Prevalence, characteristics, and predictors of police training initiatives by US SEPs: building an evidence base for structural interventions.

BACKGROUND: Community-based prevention initiatives such as syringe exchange programs (SEPs) are proven to curb injection-related HIV transmission. Policing targeting injection drug users (IDUs) can interfere with SEP functioning. Efforts to maximize the public health benefit of SEPs have included police trainings designed to reduce such interference. METHODS: We surveyed US SEP managers to assess prevalence, content, and correlates of SEP police trainings. Multivariate analyses were utilized to identify predictors of training participation. RESULTS: Of 107 SEPs (57% of all US programs), 20% reported participating in trainings during the previous year. Covered topics included the public health rationale behind SEPs (71%), police occupational health (67%), needle stick injury (62%), SEPs' legal status (57%), and harm reduction philosophy (67%). On average, trainings were seen as moderately effective, but only four programs reported conducting any formal evaluation. In multivariate modeling, training participation was independently associated with state law authorizing syringe possession by clients (aOR=3.71, 95%CI=1.04-13.23), higher frequency of client arrest (aOR=2.07, 95%CI=1.0-4.7), and systematic monitoring of adverse client-police encounters (aOR=4.02, 95%CI=1.14-14.17). Assistance with police trainings was identified by 72% of respondents as the key to improving police relations. CONCLUSION: At a time when collaboration with police may become requisite for SEPs to receive federal funding, most program managers in the US perceive police trainings as a key to improved SEP-police relations. Robust evaluation is needed to better understand the impact of these trainings on law enforcement practices, SEP operations, and community health. Such research will inform technical assistance, policy design, and resource allocation.

[The study of characteristics of overdose among users of opioid drug injections].

Overdose is a serious problem as for people addicted to opioid drug injections (ODI) as well as for the community in general. To study characteristics of overdose, authors examined 60 ODI users and analyzed 27 overdose death cases. It has been shown that overdose is rather common among ODI users. Fatal and nonfatal overdoses most frequently take place among men at home or in the street. People often did not receive sufficient help in the overdose situation. We confirm the role of alcohol, long abstinence and variability in drug quality in the development of overdose. Witnesses of overdose in other users reported more health problems, family and social relations, were more concerned with their own and others risk in future compared to those reporting no overdose. Additional predictors were determined: a higher number of overdoses in the past; disturbances of family relations and somatic disorders. Mental disorders predicted the opioid overdose risk among ODI users. ODI users are interested in counseling and training to prevent overdose. Family psychotherapy and early diagnosis of comorbid disorders may be important ways of overdose prevention.

Perspectives from the National Institute of Mental Health: Preventing or living with aids.

This article provides a succinct overview of the history and current and future research priorities of the Office on AIDS at the National Institute of Mental Health (NIMH). Throughout its history and currently, the Office on AIDS has encouraged and supported research on primary prevention of human immunodeficiency virus (HIV) transmission, effects of HIV disease on the central nervous system, and coping with the sequelae of infection. Future directions for the NIMH include the dissemination of research fmdings to the community, investigation of mechanisms for involving and retaining participants in large-scale vaccine trials, and continued attention to the prevention of HIV transmission through behavior change.

Effect of chronic intake of dietary fibers on the ultrastructural topography of rat jejunum and colon: a scanning electron microscopy study.

This report is an attempt to quantitate the observable topographical characteristics of small and large intestine after a specific dietary regimen under well-defined states of lipid absorption and metabolism. Alfalfa, white wheat bran, cellulose, and pectin were fed for 6 wk at a level of 15 g/100 g diet to four groups of rats (12 rats per dietary group). A 5th control group was maintained on Purina Rat Chow. Three animals from each group were blind-coded for morphological assessment. After anesthesia, the jejunum and mid-colon were removed and processed for scanning electron microscopy. Beginning with the mildest mucosal surface changes, the observed order in terms of increasing severity is bran less than cellulose less than pectin less than alfalfa. Our observations suggest that altered rates of cell loss in intestinal tract cytokinetics may be occurring with particular feeding patterns and should be considered as a possible mechanism in the nutritional consequences of dietary fiber intake.

Effect of bile salt-binding resins on the morphology of rat jejunum and colon. A scanning electron microscopy study.

One mechanism suggested to account for the hypocholesteremic effect of dietary fibers is their ability to sequester bile salts. Since bile salts have been found to alter intestinal structure, the morphological effects of several commonly used, xenobiotic, bile salt-binding agents was investigated. Wistar rats were fed a purified stock diet, ad libitum, for 6 weeks containing either 2% cholestyramine, 2% colestipol, or 2% DEAE-Sephadex. The bile salt-binding capacity of these substances was tested in vitro using taurocholate and glycocholate. The effect of in vivo feeding of the resins was to evoke ultrastructural topographical deviations from control appearance in both jejunal and colonic mucosae. Colonic cell injury was more severe than that observed in the jejunum of both colestipol- and DEAE-Sephadex-fed animals while the reverse was true for the rats fed cholestyramine. The degree of distortion in each condition was positively correlated with the extent of bile salt-binding capability in vitro. The rank order of both effects in terms of increasing severity was DEAE-Sephadex less than colestipol less than cholestyramine.