Feasibility of paying people who use drugs cash to distribute naloxone within their networks

INTRODUCTION

Immediate access to naloxone is needed to prevent fatal opioid-related overdoses in the presence of fentanyl analogs saturating the opioid supply. Peer models engage impacted populations who are not accessing naloxone through standard venues, yet compensating peers who utilize syringe service programs with cash stipends to distribute naloxone within networks of people who use drugs is not well described.

METHODS

As part of the HEALing Communities Study, syringe service program-based interventions were developed in Holyoke and Gloucester, MA, which paid people who use drugs ("peers") cash to distribute naloxone. Early program outcomes were evaluated for the time each program was funded within the HCS study period.

RESULTS

During 22 study-months of observation, peers in two communities distributed 1104 naloxone kits. The total cost of peer compensation for program delivery was $10,510. The rate of peer-distributed naloxone per 100 K population reached 109 kits/mo and 222 kits/mo in the two communities. Participating peers addressed gaps in harm reduction outreach and distributed naloxone and other harm reduction equipment to individuals who were not syringe service program participants, expanding organizational reach. Being compensated with unrestricted cash stipends supported dignity and acknowledged peers' work in overdose prevention.

CONCLUSION

The underutilization of compensated peer models is often attributed to funding and organizational barriers. These programs demonstrate that providing cash stipends to peers is feasible and expanded naloxone distribution at two existing syringe service programs. Providing cash stipends for peers who engage in secondary naloxone distribution offers promise in delivering naloxone to people not accessing syringe services.

Development of a medical nutrition therapy protocol for female collegiate athletes

Nutrition intervention can improve athletic performance and reduce the risk of nutrition related problems in women athletes. The current healthcare environment demands that dietitians document the outcomes of the medical nutrition therapy (MNT) they provide. This requires the development and validation of MNT protocols so that outcomes can be documented and compared in similar populations across multiple settings. The purpose of this project was to develop a sports nutrition management MNT protocol for collegiate women athletes. A registered dietitian currently working with collegiate women athletes collaborated with four dietitians from the community to develop an MNT protocol. Further testing and validation using this MNT protocol will help dietitians document the outcomes of their interventions in this population.

Enriched eggs as a source of N-3 polyunsaturated fatty acids for humans

Dietary intake of omega-3 fatty acids (n-3 PUFA) decreases the risk of heart disease, inhibits the growth of prostate and breast cancer, delays the loss of immunological functions, and is required for normal fetal brain and visual development. The US has not established a recommended daily intake for n-3 PUFA. However, Canada has established the Canadian Recommended Nutrient Intake (CRNI) at 0.5% of energy. Dietary sources of n-3 PUFA include fish, chicken, eggs, canola oil, and soybean oil. Food consumption studies in the US indicate that the majority of Americans do not meet the CRNI for n-3 PUFA. Mean n-3 PUFA consumption was 78% of the CRNI for Midwestern women during pregnancy. In Midwestern women at risk for breast cancer, the mean n-3 PUFA consumption is approximately 50% of the CRNI. Increased consumption of n-3 PUFA requires identification of a food source that the public would eat in sufficient amounts to meet recommended intake. N-3 PUFA-enriched eggs can be produced by modifying hens diets. When 70 g/kg of cod liver oil, canola oil, or linseed oil are added to a commercial control diet, the n-3 PUFA are increased from 1.2% of egg yolk fatty acids to 6.3, 4.6, and 7.8%, respectively. Feeding flaxseed increases linolenic acid in the egg yolk about 30-fold, and docosahexaenoic acid (DHA) increases nearly fourfold. When individuals are fed four n-3 PUFA-enriched eggs a day for 4 wk, plasma total cholesterol levels and low-density lipoprotein cholesterol (LDL-C) do not increase significantly. Plasma triglycerides (TG) are decreased by addition of n-3 PUFA-enriched eggs to the diet. N-3 PUFA may influence LDL particle size, causing a shift toward a less atherogenic particle. Blood platelet aggregation is significantly decreased in participants consuming n-3 PUFA-enriched eggs. Overall results of studies to date demonstrate positive effects and no negative effects from consumption of n-3-enriched eggs. Three n-3 PUFA-enriched eggs provide approximately the same amount of n-3 PUFA as one meal with fish. It is recommended that n-3 PUFA-enriched eggs be used as one source of n-3 PUFA to increase individual consumption to meet the current Canadian recommendations.

Defined, in-home, prenatal nutrition intervention for low-income women

OBJECTIVES

The purpose of this project was to develop a detailed, in-home, prenatal nutrition intervention protocol for low-income women and to assess the effectiveness of the intervention in improving their dietary intake. A secondary objective was to identify predictors of infant birth weight.

DESIGN

A defined protocol was developed and nutritionists followed it to conduct in-home nutrition sessions that included nutrition assessment, education, counseling, and goal setting for low-income women during their pregnancies. A pre/post design was used to assess the effects of the nutrition program on dietary intake. A control group was used in evaluating the effect of the nutrition intervention on birth weight.

SUBJECTS/SETTING

Forty low-income pregnant women selected randomly by the county health department nursing staff completed the nutrition intervention. Twenty-six women were also selected to serve as a control group.

INTERVENTION

For women in the intervention group, in-home visits were conducted weekly for 4 weeks, followed by 2 monthly visits. The purpose of the in-home visits was to use the defined protocol, which included monitoring weight gain and providing individualized dietary intake assessment and nutrition education and counseling.

MAIN OUTCOME MEASURES

The primary outcome measures were change in dietary intake from preintervention to postintervention, mothers' weight at time of delivery, and infant birth weight.

STATISTICAL ANALYSIS PERFORMED

Paired t tests were used to compare the women's mean daily energy and nutrient intakes before and after the nutrition intervention. Correlation analysis identified relationships between infant birth weight and independent variables, and multiple stepwise regression analysis was used to identify variables that contributed to the variation in infant birth weight. Mean birth weight was compared in the intervention and control groups by means of a t test. A chi 2 test was used for categoric variables.

RESULTS

Comparison of dietary intakes before and after the intervention revealed significant increases in total energy (2,269 to 2,431 kcal, P < .05), folate (345 to 412 micrograms, P < .01), vitamin B-6 (2.1 to 2.5 mg, P < .01), iron (17.5 to 21.2 mg, P < .01), zinc (13.6 to 14.7 mg, P < .01), and calcium (1,175 mg to 1,299 mg, P < .01) and significant (P < .01) increases in daily servings from the vegetable group (1.5 +/- 1.0 to 2.2 +/- 1.1 serving per day) and breads/grains groups (3.4 +/- 1.4 to 4.1 +/- 1.5 servings per day). There was no significant difference in mean birth weight between the intervention and control groups. Sixty-five percent of the variation in infant birth weight was accounted for by mother's weight at time of delivery, pre-pregnancy body mass index, number of visits by the nutritionist, and change in energy intake from preintervention to postintervention.

APPLICATIONS

This defined, in-home, prenatal nutrition intervention protocol can be used by providers of prenatal nutrition services to document outcomes of prenatal nutrition care in high-risk women. Use of a defined protocol will facilitate collection of meaningful outcomes data by service providers.

Estimating energy needs of pediatric patients with burns

Recent reports indicate that formulas used to estimate the energy needs of pediatric patients with burns overestimate the energy consumption that results in maintenance of body weight in these patients. The purpose of this project was to determine which of four formulas (identified as Boston, Galveston, UCSD original, or UCSD modified) most accurately estimated the energy consumption needed to maintain body weight in pediatric patients with burns. The medical records of 12 subjects, 1 to 12 years of age, who maintained body weight (within +/- 10% of dry weight) were reviewed retrospectively. Analysis of variance was used to compare the patients' energy intakes with their estimated energy needs by use of each of the four formulas. All four formulas overestimated the energy intakes that resulted in maintenance of body weight (p < 0.05), but the estimate that used the Galveston formula was closest to actual energy consumption.

Weight-for-height measurement and saturated fatty acid intake are predictors of serum cholesterol level in children

To assess the relationship of serum cholesterol level to anthropometric measurements and dietary intake, we measured serum cholesterol, height, weight, triceps skinfold, and 24-hour dietary intake in 80 children (mean age = 9.8 years) during April 1989. The mean serum cholesterol level was 3.95 mmol/l. In comparison with national data, weight-for-height and triceps skinfold measurements exceeded the 90th percentile in 18 (23%) and 26 (33%) of the children, respectively. Mean cholesterol and fat intakes were 114 mg/1,000 kcal and 36% of energy, respectively. In multiple stepwise regression analyses, weight-for-height measurement and saturated fatty acid intake were most predictive of serum cholesterol levels. Diets of children who consumed 30% of energy or less from fat (low-fat group) met or exceeded the Recommended Dietary Allowances except for energy and vitamin E and were higher in percentage of energy from carbohydrate, dietary fiber, magnesium, iron, and copper than were diets of children who consumed 31% of energy or more from fat (high-fat group). Children in the high-fat group ate more red/processed meats, baked desserts, and fats/oils than children in the low-fat group. Our data indicate that programs to reduce risk of cardiovascular disease in children may need to focus on maintaining ideal body weight and reducing saturated fatty acid intake.

Blood pressure, fluid compartments and utilization of chloride in rats fed various chloride diets

The effects of various levels and types of dietary chloride salts on blood pressure were examined in three studies. Weanling Sprague-Dawley rats were fed semipurified diets that contained moderate (1.9 mg Cl/g diet) and supplemental (15.6 mg Cl/g diet) chloride as NaCl, KCl, lysine monohydrochloride with or without CaCO3, or MgCl2 for 56 or 119 d. Rats fed excess chloride excreted more than 84% of the chloride in urine, excreted increased urine volumes (from 3 to 7 wk), tended to consume more fluids (especially if NaCl was fed), had significantly increased blood pressure (7 and 13 wk), had hypertrophied kidneys (8 and 17 wk) and had altered levels of sodium and potassium in their kidneys (17 wk), but experienced no changes in the size of fluid compartments, such as plasma volume or bromine space. Altogether, 56% of the variance in blood pressure measurements at wk 7 could be predicted on the basis of urinary chloride excretion during wk 7 and kidney weight as a percentage of body weight and kidney sodium concentration, but only 30% of the variance in blood pressure measurements at wk 16 could be predicted on the basis of urinary chloride excretion during wk 16 and kidney sodium concentrations.

Calcium supplements and milk: effects on acid-base balance and on retention of calcium, magnesium, and phosphorus

The effect of supplementing a basal diet containing 697 mg calcium daily (17.4 mmol/d) with an additional 900 mg Ca daily from milk, Ca chloride, or a Ca carbonate preparation was examined in eight adult males during a 56-d metabolic balance study. The ingestion of the milk or Ca supplements had no overall effect on Ca retention by these subjects because the milk and supplements depressed apparent absorption of Ca in the gut and fractional tubular reabsorption of Ca in the kidneys. Supplementation of the diet with CaCl and to a lesser extent with milk significantly increased renal acid excretion whereas supplementation with CaCO3 depressed renal acid excretion. The three Ca supplements significantly altered magnesium and phosphorus absorption and urinary excretion in different manners but had no overall effect on retention of P or Mg. The responses of our subjects to these treatments may be different than those of subjects who are chronically in negative balance in regard to Ca.

Cefuroxime compared with penicillin for the treatment of gonorrhea

One hundred seventy-eight men and women with acute gonorrhea were treated by intramuscular administration of cefuroxime. Use of 1 g of cefuroxime plus 1 g of probenecid gave a cure rate of 95.5%, which compared well with that of a standard treatment of 5 x 10(6) units of intramuscularly administered benzyl penicillin plus 1 g of probenecid. The latter gave a cure rate of 97.2% in a concurrent series of 178 patients. A subsequent comparison of 163 patients who received 750 mg of cefuroxime plus 1 g of probenecid with 145 patients who received 1.5 g of cefuroxime alone showed cure rates of 95.1% and 97.2%, respectively. Only two cases of possible hypersensitivity to cefuroxime were found. It is concluded that cefuroxime is a valuable drug for single-session treatment of acute gonorrhea in both men and women.