This document discusses building a pyramid model for designing HIV prevention and treatment systems for drug users in Eastern Europe. It proposes a pyramid model with multiple levels and types of care services ranging from high to low threshold based on ease of access. The model aims to provide easy access and transfer between services to reach 70-80% of injecting drug users. Priorities should be set based on public health considerations like reducing HIV/AIDS and costs, with low threshold services providing the best coverage for available resources. The pyramid model metaphor emphasizes building services gradually and sustainably from the base up.
Social Determinants and Economic Burden of Non Communicable Diseases (NCD) on...Ruby Med Plus
India is home to almost one fifth of world’s population living in different states and differ in their ethnic origin, culture and various other ways that influence their health status.
National Health Policy 2017 address the issue of NCDs.
There exist dual burden of NCDs and Infectious and maternal-child disease across different states of India.
This puts challenging situation to Indian Health Care System which must be tackled by larger health investments and a balanced approach in reducing infectious and maternal-child diseases and also blunt the rising tide of NCDs and Injuries.
Since 1990’s, the contribution of most of the major non-communicable disease groups like cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders, and chronic kidney disease to the total disease burden has increased all over India.
In 2016, three of the five leading individual causes of disease burden in India were non-communicable diseases, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause.
In 2016, the NCD burden across India was 9-fold for ischaemic heart disease, 4-fold for chronic obstructive pulmonary disease, and 6-fold for stroke, and 4-fold for diabetes.
Risks factors like unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke, and diabetes.
Our Health and Wellbeing Board spent part of a development day looking at what a strategic shift to prevention in health and social care would mean, and where to start. Next steps will be a plan for "high impact" wins
Public injecting, harm reduction servicesJozsef Racz
This ERASMUS lecture is about a Hungarian public injection scene, about the local harm reduction services (run by Blue Point Drug Counselling and Outpatient Centre) and about connections of public injecting to other risks, including "police risks".
World Alzheimer Report 2016: Improving healthcare for people living with deme...Adelina Comas-Herrera
Keynote paper at the 2016 Alzheimers NZ Biennial Conference and 19th Asia Pacific Regional Conference of Alzheimer’s Disease International, Wellington, New Zealand, November 2016
Social Determinants and Economic Burden of Non Communicable Diseases (NCD) on...Ruby Med Plus
India is home to almost one fifth of world’s population living in different states and differ in their ethnic origin, culture and various other ways that influence their health status.
National Health Policy 2017 address the issue of NCDs.
There exist dual burden of NCDs and Infectious and maternal-child disease across different states of India.
This puts challenging situation to Indian Health Care System which must be tackled by larger health investments and a balanced approach in reducing infectious and maternal-child diseases and also blunt the rising tide of NCDs and Injuries.
Since 1990’s, the contribution of most of the major non-communicable disease groups like cardiovascular diseases, diabetes, chronic respiratory diseases, mental health and neurological disorders, cancers, musculoskeletal disorders, and chronic kidney disease to the total disease burden has increased all over India.
In 2016, three of the five leading individual causes of disease burden in India were non-communicable diseases, with ischaemic heart disease and chronic obstructive pulmonary disease as the top two causes and stroke as the fifth leading cause.
In 2016, the NCD burden across India was 9-fold for ischaemic heart disease, 4-fold for chronic obstructive pulmonary disease, and 6-fold for stroke, and 4-fold for diabetes.
Risks factors like unhealthy diet, high blood pressure, high blood sugar, high cholesterol, and overweight, which mainly contribute to ischaemic heart disease, stroke, and diabetes.
Our Health and Wellbeing Board spent part of a development day looking at what a strategic shift to prevention in health and social care would mean, and where to start. Next steps will be a plan for "high impact" wins
Public injecting, harm reduction servicesJozsef Racz
This ERASMUS lecture is about a Hungarian public injection scene, about the local harm reduction services (run by Blue Point Drug Counselling and Outpatient Centre) and about connections of public injecting to other risks, including "police risks".
World Alzheimer Report 2016: Improving healthcare for people living with deme...Adelina Comas-Herrera
Keynote paper at the 2016 Alzheimers NZ Biennial Conference and 19th Asia Pacific Regional Conference of Alzheimer’s Disease International, Wellington, New Zealand, November 2016
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Speech by: Alexis Goosdeel, EMCDDA Director (European Monitoring Centre for Drugs and Drug Addiction)
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Developing Networks of Care through Long Term Conditions Year of Care Commissioning & Long Term Conditions Improvement Programmes
Bev Matthews
Programme Lead for Long Term Conditions @Bev_J_Matthews
Presentation from the Tackling Long Term Conditions conference on 29 October 2014
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Mika Salminen, European HA-REACT project
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Statistics show that as of 2017, more than one million Canadians have survived cancer for more than 10 years. Yet, the physical rehabilitation needs of cancer survivors in Canada have received little attention and few services.
Dr. Jennifer M. Jones, PhD, is a senior Scientist and Director of the Cancer Rehabilitation & Survivorship Program at the Princess Margaret Cancer Centre in Toronto. Along with her colleague Stephanie Phan, Clinical Lead for the program, they provided an overview of her program, one of the best in the world and the only one of its kind in Canada.
Canadian Cancer Survivor Network staff Allison MacAlister and Jaymee Maaghop joined in the conversation to discuss the current national landscape, and what CCSN is doing to raise awareness for cancer rehabilitation in Canada.
Presentation by Andrew Forsyth, originally given at the HHS Region III Regional Resource Forum in Wilmington, Delaware in August 2015. Presented to the Philadelphia Ryan White Part A Planning Council in September.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Speech by: Alexis Goosdeel, EMCDDA Director (European Monitoring Centre for Drugs and Drug Addiction)
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Developing Networks of Care through Long Term Conditions Year of Care Commissioning & Long Term Conditions Improvement Programmes
Bev Matthews
Programme Lead for Long Term Conditions @Bev_J_Matthews
Presentation from the Tackling Long Term Conditions conference on 29 October 2014
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Mika Salminen, European HA-REACT project
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Statistics show that as of 2017, more than one million Canadians have survived cancer for more than 10 years. Yet, the physical rehabilitation needs of cancer survivors in Canada have received little attention and few services.
Dr. Jennifer M. Jones, PhD, is a senior Scientist and Director of the Cancer Rehabilitation & Survivorship Program at the Princess Margaret Cancer Centre in Toronto. Along with her colleague Stephanie Phan, Clinical Lead for the program, they provided an overview of her program, one of the best in the world and the only one of its kind in Canada.
Canadian Cancer Survivor Network staff Allison MacAlister and Jaymee Maaghop joined in the conversation to discuss the current national landscape, and what CCSN is doing to raise awareness for cancer rehabilitation in Canada.
Presentation by Andrew Forsyth, originally given at the HHS Region III Regional Resource Forum in Wilmington, Delaware in August 2015. Presented to the Philadelphia Ryan White Part A Planning Council in September.
Diffusion of Drug Trends, NPS, the Internet and Consequences for EpidemiologyJean-Paul Grund
In this presentation I consider the changes in markets for illicit and 'unscheduled' drugs related to the ever growing influence of technology in the last 20 years.
Randomized Controlled Trials in Evaluating Socially Complex Interventions: A ...Jean-Paul Grund
Randomized Controlled Trials in Evaluating Socially Complex Interventions: A Square Peg in a Round Hole?
This lecture will discuss a number of challenges and problems in Randomized Controlled Trials (RCTs), in particular in evaluating interventions aimed at (i) altering complex human behaviour, (ii) in marginalized and stigmatized populations; and, (iii) by socially complex interventions. Using examples from the literature and his own research, Dr. Grund will provide a transdisciplinary perspective on the utility of the RCT model in evaluating interventions aimed at, for example, people who use drugs or homeless people, two very complex “Real World” problems in the Czech Republic and elsewhere.
He argues that the arena of services for PUD, the homeless and other marginalised populations is rife with poorly understood contingencies. Consequently, the complexity of the research environment becomes a function of I, ii and iii above, but with enigmatic mathematical operators. Strategies for addressing this complexity through accompanying process evaluation and qualitative research will be discussed.
Dutch drug policy - coffee shops & compromise (2014)Jean-Paul Grund
Full text can be downloaded in English and Polish at: http://www.opensocietyfoundations.org/reports/coffee-shops-and-compromise-separated-illicit-drug-markets-netherlands
Though famous for its coffee shops, where cannabis can be purchased and consumed, the Netherlands has accomplished many enviable public health outcomes through its drug policy. These include low prevalence of HIV among people who use drugs, negligible incidence of heroin use, lower cannabis use among young people than in many stricter countries, and a citizenry that has generally been spared the burden of criminal records for low level, nonviolent drug offenses.
Coffee Shops and Compromise: Separated Illicit Drug Markets in the Netherlands tells the history of the Dutch approach and describes the ongoing success of the country’s drug policy. This includes the impact of the Dutch “separation of markets,” which potentially limits people’s exposure and access to harder drugs.
Though coffee shops have traditionally commanded the most media attention, the Netherlands also pioneered needle exchange and safer consumption rooms, decriminalized possession of small quantities of drugs, and introduced easy-to-access treatment services.
These policies, coupled with groundbreaking harm reduction interventions, have resulted in the near-disappearance of HIV among people who inject drugs and the lowest rate of problem drug use in Europe.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. Building Pyramids
Introduction
• While not absent during the days of communist rule, the transition
towards democracy has undoubtedly been followed by an increase in
the availability and use of illicit drugs in all former socialist
countries.
• As a result, injecting drug use, addiction and, as a consequence, HIV
are developing into a serious public health problem.
• Addiction is associated with compromised economic, social and
psychological situations.
• It is increasingly viewed as a complex, multi-causal, chronic
relapsing condition or disease, for which ”to date there is no effective
curative treatment.”
10/18/01, Building Pyramids
J-P Grund
3. Drug Use after Socialism:
Prevalence Russia & Ukraine
Table 1. Registered & Estimated Number of Drug Users in Russia & Ukraine
Russia
Registered Number of Drug Users
Ministry of Internal Affairs:
Ministry of Health:
1 99 0
19 94
19 96
20 01
158.000 249.000
25.000
85.000 450.000 (Users)
270.000 (Addicts)
Estimates:
1996: 600,000
1998: 1-2.5 million
2001: LTP: 3 million
Ukraine
Registered Number of Drug Users:
“Early 1990s”: 20.000; 1997: 80.000
Estimate (MIA):
1997: 600.000 – 700.000 (75 - 80% IDUs)
Sources: Brunet 1996; USAID/CDC 1998; Khodakevich & Dehne 1998; Dehne et al. 1999; MOH, 2001
4. Drug Use after Socialism:
Prevalence in Cities Across the CEE Region
Table 2. Total Number of IDUs and Percentage of Population by City
Sources:
• MSF/H RSAs
• Grund et al. 2001
City
Total IDUs % of Population
35000
2.6
Nizhniy Novgorod
9000
3.6
Novorossiisk
380-440
0.2
Pskov
10000
1
Rostov Na Donu
70-80000
1.7-1.9
St. Petersburg
18000
1.7
Volgograd
25000
2
Odessa
up to 10000
3
Poltava
7000-8000
0.4-0.5
Estonia
2000-3000
0.3-0.5
Vilnius
1416
0.2
Kishineu
15-20000
1-1.5
Sofia
2500
1
Szeged
5. Drug Use after Socialism:
Qualitative Prevalence Assessments
“People drink or inject in this place.”
(Outreach suggest that
Both national and city-level dataWorker, Volgograd) in
several NIS countries more than 1% of the
population is involved in (injecting) drug use.
“It is difficult to find a building in this
town that is not affected by drug use.”
(Epidemiologist, Rostov Na Donu)
10/18/01, Building Pyramids
J-P Grund
8. A Culture of Collective Drug Use
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J-P Grund
9. A Culture of Collective Drug Use
“It is very seldom when you use alone. At minimum you use with two or
three people. … “Somebody has money for drugs, a second knows where
to get good drugs, a third has some anhydride or a place to cook and yet
another has syringes. … It is also much cheaper to use in groups.”
11. Building Pyramids:
A Model for Policy & Service Development
• Metaphorical model of the development of drug treatment
and health & social care services for drug users.
• The model is essentially a thinking model to support realistic
policy development.
• It includes graphical representations
of key variables and processes,
relevant to decision making.
• It can inform a range of
policy choices, considering and
matching these key variables.
10/18/01, Building Pyramids
J-P Grund
12. Pyramid Model:
Establishing a Typology of Care Services for IDUs
Threshold to Care
High Threshold Services
Medium Threshold Services
Low Threshold Services
‘No’ Threshold Services
10/18/01, Building Pyramids
J-P Grund
13. Pyramid Model
Professional Care Services for IDUs
High Threshold Services
• In-Patient Detoxification
(Reduction, Cold Turkey)
• Mid-Term In-Patient
Treatment
• (Long-Term) Residential
Therapeutic Communities
• Psychiatric Interventions
• After Care, Rehab, Relapse
Prevention, Acupuncture
• (Re-Entry) Housing
10/18/01, Building Pyramids
J-P Grund
14. Pyramid Model
Professional Care Services for IDUs
Medium Threshold Services
• Out-Patient Detoxification
(Reduction, Acupuncture)
• Specialized Medical
Treatment (HIV, HBV,
HCV, Dental Problems)
• Social Work, Counseling,
Case Management
• Job Training, Work
• (Supported) Housing
• Money Management
10/18/01, Building Pyramids
J-P Grund
15. Pyramid Model
Professional Care Services for IDUs
Low Threshold Services
• Out-Patient Opiate Agonist
Treatment: Methadone,
Buprenorphine, Codeine
• Emergency Medical and
General Practice Care
• (Emergency) Psychiatry
• Syringe Access: Exchange,
Distribution, Pharmacy e.a.
Sales (kiosks-coupons?)
• Outreach Work
• Overdose Prevention
10/18/01, Building Pyramids
J-P Grund
16. Pyramid Model
Professional Care Services for IDUs
Low Threshold Services
• Drop-In Centers,
• Safer Consumption Facilities
• Food, Clothing and Shelter
Projects
• Drug Use Management
programs
• Acupuncture, Stress
Reduction
• Safer Drug Use Information
• Chill-Outs @ R@ves
10/18/01, Building Pyramids
J-P Grund
17. Pyramid Model
A Dynamic Model
Key Characteristics
• Easy access @ multiple
entry points.
• Includes all service levels
• (coordinated) transfer
between services.
• Easy use of ancillary services
• Increases demand for high
threshold treatment: develops
naturally with growing contact rates.
• Can reach 70-80% of IDUs.
• Collaborative Model.
10/18/01, Building Pyramids
J-P Grund
18. Pyramid Model
Considerations for Setting Priorities
Public Health Considerations
• Fighting the HIV/AIDS Pandemic
and Other Infectious Diseases
• Reducing Drug-related Morbidity
and Mortality
• Coverage of Populations at Risk
• Treatment Retention
• Treatment of Problem Drug Use
Economic considerations
• Available $$ Resources (Funding)
• Costs of Services
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J-P Grund
19. Coverage: What proportion of the
IDU Population Needs to be Reached?
Slide: Courtesy of S. Strathdee
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J-P Grund
20. Pyramid Model
Care Services for IDUs: Level & Coverage
Level of Care
Potential Coverage of Population (%)
High Threshold Services
1-20 (?)
Medium Threshold Services
15-40 (?)
Low Threshold Services
70-80
‘No’ Threshold Services
Nx
10/18/01, Building Pyramids
J-P Grund
21. Pyramid Model
Treatment Costs by Type of Modality
Type of Treatment
Relative Costs per Treated Drug User
$$$
High Threshold Services
$$-$$$
Medium Threshold Services
$
Low Threshold Services
Q: Where to Invest Scarce Resources?
A: Where we get the Biggest
10/18/01, Building Pyramids
Bang for the Buck!
J-P Grund
22. Mean Costs Per Year For 1 Heroin Addict (USA)
$
50000
40000
Security
30000
Theft, etc.
20000
10000
Heroin
Jail
or
Prison
and
Court
Costs
0
On Street
Incarcerated
Residential
Drug-Free
Treatment
MMT
Residential
Treatment
Methadone
Maintenance
Treatment
SOURCE: Slide: M. Reisinger, Adapted from NYS DSAS, 1991, by Dole & Des Jarlais.
10/18/01, Building Pyramids
J-P Grund
23. Conclusion
Building Pyramids: A Useful Metaphor for
Development of Drug Policy and Services?
• Pyramids were not built in one
day. Nor are treatment services
for Injecting Drug Users.
• Pyramids were built stone
for stone, layer for layer,
fitting seamlessly on the
preceding layer.
• Pyramids were built to last:
Sustainable Development
• Ancient Architectural Rule:
Start with the Fundament(al)s.
10/18/01, Building Pyramids
J-P Grund