents conveys greater risk of suicide (and repetition) than self-poisoning although different methods are usually used for suicide. The findings underline the need for psychosocial assessment in all cases. © 2012 The Authors. Journal of Child Psychology and Psychiatry © 2012 Association for Child and Adolescent Mental Health.

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

    PubMed Central

    Loumakou, Maria; Brouskeli, Vasiliki; Sarafidou, Jasmin-Olga

    2006-01-01

    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. PMID:16569250

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

    PubMed

    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.

  10. Intelligent glasses, watches and vests…oh my! Rethinking the meaning of "harm" in the age of wearable technologies.

    PubMed

    Jadad, Alejandro R; Fandiño, Marcela; Lennox, Robin

    2015-02-05

    The widespread release and adoption of wearable devices will likely accelerate the "hybrid era", already initiated by mobile digital devices, with progressively deeper levels of human-technology co-evolution and increasing blurring of our boundaries with machines. Questions about the potentially harmful nature of information and communication technologies have been asked before, since the introduction of the telephone, the Web, and more recently, mobile phones. Our capacity to answer them now is limited by outdated conceptual approaches to harm, mostly derived from drug evaluation; and by the slow and static nature of traditional research tools. In this article, we propose a re-conceptualizing of the meaning of "harm", which builds on a global effort focused on health, adding flexibility and richness within a context that acknowledges the physical, mental, and social domains in which it can occur.

  11. Reduction of the coupling vibration between the bending vibrators of the frequency-change-type two-axis acceleration sensor

    NASA Astrophysics Data System (ADS)

    Sugawara, Sumio; Sasaki, Yoshifumi; Kudo, Subaru

    2018-07-01

    The frequency-change-type two-axis acceleration sensor uses a cross-type vibrator consisting of four bending vibrators. When coupling vibration exists between these four bending vibrators, the resonance frequency of each vibrator cannot be adjusted independently. In this study, methods of reducing the coupling vibration were investigated by finite-element analysis. A method of adjusting the length of the short arm of each vibrator was proposed for reducing the vibration. When piezoelectric ceramics were bonded to the single-sided surface of the vibrator, the method was not sufficient. Thus, the ceramics with the same dimensions were bonded to double-sided surfaces. As a result, a marked reduction was obtained in this case. Also, the linearity of the sensor characteristics was significantly improved in a small acceleration range. Accordingly, it was clarified that considering the symmetry along the thickness direction of the vibrator is very important.

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

    PubMed Central

    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

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

    PubMed

    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).

  14. Vaporised nicotine and tobacco harm reduction for addressing smoking among people living with HIV: A cross-sectional survey of Australian HIV health practitioners' attitudes.

    PubMed

    Bell, Stephanie K; Mena, Gabriela; Dean, Judith; Boyd, Mark; Gilks, Charles; Gartner, Coral

    2017-08-01

    Tobacco smoking is a major cause of morbidity and mortality among people living with HIV (PLHIV). Due to the limited success of standard abstinence-focused smoking cessation strategies in this population, there is growing interest in tobacco harm reduction (THR) approaches as an additional strategy to address these high smoking rates. This study explored the attitudes of health practitioners who provide healthcare to PLHIV towards THR. 179 Australian health practitioners who provide healthcare to PLHIV completed an online survey that measured their attitudes towards THR approaches, including switching from cigarettes to e-cigarettes or vaporised nicotine products (VNPs). Respondents supported the concept of THR but were undecided on the role of VNPs. Respondents most commonly reported 'don't know' or 'undecided' responses to statements regarding VNPs. More respondents, however, agreed than disagreed that switching from smoking to long-term vaping could reduce risk (36% and 22% respectively) and be an effective strategy to help PLHIV to quit smoking (37% agree and 17% disagree). Only a minority of respondents (20%) agreed that VNPs are too harmful to recommend to patients, however around half (53%) were undecided. Despite supporting the principle of THR, health practitioners may require more evidence and knowledge about VNPs before being willing to consider them as a suitable intervention strategy. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Harm and the Boundaries of Disease.

    PubMed

    McGivern, Patrick; Sorial, Sarah

    2017-08-01

    What is the relationship between harm and disease? Discussions of the relationship between harm and disease typically suffer from two shortcomings. First, they offer relatively little analysis of the concept of harm itself, focusing instead on examples of clear cases of harm such as death and dismemberment. This makes it difficult to evaluate such accounts in borderline cases, where the putative harms are less severe. Second, they assume that harm-based accounts of disease must be understood normatively rather than naturalistically, in the sense that they are inherently value based. This makes such accounts vulnerable to more general objections of normative accounts of disease. Here we draw on an influential account of harm from the philosophy of law to develop a harm-based account of disease that overcomes both of these shortcomings. © The Author 2017. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Prison suicides and self-harming behaviours in Italy, 1990-2002.

    PubMed

    Preti, Antonio; Cascio, Maria Teresa

    2006-04-01

    Data on suicides, attempted suicides and other self-harming behaviours that occurred in Italian prisons from 1990 to 2002 was studied on official records, as documented by the Ministry of Justice. Over the study interval, completed suicide rates in Italian prisons were constantly about ten times higher than among the general population, but over time they did not increase significantly despite nearly a doubling in the absolute number of inmates. The rate of completed suicides in overcrowded prisons was about ten times higher than in non-overcrowded ones. Attempted suicides were about ten times higher than completed suicides, with females being significantly more likely to attempt to take their own lives and males being more likely to complete suicide. Self-injuring acts without the intent to die involve about one in every ten individuals, with foreigners (non-EU citizens mostly) being twice as likely to self-harm than residents. A better identification of the people suffering from mental disorders and a reduction in prison overcrowding are two key issues that need to be implemented to reduce the impact of suicide and self-harming behaviours among convicts.

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

    PubMed

    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.

  18. Incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England (the iceberg model of self-harm): a retrospective study.

    PubMed

    Geulayov, Galit; Casey, Deborah; McDonald, Keltie C; Foster, Pauline; Pritchard, Kirsty; Wells, Claudia; Clements, Caroline; Kapur, Navneet; Ness, Jennifer; Waters, Keith; Hawton, Keith

    2018-02-01

    Little is known about the relative incidence of fatal and non-fatal self-harm in young people. We estimated the incidence of suicide, hospital-presenting non-fatal self-harm, and community-occurring non-fatal self-harm in adolescents in England. We used national mortality statistics (Jan 1, 2011, to Dec 31, 2013), hospital monitoring data for five hospitals derived from the Multicentre Study of Self-Harm in England (Jan 1, 2011, to Dec 31, 2013), and data from a schools survey (2015) to estimate the incidence of fatal and non-fatal self-harm per 100 000 person-years in adolescents aged 12-17 years in England. We described these incidences in terms of an iceberg model of self-harm. During 2011-13, 171 adolescents aged 12-17 years died by suicide in England (119 [70%] male and 133 [78%] aged 15-17 years) and 1320 adolescents presented to the study hospitals following non-fatal self-harm (1028 [78%] female and 977 [74%] aged 15-17 years). In 2015, 322 (6%) of 5506 adolescents surveyed reported self-harm in the past year in the community (250 [78%] female and 164 [51%] aged 15-17 years). In 12-14 year olds, for every boy who died by suicide, 109 attended hospital following self-harm and 3067 reported self-harm in the community, whereas for every girl who died by suicide, 1255 attended hospital for self-harm and 21 995 reported self-harm in the community. In 15-17 year olds, for every male suicide, 120 males presented to hospital with self-harm and 838 self-harmed in the community; whereas for every female suicide, 919 females presented to hospital for self-harm and 6406 self-harmed in the community. Hanging or asphyxiation was the most common method of suicide (125 [73%] of 171), self-poisoning was the main reason for presenting to hospital after self-harm (849 [71%] of 1195), and self-cutting was the main method of self-harm used in the community (286 [89%] of 322). Ratios of fatal to non-fatal rates of self-harm differed between males and females and between

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

    PubMed Central

    2012-01-01

    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 delivered. There were 3 first

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

    PubMed

    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

  1. Adolescent self-harm and risk factors.

    PubMed

    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.

  2. Peer engagement in harm reduction strategies and services: a critical case study and evaluation framework from British Columbia, Canada.

    PubMed

    Greer, Alissa M; Luchenski, Serena A; Amlani, Ashraf A; Lacroix, Katie; Burmeister, Charlene; Buxton, Jane A

    2016-05-27

    Engaging people with drug use experience, or 'peers,' in decision-making helps to ensure harm reduction services reflect current need. There is little published on the implementation, evaluation, and effectiveness of meaningful peer engagement. This paper aims to describe and evaluate peer engagement in British Columbia from 2010-2014. A process evaluation framework specific to peer engagement was developed and used to assess progress made, lessons learned, and future opportunities under four domains: supportive environment, equitable participation, capacity building and empowerment, and improved programming and policy. The evaluation was conducted by reviewing primary and secondary qualitative data including focus groups, formal documents, and meeting minutes. Peer engagement was an iterative process that increased and improved over time as a consequence of reflexive learning. Practical ways to develop trust, redress power imbalances, and improve relationships were crosscutting themes. Lack of support, coordination, and building on existing capacity were factors that could undermine peer engagement. Peers involved across the province reviewed and provided feedback on these results. Recommendations from this evaluation can be applied to other peer engagement initiatives in decision-making settings to improve relationships between peers and professionals and to ensure programs and policies are relevant and equitable.

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

    PubMed

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

    2018-06-01

    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.

  4. Are long physician working hours harmful to patient safety?

    PubMed

    Ehara, Akira

    2008-04-01

    Pediatricians of Japanese hospitals including not only residents but also attending physicians work long hours, and 8% work for >79 h per week. Most of them work consecutively for >or=32 h when they are on call. The aim of the present study was to evaluate the effect of long work hours on patient safety. The electronic databases MEDLINE and EMBASE to searched identify the English- and Japanese-language literature for studies on work hours, medical errors, patient safety, and malpractice for years 1966-2005. Studies that analyzed the relationship between physician work hours and outcomes directly related to patient safety were selected. Seven studies met the criteria. Four studies suggest that reduction of work hours has a favorable effect on patient safety indicators. In the other three studies no significant changes of the indicators were observed, but no report found that shorter work hours were harmful to patient safety. Decrease of physician work hours is not harmful but favorable to patient safety.

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

    PubMed

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

    2001-04-04

    Suspended algae, or phytoplankton, are the prime source of organic matter supporting food webs in freshwater ecosystems. Phytoplankton productivity is reliant on adequate nutrient supplies; however, increasing rates of nutrient supply, much of it manmade, fuels accelerating primary production or eutrophication. An obvious and problematic symptom of eutrophication is rapid growth and accumulations of phytoplankton, leading to discoloration of affected waters. These events are termed blooms. Blooms are a prime agent of water quality deterioration, including foul odors and tastes, deoxygenation of bottom waters (hypoxia and anoxia), toxicity, fish kills, and food web alterations. Toxins produced by blooms can adversely affect animal (including human) health in waters used for recreational and drinking purposes. Numerous freshwater genera within the diverse phyla comprising the phytoplankton are capable of forming blooms; however, the blue-green algae (or cyanobacteria) are the most notorious bloom formers. This is especially true for harmful toxic, surface-dwelling, scum-forming genera (e.g., Anabaena, Aphanizomenon, Nodularia, Microcystis) and some subsurface bloom-formers (Cylindrospermopsis, Oscillatoria) that are adept at exploiting nutrient-enriched conditions. They thrive in highly productive waters by being able to rapidly migrate between radiance-rich surface waters and nutrient-rich bottom waters. Furthermore, many harmful species are tolerant of extreme environmental conditions, including very high light levels, high temperatures, various degrees of desiccation, and periodic nutrient deprivation. Some of the most noxious cyanobacterial bloom genera (e.g., Anabaena, Aphanizomenon, Cylindrospermopsis, Nodularia) are capable of fixing atmospheric nitrogen (N2), enabling them to periodically dominate under nitrogen-limited conditions. Cyanobacteria produce a range of organic compounds, including those that are toxic to higher-ranked consumers, from zooplankton

  6. The impact of harm reduction programs and police interventions on the number of syringes collected from public spaces. A time series analysis in Barcelona, 2004-2014.

    PubMed

    Espelt, A; Villalbí, J R; Bosque-Prous, M; Parés-Badell, O; Mari-Dell'Olmo, M; Brugal, M T

    2017-12-01

    To estimate the effect of opening two services for people who use drugs and three police interventions on the number of discarded syringes collected from public spaces in Barcelona between 2004 and 2014. We conducted an interrupted time-series analysis of the monthly number of syringes collected from public spaces during this period. The dependent variable was the number of syringes collected per month. The main independent variables were month and five dummy variables (the opening of two facilities with safe consumption rooms, and three police interventions). To examine which interventions affected the number of syringes collected, we performed an interrupted time-series analysis using a quasi-Poisson regression model, obtaining relative risks (RR) and 95% confidence intervals (CIs). The number of syringes collected per month in Barcelona decreased from 13,800 in 2004 to 1655 in 2014 after several interventions. For example, following the closure of an open drug scene in District A of the city, we observed a decreasing trend in the number of syringes collected [RR=0.88 (95% CI: 0.82-0.95)], but an increasing trend in the remaining districts [RR=1.11 (95% CI: 1.05-1.17) and 1.08 (95% CI: 0.99-1.18) for districts B and C, respectively]. Following the opening of a harm reduction facility in District C, we observed an initial increase in the number collected in this district [RR=2.72 (95% CI: 1.57-4.71)] and stabilization of the trend thereafter [RR=0.97 (95% CI: 0.91-1.03)]. The overall number of discarded syringes collected from public spaces has decreased consistently in parallel with a combination of police interventions and the opening of harm reduction facilities. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Temporal trends in self harm and aggression on a paediatric mental health ward.

    PubMed

    Berntsen, Ellen; Starling, Jean; Durheim, Earle; Hainsworth, Cassandra; de Kloet, Liselotte; Chapman, Lucy; Hancock, Karen

    2011-02-01

    The aim of this paper is to describe trends in aggression and self harm on a mental health inpatient unit for children and adolescents between January 2006 and August 2009. Various ward interventions and the ward milieu were evaluated as possible explanatory factors for trends. This was a retrospective study whereby incidents of aggression, self harm and seclusion were obtained from a computerized Incident Information Management System (IIMS) database. Trends in incidents were analysed using linear regression analyses. Over a 44-month period, 292 incidents of aggression and 139 incidents of self harm were reported. The use of seclusion and the number of aggressive incidents both significantly decreased over time. Trends suggested a positive relationship between the introduction of restraint training, changes in leadership and full staff complement, and a reduction in aggression and seclusion. Although the findings are limited by their retrospective nature and reliance on formal records, this study suggests that different factors can contribute to decrease the incidence of adverse events on a psychiatric ward. Future prospective research is needed to assess the effectiveness of different interventions in both the prevention and management of self harm, aggression and seclusion in child and adolescent inpatient units.

  8. Digital Self-Harm Among Adolescents.

    PubMed

    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.

  9. Effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol.

    PubMed

    Anderson, Peter; Chisholm, Dan; Fuhr, Daniela C

    2009-06-27

    This paper reviews the evidence for the effectiveness and cost-effectiveness of policies and programmes to reduce the harm caused by alcohol, in the areas of education and information, the health sector, community action, driving while under the influence of alcohol (drink-driving), availability, marketing, pricing, harm reduction, and illegally and informally produced alcohol. Systematic reviews and meta-analyses show that policies regulating the environment in which alcohol is marketed (particularly its price and availability) are effective in reducing alcohol-related harm. Enforced legislative measures to reduce drink-driving and individually directed interventions to already at-risk drinkers are also effective. However, school-based education does not reduce alcohol-related harm, although public information and education-type programmes have a role in providing information and in increasing attention and acceptance of alcohol on political and public agendas. Making alcohol more expensive and less available, and banning alcohol advertising, are highly cost-effective strategies to reduce harm. In settings with high amounts of unrecorded production and consumption, increasing the proportion of alcohol that is taxed could be a more effective pricing policy than a simple increase in tax.

  10. Attitudes toward adolescent self-harm and its prevention: The views of those who self-harm and their peers.

    PubMed

    Doyle, Louise

    2017-08-01

    Adolescent self-harm is a common phenomenon; however, little is known about young peoples' attitudes toward self-harm and what they believe can be done to prevent it. This study aimed to identify adolescents' attitudes about self-harm and their perspectives on preventing it. A cross-sectional anonymous survey was administered to 856 post-primary school students across 11 schools in Dublin, Ireland. Attitudes toward self-harm were captured through a five-item scale and views on prevention of self-harm were captured through an open-ended survey question. Responses from those who self-harmed and those who did not were compared to identify differences. Significant differences were identified between those who self-harmed and their peers. Those who self-harmed were less likely to believe that self-harm was carried out to get attention or was a result of loneliness or depression; they were more likely to believe that self-harm was impulsive. Findings demonstrated that a majority of young people believed that self-harm could be prevented and a number of preventative strategies were identified. It is important that the views of adolescents are incorporated into the design and delivery of youth-friendly services and that there is a focus on increasing awareness of the youth-orientated services that currently exist. © 2018 Wiley Periodicals, Inc.

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

    PubMed Central

    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

  12. Acceleration of GPU-based Krylov solvers via data transfer reduction

    DOE PAGES

    Anzt, Hartwig; Tomov, Stanimire; Luszczek, Piotr; ...

    2015-04-08

    Krylov subspace iterative solvers are often the method of choice when solving large sparse linear systems. At the same time, hardware accelerators such as graphics processing units continue to offer significant floating point performance gains for matrix and vector computations through easy-to-use libraries of computational kernels. However, as these libraries are usually composed of a well optimized but limited set of linear algebra operations, applications that use them often fail to reduce certain data communications, and hence fail to leverage the full potential of the accelerator. In this study, we target the acceleration of Krylov subspace iterative methods for graphicsmore » processing units, and in particular the Biconjugate Gradient Stabilized solver that significant improvement can be achieved by reformulating the method to reduce data-communications through application-specific kernels instead of using the generic BLAS kernels, e.g. as provided by NVIDIA’s cuBLAS library, and by designing a graphics processing unit specific sparse matrix-vector product kernel that is able to more efficiently use the graphics processing unit’s computing power. Furthermore, we derive a model estimating the performance improvement, and use experimental data to validate the expected runtime savings. Finally, considering that the derived implementation achieves significantly higher performance, we assert that similar optimizations addressing algorithm structure, as well as sparse matrix-vector, are crucial for the subsequent development of high-performance graphics processing units accelerated Krylov subspace iterative methods.« less

  13. Childhood physical abuse, non-suicidal self-harm and attempted suicide amongst regular injecting drug users.

    PubMed

    Darke, Shane; Torok, Michelle

    2013-12-01

    Childhood physical abuse (CPA), non-suicidal self-harm and attempted suicide are all highly prevalent amongst injecting drug users (IDU). This paper reported on the association of CPA with self-harm and attempted suicide. Cross-sectional study, with 300 IDU administered a structured interview examining the prevalence of CPA, non-suicidal self-harm and suicide attempts. CPA was reported by 74.3%, and severe CPA by 40.3%. A history of non-suicidal self-harm was reported by 23.7%, and 25.7% had attempted suicide. Non-suicidal self-harm preceded the suicide attempt in 83.3% of cases where both had occurred. Independent correlates of non-suicidal self-harm were: female gender (OR 3.62), avoided home due to conflict (OR 2.28) and more extensive polydrug use (OR 1.32). Independent correlates of attempted suicide were: severe CPA (OR 3.18), frequent CPA (OR 2.54), avoided home due to conflict (OR 3.95), female gender (OR 2.99), a positive screen for Conduct Disorder (OR 3.53), and more extensive polydrug use (OR 1.52). Those presenting to treatment agencies are highly likely to have a history of CPA, that may still influence their behaviours. Screening for histories of CPA and non-suicidal self-harm appears warranted when determining suicide risk for this population. At the population level, reductions in the rate of CPA, could possibly reduce the rate of subsequent suicidality. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  14. Predictors for repeat self-harm and suicide among older people within 12 months of a self-harm presentation.

    PubMed

    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.

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

    ERIC Educational Resources Information Center

    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…

  16. Using Watershed Models and Human Behavioral Analyses to identify Management Options to Reduce Lake Erie's Harmful Algal Blooms

    NASA Astrophysics Data System (ADS)

    Martin, J.; Wilson, R. S.; Aloysius, N.; Kalcic, M. M.; Roe, B.; Howard, G.; Irwin, E.; Zhang, W.; Liu, H.

    2017-12-01

    In early 2016, the United States and Canada formally agreed to reduce phosphorus inputs to Lake Erie by 40% to reduce the severity of annual Harmful Algal Blooms (HABs). These blooms have become more severe, with record events occurring in 2011 and 2015, and have compromised public safety, shut down drinking water supplies, and negatively impacted the economy of the western Lake Erie basin. Now, a key question is what management options should be pursued to reach the 40% reduction. This presentation will highlight interdisciplinary research to compare the amount and types of practices needed for this reduction to the current and projected levels of adoption. Multiple models of the Maumee watershed identified management plans and adoption rates needed to reach the reduction targets. For example, one successful scenario estimated necessary adoption rates of 50% for subsurface application of fertilizer on row crops, 58% for cover crops, and 78% for buffer strips. Current adoption is below these levels, but future projections based on farmer surveys shows these levels are possible. This information was then used to guide another round of watershed modeling analysis to evaluate scenarios that represented more realistic scenarios based on potential levels of management adoption. In general, these results show that accelerated adoption of management plans is needed compared to past adoption rates, and that some of these greater adoption levels are possible based on likely adoption rates. Increasing the perceived efficacy of the practices is one method that will support greater voluntary rates of adoption.

  17. Rejuvenating harm reduction projects for injection drug users: Ukraine's nationwide introduction of peer-driven interventions.

    PubMed

    Smyrnov, Pavlo; Broadhead, Robert S; Datsenko, Oleksandra; Matiyash, Oksana

    2012-03-01

    A peer-driven intervention (PDI) for injecting drug users (IDUs) was implemented in five Ukrainian city-sites to test-pilot its effectiveness in rejuvenating harm reduction (HR) projects that had become moribund. A PDI relies on drug users in a unique way to educate their peers in the community and recruit them for HIV prevention services. The goal of the PDI was to recruit in six month 500 IDUs who had never been respondents before to each of the five HR projects, especially stimulant- and women-injectors, and IDUs<25 years of age. We standardized the PDI's structure and operations across all five sites. All five PDIs were started in May 2007 using a carefully selected handful of "seed" IDU-recruiters who were trained to educate three peers who had never received HR services. We also accessed the database of all five projects and analysed the new respondents they recruited six-months prior to the start-up of the PDIs with the new recruits generated by the PDIs. Whilst the HR projects in the five city-sites recruited 72 new respondents on average during the six months prior to the PDIs' start-up, the PDIs recruited 455 new respondents on average in each city during their six months of operation, indicating that the PDI was 6.3 times more powerful as a recruitment mechanism. Compared to traditional outreach the PDIs resulted in significant increases in the recruitment of women- and young-injectors, and IDUs who injected a more diverse variety of drugs. The PDI can have a rejuvenating effect when added to HR projects that had become stagnate over time, resulting in an increase in the number and diversity of new IDU-respondents. Copyright © 2012 Elsevier B.V. All rights reserved.

  18. Effectiveness of lockouts in reducing alcohol-related harm: Systematic review.

    PubMed

    Nepal, Smriti; Kypri, Kypros; Pursey, Kirrilly; Attia, John; Chikritzhs, Tanya; Miller, Peter

    2018-05-01

    Australian jurisdictions have introduced lockouts to prevent alcohol-related violence. Lockouts prohibit patrons from entering licensed premises after a designated time while allowing sale and consumption of alcohol to continue. Their purposes include managing the movement of intoxicated patrons, and preventing violence and disorder by dispersing times that patrons leave premises. We sought to evaluate the effectiveness of lockouts in preventing alcohol-related harm. We systematically searched electronic databases and reference lists and asked authors to identify relevant studies published to 1 June 2017. We deemed studies eligible if they evaluated lockouts, and if outcome measures included: assault, emergency department attendances, alcohol-related disorders or drink-driving offences. Two reviewers independently extracted data. After screening 244 records, we identified five studies from electronic databases, two from reference lists search and one from a Google search (N = 8). Two studies showed a decline in assaults; a third study showed reductions occurred only inside licensed premises; two studies showed an increase in assaults; and three studies showed no association. The studies had significant design and other limitations. Lockouts have been implemented across Australian jurisdictions as a strategy to prevent alcohol-related harm, despite limited evidence. In this systematic review, we synthesised findings from studies that evaluated lockouts as stand-alone interventions, to help clarify debate on their utility as a harm prevention strategy. There is not good evidence that lockouts prevent alcohol-related harm, in contrast to what is known about stopping the sale of alcohol earlier, for which there is evidence of effectiveness. © 2018 Australasian Professional Society on Alcohol and other Drugs.

  19. Why "do no harm"?

    PubMed

    Sharpe, V A

    1997-01-01

    Edmund Pellegrino has argued that the dramatic changes in American health care call for critical reflection on the traditional norms governing the therapeutic relationship. This paper offers such reflection on the obligation to "do no harm." Drawing on work by Beauchamp and Childress and Pellegrino and Thomasma, I argue that the libertarian model of medical ethics offered by Engelhardt cannot adequately sustain an obligation to "do no harm." Because the obligation to "do no harm" is not based simply on a negative duty of nonmaleficence but also on a positive duty of beneficence, I argue that it is best understood to derive from the fiduciary nature of the healing relationship.

  20. Helping Self-Harming Students

    ERIC Educational Resources Information Center

    Selekman, Matthew D.

    2009-01-01

    Approximately 14 to 17 percent of adolescents today self-harm, deliberately cutting, burning, or bruising themselves. Most self-harming adolescents use the behavior as a coping strategy to get immediate relief from emotional distress or other stressors in their lives. Stressors include fitting in with peers, activity and homework overload, fears…

  1. 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

    PubMed Central

    Haardoerfer, Regine; Escoffery, Cam; Zheng, Pinpin; Kegler, Michelle

    2015-01-01

    Introduction: 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. Methods: We conducted a cross-sectional survey assessing sociodemographics, tobacco use, interest in ENDS and smokeless tobacco among smokers, and knowledge about ENDS among 2,501US adults recruited through an online consumer panel. We oversampled tobacco users (36.7% current cigarette smokers), ethnic minorities, and southeastern US state residents. Results: 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. Conclusions: 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. PMID:24951496

  2. Applying 'evidence-based medicine' theory to interventional radiology. Part 2: a spreadsheet for swift assessment of procedural benefit and harm.

    PubMed

    Maceneaney, P M; Malone, D E

    2000-12-01

    To design a spreadsheet program to analyse interventional radiology (IR) data rapidly produced in local research or reported in the literature using 'evidence-based medicine' (EBM) parameters of treatment benefit and harm. Microsoft Excel(TM)was used. The spreadsheet consists of three worksheets. The first shows the 'Levels of Evidence and Grades of Recommendations' that can be assigned to therapeutic studies as defined by the Oxford Centre for EBM. The second and third worksheets facilitate the EBM assessment of therapeutic benefit and harm. Validity criteria are described. These include the assessment of the adequacy of sample size in the detection of possible procedural complications. A contingency (2 x 2) table for raw data on comparative outcomes in treated patients and controls has been incorporated. Formulae for EBM calculations are related to these numerators and denominators in the spreadsheet. The parameters calculated are benefit - relative risk reduction, absolute risk reduction, number needed to treat (NNT). Harm - relative risk, relative odds, number needed to harm (NNH). Ninety-five per cent confidence intervals are calculated for all these indices. The results change automatically when the data in the therapeutic outcome cells are changed. A final section allows the user to correct the NNT or NNH in their application to individual patients. This spreadsheet can be used on desktop and palmtop computers. The MS Excel(TM)version can be downloaded via the Internet from the URL ftp://radiography.com/pub/TxHarm00.xls. A spreadsheet is useful for the rapid analysis of the clinical benefit and harm from IR procedures.

  3. The Socioaffective Impact of Acceleration and Ability Grouping: Recommendations for Best Practice

    ERIC Educational Resources Information Center

    Neihart, Maureen

    2007-01-01

    Although the academic gains associated with acceleration and peer ability grouping are well documented, resistance to their use for gifted students continues because of concerns that such practices will cause social or emotional harm to students. Results from the broad research indicate that grade skipping, early school entrance, and early…

  4. Bundling occupational safety with harm reduction information as a feasible method for improving police receptiveness to syringe access programs: evidence from three U.S. cities

    PubMed Central

    Davis, Corey S; Beletsky, Leo

    2009-01-01

    Introduction In light of overwhelming evidence that access to sterile injection equipment reduces incidence of injection-attributable bloodborne disease without encouraging drug use, many localities have authorized sterile syringe access programs (SAPs), including syringe exchange and pharmacy-based initiatives. Even where such interventions are clearly legal, many law enforcement officers are unaware of the public health benefits and legal status of these programs and may continue to treat the possession of injection equipment as illegal and program participation as a marker of illegal behavior. Law enforcement practice can impede SAP utilization and may increase the risk of needlestick injury (NSI) among law enforcement personnel. Many SAPs conduct little or no outreach to law enforcement, in part because they perceive law enforcement actors as unreceptive to health-promotion programs targeting drug users. Case description We report on a brief training intervention for law enforcement personnel designed to increase officer knowledge of and positive attitudes towards SAPs by bundling content that addresses officer concerns about infectious disease and occupational safety with information about the legality and public health benefits of these programs. Pilot trainings using this bundled curriculum were conducted with approximately 600 officers in three US cities. Discussion and evaluation Law enforcement officers were generally receptive to receiving information about SAPs through the bundled curriculum. The trainings led to better communication and collaboration between SAP and law enforcement personnel, providing a valuable platform for better harmonization of law enforcement and public health activities targeting injection drug users. Conclusion The experience in these three cities suggests that a harm reduction training curriculum that bundles strategies for increasing officer occupational safety with information about the legality and public health benefits of

  5. Is prostitution harmful?

    PubMed

    Moen, Ole Martin

    2014-02-01

    A common argument against prostitution states that selling sex is harmful because it involves selling something deeply personal and emotional. More and more of us, however, believe that sexual encounters need not be deeply personal and emotional in order to be acceptable--we believe in the acceptability of casual sex. In this paper I argue that if casual sex is acceptable, then we have few or no reasons to reject prostitution. I do so by first examining nine influential arguments to the contrary. These arguments purport to pin down the alleged additional harm brought about by prostitution (compared to just casual sex) by appealing to various aspects of its practice, such as its psychology, physiology, economics and social meaning. For each argument I explain why it is unconvincing. I then weight the costs against the benefits of prostitution, and argue that, in sum, prostitution is no more harmful than a long line of occupations that we commonly accept without hesitation.

  6. Novel delivery systems for nicotine replacement therapy as an aid to smoking cessation and for harm reduction: rationale, and evidence for advantages over existing systems.

    PubMed

    Shahab, Lion; Brose, Leonie S; West, Robert

    2013-12-01

    Nicotine replacement therapy (NRT) has been used in the treatment of tobacco dependence for over three decades. Whilst the choice of NRT was limited early on, in the last ten years there has been substantial increase in the number of nicotine delivery devices that have become available. This article briefly summarises existing forms of NRT, evidence of their efficacy and use, and reviews the rationale for the development of novel products delivering nicotine via buccal, transdermal or pulmonary routes (including nicotine mouth spray, nicotine films, advanced nicotine inhalers and electronic cigarettes). It presents available evidence on the efficacy, tolerability and abuse potential of these products, with a focus on their advantages as well as disadvantages compared with established forms of NRT for use as an aid to both smoking cessation as well as harm reduction.

  7. Assessment of the exposure to harmful and potentially harmful constituents in healthy Japanese smokers using a novel tobacco vapor product compared with conventional cigarettes and smoking abstinence.

    PubMed

    Yuki, Dai; Takeshige, Yuki; Nakaya, Kyoko; Futamura, Yasuyuki

    2018-07-01

    The objectives of this clinical study were to demonstrate a reduction in exposure to selected harmful and potentially harmful constituents (HPHCs), and to assess product use behavior, in Japanese healthy adult smokers who switched to a novel tobacco vapor product (NTV). 60 smokers were randomly assigned for 5 days to either (a) a group who switched to an NTV (n = 20), (b) a group who continued to smoke their own brand of conventional cigarettes (CC, n = 20) or (c) a smoking abstinence group (SA, n = 20). Fifteen biomarkers of exposure (BoEs) to 14 HPHCs and pyrene were measured at baseline, day 3 and 5. Product use behavior was assessed by measuring product consumption, nicotine uptake and puffing topography. During investigations, increases were observed in product consumption and total puff volume in NTV group subjects as compared to baseline. Additionally, nicotine uptake in the NTV group was approximately half that observed in the CC group. BoE values were significantly reduced in the NTV group as compared to those in the CC group. Significantly, the magnitude of the reduction in exposure to HPHCs observed in the NTV group (49-94%) was close to that observed for the SA group (39-95%). Copyright © 2018 Elsevier Inc. All rights reserved.

  8. Public Perceptions of Self-Harm: Perceived Motivations of (and Willingness to Help in Response to) Adolescent Self-Harm.

    PubMed

    Nielsen, Emma; Townsend, Ellen

    2018-01-01

    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.

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

    PubMed

    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.

  10. Substance Use and Self-Harm: Case Studies From Patients Admitted to an Urban Hospital Following Medically Serious Self-Harm.

    PubMed

    Breet, Elsie; Bantjes, Jason

    2017-12-01

    Few qualitative studies have explored the relationship between substance use and self-harm. We employed a multiple-case study research design to analyze data from 80 patients who were admitted to a hospital in South Africa following self-harm. Our analysis revealed, from the perspective of patients, a number of distinct ways in which substance use is implicated in self-harm. Some patients reported that substance intoxication resulted in poor decision making and impulsivity, which led to self-harm. Others said substance use facilitated their self-harm. Some participants detailed how in the past their chronic substance use had served an adaptive function helping them to cope with distress, but more recently, this coping mechanism had failed which precipitated their self-harm. Some participants reported that substance use by someone else triggered their self-harm. Findings suggest that there are multiple pathways and a host of variables which mediate the relationship between substance use and self-harm.

  11. Self-harm in young offenders.

    PubMed

    Borschmann, Rohan; Coffey, Carolyn; Moran, Paul; Hearps, Stephen; Degenhardt, Louisa; Kinner, Stuart A; Patton, George

    2014-12-01

    The prevalence and correlates of self-harm and suicidal behavior in 515 young offenders (mean age 17.3 years, SD = 1.7) serving community-based orders (CBOs; n = 242) or custodial sentences (n = 273) in Victoria, Australia, are described. Results from structured interviews showed that 83 (16.1%) participants reported self-harming in the previous 6 months, and this was more common among those serving custodial sentences than those serving CBOs (19.4% vs. 12.4%; OR 3.10, 95% CI: 1.74-5.55). Multiple incidents were more common in females and 24% (95% CI: 19-39) of participants who had self-harmed reported having done so with suicidal intent. Self-harm was associated with recent bullying victimization, expulsion from school, past year violent victimization, cannabis dependence, and risk-taking behavior in the preceding year. The epidemiological profile of self-harm in this population appears to be distinct from that seen in the general population. Young offenders who self-harm are a vulnerable group with high rates of psychiatric morbidity, substance misuse problems, and social risk factors. They may benefit from targeted psychological interventions designed specifically to address impulsivity, delivered both within-and during the transition from-the youth justice system. © 2014 The American Association of Suicidology.

  12. The Role of Substorms in Storm-time Particle Acceleration

    NASA Astrophysics Data System (ADS)

    Daglis, Ioannis A.; Kamide, Yohsuke

    The terrestrial magnetosphere has the capability to rapidly accelerate charged particles up to very high energies over relatively short times and distances. Acceleration of charged particles is an essential ingredient of both magnetospheric substorms and space storms. In the case of space storms, the ultimate result is a bulk flow of electric charge through the inner magnetosphere, commonly known as the ring current. Syun-Ichi Akasofu and Sydney Chapman, two of the early pioneers in space physics, postulated that the bulk acceleration of particles during storms is rather the additive result of partial acceleration during consecutive substorms. This paradigm has been heavily disputed during recent years. The new case is that substorm acceleration may be sufficient to produce individual high-energy particles that create auroras and possibly harm spacecraft, but it cannot produce the massive acceleration that constitutes a storm. This paper is a critical review of the long-standing issue of the storm-substorm relationship, or—in other words—the capability or necessity of substorms in facilitating or driving the build-up of the storm-time ring current. We mainly address the physical effect itself, i.e. the bulk acceleration of particles, and not the diagnostic of the process, i.e. the Dst index, which is rather often the case. Within the framework of particle acceleration, substorms retain their storm-importance due to the potential of substorm-induced impulsive electric fields in obtaining the massive ion acceleration needed for the storm-time ring current buildup.

  13. Reduction of beam corkscrew motion on the ETAII linear induction accelerator

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Turner, W.C.; Allen, S.L.; Brand, H.R.

    1990-09-04

    The ETAII linear induction accelerator (6MeV, 3kA, 70ns) is designed to drive a microwave free electron laser (FEL) and demonstrate the front end accelerator technology for a shorter wavelength FEL. Performance to date has been limited by beam corkscrew motion that is driven by energy sweep and misalignment of the solenoidal focusing magnets. Modifications to the pulse power distribution system and magnetic alignment are expected to reduce the radius of corkscrew motion from its present value of 1 cm to less than 1 mm. The modifications have so far been carried out on the first 2.7 MeV (injector plus 20more » accelerator cells) and experiments are beginning. In this paper we will present calculations of central flux line alignment, beam corkscrew motion and beam brightness that are anticipated with the modified ETAII. 10 refs., 4 figs., 1 tab.« less

  14. Uncovering key patterns in self-harm in adolescents: Sequence analysis using the Card Sort Task for Self-harm (CaTS).

    PubMed

    Townsend, E; Wadman, R; Sayal, K; Armstrong, M; Harroe, C; Majumder, P; Vostanis, P; Clarke, D

    2016-12-01

    Self-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm. Forty-five young people (aged 13-21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams). A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode. Larger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care. The CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

  15. Is Personality Associated with Secondhand Harm from Drinking?

    PubMed

    Davis MacNevin, Parnell; Thompson, Kara; Teehan, Michael; Stuart, Heather; Stewart, Sherry

    2017-09-01

    Prior research suggests more than 70% of undergraduates have experienced harm from other students' drinking. This study built on the literature by, first, investigating whether secondhand harm cluster into latent factors that reflect distinct but related types of harm. Second, given the paucity of research examining factors that increase students' vulnerability to secondhand harm, we examined dimensions from Castellanos-Ryan and Conrod's 4-factor personality model for alcohol disorders (impulsivity [IMP], sensation seeking [SS], hopelessness [HOP], anxiety sensitivity [AS]) as predictors of secondhand harm exposure. We also investigated the possible mediating role of students' own problematic alcohol use in explaining personality-secondhand harm relationships. An online survey was administered to 1,537 first-year Canadian undergraduates (68% women). Problematic alcohol use was measured by the Alcohol Use Disorders Identification Test, and personality was measured by the Substance Use Risk Profile Scale. Eleven secondhand harm items were included. The secondhand harm clustered into 3 distinct but related factors: "strains" (e.g., interruption of sleep or study), "threats" (e.g., harassment or assault), and "interpersonal harm" (e.g., arguments with peers). Sixty-eight percent of respondents reported strains, 44% threats, and 64% interpersonal harm, and 35% reported experiencing all 3 types of harm, in the last term. All 4 personality dimensions were independently associated with greater secondhand harm exposure. HOP was directly associated with threats and interpersonal harm, and AS was directly associated with all 3 types of harm. SS and IMP were both indirectly associated with all 3 types of harm through students' own problematic alcohol use. In addition, IMP was directly related to threats. The prevalence of secondhand harm from alcohol is high among undergraduates. Findings suggest that distinct personality risks may predispose students to experience secondhand

  16. Deliberate self-harm in adolescents

    PubMed Central

    Lauw, Michelle; How, Choon How; Loh, Cheryl

    2015-01-01

    Deliberate self-harm refers to an intentional act of causing physical injury to oneself without wanting to die. It is frequently encountered in adolescents who have mental health problems. Primary care physicians play an important role in the early detection and timely intervention of deliberate self-harm in adolescents. This article aims to outline the associated risk factors and possible aetiologies of deliberate self-harm in adolescents, as well as provide suggestions for clinical assessment and appropriate management within the primary care setting. PMID:26106236

  17. Harm mediates the disgust-immorality link.

    PubMed

    Schein, Chelsea; Ritter, Ryan S; Gray, Kurt

    2016-09-01

    Many acts are disgusting, but only some of these acts are immoral. Dyadic morality predicts that disgusting acts should be judged as immoral to the extent that they seem harmful. Consistent with this prediction, 3 studies reveal that perceived harm mediates the link between feelings of disgust and moral condemnation-even for ostensibly harmless "purity" violations. In many cases, accounting for perceived harm completely eliminates the link between disgust and moral condemnation. Analyses also reveal the predictive power of anger and typicality/weirdness in moral judgments of disgusting acts. The mediation of disgust by harm holds across diverse acts including gay marriage, sex acts, and religious blasphemy. Revealing the endogenous presence and moral relevance of harm within disgusting-but-ostensibly harmless acts argues against modular accounts of moral cognition such as moral foundations theory. Instead, these data support pluralistic conceptions of harm and constructionist accounts of morality and emotion. Implications for moral cognition and the concept of "purity" are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  18. [Self-harm in fiction literature].

    PubMed

    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.

  19. Are benefits and harms in mammography screening given equal attention in scientific articles? A cross-sectional study.

    PubMed

    Jørgensen, Karsten Juhl; Klahn, Anders; Gøtzsche, Peter C

    2007-05-30

    were mentioned in 109 (76%) articles, and was more often provided as a relative risk reduction than an absolute risk reduction, where quantified (45 articles (31%) versus 6 articles (3%) (P < 0.001)). Scientific articles tend to emphasize the major benefits of mammography screening over its major harms. This imbalance is related to the authors' affiliation.

  20. Self-harm and ethnicity: A systematic review.

    PubMed

    Al-Sharifi, Ali; Krynicki, Carl R; Upthegrove, Rachel

    2015-09-01

    This review will focus on the rates, clinical characteristics, risk factors and methods of self-harm and suicide in different ethnic groups in the United Kingdom, providing an update synthesis of recent literature. Studies that met the inclusion criteria between 2003 and 2013 were reviewed using the following databases: MEDLINE, PsycINFO, EMBASE and CINAHL. The methodological quality of each study was then assessed using a structured scoring system. A total of 2,362 articles were retrieved, 10 of which matched the inclusion criteria were reviewed. Significant differences were found in the rates of self-harm between ethnic groups with Asian males being least likely to self-harm and Black females being most likely to self-harm. Also, Black and South Asian people were less likely to repeat self-harm. Factors that may help protect or predispose individuals to self-harm or attempt suicide (such as religion, mental health and coping styles) also differ between ethnic groups. There are clear ethnic differences in self-harm and suicide, which may be affected by factors such as cultural pressures and prevalence of mental illness. An awareness of these differences is vital to help prevent further attempts of self-harm and suicide. Further research into differences between ethnic and cultural groups and self-harm continues to be important. © The Author(s) 2015.

  1. 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.

    PubMed

    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.

  2. Multi-Mode Cavity Accelerator Structure

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Jiang, Yong; Hirshfield, Jay Leonard

    2016-11-10

    This project aimed to develop a prototype for a novel accelerator structure comprising coupled cavities that are tuned to support modes with harmonically-related eigenfrequencies, with the goal of reaching an acceleration gradient >200 MeV/m and a breakdown rate <10 -7/pulse/meter. Phase I involved computations, design, and preliminary engineering of a prototype multi-harmonic cavity accelerator structure; plus tests of a bimodal cavity. A computational procedure was used to design an optimized profile for a bimodal cavity with high shunt impedance and low surface fields to maximize the reduction in temperature rise ΔT. This cavity supports the TM010 mode and its 2ndmore » harmonic TM011 mode. Its fundamental frequency is at 12 GHz, to benchmark against the empirical criteria proposed within the worldwide High Gradient collaboration for X-band copper structures; namely, a surface electric field E sur max< 260 MV/m and pulsed surface heating ΔT max< 56 °K. With optimized geometry, amplitude and relative phase of the two modes, reductions are found in surface pulsed heating, modified Poynting vector, and total RF power—as compared with operation at the same acceleration gradient using only the fundamental mode.« less

  3. Self-harm

    MedlinePlus

    ... have trouble stopping. Examples of self-harm include Cutting yourself (such as using a razor blade, knife, ... them a sense of relief. Some people use cutting as a means to cope with a problem. ...

  4. Diagnosis‐based emergency department alcohol harm surveillance: What can it tell us about acute alcohol harms at the population level?

    PubMed Central

    Dinh, Michael; Rodgers, Craig; Muscatello, David J.; McGuire, Rhydwyn; Ryan, Therese; Thackway, Sarah

    2016-01-01

    Abstract Introduction and Aims Acute harm from heavy drinking episodes is an increasing focus of public health policy, but capturing timely data on acute harms in the population is challenging. This study aimed to evaluate the precision of readily available administrative emergency department (ED) data in public health surveillance of acute alcohol harms. Design and Methods We selected a random sample of 1000 ED presentations assigned an ED diagnosis code for alcohol harms (the ‘alcohol syndrome’) in the New South Wales, Australia, automatic syndromic surveillance system. The sample was selected from 68 public hospitals during 2014. Nursing triage free‐text fields were independently reviewed to confirm alcohol consumption and classify each presentation into either an ‘acute’ or ‘chronic’ harm. Positive predictive value (PPV) for acute harm was calculated, and predictors of acute harm presentations were estimated using logistic regression. Results The PPV of the alcohol syndrome for acute alcohol harm was 53.5%. Independent predictors of acute harm were ambulance arrival [adjusted odds ratio (aOR) = 3.4, 95% confidence interval (CI) 2.4–4.7], younger age (12–24 vs. 25–39 years: aOR = 3.4, 95% CI 2.2–5.3), not being admitted (aOR 2.2, 95% CI 1.5–3.2) and arriving between 10 pm and 5.59 am (aOR 2.1, 95% CI 1.5–2.8). PPV among 12 to 24‐year‐olds was 82%. Discussion and Conclusions The alcohol syndrome provides moderate precision as an indicator of acute alcohol harms presenting to the ED. Precision for monitoring acute harm in the population is improved by filtering the syndrome by the strongest independent predictors of acute alcohol harm presentations. [Whitlam G, Dinh M, Rodgers C, Muscatello DJ, McGuire R, Ryan T, Thackway S. Diagnosis‐based emergency department alcohol harm surveillance: What can it tell us about acute alcohol harms at the population level? Drug Alcohol Rev 2016;35:693–701] PMID:27786390

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

    PubMed

    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

  6. Psychological characteristics, stressful life events and deliberate self-harm: findings from the Child & Adolescent Self-harm in Europe (CASE) Study.

    PubMed

    Madge, Nicola; Hawton, Keith; McMahon, Elaine M; Corcoran, Paul; De Leo, Diego; de Wilde, Erik Jan; Fekete, Sandor; van Heeringen, Kees; Ystgaard, Mette; Arensman, Ella

    2011-10-01

    There is evidence to suggest that both psychological characteristics and stressful life events are contributory factors in deliberate self-harm among young people. These links, and the possibility of a dose-response relationship between self-harm and both psychological health and life events, were investigated in the context of a seven-country school-based study. Over 30,000, mainly 15 and 16 year olds, completed anonymous questionnaires at secondary schools in Belgium, England, Hungary, Ireland, the Netherlands, Norway and Australia. Pupils were asked to report on thoughts and episodes of self-harm, complete scales on depression and anxiety symptoms, impulsivity and self-esteem and indicate stressful events in their lives. Level and frequency of self-harm was judged according to whether they had thought about harming themselves or reported single or multiple self-harm episodes. Multinomial logistic regression assessed the extent to which psychological characteristics and stressful life events distinguished between adolescents with different self-harm histories. Increased severity of self-harm history was associated with greater depression, anxiety and impulsivity and lower self-esteem and an increased prevalence of all ten life event categories. Female gender, higher impulsivity and experiencing the suicide or self-harm of others, physical or sexual abuse and worries about sexual orientation independently differentiated single-episode self-harmers from adolescents with self-harm thoughts only. Female gender, higher depression, lower self-esteem, experiencing the suicide or self-harm of others, and trouble with the police independently distinguished multiple- from single-episode self-harmers. The findings reinforce the importance of psychological characteristics and stressful life events in adolescent self-harm but nonetheless suggest that some factors are more likely than others to be implicated.

  7. Self-harm and suicide in adolescents.

    PubMed

    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.

  8. Identifying environmental factors harmful to reproduction.

    PubMed Central

    Palmer, A K

    1993-01-01

    Reproduction is essential for the continuation of the species and for life itself. In biological terms, living and reproducing are essentially one and the same. There is, therefore, no sharp division between identifying factors harmful to reproduction and identifying factors harmful to life or vice versa. Detection of harmful factors requires balanced use of a variety of methodologies from databases on structure-activity relationships through in vitro and in vivo test systems of varying complexity to surveys of wildlife and human populations. Human surveys provide the only assured means of discriminating between real and imagined harmful factors, but they are time consuming and provide information after the harm has been done. Test systems with whole animals provide the best prospects for identifying harmful factors quickly, but currently available methods used for testing agrochemicals and drugs need a thorough overhaul before they can provide a role model. Whether there is a need for new methodology is doubtful. More certain is the need to use existing methodology more wisely. We need a better understanding of the environment--whatever it is--and a more thoughtful approach to investigation of multifactorial situations. PMID:8243390

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

    PubMed Central

    Chamberlain, Samuel R; Leppink, Eric W.; Redden, Sarah A.; Grant, Jon E.

    2017-01-01

    Objective Self-harm is common and is of considerable public health concern. 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, including from the perspective of formal mental disorders and neuropsychological functioning. Method Total 333 adults (mean [SD] age 22.6 (3.6) years, 61% male) were recruited from the general community, and undertook detailed clinical and cognitive assessments. History of self-harm was quantified using the Self-Harm Inventory (SHI), which asks about 22 self-harm behaviors (classic self-harm behaviors as well as broader types of behavior that may be relevant, such as engaging in emotionally abusive relationships). 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. Results 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. Classic and interpersonal self-harm dimensions were associated with impulse control disorders (ICDs) whereas reckless self-harm was associated with other mainstream mental disorders besides ICDs. Only interpersonal self-harm was significantly associated with other impulsive measures ( less risk adjustment on the Cambridge Gambling Task). Conclusions 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

  10. Trends in Self-Harm in Kuala Lumpur, 2005-2011.

    PubMed

    Armitage, Christopher J; Abdul Rahim, Wirda; Rowe, Richard; O'Connor, Rory C

    2016-01-01

    Acts of self-harm are not routinely tracked in Malaysia. The present study investigates the prevalence of self-harm in Kuala Lumpur, Malaysia, over a 7-year period. The aims were to: (a) assess the prevalence of self-harm; (b) examine any changes over a period of 7 years, and (c) identify correlates of methods of self-harm. Data were extracted from the hospital records of Kuala Lumpur Hospital to review trends in self-harm between 2005 and 2011. There were 918 episodes of self-harm across the 7-year period, with a significant peak in 2007-2009. The average rate of self-harm (7.7 per 100,000 population per year) was similar or lower than the rate of suicide (6-8 or 8-13 per 100,000) suggesting that genuine cases of self-harm are often attributed to other causes. Nevertheless, over-representation of young people, women and Indians suggest areas in which resources to prevent self-harm might usefully be targeted. Estimating rates of self-harm are fraught with problems and further research is needed to understand the economic and cultural barriers around seeking treatment for self-harm, reporting self-harm and classifying self-harm.

  11. Applied Use of Safety Event Occurrence Control Charts of Harm and Non-Harm Events: A Case Study.

    PubMed

    Robinson, Susan N; Neyens, David M; Diller, Thomas

    Most hospitals use occurrence reporting systems that facilitate identifying serious events that lead to root cause investigations. Thus, the events catalyze improvement efforts to mitigate patient harm. A serious limitation is that only a few of the occurrences are investigated. A challenge is leveraging the data to generate knowledge. The goal is to present a methodology to supplement these incident assessment efforts. The framework affords an enhanced understanding of patient safety through the use of control charts to monitor non-harm and harm incidents simultaneously. This approach can identify harm and non-harm reporting rates and also can facilitate monitoring occurrence trends. This method also can expedite identifying changes in workflow, processes, or safety culture. Although unable to identify root causes, this approach can identify changes in near real time. This approach also supports evaluating safety or policy interventions that may not be observable in annual safety climate surveys.

  12. 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.

    PubMed

    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.

  13. Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study.

    PubMed

    Vallance, Kate; Stockwell, Tim; Pauly, Bernie; Chow, Clifton; Gray, Erin; Krysowaty, Bonnie; Perkin, Kathleen; Zhao, Jinhui

    2016-05-09

    Managed alcohol programs (MAPs) are a harm reduction strategy for people with severe alcohol dependence and unstable housing. MAPs provide controlled access to alcohol usually alongside accommodation, meals, and other supports. Patterns of alcohol consumption and related harms among MAP participants and controls from a homeless shelter in Thunder Bay, Ontario, were investigated in 2013. Structured interviews were conducted with 18 MAP and 20 control participants assessed as alcohol dependent with most using non-beverage alcohol (NBA). Qualitative interviews were conducted with seven participants and four MAP staff concerning perceptions and experiences of the program. Program alcohol consumption records were obtained for MAP participants, and records of police contacts and use of health services were obtained for participants and controls. Some participants' liver function test (LFT) results were available for before and after MAP entry. Compared with periods off the MAP, MAP participants had 41 % fewer police contacts, 33 % fewer police contacts leading to custody time (x (2) = 43.84, P < 0.001), 87 % fewer detox admissions (t = -1.68, P = 0.06), and 32 % fewer hospital admissions (t = -2.08, P = 0.03). MAP and control participants shared similar characteristics, indicating the groups were broadly comparable. There were reductions in nearly all available LFT scores after MAP entry. Compared with controls, MAP participants had 43 % fewer police contacts, significantly fewer police contacts (-38 %) that resulted in custody time (x (2) = 66.10, P < 0.001), 70 % fewer detox admissions (t = -2.19, P = 0.02), and 47 % fewer emergency room presentations. NBA use was significantly less frequent for MAP participants versus controls (t = -2.34, P < 0.05). Marked but non-significant reductions were observed in the number of participants self-reporting alcohol-related harms in the domains of home life, legal issues, and

  14. Prevention of deaths from harmful drinking in the United States: the potential effects of tax increases and advertising bans on young drinkers.

    PubMed

    Hollingworth, William; Ebel, Beth E; McCarty, Carolyn A; Garrison, Michelle M; Christakis, Dimitri A; Rivara, Frederick P

    2006-03-01

    Harmful alcohol consumption is a leading cause of death in the United States. The majority of people who die from alcohol use begin drinking in their youth. In this study, we estimate the impact of interventions to reduce the prevalence of drinking among youth on subsequent drinking patterns and alcohol-attributable mortality. We first estimated the effect of public health interventions to decrease harmful drinking among youth from literature reviews and used life table methods to estimate alcohol-attributable years of life lost by age 80 years among the cohort of approximately 4 million U.S. residents aged 20 in the year 2000. Then, from national survey data on transitions in drinking habits by age, we modeled the impact of interventions on alcohol-attributable mortality. A tax increase and an advertising ban were the most effective interventions identified. In the absence of intervention, there would be 55,259 alcohol-attributable deaths over the lifetime of the cohort. A tax-based 17% increase in the price of alcohol of dollar 1 per six pack of beer could reduce deaths from harmful drinking by 1,490, equivalent to 31,130 discounted years of potential life saved or 3.3% of current alcohol-attributable mortality. A complete ban on alcohol advertising would reduce deaths from harmful drinking by 7,609 and result in a 16.4% decrease in alcohol-related life-years lost. A partial advertising ban would result in a 4% reduction in alcohol-related life-years lost. Interventions to prevent harmful drinking by youth can result in reductions in adult mortality. Among interventions shown to be successful in reducing youthful drinking prevalence, advertising bans appear to have the greatest potential for premature mortality reduction.

  15. Clarifying self-harm through evolutionary concept analysis.

    PubMed

    Tofthagen, Randi; Fagerstrøm, Lisbeth

    2010-09-01

    Clarification of the concept self-harm is needed in order to enable research and theory development and facilitate the development and evaluation of medical interventions and nursing care for individuals who self-harm. This study presents such a conceptual analysis. Articles from 1997 to 2007 were sought from the Medline, PubMed, Cinahl, and PsychINFO search engines by entering the search words 'self-harm', 'self-harming', and 'psychiatric care'. 25 medicine and 23 nursing science articles were chosen for inclusion and analysed. Rodgers' evolutionary concept analysis process was used to delineate and clarify the concept's context, surrogate terms, antecedents, attributes, and consequences, as well as to determine implications for further research. Attributes of self-harm may include repetitive injury of mouth or exterior body, that is to say the infliction of physical pain to alleviate mental pain, and time spent self-harming. Antecedents may be gender, mental pain, substance abuse and relational problems. Consequences often include the need for medication and help with altering coping behaviour. Some self-harm patients met with negative attitudes from nurses. Individualized care and treatment is recommended. Accordingly, inter-professional collaboration and postgraduate education is needed in order to provide better care and treatment for self-harm patients. Furthermore, better understanding is needed to help enable health care personnel understand why individuals self-harm. The conceptual analysis presented in this study may be helpful as regards theory development within this still rather unexplored field. © 2010 The Authors. Journal compilation © 2010 Nordic College of Caring Science.

  16. High-Volume Repeaters of Self-Harm.

    PubMed

    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.

  17. Prevention. How much harm? How much benefit? 3. Physical, psychological and social harm.

    PubMed Central

    Marshall, K G

    1996-01-01

    Harm caused by preventive programs may be physical, psychological, social or, if informed consent has not been obtained, ethical. Adverse effects of preventive screening programs may occur at any of the three levels of the "screening cascade", the screening procedure itself, the investigation of abnormal results of screening tests or the treatment of detected abnormalities or diseases. The greatest harm occurs at the second and third levels. Examples of procedures that may cause physical harm are venipuncture, mammography, colonoscopy, breast biopsy, transrectal ultrasonography, prostate biopsy, weight-reducing and cholesterol-lowering diets and radical prostatectomy. The psychological and social harm of preventive programs involves anticipated discomfort or perception of adverse effects of preventive interventions; unpleasant interactions with health care workers, time required for preventive programs, excessive overall awareness of health, anxiety over the results of a screening test implications of a positive screening test, consequences of being labelled as "sick" or "at risk," psychopathologic effects induced directly by preventive programs and, in the case of a false-negative test result, false assurance of disease-free status. Since the positive predictive value of screening tests in the general population is always low, most abnormal test results are "false-positive," these engender a great deal of psychological discuss among patients. PMID:8800074

  18. Future Climate Impacts on Harmful Algal Blooms in an Agriculturally Dominated Ecosystem

    NASA Astrophysics Data System (ADS)

    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.

  19. Effectiveness of online and mobile telephone applications ('apps') for the self-management of suicidal ideation and self-harm: a systematic review and meta-analysis.

    PubMed

    Witt, Katrina; Spittal, Matthew J; Carter, Gregory; Pirkis, Jane; Hetrick, Sarah; Currier, Dianne; Robinson, Jo; Milner, Allison

    2017-08-15

    Online and mobile telephone applications ('apps') have the potential to improve the scalability of effective interventions for suicidal ideation and self-harm. The aim of this review was therefore to investigate the effectiveness of digital interventions for the self-management of suicidal ideation or self-harm. Seven databases (Applied Science & Technology; CENTRAL; CRESP; Embase; Global Health; PsycARTICLES; PsycINFO; Medline) were searched to 31 March, 2017. Studies that examined the effectiveness of digital interventions for suicidal ideation and/or self-harm, or which reported outcome data for suicidal ideation and/or self-harm, within a randomised controlled trial (RCT), pseudo-RCT, or observational pre-test/post-test design were included in the review. Fourteen non-overlapping studies were included, reporting data from a total of 3,356 participants. Overall, digital interventions were associated with reductions for suicidal ideation scores at post-intervention. There was no evidence of a treatment effect for self-harm or attempted suicide. Most studies were biased in relation to at least one aspect of study design, and particularly the domains of participant, clinical personnel, and outcome assessor blinding. Performance and detection bias therefore cannot be ruled out. Digital interventions for suicidal ideation and self-harm may be more effective than waitlist control. It is unclear whether these reductions would be clinically meaningful at present. Further evidence, particularly with regards to the potential mechanisms of action of these interventions, as well as safety, is required before these interventions could recommended.

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

    ERIC Educational Resources Information Center

    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…

  1. Online Patient-Provider E-cigarette Consultations: Perceptions of Safety and Harm.

    PubMed

    Brown-Johnson, Cati G; Burbank, Andrea; Daza, Eric J; Wassmann, Arianna; Chieng, Amy; Rutledge, Geoffrey W; Prochaska, Judith J

    2016-12-01

    E-cigarettes are popular and unregulated. Patient-provider communications concerning e-cigarettes were characterized to identify patient concerns, provider advice and attitudes, and research needs. An observational study of online patient-provider communications was conducted January 2011-June 2015 from a network providing free medical advice, and analyzed July 2014-May 2016. Patient and provider themes, and provider attitudes toward e-cigarettes (positive, negative, or neutral) were coded qualitatively. Provider attitudes were analyzed with cumulative logit modeling to account for clustering. Patient satisfaction with provider responses was expressed via a Thank function. An increase in e-cigarette-related questions was observed over time. Patient questions (N=512) primarily concerned specific side effects and harms (34%); general safety (27%); e-cigarettes as quit aids (19%); comparison of e-cigarette harms relative to combusted tobacco (18%); use with pre-existing medical conditions (18%); and nicotine-free e-cigarettes (14%). Half of provider responses discussed e-cigarettes as a harm reduction option (48%); 26% discussed them as quit aids. Overall, 47% of providers' responses represented a negative attitude toward e-cigarettes; 33% were neutral (contradictory or non-committal); and 20% were positive. Attitudes did not differ statistically by medical specialty; provider responses positive toward e-cigarettes received significantly more Thanks. Examination of online patient-provider communications provides insight into consumer health experience with emerging alternative tobacco products. Patient concerns largely related to harms and safety, and patients preferred provider responses positively inclined toward e-cigarettes. Lacking conclusive evidence of e-cigarette safety or efficacy, healthcare providers encouraged smoking cessation and recommended first-line cessation treatment approaches. Copyright © 2016 American Journal of Preventive Medicine. Published by

  2. Genetic harm: bitten by the body that keeps you?

    PubMed

    Kahn, Jeffrey P

    1991-10-01

    ... We must attempt to explain, how, if ever, our existence may harm us. To address this and the other questions raised, I propose to examine what constitutes harm and whether it makes sense to say that our genetic makeup may harm us. To do this I will describe three approaches to the problem of describing the status of negative effects our genes have upon us, which I have named the "technical harm" view, the "constitutive" view, and the "harmful conditions" view. On the technical harm view, the standard definitions of harm are applied to genetic disposition in an attempt to couch genetic defects or flaws in terms of harming. The constitutive view rejects applying the concept of harm to genetic disposition on the grounds that it is impossible to separate genetic disposition from individual identity. Lastly, the harmful conditions view, which I conclude is the most successful of the three, focuses on the tendency of certain genetic dispositions to cause harm in the future and thus avoids what I will argue are the "context" shortcomings of the other two approaches. To conclude the discussion I will very briefly analyze the ramifications of a harmful conditions view for the concept of genetic disease and the prospects for genetic counseling, gene therapy, and reproductive decision making.

  3. E-Cigarette Awareness and Perceived Harmfulness

    PubMed Central

    Tan, Andy S.L.; Bigman, Cabral A.

    2014-01-01

    Background Electronic cigarettes, or e-cigarettes, are increasingly advertised as replacements for regular cigarettes or cessation aids for smokers. Purpose To describe the prevalence and correlates of e-cigarette awareness and perceived harmfulness among U.S. adults and analyze whether these variables are associated with smokers’ past year quit attempts and intention to quit. Methods Data were obtained from the Health Information National Trends Survey (HINTS 4 Cycle 2), conducted from October 2012 to January 2013. Data analyses were performed from June to August 2013. Results Overall, 77% of respondents were aware of e-cigarettes. Of these, 51% believed e-cigarettes were less harmful than cigarettes. Younger, white (compared with Hispanic), more educated respondents, and current or former smokers (compared with non-smokers) were more likely to be aware of e-cigarettes. Among those who were aware of e-cigarettes, younger, more educated respondents and current smokers (compared with former and non-smokers) were more likely to believe that e-cigarettes were less harmful. Awareness and perceived harm were not associated with smokers’ past year quit attempts or intention to quit. Conclusions Overall e-cigarette awareness increased while smokers’ perceived harm of e-cigarettes declined compared with earlier surveys. However, awareness and perceived harm of e-cigarettes did not show evidence of promoting smoking cessation at the population level. PMID:24794422

  4. Violent Self-Harm in Schizophrenia

    ERIC Educational Resources Information Center

    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,…

  5. Alcohol Involvement in Suicide and Self-Harm.

    PubMed

    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.

  6. Method Choice in Nonfatal Self-Harm as a Predictor of Subsequent Episodes of Self-Harm and Suicide: Implications for Clinical Practice

    PubMed Central

    Hempstead, Katherine; Nguyen, Tuan; Barber, Catherine; Rosenberg-Wohl, Sarah; Azrael, Deborah

    2013-01-01

    Objectives. We examined time-varying and time-invariant characteristics of nonfatal intentional self-harm episodes in relation to subsequent episodes of self-harm and suicide. Methods. We conducted a follow-up cohort study through 2007 of 3600 patients discharged from hospitals in New Jersey with a primary diagnosis of intentional self-harm in 2003. We determined repetition of self-harm from hospital records and suicide from state registers. Results. Use of methods other than drug overdose and cutting in self-harm events, greater medical severity of nonfatal episodes, and a history of multiple self-harm episodes increased the risk of suicide. However, most suicides occurred without these risk factors. Most suicides took place without intervening episodes of self-harm, and most persons used a low-lethality method (drug overdose or cutting) in their index episode, but switched to a more lethal method in their fatal episode. Conclusions. Our findings suggest that preventing suicide among persons with a history of self-harm must account for the possibility that they will adopt methods with higher case-fatality ratios than they previously tried. PMID:23597351

  7. Alcohol industry corporate social responsibility initiatives and harmful drinking: a systematic review.

    PubMed

    Mialon, Melissa; McCambridge, Jim

    2018-04-25

    There is growing awareness of the detrimental effects of alcohol industry commercial activities, and concern about possible adverse impacts of its corporate social responsibility (CSR) initiatives, on public health. The aims of this systematic review were to summarize and examine what is known about CSR initiatives undertaken by alcohol industry actors in respect of harmful drinking globally. We searched for peer-reviewed studies published since 1980 of alcohol industry CSR initiatives in seven electronic databases. The basic search strategy was organized around the three constructs of 'alcohol', 'industry' and 'corporate social responsibility'. We performed the searches on 21 July 2017. Data from included studies were analyzed inductively, according to the extent to which they addressed specified research objectives. A total of 21 studies were included. We identified five types of CSR initiatives relevant to the reduction of harmful drinking: alcohol information and education provision; drink driving prevention; research involvement; policy involvement and the creation of social aspects organizations. Individual companies appear to undertake different CSR initiatives than do industry-funded social aspects organizations. There is no robust evidence that alcohol industry CSR initiatives reduce harmful drinking. There is good evidence, however, that CSR initiatives are used to influence the framing of the nature of alcohol-related issues in line with industry interests. This research literature is at an early stage of development. Alcohol policy measures to reduce harmful drinking are needed, and the alcohol industry CSR initiatives studied so far do not contribute to the attainment of this goal.

  8. Harmful practices in the management of childhood diarrhea in low- and middle-income countries: a systematic review.

    PubMed

    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.

  9. Single-particle dynamics in a nonlinear accelerator lattice: attaining a large tune spread with octupoles in IOTA

    NASA Astrophysics Data System (ADS)

    Antipov, S. A.; Nagaitsev, S.; Valishev, A.

    2017-04-01

    Fermilab is constructing the Integrable Optics Test Accelerator (IOTA) as the centerpiece of the Accelerator R&D Program towards high-intensity circular machines. One of the factors limiting the beam intensity in present circular accelerators is collective instabilities, which can be suppressed by a spread of betatron frequencies (tunes) through the Landau damping mechanism or by an external damper, if the instability is slow enough. The spread is usually created by octupole magnets, which introduce the tune dependence on the amplitude and, in some cases, by a chromatic spread (tune dependence on particle's momentum). The introduction of octupoles usually has both beneficial (improved Landau damping) and harmful properties, such as a resonant behavior and a reduction of the dynamic aperture. One of the research goals at the IOTA ring is to achieve a large betatron tune spread, while retaining a large dynamic aperture, using conventional octupole magnets in a special but realistic accelerator configuration. The configuration, although not integrable by design, approximates an autonomous 2D Hamiltonian system. In this paper, we present results of computer simulations of an electron beam in the IOTA by particle tracking and the Frequency Map Analysis. The results show that the ring's octupole magnets can be configured to provide a betatron tune shift of 0.08 (for particles at large amplitudes) with the dynamical aperture of over 20 beam sigma for a 150-MeV electron beam. The influence of the synchrotron motion, lattice errors, and magnet imperfections is insignificant for the parameters and levels of tolerances set by the design of the ring. The described octupole insert could be beneficial for enhancing Landau damping in high intensity machines.

  10. Authority dependence and judgments of utilitarian harm.

    PubMed

    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.

  11. Particle acceleration on a chip: A laser-driven micro-accelerator for research and industry

    NASA Astrophysics Data System (ADS)

    Yoder, R. B.; Travish, G.

    2013-03-01

    Particle accelerators are conventionally built from radio-frequency metal cavities, but this technology limits the maximum energy available and prevents miniaturization. In the past decade, laser-powered acceleration has been intensively studied as an alternative technology promising much higher accelerating fields in a smaller footprint and taking advantage of recent advances in photonics. Among the more promising approaches are those based on dielectric field-shaping structures. These ``dielectric laser accelerators'' (DLAs) scale with the laser wavelength employed and can be many orders of magnitude smaller than conventional accelerators; DLAs may enable the production of high-intensity, ultra-short relativistic electron bunches in a chip-scale device. When combined with a high- Z target or an optical-period undulator, these systems could produce high-brilliance x-rays from a breadbox-sized device having multiple applications in imaging, medicine, and homeland security. In our research program we have developed one such DLA, the Micro-Accelerator Platform (MAP). We describe the fundamental physics, our fabrication and testing program, and experimental results to date, along with future prospects for MAP-based light-sources and some remaining challenges. Supported in part by the Defense Threat Reduction Agency and National Nuclear Security Administration.

  12. Extremely Preterm Infant Skin Care: A Transformation of Practice Aimed to Prevent Harm.

    PubMed

    Johnson, Deanna E

    2016-10-01

    The skin of extremely preterm infants is underdeveloped and has poor barrier function. Skin maintenance interventions initiated in the neonatal intensive care unit (NICU) have immediate and lifelong implications when the potential for infection, allergen sensitization, and altered aesthetic outcomes are considered. In addition, the high-level medical needs of extremely preterm infants demand skin-level medical interventions that too often result in unintended skin harm. We describe the use of a harm prevention, or consequence-centered, approach to skin care, which facilitates safer practice for extremely premature infants. Neonatal and pediatric Advanced Practice Registered Nurses (APRN) came together for monthly meetings to review the evidence around best skin care practices for extremely preterm infants, with an emphasis on reduction of skin harm. Findings were focused on the population of interest and clinical implementation strategies. Skin care for extremely preterm infants remains overlooked by current literature. However, clinical practice pearls were extracted and applied in a manner that promotes safer skin care practices in the NICU. Gentle adhesives, such as silicone tapes and hydrogel-backed electrodes, can help to reduce medical adhesive-related skin injuries. Diaper wipes are not appropriate for use among extremely preterm infants, as many ingredients may contain potential allergens. Skin cleansers should be pH neutral to the skin and the prophylactic use of petrolatum-based emollients should be avoided. Further exploration and understanding of skin care practices that examine issues of true risk versus hypothetical risk of harm.

  13. Monitoring indicators of harmful cyanobacteria in Texas

    USGS Publications Warehouse

    Kiesling, Richard L.; Gary, Robin H.; Gary, Marcus O.

    2008-01-01

    Harmful algal blooms can occur when certain types of microscopic algae grow quickly in water, forming visible patches that might harm the health of the environment, plants, or animals. In freshwater, species of Cyanobacteria (also known as bluegreen algae) are the dominant group of harmful, bloom-forming algae. When Cyanobacteria form a harmful algal bloom, potential impairments include restricted recreational activities because of algal scums or algal mats, potential loss of public water supply because of taste and odor compounds (for example, geosmin), and the production of toxins (for example, microcystin) in amounts capable of threatening human health and wildlife.

  14. Assessing the harms of cannabis cultivation in Belgium.

    PubMed

    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

  15. Deliberate self-harm in 15-year-old adolescents: a pilot study with a modified version of the Deliberate Self-Harm Inventory.

    PubMed

    Lundh, Lars-Gunnar; Karim, Jessica; Quilisch, Eva

    2007-02-01

    The purpose of the present study was to investigate the rate of deliberate self-harm in 15-year-old Swedish adolescents, gender differences in this behavior, and possible associations with self-esteem and mindfulness. For this purpose, we developed a simplified version of Gratz's (2001) Deliberate Self-Harm Inventory (DSHI), and carried out a pilot study with 123 adolescents from three different schools in southern Sweden. The results showed that 65.9% of the adolescents reported having engaged in some kind of deliberate self-harm at least once; 41.5% reported at least one kind of self-harm more than once; and 13.8% reported at least one kind of deliberate self-harm behavior "many times". Although there were no overall gender differences in self-harm, the girls reported significantly more of cutting wrists, arms and other body areas than the boys. High rates of deliberate self-harm were associated with low self-esteem and low mindfulness.

  16. Routine hospital management of self-harm and risk of further self-harm: propensity score analysis using record-based cohort data.

    PubMed

    Steeg, S; Emsley, R; Carr, M; Cooper, J; Kapur, N

    2018-01-01

    The care received by people presenting to hospital following self-harm varies and it is unclear how different types of treatment affect risk of further self-harm. Observational cohort data from the Manchester Self-Harm Project, UK, included 16 456 individuals presenting to an Emergency Department with self-harm between 2003 and 2011. Individuals were followed up for 12 months. We also used data from a smaller cohort of individuals presenting to 31 hospitals in England during a 3-month period in 2010/2011, followed up for 6 months. Propensity score (PS) methods were used to address observed confounding. Missing data were imputed using multiple imputation. Following PS stratification, those who received a psychosocial assessment had a lower risk of repeat hospital attendance for self-harm than those who were not assessed [RR 0.87, 95% confidence interval (CI) 0.80-0.95]. The risk was reduced most among people less likely to be assessed. Following PS matching, we found no associations between risks of repeat self-harm and admission to a medical bed, referral to outpatient psychiatry or admission to a psychiatric bed. We did not find a relationship between psychosocial assessment and repeat self-harm in the 31 centre cohort. This study shows the potential value of using novel statistical techniques in large mental health datasets to estimate treatment effects. We found that specialist psychosocial assessment may reduce the risk of repeat self-harm. This type of routine care should be provided for all individuals who present to hospital after self-harm, regardless of perceived risk.

  17. Children's Hospitals' Solutions for Patient Safety Collaborative Impact on Hospital-Acquired Harm.

    PubMed

    Lyren, Anne; Brilli, Richard J; Zieker, Karen; Marino, Miguel; Muething, Stephen; Sharek, Paul J

    2017-09-01

    To determine if an improvement collaborative of 33 children's hospitals focused on reliable best practice implementation and culture of safety improvements can reduce hospital-acquired conditions (HACs) and serious safety events (SSEs). A 3-year prospective cohort study design with a 12-month historical control population was completed by the Children's Hospitals' Solutions for Patient Safety collaborative. Identification and dissemination of best practices related to 9 HACs and SSE reduction focused on key process and culture of safety improvements. Individual hospital improvement teams leveraged the resources of a large, structured children's hospital collaborative using electronic, virtual, and in-person interactions. Thirty-three children's hospitals from across the United States volunteered to be part of the Children's Hospitals' Solutions for Patient Safety collaborative. Thirty-two met all the data submission eligibility requirements for the HAC improvement objective of this study, and 21 participated in the high-reliability culture work aimed at reducing SSEs. Significant harm reduction occurred in 8 of 9 common HACs (range 9%-71%; P < .005 for all). The mean monthly SSE rate decreased 32% (from 0.77 to 0.52; P < .001). The 12-month rolling average SSE rate decreased 50% (from 0.82 to 0.41; P < .001). Participation in a structured collaborative dedicated to implementing HAC-related best-practice prevention bundles and culture of safety interventions designed to increase the use of high-reliability organization practices resulted in significant HAC and SSE reductions. Structured collaboration and rapid sharing of evidence-based practices and tools are effective approaches to decreasing hospital-acquired harm. Copyright © 2017 by the American Academy of Pediatrics.

  18. Harmful cyanobacterial blooms: causes, consequences, and controls.

    PubMed

    Paerl, Hans W; Otten, Timothy G

    2013-05-01

    Cyanobacteria are the Earth's oldest oxygenic photoautotrophs and have had major impacts on shaping its biosphere. Their long evolutionary history (≈ 3.5 by) has enabled them to adapt to geochemical and climatic changes, and more recently anthropogenic modifications of aquatic environments, including nutrient over-enrichment (eutrophication), water diversions, withdrawals, and salinization. Many cyanobacterial genera exhibit optimal growth rates and bloom potentials at relatively high water temperatures; hence global warming plays a key role in their expansion and persistence. Bloom-forming cyanobacterial taxa can be harmful from environmental, organismal, and human health perspectives by outcompeting beneficial phytoplankton, depleting oxygen upon bloom senescence, and producing a variety of toxic secondary metabolites (e.g., cyanotoxins). How environmental factors impact cyanotoxin production is the subject of ongoing research, but nutrient (N, P and trace metals) supply rates, light, temperature, oxidative stressors, interactions with other biota (bacteria, viruses and animal grazers), and most likely, the combined effects of these factors are all involved. Accordingly, strategies aimed at controlling and mitigating harmful blooms have focused on manipulating these dynamic factors. The applicability and feasibility of various controls and management approaches is discussed for natural waters and drinking water supplies. Strategies based on physical, chemical, and biological manipulations of specific factors show promise; however, a key underlying approach that should be considered in almost all instances is nutrient (both N and P) input reductions; which have been shown to effectively reduce cyanobacterial biomass, and therefore limit health risks and frequencies of hypoxic events.

  19. Residual acceleration data on IML-1: Development of a data reduction and dissemination plan

    NASA Technical Reports Server (NTRS)

    Rogers, Melissa J. B.; Alexander, J. Iwan D.; Wolf, Randy

    1992-01-01

    The main thrust of our work in the third year of contract NAG8-759 was the development and analysis of various data processing techniques that may be applicable to residual acceleration data. Our goal is the development of a data processing guide that low gravity principal investigators can use to assess their need for accelerometer data and then formulate an acceleration data analysis strategy. The work focused on the flight of the first International Microgravity Laboratory (IML-1) mission. We are also developing a data base management system to handle large quantities of residual acceleration data. This type of system should be an integral tool in the detailed analysis of accelerometer data. The system will manage a large graphics data base in the support of supervised and unsupervised pattern recognition. The goal of the pattern recognition phase is to identify specific classes of accelerations so that these classes can be easily recognized in any data base. The data base management system is being tested on the Spacelab 3 (SL3) residual acceleration data.

  20. Effects of benefits and harms on older persons' willingness to take medication for primary cardiovascular prevention.

    PubMed

    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.

  1. Prevention of HIV/AIDS among injecting drug users in Russia: opportunities and barriers to scaling-up of harm reduction programmes.

    PubMed

    Tkatchenko-Schmidt, Elena; Renton, Adrian; Gevorgyan, Ruzanna; Davydenko, Ludmila; Atun, Rifat

    2008-02-01

    to examine attitudes of Russian policy-makers and HIV stakeholders towards harm reduction (HR) scale up, focusing on the factors constraining the scale-up process. Semi-structured interviews with representatives of 58 government and non-governmental organisations involved in HIV policies and programmes in Volgograd Region, Russian Federation. We found a considerable diversity of opinion on HR scale-up and suggest that Russia is experiencing the situation of power parity between HR supporters and opponents with many stakeholders being indecisive or cautious to express their views. We identified six main factors which constrain policy decisions in favour of HR scale-up: insufficient financial resources; lack of information on HR effectiveness; perception of HR as being culturally unacceptable; reluctance of IDUs to use the services; opposition from law enforcement agencies and the Russian Church; and unclear legal regulations. We demonstrate a complex interplay between these factors, policy-makers' attitudes and their choices on HR scale-up. A number of actions are needed to achieve a successful scale-up of HR programmes in Russia and similar political contexts: (i) a strategic approach to HR advocacy, targeting neutral and indecisive stakeholders; (ii) more systematic evidence on HR effectiveness and cost-effectiveness in the local context; (iii) HR advocacy targeting law enforcement agencies and the Russian Church; and (iv) aligning best international HR practices with the objectives of local policy-makers, practitioners and service-users.

  2. Caring for self-harming patients in general practice.

    PubMed

    Rowe, Joanne; Jaye, Chrystal

    2017-12-01

    INTRODUCTION Intentional self-harm is an international public health issue with high personal, social and financial costs to society. Poor relationship dynamics are known to have a negative influence on the psyche of people who self-harm, and this can increase anxiety and decrease self-esteem, both shown to be significant contributors to self-harm behaviours. Positive and functional social supports have been proposed as a cost-effective and constructive approach in diminishing self-harming behaviours. AIM This qualitative study investigated the aspects of professional, social, familial and romantic relationships that people who have self-harmed identified as having a positive and constructive effect on their self-harm behaviour. METHODS Twelve participants with a history of self-harming behaviours were recruited through free press advertising in primary care and interviewed. The participants ranged in age from 19 to 70 years, and represented New Zealand (NZ) European and Māori from across the Southern region of NZ. RESULTS This study shows that constructive relationships that inhibit self-harm behaviours are characterised by participants' perceptions of authenticity in their relationships, and knowing that other people genuinely care. Feeling cared for within an authentic therapeutic relationship enabled participants to overcome their perception of being damaged selves and gave them the skills and confidence to develop functional relationships within their communities. A relationship-centred care approach may be useful for general practitioners seeking to develop more effective therapeutic relationships with patients who deliberately self-harm.

  3. AcceleDent as a Means for Pain Reduction During Orthodontic Treatment

    DTIC Science & Technology

    2015-05-30

    AcceleDent as a Means for Pain Reduction During Orthodontic Treatment Wendy D. Lobre APPROVED: Brent Callegari, Supervising Pro ssor and Program...entitled: "AcceleDent as a Means for Pain Reduction During Orthodontic Treatment" is appropriately acknowledged and beyond brief excerpts is with the...Those in Harms Way AcceleDent as a Means for Pain Reduction During Orthodontic Treatment TITLE PAGE A THESIS Presented to the Faculty of Uniform

  4. Effect of the increase in "alcopops" tax on alcohol-related harms in young people: a controlled interrupted time series.

    PubMed

    Kisely, Steve R; Pais, Joanne; White, Angela; Connor, Jason; Quek, Lake-Hui; Crilly, Julia L; Lawrence, David

    2011-12-19

    To measure alcohol-related harms to the health of young people presenting to emergency departments (EDs) of Gold Coast public hospitals before and after the increase in the federal government "alcopops" tax in 2008. Interrupted time series analysis over 5 years (28 April 2005 to 27 April 2010) of 15-29-year-olds presenting to EDs with alcohol-related harms compared with presentations of selected control groups. Proportion of 15-29-year-olds presenting to EDs with alcohol-related harms compared with (i) 30-49-year-olds with alcohol-related harms, (ii)15-29-year-olds with asthma or appendicitis, and (iii) 15-29-year-olds with any non-alcohol and non-injury related ED presentation. Over a third of 15-29-year-olds presented to ED with alcohol-related conditions, as opposed to around a quarter for all other age groups. There was no significant decrease in alcohol-related ED presentations of 15-29-year-olds compared with any of the control groups after the increase in the tax. We found similar results for males and females, narrow and broad definitions of alcohol-related harms, under-19s, and visitors to and residents of the Gold Coast. The increase in the tax on alcopops was not associated with any reduction in alcohol-related harms in this population in a unique tourist and holiday region. A more comprehensive approach to reducing alcohol harms in young people is needed.

  5. Self-harm in patients with schizophrenia spectrum disorders.

    PubMed

    Mork, Erlend; Mehlum, Lars; Barrett, Elizabeth A; Agartz, Ingrid; Harkavy-Friedman, Jill M; Lorentzen, Steinar; Melle, Ingrid; Andreassen, Ole A; Walby, Fredrik A

    2012-01-01

    This study describes the prevalence, clinical characteristics, and gender profile of self-harm in a cross-sectional sample of 388 patients with schizophrenia spectrum disorders. All patients were interviewed and assessed with respect to lifetime self-harm and relevant clinical variables. An overall of 49% of the patients reported self-harm which was associated with female gender, having had a depressive episode, younger age at psychosis onset, alcohol abuse or dependence, current suicidality, awareness of illness, and low adherence to prescribed medication. Higher awareness of having a mental disorder was associated with self-harm in men only, while emotional dysregulation was associated with self-harm in women only. We conclude that while self-harm in patients with schizophrenia spectrum disorders is highly prevalent in both genders, risk factors in men and women differ in several important ways.

  6. What's the Harm? The Coverage of Ethics and Harm Avoidance in Research Methods Textbooks

    ERIC Educational Resources Information Center

    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…

  7. Is incest harmful?

    PubMed

    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.

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

    PubMed Central

    Altaf, Arshad; Shah, Sharaf Ali; Zaidi, Najam A; Memon, Ashraf; Nadeem-ur-Rehman; Wray, Norman

    2007-01-01

    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. Conclusion Prudent

  9. Impulsivity and self-harm in adolescence: a systematic review.

    PubMed

    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.

  10. Electron dynamics in a plasma focus. [electron acceleration

    NASA Technical Reports Server (NTRS)

    Hohl, F.; Gary, S. P.; Winters, P. A.

    1977-01-01

    Results are presented of a numerical integration of the three-dimensional relativistic equations of motion of electrons subject to given electric and magnetic fields deduced from experiments. Fields due to two different models are investigated. For the first model, the fields are those due to a circular distribution of axial current filaments. As the current filaments collapse toward the axis, large azimuthal magnetic and axial electric fields are induced. These fields effectively heat the electrons to a temperature of approximately 8 keV and accelerate electrons within the radius of the filaments to high axial velocities. Similar results are obtained for the current-reduction phase of focus formation. For the second model, the fields are those due to a uniform current distribution. Both the current-reduction and the compression phases were studied. These is little heating or acceleration of electrons during the compression phase because the electrons are tied to the magnetic field. However, during the current-reduction phase, electrons near the axis are accelerated toward the center electrode and reach energies of 100 keV. A criterion is obtained which limits the runaway electron current to about 400 A.

  11. Long-pulse beam acceleration of MeV-class H(-) ion beams for ITER NB accelerator.

    PubMed

    Umeda, N; Kashiwagi, M; Taniguchi, M; Tobari, H; Watanabe, K; Dairaku, M; Yamanaka, H; Inoue, T; Kojima, A; Hanada, M

    2014-02-01

    In order to realize neutral beam systems in International Thermonuclear Experimental Reactor whose target is to produce a 1 MeV, 200 A/m(2) during 3600 s D(-) ion beam, the electrostatic five-stages negative ion accelerator so-called "MeV accelerator" has been developed at Japan Atomic Energy Agency. To extend pulse length, heat load of the acceleration grids was reduced by controlling the ion beam trajectory. Namely, the beam deflection due to the residual magnetic field of filter magnet was suppressed with the newly developed extractor with a 0.5 mm off-set aperture displacement. The new extractor improved the deflection angle from 6 mrad to 1 mrad, resulting in the reduction of direct interception of negative ions from 23% to 15% of the total acceleration power, respectively. As a result, the pulse length of 130 A/m(2), 881 keV H(-) ion beam has been successfully extended from a previous value of 0.4 s to 8.7 s. This is the first long pulse negative ion beam acceleration over 100 MW/m(2).

  12. Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study

    PubMed Central

    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

  13. Predicting Treatment Outcomes from Prefrontal Cortex Activation for Self-Harming Patients with Borderline Personality Disorder: A Preliminary Study.

    PubMed

    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.

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

    PubMed

    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.

  15. Perceived intent motivates people to magnify observed harms

    PubMed Central

    Ames, Daniel L.; Fiske, Susan T.

    2015-01-01

    Existing moral psychology research commonly explains certain phenomena in terms of a motivation to blame. However, this motivation is not measured directly, but rather is inferred from other measures, such as participants’ judgments of an agent’s blameworthiness. The present paper introduces new methods for assessing this theoretically important motivation, using tools drawn from animal-model research. We test these methods in the context of recent “harm-magnification” research, which shows that people often overestimate the damage caused by intentional (versus unintentional) harms. A preliminary experiment exemplifies this work and also rules out an alternative explanation for earlier harm-magnification results. Exp. 1 asks whether intended harm motivates blame or merely demonstrates the actor’s intrinsic blameworthiness. Consistent with a motivational interpretation, participants freely chose blaming, condemning, and punishing over other appealing tasks in an intentional-harm condition, compared with an unintentional-harm condition. Exp. 2 also measures motivation but with converging indicators of persistence (effort, rate, and duration) in blaming. In addition to their methodological contribution, these studies also illuminate people’s motivational responses to intentional harms. Perceived intent emerges as catalyzing a motivated social cognitive process related to social prediction and control. PMID:25733850

  16. Accelerated Mutation Accumulation in Asexual Lineages of a Freshwater Snail

    PubMed Central

    Neiman, Maurine; Hehman, Gery; Miller, Joseph T.; Logsdon, John M.; Taylor, Douglas R.

    2010-01-01

    Sexual reproduction is both extremely costly and widespread relative to asexual reproduction, meaning that it must also confer profound advantages in order to persist. One theorized benefit of sex is that it facilitates the clearance of harmful mutations, which would accumulate more rapidly in the absence of recombination. The extent to which ineffective purifying selection and mutation accumulation are direct consequences of asexuality and whether the accelerated buildup of harmful mutations in asexuals can occur rapidly enough to maintain sex within natural populations, however, remain as open questions. We addressed key components of these questions by estimating the rate of mutation accumulation in the mitochondrial genomes of multiple sexual and asexual representatives of Potamopyrgus antipodarum, a New Zealand snail characterized by mixed sexual/asexual populations. We found that increased mutation accumulation is associated with asexuality and occurs rapidly enough to be detected in recently derived asexual lineages of P. antipodarum. Our results demonstrate that increased mutation accumulation in asexuals can differentially affect coexisting and ecologically similar sexual and asexual lineages. The accelerated rate of mutation accumulation observed in asexual P. antipodarum provides some of the most direct evidence to date for a link between asexuality and mutation accumulation and implies that mutational buildup could be rapid enough to contribute to the short-term evolutionary mechanisms that favor sexual reproduction. PMID:19995828

  17. Effects of dram shop liability and enhanced overservice law enforcement initiatives on excessive alcohol consumption and related harms: Two community guide systematic reviews.

    PubMed

    Rammohan, Veda; Hahn, Robert A; Elder, Randy; Brewer, Robert; Fielding, Jonathan; Naimi, Timothy S; Toomey, Traci L; Chattopadhyay, Sajal K; Zometa, Carlos

    2011-09-01

    Dram shop liability holds the owner or server(s) at a bar, restaurant, or other location where a patron, adult or underage, consumed his or her last alcoholic beverage responsible for harms subsequently inflicted by the patron on others. Liability in a state can be established by case law or statute. Overservice laws prohibit the sale of alcoholic beverages to intoxicated patrons drinking in on-premises retail alcohol outlets (i.e., premises where the alcohol is consumed where purchased); enhanced enforcement of these laws is intended to ensure compliance by premises personnel. Both of these interventions are ultimately designed to promote responsible beverage service by reducing sales to intoxicated patrons, underage youth, or both. This review assesses the effectiveness of dram shop liability and the enhanced enforcement of overservice laws for preventing excessive alcohol consumption and related harms. Studies assessing alcohol-related harms in states adopting dram shop laws were evaluated, as were studies assessing alcohol-related harms in regions with enhanced overservice enforcement. Methods previously developed for systematic reviews for the Guide to Community Preventive Services were used. Eleven studies assessed the association of state dram shop liability with various outcomes, including all-cause motor vehicle crash deaths, alcohol-related motor vehicle crash deaths (the most common outcome assessed in the studies reviewed), alcohol consumption, and other alcohol-related harms. There was a median reduction of 6.4% (range of values 3.7% to 11.3% reduction) in alcohol-related motor vehicle fatalities associated with the presence of dram shop liability in jurisdictions where premises are licensed. Other alcohol-related outcomes also showed a reduction. Only two studies assessed the effects of enhanced enforcement initiatives on alcohol-related outcomes; findings were inconsistent, some indicating benefit and others none. According to Community Guide rules

  18. Getting out of (self-) harm's way: A study of factors associated with self-harm among asylum seekers in Australian immigration detention.

    PubMed

    Hedrick, Kyli

    2017-07-01

    The monitoring of self-harm among asylum seekers in Australian immigration detention has not occurred routinely or transparently. Thus whilst concerns regarding rates of self-harm among asylum seekers have been frequently raised, a paucity of systematic information regarding key factors associated with self-harm among asylum seekers exists. The present study was designed therefore to fill a number of gaps in government monitoring by examining the government's own archived self-harm data. Via a descriptive analysis of self-harm incident reports from all operational Australian immigration detention facilities over a 20-month period to May 2011, obtained under Freedom of Information, the present study identified that 959 incidents of self-harm occurred during this period. A gender bias towards men was also found. In addition to this, 10 different methods of self-harm were identified, the four most common being: cutting (47%), attempted hanging (19%), head hitting (12%) and self-poisoning by medication (6%). Seven different precipitating factors for self-harm were also identified, the four most common were: detention conditions (39%), processing arrangements (27%), negative decisions (24%) and family separation (3%). These findings point strongly to the health benefits of considering alternatives to held immigration detention, such as community based processing. Copyright © 2017 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  19. Against Harmful Research on Non-Agreeing Children.

    PubMed

    Chwang, Eric

    2015-07-01

    The Code of Federal Regulations permits harmful research on children who have not agreed to participate, but I will argue that it should be no more permissive of harmful research on such children than of harmful research on adults who have not agreed to participate. Of course, the Code permits harmful research on adults. Such research is not morally problematic, however, because adults must agree to participate. And, of course, the Code also permits beneficial research on children without needing their explicit agreement. This sort of research is also not problematic, this time because paternalism towards children may be justifiable. The moral problem at the center of this paper arises from the combination of two potential properties of pediatric research, first that it might be harmful and second that its subjects might not agree to participate. In Section 2 of this article I explain how the Code permits harmful research on non-agreeing children. Section 3 contains my argument that we should no more permit harmful research on non-agreeing children than on non-agreeing adults. In Section 4, I argue that my thesis does not presuppose that pediatric assent has the same moral force that adult consent does. In Section 5, I argue that the distinction between non-voluntary and involuntary research is irrelevant to my thesis. In Section 6, I rebut an objection based on the power of parental permission. In Section 7 I suggest how the Code of Federal Regulations might be changed. © 2014 John Wiley & Sons Ltd.

  20. 76 FR 5387 - Guidance for Industry and Food and Drug Administration Staff; “`Harmful and Potentially Harmful...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-31

    ... of Dockets Management (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville... harmful constituents, including smoke constituents, to health in each tobacco product by brand and by quantity in each brand and subbrand.'' The guidance discusses the meaning of the term ``harmful and...

  1. Accelerated Slice Encoding for Metal Artifact Correction

    PubMed Central

    Hargreaves, Brian A.; Chen, Weitian; Lu, Wenmiao; Alley, Marcus T.; Gold, Garry E.; Brau, Anja C. S.; Pauly, John M.; Pauly, Kim Butts

    2010-01-01

    Purpose To demonstrate accelerated imaging with artifact reduction near metallic implants and different contrast mechanisms. Materials and Methods Slice-encoding for metal artifact correction (SEMAC) is a modified spin echo sequence that uses view-angle tilting and slice-direction phase encoding to correct both in-plane and through-plane artifacts. Standard spin echo trains and short-TI inversion recovery (STIR) allow efficient PD-weighted imaging with optional fat suppression. A completely linear reconstruction allows incorporation of parallel imaging and partial Fourier imaging. The SNR effects of all reconstructions were quantified in one subject. 10 subjects with different metallic implants were scanned using SEMAC protocols, all with scan times below 11 minutes, as well as with standard spin echo methods. Results The SNR using standard acceleration techniques is unaffected by the linear SEMAC reconstruction. In all cases with implants, accelerated SEMAC significantly reduced artifacts compared with standard imaging techniques, with no additional artifacts from acceleration techniques. The use of different contrast mechanisms allowed differentiation of fluid from other structures in several subjects. Conclusion SEMAC imaging can be combined with standard echo-train imaging, parallel imaging, partial-Fourier imaging and inversion recovery techniques to offer flexible image contrast with a dramatic reduction of metal-induced artifacts in scan times under 11 minutes. PMID:20373445

  2. Accelerated slice encoding for metal artifact correction.

    PubMed

    Hargreaves, Brian A; Chen, Weitian; Lu, Wenmiao; Alley, Marcus T; Gold, Garry E; Brau, Anja C S; Pauly, John M; Pauly, Kim Butts

    2010-04-01

    To demonstrate accelerated imaging with both artifact reduction and different contrast mechanisms near metallic implants. Slice-encoding for metal artifact correction (SEMAC) is a modified spin echo sequence that uses view-angle tilting and slice-direction phase encoding to correct both in-plane and through-plane artifacts. Standard spin echo trains and short-TI inversion recovery (STIR) allow efficient PD-weighted imaging with optional fat suppression. A completely linear reconstruction allows incorporation of parallel imaging and partial Fourier imaging. The signal-to-noise ratio (SNR) effects of all reconstructions were quantified in one subject. Ten subjects with different metallic implants were scanned using SEMAC protocols, all with scan times below 11 minutes, as well as with standard spin echo methods. The SNR using standard acceleration techniques is unaffected by the linear SEMAC reconstruction. In all cases with implants, accelerated SEMAC significantly reduced artifacts compared with standard imaging techniques, with no additional artifacts from acceleration techniques. The use of different contrast mechanisms allowed differentiation of fluid from other structures in several subjects. SEMAC imaging can be combined with standard echo-train imaging, parallel imaging, partial-Fourier imaging, and inversion recovery techniques to offer flexible image contrast with a dramatic reduction of metal-induced artifacts in scan times under 11 minutes. (c) 2010 Wiley-Liss, Inc.

  3. Harm avoidance and disability in old age.

    PubMed

    Wilson, Robert S; Buchman, Aron S; Arnold, Steven E; Shah, Raj C; Tang, Yuxiao; Bennett, David A

    2006-01-01

    The relation of personality to disability in old age is not well understood. The authors examined the relation of harm avoidance, a trait indicating a tendency to worry, fear uncertainty, be shy, and tire easily, to disability in a group of 474 older persons without dementia. Participants completed the 35-item Harm Avoidance scale. Disability was assessed with the Rosow-Breslau scale, a self-report measure of physical mobility. Performance-based tests of lower limb functions were also administered from which composite measures of gait, balance, and strength were derived. In a logistic regression model controlled for age, sex, education, and lower limb function, persons with high levels of harm avoidance were nearly three times as likely to report mobility limitations as persons with low levels, and these effects largely reflected fatigability and fear of uncertainty. The association of harm avoidance with disability was not explained or modified by frailty, physical activity, depressive symptoms, neuroticism, extraversion, or cognition. The results suggest that harm avoidance is associated with disability in old age.

  4. Practitioner Review: Self-Harm in Adolescents

    ERIC Educational Resources Information Center

    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…

  5. Compressed Sensing SEMAC: 8-fold Accelerated High Resolution Metal Artifact Reduction MRI of Cobalt-Chromium Knee Arthroplasty Implants.

    PubMed

    Fritz, Jan; Ahlawat, Shivani; Demehri, Shadpour; Thawait, Gaurav K; Raithel, Esther; Gilson, Wesley D; Nittka, Mathias

    2016-10-01

    The aim of this study was to prospectively test the hypothesis that a compressed sensing-based slice encoding for metal artifact correction (SEMAC) turbo spin echo (TSE) pulse sequence prototype facilitates high-resolution metal artifact reduction magnetic resonance imaging (MRI) of cobalt-chromium knee arthroplasty implants within acquisition times of less than 5 minutes, thereby yielding better image quality than high-bandwidth (BW) TSE of similar length and similar image quality than lengthier SEMAC standard of reference pulse sequences. This prospective study was approved by our institutional review board. Twenty asymptomatic subjects (12 men, 8 women; mean age, 56 years; age range, 44-82 years) with total knee arthroplasty implants underwent MRI of the knee using a commercially available, clinical 1.5 T MRI system. Two compressed sensing-accelerated SEMAC prototype pulse sequences with 8-fold undersampling and acquisition times of approximately 5 minutes each were compared with commercially available high-BW and SEMAC pulse sequences with acquisition times of approximately 5 minutes and 11 minutes, respectively. For each pulse sequence type, sagittal intermediate-weighted (TR, 3750-4120 milliseconds; TE, 26-28 milliseconds; voxel size, 0.5 × 0.5 × 3 mm) and short tau inversion recovery (TR, 4010 milliseconds; TE, 5.2-7.5 milliseconds; voxel size, 0.8 × 0.8 × 4 mm) were acquired. Outcome variables included image quality, display of the bone-implant interfaces and pertinent knee structures, artifact size, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Statistical analysis included Friedman, repeated measures analysis of variances, and Cohen weighted k tests. Bonferroni-corrected P values of 0.005 and less were considered statistically significant. Image quality, bone-implant interfaces, anatomic structures, artifact size, SNR, and CNR parameters were statistically similar between the compressed sensing-accelerated SEMAC prototype and SEMAC

  6. 30 CFR 7.508 - Harmful gas removal components.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... chemical used for removal of harmful gas shall be— (1) Contained such that when stored or used it cannot... for disposal of used chemical. (c) Each harmful gas removal component shall be tested to determine its... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Harmful gas removal components. 7.508 Section 7...

  7. 30 CFR 7.508 - Harmful gas removal components.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... chemical used for removal of harmful gas shall be— (1) Contained such that when stored or used it cannot... for disposal of used chemical. (c) Each harmful gas removal component shall be tested to determine its... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Harmful gas removal components. 7.508 Section 7...

  8. 30 CFR 7.508 - Harmful gas removal components.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... chemical used for removal of harmful gas shall be— (1) Contained such that when stored or used it cannot... for disposal of used chemical. (c) Each harmful gas removal component shall be tested to determine its... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Harmful gas removal components. 7.508 Section 7...

  9. How Would We Know if Psychotherapy Were Harmful?

    ERIC Educational Resources Information Center

    Dimidjian, Sona; Hollon, Steven D.

    2010-01-01

    Patients can be harmed by treatment or by the decisions that are made about those treatments. Although dramatic examples of harmful effects of psychotherapy have been reported, the full scope of the problem remains unclear. The field currently lacks consensus about how to detect harm and what to do about it when it occurs. In this article, we…

  10. Repeated self-harm in young people: a review.

    PubMed

    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.

  11. Is Africa a 'Graveyard' for Linear Accelerators?

    PubMed

    Reichenvater, H; Matias, L Dos S

    2016-12-01

    Linear accelerator downtimes are common and problematic in many African countries and may jeopardise the outcome of affected radiation treatments. The predicted increase in cancer incidence and prevalence on the African continent will require, inter alia, improved response with regard to a reduction in linear accelerator downtimes. Here we discuss the problems associated with the maintenance and repair of linear accelerators and propose alternative solutions relevant for local conditions in African countries. The paper is based on about four decades of experience in capacity building, installing, commissioning, calibrating, servicing and repairing linear accelerators in Africa, where about 40% of the low and middle income countries in the world are geographically located. Linear accelerators can successfully be operated, maintained and repaired in African countries provided proper maintenance and repair plans are put in place and executed. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  12. Alleviation of harmful effect in stillage reflux in food waste ethanol fermentation based on metabolic and side-product accumulation regulation.

    PubMed

    Ma, Hongzhi; Yang, Jian; Jia, Yan; Wang, Qunhui; Ma, Xiaoyu; Sonomoto, Kenji

    2016-10-01

    Stillage reflux fermentation in food waste ethanol fermentation could reduce sewage discharge but exert a harmful effect because of side-product accumulation. In this study, regulation methods based on metabolic regulation and side-product alleviation were conducted. Result demonstrated that controlling the proper oxidation-reduction potential value (-150mV to -250mV) could reduce the harmful effect, improve ethanol yield by 21%, and reduce fermentation time by 20%. The methods of adding calcium carbonate to adjust the accumulated lactic acid showed that ethanol yield increased by 17.3%, and fermentation time decreased by 20%. The accumulated glyceal also shows that these two methods can reduce the harmful effect. Fermentation time lasted for seven times without effect, and metabolic regulation had a better effect than side-product regulation. Copyright © 2016 Elsevier Ltd. All rights reserved.

  13. Self-harming behavior of a parent with borderline personality disorder assessed using revealed preference and attributional approaches: a case study.

    PubMed

    Tustin, R Don

    2002-08-01

    This article discusses a case study involving a parent with Borderline Personality Disorder who exhibited self-harming behaviors. Assessment and intervention were based both on a review of the client's attributions about causes of her own behavior as being either internalizing or externalizing, and on a review of motivation of the behaviors using functional analysis. Antecedent situations for self-harming behaviors were identified to provide a basis for reviewing the client's attributions of reasons for disordered behavior. A new technique of functional analysis was applied using the principle of revealed preference arising from behavioral economics. Revealed preference identified outcomes that were valued by the client, enabling new responses to be identified to attain these reinforcers. Attribution re-training was provided. Significant reductions in self-harming behaviors were achieved during brief therapy and were maintained during follow-up.

  14. A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown.

    PubMed

    Marchant, Amanda; Hawton, Keith; Stewart, Ann; Montgomery, Paul; Singaravelu, Vinod; Lloyd, Keith; Purdy, Nicola; Daine, Kate; John, Ann

    2017-01-01

    Research exploring internet use and self-harm is rapidly expanding amidst concerns regarding influences of on-line activities on self-harm and suicide, especially in young people. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people. We conducted a systematic review based on an electronic search for articles published between 01/01/2011 and 26/01/2015 across databases including Medline, Cochrane and PsychInfo. Articles were included if: the study examined internet use by individuals who engaged in self-harm/ suicidal behaviour, or internet use clearly related to self-harm content; reported primary empirical data; participants were aged under 25 years. New studies were combined with those identified in a previous review and subject to data extraction, quality rating and narrative synthesis. Forty-six independent studies (51 articles) of varying quality were included. Perceived influences were: positive for 11 studies (38191 participants); negative for 18 studies (119524 participants); and mixed for 17 studies (35235 participants). In contrast to previous reviews on this topic studies focused on a wide range of internet mediums: general internet use; internet addiction; online intervention/treatment; social media; dedicated self-harm websites; forums; video/image sharing and blogs. A relationship between internet use and self-harm/suicidal behaviour was particularly associated with internet addiction, high levels of internet use, and websites with self-harm or suicide content. While there are negative aspects of internet use the potential for isolation reduction, outreach and as a source of help and therapy were also identified. There is significant potential for harm from online behaviour (normalisation, triggering, competition, contagion) but also the potential to exploit its benefits (crisis support, reduction of social isolation, delivery of therapy, outreach). Young people

  15. A systematic review of the relationship between internet use, self-harm and suicidal behaviour in young people: The good, the bad and the unknown

    PubMed Central

    Marchant, Amanda; Hawton, Keith; Stewart, Ann; Montgomery, Paul; Singaravelu, Vinod; Lloyd, Keith; Purdy, Nicola; Daine, Kate

    2017-01-01

    Background Research exploring internet use and self-harm is rapidly expanding amidst concerns regarding influences of on-line activities on self-harm and suicide, especially in young people. We aimed to systematically review evidence regarding the potential influence of the internet on self-harm/suicidal behaviour in young people. Methods We conducted a systematic review based on an electronic search for articles published between 01/01/2011 and 26/01/2015 across databases including Medline, Cochrane and PsychInfo. Articles were included if: the study examined internet use by individuals who engaged in self-harm/ suicidal behaviour, or internet use clearly related to self-harm content; reported primary empirical data; participants were aged under 25 years. New studies were combined with those identified in a previous review and subject to data extraction, quality rating and narrative synthesis. Results Forty-six independent studies (51 articles) of varying quality were included. Perceived influences were: positive for 11 studies (38191 participants); negative for 18 studies (119524 participants); and mixed for 17 studies (35235 participants). In contrast to previous reviews on this topic studies focused on a wide range of internet mediums: general internet use; internet addiction; online intervention/treatment; social media; dedicated self-harm websites; forums; video/image sharing and blogs. A relationship between internet use and self-harm/suicidal behaviour was particularly associated with internet addiction, high levels of internet use, and websites with self-harm or suicide content. While there are negative aspects of internet use the potential for isolation reduction, outreach and as a source of help and therapy were also identified. Conclusions There is significant potential for harm from online behaviour (normalisation, triggering, competition, contagion) but also the potential to exploit its benefits (crisis support, reduction of social isolation, delivery

  16. COLLABORATIVE MODELING OF THE BENEFITS AND HARMS ASSOCIATED WITH DIFFERENT U.S. BREAST CANCER SCREENING STRATEGIES

    PubMed Central

    Mandelblatt, Jeanne S.; Stout, Natasha K.; Schechter, Clyde B.; van den Broek, Jeroen J.; Miglioretti, Diana; Krapcho, Martin; Trentham-Dietz, Amy; Munoz, Diego; Lee, Sandra J.; Berry, Donald A.; van Ravesteyn, Nicolien T.; Alagoz, Oguzhan; Kerlikowske, Karla; Tosteson, Anna N.A.; Near, Aimee M.; Hoeffken, Amanda; Chang, Yaojen; Heijnsdijk, Eveline A.; Chisholm, Gary; Huang, Xuelin; Huang, Hui; Ergun, Mehmet Ali; Gangnon, Ronald; Sprague, Brian L.; Plevritis, Sylvia; Feuer, Eric; de Koning, Harry J.; Cronin, Kathleen A.

    2016-01-01

    Background Controversy persists about optimal mammography screening strategies. Objective To evaluate mammography strategies considering screening and treatment advances. Design Collaboration of six simulation models. Data Sources National data on incidence, risk, breast density, digital mammography performance, treatment effects, and other-cause mortality. Target Population An average-risk cohort. Time Horizon Lifetime. Perspective Societal. Interventions Mammograms from age 40, 45 or 50 to 74 at annual or biennial intervals, or annually from 40 or 45 to 49 then biennially to 74, assuming 100% screening and treatment adherence. Outcome Measures Screening benefits (vs. no screening) include percent breast cancer mortality reduction, deaths averted, and life-years gained. Harms include number of mammograms, false-positives, benign biopsies, and overdiagnosis. Results for Average-Risk Women Biennial strategies maintain 79.8%-81.3% (range across strategies and models: 68.3–98.9%) of annual screening benefits with almost half the false-positives and fewer overdiagnoses. Screening biennially from ages 50–74 achieves a median 25.8% (range: 24.1%-31.8%) breast cancer mortality reduction; annual screening from ages 40–74 years reduces mortality an additional 12.0% (range: 5.7%-17.2%) vs. no screening, but yields 1988 more false-positives and 7 more overdiagnoses per 1000 women screened. Annual screening from ages 50–74 had similar benefits as other strategies but more harms, so would not be recommended. Sub-population Results Annual screening starting at age 40 for women who have a two- to four-fold increase in risk has a similar balance of harms and benefits as biennial screening of average-risk women from 50–74. Limitations We do not consider other imaging technologies, polygenic risk, or non-adherence. Conclusion These results suggest that biennial screening is efficient for average-risk groups, but decisions on strategies depend on the weight given to the

  17. Quality of Care in a Safe-Abortion Hotline in Indonesia: Beyond Harm Reduction.

    PubMed

    Gerdts, Caitlin; Hudaya, Inna

    2016-11-01

    To examine services offered by safe-abortion hotlines in contexts in which abortion is legally restricted and to document the experiences of women contacting a safe-abortion hotline in Indonesia. We analyzed 1829 first-time contacts to a safe-abortion hotline in Indonesia as a part of routine service provision between January 1, 2012 and December 31, 2014. Nearly one third (29.9%) of initial contacts reported their age as between 18 and 24 years, and most (51.2%) reported being unmarried. When asked about their reason for calling the hotline, the majority of initial contacts stated that they were pregnant and not ready to have a child. More than one third reported gestational ages below 12 weeks, and nearly one fifth (18.3%) reported a gestation of 13 weeks or greater. These unique data provide a window of understanding into who contacts safe-abortion hotlines and why, and enable exploration of future directions for research on the role of safe-abortion hotlines in women's access to safe abortion. Public Health Implications. Safe-abortion hotlines should be evaluated not only for reducing harm but also for providing high-quality abortion care.

  18. Impact of the recent recession on self-harm: Longitudinal ecological and patient-level investigation from the Multicentre Study of Self-harm in England.

    PubMed

    Hawton, Keith; Bergen, Helen; Geulayov, Galit; Waters, Keith; Ness, Jennifer; Cooper, Jayne; Kapur, Navneet

    2016-02-01

    Economic recessions are associated with increases in suicide rates but there is little information for non-fatal self-harm. To investigate the impact of the recent recession on rates of self-harm in England and problems faced by patients who self-harm. Analysis of data from the Multicentre Study of Self-harm in England for 2001-2010 and local employment statistics for Oxford, Manchester and Derby, including interrupted time series analyses to estimate the effect of the recession on rates of self-harm. Rates of self-harm increased in both genders in Derby and in males in Manchester in 2008-2010, but not in either gender in Oxford, results which largely followed changes in general population unemployment. More patients who self-harm were unemployed in 2008-10 compared to before the recession. The proportion in receipt of sickness or disability allowances decreased. More patients of both genders had employment and financial problems in 2008-2010 and more females also had housing problems, changes which were also largely found in employed patients. We have assumed that the recession began in 2008 and information on problems was only available for patients having a psychosocial assessment. Increased rates of self-harm were found in areas where there were greater rises in rates of unemployment. Work, financial and housing problems increased in people who self-harmed. Changes in welfare benefits may have contributed. None. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Effectiveness of assertive case management on repeat self-harm in patients admitted for suicide attempt: Findings from ACTION-J study.

    PubMed

    Furuno, Taku; Nakagawa, Makiko; Hino, Kosuke; Yamada, Tomoki; Kawashima, Yoshitaka; Matsuoka, Yutaka; Shirakawa, Osamu; Ishizuka, Naoki; Yonemoto, Naohiro; Kawanishi, Chiaki; Hirayasu, Yoshio

    2018-01-01

    Self-harm is an important risk factor for subsequent suicide and repetition of self-harm, and a common cause of emergency department presentations. However, there still remains limited evidence on intervention in emergency department settings for individuals who self-harm. This multicentre, randomised controlled trial was conducted at 17 general hospitals in Japan. In total, 914 adult patients admitted to emergency departments for a suicide attempt and had a DSM-IV-TR axis I disorder were randomly assigned to two groups, to receive either assertive case management (intervention) or enhanced usual care (control). Assertive case management was introduced by the case manager during emergency department admissions for suicide attempts, and continued after discharge. Interventions were provided until the end of the study period (for at least 18 months and up to 5 years). The number of overall self-harm episodes per person-year was significantly lower in the intervention group (adjusted incidence risk ratio (IRR) 0.88, 95%CI 0.80-0.96, p=0.0031). Subgroup analysis showed a greater reduction of overall self-harm episodes among patients with no previous suicide attempt at baseline (adjusted IRR 0.73, 95% CI 0.53-0.98, p=0.037). Patients younger than 20 years and patients who self-harmed but were not admitted to an emergency department were excluded. The present study showed that assertive case management following emergency admission for a suicide attempt reduced the incident rate of repeat overall self-harm. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Deliberate self harm in children.

    PubMed

    Krishnakumar, P; Geeta, M G; Riyaz, A

    2011-05-01

    To study the nature of deliberate self-harm (DSH) in children and to identify the associated factors. Child Guidance Clinic attached to the Department of Pediatrics of a teaching hospital in South India. Children with history of deliberate self harm who were referred to the CGC for psychological evaluation during a 10 year period. Children and parents were interviewed together and separately and details regarding age, sex, family and school environment, stresses and nature of self harm were documented. Psychiatric diagnosis was made based on DSM IV diagnostic criteria. Among the 30 children included in the study, 21 were boys and 9 were girls. Majority of children were between the ages of 11 and 13 years, the youngest being 6 years old. 76%of children had history of acute stressful life events and 62%of them had chronic ongoing stress. 62%of children had stress in the family and 41%had stress at school. Stress in the family included death of a parent, conflicts with parents or siblings, mental illness in the family, parental alcoholism and parental disharmony. Stress at school included conflicts with classmates, punishment or negative comments by teachers and learning problems. Psychiatric disorders were present in 52%of children, the commonest being depressive disorder. The commonest mode of DSH was self poisoning, and rat poison (zinc phosphide) was the commonest substance used. Deliberate self harm occurs in young children and the risk factors are comparable to those in adolescents.

  1. Factors associated with deliberate self-harm among Irish adolescents.

    PubMed

    McMahon, E M; Reulbach, U; Corcoran, P; Keeley, H S; Perry, I J; Arensman, E

    2010-11-01

    Deliberate self-harm (DSH) is a major public health problem, with young people most at risk. Lifetime prevalence of DSH in Irish adolescents is between 8% and 12%, and it is three times more prevalent among girls than boys. The aim of the study was to identify the psychological, life-style and life event factors associated with self-harm in Irish adolescents. A cross-sectional study was conducted, with 3881 adolescents in 39 schools completing an anonymous questionnaire as part of the Child and Adolescent Self-harm in Europe (CASE) study. There was an equal gender balance and 53.1% of students were 16 years old. Information was obtained on history of self-harm life events, and demographic, psychological and life-style factors. Based on multivariate analyses, important factors associated with DSH among both genders were drug use and knowing a friend who had engaged in self-harm. Among girls, poor self-esteem, forced sexual activity, self-harm of a family member, fights with parents and problems with friendships also remained in the final model. For boys, experiencing bullying, problems with schoolwork, impulsivity and anxiety remained. Distinct profiles of boys and girls who engage in self-harm were identified. Associations between DSH and some life-style and life event factors suggest that mental health factors are not the sole indicators of risk of self-harm. The importance of school-related risk factors underlines the need to develop gender-specific initiatives in schools to reduce the prevalence of self-harm.

  2. Minor Self-Harm and Psychiatric Disorder: A Population-Based Study

    ERIC Educational Resources Information Center

    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…

  3. Effect of Response Reduction Factor on Peak Floor Acceleration Demand in Mid-Rise RC Buildings

    NASA Astrophysics Data System (ADS)

    Surana, Mitesh; Singh, Yogendra; Lang, Dominik H.

    2017-06-01

    Estimation of Peak Floor Acceleration (PFA) demand along the height of a building is crucial for the seismic safety of nonstructural components. The effect of the level of inelasticity, controlled by the response reduction factor (strength ratio), is studied using incremental dynamic analysis. A total of 1120 nonlinear dynamic analyses, using a suite of 30 recorded ground motion time histories, are performed on mid-rise reinforced-concrete (RC) moment-resisting frame buildings covering a wide range in terms of their periods of vibration. The obtained PFA demands are compared with some of the major national seismic design and retrofit codes (IS 1893 draft version, ASCE 41, EN 1998, and NZS 1170.4). It is observed that the PFA demand at the building's roof level decreases with increasing period of vibration as well as with strength ratio. However, current seismic building codes do not account for these effects thereby producing very conservative estimates of PFA demands. Based on the identified parameters affecting the PFA demand, a model to obtain the PFA distribution along the height of a building is proposed. The proposed model is validated with spectrum-compatible time history analyses of the considered buildings with different strength ratios.

  4. 47 CFR 76.1203 - Incidence of harm.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 47 Telecommunication 4 2010-10-01 2010-10-01 false Incidence of harm. 76.1203 Section 76.1203 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) BROADCAST RADIO SERVICES MULTICHANNEL VIDEO AND CABLE TELEVISION SERVICE Competitive Availability of Navigation Devices § 76.1203 Incidence of harm. A...

  5. Delusions as harmful malfunctioning beliefs.

    PubMed

    Miyazono, Kengo

    2015-05-01

    Delusional beliefs are typically pathological. Being pathological is clearly distinguished from being false or being irrational. Anna might falsely believe that his husband is having an affair but it might just be a simple mistake. Again, Sam might irrationally believe, without good evidence, that he is smarter than his colleagues, but it might just be a healthy self-deceptive belief. On the other hand, when a patient with brain damage caused by a car accident believes that his father was replaced by an imposter or another patient with schizophrenia believes that "The Organization" painted the shops on a street in red and green to convey a message, these beliefs are not merely false or irrational. They are pathological. What makes delusions pathological? This paper explores the negative features because of which delusional beliefs are pathological. First, I critically examine the proposals according to which delusional beliefs are pathological because of (1) their strangeness, (2) their extreme irrationality, (3) their resistance to folk psychological explanations or (4) impaired responsibility-grounding capacities of people with them. I present some counterexamples as well as theoretical problems for these proposals. Then, I argue, following Wakefield's harmful dysfunction analysis of disorder, that delusional beliefs are pathological because they involve some sorts of harmful malfunctions. In other words, they have a significant negative impact on wellbeing (=harmful) and, in addition, some psychological mechanisms, directly or indirectly related to them, fail to perform the jobs for which they were selected in the past (=malfunctioning). An objection to the proposal is that delusional beliefs might not involve any malfunctions. For example, they might be playing psychological defence functions properly. Another objection is that a harmful malfunction is not sufficient for something to be pathological. For example, false beliefs might involve some malfunctions

  6. The role of interpersonal harm in distinguishing regret from guilt.

    PubMed

    Zeelenberg, Marcel; Breugelmans, Seger M

    2008-10-01

    Regret and guilt are emotions that are produced by negative outcomes for which one is responsible. Both emotions have received ample attention in the psychological literature; however, it is still unclear to what extent regret and guilt represent distinct psychological processes. We examined the extent to which the distinction between interpersonal harm (negative outcomes for others) and intrapersonal harm (negative outcomes for self) is crucial in differentiating these two emotions. In a series of 3 studies we found that guilt is predominantly felt in situations of interpersonal harm, whereas regret is felt in both situations of interpersonal harm and intrapersonal harm. Moreover, the results show that in situations of interpersonal harm the phenomenology of regret shares many, but not all features with the phenomenology of guilt. We conclude that the emotion processes resulting from interpersonal and intrapersonal harm are clearly distinct, but that regret as an emotion label is applied to both types of processes whereas the emotion label guilt is primarily used to refer to experiences of interpersonal harm. Implications for emotion research are discussed. (c) 2008 APA, all rights reserved

  7. Moral complexity in middle childhood: children's evaluations of necessary harm.

    PubMed

    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 participants. Moral judgments and justifications, knowledge of the actor's psychological experience, and their associations were examined. At all ages, children negatively evaluated prototypical harm; judgments of necessary harm became increasingly more forgiving with age as justifications pertaining to the actor's harm decreased. References to the actor's positive actions and children's tendency to coordinate conflicting concerns increased with age, but only when evaluating psychological harm. Across conditions, older children viewed transgressors as holding increasingly more positive attitudes toward their own actions, and this was uniquely associated with more forgiving moral judgments and justifications of necessary but not prototypical harm. Findings are discussed in relation to the emergence of more flexible and nuanced moral evaluations during middle childhood. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  8. HIV, HCV, and Health-Related Harms Among Women Who Inject Drugs: Implications for Prevention and Treatment.

    PubMed

    Iversen, Jenny; Page, Kimberly; Madden, Annie; Maher, Lisa

    2015-06-01

    Although an estimated 3.5 million women inject drugs globally, women are outnumbered 4 to one by men who inject drugs and are often ignored or overlooked in the development and delivery of prevention and treatment services for this population. This study aimed to identify key comorbidities prevalent among women who inject drugs (WWID), consider factors that contribute to vulnerability of this population, and examine implications for prevention and treatment. The literature was reviewed to examine the specific challenges and needs of WWID. We searched health-related bibliographic databases and grey literature to identify studies conducted among WWID and studies conducted among people who inject drugs (PWID), where results were disaggregated by gender and policies/guidelines/reports relevant to WWID. WWID face a range of unique, gender-specific, and often additional challenges and barriers. The lack of a targeted focus on WWID by prevention and treatment services and harm-reduction programs increases women's vulnerability to a range of health-related harms, including blood-borne viral and sexually transmitted infections, injection-related injuries, mental health issues, physical and sexual violence, poor sexual and reproductive health, issues in relation to childbearing and child care, and pervasive stigma and discrimination. There is a need to improve the collection and reporting of gender-disaggregated data on prevalence of key infections and prevention and treatment service access and program coverage. Women-focussed services and integrating gender equity and human rights into the harm-reduction programming will be a prerequisite if improvements in the health, safety, and well-being of this often invisible and highly vulnerable population are to be achieved.

  9. Harmful Algal Bloom Webinar

    EPA Pesticide Factsheets

    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.

  10. Damage to ventromedial prefrontal cortex impairs judgment of harmful intent.

    PubMed

    Young, Liane; Bechara, Antoine; Tranel, Daniel; Damasio, Hanna; Hauser, Marc; Damasio, Antonio

    2010-03-25

    Moral judgments, whether delivered in ordinary experience or in the courtroom, depend on our ability to infer intentions. We forgive unintentional or accidental harms and condemn failed attempts to harm. Prior work demonstrates that patients with damage to the ventromedial prefrontal cortex (VMPC) deliver abnormal judgments in response to moral dilemmas and that these patients are especially impaired in triggering emotional responses to inferred or abstract events (e.g., intentions), as opposed to real or actual outcomes. We therefore predicted that VMPC patients would deliver abnormal moral judgments of harmful intentions in the absence of harmful outcomes, as in failed attempts to harm. This prediction was confirmed in the current study: VMPC patients judged attempted harms, including attempted murder, as more morally permissible relative to controls. These results highlight the critical role of the VMPC in processing harmful intent for moral judgment. (c) 2010 Elsevier Inc. All rights reserved.

  11. The multifactorial role of the 3Rs in shifting the harm-benefit analysis in animal models of disease.

    PubMed

    Graham, Melanie L; Prescott, Mark J

    2015-07-15

    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. Copyright © 2015 Elsevier B.V. All rights reserved.

  12. The multifactorial role of the 3Rs in shifting the harm-benefit analysis in animal models of disease

    PubMed Central

    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

  13. Effectiveness and cost-effectiveness of dialectical behaviour therapy for self-harming patients with personality disorder: a pragmatic randomised controlled trial.

    PubMed

    Priebe, Stefan; Bhatti, Nyla; Barnicot, Kirsten; Bremner, Stephen; Gaglia, Amy; Katsakou, Christina; Molosankwe, Iris; McCrone, Paul; Zinkler, Martin

    2012-01-01

    A primary goal of dialectical behaviour therapy (DBT) is to reduce self-harm, but findings from empirical studies are inconclusive. The aim of this study was to assess the effectiveness and cost-effectiveness of DBT in reducing self-harm in patients with personality disorder. Participants with a personality disorder and at least 5 days of self-harm in the previous year were randomised to receive 12 months of either DBT or treatment as usual (TAU). The primary outcome was the frequency of days with self-harm; secondary outcomes included borderline personality disorder symptoms, general psychiatric symptoms, subjective quality of life, and costs of care. Forty patients each were randomised to DBT and TAU. In an intention-to-treat analysis, there was a statistically significant treatment by time interaction for self-harm (incidence rate ratio 0.91, 95% CI 0.89-0.92, p < 0.001). For every 2 months spent in DBT, the risk of self-harm decreased by 9% relative to TAU. There was no evidence of differences on any secondary outcomes. The economic analysis revealed a total cost of a mean of 5,685 GBP (6,786 EUR) in DBT compared to a mean of 3,754 GBP (4,481 EUR) in TAU, but the difference was not significant (95% CI -603 to 4,599 GBP). Forty-eight per cent of patients completed DBT. They had a greater reduction in self-harm compared to dropouts (incidence rate ratio 0.78, 95% CI 0.76-0.80, p < 0.001). DBT can be effective in reducing self-harm in patients with personality disorder, possibly incurring higher total treatment costs. The effect is stronger in those who complete treatment. Future research should explore how to improve treatment adherence. Copyright © 2012 S. Karger AG, Basel.

  14. Optimized operation of dielectric laser accelerators: Multibunch

    NASA Astrophysics Data System (ADS)

    Hanuka, Adi; Schächter, Levi

    2018-06-01

    We present a self-consistent analysis to determine the optimal charge, gradient, and efficiency for laser driven accelerators operating with a train of microbunches. Specifically, we account for the beam loading reduction on the material occurring at the dielectric-vacuum interface. In the case of a train of microbunches, such beam loading effect could be detrimental due to energy spread, however this may be compensated by a tapered laser pulse. We ultimately propose an optimization procedure with an analytical solution for group velocity which equals to half the speed of light. This optimization results in a maximum efficiency 20% lower than the single bunch case, and a total accelerated charge of 1 06 electrons in the train. The approach holds promise for improving operations of dielectric laser accelerators and may have an impact on emerging laser accelerators driven by high-power optical lasers.

  15. Rates of self-harm presenting to general hospitals: a comparison of data from the Multicentre Study of Self-Harm in England and Hospital Episode Statistics

    PubMed Central

    Turnbull, Pauline; Hawton, Keith; Geulayov, Galit; Waters, Keith; Ness, Jennifer; Townsend, Ellen; Khundakar, Kazem; Kapur, Nav

    2016-01-01

    Objective Rates of hospital presentation for self-harm in England were compared using different national and local data sources. Design The study was descriptive and compared bespoke data collection methods for recording self-harm presentations to hospital with routinely collected hospital data. Setting Local area data on self-harm from the 3 centres of the Multicentre Study of Self-harm in England (Oxford, Manchester and Derby) were used along with national and local routinely collected data on self-harm admissions and emergency department attendances from Hospital Episode Statistics (HES). Primary outcome Rate ratios were calculated to compare rates of self-harm generated using different data sources nationally and locally (between 2010 and 2012) and rates of hospital presentations for self-harm were plotted over time (between 2003 and 2012), based on different data sources. Results The total number of self-harm episodes between 2010 and 2012 was 13 547 based on Multicentre Study data, 9600 based on HES emergency department data and 8096 based on HES admission data. Nationally, routine HES data underestimated overall rates of self-harm by approximately 60% compared with rates based on Multicentre Study data (rate ratio for HES emergency department data, 0.41 (95% CI 0.35 to 0.49); rate ratio for HES admission data, 0.42 (95% CI 0.36 to 0.49)). Direct local area comparisons confirmed an overall underascertainment in the HES data, although the difference varied between centres. There was a general increase in self-harm over time according to HES data which contrasted with a fall and then a rise in the Multicentre Study data. Conclusions There was a consistent underestimation of presentations for self-harm recorded by HES emergency department data, and fluctuations in year-on-year figures. HES admission data appeared more reliable but missed non-admitted episodes. Routinely collected data may miss important trends in self-harm and cannot be used in isolation as

  16. Experimental Results from a Resonant Dielectric Laser Accelerator

    NASA Astrophysics Data System (ADS)

    Yoder, Rodney; McNeur, Joshua; Sozer, Esin; Travish, Gil; Hazra, Kiran Shankar; Matthews, Brian; England, Joel; Peralta, Edgar; Wu, Ziran

    2015-04-01

    Laser-powered accelerators have the potential to operate with very large accelerating gradients (~ GV/m) and represent a path toward extremely compact colliders and accelerator technology. Optical-scale laser-powered devices based on field-shaping structures (known as dielectric laser accelerators, or DLAs) have been described and demonstrated recently. Here we report on the first experimental results from the Micro-Accelerator Platform (MAP), a DLA based on a slab-symmetric resonant optical-scale structure. As a resonant (rather than near-field) device, the MAP is distinct from other DLAs. Its cavity resonance enhances its accelerating field relative to the incoming laser fields, which are coupled efficiently through a diffractive optic on the upper face of the device. The MAP demonstrated modest accelerating gradients in recent experiments, in which it was powered by a Ti:Sapphire laser well below its breakdown limit. More detailed results and some implications for future developments will be discussed. Supported in part by the U.S. Defense Threat Reduction Agency (UCLA); U.S. Dept of Energy (SLAC); and DARPA (SLAC).

  17. The harm argument against surrogacy revisited: two versions not to forget.

    PubMed

    Agnafors, Marcus

    2014-08-01

    It has been a common claim that surrogacy is morally problematic since it involves harm to the child or the surrogate-the harm argument. Due to a growing body of empirical research, the harm argument has seen a decrease in popularity, as there seems to be little evidence of harmful consequences of surrogacy. In this article, two revised versions of the harm argument are developed. It is argued that the two suggested versions of the harm argument survive the current criticism against the standard harm argument. The first version argues that the child is harmed by being separated from the gestational mother. The second version directs attention to the fact that surrogacy involves great incentives to keep the gestational mother's level of maternal-fetal attachment low, which tend to increase the risk of harm to the child. While neither of the two arguments is conclusive regarding the moral status of surrogacy, both constitute important considerations that are often ignored.

  18. TEXAS HARMFUL ALGAL BLOOM COORDINATION MX964014

    EPA Science Inventory

    Harmful algal blooms (HAB) are an expanding problem in coastal Texas. Nearly � of the known harmful algal blooms along the Texas coast have occurred in the past ten years and have led to significant resource and tourism losses. For example, there are at least two types of toxic...

  19. Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm.

    PubMed

    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.

  20. Experiences with Lean Six Sigma as improvement strategy to reduce parenteral medication administration errors and associated potential risk of harm

    PubMed Central

    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. PMID:28674608

  1. The harm-benefit tradeoff in "bad deal" trials.

    PubMed

    Nycum, Gillian; Reid, Lynette

    2007-12-01

    This paper examines the nature of the harm-benefit tradeoff in early clinical research for interventions that involve remote possibility of direct benefit and likelihood of direct harms to research participants with fatal prognoses, by drawing on the example of gene transfer trials for glioblastoma multiforme. We argue that the appeal made by the component approach to clinical equipoise fails to account fully for the nature of the harm-benefit tradeoff-individual harm for social benefit-that would be required to justify such research. An analysis of what we label "collateral affective benefits," such as the experience of hope or exercise of altruism, shows that the existence of these motivations reinforces rather than mitigates the necessity of justification by reference to social benefit. Evaluations of social benefit must be taken seriously in the research ethics review process to avoid the exploitation of research participants' motivations of hope or altruism and to avoid the possibility of inadvertent exploitation of high-risk research participants and the harms that would associate with such exploitation.

  2. Self-harm and overcrowding among prisoners in Geneva, Switzerland.

    PubMed

    Wolff, Hans; Casillas, Alejandra; Perneger, Thomas; Heller, Patrick; Golay, Diane; Mouton, Elisabeth; Bodenmann, Patrick; Getaz, Laurent

    2016-01-01

    Prison institutional conditions affect risk for self-harm among detainees. In particular, prison overcrowding may increase the likelihood of self-harm by creating competition for resources, space, and enhancing a "deprivation state." The purpose of this paper is to examine the association between overcrowding and prisoner acts of self-harm. This cross-sectional study took place at Geneva's pre-trial prison (capacity:376) between 2006 and 2014. Outcomes were acts of self-harm that required medical attention, and self-strangulation/hanging events (combined into one group, as these are difficult to differentiate). Dichotomous predictors were overcrowding index- annual mean daily population divided by capacity ( > 200 percent vs < 200 percent), and year group (2006-2009 vs 2011-2014). Self-harm and self-strangulations/hangings increased in 2011-2014 compared to 2006-2010 (p < 0.001). Overcrowding in excess of 200 percent was associated with self-strangulation/hangings (p < 0.001) but not with all self-harm events. In terms of pertinent demographics that would affect self-harm, there was no prison change in gender, area of origin, foreign residency, religion, or psychiatric treatment. The present study is limited by the definition and identification of self-harm. The distinction between self-strangulation and self-hanging, and the precise classification of an intent to die is difficult to make in practice, especially with limited prison data records available. The relevant literature addresses the complexity of the association between non-suicidal and suicidal behavior. Despite this, the combined category self-strangulations/hangings gives some indication of severe self-harm events, especially since the methodology of categorization employed was consistent throughout the entire period of the study. Other limitations include the small sample size and the lack of individual patient data and prison data to help control for confounding factors. Despite these drawbacks

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

    ERIC Educational Resources Information Center

    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…

  4. Denying Social Harm: Students' Resistance to Lessons about Inequality

    ERIC Educational Resources Information Center

    Kleinman, Sherryl; Copp, Martha

    2009-01-01

    Students share folk beliefs that make it difficult for them to understand inequality, especially the harmful consequences of social practices they routinely engage in, are attached to, and take for granted. Four of these beliefs include: (a) harm is direct, extreme, and the product of an individual's intentions; (2) harm is the product of the…

  5. Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study.

    PubMed

    Brehmer, Jess L; Husband, Jeffrey B

    2014-10-01

    There are relatively few studies in the literature that specifically evaluate accelerated rehabilitation protocols for distal radial fractures treated with open reduction and internal fixation (ORIF). The purpose of this study was to compare the early postoperative outcomes (at zero to twelve weeks postoperatively) of patients enrolled in an accelerated rehabilitation protocol with those of patients enrolled in a standard rehabilitation protocol following ORIF for a distal radial fracture. We hypothesized that patients with accelerated rehabilitation after volar ORIF for a distal radial fracture would have an earlier return to function compared with patients who followed a standard protocol. From November 2007 to November 2010, eighty-one patients with an unstable distal radial fracture were prospectively randomized to follow either an accelerated or a standard rehabilitation protocol after undergoing ORIF with a volar plate for a distal radial fracture. Both groups began with gentle active range of motion at three to five days postoperatively. At two weeks, the accelerated group initiated wrist/forearm passive range of motion and strengthening exercises, whereas the standard group initiated passive range of motion and strengthening at six weeks postoperatively. Patients were assessed at three to five days, two weeks, three weeks, four weeks, six weeks, eight weeks, twelve weeks, and six months postoperatively. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores (primary outcome) and measurements of wrist flexion/extension, supination, pronation, grip strength, and palmar pinch. The patients in the accelerated group had better mobility, strength, and DASH scores at the early postoperative time points (zero to eight weeks postoperatively) compared with the patients in the standard rehabilitation group. The difference between the groups was both clinically relevant and statistically significant. Patients who follow an accelerated rehabilitation

  6. Prevalence, Harm Perceptions, and Reasons for Using Noncombustible Tobacco Products Among Current and Former Smokers

    PubMed Central

    Pearson, Jennifer; Xiao, Haijun; Stalgaitis, Carolyn; Vallone, Donna

    2014-01-01

    Objectives. We provided estimates of noncombustible tobacco product (electronic nicotine delivery systems [ENDS]; snus; chewing tobacco, dip, or snuff; and dissolvables) use among current and former smokers and examined harm perceptions of noncombustible tobacco products and reasons for their use. Methods. We assessed awareness of, prevalence of, purchase of, harm perceptions of, and reasons for using noncombustible tobacco products among 1487 current and former smokers from 8 US designated market areas. We used adjusted logistic regression to identify correlates of noncombustible tobacco product use. Results. Of the sample, 96% were aware of at least 1 noncombustible tobacco product, but only 33% had used and 21% had purchased one. Noncombustible tobacco product use was associated with being male, non-Hispanic White, younger, and more nicotine dependent. Respondents used noncombustible tobacco products to cut down or quit cigarettes, but only snus was associated with a higher likelihood of making a quit attempt. Users of noncombustible tobacco products, particularly ENDS, were most likely to endorse the product as less harmful than cigarettes. Conclusions. Smokers may use noncombustible tobacco products to cut down or quit smoking. However, noncombustible tobacco product use was not associated with a reduction in cigarettes per day or cessation. PMID:24922154

  7. A Defence of the Counterfactual Account of Harm.

    PubMed

    Purshouse, Craig

    2016-05-01

    In order to determine whether a particular course of conduct is ethically permissible it is important to have a concept of what it means to be harmed. The dominant theory of harm is the counterfactual account, most famously proposed by Joel Feinberg. This determines whether harm is caused by comparing what actually happened in a given situation with the 'counterfacts' i.e. what would have occurred had the putatively harmful conduct not taken place. If a person's interests are worse off than they otherwise would have been, then a person will be harmed. This definition has recently faced challenges from bioethicists such as John Harris, Guy Kahane and Julian Savulescu who, believing it to be severely flawed, have proposed their own alternative theories of the concept. In this article I will demonstrate that the shortcomings Harris, Kahane and Savulescu believe are present in Feinberg's theory are illusory and that it is their own accounts of harm that are fraught with logical errors. I maintain that the arguments presented to refute Feinberg's theory not only fail to achieve this goal and can be accommodated within the counterfactual account but that they actually undermine the theories presented by their respective authors. The final conclusion will be that these challenges are misconceived and fail to displace the counterfactual theory. © 2015 John Wiley & Sons Ltd.

  8. Suicide After Deliberate Self-Harm in Adolescents and Young Adults.

    PubMed

    Olfson, Mark; Wall, Melanie; Wang, Shuai; Crystal, Stephen; Bridge, Jeffrey A; Liu, Shang-Min; Blanco, Carlos

    2018-04-01

    Among adolescents and young adults with nonfatal self-harm, our objective is to identify risk factors for repeated nonfatal self-harm and suicide death over the following year. A national cohort of patients in the Medicaid program, aged 12 to 24 years ( n = 32 395), was followed for up to 1 year after self-harm. Cause of death information was obtained from the National Death Index. Repeat self-harm per 1000 person-years and suicide deaths per 100 000 person-years were determined. Hazard ratios (HRs) of repeat self-harm and suicide were estimated by Cox proportional hazard models. Suicide standardized mortality rate ratios were derived by comparison with demographically matched general population controls. The 12-month suicide standardized mortality rate ratio after self-harm was significantly higher for adolescents (46.0, 95% confidence interval [CI]: 29.9-67.9) than young adults (19.2, 95% CI: 12.7-28.0). Hazards of suicide after self-harm were significantly higher for American Indians and Alaskan natives than non-Hispanic white patients (HR: 4.69, 95% CI: 2.41-9.13) and for self-harm patients who initially used violent methods (HR: 18.04, 95% CI: 9.92-32.80), especially firearms (HR: 35.73, 95% CI: 15.42-82.79), compared with nonviolent self-harm methods (1.00, reference). The hazards of repeat self-harm were higher for female subjects than male subjects (HR: 1.25, 95% CI: 1.18-1.33); patients with personality disorders (HR: 1.55, 95% CI: 1.42-1.69); and patients whose initial self-harm was treated in an inpatient setting (HR: 1.65, 95% CI: 1.49-1.83) compared with an emergency department (HR: 0.62, 95% CI: 0.55-0.69) or outpatient (1.00, reference) setting. After nonfatal self-harm, adolescents and young adults were at markedly elevated risk of suicide. Among these high-risk patients, those who used violent self-harm methods, particularly firearms, were at especially high risk underscoring the importance of follow-up care to help ensure their safety

  9. Motivations for adolescent self-harm and the implications for mental health nurses.

    PubMed

    Doyle, L; Sheridan, A; Treacy, M P

    2017-03-01

    WHAT IS KNOWN ON THE SUBJECT?: Self-harm is a relatively common occurrence in adolescents; however, there remains a lack of understanding about the motivations behind adolescent self-harm, and this poor understanding can have a negative impact on how mental health professionals respond to young people who self-harm. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper identifies the reasons for self-harm in a community sample of young people and finds that the functions of self-harm differ for different people and that there may be multiple reasons for self-harm. Findings provide support for the affect-regulation model of self-harm which states that young people self-harm to regulate how they are feeling, but provides little support for the interpersonal influence model which proposes that self-harm is an attempt to influence how other people respond to them. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Self-harm for most young people serves at least one specific function and is an indication of distress. There is a requirement for a non-pathologizing response towards young people who self-harm; self-harm should be understood as a meaningful behaviour rather than a symptom of an illness. Mental health nurses need to understand the multiple functions of self-harm. A better understanding of the individualized meaning behind self-harm can positively impact on attitudes towards young people who self-harm and provide for improved mental health service provision. Introduction Although self-harm is a relatively common occurrence in adolescents, there is a lack of understanding about the motivations behind it. A poor understanding of self-harm contributes to negative perceptions about those who self-harm and a poor healthcare experience. Aim & Methods This study identifies motivations behind self-harm in school-based adolescents using a cross-sectional survey. Motivations behind self-harm were elicited using a scale and open-ended responses. Results Of the 856

  10. Angular Impact Mitigation System for Bicycle Helmets to Reduce Head Acceleration and Risk of Traumatic Brain Injury

    PubMed Central

    Hansen, Kirk; Dau, Nathan; Feist, Florian; Deck, Caroline; Willinger, Rémy; Madey, Steven M.; Bottlang, Michael

    2013-01-01

    Angular acceleration of the head is a known cause of traumatic brain injury (TBI), but contemporary bicycle helmets lack dedicated mechanisms to mitigate angular acceleration. A novel Angular Impact Mitigation (AIM) system for bicycle helmets has been developed that employs an elastically suspended aluminum honeycomb liner to absorb linear acceleration in normal impacts as well as angular acceleration in oblique impacts. This study tested bicycle helmets with and without AIM technology to comparatively assess impact mitigation. Normal impact tests were performed to measure linear head acceleration. Oblique impact tests were performed to measure angular head acceleration and neck loading. Furthermore, acceleration histories of oblique impacts were analyzed in a computational head model to predict the resulting risk of TBI in the form of concussion and diffuse axonal injury (DAI). Compared to standard helmets, AIM helmets resulted in a 14% reduction in peak linear acceleration (p < 0.001), a 34% reduction in peak angular acceleration (p < 0.001), and a 22% to 32% reduction in neck loading (p < 0.001). Computational results predicted that AIM helmets reduced the risk of concussion and DAI by 27% and 44%, respectively. In conclusion, these results demonstrated that AIM technology could effectively improve impact mitigation compared to a contemporary expanded polystyrene-based bicycle helmet, and may enhance prevention of bicycle-related TBI. Further research is required. PMID:23770518

  11. Association Between Deliberate Self-harm and Violent Criminality.

    PubMed

    Sahlin, Hanna; Kuja-Halkola, Ralf; Bjureberg, Johan; Lichtenstein, Paul; Molero, Yasmina; Rydell, Mina; Hedman, Erik; Runeson, Bo; Jokinen, Jussi; Ljótsson, Brjánn; Hellner, Clara

    2017-06-01

    Individuals who self-harm may have an increased risk of aggression toward others, but this association has been insufficiently investigated. More conclusive evidence may affect assessment, treatment interventions, and clinical guidelines. To investigate the association between nonfatal self-harm and violent crime. This population-based longitudinal cohort study, conducted from January 1, 1997, through December 31, 2013, studied all Swedish citizens born between 1982 and 1998 who were 15 years and older (N = 1 850 252). Individuals who emigrated from Sweden before the age of 15 years (n = 104 051) or immigrated to Sweden after the age of 13 years (ie, <2 years before the beginning of the follow-up; n = 22 009) were excluded. Data analysis was performed from April 21, 2016, to June 4, 2016. Receipt of self-harm-associated clinical care. Conviction of a violent crime according to the Swedish penal code. The study cohort consisted of 1 850 525 individuals (950 382 males and 900 143 females), and the mean (SD) follow-up time was 8.1 (4.7) years (range, 0-17.0 years; minimum age, 15 years; maximum age, 32 years). During a mean follow-up period of 8.1 years, 55 185 individuals (3.0%) received clinical care for self-harm. The crude hazard ratio was 4.9 (95% CI, 4.8-5.0) for violent crime conviction in exposed individuals compared with the unexposed group. Women who self-harm were at particularly high risk for expressing violent behaviors. After adjustment for relevant psychiatric comorbidities and socioeconomic status, an almost doubled hazard of violent offense remained (hazard ratio, 1.8; 95% CI, 1.8-1.9). Self-harm is associated with an increased risk of conviction for a violent offense in both sexes. The risk of violence, as well as the risk of suicide and self-harm, should be assessed among offending and self-harming individuals.

  12. Psychological characteristics of self-harming behavior in Korean adolescents.

    PubMed

    Lee, Woo Kyeong

    2016-10-01

    Recently, self-injury is drawing the attention of researchers and clinicians. The purpose of this study was to investigate the prevalence and psychological characteristics of adolescents who engage in self-harm and to examine the risk factors for engaging in this harmful behavior among Korean mid-adolescents. Participants were 784 adolescents aged 13-15 years. They completed self-report questionnaires that assessed (1) Non-Suicidal Self-Injury: the Self-Harm Questionnaire, Toronto Alexithymia Scale; (2) depression: Children's Depression Inventory; (3) adolescent-parent relationship: Parental Bonding Instrument; (4) peer attachment: Inventory of Parent and Peer Attachment; and (5) academic stress. Overall, 12.4% (n=97) of participants reported engaging in self-destructive behavior at least once in their lives. The primary reason for engaging in self-harm was to regulate negative emotions such as anger and sadness. As expected, the self-harm group showed statistically significant higher levels of academic stress, alexithymia, depression, and poor relationships with their parents and peers. Stepwise multiple regression analysis showed that alexithymia, depression, and peer relations were significant predictors of self-harming behavior. Given that the primary reason for engaging in self-harm is to cope with negative emotions, mental health professionals in school settings should regularly evaluate self-injurious behavior and provide prevention programs for adolescents at risk. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Adolescent self-harm: a school-based study in Northern Ireland.

    PubMed

    O'Connor, Rory C; Rasmussen, Susan; Hawton, Keith

    2014-04-01

    The prevalence of adolescent self-harm in Northern Ireland (NI) and its associated factors are unknown. Given the established relationship between conflict and mental health, and NI׳s recent history of conflict, it is important to investigate the factors associated with self-harm in NI. This study aimed to determine the prevalence of self-harm in NI adolescents and the factors associated with it, including exposure to the NI conflict. Observational study of 3596 school pupils employing an anonymous self-report survey. Information was obtained on demographic characteristics, lifestyle, life events and problems, exposure to the NI conflict, social and internet influences, and psychological variables. Self-harm was reported by 10% of respondents. In univariate analyses, exposure to the NI conflict was associated with self-harm alongside established risk factors. In multivariate analyses, bullying and exposure to self-harm were associated with lifetime self-harm in both girls and boys. Alcohol use, drug use, physical and sexual abuse, and self-esteem were also associated with self-harm in girls. In boys, absence of exercise, sexual orientation concerns, anxiety and impulsivity were additional risk factors. The internet/social media and the self-harm of others were also key influences. This is a cross-sectional study. The rate of self-harm was lower than elsewhere in the UK/Ireland. The study highlights the factors which should be considered in terms of risk assessment. In addition to established risk factors, the findings suggest that more research on the legacy of the NI conflict as well as the influence of new technologies warrant urgent attention. Copyright © 2014 Elsevier B.V. All rights reserved.

  14. Characteristics and trends of self-harming behaviour in young people.

    PubMed

    Cleaver, Karen

    Deliberate self-harm is recognized as a serious public health issue in young people. There is evidence that young people who self-harm are more likely to repeat self-harm, and this in turn increases their risk of completed suicide. Prevalence studies have identified that the rate of self-harm among young people is on the increase, information largely based on data arising from review and analysis of hospital attendances. However, community-based studies indicate that the prevalence is much higher, with those seen in emergency departments representing the 'tip of the iceberg' (Hawton and Rodham, 2006). Young people's motives for self-harm are discussed, as are research findings which indicate that nurses can have negative attitudes towards patients who self-harm. The article considers the implications of this for young people and identifies areas for future research.

  15. Potentially Harmful Therapy and Multicultural Counseling: Bridging Two Disciplinary Discourses

    PubMed Central

    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

  16. Incidence Rates of Deliberate Self-Harm in Denmark 1994–2011

    PubMed Central

    2016-01-01

    Abstract. Background: The validity and reliability of suicide statistics have been questioned and few nationwide studies of deliberate self-harm have been presented. Aim: To calculate rates of deliberate self-harm in Denmark in order to investigate trends and assess the reliability of hospital records. Method: A register study based on all individuals recorded with an episode of deliberate self-harm or probable deliberate self-harm in nationwide registers during 1994–2011. Results: A substantial difference in the rates of deliberate self-harm and probable deliberate self-harm was noted for both genders. The average incidence rate of deliberate self-harm for women and men was 130.7 (95% CI = 129.6–131.8) per 100,000 and 86.9 (95% CI = 86.0–87.8) per 100,000, respectively. The rates of deliberate self-harm for women increased from 137.6 (95% CI = 132.9–142.3) per 100,000 in 1994 to 152.7 (95% CI = 147.8–157.5) in 2011. For a subgroup of younger women aged 15–24 years, an almost threefold increase was observed, IRR = 2.5 (95% CI = 2.4–2.7). The most frequently used method was self-poisoning. Conclusion: The rates of deliberate self-harm and probable deliberate self-harm differed significantly. An increased incidence of deliberate self-harm among young Danish women was observed, despite detection bias. An improved registration procedure of suicidal behavior is needed. PMID:27278571

  17. Acceleration and Velocity Sensing from Measured Strain

    NASA Technical Reports Server (NTRS)

    Pak, Chan-Gi; Truax, Roger

    2016-01-01

    A simple approach for computing acceleration and velocity of a structure from the strain is proposed in this study. First, deflection and slope of the structure are computed from the strain using a two-step theory. Frequencies of the structure are computed from the time histories of strain using a parameter estimation technique together with an Autoregressive Moving Average model. From deflection, slope, and frequencies of the structure, acceleration and velocity of the structure can be obtained using the proposed approach. shape sensing, fiber optic strain sensor, system equivalent reduction and expansion process.

  18. 40 CFR 51.151 - Significant harm levels.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 2 2010-07-01 2010-07-01 false Significant harm levels. 51.151 Section... Emergency Episodes § 51.151 Significant harm levels. Each plan for a Priority I region must include a... concentrations at any location in such region from reaching the following levels: Sulfur dioxide—2.620 µg/m3 (1.0...

  19. Emergency Department Staff Beliefs About Self-Harm: A Thematic Framework Analysis.

    PubMed

    Koning, Kate Louise; McNaught, Angela; Tuffin, Keith

    2017-11-03

    To explore the beliefs and attitudes of emergency department staff about self-harm behaviour. Existing studies looking at views regarding self-harm rely solely on the information provided by medical and nursing staff using a questionnaire format. No studies currently consider ancillary staff members' beliefs about self-harm, even though they also work with these patients. A thematic framework analysis of interview transcripts was carried out. Individual semi-structured interviews were conducted from December 2015 to February 2016. Fifteen medical, nursing, and ancillary staff members from a large, tertiary emergency department participated. There were 5 major themes identified-causes of self-harm are multifactorial; beliefs about self-harm can change over time; emergency departments should only focus on the physical; self-harm occurs on a spectrum; and the system has failed. The results suggest participants felt ill-prepared and lacking in appropriate training to help patients that self-harm, and furthermore they have little faith in the mental health system. Staff beliefs and attitudes may change over time with exposure to patients who self-harm, possibly becoming more positive in response to a greater understanding of why the self-harm behaviour is occurring.

  20. The use of charcoal in modified cigarette filters for mainstream smoke carbonyl reduction

    PubMed Central

    Holman, Matthew R.; Ding, Yan S.; Yan, Xizheng; Chan, Michele; Chafin, Dana; Perez, Jose; Mendez, Magaly I.; Cardenas, Roberto Bravo; Watson, Clifford

    2017-01-01

    Carbonyls are harmful and potentially harmful constituents (HPHCs) in mainstream cigarette smoke (MSS). Carbonyls, including formaldehyde and acrolein, are carcinogenic or mutagenic in a dose-dependent manner. Past studies demonstrate significant reduction of HPHCs by charcoal filtration. However, limits of charcoal filtration and cigarette design have not yet been investigated in a systematic manner. Objective data is needed concerning the feasibility of HPHC reduction in combustible filtered cigarettes. This systematic study evaluates the effect of charcoal filtration on carbonyl reduction in MSS. We modified filters of ten popular cigarette products with predetermined quantities (100–400 mg) of charcoal in a plug-space-plug configuration. MSS carbonyls, as well as total particulate matter, tar, nicotine, carbon monoxide (TNCO), and draw resistance were quantified. Significant carbonyl reductions were observed across all cigarette products as charcoal loading increased. At the highest charcoal loadings, carbonyls were reduced by nearly 99%. Tar and nicotine decreased modestly (<20%) compared to reductions in carbonyls. Increased draw resistance was significant at only the highest charcoal loadings. This work addresses information gaps in the science base that can inform the evaluation of charcoal filtration as an available technological adaptation to cigarette design which reduces levels of carbonyls in MSS. PMID:28238852

  1. Mitigating Harmful Cyanobacterial Blooms in a Human- and Climatically-Impacted World

    PubMed Central

    Paerl, Hans W.

    2014-01-01

    Bloom-forming harmful cyanobacteria (CyanoHABs) are harmful from environmental, ecological and human health perspectives by outcompeting beneficial phytoplankton, creating low oxygen conditions (hypoxia, anoxia), and by producing cyanotoxins. Cyanobacterial genera exhibit optimal growth rates and bloom potentials at relatively high water temperatures; hence, global warming plays a key role in their expansion and persistence. CyanoHABs are regulated by synergistic effects of nutrient (nitrogen:N and phosphorus:P) supplies, light, temperature, vertical stratification, water residence times, and biotic interactions. In most instances, nutrient control strategies should focus on reducing both N and P inputs. Strategies based on physical, chemical (nutrient) and biological manipulations can be effective in reducing CyanoHABs; however, these strategies are largely confined to relatively small systems, and some are prone to ecological and environmental drawbacks, including enhancing release of cyanotoxins, disruption of planktonic and benthic communities and fisheries habitat. All strategies should consider and be adaptive to climatic variability and change in order to be effective for long-term control of CyanoHABs. Rising temperatures and greater hydrologic variability will increase growth rates and alter critical nutrient thresholds for CyanoHAB development; thus, nutrient reductions for bloom control may need to be more aggressively pursued in response to climatic changes globally. PMID:25517134

  2. Measuring and preventing alcohol use and related harm among young people in Asian countries: a thematic review.

    PubMed

    Jiang, Heng; Xiang, Xiaojun; Hao, Wei; Room, Robin; Zhang, Xiaojie; Wang, Xuyi

    2018-01-01

    The paper reviews alcohol consumption patterns and alcohol-related social and health issues among 15-29-year old young people in Asian countries, and discusses strategies for preventing and controlling alcohol use and related harms. We searched Google Scholar, PubMed, and Web of Science for reports, reviews and journal articles published in English between 1st Jan 1990 and 31st August 2016. Forty-one reports, reviews and journal papers were identified and included in the final review. The current drinking levels and prevalence among young people are markedly different between eight included Asian countries, ranging from 4.2% in Malaysia to 49.3% in China. In a majority of the selected Asian countries, over 15% of total deaths among young men and 6% among young women aged 15-29 years are attributable to alcohol use. Alcohol use among young people is associated with a number of harms, including stress, family violence, injuries, suicide, and sexual and other risky behaviours. Alcohol policies, such as controlling sales, social supply and marketing, setting up/raising a legal drinking age, adding health warning labels on alcohol containers, and developing a surveillance system to monitor drinking pattern and risky drinking behaviour, could be potential means to reduce harmful use of alcohol and related harm among young people in Asia. The review reveals that drinking patterns and behaviours vary across eight selected Asian countries due to culture, policies and regional variations. The research evidence holds substantial policy implications for harm reduction on alcohol drinking among young people in Asian countries -- especially for China, which has almost no alcohol control policies at present.

  3. Potential reduction exposure products and FDA tobacco and regulation: a CNS call to action.

    PubMed

    Heath, Janie; Andrews, Jeannette; Balkstra, Cindy R

    2004-01-01

    A new generation of tobacco harm reduction products is stirring controversy and confusion among healthcare providers. These products, known as "potential reduction exposure products" (PREPs), can be described in terms of reported scientific evidence, as "the good, the bad, and the ugly." On the good side, there is sufficient scientific evidence to support the use of Commit, a new over-the-counter nicotine lozenge PREP, approved for smoking cessation. On the bad side, there is no scientific evidence to support the use of Ariva, another over-the-counter nicotine lozenge PREP, marketed as an alternative to cigarettes when smoking is restricted. On the ugly side, both of these PREPs are nicotine delivery systems with "candy-like" appearances; however, one (Commit) has the Food and Drug Administration (FDA) approval and the other (Ariva) does not. This article provides an overview of PREPs and strategies to help clinical nurse specialists (CNSs) address tobacco harm reduction issues.

  4. Reduced Exposure to Harmful and Potentially Harmful Smoke Constituents With the Tobacco Heating System 2.1.

    PubMed

    Lüdicke, Frank; Baker, Gizelle; Magnette, John; Picavet, Patrick; Weitkunat, Rolf

    2017-02-01

    Heating rather than burning tobacco reduces levels of harmful and potentially harmful constituents, and consumer products using this approach aim to reduce exposure to tobacco toxicants. The Tobacco Heating System (THS) version 2.1 has been enhanced from earlier prototypes with an improved heat control and sensorial experience and thereby user acceptance. Exposure measurements are required to determine whether it may be possible to reduce the individual health risk compared to smoking combustible cigarettes (CCs). This controlled clinical study randomly assigned 40 smokers to either a group continuing to use of their own CC brand (n = 20) or a group switching to THS 2.1 (n = 20) for 5 days. Biomarkers of exposure were measured at baseline and on day 1 through day 5. Product consumption, Human Puffing Topography, the occurrence of adverse events, and an assessment of subjective effects, such as smoking satisfaction and enjoyment of respiratory tract sensations, were also determined. The group of smokers who switched to THS 2.1 adapted their puffing behavior initially through longer puff duration and more puffs. During the duration of the study, total puff volume returned to baseline levels and the mean daily product consumption increased but with similar nicotine exposure compared to baseline CC use. Biomarkers of exposure to tobacco smoke toxicants which inform product risk assessment were significantly reduced with THS use compared to the CC group. THS 2.1 users experienced less reinforcing effects with THS 2.1 than with their own cigarette brand. THS 2.1 is a promising alternative to smoking CCs. Notwithstanding possible use adaption through consumption or puffing behavior, the exposure to harmful smoke constituents was markedly reduced with the new heated tobacco platform. Exposure markers to harmful and potentially harmful smoke constituents were lowered with the THS 2.1. Heating tobacco instead of burning can offer a potentially lower risk of delivering

  5. Reduced Exposure to Harmful and Potentially Harmful Smoke Constituents With the Tobacco Heating System 2.1

    PubMed Central

    Baker, Gizelle; Magnette, John; Picavet, Patrick; Weitkunat, Rolf

    2017-01-01

    Introduction: Heating rather than burning tobacco reduces levels of harmful and potentially harmful constituents, and consumer products using this approach aim to reduce exposure to tobacco toxicants. The Tobacco Heating System (THS) version 2.1 has been enhanced from earlier prototypes with an improved heat control and sensorial experience and thereby user acceptance. Exposure measurements are required to determine whether it may be possible to reduce the individual health risk compared to smoking combustible cigarettes (CCs). Methods: This controlled clinical study randomly assigned 40 smokers to either a group continuing to use of their own CC brand (n = 20) or a group switching to THS 2.1 (n = 20) for 5 days. Biomarkers of exposure were measured at baseline and on day 1 through day 5. Product consumption, Human Puffing Topography, the occurrence of adverse events, and an assessment of subjective effects, such as smoking satisfaction and enjoyment of respiratory tract sensations, were also determined. Results: The group of smokers who switched to THS 2.1 adapted their puffing behavior initially through longer puff duration and more puffs. During the duration of the study, total puff volume returned to baseline levels and the mean daily product consumption increased but with similar nicotine exposure compared to baseline CC use. Biomarkers of exposure to tobacco smoke toxicants which inform product risk assessment were significantly reduced with THS use compared to the CC group. THS 2.1 users experienced less reinforcing effects with THS 2.1 than with their own cigarette brand. Conclusions: THS 2.1 is a promising alternative to smoking CCs. Notwithstanding possible use adaption through consumption or puffing behavior, the exposure to harmful smoke constituents was markedly reduced with the new heated tobacco platform. Implications: Exposure markers to harmful and potentially harmful smoke constituents were lowered with the THS 2.1. Heating tobacco instead of

  6. Predictors of short-term repetition of self-harm among patients admitted to an emergency room following self-harm: A retrospective one-year cohort study.

    PubMed

    Kawahara, Yoko Yoshida; Hashimoto, Satoshi; Harada, Masahiro; Sugiyama, Daisuke; Yamada, Shu; Kitada, Maki; Sakurai, Toshihiro; Takahashi, Takeshi; Yamashita, Kensho; Watanabe, Kenjiro; Mimura, Masaru; Fujisawa, Daisuke

    2017-12-01

    We conducted a retrospective chart-review study, examining predictors of the repetition of short-term self-harm (<1 month and <6 months) among the patients who were admitted to an emergency department in Japan following self-harm. A total of 405 patients were enrolled and were followed-up for a subsequent one year. The incidence of repeated self-harm within one- and six- months were 6.4% and 13.1%, respectively. Cox's proportional hazards model analyses demonstrated that history of self-harm and comorbid physical illness were associated with repeated self-harm within one month. The patients who lived alone and who were directly discharged from the emergency room after referral to a psychiatrist were at higher risk for repeated self-harm within both one and six months. Living on public assistance and having been discharged from psychiatric wards within the past 12 months were associated with repetition within six months. These risk factors should be incorporated into routine assessment at an emergency room, and elaborate follow-up plan should be provided to the patients with these risk factors upon discharge from the emergency room. Further prospective studies are warranted, addressing more comprehensive factors that are associated with short-term risk for self-harm and suicide. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Parental Detection of Youth's Self-Harm Behavior

    ERIC Educational Resources Information Center

    Mojtabai, Ramin; Olfson, Mark

    2008-01-01

    The rate and predictors of parental detection of youth self-harm behavior and relationship with help-seeking were examined in 7,036 parent-child dyads from the 1999 and 2004 surveys of Mental Health of Children and Young People in Great Britain. Youth self-harm behavior was reported by 463 (6.6%) children and adolescents but only 190 (2.7%) of the…

  8. Regulating Emotion and Identity by Narrating Harm

    PubMed Central

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

    2015-01-01

    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. PMID:26392641

  9. Weight reduction for non-alcoholic fatty liver disease.

    PubMed

    Peng, Lijun; Wang, Jiyao; Li, Feng

    2011-06-15

    Non-alcoholic fatty liver disease (NAFLD) is becoming a wide spread liver disease. The present recommendations for treatment are not evidence-based. Some of them are various weight reduction measures with diet, exercise, drug, or surgical therapy. To assess the benefits and harms of intended weight reduction for patients with NAFLD. We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, PubMed, EMBASE, Science Citation Index Expanded, Chinese Biomedicine Database, and ClinicalTrials.gov until February 2011. We included randomised clinical trials evaluating weight reduction with different measures versus no intervention or placebo in NAFLD patients. We extracted data independently. We calculated the odds ratio (OR) for dichotomous data and calculated the mean difference (MD) for continuous data, both with 95% confidence intervals (CI). The review includes seven trials; five on aspects of lifestyle changes (eg, diet, physical exercise) and two on treatment with a weight reduction drug 'orlistat'. In total, 373 participants were enrolled, and the duration of the trials ranged from 1 month to 1 year. Only one trial on lifestyle programme was judged to be of low risk of bias. We could not perform meta-analyses for the main outcomes as they were either not reported or there were insufficient number of trials for each outcome to be meta-analysed. We could meta-analyse the available data for body weight and body mass index only. Adverse events were poorly reported. The sparse data and high risk of bias preclude us from drawing any definite conclusion on lifestyle programme or orlistat for treatment of NAFLD. Further randomised clinical trials with low risk of bias are needed to test the beneficial and harmful effects of weight reduction for NAFLD patients. The long-term prognosis of development of fibrosis, mortality, and quality of life should be studied.

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

    ERIC Educational Resources Information Center

    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…

  11. Gender roles, suicidal ideation, and self-harming in young adults.

    PubMed

    Straiton, Melanie L; Roen, Katrina; Hjelmeland, Heidi

    2012-01-01

    This study investigates whether positive and negative conventional gender roles relate to suicidal ideation and self-harming in different ways among young adults. Participants completed an online survey about previous self-harm, recent suicidal ideation, and positive and negative aspects of conventional masculinity and femininity. Logistic regression analyses showed that negative femininity positively predicted self-harm and recent suicidal ideation status. Positive femininity was unrelated. Positive masculinity was negatively related to suicidal ideation and self-harming while negative masculinity was negatively related to self-harming only. The findings suggest that it is not the conventional feminine gender role per se that is associated with suicidality but specific negatively evaluated aspects. Conceptualizing gender as a multivariate construct may be useful in the gender socialization theory of suicidal behavior.

  12. Why Do the Very Old Self-Harm? A Qualitative Study.

    PubMed

    Wand, Anne P F; Peisah, Carmelle; Draper, Brian; Brodaty, Henry

    2018-03-15

    To examine the perspectives of people aged 80 years or older who self-harmed regarding their reasons for self-harm and its consequences, and their perceptions of care. A qualitative study using in-depth interviews. Participants were recruited from two teaching hospitals and associated community services. People aged 80 years or older who had self-harmed within the previous month. Structured psychiatric assessment including cognitive testing, DSM-5 diagnosis, and an in-depth qualitative interview focusing upon the reasons for and consequences of self-harm. Narrative enquiry was used to guide the discussion. All interviews were undertaken by a geriatric psychiatrist, audio recorded, transcribed verbatim, and subjected to thematic analysis using N-VIVO. Themes that emerged for the reasons for self-harm included "enough is enough"; "loneliness"; "disintegration of self"; "being a burden"; "cumulative adversity"; "hopelessness and endless suffering"; "helplessness with rejection"; and "the untenable situation". Themes for the consequences of self-harm were "becoming engaged with or distanced from family"; "the problem was solved"; "gaining control"; "I"m worse off now"; "rejection by health professionals"; and "tension in the role of the inpatient clinical environment". Self-harm may communicate a need that cannot otherwise be expressed. An individualized person-centered approach is required to respond to self-harm, including a combination of practical, medical, and psychological approaches as indicated. Involvement of families in the process of understanding the meaning of and responding to self-harm through education and family therapy, as well as education of healthcare professionals beyond risk factor notation may be indicated. Copyright © 2018 American Association for Geriatric Psychiatry. All rights reserved.

  13. Harmful Algal Blooms Research

    EPA Science Inventory

    This project represents the Agency’s first effort to unify harmful algal blooms (HABs) research that had been previously carried out in isolation within various laboratories. A unified program is the most efficient way generate useful results for the Agency’s decision...

  14. Harmful excipients in medicines for neonates in Spain.

    PubMed

    Garcia-Palop, Beatriz; Movilla Polanco, Emma; Cañete Ramirez, Carmen; Cabañas Poy, Maria Jose

    2016-04-01

    Neonates may respond differently from adults to drug components. Hence, ingredients that seem safe in adults may not be safe in this age group. To describe the content of harmful excipients in drugs used in our neonatal wards and compare the daily dose a neonate may receive with the accepted daily intake (ADI) in adults. All drugs included in the hospital's neonatal treatment guide were reviewed, using information from the package inserts or the summary of product characteristics. Those containing at least one harmful excipient (e.g., metabisulfite, sorbitol) were analyzed. Minimum and maximum usual daily drug doses were determined, and excipient exposure was estimated by extrapolation of the minimum and maximum of excipient referred to the active ingredient. These amounts were compared with ADIs for each excipient in adults. In total, 32 % of intravenous and 62 % of oral formulations used in neonates contained at least one harmful excipient. On quantitative analysis, 25 % of intravenous and 19 % of oral drugs contained harmful excipients exceeding the ADI in adults. Several drugs commonly used to treat neonates contain harmful excipients in amounts that may exceed the ADI in adults. Clinicians should be aware of this to prescribe appropriate treatment in this population.

  15. Local competition increases people's willingness to harm others

    PubMed Central

    Barker, Jessica L.; Barclay, Pat

    2016-01-01

    Why should organisms incur a cost in order to inflict a (usually greater) cost on others? Such costly harming behavior may be favored when competition for resources occurs locally, because it increases individuals’ fitness relative to close competitors. However, there is no explicit experimental evidence supporting the prediction that people are more willing to harm others under local versus global competition. We illustrate this prediction with a game theoretic model, and then test it in a series of economic games. In these experiments, players could spend money to make others lose more. We manipulated the scale of competition by awarding cash prizes to the players with the highest payoffs per set of social partners (local competition) or in all the participants in a session (global competition). We found that, as predicted, people were more harmful to others when competition was local (Study 1). This result still held when people “earned” (rather than were simply given) their money (Study 2). In addition, when competition was local, people were more willing to harm ingroup members than outgroup members (Study 3), because ingroup members were the relevant competitive targets. Together, our results suggest that local competition in human groups not only promotes willingness to harm others in general, but also causes ingroup hostility. PMID:29805247

  16. Pregnancy as a harm?

    PubMed

    Kraft, Rory E

    2012-01-01

    Michigan's Appellate Court ruled in 2004 that a pregnancy that resulted from a rape should be considered a bodily injury for sentencing purposes. Interestingly, all three possible outcomes of a pregnancy-abortion, miscarriage, or childbirth-are considered to bring with them significant and substantial physical, psychological, and emotional changes. While the immediate impact of the ruling in People v. Cathey affected only the guilty individual, there are larger implications for this ruling beyond just sentencing guidelines. The ruling can be considered a step forward in prosecuting rapists, but possibly at the expense of reimagining the female body. This article considers the Cathey ruling itself, the potential benefits and consequences of this understanding on feminist discourse, and, crucially, the impact of this decision on abortion discussions. The central question that emerges is, can we both consider pregnancy a harm and believe that this harm is not always wrong-making?

  17. Explaining Self-Harm: Youth Cybertalk and Marginalized Sexualities and Genders

    ERIC Educational Resources Information Center

    McDermott, Elizabeth; Roen, Katrina; Piela, Anna

    2015-01-01

    This study investigates self-harm among young lesbian, gay, bisexual, and trans (LGBT) people. Using qualitative virtual methods, we examined online forums to explore young LGBT people's cybertalk about emotional distress and self-harming. We investigated how youth explained the relationship between self-harm and sexuality and gender. We found…

  18. Deontological Dilemma Response Tendencies and Sensorimotor Representations of Harm to Others

    PubMed Central

    Christov-Moore, Leonardo; Conway, Paul; Iacoboni, Marco

    2017-01-01

    The dual process model of moral decision-making suggests that decisions to reject causing harm on moral dilemmas (where causing harm saves lives) reflect concern for others. Recently, some theorists have suggested such decisions actually reflect self-focused concern about causing harm, rather than witnessing others suffering. We examined brain activity while participants witnessed needles pierce another person’s hand, versus similar non-painful stimuli. More than a month later, participants completed moral dilemmas where causing harm either did or did not maximize outcomes. We employed process dissociation to independently assess harm-rejection (deontological) and outcome-maximization (utilitarian) response tendencies. Activity in the posterior inferior frontal cortex (pIFC) while participants witnessed others in pain predicted deontological, but not utilitarian, response tendencies. Previous brain stimulation studies have shown that the pIFC seems crucial for sensorimotor representations of observed harm. Hence, these findings suggest that deontological response tendencies reflect genuine other-oriented concern grounded in sensorimotor representations of harm. PMID:29311859

  19. A media information analysis for implementing effective countermeasure against harmful rumor

    NASA Astrophysics Data System (ADS)

    Nagao, Mitsuyoshi; Suto, Kazuhiro; Ohuchi, Azuma

    2010-04-01

    When large scale earthquake occurred, the word of "harmful rumor" came to be frequently heard. The harmful rumor means an economic damage which is caused by the action that people regard actually safe foods or areas as dangerous and then abort consumption or sightseeing. In the case of harmful rumor caused by earthquake, especially, tourism industry receives massive economic damage. Currently, harmful rumor which gives substantial economic damage have become serious social issue which must be solved. In this paper, we propose a countermeasure method for harmful rumor on the basis of media trend in order to implement speedy recovery from harmful rumor. Here, we investigate the amount and content of information which is transmitted to the general public by the media when an earthquake occurred. In addition, the media information in three earthquakes is treated as instance. Finally, we discuss an effective countermeasure method for dispeling harmful rumor through these analysis results.

  20. The Theory of Dyadic Morality: Reinventing Moral Judgment by Redefining Harm.

    PubMed

    Schein, Chelsea; Gray, Kurt

    2018-02-01

    The nature of harm-and therefore moral judgment-may be misunderstood. Rather than an objective matter of reason, we argue that harm should be redefined as an intuitively perceived continuum. This redefinition provides a new understanding of moral content and mechanism-the constructionist Theory of Dyadic Morality (TDM). TDM suggests that acts are condemned proportional to three elements: norm violations, negative affect, and-importantly-perceived harm. This harm is dyadic, involving an intentional agent causing damage to a vulnerable patient (A→P). TDM predicts causal links both from harm to immorality (dyadic comparison) and from immorality to harm (dyadic completion). Together, these two processes make the "dyadic loop," explaining moral acquisition and polarization. TDM argues against intuitive harmless wrongs and modular "foundations," but embraces moral pluralism through varieties of values and the flexibility of perceived harm. Dyadic morality impacts understandings of moral character, moral emotion, and political/cultural differences, and provides research guidelines for moral psychology.

  1. 46 CFR 4.03-65 - Significant harm to the environment.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Significant harm to the environment. 4.03-65 Section 4... MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-65 Significant harm to the environment. Significant harm to the environment means— (a) In the navigable waters of the United States, a discharge of...

  2. 46 CFR 4.03-65 - Significant harm to the environment.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Significant harm to the environment. 4.03-65 Section 4... MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-65 Significant harm to the environment. Significant harm to the environment means— (a) In the navigable waters of the United States, a discharge of...

  3. 46 CFR 4.03-65 - Significant harm to the environment.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Significant harm to the environment. 4.03-65 Section 4... MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-65 Significant harm to the environment. Significant harm to the environment means— (a) In the navigable waters of the United States, a discharge of...

  4. 46 CFR 4.03-65 - Significant harm to the environment.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Significant harm to the environment. 4.03-65 Section 4... MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-65 Significant harm to the environment. Significant harm to the environment means— (a) In the navigable waters of the United States, a discharge of...

  5. 46 CFR 4.03-65 - Significant harm to the environment.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Significant harm to the environment. 4.03-65 Section 4... MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-65 Significant harm to the environment. Significant harm to the environment means— (a) In the navigable waters of the United States, a discharge of...

  6. Evolution of helping and harming in heterogeneous populations.

    PubMed

    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).

  7. Deliberate self harm in adolescents: self report survey in schools in England

    PubMed Central

    Hawton, Keith; Rodham, Karen; Evans, Emma; Weatherall, Rosamund

    2002-01-01

    Objective To determine the prevalence of deliberate self harm in adolescents and the factors associated with it. Design Cross sectional survey using anonymous self report questionnaire. Setting 41 schools in England. Participants 6020 pupils aged 15 and 16 years. Main outcome measure Deliberate self harm. Results 398 (6.9%) participants reported an act of deliberate self harm in the previous year that met study criteria. Only 12.6% of episodes had resulted in presentation to hospital. Deliberate self harm was more common in females than it was in males (11.2% v 3.2%; odds ratio 3.9, 95% confidence interval 3.1 to 4.9). In females the factors included in a multivariate logistic regression for deliberate self harm were recent self harm by friends, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem. In males the factors were suicidal behaviour in friends and family members, drug use, and low self esteem. Conclusions Deliberate self harm is common in adolescents, especially females. School based mental health initiatives are needed. These could include approaches aimed at educating school pupils about mental health problems and screening for those at risk. What is already known on this topicDeliberate self harm is a common reason for presentation of adolescents to hospitalCommunity studies from outside the United Kingdom have shown much greater prevalence of self harm in adolescents than hospital based studiesWhat this study addsDeliberate self harm defined according to strict criteria is common in adolescents, especially femalesAssociated factors include recent awareness of self harm in peers, self harm by family members, drug misuse, depression, anxiety, impulsivity, and low self esteem PMID:12446536

  8. Association Between Deliberate Self-harm and Violent Criminality

    PubMed Central

    Kuja-Halkola, Ralf; Bjureberg, Johan; Lichtenstein, Paul; Molero, Yasmina; Rydell, Mina; Hedman, Erik; Runeson, Bo; Jokinen, Jussi; Ljótsson, Brjánn; Hellner, Clara

    2017-01-01

    Importance Individuals who self-harm may have an increased risk of aggression toward others, but this association has been insufficiently investigated. More conclusive evidence may affect assessment, treatment interventions, and clinical guidelines. Objective To investigate the association between nonfatal self-harm and violent crime. Design, Setting, and Participants This population-based longitudinal cohort study, conducted from January 1, 1997, through December 31, 2013, studied all Swedish citizens born between 1982 and 1998 who were 15 years and older (N = 1 850 252). Individuals who emigrated from Sweden before the age of 15 years (n = 104 051) or immigrated to Sweden after the age of 13 years (ie, <2 years before the beginning of the follow-up; n = 22 009) were excluded. Data analysis was performed from April 21, 2016, to June 4, 2016. Exposures Receipt of self-harm–associated clinical care. Main Outcomes and Measures Conviction of a violent crime according to the Swedish penal code. Results The study cohort consisted of 1 850 525 individuals (950 382 males and 900 143 females), and the mean (SD) follow-up time was 8.1 (4.7) years (range, 0-17.0 years; minimum age, 15 years; maximum age, 32 years). During a mean follow-up period of 8.1 years, 55 185 individuals (3.0%) received clinical care for self-harm. The crude hazard ratio was 4.9 (95% CI, 4.8-5.0) for violent crime conviction in exposed individuals compared with the unexposed group. Women who self-harm were at particularly high risk for expressing violent behaviors. After adjustment for relevant psychiatric comorbidities and socioeconomic status, an almost doubled hazard of violent offense remained (hazard ratio, 1.8; 95% CI, 1.8-1.9). Conclusions and Relevance Self-harm is associated with an increased risk of conviction for a violent offense in both sexes. The risk of violence, as well as the risk of suicide and self-harm, should be assessed among offending and self-harming

  9. A Smartphone App (BlueIce) for Young People Who Self-Harm: Open Phase 1 Pre-Post Trial

    PubMed Central

    Porter, Joanna; Grist, Rebecca

    2018-01-01

    Background Recent years have seen a significant increase in the availability of smartphone apps for mental health problems. Despite their proliferation, few apps have been specifically developed for young people, and almost none have been subject to any form of evaluation. Objective This study aimed to undertake a preliminary evaluation of a smartphone app (BlueIce), coproduced with young people and designed to help young people manage distress and urges to self-harm. We aimed to assess the acceptability, safety, and use of BlueIce and to explore the effects on the primary outcome of self-harm and the secondary outcomes of psychological functioning. Methods We undertook an open trial where we recruited young people aged 12 to 17 years attending specialist child and adolescent mental health services (CAMHS) who were currently self-harming or had a history of self-harm. Eligible participants were assessed at baseline and then given BlueIce. They were assessed 2 weeks later (post familiarization) and again at 12 weeks (post use). A behavior-screening questionnaire (Strengths and Difficulties Questionnaire) was completed along with standardized measures of depression (Mood and Feelings Questionnaire or MFQ) and anxiety (Revised Child Anxiety and Depression Scale or RCADS), taking into account self-reports of self-harm, app helpfulness, and safety. Results All core CAMHS professional groups referred at least 1 young person. Out of 40 young people recruited, 37 (93%) elected to use BlueIce after familiarization, with 29 out of 33 (88%) wanting to keep it at the end of the study. No young person called the emergency numbers during the 12-week trial, and no one was withdrawn by his or her clinician due to increased risk of suicide. Almost three-quarters (73%) of those who had recently self-harmed reported reductions in self-harm after using BlueIce for 12 weeks. There was a statistically significant mean difference of 4.91 (t31=2.11; P=.04; 95% CI 0.17-9.64) on postuse

  10. E-cigarette Advertising Exposure, Explicit and Implicit Harm Perceptions, and E-Cigarette use Susceptibility Among Non-Smoking Young Adults.

    PubMed

    Pokhrel, Pallav; Herzog, Thaddeus A; Fagan, Pebbles; Unger, Jennifer B; Stacy, Alan W

    2018-02-10

    This study tested whether exposure to e-cigarette advertising increases e-cigarette use susceptibility among non-smoking young adults by promoting explicit and implicit attitudes towards e-cigarettes as a safer and healthier alternative to combustible cigarettes. Young adult current non-smokers who had never used an e-cigarette (N = 393; Mean age = 22.1, Standard Deviation = 3.9; 66% Women) were randomly assigned to one of the 3 conditions that involved viewing real-world, print e-cigarette ads. Two of the 3 conditions were experimental conditions where ads with different predominant themes [harm-reduction ("Health") vs. social enhancement ("Social") focused] were interspersed among ads of everyday objects. The third condition was the control condition involving ads of everyday objects only. Participants provided data on explicit (i.e., self-reported harm perceptions) and implicit (i.e., Implicit Association Test) attitudes towards e-cigarette use and e-cigarette use intentions. Hypotheses were tested using structural equation modeling. Relative to Control participants, participants in Health and Social conditions were more likely to show higher implicit attitudes towards e-cigarettes as a safer alternative to cigarettes. Only the Social condition, relative to Control, had a significant effect on lower explicit harm perceptions of e-cigarette versus cigarette use. The Social condition had a significant indirect effect on e-cigarette use susceptibility, mediated by explicit harm perceptions. Social enhancement-themed ads may communicate the reduced-harm messages more strongly among young adults so as to affect both explicit and implicit attitudes and, through these, e-cigarette use susceptibility. Regulatory bodies may need to scrutinize reduced-harm claims communicated through social enhancement-themed ads. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions

  11. Experimental Investigation on Reduction Kinetics of Stainless Steel-Making Slag in Iron Bath Smelting Reduction

    NASA Astrophysics Data System (ADS)

    Zhang, Bo; Liu, Jienan; Yang, Yanfeng; Liu, Luming; Liu, Jiechao; Luo, Lijian; Ma, Yubao; Hong, Xin

    Reduction kinetics of stainless steel slag in iron bath smelting reduction was studied at the temperature of 1500°C ˜ 1650°C. It was concluded that the reduction process consisted of two parts. That is to say smelting reduction was controlled by stainless steel slag melting initially and by interface reaction later. In order to increase smelting reaction rate, the melting point of slag should be decreased at the first stage and adjust the liquidity of slag at later stage. Smelting reaction rate will be accelerated by means of optimize the slag content. The optimal reduction result that all most all of the chromium in slag been recovered was obtained in temperature was 1500°C, basicity of slag was 1.0˜1.2, the value of Al2O3+MgO was 25%.

  12. An Empirical Analysis of Internet Message Boards for Self-Harming Behavior.

    PubMed

    Eichenberg, Christiane; Schott, Markus

    2017-01-01

    Much debate surrounds the potential effects of self-harm forum use. Arguments in favor highlight factors such as providing access to a supportive community. However critical voice highlighting potential dangers such as forums serving as a platform to promote self-harm, clearly dominate the debate. Using an online questionnaire, the goal of the current study was to examine sociodemographic characteristics, the psychopathology of forum users, motives for participating, and subjective effects of self-harm forum use. A total of 309 self-harm forum users participated in this study. 3 heterogeneous user types with differing motives for visiting the forum and different usage effects were identified. The results question the assumptions that self-harm forums are a source of harm and point to their predominantly constructive and preventive functions.

  13. Epidemiology and trends in non-fatal self-harm in three centres in England, 2000–2012: findings from the Multicentre Study of Self-harm in England

    PubMed Central

    Geulayov, Galit; Kapur, Navneet; Turnbull, Pauline; Waters, Keith; Ness, Jennifer; Townsend, Ellen; Hawton, Keith

    2016-01-01

    Objectives Self-harm is a major health problem in many countries, with potential adverse outcomes including suicide and other causes of premature death. It is important to monitor national trends in this behaviour. We examined trends in non-fatal self-harm and its management in England during the 13-year period, 2000–2012. Design and setting This observational study was undertaken in the three centres of the Multicentre Study of Self-harm in England. Information on all episodes of self-harm by individuals aged 15 years and over presenting to five general hospitals in three cities (Oxford, Manchester and Derby) was collected through face-to-face assessment or scrutiny of emergency department electronic databases. We used negative binomial regression models to assess trends in rates of self-harm and logistic regression models for binary outcomes (eg, assessed vs non-assessed patients). Participants During 2000–2012, there were 84 378 self-harm episodes (58.6% by females), involving 47 048 persons. Results Rates of self-harm declined in females (incidence rate ratio (IRR) 0.98; 95% CI 0.97 to 0.99, p<0.0001). In males, rates of self-harm declined until 2008 (IRR 0.96; 95% CI 0.95 to 0.98, p<0.0001) and then increased (IRR 1.05; 95% CI 1.02 to 1.09, p=0.002). Rates of self-harm were strongly correlated with suicide rates in England in males (r=0.82, p=0.0006) and females (r=0.74, p=0.004). Over 75% of self-harm episodes were due to self-poisoning, mainly with analgesics (45.7%), antidepressants (24.7%) and benzodiazepines (13.8%). A substantial increase in self-injury occurred in the latter part of the study period. This was especially marked for self-cutting/stabbing and hanging/asphyxiation. Psychosocial assessment by specialist mental health staff occurred in 53.2% of episodes. Conclusions Trends in rates of self-harm and suicide may be closely related; therefore, self-harm can be a useful mental health indicator. Despite national guidance, many patients

  14. 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

    ERIC Educational Resources Information Center

    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…

  15. Lifetime Self-Harm Behaviors Are Not More Prevalent in Bariatric Surgery Candidates than in Community Controls with Obesity.

    PubMed

    Müller, Astrid; Claes, Laurence; Smits, Dirk; Schag, Kathrin; de Zwaan, Martina

    2018-01-01

    The study aimed at investigating the lifetime prevalence of 22 self-harm behaviors in bariatric surgery candidates (pre-bariatric surgery group; PSG) compared to community controls with obesity (obese community group; OCG). The Self-Harm Inventory (SHI) was administered to the PSG (n = 139, BMI ≥ 35 kg/m2) and to the OCG (n = 122, BMI ≥ 35 kg/m2). Group comparison of cumulative SHI scores indicated a trend towards less endorsed SHI items in the PSG compared to the OCG (medianPSG = 1.00, IQRPSG = 2.00, medianOCG = 1.00, IQROCG = 2.25, U = 7.241, p = 0.033, η2 = 0.02). No significant group differences were found with regard to the rate of suicide attempts (12.4% vs. 9.4% for OCG vs. PSG). At least one type of lifetime self-harm behavior was admitted by 51.8% of the PSG and 63.9% of the OCG (χ2(1) = 3.91, p = 0.048). The results of logistic regressions using Firth's bias reduction method with at least one SHI item endorsed as dependent variable, group as categorical predictor (PSG as baseline), and age or BMI or PHQ-4 as continuous control variable indicated that only PHQ-4 had a positive effect on the odds ratio. The results suggest that self-harm (including suicidal attempts) is not more prevalent in bariatric surgery candidates than in community control participants with obesity. Further studies are needed to investigate self-harm in bariatric surgery patients, prior and following surgery, compared to non-operated patients with obesity. © 2018 The Author(s) Published by S. Karger GmbH, Freiburg.

  16. Motion sickness and otolith sensitivity - A pilot study of habituation to linear acceleration

    NASA Technical Reports Server (NTRS)

    Potvin, A. R.; Sadoff, M.; Billingham, J.

    1977-01-01

    Astronauts, particularly in Skylab flights, experienced varying degrees of motion sickness lasting 3-5 days. One possible mechanism for this motion sickness adaptation is believed to be a reduction in otolith sensitivity with an attendant reduction in sensory conflict. In an attempt to determine if this hypothesis is valid, a ground-based pilot study was conducted on a vertical linear accelerator. The extent of habituation to accelerations which initially produced motion sickness was evaluated, along with the possible value of habituation training to minimize the space motion sickness problem. Results showed that habituation occurred for 6 of the 8 subjects tested. However, in tests designed to measure dynamic and static otolith function, no significant differences between pre- and post-habituation tests were observed. Cross habituation effects to a standard Coriolis acceleration test were not significant. It is unlikely that ground-based pre-habituation to linear accelerations of the type examined would alter susceptibility to space motion sickness.

  17. Why Suicide? The Analysis of Motives for Self-Harm.

    PubMed

    Abbas, Mohammed J; Mohanna, Mostafa A; Diab, Tarig A; Chikoore, Millicent; Wang, Michael

    2018-03-01

    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.

  18. Intoxication with alcohol at the time of self-harm and pre-existing involvement with mental health services are associated with a pre-disposition to repetition of self-harming behavior in a large cohort of older New Zealanders presenting with an index episode of self-harm.

    PubMed

    Ames, David

    2017-08-01

    The paper on predictors of repeat self-harm and suicide by Cheung et al. (2017), which has been chosen by the editorial team as paper of the month for this issue of International Psychogeriatrics, makes a very useful contribution to the study of self-harm and suicide in late life. Of 339 individuals presenting with an index episode of self-harm to one of seven Emergency Departments (EDs) in New Zealand, close to 15% harmed themselves again within one year and for nearly one in six of these 50 people, the repeat episode was fatal. Having alcohol in the blood and already being engaged with mental health services at the time of the index episode both had some utility in predicting the occurrence of a further self-harm episode. While it is encouraging that mental health services look to have been focusing on those who turned out to be at highest risk, clinicians may need to be particularly vigilant when following up individuals who had been drinking alcohol at the time of an initial self-harm presentation. This study also emphasizes the high risk of recurrent self-harm and completed suicide in those older adults who harm themselves and survive the initial episode. It deserves to be widely cited and gives some direction for future research on interventions designed to diminish the recurrence of self-harm in those of our patients who have presented to an ED with an initial self-harm episode.

  19. Absolute Effect of Prostate Cancer Screening: Balance of benefits and harms by center within the European Randomized Study of Prostate Cancer Screening

    PubMed Central

    Auvinen, Anssi; Moss, Sue M; Tammela, Teuvo L J; Taari, Kimmo; Roobol, Monique J; Schröder, Fritz H; Bangma, Chris H; Carlsson, Sigrid; Aus, Gunnar; Zappa, Marco; Puliti, Donella; Denis, Louis J; Nelen, Vera; Kwiatkowski, Maciej; Randazzo, Marco; Paez, Alvaro; Lujan, Marcos; Hugosson, Jonas

    2016-01-01

    Purpose The balance of benefits and harms in prostate cancer screening has not been sufficiently characterized. We related indicators of mortality reduction and overdetection by center within the European Randomized Study of Prostate Cancer Screening. Experimental Design We analyzed the absolute mortality reduction expressed as number needed to invite (NNI=1/absolute risk reduction; indicating how many men had to be randomized to screening arm to avert a prostate cancer death) for screening and the absolute excess of prostate cancer detection as number needed for overdetection (NNO=1/absolute excess incidence; indicating the number of men invited per additional prostate cancer case), and compared their relationship across the seven ERSPC centers. Results Both absolute mortality reduction (NNI) and absolute overdetection (NNO) varied widely between the centers: NNI 200-7000 and NNO 16-69. Extent of overdiagnosis and mortality reduction were closely associated (correlation coefficient r=0.76, weighted linear regression coefficient β=33, 95% 5-62, R2=0.72). For an averted prostate cancer death at 13 years of follow-up, 12-36 excess cases had to be detected in various centers. Conclusions The differences between the ERSPC centers likely reflect variations in prostate cancer incidence and mortality, as well as in screening protocol and performance. The strong interrelation between the benefits and harms suggests that efforts to maximize the mortality effect are bound to increase overdiagnosis, and might be improved by focusing on high-risk populations. The optimal balance between screening intensity and risk of overdiagnosis remains unclear. PMID:26289069

  20. Bullying victimisation, self harm and associated factors in Irish adolescent boys.

    PubMed

    McMahon, Elaine M; Reulbach, Udo; Keeley, Helen; Perry, Ivan J; Arensman, Ella

    2010-10-01

    School bullying victimisation is associated with poor mental health and self harm. However, little is known about the lifestyle factors and negative life events associated with victimisation, or the factors associated with self harm among boys who experience bullying. The objectives of the study were to examine the prevalence of bullying in Irish adolescent boys, the association between bullying and a broad range of risk factors among boys, and factors associated with self harm among bullied boys and their non-bullied peers. Analyses were based on the data of the Irish centre of the Child and Adolescent Self Harm in Europe (CASE) study (boys n = 1870). Information was obtained on demographic factors, school bullying, deliberate self harm and psychological and lifestyle factors including negative life events. In total 363 boys (19.4%) reported having been a victim of school bullying at some point in their lives. The odds ratio of lifetime self harm was four times higher for boys who had been bullied than those without this experience. The factors that remained in the multivariate logistic regression model for lifetime history of bullying victimisation among boys were serious physical abuse and self esteem. Factors associated with self harm among bullied boys included psychological factors, problems with schoolwork, worries about sexual orientation and physical abuse, while family support was protective against self harm. Our findings highlight the mental health problems associated with victimisation, underlining the importance of anti-bullying policies in schools. Factors associated with self harm among boys who have been bullied should be taken into account in the identification of boys at risk of self harm.

  1. Characterising microbial reduction of arsenate sorbed to ferrihydrite and its concurrence with iron reduction.

    PubMed

    Huang, Jen-How

    2018-03-01

    A series of model anoxic incubations were performed to understand the concurrence between arsenate and ferrihydrite reduction by Shewanella putrefaciens strain CN-32 at different concentrations of arsenate, ferrihydrite and lactate, and with given ΔG rxn for arsenate and ferrihydrite reduction in non-growth conditions. The reduction kinetics of arsenate sorbed to ferrihydrite is predominately controlled by the availability of dissolved arsenate, which is measured by the integral of dissolved arsenate concentrations against incubation time and shown to correlate with the first order rate constants. High lactate concentrations slightly slowed down the rate of arsenate reduction due to the competition with arsenate for microbial contact. Under all experimental conditions, simultaneous arsenate and ferrihydrite reduction occurred following addition of S. putrefaciens inoculums and suggested no apparent competition between these two enzymatic reductions. Ferrous ions released from iron reduction might retard microbial arsenate reduction at high arsenate and ferrihydrite concentrations due to formation of ferrous arsenate. At high arsenate to ferrihydrite ratios, reductive dissolution of ferrihydrite shifted arsenate from sorption to dissolution and hence accelerated arsenate reduction. The interaction between microbial arsenate and ferrihydrite reduction did not correlate with ΔG rxn , but instead was governed by other factors such as geochemical and microbial parameters. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Self-Harm and Conventional Gender Roles in Women

    ERIC Educational Resources Information Center

    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.…

  3. Harmful Non-Indigenous Species in the United States.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Office of Technology Assessment.

    Non-indigenous species (NIS) are common in the United States landscape. While some are beneficial, others are harmful and can cause significant economic, environmental, and health damage. This study, requested by the U.S. House Merchant Marine and Fisheries Committee, examined State and Federal policies related to these harmful NIS. The report is…

  4. Using HFMEA to assess potential for patient harm from tubing misconnections.

    PubMed

    Kimehi-Woods, Judy; Shultz, John P

    2006-07-01

    Reported cases of tubing misconnections and other tubing errors prompted Columbus Children's Hospital to study their potential for harm in its patient population. A Health Failure Mode and Effects Analysis (HFMEA) was conducted in October 2004 to determine the risks inherent in the use and labeling of various enteral, parenteral, and other tubing types in patient care and the potential for patient harm. An assessment of the practice culture revealed considerable variability among nurses and respiratory therapists within and between units. Work on an HFMEA culminated in recommendations of risk reduction strategies. These included standardizing the process of labeling of tubing throughout the organization, developing an online pictorial catalog to list available tubing supplies with all aliases used by staff, and conducting an inventory of all supplies to identify products that need to be purchased or discontinued. Three groups are working on implementing each of the recommendations. Most of the results already realized occurred in labeling of tubing. The pediatric intensive care unit labels all tubing with infused medications 85% of the time; tubings inserted during surgery or in interventional radiology are labeled 53% and 93% of the time. Pocket-size cards with printed labels were tested in three units. This proactive risk assessment project has identified failure modes and possible causes and solutions; several recommendations have been implemented. No tubing misconnections have been reported.

  5. Harms to “Others” and the Selection Against Disability View

    PubMed Central

    2017-01-01

    Abstract In recent years, the question of whether prospective parents might have a moral obligation to select against disability in their offspring has piqued the attention of many prominent philosophers and bioethicists, and a large literature has emerged surrounding this question. Rather than looking to the most common arguments given in support of a positive response to the abovementioned question, such as those focusing on the harms disability may impose on the child created, duties and role-specific obligations, and impersonal ‘harms’, a less commonly made set of arguments is focused upon which looks to the harms that a decision not to select against disability may impose on others. Three different possible arguments supporting a limited duty of disability avoidance are thus identified and subsequently explored: harms to parents themselves, harms to existing family members, and harms to other existing members of society. PMID:28180274

  6. Acceleration modules in linear induction accelerators

    NASA Astrophysics Data System (ADS)

    Wang, Shao-Heng; Deng, Jian-Jun

    2014-05-01

    The Linear Induction Accelerator (LIA) is a unique type of accelerator that is capable of accelerating kilo-Ampere charged particle current to tens of MeV energy. The present development of LIA in MHz bursting mode and the successful application into a synchrotron have broadened LIA's usage scope. Although the transformer model is widely used to explain the acceleration mechanism of LIAs, it is not appropriate to consider the induction electric field as the field which accelerates charged particles for many modern LIAs. We have examined the transition of the magnetic cores' functions during the LIA acceleration modules' evolution, distinguished transformer type and transmission line type LIA acceleration modules, and re-considered several related issues based on transmission line type LIA acceleration module. This clarified understanding should help in the further development and design of LIA acceleration modules.

  7. Prevalence of gambling-related harm provides evidence for the prevention paradox.

    PubMed

    Browne, Matthew; Rockloff, Matthew J

    2018-05-23

    Background The prevention paradox (PP) describes a situation in which a greater number of cases of a disease-state come from low-risk members of a population, because they are more prevalent than high-risk members. Past research has provided only tangential and disputed evidence to support the application of the PP to gambling-related harm. Aims To assess whether the PP applies to gambling, the prevalence of a large set (72) of diverse harmful consequences from gambling was examined across four risk categories for problem gambling, including no-risk, low-risk, moderate-risk, and problem-gambling. Methods Respondents who had gambled on non-lottery forms in the past 6 months completed an online survey (N = 1,524, 49.4% male). The data were weighted to the known prevalence of gambling problems in the Victorian community. Results The prevalence of gambling harms, including severe harms, was generally higher in the combined categories of lower risk categories compared to the high-risk problem-gambling category. There were some notable exceptions, however, for some severe and rare harms. Nevertheless, the majority of harms in the 72-item list, including serious harms such as needing temporary accommodation, emergency welfare assistance, experiencing separation or end of a relationship, loss of a job, needing to sell personal items, and experiencing domestic violence from gambling, were more commonly associated with lower risk gamblers. Conclusion Many significant harms are concentrated outside the ranks of gamblers with a severe mental health condition, which supports a public-health approach to ameliorating gambling-related harm.

  8. Cutting Class Harms Grades

    ERIC Educational Resources Information Center

    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…

  9. Ion extraction capabilities of two-grid accelerator systems. [for spacecraft propulsion

    NASA Technical Reports Server (NTRS)

    Rovang, D. C.; Wilbur, P. J.

    1984-01-01

    An experimental investigation into the ion extraction capabilities of two-grid accelerator systems common to electrostatic ion thrusters is described. A large body of experimental data which facilitates the selection of the accelerator system geometries and operating parameters necessary to maximize the extracted ion current is presented. Results suggest that the impingement-limited perveance is not dramatically affected by reductions in screen hole diameter to 0.5 mm. Impingement-limited performance is shown to depend most strongly on grid separation distance, accelerator hole diameter ratio, the discharge-to-total accelerating voltage ratio, and the net-to-total accelerating voltage ratio. Results obtained at small grid separation ratios suggest a new grid operating condition where high beam current per hole levels are achieved at a specified net accelerating voltage. It is shown that this operating condition is realized at an optimum ratio of net-to-total accelerating voltage ratio which is typically quite high.

  10. Drug policy, harm and human rights: a rationalist approach.

    PubMed

    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.

  11. Do no harm: a defense of markets in healthcare.

    PubMed

    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.

  12. [Familial transmission of depression: the importance of harm avoidance].

    PubMed

    Ulrich, I; Stopsack, M; Spitzer, C; Grabe, H-J; Freyberger, H J; Barnow, S

    2011-09-01

    Previous research about the aetiology of depression has analysed how depression-associated personality traits influence familial transmission. Using the community-based sample of the Greifswald Family Study, we investigated longitudinally to which extent the temperament factor harm avoidance influences the correlation between parent's depression and the depression of their offspring (with regard to possible sex differences). To test this familial transmission a structural equation model was conducted with the data of 193 children (mean age 19.5, SD=2.41) and their biological parents. Depression was assessed with structured clinical interviews, and harm avoidance with Cloninger's Temperament and Character Inventory (TCI, JTCI). The harm avoidance scores of the mothers were significantly correlated with the harm avoidance scores of their children, but the correlation of the father's and children's scores did not reach significance. The extent of harm avoidance at the first assessment of the 14-year-old children predicted depression 5 years later. These results indicate the importance of personality as a vulnerability marker for developing affective disorders. The results are discussed with respect to prevention programmes for children and parents with depression, especially if they exhibit strongly avoidant or anxious behaviour.

  13. Anger, disgust, and presumption of harm as reactions to taboo-breaking behaviors.

    PubMed

    Gutierrez, Roberto; Giner-Sorolla, Roger

    2007-11-01

    Three experiments investigated the relationship between the presumption of harm in harmfree violations of creatural norms (taboos) and the moral emotions of anger and disgust. In Experiment 1, participants made a presumption of harm to others from taboo violations, even in conditions described as harmless and not involving other people; this presumption was predicted by anger and not disgust. Experiment 2 manipulated taboo violation and included a cognitive load task to clarify the post hoc nature of presumption of harm. Experiment 3 was similar but more accurately measured presumed harm. In Experiments 2 and 3, only without load was symbolic harm presumed, indicating its post hoc function to justify moral anger, which was not affected by load. In general, manipulations of harmfulness to others predicted moral anger better than moral disgust, whereas manipulations of taboo predicted disgust better. The presumption of harm was found on measures of symbolic rather than actual harm when a choice existed. These studies clarify understanding of the relationship between emotions and their justification when people consider victimless, offensive acts.

  14. Predicting brain acceleration during heading of soccer ball

    NASA Astrophysics Data System (ADS)

    Taha, Zahari; Hasnun Arif Hassan, Mohd; Azri Aris, Mohd; Anuar, Zulfika

    2013-12-01

    There has been a long debate whether purposeful heading could cause harm to the brain. Studies have shown that repetitive heading could lead to degeneration of brain cells, which is similarly found in patients with mild traumatic brain injury. A two-degree of freedom linear mathematical model was developed to study the impact of soccer ball to the brain during ball-to-head impact in soccer. From the model, the acceleration of the brain upon impact can be obtained. The model is a mass-spring-damper system, in which the skull is modelled as a mass and the neck is modelled as a spring-damper system. The brain is a mass with suspension characteristics that are also defined by a spring and a damper. The model was validated by experiment, in which a ball was dropped from different heights onto an instrumented dummy skull. The validation shows that the results obtained from the model are in a good agreement with the brain acceleration measured from the experiment. This findings show that a simple linear mathematical model can be useful in giving a preliminary insight on what human brain endures during a ball-to-head impact.

  15. Clinical and social outcomes of adolescent self harm: population based birth cohort study

    PubMed Central

    Heron, Jon; Crane, Catherine; Hawton, Keith; Lewis, Glyn; Macleod, John; Tilling, Kate; Gunnell, David

    2014-01-01

    Objectives To investigate the mental health, substance use, educational, and occupational outcomes of adolescents who self harm in a general population sample, and to examine whether these outcomes differ according to self reported suicidal intent. Design Population based birth cohort study. Setting Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort of children born in 1991-92. Participants Data on lifetime history of self harm with and without suicidal intent were available for 4799 respondents who completed a detailed self harm questionnaire at age 16 years. Multiple imputation was used to account for missing data. Main outcome measures Mental health problems (depression and anxiety disorder), assessed using the clinical interview schedule-revised at age 18 years, self reported substance use (alcohol, cannabis, cigarette smoking, and illicit drugs) at age 18 years, educational attainment at age 16 and 19 years, occupational outcomes at age 19 years, and self harm at age 21 years. Results Participants who self harmed with and without suicidal intent at age 16 years were at increased risk of developing mental health problems, future self harm, and problem substance misuse, with stronger associations for suicidal self harm than for non-suicidal self harm. For example, in models adjusted for confounders the odds ratio for depression at age 18 years was 2.21 (95% confidence interval 1.55 to 3.15) in participants who had self harmed without suicidal intent at age 16 years and 3.94 (2.67 to 5.83) in those who had self harmed with suicidal intent. Suicidal self harm, but not self harm without suicidal intent, was also associated with poorer educational and employment outcomes. Conclusions Adolescents who self harm seem to be vulnerable to a range of adverse outcomes in early adulthood. Risks were generally stronger in those who had self harmed with suicidal intent, but outcomes were also poor among those who had self harmed without suicidal

  16. Demonstration of passive plasma lensing of a laser wakefield accelerated electron bunch

    DOE PAGES

    Kuschel, S.; Hollatz, D.; Heinemann, T.; ...

    2016-07-20

    We report on the first demonstration of passive all-optical plasma lensing using a two-stage setup. An intense femtosecond laser accelerates electrons in a laser wakefield accelerator (LWFA) to 100 MeV over millimeter length scales. By adding a second gas target behind the initial LWFA stage we introduce a robust and independently tunable plasma lens. We observe a density dependent reduction of the LWFA electron beam divergence from an initial value of 2.3 mrad, down to 1.4 mrad (rms), when the plasma lens is in operation. Such a plasma lens provides a simple and compact approach for divergence reduction well matchedmore » to the mm-scale length of the LWFA accelerator. The focusing forces are provided solely by the plasma and driven by the bunch itself only, making this a highly useful and conceptually new approach to electron beam focusing. Possible applications of this lens are not limited to laser plasma accelerators. Since no active driver is needed the passive plasma lens is also suited for high repetition rate focusing of electron bunches. As a result, its understanding is also required for modeling the evolution of the driving particle bunch in particle driven wake field acceleration.« less

  17. Duty to warn of genetic harm in breach of patient confidentiality.

    PubMed

    Keeling, Sharon L

    2004-11-01

    Harm caused by the failure of health professionals to warn an at-risk genetic relative of her or his risk is genetic harm. Genetic harm should be approached using the usual principles of negligence. When these principles are applied, it is shown that (a) genetic harm is foreseeable; (b) the salient features of vulnerability, the health professional's knowledge of the risk to the genetic relative and the determinancy of the affected class and individual result in a duty of care being owed to the genetic relative; (c) the standard of care required to fulfil the duty to warn should be the expectations of a reasonable person in the position of the relative; and (d) causation is satisfied as the harm is caused by the failure of intervention of the health professional. Legislation enacted subsequent to the Report of the Commonwealth of Australia, Panel of Eminent Persons (Chair D Ipp), Review of the Law of Negligence Report (2002) and relevant to a duty to warn of genetic harm is considered. The modes of regulation and penalties for breach of any future duty to warn of genetic harm are considered.

  18. A framework for organizing and selecting quantitative approaches for benefit-harm assessment.

    PubMed

    Puhan, Milo A; Singh, Sonal; Weiss, Carlos O; Varadhan, Ravi; Boyd, Cynthia M

    2012-11-19

    Several quantitative approaches for benefit-harm assessment of health care interventions exist but it is unclear how the approaches differ. Our aim was to review existing quantitative approaches for benefit-harm assessment and to develop an organizing framework that clarifies differences and aids selection of quantitative approaches for a particular benefit-harm assessment. We performed a review of the literature to identify quantitative approaches for benefit-harm assessment. Our team, consisting of clinicians, epidemiologists, and statisticians, discussed the approaches and identified their key characteristics. We developed a framework that helps investigators select quantitative approaches for benefit-harm assessment that are appropriate for a particular decisionmaking context. Our framework for selecting quantitative approaches requires a concise definition of the treatment comparison and population of interest, identification of key benefit and harm outcomes, and determination of the need for a measure that puts all outcomes on a single scale (which we call a benefit and harm comparison metric). We identified 16 quantitative approaches for benefit-harm assessment. These approaches can be categorized into those that consider single or multiple key benefit and harm outcomes, and those that use a benefit-harm comparison metric or not. Most approaches use aggregate data and can be used in the context of single studies or systematic reviews. Although the majority of approaches provides a benefit and harm comparison metric, only four approaches provide measures of uncertainty around the benefit and harm comparison metric (such as a 95 percent confidence interval). None of the approaches considers the actual joint distribution of benefit and harm outcomes, but one approach considers competing risks when calculating profile-specific event rates. Nine approaches explicitly allow incorporating patient preferences. The choice of quantitative approaches depends on the

  19. A framework for organizing and selecting quantitative approaches for benefit-harm assessment

    PubMed Central

    2012-01-01

    Background Several quantitative approaches for benefit-harm assessment of health care interventions exist but it is unclear how the approaches differ. Our aim was to review existing quantitative approaches for benefit-harm assessment and to develop an organizing framework that clarifies differences and aids selection of quantitative approaches for a particular benefit-harm assessment. Methods We performed a review of the literature to identify quantitative approaches for benefit-harm assessment. Our team, consisting of clinicians, epidemiologists, and statisticians, discussed the approaches and identified their key characteristics. We developed a framework that helps investigators select quantitative approaches for benefit-harm assessment that are appropriate for a particular decisionmaking context. Results Our framework for selecting quantitative approaches requires a concise definition of the treatment comparison and population of interest, identification of key benefit and harm outcomes, and determination of the need for a measure that puts all outcomes on a single scale (which we call a benefit and harm comparison metric). We identified 16 quantitative approaches for benefit-harm assessment. These approaches can be categorized into those that consider single or multiple key benefit and harm outcomes, and those that use a benefit-harm comparison metric or not. Most approaches use aggregate data and can be used in the context of single studies or systematic reviews. Although the majority of approaches provides a benefit and harm comparison metric, only four approaches provide measures of uncertainty around the benefit and harm comparison metric (such as a 95 percent confidence interval). None of the approaches considers the actual joint distribution of benefit and harm outcomes, but one approach considers competing risks when calculating profile-specific event rates. Nine approaches explicitly allow incorporating patient preferences. Conclusion The choice of

  20. Simultaneous reduction and nitrogen functionalization of graphene oxide using lemon for metal-free oxygen reduction reaction

    NASA Astrophysics Data System (ADS)

    Begum, Halima; Ahmed, Mohammad Shamsuddin; Cho, Sung; Jeon, Seungwon

    2017-12-01

    Inspire by the vision of finding a simple and green method for simultaneous reduction and nitrogen (N)-functionalization of graphene oxide (GO), a N-rich reduced graphene oxide (rGO) has been synthesized through a facile and ecofriendly hydrothermal strategy while most of the existing methods are involving with multiple steps and highly toxic reducing agents that are harmful to human health and environment. In this paper, the simultaneous reduction and N-functionalization of GO using as available lemon juice (denoted as Lem-rGO) for metal-free electrocatalysis towards oxygen reduction reaction (ORR) is described. The proposed method is based on the reduction of GO using of the reducing and the N-precursor capability of ascorbic acid and citric acid as well as the nitrogenous compounds, respectively, that containing in lemon juice. The resultant Lem-rGO has higher reduction degree, higher specific surface area and better crystalline nature with N-incorporation than that of well investigated ascorbic acid and citric acid treated rGO. As a result, it shows better ORR electrocatalytic activity in respect to the improved onset potential, electron transfer rate and kinetics than those typical rGO catalysts. Moreover, it shows a significant tolerance to the anodic fuels and durability than the Pt/C during ORR.