Access to Drug Abuse Treatment Under Treatment On Demand Policy in San Francisco

Objectives: We evaluated whether implementation of Treatment on Demand (TOD) policy in San Francisco was associated with improved access to drug abuse treatment. Methods: Data came from San Francisco's treatment program waiting list over 4 years spanning the implementation of TOD policy. Access measures were monthly applicants waiting and days waited by treatment admissions. Quantitative analyses with 69 treatment facilities contrasted those receiving vs. not receiving TOD funds. Qualitative data came from interviews with facility administrators. Results: There was a small statistically significant decline in monthly waiting lists in the number of people waiting for treatment during the study period. The days waited by those admitted to treatment, however, significantly increased in TOD-funded facilities. Facilities used varied criteria for completing the access measures, which limit the utility of the measures. Conclusions: Access to treatment improved slightly with implementation of TOD policy.     

群体尿氟发氟在地方性氟中毒防治中的作用

目的 研究人群尿氟、发氟在地方性氟中毒病区的判定与防治效果评价中的作用。方法 选择饮水含氟量相近的村为调查点,分为6个水氟剂量组,对长期居住在当地的人群用氟离子选择电极法作尿氟和发氟含量检测。结果 饮水含氟量与尿氟含量有高度的相关性。与发氟无相关性;尿氟与发氟含量无相关性;尿氟、发氟含量在非病区与病区和轻病区中等病区之间均有极显著差异。结论 人群尿氟、发氟均可作为确定地氟病病区的参考依据,尤其是在环境氟较高,但尚未产生明显的健康效应,暂时不能根据病情资料确定病区或氟污染危害等情况下,用群体尿氟水平作为确定地氟病病区或判定氟污染危害,评价其防治效果是一项重要依据;由于发氟检测方法较复杂等原因,应用范围受到限制。     

Polydrug Use in an Inpatient Treatment Sample of Problem Drinkers

Over the past 30 years in the United States, there have been marked secular increases in polydrug use. Alcohol and other substance use disorders are highly comorbid. Yet, little research has characterized patterns of polydrug use in persons with alcohol dependence. In particular, little is known about this population's use of alcohol and other drugs in combination or on the same day, which is termed simultaneous polydrug use (SPU). This research assessed patterns of SPU in 212 problem drinkers who participated in an alcohol treatment outcome study. Subjects were given a Time-Line Follow-Back interview that assessed the use of alcohol and nine other drug classes for each day of the 120 days before treatment entry. A majority of subjects (61%) reported SPU during this assessment interval. Subjects who reported SPU were disproportionately younger, male, and unmarried, compared with those who did not report SPU. The most common alcohol/drug combinations were alcohol with cocaine (60% of subjects who reported SPU), alcohol with marijuana (51 % of SPU subjects), and alcohol with sedatives (31 % of SPU subjects). The most common three-drug combination was alcohol, cocaine, and marijuana (23% of SPU subjects). Alcohol use and drug use were associated at the event level, significantly more than association predicted by the base rates of the individual behaviors. Time-Line Follow-Back data correlated highly with a questionnaire measure of SPU. Results indicate that polydrug use is an important focus for assessment and intervention in alcohol treatment programs.     

饮茶型氟骨症患者发和尿中9种元素水平分析

目的了解饮茶型氟骨症患者发、尿中氟、铝、钙、镁、磷、铜、锌、铁、锰9种元素水平。方法在内蒙古饮茶型氟中毒病区陈巴尔虎旗和鄂温克旗，共选择氟骨症患者73人及对照（不饮砖茶的汉族居民）64人，采集发样、尿样。用氟离子选择电极法和时序式电感耦合等离子体发射光谱仪（ICP-AES）分别测定样品中9种元素水平。利用Stat6．0软件，对分析结果进行正态分布检验和Kruskal-Wallis非参数差异性检验。结果饮茶型氟骨症组发铝、发铁、发磷及尿锰水平呈正态分布，对照组发铝、发磷、尿氟及尿铝水平呈正态分布，而两组发、尿中其他元素均为偏态分布。Kruskal-Wallis方差分析和中位数检验结果表明，饮茶型氟骨症组发铝、发锰、尿氟、尿铝、尿钙水平显著高于对照组（P〈0．05），而发锌、尿磷水平明显低于对照组（P〈0．05）。结论饮茶型氟骨症患者发、尿中铝、锰、锌、钙、磷元素存在代谢紊乱，其中铝、锰、锌等元素在饮茶型氟中毒病情发展中的作用需进一步深入研究。     

Witnessing heroin-related overdoses: the experiences of young injectors in San Francisco

Aims  Assessment of young injectors' exposure and response to others' heroin-related overdose.
Design  Cross-sectional survey.
Setting  San Francisco, CA, United States.
Participants  Nine hundred and seventy-three street-recruited current injectors under 30 years old.
Measurements  Self-reported experiences of witnessing heroin-related overdoses from structured interviews.
Findings  Seven hundred and nine of 973 (73%) had ever witnessed at least one heroin-related overdose, and 491 of 973 (50%) had witnessed an overdose in the last 12 months. Fourteen per cent of those who had witnessed an overdose in the past year reported that the outcome of the overdose was death. Emergency services were called to 52% of most recent witnessed overdoses. Cardiopulmonary resuscitation (CPR) or expired air resuscitation (EAR or 'rescue breathing') was performed in 61% of cases. Inappropriate strategies such as injection with stimulants or application of ice were rare. In 67% of cases in which emergency services were not called the witness said this was because the victim regained consciousness. In the remaining 33%, 56% stated emergency services were not called due to fear of the police.
Conclusions  Respondents were willing to act at overdoses at which they were present, but frequently did not do so in the most efficacious manner. Fear of police was identified as the most significant barrier to the ideal first response of calling emergency services.     

Social context of work injury among undocumented day laborers in San Francisco

OBJECTIVE: To identify ways in which undocumented day laborers' social context affects their risk for occupational injury, and to characterize the ways in which these workers' social context influences their experience of disability. DESIGN: Qualitative study employing ethnographic techniques of participant-observation, supplemented by semistructured in-depth interviews. SETTINGS: Street corners in San Francisco's Mission District, a homeless shelter, and a nonprofit day labor hiring hall. PARTICIPANTS: Thirty-eight Mexican and Central American male day laborers, 11 of whom had been injured. PRIMARY THEMES: Anxiety over the potential for work injury is omnipresent for day laborers. They work in dangerous settings, and a variety of factors such as lack of training, inadequate safety equipment, and economic pressures further increase their risk for work injury. The day laborers are isolated from family and community support, living in a local context of homelessness, competition, and violence. Injuries tend to have severe emotional, social, and economic ramifications. Day laborers frequently perceive injury as a personal failure that threatens their masculinity and their status as patriarch of the family. Their shame and disappointment at failing to fulfill culturally defined masculine responsibilities leads to intense personal stress and can break family bonds. Despite the high incidence of work injuries and prevalence of work-related health conditions, day laborers are frequently reluctant to use health services due to anxiety regarding immigration status, communication barriers, and economic pressure. IMPLICATIONS: On the basis of these ethnographic data, we recommend strategies to improve ambulatory care services to day laborers in 3 areas: structural changes in ambulatory care delivery, clinical interactions with individual day laborers, and policymaking around immigration and health care issues.     

Risk behaviors for HIV in sexual partnerships of San Francisco injection drug users

While injection drug users (IDU) in the USA are known to form sexual partnerships with IDU as well as non-IDU, scientific research is lacking regarding risk behaviors for HIV transmission within these partnerships. Such information could aid HIV-prevention efforts among IDU and could also explain the relatively low prevalence of HIV among non-IDU heterosexuals in US cities such as San Francisco. Using data from a cross-sectional sample of San Francisco IDU we estimated (1) the prevalence of IDU–IDU and IDU–non-IDU sexual partnerships, (2) the frequency of serodiscordant unprotected intercourse in IDU–IDU and IDU–non-IDU sexual partnerships, and (3) the frequency of concurrence of sexual risk and injection-related risk within IDU–IDU sexual partnerships. An estimated 68% of sexually active San Francisco IDU is in IDU–IDU partnerships. Our analysis suggests that compared to IDU–non-IDU partnerships, IDU–IDU partnerships include a greater rate of episodes of serodiscordant unprotected intercourse (incidence rate ratio: 10.2; 95% confidence interval: 2.1–50.7). In fact, our data suggest that 92% of serodiscordant sexual episodes involving IDU are attributable to IDU–IDU pairings. Unprotected intercourse and needle sharing occur concurrently in an estimated 29% of IDU–IDU partnerships. Our data suggest that HIV-transmission risk is higher within IDU–IDU partnerships than it is within IDU–non-IDU partnerships. This disparity could explain the relatively low prevalence of HIV among non-IDU heterosexuals in San Francisco. We recommend that HIV-prevention efforts among IDU continue to address sexual risk behaviors for HIV transmission in addition to injection-related risk behaviors, with emphasis on IDU–IDU partnerships.     

Brief report: The aging of the homeless population: Fourteen-year trends in San Francisco

BACKGROUND: Homelessness is associated with high rates of health and substance use problems. OBJECTIVE: To examine trends in the age, housing, health status, health service utilization, and drug use of the homeless population over a 14-year period. DESIGN: Serial cross-sectional. PARTICIPANTS: We studied 3,534 literally homeless adults recruited at service providers in San Francisco in 4 waves: 1990-1994, 1996-1998, 1999-2000, and 2003. MEASUREMENTS: Age, time homeless, self-reported chronic conditions, hospital and emergency department utilization, and drug and alcohol use. RESULTS: The median age of the homeless increased from 37 to 46 over the study waves, at a rate of 0.66 years per calendar year (P<.01). The median total time homeless increased from 12 to 39.5 months (P<.01). Emergency department visits, hospital admissions, and chronic health conditions increased. CONCLUSIONS: The homeless population is aging by about two thirds of a year every calendar year, consistent with trends in several other cities. It is likely that the homeless are static, aging population cohort. The aging trends suggest that chronic conditions will become increasingly prominent for homeless health services. This will present challenges to traditional approaches to screening, prevention, and treatment of chronic diseases in an aging homeless population.     

Maternal transfer of xenobiotics and effects on larval striped bass in the San Francisco Estuary

Aquatic ecosystems around the world face serious threats from anthropogenic contaminants. Results from 8 years of field and laboratory investigations indicate that sublethal contaminant exposure is occurring in the early life stages of striped bass in the San Francisco Estuary, a population in continual decline since its initial collapse during the 1970s. Biologically significant levels of polychlorinated biphenyls, polybrominated diphenyl ethers, and current-use/legacy pesticides were found in all egg samples from river-collected fish. Developmental changes previously unseen with standard methods were detected with a technique using the principles of unbiased stereology. Abnormal yolk utilization, brain and liver development, and overall growth were observed in larvae from river-collected fish. Histopathological analyses confirmed and identified developmental alterations. Using this methodology enabled us to present a conclusive line of evidence for the maternal transfer of xenobiotics and their adverse effects on larval striped bass in this estuary.     

San Francisco childcare centers' preparedness in the prevention and management of asthma among preschool-aged children

Introduction: Asthma is a common health condition for children in childcare. National recommendations for asthma in childcare exist. However, no studies have investigated the extent to which childcare centers adhere to these recommendations. We aimed to assess childcare center adherence to National Asthma Education and Prevention Program (NAEPP) recommendations for asthma care and preparedness and to identify characteristics associated with increased adherence to national asthma recommendations. Methods: We developed a standardized instrument. Each childcare center received a score of 0 through 7 based on number of recommendations met. We conducted t-tests, chi square tests and linear regression to identify childcare center factors associated with increased asthma preparedness. Results: 36 out of 40 eligible childcare centers (90%) participated. These sites served 1570 children primarily between the ages of 2 to 5 years. On average, centers met 3.8 out of 7 (SD = 1.3) recommendations. Staff familiarity caring for children with asthma (p?<?0.001) and the center's asthma prevalence (p = 0.01) was positively associated with the center's asthma preparedness. The 3 areas most in need of improvement related to asthma medications, asthma action plans and asthma policies. None of the managers reported being familiar with the NAEPP recommendations. Discussion: There is room for improvement in the asthma care and preparedness of childcare centers. The 3 areas in which centers performed poorly (appropriate asthma medication management, use of asthma action plans, and presence of appropriate asthma policies) suggest that closer collaboration between clinicians and childcare centers may be a key to improving asthma management for young children.     

A cold phase of the East Pacific triggers new phytoplankton blooms in San Francisco Bay

Ecological observations sustained over decades often reveal abrupt changes in biological communities that signal altered ecosystem states. We report a large shift in the biological communities of San Francisco Bay, first detected as increasing phytoplankton biomass and occurrences of new seasonal blooms that began in 1999. This phytoplankton increase is paradoxical because it occurred in an era of decreasing wastewater nutrient inputs and reduced nitrogen and phosphorus concentrations, contrary to the guiding paradigm that algal biomass in estuaries increases in proportion to nutrient inputs from their watersheds. Coincidental changes included sharp declines in the abundance of bivalve mollusks, the key phytoplankton consumers in this estuary, and record high abundances of several bivalve predators: Bay shrimp, English sole, and Dungeness crab. The phytoplankton increase is consistent with a trophic cascade resulting from heightened predation on bivalves and suppression of their filtration control on phytoplankton growth. These community changes in San Francisco Bay across three trophic levels followed a state change in the California Current System characterized by increased upwelling intensity, amplified primary production, and strengthened southerly flows. These diagnostic features of the East Pacific "cold phase" lead to strong recruitment and immigration of juvenile flatfish and crustaceans into estuaries where they feed and develop. This study, built from three decades of observation, reveals a previously unrecognized mechanism of ocean-estuary connectivity. Interdecadal oceanic regime changes can propagate into estuaries, altering their community structure and efficiency of transforming land-derived nutrients into algal biomass.     

Hepatitis B virus infection and immunization status in a new generation of injection drug users in San Francisco

Hepatitis B virus (HBV) infection is common among injection drug users (IDU). Younger IDU, however, may be less susceptible to infection due to the implementation of public health interventions, such as universal immunization programs and syringe exchange programs. To investigate the current epidemiology of HBV infection and control among a new generation of drug users in the United States, we conducted interviews and examined HBV serologic markers in a cross-section of street-recruited IDU under age 30 in San Francisco, CA. Of the 831 persons studied, 21% showed serologic evidence of current or past infection; 22% had isolated antibodies to hepatitis B surface antigen consistent with vaccine-mediated immunity; and 56% had no HBV markers. In multivariate analyses, HBV infection was associated with drug use behaviour in heterosexual males; sexual behaviour in males who have sex with males; and both drug use and sexual behaviour in females. Vaccine-mediated immunity was independently associated with female sex and younger age. In conclusion, HBV transmission persists among young IDU in San Francisco. Few young injectors show evidence of successful immunization and the majority remains susceptible to disease. Until the broad effects of universal vaccination are seen, targeted and innovative approaches to immunizing young IDU in the US are needed to prevent a substantial number of new HBV infections.     

不同剂量厄贝沙坦治疗慢性肾小球肾炎患者后尿蛋白的变化

目的 观察慢性肾小球肾炎患者应用厄贝沙坦治疗后尿蛋白的变化,探讨高剂量厄贝沙坦治疗对尿蛋白的疗效.方法 32例经肾活检确诊的慢性肾小球肾炎患者,所有患者24 h尿蛋白≥0.5 g/d,随机分为常规剂量组(口服厄贝沙坦0.15 g/d,n=16)和高剂量组(口服厄贝沙坦0.3 g/d,n=16),治疗8周后观察24 h尿蛋白和血钾、血肌酐及尿素氮水平.结果 受试患者服用厄贝沙坦后尿蛋白均下降,常规剂量组尿蛋白较治疗前减少40%,而高剂量组尿蛋白较治疗前减少63%,两组血清钾、血肌酐及尿素氮水平均无明显改变.结论 对慢性肾小球肾炎患者,高剂量厄贝沙坦在减少尿蛋白方面更为显效,且患者耐受性、医从性均较好.     

云南省大理州人群发硒动态资料分析

目的探讨大理州克山病病区及非病区人群发硒动态变化、相互关系及其差异的显著性.方法对大理州11个克山病病区县市366份发样、5个病区县的88份粮食样及1个非病区30份发样进行了硒含量测定分析,并对2个重病区人群发硒进行了11年的连续监测分析.结果克山病病区农业人口发硒水平在0.112～0.186 mg/kg,平均为0.154 mg/kg,粮食硒含量平均在0.016 mg/kg;病区非农业户的人群发硒含量达到0.208 mg/kg,而非病区发硒水平在0.267 mg/kg;病区农业人口的发硒水平与非农业人口发硒水平之间有统计学差异(P＜0.01),病区农业人口与非病区人群之间发硒水平也有统计学差异(P＜0.01).结论人群发硒水平也有逐年上升趋势,与克山病发病率逐年下降呈正相关关系.硒预防克山病效果显著.     

高砷区人尿中4种形态砷化物的测定方法研究

目的研究高砷区人尿中4种形态砷化物的测定方法。方法采用阴离子交换分析柱,以15 mmol/L(NH4)2HPO4(1.0 ml/min)为流动相,pH6.0,以1.5%KBH4/0.5%KOH(3.4 ml/min)为还原剂成功分离了亚砷酸[As(Ⅲ)]、二甲基砷酸(DMA)、一甲基砷酸(MMA)和砷酸[As(V)]。结果检出限分别为0.8μg/L[As(Ⅲ)]、1.7μg/L(DMA)、1.3μg/L(MMA)、3.6μg/L[As(V)]。尿样经过离心、0.22μm水系醋酸纤维素膜过滤2次上机测定。样品加标平均萃取回收率在74.5%～97.4%之间,RSD在1.8%～4.2%之间。结论该方法简便、快速,具有较好的精密度和准确度,适用于人尿中4种形态砷的测定。     

非淤胆型婴儿巨细胞病毒性肝炎治疗68例

目的:探讨非淤胆型婴儿巨细胞病毒性肝炎的治疗方法.方法:选择2008-01/2010-07本院儿科住院的68例非淤胆型婴儿巨细胞病毒性肝炎患儿,随机分为治疗组34例和对照组34例,均予复方甘草酸苷2 mL/(kg.次),1次/d,共3 wk.治疗组加用更昔洛韦5 mg/(kg.次),2次/d,2 wk;1次/d,1 wk.结果:治疗组和对照组总有效率分别为94.1%和91.1%,治疗3 wk复查肝功能指标结果提示丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(total bilirubin,T B I L)、谷氨酰转肽酶(g a m m a g l u t a m y ltranspeptidase,GGT)和碱性磷酸酶(alkalinephosphatase,ALP)指标较治疗前均明显下降,差异有显著意义(P<0.05);直接胆红素(directbilirubin,DBIL)、总胆汁酸(total bile acid,TBA)指标较治疗前均无明显变化,差异无显著意义(P>0.05).治疗前或治疗后2组间比较上述指标差异无显著意义(P>0.05).随访1年,失访5人,余患儿肝功能均正常;尿CMV-DNA,治疗组18人(54.5%)阳性,对照组15人(50.0%)阳性,差异无显著意义(P>0.05).结论:非淤胆型婴儿巨细胞病毒性肝炎不建议常规予更昔洛韦抗病毒治疗.