Research Findings - International Research

HHH Fellow: Stephen E. Nsimba, Tanzania, 2005-2006
Nsimba SE.
Anti-retroviral (ARV) Rationing Schemes in Developing Countries: A Review Article on Strategies and Ethical Issues Related to the Successes and failures of ARV Programmes.
East African Journal of Public Health. 2009 Aug; 6(2): 219-222.

When a patient receives a counterfeit drug, he/she becomes a victim of fraud medicine and is put at risk of developing adverse effects from unwanted medication that is not prescribed. These individuals health also becomes compromised because they are cheated of both successful treatment regimens and economically. Indeed counterfeit drugs pose many threats to society; not only to the individual in terms of the health side effects experienced, but also to the public in terms of trade relations, economic implications, and the effects on global pandemics. Apart from the pharmaceutical aspect in producing substandard drugs, there area also climatic or environmental factors as well as patients and economic factors. All these need to be addressed when considering any proper rationing strategy for antiretroviral drugs (ARVs) in sub-Saharan countries.

HHH Fellow: Chung Tai Lee, South Korea, 1994-1995
Lee SJ, Lee HK, Kweon YS, Lee CT, Lee KU.
The Impact of Executive Function on Emotion Recognition and Emotion Experience in Patients with Schizophrenia.
Psychiatry Investigation. 2009 Sep; 6(3): 156-162. Epub 2009 Jun 23.

This study investigated the impact of executive function on the performance of two different affective tasks, the Facial Affect Identification Task (FAIT) and the Iowa Gambling Task (IGT), in patients with schizophrenia. Thirty-nine patients with schizophrenia and 33 healthy controls completed the FAIT and the IGT, followed by the Wisconsin Card Sorting Test (WCST) and the intelligence quotient (IQ) test. In addition to correlation analysis, regression analysis was used to determine the extent to which the performance of the WCST, in particular, perseverative error (PE), accounted for the variation in both the FAIT and the IGT. Relative to normal controls, patients with schizophrenia showed significant impairments in the IGT, the FAIT and the WCST even after controlling for IQ. While normal controls did not show any relationships between the WCST and two affective tasks, patients with schizophrenia showed that variables in the WCST correlated not only with the FAIT total correct score (r=-0.503, p=0.001 for PE) but also with the IGT net score (r=0.385, p=0.016 for PE). The PE score was a better predictor of the performance on the FAIT (R(2)=0.25) than that of the performance on the IGT (R(2)=0.15). These findings imply that deficits in executive function in schizophrenia can affect performance on facial emotion recognition tasks more than performance on tasks based on emotion experience, that is, the feedback from the body. Therefore, more consideration is needed of the impact of executive function when interpreting the result of "conventional" facial affect recognition tests as opposed to interpreting the IGT.

HHH Fellow: Nimesh Desai, India, 1999-2000
Pandurangi AK, Desai NG.
Report of the Indo-US Health Care Summit 2009 - Mental Health Section.
Indian Journal of Psychiatry. 2009 Oct-Dec; 51(4): 292-301.

The 2nd Indo-US Health Care Summit held in January 2009 was a forum to discuss collaboration between physicians in the US and India on medical education, health care services and research. Six specialties were represented including Mental Health (MH). Using Depression as the paradigmatic disorder, the following objectives were developed. Objective I - Leadership and Public Education: Linkage with like-minded agencies and organizations. The core message should be simple. Major Depression is a brain disorder. Depression is treatable. Timely treatment prevents disability and suicide. Objective II - Medical Education: To improve psychiatric education, it was proposed that (1) relations between US/UK and Indian mid-level institutions be established, (2) teaching methods such as tele-psychiatry and online courses be pursued, (3) use models of teaching excellence to arouse student interest, and (4) develop core curricula for other branches of medicine, and CME. Objective III - Reduce Complications of Depression (Suicide, Alcoholism): Goals include (1) decriminalizing attempted suicide, (2) improving reporting systems, and including depression, psychosis, alcoholism, and suicide in the national registry, (3) pilot studies in vulnerable groups on risk and interventions, and (4) education of colleagues on alcoholism as a link between psychiatric and medical disorders. Objective IV - Integrating MH Treatment & Primary Health Care: The focus should be on training of general practitioners in psychiatry. Available training modules including long distance learning modules to be suitably modified for India. Collaborations and specific project designs are to be developed, implemented and monitored by each specialty group and reviewed in future summits. PMID: 20048457 [PubMed - in process]

HHH Fellow: Arun Kumar Sharma, India 2004-2005
Ghosh R, Sharma AK.
Intra- and Inter-Household Differences in Antenatal Care, Delivery Practices and Postnatal Care between Last Neonatal Deaths and Last Surviving Children in a Peri-Urban Area of India.
Journal of Biosocial Science. 2010 Mar 5:1-20. [Epub ahead of print]

Nearly a quarter of the world's neonatal deaths take place in India. The state of Uttar Pradesh alone accounts for one-quarter of all neonatal deaths in the country. In this study 892 married women aged less than 50 years living in a peri-urban area of Kanpur city in Uttar Pradesh were interviewed. In all, 109 women reported neonatal deaths. Characteristics of the last neonatal deaths of these 109 women were compared with those of the last surviving children. Also, characteristics of women who had a neonatal death were compared with those of 783 women who had no neonatal death. It was found that as compared with neonatal deaths, the last surviving children of the 109 women had: (a) significantly better antenatal tests during pregnancy, intake of iron/folic acid tablets and higher percentage of tetanus toxoid immunization; (b) safer delivery practices such as a higher percentage of institutional delivery, sterilization of instruments and application of antiseptic after removal of umbilical cord; (c) postnatal care, such as application of antiseptic to the navel and postnatal checkups; and (d) higher maternal age and greater birth spacing. Likewise, better antenatal care and safer delivery practices and postnatal care were observed among the 783 women with no neonatal deaths, when compared with women who had experienced neonatal death. The complexities of inter- and intra-household differences in health care are discussed. The paper concludes that to improve child survival general education and awareness regarding safe delivery should be increased. Continuing cultural stigmas and misconceptions about birth practices before, during and after childbirth should be an important part of the awareness campaigns.

HHH Fellow: Rouman Sedefov, Bulgaria, 1994-1995
Hillebrand J, Olszewski D, Sedefov R.
Legal Highs on the Internet.
Substance Use & Misuse. 2010 Feb; 45(3): 330-340.

This article describes the findings of a descriptive analysis of 27 online drug retailers selling legal alternatives to illegal drugs, commonly referred to as "herbal highs" and "legal highs" in 2008 . The study attempted to quantify the online availability of drug retailers, to describe common products and characteristics in EU-based retail sales. The findings highlight the concern about the lack of objective information about products offered, including potential risks to health. Systems should be developed to assess the contents of products and the accuracy of information provided on the Internet, alongside continued monitoring of this market for "legal high" substances. PMID: 20141450 [PubMed - in process]

HHH Fellow: Alisher Latypov, Tajikistan 2002-2003
Latypov A.
Opioid Substitution Therapy in Tajikistan: Another Perpetual Pilot?
International Journal on Drug Policy. 2010 Feb 23. [Epub ahead of print]

Opioid substitution therapy (OST) continues to face strong resistance in the former Soviet Central Asian republics. OST was discontinued by the Uzbek government in 2009. In Kyrgyzstan, with about 950 people currently receiving OST, the programme was about to be suspended in 2009. In Kazakhstan, a small pilot project serves 50 clients. Turkmenistan may introduce OST in 2010, while the Tajik Ministry of Health approved the introduction of an OST pilot in summer 2009. This paper draws upon the analysis of interests of the OST-affected groups in Tajikistan as a case study to understand the roots of resistance to OST. In Tajikistan, OST may be contrary to the interests of some narcologists, law enforcement officers and drug dealers. People who use drugs do not play any role in national drug-policy making. The HIV prevention community within the Tajik executive bodies receives major financial support from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to respond to an IDU driven epidemic, and yet it is the only group which has nothing to gain from the absence of OST. The Tajik government agreed to introduce OST in order not to jeopardize its future funding from GFATM. If the interests of the OST-affected groups are ignored, there is a high chance that OST in Tajikistan may remain a perpetual pilot project even despite all the necessary resources would come from GFATM and other donors. Putting "narcology on pilot" may prove helpful in both tackling the OST "perpetual pilots" and shifting the focus of public attention towards major inadequacies of the existing state-funded drug treatment systems in the region.