Overdose beliefs and management practices among ethnic Vietnamese heroin users in Sydney, Australia

<p>Abstract</p> <p>Background</p> <p>Ethnic Vietnamese injecting drug users (IDUs) in Australia draw on a range of beliefs and etiologic models, sometimes simultaneously, in order to make sense of health and illness. These include understandings of illness as the result of internal imbalances and Western concepts of disease causation including germ/pollution theory.</p> <p>Methods</p> <p>Observational fieldwork and in-depth interviews were conducted between 2001 and 2006 in neighbourhoods characterised by high proportions of Asian background IDUs and street-based drug markets. Eligibility criteria for the study were: 1) ethnic Vietnamese cultural background; 2) aged 16 years and over and; 3) injected drugs in the last 6 months.</p> <p>Results</p> <p>Participants commonly attempted to treat heroin overdose by withdrawing blood (rút máu) from the body. Central to this practice are cultural beliefs about the role and function of blood in the body and its relationship to illness and health. Participants' beliefs in blood were strongly influenced by understandings of blood expressed in traditional Chinese and Vietnamese medicine. Many participants perceived Western drugs, particularly heroin, as "hot" and "strong". In overdose situations, it was commonly believed that an excessive amount of drugs (particularly heroin) entered the bloodstream and traveled to the heart, making the heart work too hard. Withdrawing blood was understood to reduce the amount of drugs in the body which in turn reduced the effects of drugs on the blood and the heart.</p> <p>Conclusion</p> <p>The explanatory model of overdose employed by ethnic Vietnamese IDUs privileges traditional beliefs about the circulatory, rather than the respiratory, system. This paper explores participants' beliefs about blood, the effects of drugs on blood and the causes of heroin overdose in order to document the explanatory model of overdose used by ethnic Vietnamese IDUs. Implications for overdose prevention, treatment and management are identified and discussed.</p

Potential Implications of Elevated CO2 for Enhanced Rock Weathering in Croplands

Atmospheric carbon dioxide (CO2) levels are increasing by 2.37 ppm year, and levels have increased from about 370 ppm in 2000 to about 420 ppm in 20231 Increased CO2 levels result in climate change, including increased temperatures and drought which impacts soybean crops Enhanced Rock Weathering (ERW) is the process of spreading basalt on fields to accelerate the natural reaction between rocks, CO2, and water2 Enhanced Rock Weathering is a possible way to combat increasing CO2 levels because of its carbon sequestration properties

Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs

AIM: To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom. DESIGN: Cost-effectiveness analysis from a National Health Service (NHS)/health-provider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence. SETTING AND PARTICIPANTS: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%) INTERVENTIONS: Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. MEASUREMENTS: HCV infections and cost per quality-adjusted life year (QALY) gained through NSPs over 50 years. FINDINGS: Compared with a willingness-to-pay threshold of £20 000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses, including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year. CONCLUSIONS: Needle and syringe programmes are a highly effective low-cost intervention to reduce hepatitis C virus transmission, and in some settings they are cost-saving. Needle and syringe programmes are likely to remain cost-effective irrespective of changes in hepatitis C virus treatment cost and scale-up

Extreme rainfall variability in Australia: Patterns, drivers and predictability

Leading patterns of observed monthly extreme rainfall variability in Australia are examined using an Empirical Orthogonal Teleconnection (EOT) method. Extreme rainfall variability is more closely related to mean rainfall variability during austral summer than in winter. The leading EOT patterns of extreme rainfall explain less variance in Australia-wide extreme rainfall than is the case for mean rainfall EOTs. We illustrate that, as with mean rainfall, the El Niño-Southern Oscillation (ENSO) has the strongest association with warm-season extreme rainfall variability, while in the cool-season the primary drivers are atmospheric blocking and the subtropical ridge. The Indian Ocean Dipole and Southern Annular Mode also have significant relationships with patterns of variability during austral winter and spring. Leading patterns of summer extreme rainfall variability have predictability several months ahead from Pacific sea surface temperatures (SSTs) and as much as a year in advance from Indian Ocean SSTs. Predictability from the Pacific is greater for wetter than average summer months than for months that are drier than average, whereas for the Indian Ocean the relationship has greater linearity. Several cool-season EOTs are associated with mid-latitude synoptic-scale patterns along the south and east coasts. These patterns have common atmospheric signatures denoting moist onshore flow and strong cyclonic anomalies often to the north of a blocking anti-cyclone. Tropical cyclone activity is observed to have significant relationships with some warm season EOTs. This analysis shows that extreme rainfall variability in Australia can be related to remote drivers and local synoptic-scale patterns throughout the year

The environmental setting of Epipalaeolithic aggregation site Kharaneh IV

The archaeological site of Kharaneh IV in Jordan's Azraq Basin, and its relatively near neighbour Jilat 6 show evidence of sustained occupation of substantial size through the Early to Middle Epipalaeolithic (c. 24,000 - 15,000 cal BP). Here we review the geomorphological evidence for the environmental setting in which Kharaneh IV was established. The on-site stratigraphy is clearly differentiated from surrounding sediments, marked visually as well as by higher magnetic susceptibility values. Dating and analysis of off-site sediments show that a significant wetland existed at the site prior to and during early site occupation (~ 23,000 - 19,000 BP). This may explain why such a substantial site existed at this location. This wetland dating to the Last Glacial Maximum also provides important information on the palaeoenvironments and potential palaeoclimatic scenarios for today's eastern Jordanian desert, from where such evidence is scarce