Needle exchange is a practical and important part of the Dutch prevention strategy to check the spread of HIV among injecting drug users (IDUs). However, needle-exchange programs are often tied to drug treatment programs that only reach a limited number of IDUs. To overcome this limitation, alternative designs are considered and initiated. This article describes a community-based approach to needle exchange that is built on empowerment of, and intense participation by, known IDUs to target unknown IDUs for delivery of clean needles. The needle-exchange patterns of the IDUs participating in this collective scheme are compared to those of other users who exchanged needles on an individual basis. It was found that this approach extended the reach of the program to a great degree and that it was well received in the IDU community. However, the results were negatively influenced by police activities aimed at closing down places where drugs were used and sold. It is concluded that engaging IDUs in peer-group-directed prevention efforts is both feasible and promising.

AIM The aim of this study was to investigate within a population-based cohort of 4384 infants (2182 males, 2202 females) whether fetal growth from early pregnancy onwards is related to infant development and whether this potential relationship is independent of postnatal growth.METHOD Ultrasound measurements were performed in early, mid-, and late pregnancy. Estimated fetal weight was calculated using head and abdominal circumference and femur length. Infant development was measured with the Minnesota Infant Development Inventory at 12 months (SD 1.1mo, range 10-17mo). Information on postnatal head size and body weight at 7 months was obtained from medical records. INTERPRETATION Faster fetal growth predicts a lower risk of delayed infant development independent of postnatal growth. These results suggest that reduced fetal growth between mid-and late pregnancy may determine subsequent developmental outcomes. RESULTSThe 'fetal programming' hypothesis postulates that human fetal experience determines developmental patterns.1 Fetal programming is a process that occurs during a sensitive developmental period with a long-lasting effect on the maturation of organs and associated physiological systems. Support for the fetal programming hypothesis stems from research investigating the relation between low birthweight (<2500g) and adverse somatic health outcomes, such as heart disease.1 Low birthweight also negatively influences psychological outcomes, including cognitive and motor functioning in childhood. Little is known, however, about the relation between fetal growth within the entire range of gestation and infant development. Most population-based studies examining the association between fetal growth and development have used birthweight or length as indicators of intrauterine growth. These studies reported that higher birthweight or length predicted better cognitive and motor functioning in childhood. 3,4 Birthweight and length are crude summary measures at the endpoint of intrauterine growth, as they do not provide information on specific periods of fetal growth or on different body parts. The same birthweight can be obtained by different fetal growth patterns.5 While experiencing fetal growth restriction due to environmental influences, an individual fetus may still attain a normal birthweight because of its high genetic growth potential. Therefore, in this study, birthweight and serial fetal ultrasound assessments from early pregnancy onwards were used as indicators of fetal development. Serial measurements offer the opportunity to address the effect of fetal growth rate on infant development. Moreover, as head circumference correlates with brain volume, 6 repeated measures of fetal head growth can indicate fetal brain development.A few studies with small sample sizes (n<200) have investigated the relation between repeated fetal ultrasound measurements and development and found evidence suggesting that fetal growth in early and mid-pregnancy rather than in late pregnancy may predict developmental outcome. 7,8 ...

The Rotterdam Drug Monitoring System used survey data, fieldnotes and interviews with staff to investigate the functioning of four (out of six) consumption rooms in Rotterdam. The results show that for most drug users, access to the drug consumption room results in less frequent drug use in public places and more time and rest. Pass holders value being able to use drugs safely inside, and make use of the additional services provided, such as refreshments, washing/showering facilities and talking with others about their personal problems. Two ‘weak points’ reported by the drug users are discussed in relation to their personal health situation and public nuisance reduction.

Snowball sampling and targeted sampling are widely applied techniques to recruit samples from hidden populations, such as problematic drug users. The disadvantage is that they yield non-probability samples which cannot be generalised to the population. Despite thorough preparatory mapping procedures, selection effects continue to occur. This paper proposes an interpretation frame that allows estimating the direction of selection bias after data collection. Critical examination of the recruitment procedure and comparison with statistical and non-statistical external data sources are the core features of the interpretation frame. Applying the interpretation frame increases insight into the reliability of the results and allows to estimate where selection bias may have occurred.