The general brief for this report was to evaluate the evidence on the effectiveness of sterile needle and syringe programming (including other injecting paraphernalia)for HIV prevention among IDUs in different settings and parts that surround a word or passage, and to recommend how the evidence can guide public health policy-makers in programming for HIV prevention among IDUs.
The report was to include all of the following subcategories: needle and syringe decontamination strategies; needle and syringe exchange; pharmacy, vending(slot-machine selling small items) and other distribution programmes; needle and syringe disposal; and
injecting paraphernalia laws collectively.
Additional feasibility an dimplementation criteria :
Cost effectiveness:

Although estimated in a number of different ways, authorities pay increasing
attention these days to the magnitude of benefit achieved from assigning or devoting of scarce public resources. Is the introduction of NSPs and other interventions cost-effective in all parts of the world and at different stages of an HIV epidemic?

Absence of negative consequences:

Consideration of possible uni-intentional and in-attentive adverse consequences is an important part of evaluating clinical and public health interventions. The presence of unintended negative consequences has a major impact on adoption or expansion of interventions. Fear that increased availability of sterile needle syringe programmes might make worse unlawful or forbidden drug use has been a major factor delaying adoption and expansion of these programmes.

The effectiveness of needle syringe programmes :

Strength of association
There were 48 studies dating from 1989 to 2002 that were identified with NSP implementation as an intervention and HIV super conversion, HIV seroprevalence or HIV risk behaviours among IDUs examined as outcome variables. Some studies assessed multiple outcomes. Out of 11 studies that evaluated HIV superconversion or seropositivity as outcomes  found that NSP use was protective; outcomes in 3 studies were negatively associated with NSP use and 2 studies showed no effect HIV risk behaviour outcomes were examined in 33studies (with some authors reporting on more than one study or outcome). The majority focused on syringe sharing, borrowing, lending or reuse 1 negative and  not fixed in extent while 6 studies examined diverse outcomes including ‘injection frequency’ ,‘proportion of syringes exchanged’ ,‘syringe return rate or exchange rate’ and ‘mortality among NSP users versus non-users’.

There are various tools that can be used in acupuncture treatment. Acupuncture needles are the main tool that is used. These needles are placed at various points to improve the function of the affected organs. Acupuncture involves the use of very fine needles inserted into the skin at certain points of the body which are believed to be situated on energy channels called meridians. Acupuncture needles come in different gauges (diameter) and lengths to be used on the different areas of the body where they are to be inserted. Historically, Chinese acupuncture needles have tended to be tapered and thicker than Japanese needles, however, the needles used nowadays are mostly very fine — they vary from 0.12 mm to 0.35 mm in diameter — that’s about a third of a millimeter in diameter for the thickest one. There are several types of acupuncture needles. In ancient China 9 different types of acupuncture needle were used.

Today, the most commonly used needle is the metal filiform (thread-like) needle that is made from stainless steel but can also be made of silver, gold, copper etc. The sizes vary from a 3mm stud used on the earlobe, to 15cm long needles used in deep muscles. The insertion of a needle should not be painful, apart from the initial prick; this is followed by a deeper “needling sensation”, which is similar to the sensation experienced when bumping a “funny bone”. This indicates that the Qi has been successfully stimulated. The majority of needles used today in Australia are pre-sterilized, single use, disposable types. They are manufactured and packed under sterile conditions into foil-backed blister packs with guide tubes on the end. Acupuncture needles are commonly left in for any length of time between a few seconds and half an hour or so. The acupuncturist may tweak the needles during this time. Some specialized very small, short needles are left in for a few days. Electro-acupuncture is another type of acupuncture in which electricity is used as a tool. In certain circumstances it may be necessary to attach electrical clips to some of the needles so that they can be electrically stimulated with an almost imperceptible current. Certain conditions such as osteo-arthritis may require heat, which can be applied by burning the herb Artemisia vulgaris [Mugwort] on the needles or near the acupuncture points.

This painless but very effective treatment is also called “moxa”. Laser acupuncture is latest type in acupuncture. It is done with the help of laser. If all this talk about needles is making you squirm, there is an alternative; acupuncture points can also be effectively stimulated with a low energy laser beam, which is harmless and painless. Many clinical acupuncturists use a laser, which is a modern Western modification. Laser has the distinct advantage of being able to treat children, and those with a needle phobia. They have several other advantages. Some of them are speeding up the healing of injured tissues e.g. ulcers and fever blisters, following injury or surgery, stimulating circulation, reducing inflammation, stimulating new cell growth, reducing fibrous tissue formation e.g. following burns and surgery.

These include endorphins, bradykinins and prostaglandins. Endorphins are pain relieving and mood elevating and are probably responsible for the euphoria that is often experienced after a treatment. Bradykinins are also pain relieving, and prostaglandins have anti-inflammatory effects. Placebo effect is efficient method of scientific validation. Placebo effects are beneficial health outcomes not related to the relatively direct biological effects of an intervention and can be elicited by an agent that, by itself, is inert. Understanding these placebo effects will help to improve clinical trial design, especially for interventions such as surgery, CNS-active drugs and behavioral interventions which are often non-blinded. A literature review was performed to retrieve articles discussing placebo implications of clinical trials, the neurobiology of placebo effects and the implications of placebo effect for several disorders of neurological relevance. Recent research in placebo analgesia and other conditions has demonstrated that several neurotransmitter systems, such as opiate and dopamine, are involved with the placebo effect. Brain regions including anterior cingulated cortex, dorsolateral prefrontal cortex and basal ganglia have been activated following administration of placebo. A patient’s expectancy of improvement may influence outcomes as much as some active interventions and this effect may be greater for novel interventions and for procedures. Maximizing this expectancy effect is important for clinicians to optimize the health of their patient. There have been many relatively acute placebo studies that are now being extended into clinically relevant models of placebo effect. Proponents of acupuncture often argue that the benefits are all in the mind. The scientific term for this concept is the “placebo effect”. It is generally accepted that in any healing, the placebo or psychological effect accounts for about 30% of the benefit, and that one’s state of mind can affect the outcome of any treatment. Despite this benefit, one does not have to believe in acupuncture for it to work; notably, acupuncture works in children and animals, which are not subject to the preconceptions of the placebo effect. Acupuncture does not work any more effectively in one racial group compared to others, nor does it form part of any religion, Eastern or otherwise.

The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones which influence the body’s own internal regulating system. The improved energy and biochemical balance produced by acupuncture results in stimulating the body’s natural healing abilities, and in promoting physical and emotional well-being. Research has found that several types of opioids may be released into the central nervous system during acupuncture treatment, thereby reducing pain. Western scientists have found evidence that acupuncture points are strategic conductors of electromagnetic signals. Stimulating points along these pathways through acupuncture enables electromagnetic signals to be relayed at a greater rate than under normal conditions. These signals may start the flow of pain-killing biochemicals, such as endorphins, and of immune system cells to specific sites in the body that are injured or vulnerable to disease. Studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones. Acupuncture also has been documented to affect the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes whereby a person’s blood pressure, blood flow, and body temperature are regulated.
Preclinical studies have documented acupuncture’s effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine. Acupuncture also has been documented to affect functions such as immune reactions and processes whereby a person’s blood pressure, blood flow, and body temperature are regulated. A person will lie on a comfortable surface before the needles are placed, where the position (side, face up or face down) will depend on where the needles should go. Although the procedure of inserting the needles in the body isn’t painful, a sharp sensation may be felt when the needle is inserted first. When the needle reaches the correct depth a deep aching sensation or acupuncture pain is common. Sometimes after the placement, needles are moved or stimulated by heat or electricity. Even though the powerful technologies are available today, the modern physicists cannot explain exactly how this ancient healing therapy works. Perhaps in the near future, the actual chemical and electromagnetic events that occur during acupuncture will be explained.

How Can I Find a Qualified Practitioner
Although today people are accustomed to receiving healthcare from professionals, this is not necessary with Reiki. Reiki has always been a generally become sound or healthy practice, and if you have a friend who is trained and who practices on himself/herself regularly, you may want to receive treatments from your friend. If you are happy with that experience, you can continue with your friend or contact your friend’s Reiki master. If you don’t have a friend who does Reiki, you can look for a Reiki practitioner in private practice or a healthcare environment. In recent years, Reiki practitioners are increasingly setting themselves up as professionals in private practice or offering Reiki in healthcare environments. In addition, more healthcare institutions are incorporating Reiki into their model of care. Many nurses and other healthcare professionals offer Reiki as part of their patient care, either through integrating moments of Reiki touch into routine care or through longer Reiki treatments.
According to a national survey published in 2002, more than 2.2 million Americans had already experienced or practiced Reiki. Reiki is offered in prominent medical centers across the country, some of which include: Memorial Sloan Kettering Cancer Center and New York-Presbyterian Hospital (N.Y.)Dana-Farber/Harvard Cancer Center (Boston, Mass.)Yale-New Haven Hospital (New Haven, Conn.)Johns Hopkins Hospital and Health System (Baltimore, Md.) M.D. Anderson Cancer Center (Houston, Tex.) George Washington University Hospital (Washington, D.C.) California Pacific Medical Center (San Francisco, Calif.)
One good strategy for finding a practitioner is word of mouth. Local practitioners of complementary therapies (such as acupuncture, shiatsu, reflexology, massage, herbalism, homeopathy, etc.) usually know one another by reputation and sometimes they share offices or cross-refer. As with finding a Reiki teacher, you can also try looking at community news report boards in yoga studios and health food stores. In addition, your local hospital may have a complementary or integrative medicine service. Since Reiki is used by many people to cope with chronic illness, any local organization that offers services to people with illnesses such as cancer, HIV, fibromyalgia, or diabetes may have a list of community resources or even sponsor a Reiki clinic.
How do I evaluate their qualifications
Once you’ve found a Reiki practitioner, how can you standardly measure qualifications? What should you look for? Because the Reiki profession has grown out of a grass roots movement rather than emerging from academic healthcare programs, many different perspectives and practice styles have developed without oversight, and there are no common standards of education or treatment that are agreed upon across all practice styles. Although Reiki masters often give their students certificates, these certificates are not supported by educational standards that have been agreed upon throughout the Reiki community. Therefore the possession of a certificate is no guarantee that the practitioner has thorough training. You need to ask some specific questions to determine training and experience.

What does Reiki Cost
Currently Reiki is only covered by health insurance when it is part of a treatment such as physical therapy, massage, or without curing the care that is covered by your insurance or when it is delivered by a nurse or licensed care professional as part of routine care during a hospital stay. So, if you visit a Reiki practitioner, plan on paying out of pocket.

Hot flushes are the most frequent climacteric symptom and a major cause of suffering among menopausal women. Menopause is said to have occurred once a period of 12 months of amenorrhea has elapsed, which reflects a near complete but natural diminution of ovarian hormone secretion (Soules 2001). Perimenopause is the time period prior to menopause and ends 12 months after the final menstrual period (Soules 2001). This menopausal transition reflects a period of changing ovarian function which may precede the final menstrual period by between two and 8 years (Greendale 1999).

Postmenopause is defined as all the years beyond the last menstrual period (Soules 2001). The menopause can occur naturally as the result of aging or from surgical removal of ovaries, radiation, or chemotherapy. Most women experience natural menopause between 40 and 58 years of age (NIH 2005).From Perimenopause to late Postmenopause, some women experience various signs and symptoms such as vasomotor symptoms, headaches, vaginal dryness, urinary incontinence, sleep disturbances, sexual dysfunction, fatigue, mood disturbance, depression and cognitive difficulties (Greendale 1999; Grady 2006). Hot flushes (or hot flashes) are the most common symptoms related to menopause and Perimenopause. Hot flush is characterized by a sensation of intense heat associated with objective signs of coetaneous vasodilatation and a subsequent drop in core temperature (Stearns 2002). This sensation can also be accompanied by sweating, flushing, palpitations, anxiety, irritability and night sweats (Stearns 2002). A recent systematic review indicated that vasomotor symptoms were highly prevalent across menopausal stages in most societies (Freeman 2007).

The prevalence of hot flushes varies between 13% and 79% (median rate of 41%) among perimenopausal women and between 8% and 80% (median rate of 41.5%) in postmenopausal women. The condition negatively influences many aspects of women’s lives. To date, conventional hormone replacement therapy (HRT) is considered the most effective treatment for hot flushes. However, HRT is associated with a host of negative side effects. Complementary and alternative medical (CAM) approaches have been employed to relieve symptoms and to avoid these side effects. Acupuncture is one of the most strongly preferred CAM treatments for many diseases, causing few serious adverse effects, and is frequently used in Korea. We aim to evaluate the effectiveness of Traditional Korean Acupuncture (TKA) in conjunction with usual care, compared to usual care alone, on hot flushes in Perimenopausal and postmenopausal women in Korea. This study consists of a multi-center randomized controlled trial with 2 parallel arms. Participants included in the study will meet the following criteria: 1) a documented daily average hot flush score greater than or equal to10 for one week prior to the screening visit 2) not taking HRT and other pharmaceutical therapies which might affect hot flushes or other vasomotor symptoms. While maintaining usual care, the treatment group will receive acupuncture 3 times a week, for a total of 12 sessions over 4 weeks.

The control group will receive usual care alone during the same period. Post-treatment follow-up will be performed one month after completing 12 sessions of acupuncture. This trial will provide evidence for the effectiveness of acupuncture as a treatment for hot flushes. The primary endpoint in both groups is a change in hot flush score from baseline to week 4 and/or week 8. As the secondary endpoint, we will employ the Menopause Rating Scale (MRS), a health-related quality of life questionnaire. Further analysis will examine the frequency, severity and difference in symptoms for daytime vs. nighttime hot flushes, sub-domain analysis of MRS, and participants’ expectations of acupuncture treatment.

Ear acupuncture did not develop originally in the Orient, as is often thought. . The Chinese try to find points on the ear which corresponded to areas on the body, and they used small seeds or needles to stimulate these points in the hopes of affecting pain and other disorders. Ear acupuncture is one of several “holographic” systems which theorize that the entire body can be represented in miniature within the body itself.  In Japan, Dr. Yamamoto has developed a theory of scalp acupuncture based on this concept, and he has taught this approach to several groups of acupuncturists and physicians in the U.S. Dr. Yamomoto feels that frequent stimulation of points on the scalp can be helpful in neurological disease and in the rehabilitation of stroke patients, and his own practice is focused on the treatment of these disorders. In a similar fashion, a form of hand acupuncture developed in Korea theorizes that all of the 12 primary channels and two of the secondary channels of traditional Chinese acupuncture are represented on the hand. Very small needles or magnets are used to treat these points with the goal of achieving the same result as treating the body points used by traditional acupuncturists. Chinese physicians have even theorized a system of “nose” acupuncture (which I have not personally investigated) which utilizes points on the nose to treat problems in other areas of the body.

The benefits of ear acupuncture and stimulation of points on the ears with small magnets, seeds, and beads have yet to be studied in depth. I have found ear points to be useful occasionally as an adjunct to treatment of the body, though it is difficult to say how much clinical effect ear stimulation contributes when other components of Oriental medicine are utilized in addition. In the brain, there are larger representations of head and hand in association with actual brain structures than there are representations of other areas of the body. Because of the importance of facial expression and finger coordination in humans, stimulation of these areas may have increased potency when compared with other areas of the body. This may also be the reason why face, scalp and hand acupuncture have their effectiveness. Certainly Dr. Nogier investigated an intriguing and seemingly effective folk practice. Any low risk procedure that offers the promise of relief should be investigated, but the long term value of ear stimulation in pain control and to reduce appetite has not been rigorously studied. If you are interested in experimenting to see if ear stimulation can help the problem you are having, I suggest you try massaging the ear in the areas indicated on the chart with sesame oil, and see if you think there is a benefit. A fingernail or a dull probe, such as the tip of a ball point pen, might be used to press a particular point for 7-15 seconds to see if you note a benefit. Don’t press to the point of extreme pain, but some discomfort is to be expected when stimulating the ear.

Try stimulation twice or three times a day to see if you note any difference in the duration, intensity, or frequency of discomfort. If you find some value in ear stimulation, you may either continue massage on a regular basis, or you may attempt to focus in on a particular point on the ear. Expert acupuncturists will use a small needle at the point, or tape a small bead (like a tiny jewelry bead), or a seed, or even a small Korean hand magnet at the point. The needle certainly stays in place more easily than the tape, but must be removed if it is uncomfortable or if any signs of infection develop. Practically speaking, it is difficult to maintain any tape on the complex and flexible surfaces of the ear. Taped products such as the “acubeads” offer a convenient method of experimenting with ear stimulation if you can afford the expense.

These energy channels, called meridians, are like rivers flowing through the body to irrigate and nourish the tissues. An obstruction in the movement of these energy rivers is like a dam that backs up in others. Cosmetic acupuncture is a great alternative to modern anti-aging treatments such as lasers, injections, and face-lift surgeries.  It does not carry the risks associated with these more invasive procedures, which can include numbness, scarring, atrophy, and lengthy recovery.  Following these other anti-aging treatments, clients’ faces can look stretched, burned, puffy, or “banded.”  Cosmetic acupuncture is a less expensive, healthy, safe and effective anti-aging choice. A study in the 1996 Journal of Clinical Acupuncture notes that among 300 cases treated with Cosmetic Acupuncture, 90% had marked improvement in their faces.  The subjects reported an improvement in the elasticity of facial muscles, smoothing of wrinkles, brighter complexion and overall rejuvenation. They also experienced an overall rejuvenation not confined to the face. Since acupuncture focuses on bringing the whole body into balance, clients also experience other positive “side effects”.  These include a reduction in hot flashes, less anxiety, reduction in mild depression, more energy, better sleep, and overall body rejuvenation.  Acupuncture also reduces stress.  Stress has been shown to cause inflammation and an oxidative response in the body which increases the signs of aging. Some of the benefits of Cosmetic acupuncture are Improvement in complexion and skin elasticity,Reduction in broken capillaries and redness,Increased luster of skin,Reduction in wrinkles and fine lines,Improvement in the beginning of jowls,Reduction of acne and rosacea, Reduction in puffiness,Lifting of drooping skin around eyelids and cheeks etc.

A free consultation is available to make sure Mei Zen cosmetic acupuncture is right for you.  It is not usually suitable for people who smoke or those with pituitary disorders, diabetes, and some heart disorders.  People who have a pace maker or suffer from excessive bruising or bleeding are not good candidates for the procedure.  It is also not recommended for people with many broken capillaries on the face. People who suffer from severe headaches may not be the best candidates either, so make sure to discuss with the acupuncturist if this procedure is the best choice for you. Mei Zen cosmetic acupuncture has very few side effects compared to other cosmetic procedures.  There is absolutely no risk of disfigurement or trauma.  There are some mild risks with cosmetic acupuncture.

These include bruising and redness at the site of needle insertion. The Mei Zen style of cosmetic acupuncture uses very shallow needling, so even these risks are minimal.  There may also be mild pain during needle insertion.  Many people compare it to a “mosquito bite.” This usually goes away quickly, and during treatment most people go into a deep state of relaxation.

Acupuncture treatment is preformed in an outpatient setting where depending on the acupuncture practitioner and assessment of your condition, number of sittings would be decided. A person will lie on a comfortable surface before the needles are placed, where the position (side, face up or face down) will depend on where the needles should go. Although the procedure of inserting the needles in the body isn’t painful, a sharp sensation may be felt when the needle is inserted first. When the needle reaches the correct depth a deep aching sensation or acupuncture pain is common. Sometimes after the placement, needles are moved or stimulated by heat or electricity. Once inserted the needles are generally left in the acupuncture point for about five to twenty minutes. The western theory for acupuncture focuses on the modern concepts of neuroscience. It is believed that acupuncture points stimulate the muscles, nerves and connective tissue. This stimulation in turn helps to increase the blood flow and appears to boost the activity of the body’s natural pain killers. On the other hand health is a result of the balance between yin and yang – the complementary extremes of life. Chinese medicine believes that any illness is due to an imbalance in this harmony and acupuncture helps to rebalance this energy flow.

Acupuncture can be used in conjunction with one or more conventional medical treatments or can be successfully used as a stand alone treatment for some conditions. Many preliminary studies indicate that acupuncture may provide symptomatic relief in many conditions like migraines, lower backaches, headaches, fibromyalgia and osteoarthritis. Acupuncture may also offer relief for certain postoperative pains including dental pain, chemotherapy induced nausea and vomiting, tennis elbow and chronic menstrual cramps. Acupuncture is safe when performed by an expert acupuncture practitioner properly. It has few side effects and can be successfully used in conjunction with other treatments. However it may not be safe to perform acupuncture if a person is on blood thinners or having a bleeding disorder. Make sure that the practitioner uses sterilized single use packed needles, because reused needles can accidentally cause transmission of certain infectious disease.