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Use of opioid antagonists, particularly when delivered as an extended-release formulation, is a meaningful treatment option for individuals with opioid use disorder who are highly motivated to remain opioid abstinent or do not have access to agonist treatment. Current evidence suggests that use of injectable and implantable depot formulations of naltrexone is safe and well-tolerated. Initiation of an extended-release naltrexone remains a challenge for patients using opioid agonists and requires further development of rapid and effective methods of induction. When initiated, the extended-release naltrexone is effective for relapse prevention and is comparable to buprenorphine-naloxone. An extended-release naltrexone effectively prevented relapse among persons under criminal justice supervision and improved treatment outcomes in patients with comorbid HIV. Further strategies to improve retention in treatment and expand use of antagonists in other target populations need to be implemented.

Until 2020, the tourism industry was characterized by a growth rate, the statistics highlight that globally 2019 was the tenth year with a consecutive annual growth. However, the Covid-19 pandemic marked a major turning point in the development of tourism, instead of tourism overdevelopment, the underdevelopment issues appeared in front pages of the industry news. The effects of the pandemic are intensified by the fact that tourism is a labour-intensive industry and that most companies in the sector are SMEs (small and medium sized enterprises). At this time, it is crucially important to look at sustainability issues, therefore the aim of this study is to analyse the social and economic dimensions of sustainability for tourism SMEs. Descriptive statistics as well as qualitative research methods were used to study the challenges posed by the pandemic, in-depth interviews were conducted with tourism SMEs from three different countries. The conclusions show the situation from an enterprise perspective in Russian Federation, Georgia and Latvia.

At present, the role of Russia in the world economy is mainly associated with the supply of various raw materials to world markets, the share of which in the volume of Russian exports is more than 80%. At the same time, there is a rather significant processing sector of the economy in Russia. Since inertial development is aimed at simplifying the nature of the Russian economy and consolidating its raw material orientation, the development of manufacturing industries, at least at first, should be associated with protectionist measures and an active role of the state. The paper examines the existing approaches to the study of the problem of combining the principle of free trade and protectionist measures proposed by Russian and foreign authors and describes the methodological aspects of assessing the current state and prospects of implementing the import substitution policy in Russia.

The current situation in the world market of tourist services is characterized by several restrictions concerning both the impossibility of traveling to some countries and tourist formalities aimed at observing the safety measures of tourists. In addition, the structure of tourists’ needs has changed significantly, in connection with which the directions of “green” nature-oriented tourism have become actualized, contributing to the implementation of the concept of sustainable tourism development. In this regard, it is required to assess and re-evaluate the tourist potential of local territories and its development, considering the recreational needs of the local population. The article presents a methodological approach to assessing the tourist potential of local territories, considering the recreational needs of the population. The approach is based on the synthesis of methods for assessing the tourist-recreational potential of local territories and the real needs of tourist-recreational services among the population of the region. The methods of recreational-geographical, marketing, cluster approaches, as well as economic and mathematical modeling and cross-classification were used for methodology forming. The proposed methodological approach is in demand by regional and local authorities, tour operators and investors to objectively assess the tourist potential of local territories, considering the recreational needs of the population and the priorities of tourism development.

Naltrexone is a μ-opioid receptor antagonist that blocks opioid effects. Craving, depression, anxiety, and anhedonia are common among opioid dependent individuals and concerns have been raised that naltrexone increases them due to blocking endogenous opioids. Here, we present data that address these concerns.Assess the relationship between affective responses and naltrexone treatment.Opioid dependent patients (N = 306) were enrolled in a three cell (102ss/cell) randomized, double blind, double dummy, placebo-controlled 6-month trial comparing extended release implantable naltrexone with oral naltrexone and placebo (oral and implant). Monthly assessments of affective responses used a Visual Analog Scale for opioid craving, the Beck Depression Inventory, Spielberger Anxiety Test, and the Ferguson and Chapman Anhedonia Scales. Between-group outcomes were analyzed using mixed model analysis of variance (Mixed ANOVA) and repeated measures and the Tukey test for those who remained and treatment and did not relapse, and between the last measure before dropout with the same measure for those remaining in treatment.Depression, anxiety, and anhedonia were elevated at baseline but reduced to normal within the first 1-2 months for patients who remained in treatment and did not relapse. Other than a slight increase in two anxiety measures at week two, there were no significant between-group differences prior to treatment dropout.These data do not support concerns that naltrexone treatment of opioid dependence increases craving, depression, anxiety or anhedonia.

To assess the relationship between long-term naltrexone treatment and anxiety, depression and craving in opioid dependent individuals.Opioid dependent patients (n=306) were enrolled in a three cell (102ss/cell) randomized, double blind, double dummy, placebo-controlled 6-month trial comparing extended release implantable naltrexone with oral naltrexone and placebo (oral and implant). Monthly assessments of affective responses used a Visual Analog Scale for opioid craving, the Beck Depression Inventory, Spielberger Anxiety Inventory, and the Ferguson and Chapman Anhedonia Scales. Between-group outcomes were analyzed using mixed model analysis of variance (Mixed ANOVA) and repeated measures and the post hoc Tukey test.Anhedonia, depression, anxiety, and craving for opiates were elevated at baseline but gradually reduced to normal within the first 1-2 months for patients who remained in treatment and did not relapse. There were no significant between-group differences prior to treatment dropout as well as between those who relapsed and who continued on naltrexone.These data do not support concerns that naltrexone treatment of opioid dependence precipitates anhedonia, depression, anxiety or craving for opiates.Цель исследования. Изучение влияния длительной терапии налтрексоном больных с синдромом зависимости от опиоидов на ангедонию, депрессию, тревогу и влечение к опиатам. Материал и методы. Пациенты (n=306) с синдромом зависимости от опиоидов были включены в рандомизированное двойное слепое плацебо-контролируемое 6-месячное исследование, сравнивающее эффективность в трех группах больных, в лечении которых использовались имплантируемая лекарственная форма налтрексона, пероральная его форма или плацебо. Для ежемесячной психометрической оценки были использованы визуальная аналоговая шкала влечения к употреблению опиоидов, шкала депрессии Бека, шкала тревоги Спилбергера, шкалы ангедонии Чапмена и Фергюсона. Для оценки межгрупповых различий проводился дисперсионный анализ (Mixed ANOVA) с апостериорным тестом Тьюки. Результаты и обсуждение. Показатели ангедонии, депрессии, тревоги и влечения к опиоидам были повышены в периоде включения больных в исследование и постепенно снижались до нормальных значений в течение первых 1-2 мес среди больных, удерживающихся в программе терапии. Значимых различий между тремя группами больных, а также между пациентами, прекратившими лечение и приверженными терапии, не обнаружено. Полученные данные не подтвердили предположение о том, что длительное лечение налтрексоном может способствовать развитию ангедонии, депрессии, тревоги и влечения к опиатам у больных с синдромом зависимости от опиоидов.

This paper justifies the actuality and peculiarities of value-oriented management of modern university. In authors’ opinion, such a management can provide stable “rules of the game” in the Higher Education Institution, promote identification and integration of collective and individual values of educational community. In case of that, the special role is played by the corporate culture, the effective implementation of main functions that enables the full application of value-oriented management. Authors provide the algorithm of Higher Education Institution management, various mechanisms and tools facilitating its functionality improvement. Individual values of Higher Education Institutions directors, lecturers, students and employers. In their opinion, the uncertainty of their interpretation and sometimes ignorance by the Higher Education Institution management, restricts the wider spreading of value-oriented approach in the educational organization management.

Stress is a key precipitant to discontinuing naltrexone and relapsing to opiate abuse. Alpha-2 adrenergic agonists like guanfacine may reduce stress induced craving and have reduced opiate relapse in small clinical trials.This randomized, double blind double dummy placebo-controlled 6-month trial tested oral naltrexone with or without guanfacine for reducing stress and preventing opiate relapse. We randomized 301 patients to: naltrexone 50 mg/day+guanfacine 1 mg/day (n=75) (N/G), naltrexone+guanfacine placebo (N/P) (n=76), naltrexone placebo+guanfacine (n=75) (P/G), and double placebo (n=75) (P/P).Among the 75 patients in each group the percentage still retained on naltrexone treatment at six months was: N/G 26.7%, N/P 19.7% (p=0.258 to N/G), P/G 6.7% (p0.05 to both N groups), and P/P 10.7% (p=0.013 to N+G). Guanfacine reduced the severity of stress particularly at weeks 10 and 18. Adverse events (AE) were infrequent (4.7%) without group differences, with most common AEs: headache, poor appetite, insomnia, and dizziness.Adding guanfacine to naltrexone did not improve treatment retention or opiate free urines, but it reduced both stress and craving at later time points in treatment, which may be related to stress-induced craving and the animal model of incubation of reinstatement. During treatment, HIV risk, anxiety, and depression reduced among all patients in treatment, regardless of group.

This chapter covers the various drug interactions of psychotropic agents with other drugs, over the counter (OTC) medications, food substances, herbals, alcohol, and smoking. The basic mechanisms of pharmacokinetics, pharmacodynamics, and other interactions are discussed. The disease states and age-related changes underlying the drug interactions in the elderly are briefly addressed. Drug interactions discussed have been classified as severe, moderate, or mild, according to the severity of their anticipated clinical consequences. Serious complications including death may occur in severe interactions involving cardiovascular drugs. A thorough understanding of the basis of drug interactions, and patient participation in the treatment are vital. It is also particularly important to compile a list of medications, including OTC and herbal drugs, currently taken by the patient.

The method for high-tech products' consumer base analysis based on the RFM-analysis application involving classification methods is presented. Instead of the standard partition of the customer base into quintiles the analytical method of ABC-analysis is applied. It has been revealed that the distribution of customer segments is nonuniform. The approbation of the method was carried out on the example of a high-tech and office tools retail company.

Research on the neurocognitive characteristics of heroin addiction is sparse and studies that do exist include polydrug abusers; thus, they are unable to distinguish neurocognitive effects of heroin from those of other drugs. To identify neurocognitive correlates specific to heroin addiction, the present study was conducted in St. Petersburg, Russia where individuals typically abuse and/or become addicted to only one substance, generally alcohol or heroin. Heroin addicts were recruited from an inpatient treatment facility in St. Petersburg. Three comparison groups included alcoholics, addicts who used both alcohol and heroin, and non-abusers. Psychiatric, background, and drug history evaluations were administered after detoxification to screen for exclusion criteria and characterize the sample. Executive Cognitive Functions (ECF) that largely activate areas of the prefrontal cortex and its circuitry measured include complex visual pattern recognition (Paired Associates Learning), working memory (Delayed Matching to Sample), problem solving (Stockings of Cambridge), executive decision making (Cambridge Decision Making Task), cognitive flexibility (Stroop Color-Word Task) and response shifting (Stop Change Task). In many respects, the heroin addicts were similar to alcohol and alcohol+heroin dependent groups in neurocognitive deficits relative to controls. The primary finding was that heroin addicts exhibited significantly more disadvantageous decision making and longer deliberation times while making risky decisions than the other groups. Because the nature and degree of recovery from drug abuse are likely a function of the type or pattern of neurocognitive impairment, differential drug effects must be considered.

One of the reasons of growing incidence of tuberculosis (TB) is spread of AIDS, drug dependence, and alcoholism. To investigate their mutual influence the authors examined 185 lung TB patients (of them, 124 males) admitted to TB hospitals of St-Petersburg in 2003-2005. Inclusive criteria were age of 18 to 79 yrs, recent admission to the hospital, the patient's consent to participate the study. Patients were excluded if they were severely ill or had psychiatric disorders. The lung TB was evaluated using medical history, physical, clinic, laboratory, radiologic, and bacteriologic data. Alcohol and drug abuse was assessed with Addiction Severity Index (ASI), retrospective analysis of alcohol and substance use for previous 90 days, Michigan Alcohol Screening Test (MAST), measurement of alcohol in exhaled air and detection of substances in urine. Somatic and psychic health was evaluated using ASI, Beck Depression Inventory, and Spielberger Trait Anxiety Inventory. Risk of HIV-infection was determined in a test of HIV risk assessment and with HIV risk questionnaire developed at Johns Hopkins University. The average age of the participants was 40.5 yrs. More than 60 % of them had abuse-related disorders: alcohol abuse in 51.9 %, alcoholism plus drug dependence in 8.6 %, and drug dependence in 3.8 %. Alcohol dependence facilitated development of TB multiple drug resistance (21 % vs 7.6 % in patients without alcohol dependence, p < 0.05), extensive (73.9 % and 40.9 %, respectively, p < 0.001) and chronic (28.6 % and 16.7 %, respectively) forms of TB. Most of TB patients with abuse-related disorders tended to have psychiatric disorders (depression, anxiety). The risk of HIV-infection was significantly higher in TB patients with drug abuse (3.51 vs 0.07). Thus, it is necessary to consider co-morbidity in TB patients for more effective treatment of lung tuberculosis.

Ethanol blocks N-methyl-d-aspartic acid (NMDA) glutamate receptors. Increased NMDA receptor function may contribute to motivational disturbances that contribute to alcoholism. The authors assessed whether the NMDA receptor antagonist memantine reduces cue-induced alcohol craving and produces ethanol-like subjective effects.Thirty-eight alcohol-dependent inpatients participated in three daylong testing sessions in a randomized order under double-blind conditions. On each test day, subjects received 20 mg of memantine, 40 mg of memantine, or placebo, and subjective responses to treatment were assessed. The level of alcohol craving was assessed before and after exposure to an alcohol cue.Memantine did not stimulate alcohol craving before exposure to an alcohol cue, and it attenuated alcohol cue-induced craving in a dose-related fashion. It produced dose-related ethanol-like effects without adverse cognitive or behavioral effects.These data support further exploration of whether well-tolerated NMDA receptor antagonists might have a role in the treatment of alcoholism.

Alcohol consumption in Russia is reportedly high for both men and women; most studies of Russian drinking have used questionnaires not designed specifically to measure alcohol consumption or to interview women. This study was designed specifically to measure drinking patterns among pregnant and nonpregnant Russian women. Eight hundred ninety-nine women of child-bearing age in St. Petersburg Russia were interviewed in employment centers educational centers and at obstetric and gynecologic (OB/GYN) clinics and hospitals. Measurement of drinking used several types of drinking questions and time frames. Nearly all nonpregnant Russian women (95.9%) reported consuming alcohol in the last 12 months. Among nonpregnant women drinkers 7.6% reported drinking heavily (29.58 mL or more ethanol/d) and 18.4% reported drinking = 5 on at least 1 occasion. Contrary to expectations of Russian obstetricians pregnant Russian women readily answered detailed questions about their drinking behavior during pregnancy. Nearly all pregnant women drank in the year before they became pregnant; of these 60.0% reported drinking when they knew they were pregnant and 34.9% drank in the past 30 days. Among pregnant women who drank in the past 30 days 7.4% reporting having = 5 drinks on at least 1 occasion. Nevertheless more than 90% of pregnant and nonpregnant Russian women believed that alcohol has a detrimental effect on pregnancy outcomes. Pregnant and nonpregnant Russian women were willing to answer detailed questions about their drinking behavior. Although most pregnant women studied reduced their drinking during pregnancy one-third of the pregnant women did not stop drinking. It is important to find out what enabled two-thirds of the pregnant women to stop drinking before or during their pregnancy. (authors)

This randomized placebo-controlled trial tested the efficacy of oral naltrexone with or without fluoxetine for preventing relapse to heroin addiction and for reducing HIV risk, psychiatric symptoms, and outcome. All patients received drug counseling with parental or significant-other involvement to encourage adherence. Patients totaling 414 were approached, 343 gave informed consent, and 280 were randomized (mean age, 23.6 +/- 0.4 years). At 6 months, two to three times as many naltrexone patients as naltrexone placebo patients remained in treatment and had not relapsed, odds ratio (OR) = 3.5 (1.96-6.12), p < .0001. Overall, adding fluoxetine did not improve outcomes, OR = 1.35 (0.68-2.66), p = .49; however, women receiving naltrexone and fluoxetine showed a trend toward a statistically significant advantage when compared to women receiving naltrexone and fluoxetine placebo, OR = 2.4 (0.88-6.59), p = .08. HIV risk, psychiatric symptoms, and overall adjustment were markedly improved among all patients who remained on treatment and did not relapse, regardless of group assignment. More widespread use of naltrexone could be an important addition to addiction treatment and HIV prevention in Russia.

Background: There are a limited number of studies that have examined gender differences in the neurocognitive test performances of alcohol-dependent individuals. Those that have been conducted reported that compared with men, women's visuospatial skills, psychomotor speed, and working memory are more profoundly affected by chronic alcohol abuse despite a shorter duration of drinking and a lesser quantity of alcohol consumed. Methods: The performances of Russian male and female alcoholic and nonalcoholic control subjects were compared on a series of neurocognitive tasks that assess motor speed, visuoperceptual processing, visuospatial processing, decision making, and cognitive flexibility. Results: Group and gender differences emerged on specific components of each task administered. Female compared with male alcoholic subjects exhibited poorer performances on tests of visual working memory, spatial planning and problem solving, and cognitive flexibility. Conclusion: The data support and extend prior research demonstrating a more deleterious impact of alcohol dependence on female alcoholic subjects' cognitive functioning compared with male alcoholic subjects. Several theories are offered to account for gender differences in neurocognitive performance.

The Russian health care system is organized around specific diseases, with relatively little focus on integration across specialties to address co-morbidities. This organizational structure presents new challenges in the context of the recent epidemics of injection drug use (IDU) and HIV. This paper uses existing and new data to examine the prevalence of reported new cases of drug dependence (heroin) and HIV over time as well as associations between drug dependence and alcoholism, hepatitis B and C, and tuberculosis in the City of St. Petersburg and the Leningrad region. We found a sharp rise in reported cases of IDU beginning in 1991 and continuing until 2002/2003, followed by a sharp rise in newly reported cases of HIV. These rises were followed by a drop in new cases of HIV and drug addiction in 2002/2003 and a drop in the proportion of HIV-positve individuals with IDU as a risk factor. Infection with hepatitis B and C were common, especially among injection drug users (38 and 85%, respectively), but also in alcoholics (7 and 14%). Tuberculosis was more common in alcoholics (53%) than in persons with alcoholism and drug dependence (10%), or with drug dependence alone (4%). Though these data have many limitations, they clearly demonstrate that drug dependence and/or alcoholism, HIV, hepatitis, and tuberculosis frequently co-occur in St. Petersburg and the Leningrad Region. Prevention and treatment services across medical specialties should be integrated to address the wide range of issues that are associated with these co-morbidities.

Aim To describe a situation in which an opioid-dependent patient overcame naltrexone blockade. Design, case report, setting Addiction treatment center in St Petersburg, Russia. Participant Patient with naltrexone implant. Intervention Detoxification. Measurements Clinical observations. Conclusions It is possible, but very difficult, to overcome naltrexone blockade by using large doses of heroin.

CONTEXT Sustained-release naltrexone implants may improve outcomes of nonagonist treatment of opioid addiction. OBJECTIVE To compare outcomes of naltrexone implants, oral naltrexone hydrochloride, and nonmedication treatment. DESIGN Six-month double-blind, double-dummy, randomized trial. SETTING Addiction treatment programs in St Petersburg, Russia. PARTICIPANTS Three hundred six opioid-addicted patients recently undergoing detoxification. INTERVENTIONS Biweekly counseling and 1 of the following 3 treatments for 24 weeks: (1) 1000-mg naltrexone implant and oral placebo (NI+OP group; 102 patients); (2) placebo implant and 50-mg oral naltrexone hydrochloride (PI+ON group; 102 patients); or (3) placebo implant and oral placebo (PI+OP group; 102 patients). MAIN OUTCOME MEASURE Percentage of patients retained in treatment without relapse. RESULTS By month 6, 54 of 102 patients in the NI+OP group (52.9%) remained in treatment without relapse compared with 16 of 102 patients in the PI+ON group (15.7%) (survival analysis, log-rank test, P.001) and 11 of 102 patients in the PI+OP group (10.8%) (P.001). The PI+ON vs PI+OP comparison showed a nonsignificant trend favoring the PI+ON group (P = .07). Counting missing test results as positive, the proportion of urine screening tests yielding negative results for opiates was 63.6% (95% CI, 60%-66%) for the NI+OP group; 42.7% (40%-45%) for the PI+ON group; and 34.1% (32%-37%) for the PI+OP group (P.001, Fisher exact test, compared with the NI+OP group). Twelve wound infections occurred among 244 implantations (4.9%) in the NI+OP group, 2 among 181 (1.1%) in the PI+ON group, and 1 among 148 (0.7%) in the PI+OP group (P = .02). All events were in the first 2 weeks after implantation and resolved with antibiotic therapy. Four local-site reactions (redness and swelling) occurred in the second month after implantation in the NI+OP group (P = .12), and all resolved with antiallergy medication treatment. Other nonlocal-site adverse effects were reported in 8 of 886 visits (0.9%) in the NI+OP group, 4 of 522 visits (0.8%) in the PI+ON group, and 3 of 394 visits (0.8%) in the PI+ON group; all resolved and none were serious. No evidence of increased deaths from overdose after naltrexone treatment ended was found. CONCLUSIONS The implant is more effective than oral naltrexone or placebo. More patients in the NI+OP than in the other groups develop wound infections or local irritation, but none are serious and all resolve with treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00678418.

Enterprise cooperation has been analysed from many aspects – global competition, new innovations in technology advancements, tendencies of direct sales in tourism, increase of tourist experience; these are the main driving forces that are pushing traditional travel agencies out of the market and transforming the tourism intermediates into new open business model. Cooperation and networking creates ability to achieve goals that an enterprise is not capable of achieving on its own, thus giving rise to a new phenomenon referred to as collaborative advantage. Networking and collaboration in the tourism sector has gained importance particularly since these networks promote the spread of information and strengthens the connections between heterogeneous sectors of tourism industry, private and public companies, international partners, contribute to more sustainable tourism development that has greater actuality this year as the United Nations General Assembly announced 2017 as the International Year of Sustainable Tourism for Development. Research is based on qualitative research method of 5 case studies from each of two destinations Riga and Novosibirsk; using semi-structured interviews with company managers that allows interaction with each study object and gives advantage of collecting more detailed information, analysing motivation for involvement in cooperation. Article aims to investigate if there are cooperation peculiarities for the different types of travel agencies and tour-operator enterprises. Cooperation factors for analyses include cooperation importance, objectives, motives, trust, coordination, networking coverage, frequency and other important indications. Despite the fact that all examined tourism enterprises are involved in cooperation activities, in conclusion the study indicates the differences in cooperation habits, advantages and disadvantages of these studied tourism enterprises., peer-reviewed