Examining the impact of grip strength and officer gender on shooting performance.

BACKGROUND: Effective shooting performance relies heavily on sufficient grip strength. However, some standard issue pistols used by police services may have a trigger weight that causes problems for officers with insufficient grip strength, including female officers. The current study aimed to replicate previous findings, which show that grip strength is positively related to shooting performance. We also sought to determine what grip strength is required to achieve proficient scores on a standard police pistol qualification (PPQ) when a heavy trigger weight (i.e., 8lbs-12lbs) is used. Finally, we explored the relationship between officer gender and PPQ scores to determine if grip strength plays a mediating role in this relationship. METHOD: The dominant hand grip strength (in lbs) of 86 male and 32 female officers were recorded prior to their participation in their agency mandated annual PPQ. Officer gender, grip strength, and PPQ scores were analyzed to explore how they related to one another. RESULTS: Grip strength significantly impacted officers' ability to pass the PPQ, with female officers possessing lower grip strength compared to male officers, as well as achieving poorer scores on the PPQ. We determined that grip strengths in the range of 80lbs and 125lbs were needed to score approximately 85 % and 90 % on the PPQ, respectively; exceeding that of the average grip strength for the female officers in the study (M = 77.5lbs). Mediation analysis suggested that grip strength may mediate the relationship between officer gender and shooting performance, but studies with more power are needed to confirm that. CONCLUSION: To improve shooting performance as well as public and police safety, law enforcement agencies may need to consider including grip strength training in their conditioning regime or examine the adoption pistols with a lighter trigger pull weight (e.g., 6lbs).

High-intensity Focused Ultrasound for the Treatment of Prostate Cancer: A National Cohort Study Focusing on the Development of Stricture and Fistulae.

BACKGROUND: High-intensity focused ultrasound (HIFU) is a novel therapy for prostate cancer. Owing to a lack of long-term data, HIFU is recommended for use only in the context of research. OBJECTIVE: To examine the trend for HIFU use nationally and rates of strictures and fistulae. DESIGN, SETTING, AND PARTICIPANTS: Patients undergoing HIFU for prostate cancer between April 2007 and March 2018 were studied in an English national database (Hospital Episode Statistics). Data on complications were included for patients with a minimum of 1-yr follow-up. Analysis of complications was controlled for other interventions. OUTCOME MEASURES AND STATISTICAL ANALYSIS: Descriptive analyses of HIFU rates and the incidence of strictures and fistulae were carried out. Cox and logistic regression models were built for urethral stricture incidence. RESULTS AND LIMITATIONS: A total of 2320 HIFU treatments among 1990 patients were identified. The median age was 67yr (interquartile range 61-72). Some 1742 patients met the criteria for follow-up analysis. The highest-volume centre performed 1513 HIFU procedures, followed by 194 at the second highest. The number of HIFU procedures increased annually, rising from 196 to 283 per year. There were 208 patients (11.9%) who went on to have radiotherapy and 102 (5.9%) radical prostatectomy after HIFU. Following HIFU, stricture developed in 133/1290 patients (10.3%) and urinary fistula in 16/1240 (1.3%) before any further intervention. More recent years for HIFU were associated with a lower likelihood of stricture formation (2016/2017 vs 2007/2008: hazard ratio 0.30, 95% confidence interval 0.11-0.79; p=0.015). Limitations include the lack of staging information and unknown rates of HIFU outside of publicly funded health care. CONCLUSIONS: HIFU is performed at a large number of low-volume centres and complication rates do not differ from those for established therapies. PATIENT SUMMARY: This report highlights the trend for provision of high-intensity focused ultrasound treatment for prostate cancer in England. The results suggest that the rate of urethral structural complications may not be lower than that for established prostate cancer treatments.

A Reasonable Officer: Examining the Relationships Among Stress, Training, and Performance in a Highly Realistic Lethal Force Scenario.

Under conditions of physiological stress, officers are sometimes required to make split-second life-or-death decisions, where deficits in performance can have tragic outcomes, including serious injury or death and strained police-community relations. The current study assessed the performance of 122 active-duty police officers during a realistic lethal force scenario to examine whether performance was affected by the officer's level of operational skills training, years of police service, and stress reactivity. Results demonstrated that the scenario produced elevated heart rates (i.e., 150 beats per minute), as well as perceptual and cognitive distortions, such as tunnel vision, commensurate with those observed in naturalistic use of force encounters. The average performance rating from the scenario was 59%, with 27% of participants making at least one lethal force error. Elevated stress reactivity was a predictor of poorer performance and increased lethal force errors. Level of training and years of police service had differential and complex effects on both performance and lethal force errors. Our results illustrate the need to critically reflect on police training practices and continue to make evidence-based improvements to training. The findings also highlight that while training may significantly improve outcomes, flawless performance is likely not probable, given the limits of human performance under stress. Implications for the objective reasonableness standard, which is used to assess the appropriateness of force in courts of law, are discussed.

Mental health in hospital emergency departments: cross-sectional analysis of attendances in England 2013/2014.

OBJECTIVE: To describe the population of patients who attend emergency departments (ED) in England for mental health reasons. METHODS: Cross-sectional observational study of 6 262 602 ED attendances at NHS (National Health Service) hospitals in England between 1 April 2013 and 31 March 2014. We assessed the proportion of attendances due to psychiatric conditions. We compared patient sociodemographic and attendance characteristics for mental health and non-mental health attendances using logistic regression. RESULTS: 4.2% of ED attendances were attributable to mental health conditions (median 3.2%, IQR 2.6% to 4.1%). Those attending for mental health reasons were typically younger (76.3% were aged less than 50 years), of White British ethnicity (73.2% White British), and resident in more deprived areas (59.9% from the two most deprived Index of Multiple Deprivation quintiles (4 and 5)). Mental health attendances were more likely to occur 'out of hours' (68.0%) and at the weekend (31.3%). Almost two-thirds were brought in by ambulance. A third required admission, but around a half were discharged home. CONCLUSIONS: This is the first national study of mental health attendances at EDs in England. We provide information for those planning and providing care, to ensure that clinical resources meet the needs of this patient group, who comprise 4.2% of attendances. In particular, we highlight the need to strengthen the availability of hospital and community care 'out of hours.'

Higher volume providers are associated with improved outcomes following ERCP for the palliation of malignant biliary obstruction.

BACKGROUND: Relieving malignant biliary obstruction improves quality of life and permits chemotherapy. Outcomes of endoscopic retrograde cholangio-pancratography(ERCP) in inoperable malignant biliary obstruction have been examined in a national cohort to establish factors associated with poor outcomes. METHODS: Hospital Episode Statistics include diagnostic and procedural data for all NHS hospital attendances in England. Patients from 2006 to 2017 with a Hepaticopancreaticobiliary (HPB) malignancy who had undergone ERCP were studied. Patients undergoing a potentially curative operation were excluded. Associations between demographics, co-morbidities, unit ERCP volume and mortality were examined by logistic regression. FINDINGS: 39,702 patients were included; 49.4% were male; median age was 75 (IQR 66-88)years. Pancreatic cancer was the most common tumour (63.9%). Mortality was 4.1%, 9.7% and 19.1% for 7-day, in hospital and 30-day respectively. On multivariable analysis: men (OR 1.20(95%CI 1.14-1.26), p < 0.001); increasing age quintile 78-83(1.73(1.59-1.89), p < 0.001), >83(2.70(2.48-2.94),p < 0.001); most deprived quintile (1.21(1.11-1.32), p < 0.001); increasing co-morbidity score >20(3.36(2.94-3.84),p < 0.001); small bowel malignancy (1.45(1.22-1.72), p < 0.001), intrahepatic biliary malignancy(1.10(1.03-1.17), p = 0.005) and year of ERCP 2006/07 (1.37(1.22-1.55), p < 0.001) were associated with increased 30-day mortality. Extrahepatic biliary tree cancers (0.67(0.61-0.73), p<0.001), high volume providers of ERCP (>318 annually, 0.91(0.84-0.98), p = 0.01) and high volume of ERCP for malignant obstruction (>40 annually (0.91(0.85-0.98), p = 0.014) were negatively associated with 30-day mortality. Patients were less likely to require a second ERCP in high volume providers (>318, 8.0%) compared to low volume ((<204, 13.4%), p<0.001). INTERPRETATION: Short term mortality in patients with malignant biliary obstruction following ERCP was high. 30-day mortality was positively associated with increasing age and co-morbidity, men, deprivation, and earlier year of ERCP and negatively with extrahepatic biliary tree cancer and high volume ERCP providers. FUNDING: Internal funding only.

A national study of artificial urinary sphincter and male sling implantation after radical prostatectomy in England.

OBJECTIVES: To consider the provision of post-radical prostatectomy (RP) continence surgery in England. MATERIALS AND METHODS: Patients with an Office of Population Census and Surveys Classification of Interventions and Procedures, version 4 code for an artificial urinary sphincter (AUS) or male sling between 1 January 2010 and 31 March 2018 were searched for within the Hospital Episode Statistics (HES) dataset. Those without previous RP were excluded. Multivariable logistic regressions for repeat AUS and sling procedures were built in stata. Further descriptive analysis of provision of procedures was performed. RESULTS: A total of 1414 patients had received index AUS, 10.3% of whom had undergone prior radiotherapy; their median follow-up was 3.55 years. The sling cohort contained 816 patients; 6.7% of these had received prior radiotherapy and the median follow-up was 3.23 years. Whilst the number of AUS devices implanted had increased each year, male slings peaked in 2014/2015. AUS redo/removal was performed in 11.2% of patients. Patients in low-volume centres were more likely to require redo/removal (odds ratio [OR] 2.23 95% confidence interval [CI] 1.02-4.86; P = 0.045). A total of 12.0% patients with a sling progressed to AUS implantation and 1.3% had a second sling. Patients with previous radiotherapy were more likely to require a second operation (OR 2.03 95% CI 1.01-4.06; P = 0.046). Emergency re-admissions within 30 days of index operation were 3.9% and 3.6% fewer in high-volume centres, for AUS and slings respectively. The median time to initial continence surgery from RP was 2.8 years. Increased time from RP conferred no reduced risk of redo surgery for either procedure. CONCLUSION: There is a volume effect for outcomes of AUS procedures, suggesting that they should only be performed in high-volume centres. Given the known impact of incontinence on quality of life, patients should be referred sooner for post-prostatectomy continence surgery.

Stress-Activity Mapping: Physiological Responses During General Duty Police Encounters.

Policing is a highly stressful and dangerous profession that involves a complex set of environmental, psychosocial, and health risks. The current study examined autonomic stress responses experienced by 64 police officers, during general duty calls for service (CFS) and interactions with the public. Advancing previous research, this study utilized GPS and detailed operational police records as objective evidence of specific activities throughout a CFS. These data were then used to map officers' heart rate to both the phase of a call (e.g., dispatch, enroute) and incident factors (e.g., call priority, use-of-force). Furthermore, physical movement (i.e., location and inertia) was tracked and assisted in differentiating whether cardiovascular reactivity was due to physical or psychological stress. Officer characteristics, including years of service and training profiles, were examined to conduct a preliminary exploration of whether experience and relevant operational skills training impacted cardiovascular reactivity. Study results provide foundational evidence that CFS factors, specifically the phase of the call (i.e., arrival on scene, encountering a subject) and incident factors (i.e., call priority, weapons, arrest, use-of-force), influence physiological stress responses, which may be associated with short-term performance impairments and long-term health outcomes. Implications of research findings for operational policing, police training, and health research are discussed.

Outcomes of colorectal stents when used as a bridge to curative resection in obstruction secondary to colorectal cancer.

BACKGROUND: Up to 25% of colorectal cancers present with bowel obstruction. Metal stents (MS) can provide a bridge to surgery by relieving obstruction and allowing the subject's condition to improve pre-operatively. METHODS: Hospital Episode Statistics (HES) is a database of all NHS funded secondary care episodes in England. Subjects admitted with bowel obstruction secondary to colorectal cancer without metastases were identified and subdivided into two groups: MS insertion prior to surgery and surgery only. Due to demographic differences between the groups, propensity score matching was used to analyse procedural outcomes, mortality and readmission within 30 days in left-sided cancers based upon age, sex and Charlson co-morbidity score. RESULTS: Over 10 years, 4571 subjects were identified; 401 received a MS and 4170 underwent surgery only. Median age of MS subjects was 71 (IQR 62-79) years; 226 (56.4%) were male. Median age of surgery-only subjects was 73 (64-81); 2165 (51.9%) were male. Following propensity matching 375 MS and 375 surgery-only subjects remained; MS had fewer readmissions within 30 days (28 (7.5%) versus 44 (11.7%), p = 0.047), fewer respiratory complications (< 6 (< 1.5%) versus 28 (7.5%), p < 0.001), lower stoma rates (49 (13.1%) versus 159 (42.4%), p < 0.001) and higher rates of laparoscopic surgery (154 (41.1%) versus 25 (6.7%), p < 0.001). Mortality was lower in the MS group at 30 days (7 (1.9%) versus 33 (8.8%), p < 0.001) and 1 year (37 (9.9%) versus 71 (19.0%), p < 0.001). CONCLUSIONS: In subjects presenting with obstructing colorectal cancer outcomes including respiratory complications, readmission and mortality appear to be better in subjects undergoing MS as a bridge to surgery compared to surgery alone.

Excited delirium syndrome (ExDS): Situational factors and risks to officer safety in non-fatal use of force encounters.

STUDY OBJECTIVE: Police use of force (UoF) encounters include individuals with Excited Delirium Syndrome (ExDS) with some frequency. Situational factors and risks to officer safety associated with these encounters have not been well studied. We examined the likelihood that subjects displaying various concomitant features of ExDS were under the influence of drugs and/or alcohol. We also examined the extent of subject violence, and the impact of this behaviour on the encounter (e.g., the odds of a struggle). Greater understanding of the prevalence of ExDS and the specific risk it represents to law enforcement officers and the subjects they encounter will guide appropriate policy and response strategies. METHODS: A prospective evaluation of a consecutive cohort of subjects involved in UoF encounters with police was conducted. Data were collected from January 2012 to December 2015. Consistent with previous research, the presence of six or more features was used to identify probable cases of ExDS. The odds that subjects in a state of probable ExDS were under the influence of drugs and/or alcohol was calculated and compared against subjects who exhibited less than three features of ExDS. In addition, the violent nature of subjects (e.g., the odds of a subject being in possession of a weapon) displaying various concomitant features of the syndrome was examined. The number of sudden and unexpected arrest-related death (ARDs) was documented. RESULTS: UoF occurred in 9006 of 10.9 million police-public interactions (0.08%). Of the UoF encounters, 156 (1.7%) subjects displayed six or more features of ExDS. With four recorded sudden and unexpected ARDs of violent and agitated subjects in our cohort, up to 6.3% of these subjects experiencing probable ExDS could be expected to be at risk of sudden death. Logistic regression analyses indicated that there were significantly higher odds that subjects exhibiting more features of ExDS (e.g., six or more) were under the influence of drugs. On the other hand, there were significantly lower odds that individuals exhibiting ExDS were under the influence of alcohol alone. In addition, those displaying a greater number of features demonstrated higher odds of engaging in assaultive behaviour, presenting a threat of grievous bodily harm or death, and being involved in a struggle that went to the ground with an officer. A slight increase in the presence of weapons was observed in encounters with probable ExDS. CONCLUSION: Our study provides important information to guide the development of policy and procedure in law enforcement. Police encounter a subject with ExDS 1 in every 58 UoF incidents (1.7%). Those individuals are at higher odds of being intoxicated with drugs according to officers' assessments and at risk of being further exerted during a struggle on the ground, both of which appear to play a major role in deaths associated to ExDS. There is a demonstrable increase in risk to officers and public safety from the violent behaviour displayed by subjects presenting a greater number of features of ExDS. Our data suggests that up to 6.3% of subjects in a state of ExDS could succumb to ARDs; however, we cannot comment on the prevalence of death for persons with ExDS who do not encounter police. Further research is needed to determine which force options optimize outcome for police and subjects. Additionally, research surrounding pathophysiology leading to death should focus on subjects with six or more features of ExDS. Ultimately, a better understanding in this area will contribute to improving the outcomes of these encounters for those suffering from ExDS and those tasked with assisting them.

Distinguishing features of Excited Delirium Syndrome in non-fatal use of force encounters.

STUDY OBJECTIVE: The frequency with which the police encounter non-fatal cases of Excited Delirium Syndrome (ExDS) has not been well studied. To date only a single prospective, epidemiologic study has been completed to determine the prevalence of the features of ExDS in police use of force (UoF) encounters. We examined a cluster of previously published features associated with ExDS to establish if these features were consistently recognizable across policing populations, thus demonstrating reproducibility. We further sought to determine whether any feature or number of concomitant features were likely to have physiologic significance. These are important first steps in determining a case definition of ExDS in a law enforcement and medical setting. METHODS: A prospective evaluation of a consecutive cohort of subjects involved in UoF encounters with police was conducted. Data were collected through the UoF reporting database of a large Canadian law enforcement agency from January, 2012 to December, 2013. The ten core characteristics of ExDS that have been observed in past research were documented by officers and, consistent with previous research, the presence of six or more features was used to identify probable cases of ExDS and a state of medical emergency. RESULTS: UoF occurred in 4799 of 5.4 million police-public interactions (0.09%). Of the UoF encounters, 73 (1.5%) subjects displayed six or more features of ExDS. Upwards of 9.2% of these subjects could be expected to be at risk of sudden and unexpected arrest-related death (ARD). Features with the highest odds of being presented with a large number of concomitant features included "Does not Fatigue", "Superhuman Strength" and "Tactile Hyperthermia" (287, 137 and 93 times higher, respectively). Moreover, "Tactile Hyperthermia" demonstrated the highest odds of being presented in individuals with a large number of features as opposed to those with fewer (33 times higher). CONCLUSION: We demonstrate that there is the ability for law enforcement officers to consistently recognize and report features of ExDS that have been associated with ARD. The varying presence of features across the examined categories indicates that some features are more distinguishing than others, which may enable narrowing the scope of features that represent ExDS and understanding its pathophysiology. The current debate surrounding whether or not ExDS exists limits first responders and emergency physicians in their ability to increase awareness, improve training and interventions, and design appropriate policy and response protocols to reduce ARDs.

HIV risk among drug-using men who have sex with men, men selling sex, and transgender individuals in Vietnam.

Knowledge about drug use and its association with HIV risk among men who have sex with men is limited. Although the HIV epidemic among this population in Vietnam is increasingly acknowledged, understanding the impact of drug use on the spread of HIV is largely lacking. Using qualitative data from in-depth interviews and focus group discussions with 93 drug users, 15 non-drug users and 9 community stakeholders, this analysis explores emerging patterns of drug use and risk factors for engaging in risk behaviours among drug-using men having sex with men, men selling sex and transgender individuals in Hanoi and Ho Chi Minh City. Findings revealed that drug use is shifting from heroin to ecstasy and ice. Drug users reported unsafe sex associated with drug use and men selling sex were particularly at elevated risk because of using drugs as a tool for sex work and trading sex for drugs. These findings are guiding development of programmes addressing unmet HIV-prevention needs in Vietnam.

Drug policy in Vietnam: a decade of change?

BACKGROUND: Driven by the rapid spread of HIV, Vietnam's response to drug use has undergone significant transformation in the past decade. This paper seeks to identify and analyse factors that prompted these changes and to investigate their impact on the lives of people who use drugs. METHOD: This policy analysis is based on a review of Vietnamese Government documents, peer-reviewed publications and the authors' knowledge of and involvement in drug policy in Vietnam. RESULTS: The last decade has witnessed a progressive change in the mindset of political leaders in Vietnam around illicit drug use and HIV issues. This has led to adoption of evidence-based interventions and the evolution of drug policy that support the scale up of these interventions. However, HIV prevalence among drug users at 31.5% remains high due to limited access to effective interventions and impediments caused by the compulsory treatment centre system. CONCLUSIONS: The twin epidemics of HIV and illicit drug use have commanded high-level political attention in Vietnam. Significant policy changes have allowed the implementation of HIV prevention and drug dependence treatment services. Nevertheless, inconsistencies between policies and a continued commitment to compulsory treatment centres remain as major impediments to the provision of effective services to drug users. It is critical that Vietnamese government agencies recognise the social and health consequences of policy conflicts and acknowledge the relative ineffectiveness of centre-based compulsory treatment. In order to facilitate practical changes, the roles of the three ministries directly charged with HIV and illicit drug use need to be harmonised to ensure common goals. The participation of civil society in the policymaking process should also be encouraged. Finally, stronger links between local evidence, policy and practice would increase the impact on HIV prevention and drug addiction treatment programming.

Managing information: using systematic data collection to estimate process and impact indicators related to harm reduction services in Myanmar.

BACKGROUND: Discussion about coverage has primarily focused on answering the question: what level of coverage is required to reduce the spread of HIV among people who inject drugs? This paper documents the process involved in designing a Monitoring Information System (MIS) that provides a tool to estimate coverage, frequency of contacts as well as provides a mechanism for correlating these data with changes in risk behaviour among the surveyed population. METHODS: The system uses paper and pencil data collection forms to record information about the type and location of a contact. Information about the content of the contact such as the services, equipment or education that is delivered is also collected. This data is then entered into a computer program that manages the information and allows for simple standardised reports to be generated. The reports provide a simple mechanism for analysing process indicators such as the number and frequency of contacts, where the contact occurred as well as what the contact consisted of (i.e. education content or distribution of equipment). The system also allows correlations to be made between exposure to services and changes in behaviour thus providing a mechanism for assessing impact indicators. CONCLUSION AND DISCUSSION: We present a brief description of the Monitoring Information System, its structure and functions and encourage practitioners to consider the importance of adopting standardised monitoring systems to measure coverage. We also explore some potential ethical limitations around using the system.

Harm reduction programmes in the Asia--Pacific Region.

INTRODUCTION AND AIMS: This paper reports on the public health intervention of harm reduction to address drug use issues in the Asia-Pacific region. DESIGN AND METHODS: 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. RESULTS: 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. DISCUSSION AND CONCLUSIONS: 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.

Prevalence of illicit drug use in Asia and the Pacific.

This paper reports on the prevalence of drug use in Asia and the Pacific. 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. Review of existing estimates of the prevalence of people who use illicit drugs from published and unpublished literature and information from key informants and regional institutions was undertaken for the period 1998 - 2004. Estimates of the prevalence of people who use illicit drugs were conducted for 12 Asian and six Pacific Island countries. The estimated prevalence of those using illicit drugs ranges from less than 0.01% to 4.6%. Countries with estimated prevalence rates higher than 2% are Cambodia, Hong Kong, Philippines, Thailand, Indonesia, Laos and Malaysia. China, Myanmar and Vietnam have estimated prevalence rates ranging between less than 0.01% and 2%. Data to estimate prevalence rates was not available for Pacific Island countries and Brunei. Estimates of the prevalence of drug use are critical to policy development, planning responses and measuring the coverage of programs. However, reliable estimates of the numbers of people using illicit drugs are rare in Asia, particularly the Pacific.

Drug production, trafficking and trade in Asia and Pacific Island countries.

We report here on illicit drug production, trafficking and transit routes found in the Asia Pacific region. The report is based on the '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. The situational analysis was a comprehensive desk based review; data sources included published and unpublished literature and key informant reports. It was found that Myanmar was the main producer of opium, heroin and amphetamine-type stimulants (ATS) in the Asia-Pacific region. China is now considered a major producer of methamphetamines, but other Asia-Pacific nations are also involved in production. Cannabis production was found throughout most of the Asia-Pacific region, in particular Cambodia and the Philippines. Drug trafficking and transit routes of Asia and the Pacific were proliferating and dynamic. The Pacific is mainly known as a trans-shipment point for drugs entering other countries in the region. Drug cultivation and production in Asia is substantial. The expansion of ATS production in the Asia Pacific region is causing much concern. Most drug traffickers change routes and tactics to exploit available vulnerable points along international borders. Responding effectively to the complexity and scale of drug production and trafficking in the Asia-Pacific region will remain a major challenge.

Illicit drug use and responses in six Pacific Island countries.

We report here on the illicit drug situation in six Pacific nations: Fiji, Papua New Guinea, Samoa, Solomon Islands, Tonga and Vanuatu. The report is based on the '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. The situational analysis was a comprehensive desk-based review; data sources included published and unpublished literature and information from key informants. A range of psychoactive substances have been used traditionally across the Pacific region. Cannabis is the by far the most common and widespread illicit drug used in the six Pacific Islands reviewed. Drugs such as heroin, methamphetamines and cocaine are not used commonly due to their high cost compared to the average income. Currently, there is no overall regional or country-based illicit drug policy for the Pacific and few treatment programs; limited data exist to aid in understanding illicit drug use and the harms associated with its use in the Pacific. This review highlights the urgent need for strategic alcohol and drug research in the Pacific as a foundation for the development of policy.

Randomized controlled trial of a brief behavioural intervention for reducing hepatitis C virus risk practices among injecting drug users.

AIM: To develop and evaluate a brief intervention for reducing risk behaviours associated with HCV transmission in injecting drug users (IDU). DESIGN: Randomized controlled trial of an individually tailored brief behavioural intervention (BBI) (experimental) versus a standardized educational intervention (control). SETTING: Specialist drug treatment facility in Melbourne, Australia. PARTICIPANTS: One hundred and forty-five IDU (aged 18 or over, injecting at least weekly in the preceding 6 months) recruited and randomized to the experimental condition (n = 73) or the control condition (n = 72). INTERVENTIONS: The BBI was based on the Blood-Borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ)-a standardized blood-borne virus risk assessment instrument comprising injecting risk, sexual risk and other skin penetration risk subscales. The BBV-TRAQ was used to identify individual HCV risk practices and to tailor the 30-minute experimental BBI. Control participants received a standardized HCV educational session, using current educational materials. MAIN OUTCOME MEASURES: BBV-TRAQ subscale and total scores and measures of participant satisfaction. RESULTS: One hundred and twenty-four participants (86%) were followed-up at 4 weeks (+/-7 days). Analyses revealed a significant reduction in HCV risk behaviours for both groups at 1-month follow-up, with participants in the experimental BBI condition reporting higher overall satisfaction with the intervention compared to the control group. CONCLUSIONS: Both groups reported significant reductions in risk behaviour, indicating that while BBI methods hold promise for HCV education and prevention, they were not demonstrated to be more effective than the provision of standard educational materials. Future research could evaluate the efficacy of the BBV-TRAQ as a risk behaviour intervention and counselling tool in clinical, NSP and peer education settings.