Beyond the drug-terror nexus: Drug trafficking and state-crime relations in Central Asia

BackgroundIn the wake of collapse of the Soviet Union, Central Asia has transformed into a key hub along the Afghan opiates trafficking routes. Around 30 percent of the heroin manufactured in Afghanistan is estimated to be smuggled through Central Asian republics in its way to booming drug markets in Russia and Eastern Europe.MethodsBuilding upon available evidence and extensive fieldwork research, the article seeks to confute mainstream analyses which emphasize connections between criminal and terrorist networks. The focus is on conducive factors for the establishment of drug routes in Central Asia, the characteristics of drug related networks, and the nature of political-criminal relations across the region.ResultsIt is argued that in all five Central Asia republics strategic partnerships have formed between drug traffickers and state actors around the exploitation of drug rents and that mafias’ influence on politics is stronger in Tajikistan and Kyrgyzstan, the region's poorest countries.ConclusionBy moving the focus from narco-terror to the state-crime connections, the article provides a critical insight into political economy issues surrounding a complex and multifaceted phenomenon such as the drug trade.     

Compound Heterozygosity for HKαα and an in Cis Deletion of Double α Genes Presents as α-Thalassemia Trait

Abstract

The HKαα (Hong Kongαα) allele is an unusual rearrangement of the α-globin gene cluster containing both the –α^3.7 (rightward) and ααα^anti?4.2 crossover deletion/insertion. During our thalassemia screening program, we identified 10 adult individuals and two newborns who were confirmed to be compound heterozygotes for HKαα and the Southeast Asian deletion (–?–^SEA). Their hematological data showed a typical α-thalassemia (α-thal) trait. The routine gap-polymerase chain reaction (gap-PCR) based assay revealed the presence of –α^3.7, –?–^SEA and normal α2 alleles in the α-globin gene clusters. These confusing findings indicated the existence of more complex derivative alleles produced possibly by repeated unequal crossover of recombinant alleles between α-globin gene clusters. A two-round nested PCR strategy confirmed the diagnosis of HKαα. Considering the large-scale population screening in the thalassemia-prevalent regions in China, the current diagnostic strategy might need to be modified accordingly. The detection of HKαα would improve accuracy in genetic counseling, especially in couples where one partner was a –?–^SEA carrier and the other carries a –α^3.7 deletion identified by routine gap-PCR methods.     

Survey of implementation of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in nine Asian countries

After the release of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in 2001 and update in 2003, its implementation in nine Asian countries was investigated. Questionnaire surveys involving thoraco-pulmonary physicians or internists investigated the awareness and consensus of the GOLD guidelines including the care and management of chronic obstructive pulmonary disease (COPD) patients in Asian. Two surveys were conducted, in June 2002 and March 2004, through questionnaires by direct mail in Japan and face-to-face interviews in the other countries. Approximately 600 questionnaires were returned with approximately 84% awareness of the publication and its update and nearly 90% appreciated the globalization efforts. The survey revealed great variances concerning the definition of COPD, its diagnosis, and use of computed tomography. As for the implementation, the majority answered the use of the combined local and GOLD guidelines in five of nine countries surveyed, while the GOLD guidelines were implemented mainly in Korea, suggesting the influence in daily practice for care and management of COPD patients. Implication of rehabilitation in clinical practice has not been standardized despite high evidence of its advantages. Most respondents stated the necessity of developing a local or regional guideline for best practice. Our survey revealed: (i) awareness of the GOLD guidelines was high and well accepted; (ii) the possibility of developing a uniform or standard guideline in Asia is low due to local characteristics; (iii) modifications of the GOLD guidelines may be more practical; and (iv) that the multidisciplinary pulmonary rehabilitation program needs to be further activated in GOLD implementation for the Asia–Pacific region.     

Women's empowerment and child nutritional status in South Asia: a synthesis of the literature

Women's disempowerment is hypothesised to contribute to high rates of undernutrition among South Asian children. However, evidence for this relationship has not been systematically reviewed. This review of empirical studies aims to: (1) synthesise the evidence linking women's empowerment and child nutritional status in South Asia and (2) suggest directions for future research. We systematically searched Global Health, Embase (classic and Ovid), MEDLINE, Campbell Collaboration, Popline, Eldis, Web of Science, EconLit and Scopus. We generated 1661 studies for abstract and title screening. We full‐text screened 44 of these, plus 10 additional studies the authors were aware of. Only 12 studies fulfilled our inclusion criteria. We included English materials published between 1990 and 2012 that examined the relationship(s) of at least one women's empowerment domain and nutritional status among South Asian children. Data were extracted and synthesised within three domains of empowerment: control of resources and autonomy, workload and time, and social support. The results showed women's empowerment to be generally associated with child anthropometry, but the findings are mixed. Inter‐study differences in population characteristics, settings or methods/conceptualisations of women's empowerment, and the specific domains studied, likely contributed to these inconsistencies. This review also highlights that different women's empowerment domains may relate differently to child nutritional status. Future research should aim to harmonise definitions of women's empowerment, which key domains it should include, and how it is measured. Rigorous evaluation work is also needed to establish which policies and programmes facilitate women's empowerment and in turn, foster child nutritional well‐being.     

Impact of Family History of Substance Abuse on Admission Opioid Dose,Depressive Symptoms,and Pain Catastrophizing in Patients with Chronic Pain

The objectives of this study were to examine association between a family history of substance abuse and admission morphine equivalent dose, depression and pain catastrophizing screening scores, as well as reported personal history of substance use. The retrospective research was completed in an interdisciplinary three-week pain rehabilitation center. The subject cohort included admissions from January through December 2014 with 351 datasets for family history of substance abuse and oral morphine equivalency and 341 for depression, pain catastrophizing and use of substances. Outcome measures included admission self-reported data on family history of substance abuse and past and current substance use, admission morphine equivalency dose, and scores on the Center for Epidemiologic Studies-Depression Scale and the Pain Catastrophizing Scale. One hundred forty-seven patients were using opioid medications on admission and those with a positive family history of substance abuse had an oral morphine equivalency (M = 92.12, SD = 95.32) compared to a negative history (M = 80.34, SD = 64.86); the difference was not statistically significant, t (120.01) =.87, p = .39. Patients with a positive family history reported higher levels of both depression, t (327.40) = 3.15, p = .002 and pain catastrophizing, t (338) = 2.76, p = .01. Those with a positive family history endorsed greater frequency of past alcohol use χ² (1, N = 326) = 6.67, p = 0.1 and marijuana use χ² (1, N = 341) = 4.23, p = .04 and past χ² (1, N = 329) = 9.90, p = .002 and current tobacco use χ² (1, N = 327) = 8.81, p = .003. Use of family history of substance abuse information may help provide data for multimodal treatments of chronic non-cancer-pain. The findings from this study can be used to guide future research.     

Induction of Multidrug Tolerance in Plasmodium falciparum by Extended Artemisinin Pressure

Plasmodium falciparum resistance to artemisinin derivatives in Southeast Asia threatens global malaria control strategies. Whether delayed parasite clearance, which exposes larger parasite numbers to artemisinins for longer times, selects higher-grade resistance remains unexplored. We investigated whether long-lasting artemisinin pressure selects a novel multidrug-tolerance profile. Although 50% inhibitory concentrations for 10 antimalarial drugs tested were unchanged, drug-tolerant parasites showed higher recrudescence rates for endoperoxides, quinolones, and an antifolate, including partner drugs of recommended combination therapies, but remained susceptible to atovaquone. Moreover, the age range of intraerythrocytic stages able to resist artemisinin was extended to older ring forms and trophozoites. Multidrug tolerance results from drug-induced quiescence, which enables parasites to survive exposure to unrelated antimalarial drugs that inhibit a variety of metabolic pathways. This novel resistance pattern should be urgently monitored in the field because this pattern is not detected by current assays and represents a major threat to antimalarial drug policy.     

Novel Reassortant Influenza A(H5N8) Viruses among Inoculated Domestic and Wild Ducks,South Korea, 2014

An outbreak of highly pathogenic avian influenza, caused by a novel reassortant influenza A (H5N8) virus, occurred among poultry and wild birds in South Korea in 2014. The aim of this study was to evaluate the pathogenesis in and mode of transmission of this virus among domestic and wild ducks. Three of the viruses had similar pathogenicity among infected domestic ducks: the H5N8 viruses were moderately pathogenic (0%–20% mortality rate); in wild mallard ducks, the H5N8 and H5N1 viruses did not cause severe illness or death; viral replication and shedding were greater in H5N8-infected mallards than in H5N1-infected mallards. Identification of H5N8 viruses in birds exposed to infected domestic ducks and mallards indicated that the viruses could spread by contact. We propose active surveillance to support prevention of the spread of this virus among wild birds and poultry, especially domestic ducks.