Methodological issues in the surveillance of poisoning,illicit drug overdose,and heroin overdose deaths in new Mexico

New Mexico leads the nation in poisoning mortality, which has increased during the 1990s in New Mexico and the United States. Most of this increase has been due to unintentional deaths from illicit drug overdoses. Medical examiner and/or vital statistics data have been used to track poisoning deaths. In this study, the authors linked medical examiner and vital statistics records on underlying cause of death, coded using the International Classification of Diseases, Ninth Revision, to assess the extent to which these data sources agreed with respect to poisoning deaths. The authors used multiple-cause files, which are files with several causes listed for each death, to further assess poisoning deaths involving more than one drug. Using vital statistics or medical examiner records, 94.7% of poisoning deaths were captured by each source alone. For unintentional illicit drug and heroin overdose deaths, each data source alone captured smaller percentages of deaths. Deaths coded as E858.8 (unintentional poisoning due to other drugs) require linkage with medical examiner or multiple-cause records, because this code identifies a significant percentage of illicit drug overdose deaths but obscures the specific drug(s) involved. Surveillance of poisoning death should include the use of medical examiner records and underlying- and multiple-cause vital statistics records.     

Governing street-based injecting drug users: a critique of heroin overdose prevention in Australia

This article provides a critical analysis of existing approaches to the prevention of heroin overdose in Australia. It draws on almost 2 years of ethnographic research with street-based injecting drug users (IDUs), street-based sex workers and service providers in Melbourne, Australia's second largest city, and on recent anthropological and sociological work on governmentality. The substantive sections of the article argue: (1) that heroin overdose prevention in Australia contains implicit or explicit assumptions of rationality and personal autonomy, continues to emphasise individual behaviour change and inscribes a self-disciplined, self-aware, self-regulating subject; and (2) that the social, cultural and economic realities--the 'lived experience'--of street-based IDUs and sex workers may undermine or hinder the successful adoption of overdose prevention strategies. The paper concludes by arguing that the 'chaotic' practices of street-based IDUs and sex workers arise in response to particular 'risk environments', and that individually focused overdose prevention strategies, while an important first step, need to be complemented by measures addressing the macro- and micro-aspects of risk environments.     

Response to overdose among injection drug users

BACKGROUND: Drug overdose is a leading cause of mortality among illicit drug users. This study characterizes responses to overdose among injection drug users (IDUs) in Baltimore, Maryland, and identifies factors associated with medically inappropriate response. METHODS: A cross-sectional survey was administered to 924 IDUs in an ongoing cohort study between August 2003 and September 2004. Self-reported experiences of witnessing overdose were obtained by structured interview. Multiple logistic regression identified associations between overdose information sources and medically inappropriate responses. RESULTS: Most IDUs (69.7%) reported ever witnessing an overdose. The most common responses were walking the victim around (70.8%), shaking them (64.9%), and inflicting pain (62.6%). One in four (25.8%) injected the victim with salt water. Two thirds (63.4%) called 911, but more than half delayed the call by 5 or more minutes. The most common reason cited for delaying or foregoing the 911 call was the belief that they could revive the victim themselves, followed by fear of police involvement. Most IDUs had received information on how to prevent or respond to an overdose, but most (73.2%) received this information from friends or other drug users. IDUs who got overdose information solely from lay sources were less likely to call 911 (adjusted odds ratio [AOR] = 0.66, 95% confidence interval [CI] = 0.46-0.94) and more likely to inject the victim with salt water (AOR = 2.06, 95% CI = 1.36-3.13) than IDUs who received no information at all. Injection drug users who received information from medical and social services providers only were less likely to delay the 911 call (AOR = 0.35, 95% CI = 0.22-0.72). CONCLUSIONS: Inappropriate overdose responses are widespread among IDUs in Baltimore. Interventions that provide overdose education and reduce police response to overdose events may improve witness response and reduce mortality associated with drug overdose.     

Contraceptive practices among female heroin addicts.

In a sample of 115 heroin-addicted women, 25.8 per cent reported any type of contraception compared to 48.5 per cent of a national sample. Matching for age, ethnic group, and income level, reported contraceptive rates for the heroin-addicted sample versus the national sample for the never married, married, and formerly married groups were 40.1 per cent versus 37.7 per cent; 64.9 per cent versus 22.0 per cent; and 51.9 per cent versus 19.9 per cent, respectively.     

海洛因依赖者述情障碍与家庭环境特征关系

目的 了解海洛因依赖者述情障碍与家庭环境特征的关系.方法 采用一般情况问卷、多伦多述情障碍量表(TAS)及家庭环境量表中文版(FES-CV)对天津市公安局安康医院2010年收治的180例海洛因依赖者进行测评.结果 海洛因依赖者FES-CV亲密度、情感表达、矛盾性、独立性、成功性、知识性、娱乐性、组织性、控制性得分分别为(5.77±2.06)、(4.93±1.50)、(3.73±1.87)、(5.19±1.66)、(8.27±1.61)、(3.80±1.69)、(3.71±1.88)、(4.68±1.53)、(4.56±1.75)分,与中国常模比较差异均有统计学意义(均P<0.001);海洛因依赖者TAS总分与情感表达障碍呈负相关关系;因子I、Ⅱ与知识性呈负相关关系;因子Ⅲ与矛盾性呈负相关关系,与娱乐性、道德宗教观、控制性呈正相关关系;因子Ⅳ与亲密度、成功性、组织性呈负相关关系(P<0.05或P<0.01).结论 海洛因依赖者在家庭环境、述情方面存在明显缺陷;述情障碍与不良的家庭环境密切相关.     

Nonfatal overdose among a cohort of street-involved youth

Limited data exist concerning patterns of nonfatal illicit drug overdoses among street-involved youth. We therefore evaluated factors associated with nonfatal overdose among a cohort of street-involved youth in Vancouver, Canada. Our findings indicate that nonfatal overdose was common among street-involved youth in our setting, and was associated with various forms of drug use, including methamphetamine use.     

Radiation therapy among A-bomb survivors.

Survey of hospitals and clinics where atomic bomb survivors and their comparisons reported having received radiation therapy confirmed that 137 were so treated. The malignancies of five subjects were possibly related to their earlier radiation therapy rather than their atomic bomb radiation exposure, stressing the importance of recording all medical X-ray exposures as a potential variable in epidemiological studies of cancer etiology.     

Cancer screening practices among cancer survivors

BACKGROUND: Cancer survivors are more vulnerable to future cancers than individuals without cancer. As such, it is important to understand whether survivors are engaging in cancer screenings. METHODS: The screening practices reported in response to the 2000 Health Interview Survey of 2151 individuals with cancer were examined and compared to those of 30,195 individuals without cancer. RESULTS: The proportion of cancer survivors obtaining screenings ranged from 21% to 77%. Compared to individuals without cancer, women with cancer were more likely to have had a mammogram (odds ratio [OR]=1.8, 95% CI=1.5-2.1), a clinical breast exam (OR=2.2, 95% CI=1.9-2.5), and/or a Papanicolaou test (OR=1.3, 95% CI=1.1-1.5) in the recommended timeframe. Similarly, men with cancer were more likely than men without cancer to have had a prostate-specific antigen test performed (OR=2.5, 95% CI=2.0-3.0). All cancer survivors were more likely than individuals without a cancer diagnosis to have had a total body skin exam (OR=4.0, 95% CI=3.5-4.6), a fecal occult blood test (OR=1.4, 95% CI=1.2-1.6), and/or a colorectal exam (OR=2.2, 95% CI=1.9-2.5). Similar results were obtained when individuals diagnosed with the cancer for which the screen was designed to detect were excluded. CONCLUSIONS: The results demonstrate that cancer survivors have higher screening rates than individuals without a cancer diagnosis. Despite this, the proportion of survivors obtaining screenings varies considerably by the type of screen. An understanding of the impact of cancer screening in cancer survivors, as well as the reasons for and against obtaining cancer screenings, is necessary.     

Inconsistent condom use among socially excluded heroin users

The study focused in sexual behaviour among socially excluded heroin users, identifying factors associated with inconsistent condom use. Data was collected in the cities of Granada and Seville between July and October 2000, through a structured questionnaire, to 391 participants. Twenty two and 15% of participants have made consistent use of condoms in vaginal sex in the last year with occasional and regular partners respectively. There is a greater likelihood of inconsistent condom use with occasional partners among users who had had oral sex, and who does not know if their partner(s) inject or injected drugs. For regular partners those who have an injecting partner and do not speak with their sexual partners about AIDS have a higher probability to do not use always a condom. For both groups, when always the partner is who propose the use of condoms (when used) and not themselves, the risk not to use it is near 4 times more than when themselves propose to use it. Speaking about condoms and AIDS with mate, partners and family, and learning to negotiate the use of condoms seems to be the most important strategies to be approached for this sample, from the social and health care system in order to promote a protected sex.     

Initiation to heroin injecting among heroin users in Sydney,Australia: cross sectional survey

Background  

Heroin injection is associated with health and social problems including hepatitis C virus (HCV) transmission. Few studies have examined the circumstances surrounding initiation to heroin injecting, especially current users initiating others. The current study aimed to examine the age of first heroin use and injection; administration route of first heroin use; relationship to initiator; the initiation of others among a group of heroin users; and to examine these factors in relation to HCV status and risk.     

A qualitative study of overdose responses among Chicago IDUs

Background  

Opioid overdose is a leading cause of death among injection drug users. Over half of injection drug users report at least one nonfatal overdose during their lifetime. Death from opioid overdose rarely occurs instantaneously, but rather over the course of one to three hours, allowing ample time for providing life-saving measures. In response to the prevalence of overdoses in the U.S., there are a growing number of overdose prevention and naloxone distribution programs targeting the injection drug using community.     

Media reports of heroin overdose spates: Public health messages,moral panics or risk advertisements?

This article reports on an investigation of the public health utility of media messages concerning spates (temporal clusters) of heroin-related overdose (HOD) from the perspective of some injecting drug users (IDUs). In-depth qualitative interviews were carried out with a convenience sample of 60 IDUs, in the setting of two Needle and Syringe Programs in an Australian regional city (Geelong) between April and May 2000. Very few interviewees reported that they had personally experienced a spate of overdoses. None of the interviewees reported communicating the existence of a killer batch to other IDUs. No interviewees reported having changed either their injecting practices or the amount of heroin they used following such a media alert. Indeed, a substantial minority of the interviewees reported seeking out these stronger batches and participant narratives illustrate that, for a substantial group of interviewees, the media reporting of a hypothetical ‘killer batch’ of heroin may have implications for their drug-seeking and health-related behaviour. It was found that the accuracy of information available to IDUs is mixed and that the flow of information within this social network was slow. Findings demonstrate that media reporting of killer batches of heroin has little value as a public health strategy and provide an example of how some activities that are proposed as public health measures may in fact have the opposite effect.     

Wound botulism among black tar heroin users--Washington, 2003

During August 22-26, 2003, four injection-drug users (IDUs) in Yakima County, Washington, sought medical care at the same hospital with complaints of several days of weakness, drooping eyelids, blurred vision, and difficulty speaking and swallowing. All four were regular, nonintravenous injectors of black tar heroin (BTH), and one also snorted BTH. This report summarizes the investigation of these cases, which implicated wound botulism (WB) as the cause of illness.     

Internet use among Chinese-American breast cancer survivors

This study describes information seeking behaviors and patient characteristics associated with Internet use by 72 Chinese-American breast cancer survivors diagnosed in the past 5 years and living in Houston, Texas. Face-to-face interviews showed that only 56% used the Internet for health information; only 9% used e-mail or visited a website to communicate with a doctor's office or get online provider advice. Results indicate that health providers who want to reach breast cancer patients with limited English skills need to take into account this low use of Internet resources and web-based information. Particularly important is the need to develop and make available culturally effective and appropriate health information in the native languages of the patients to promote greater health literacy.     

Intentional weight loss and mortality among initially healthy men and women

Most prospective observational studies suggest that weight loss increases the risk of premature death among obese individuals. This is surprising because clinical studies show that weight loss generally leads to overall improvements in cardiovascular risk factors. It is sometimes argued that the increased mortality observed with weight loss must depend on confounding or poor study designs. This review was conducted to summarize results from studies on intentional weight loss and mortality among healthy individuals, while carefully considering the designs and problems in these studies. Evaluation criteria with a rating scale were developed. Of the studies evaluated, two found decreased mortality with intentional weight loss, three found increased mortality, and four found no significant associations between intentional weight loss and total mortality. Thus, it is still not possible for health authorities to make secure recommendations on intentional weight loss. More studies designed to specifically address this issue are warranted.     

美沙酮维持治疗海洛因依赖者血液微量元素分析

目的 了解用美沙酮维持治疗1年后海洛因依赖者血液中锌、铜、铁、钙、镁5种微量元素变化情况。方法 用MP-2型溶出分析仪测定96例海洛因依赖者美沙酮维持治疗1年前后及74名非药物滥用健康者血中锌、铜、铁、钙、镁含量。结果 美沙酮维持治疗1年后锌、铁、钙、镁、铜的含量分别为(8.46±2.54),(14.20±5.98),(67.75±14.54),(36.38±9.54),(2.87±1.13)μg/L;海洛因依赖者作为对照组锌、铁、钙、镁、铜含量分别为(7.02±2.02)、(14.12±3.77)、(59.47±19.60)、(35.07±6.23)、(2.67±2.43)μg/L;非药物滥用健康者对照组锌、铁、钙、镁、铜的含量分别为(7.65±2.05),(15.02±3.71),(95.44±20.38),(36.19±8.83),(3.03±1.80)μg/L;美沙酮维持治疗前后血液锌、钙升高尤其明显(P<0.01),而铁、镁、铜的含量差异无统计学意义(P>0.05);与非药物滥用健康者比较,钙降低尤其明显(P<0.01),锌明显升高(P<0.01),而铁、镁、铜的含量差异无统计学意义(P>0.05)。结论 美沙酮维持治疗1年后使海洛因依赖者血液中钙、锌元素含量明显上升,相应的缓解了因体内微量元素含量改变所引起的相关疾病,为戒毒治疗(通过纠正微量元素含量)提供了理论依据。