Injection drug users' access to a supervised injection facility in Vancouver, Canada: the influence of operating policies and local drug culture

North America's first supervised injection facility (SIF) was established in Vancouver, Canada, in 2003. Although evaluation research has documented reductions in risk behavior among SIF users, there has been limited examination of the influence of operational features on injection drug users' access to these facilities. We conducted an ethnographic study that included observational research within the SIF, 50 in-depth individual interviews with SIF users, and analysis of the regulatory frameworks governing the SIF. The government-granted exemption allowing the facility to operate legally imposes key operating regulations, as well as a cap on capacity, which results in significant wait times to enter the injecting room. Regulations that prohibit practices that are common in the local drug culture also negatively affect SIF utilization. Restructuring policies that shape the operation of the SIF could enhance access to the facility and permit SIF services to better accommodate local drug use practices.     

Informing rural and remote students about careers in health: factors influencing career decisions

OBJECTIVE: Since 1994 a state-wide program has been operating in Queensland to provide non-metropolitan secondary school students with information about health careers. Determination of the factors influencing the career decisions of rural and remote students was one objective of the evaluation of that program. DESIGN: Telephone interviews. SETTING: Secondary schools. SUBJECTS: People who had previously attended Year 10 residential health career workshops run by Queensland Health. Ninety-four of 277 past participants to Year 10 Health Careers Workshops responded to a postal questionnaire and were invited to take part in a telephone questionnaire to collect further information related to the course and career choices. MAIN OUTCOME MEASURES: Self-reported factors affecting career decisions of students from rural and remote areas. RESULTS: Of the 94 past workshop participants, interviews were held with 70. All participants had left secondary education and had either undertaken or were undertaking some form of tertiary study. The most influential of nine factors to both undergraduate and postgraduate course choices was self-interest. Various other factors differentially contributed to undergraduate and postgraduate course choices among them were the health careers workshops, which played a major influence on undergraduate course decisions of students. CONCLUSION: Self-interest is the largest self-reported factor to career decision making among students from rural and remote areas. Finance and career advice from school are not considered to be highly influential. However, these independent decisions can be substantially influenced by external information provided through health career workshops.     

Acute toxicity of methyl isocyanate: a preliminary study of the dose response for eye and other effects.

Acute toxic effects of methyl isocyanate in the rat were determined for two hour exposures to concentrations in the range 11 ppm (very slight effect) to 65 ppm (lethality: pulmonary oedema). Changes in the eye, lungs, and behaviour were noted. Eye changes were confined to erosions of the corneal epithelium and were most severe at intermediate levels of exposure. A comparison was made of the effects noted in rats with reported effects on survivors of the Bhopal disaster. Urinary thiocyanate concentrations in exposed rats were found to be reduced relative to control values.     

Solid lipid microparticles containing loratadine prepared using a Micromixer

Solid lipid microparticles were investigated as a taste-masking approach for a lipophilic weak base in a suspension. The idea was that the drug concentration in the aqueous phase of a suspension might be reduced by its partitioning into the solid lipid particles. Loratadine, as a model drug, was used to prepare Precirol ATO 5 microparticles by a Micromixer. The effects of three process variables: drug loading, PVA concentration and water/lipid ratio on the microparticle size, encapsulation efficiency, surface appearance, in-vitro release and drug partitioning in a suspension were studied. Loratadine release was slow in simulated saliva and very fast at the pH of stomach. In suspension of loratadine lipid microparticles, drug was released into the aqueous phase to the same concentration as in a drug suspension. Therefore, the usefulness of these microparticles for taste-masking in liquids is limited. However, they might be useful for taste-masking in solid dosage forms.     

Ethnic and racial differences in HPV knowledge and vaccine intentions among men receiving HPV test results

We examined factors associated with HPV vaccine intentions by racial/ethnic group among men participating in a HPV natural history study. HPV knowledge, vaccine intentions and perceived barriers were assessed among non-Hispanic White, non-Hispanic Black and Hispanic men. Men were tested for HPV every 6 months. After receiving test results from their previous visit, participants (N = 477) reported their intentions for HPV vaccination in a computer-assisted survey instrument (CASI). Vaccine intentions were high among all respondents, although differences were found between racial and ethnic groups in awareness and knowledge of HPV and, vaccine intentions and perceived access and barriers to receiving the HPV vaccine. In order to effectively disseminate the vaccine among men, factors that may promote or inhibit vaccine acceptability need to be identified. Identifying these factors related to vaccine intentions among minority and majority men offers an opportunity for addressing barriers to health equity and, in turn, reductions in HPV-related disparities.     

Individual,Social, and Environmental Factors Associated with Initiating Methamphetamine Injection: Implications for Drug Use and HIV Prevention Strategies

The purpose of this study was to determine the incidence and predictors of initiating methamphetamine injection among a cohort of injection drug users (IDU). We conducted a longitudinal analysis of IDU participating in a prospective study between June 2001 and May 2008 in Vancouver, Canada. IDU who had never reported injecting methamphetamine at the study’s commencement were eligible. We used Cox proportional hazards models to identify the predictors of initiating methamphetamine injection. The outcome was time to first report of methamphetamine injection. Time-updated independent variables of interest included sociodemographic characteristics, drug use patterns, and social, economic and environmental factors. Of 1317 eligible individuals, the median age was 39.9 and 522 (39.6%) were female. At the study’s conclusion, 200 (15.2%) participants had initiated injecting methamphetamine (incidence density: 4.3 per 100 person-years). In multivariate analysis, age (adjusted hazard ratio [aHR]: 0.96 per year older, 95%CI: 0.95–0.98), female sex (aHR: 0.58, 95%CI: 0.41–0.82), sexual abuse (aHR: 1.63, 95%CI: 1.18–2.23), using drugs in Vancouver’s drug scene epicentre (aHR: 2.15 95%CI: 1.49–3.10), homelessness (aHR: 1.43, 95%CI: 1.01–2.04), non-injection crack cocaine use (aHR: 2.06, 95%CI: 1.36–3.14), and non-injection methamphetamine use (aHR: 3.69, 95%CI: 2.03–6.70) were associated with initiating methamphetamine injection. We observed a high incidence of methamphetamine initiation, particularly among young IDU, stimulant users, homeless individuals, and those involved in the city’s open drug scene. These data should be useful for the development of a broad set of interventions aimed at reducing initiation into methamphetamine injection among IDU.     

Racial and ethnic differences in all-cause mortality risk according to alcohol consumption patterns in the national alcohol surveys

Previous studies have found J-shaped relations between volume of alcohol consumed and mortality risk in white Americans but not in African Americans, suggesting the need for studies in which race/ethnicity-defined subgroups are analyzed in separate comparable models. In the present study, the authors utilized mortality follow-up data (through 2006) on respondents from the 1984 and 1995 National Alcohol Surveys, including similar numbers of black, white, and Hispanic respondents by oversampling the minority groups. Cox proportional hazards models controlling for demographic, socioeconomic, mental health, and drug- and tobacco-use measures were used to estimate mortality risk from all causes. Findings indicated a protective effect of moderate alcohol drinking (2-30 drinks/month for women and 2-60 drinks/month for men) with no monthly ≥5-drink days) relative to lifetime abstention for whites only. Elevated mortality risk relative to moderate drinking was found in former drinkers with lifetime alcohol problems. Moderate drinkers who consumed ≥5 drinks in 1 day at least monthly were also found to have increased risk, suggesting the importance of identifying heavy-occasion drinking for mortality analyses. These differential results regarding lifetime abstainers may suggest bias from differential unmeasured confounding or unmeasured aspects of alcohol consumption pattern or may be due to genetic differences in the health impact of alcohol metabolism.     

Tracking of children's body-mass index, television viewing and dietary intake over five-years

ObjectiveTo examine the tracking of children's body mass index, television viewing, and dietary intake over five-years.MethodsIn 2002/3 (T1) parents of children aged 5–6 years (n = 175) and 10–12 years (n = 121), from Victoria, Australia, completed measures assessing their child's frequency of fruit, vegetable, and energy-dense sweet and savory snack consumption, and their child's television (TV) viewing. Children's height and weight were measured by researchers and sex–age adjusted body mass index (BMI) calculated. All measures were repeated in 2006 (T2) and 2008 (T3). Generalized estimating equations (GEE) (standardized stability coefficients, β) were used to assess tracking and were interpreted as: β < 0.3 = low, 0.3–0.6 = moderate, and > 0.6 = high.ResultsHigh standardized stability coefficients were found for BMI (β = 0.74–0.92), TV viewing (β = 0.65–0.73), and frequency of fruit consumption (β = 0.73–0.89) among younger and older children. Moderate-to-high standardized stability coefficients were found for frequency of vegetable (β = 0.52–0.86), energy-dense sweet (β = 0.41–0.65), and savory snack consumption (0.40–0.67) among younger and older children.ConclusionsBMI, TV viewing and dietary intake patterns are moderate-highly stable throughout childhood and into adolescence. Further research that identifies and targets high risk groups to prevent increased BMI, reduce TV viewing and promote healthy dietary behaviors may be justified.     

Neighborhood environment profiles related to physical activity and weight status: a latent profile analysis

Background

Neighborhood built environments (BE) include combinations of co-existing stimuli influencing physical activity (PA). Dealing with numerous environmental variables and complexity presents a significant challenge. The current analysis explored whether a range of reported BE features associated with adults' physical activity produced distinct multivariate patterns, and tested whether adults' PA and body mass differed by BE profiles.

Methods

Participants (20-65 years, 48.2% female, 26% ethnic minority) were recruited between 2002 and 2005 from 32 neighborhoods from Seattle-King County, WA (N = 1287) and Baltimore, MD-Washington, DC regions (N = 912). Independent Latent Profile Analyses were conducted in each region with 11 environmental variables from the Neighborhood Environment Walkability Scale. Validity of the neighborhood profiles was examined by their relationship to PA (accelerometer-derived moderate-to-vigorous minutes/day, self-reported minutes/week of walking for transportation and leisure) and self-reported BMI using ANCOVA models.

Results

Neighborhood profiles for Seattle and Baltimore regions were visually similar, suggesting generalizability. High-walkable recreationally-dense neighborhoods differed significantly from other neighborhood types by as much as 13 MVPA minutes/day, almost 60 minutes/week of walking for transportation, and 75 min/week of leisure-time activity. Neighborhood profiles also differed significantly for BMI.

Discussion

These findings could help identify optimal patterns of environmental attributes that facilitate physical activity and improve weight status.     

Epidemiology of urinary incontinence in women

In this paper, the current knowledge and recent literature on the epidemiology of urinary incontinence are examined. The populations discussed include community-dwelling women and institutionalized women. This review includes discussions of the prevalence of urinary incontinence with age, the prevalence of the types and severity of urinary incontinence, the variations with racial and ethnic differences, and the risk factors proposed for urinary incontinence. The theories behind the currently recognized risk factors and the recent literature supporting or refuting them are analyzed. Because of an abundance of studies, only a small fraction is represented in this paper, but we attempted to emphasize high-quality and larger population studies.