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Association of Medicaid expansion with health insurance, unmet need for medical care and substance use disorder treatment among people who inject drugs in 13 US states. Addiction 2024; 119:582-592. [PMID: 38053235 PMCID: PMC11025622 DOI: 10.1111/add.16383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 10/09/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND AND AIMS Impoverished people who inject drugs (PWID) are at the epicenter of US drug-related epidemics. Medicaid expansion is designed to reduce cost-related barriers to care by expanding Medicaid coverage to all US adults living at or below 138% of the federal poverty line. This study aimed to measure whether Medicaid expansion is (1) positively associated with the probability that participants are currently insured; (2) inversely related to the probability of reporting unmet need for medical care due to cost in the past year; and (3) positively associated with the probability that they report receiving substance use disorder (SUD) treatment in the past year, among PWID subsisting at ≤ 138% of the federal poverty line. DESIGN A two-way fixed-effects model was used to analyze serial cross-sectional observational data. SETTING Seventeen metro areas in 13 US states took part in the study. PARTICIPANTS Participants were PWID who took part in any of the three waves (2012, 2015, 2018) of data gathered in the Center for Disease Control and Prevention's National HIV Behavioral Surveillance (NHBS), were aged ≤ 64 years and had incomes ≤ 138% of the federal poverty line. For SUD treatment analyses, the sample was further limited to PWID who used drugs daily, a proxy for SUD. MEASUREMENTS State-level Medicaid expansion was measured using Kaiser Family Foundation data. Individual-level self-report measures were drawn from the NHBS surveys (e.g. health insurance coverage, unmet need for medical care because of its cost, SUD treatment program participation). FINDINGS The sample for the insurance and unmet need analyses consisted of 19 946 impoverished PWID across 13 US states and 3 years. Approximately two-thirds were unhoused in the past year; 41.6% reported annual household incomes < $5000. In multivariable models, expansion was associated with a 19.0 [95% confidence interval (CI) = 9.0, 30.0] percentage-point increase in the probability of insurance coverage, and a 9.0 (95% CI = -15.0, -0.2) percentage-point reduction in the probability of unmet need. Expansion was unrelated to SUD treatment among PWID who used daily (n = 17 584). CONCLUSIONS US Medicaid expansion may curb drug-related epidemics among impoverished people who inject drugs by increasing health insurance coverage and reducing unmet need for care. Persisting non-financial barriers may undermine expansion's impact upon substance use disorder treatment in this sample.
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Socioeconomic and racial/ethnic spatial polarization and incarceration among people who inject drugs in 19 US metropolitan areas, 2015. SSM Popul Health 2023; 23:101486. [PMID: 37635990 PMCID: PMC10448199 DOI: 10.1016/j.ssmph.2023.101486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/01/2022] [Accepted: 08/05/2023] [Indexed: 08/29/2023] Open
Abstract
The purpose of this study is to test, for the first time, the association between spatial social polarization and incarceration among people who inject drugs (PWID) in 19 large U.S. metropolitan statistical areas (MSAs) in 2015. PWID were recruited from MSAs for the Centers for Disease Control and Prevention's 2015 National HIV Behavioral Surveillance. Administrative data were used to describe the ZIP-code areas, counties, and MSAs where PWID lived. We operationalized spatial polarization using the Index of Concentration at the Extremes (ICE), a measure that reflects polarization in race and household income at the ZIP-code level. We tested the association between spatial polarization and odds of past-year arrest and detainment using multilevel multivariable models. We found 37% of the sample reported being incarcerated in the past year. Report of past-year incarceration varied by race/ethnicity: 45% of non-Hispanic white PWID reported past-year incarceration, as did 25% of non-Hispanic Black PWID, and 43% of Hispanic/Latino PWID (N = 9047). Adjusted odds ratios suggest that Black PWID living in ZIP-code areas with a higher ICE score, meaning more white and affluent, had higher odds of past-year incarceration, compared to white PWID. In previous research, incarceration has been found to be associated with HIV acquisition and can deter PWID from engaging in harm reduction activities.
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Public service providers' perspectives on and responses to the health and social consequences of gentrification in Atlanta, Georgia. JOURNAL OF SOCIAL SERVICE RESEARCH 2023; 49:494-509. [PMID: 37693303 PMCID: PMC10487345 DOI: 10.1080/01488376.2023.2237517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Service providers' perspectives on, and responses to the health and social impacts of gentrification have been underexplored. This study's objectives were to assess health and social service providers' perspectives on the causes and impacts of gentrification and their responses to gentrification's impacts. Qualitative in-depth interviews were conducted with 15 service providers sampled using maximum variation and snowball sampling, in Atlanta, Georgia, U.S.A. Inductive thematic analysis was used. Providers characterized gentrification as increases in community-level social and economic advantage and displacement of Black and Brown people. Neighborhood divestment and speculative development were reported determinants of gentrification. Revitalization and economic growth were reported positive effects of gentrification; negative ramifications included inflated housing costs, residential displacement, and reduced access to health and social services. Providers enacted multiple solutions to mitigate the negative consequences they observed, including educating residents on housing rights and collaborating with other organizations to expand outreach to displaced residents. Service providers are integral to contributing to knowledge on the causes and impacts of gentrification, and absolving problems resulting from gentrification. . Additional research documenting service provider's responses to the impacts of gentrification are needed to inform how future community development strategies are developed to create more benefits than harms.
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Housing Insecurity among Black Women Surviving Intimate Partner Violence during the COVID-19 Pandemic: An Intersectional Qualitative Approach. RESEARCH SQUARE 2023:rs.3.rs-2662616. [PMID: 36993320 PMCID: PMC10055545 DOI: 10.21203/rs.3.rs-2662616/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background To investigate housing experiences during the COVID-19 pandemic among Black women experiencing intimate partner violence (IPV) who are also navigating racism, sexism, and classism. Methods From January to April 2021, we conducted in-depth interviews with 50 Black women experiencing IPV in the United States. Guided by intersectionality, a hybrid thematic and interpretive phenomenological analytic approach was used to identify sociostructural factors shaping housing insecurity. Results Our findings demonstrate the various ways in which the COVID-19 pandemic shaped Black women IPV survivors' ability to obtain and sustain safe housing. Five themes were derived to capture factors contributing to housing experiences: challenges with separate and unequal neighborhoods; pandemic-related economic inequalities; economic abuse limitations; mental toll of eviction; and strategies to maintain housing. Conclusions Obtaining and maintaining safe housing during the COVID-19 pandemic was difficult for Black women IPV survivors who were also navigating racism, sexism, and socioeconomic position. Structural-level interventions are needed to reduce the impact of these intersecting systems of oppression and power in order to facilitate the resources necessary for Black women IPV survivors to identify safe housing.
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Place-Based Correlates of Exchange Sex Among People Who Inject Drugs in 19 U.S. Metropolitan Areas, 2012. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2897-2909. [PMID: 33796991 DOI: 10.1007/s10508-020-01883-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
This study examined overall and gender-specific associations between place-based characteristics and opposite-sex exchange sex among people who inject drugs (PWID) in the U.S. PWID were recruited from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2012 National HIV Behavioral Surveillance. Administrative data were used to describe the economic, social, and political features of the ZIP codes, MSAs, counties, and states where PWID lived. Multilevel modeling estimated associations of place characteristics and exchange sex. We found that 52% of women and 23% of men reported past-year opposite-sex exchange sex (N = 7599). Female PWID living in states with stronger policies supporting working caregivers had lower odds of exchange sex (aOR = 0.80; 95% CI 0.69, 0.94). PWID living in ZIP codes with greater economic deprivation had higher odds of exchange sex (aOR = 1.10; 95% CI 1.03, 1.17). We found that a high percentage of male PWID exchanged sex with women; determinants and risks of this group merit exploration. If future research establishes that the relationships identified here are causal, interventions to reduce exchange sex among PWID should include policies supporting working caregivers and reducing poverty rates.
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Is the severity of the Great Recession's aftershocks correlated with changes in access to the combined prevention environment among people who inject drugs? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 95:103264. [PMID: 33990058 PMCID: PMC11091490 DOI: 10.1016/j.drugpo.2021.103264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 04/07/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The 2008 Recession was a global event that led to funding cuts for programs and services in the United States; though this recession officially ended in 2009, its aftershocks continued through 2012. We evaluated the relationship between the severity of the Great Recession's aftermath and spatial access to combined prevention services (i.e. HIV testing, syringe service programs, substance use disorder treatment program) for people who inject drugs (PWID) living in 19 metropolitan statistical areas (MSAs) in the United States. METHODS The unit of analysis was the ZIP code; we sampled ZIP codes in these 19 MSAs where ≥1 PWID lived in 2009 and 2012, according to the CDC's National HIV Behavioral Surveillance. We used administrative data to describe the combined prevention environment (i.e., spatial access to HIV testing) for each ZIP code, and measured the severity of the recession's aftermath in each ZIP code, and in the counties and MSAs where these ZIP codes were located. Multilevel modeling estimated associations between changes in the aftermath of the Great Recession and ZIP code-level changes in spatial access to combined prevention services from 2009 to 2012. RESULTS 675 ZIP codes located in 36 counties and 19 MSAs were included in this analysis. From 2009 to 2012, 21% of ZIP code areas lost access to combined prevention services and 14% gained access. ZIP codes with higher poverty rates relative to their respective MSAs were less likely to lose access (aOR: 0.91; 95% CI: 0.88, 0.95) and more likely to gain access (aOR: 1.05; 95% CI: 1.01, 1.09); there is some evidence to suggest the former association was attenuated for ZIP codes with higher percentages of non-Hispanic white residents. CONCLUSION Combined prevention services for PWID living in these 675 ZIP codes demonstrated resilience in the aftermath of the Great Recession. Future research should explore whether community-based and federal HIV prevention initiatives contributed to this resilience, particularly in areas with higher concentrations of people of color.
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Limited Technology Access Among Residents of Affordable Senior Housing During the COVID-19 Pandemic. J Appl Gerontol 2021; 40:958-962. [PMID: 33980058 DOI: 10.1177/07334648211013634] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
While U.S. adults living in affordable senior housing represent a vulnerable population during the COVID-19 pandemic, affordable housing may provide a foundation for interventions designed to improve technology access to support health. To better understand technology access among residents of affordable senior housing, we surveyed members of a national association of resident service coordinators to assess their experiences working with residents during the pandemic (n = 1,440). While nearly all service coordinators report that most or all residents have reliable phone access, under a quarter report that most or all have reliable internet access; they also report limited access to technology for video calls. Lack of internet access and technology literacy are perceived as barriers to medical visits and food procurement for low-income older adult residents of affordable housing. Policies to expand internet access as well as training and support to enable use of online services are required to overcome these barriers.
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Public Housing Relocations and Relationships of Changes in Neighborhood Disadvantage and Transportation Access to Unmet Need for Medical Care. J Health Care Poor Underserved 2018; 28:315-328. [PMID: 28239005 DOI: 10.1353/hpu.2017.0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Cross-sectional research suggests that neighborhood characteristics and transportation access shape unmet need for medical care. This longitudinal analysis explores relationships of changes in neighborhood socioeconomic disadvantage and trans- portation access to unmet need for medical care. METHODS We analyzed seven waves of data from African American adults (N = 172) relocating from severely distressed public housing complexes in Atlanta, Georgia. Surveys yielded individual-level data and admin- istrative data characterized census tracts. We used hierarchical generalized linear models to explore relationships. RESULTS Unmet need declined from 25% pre-relocation to 12% at Wave 7. Post-relocation reductions in neighborhood disadvantage were inversely associated with reductions in unmet need over time (OR = 0.71, 95% CI = 0.51-0.99). More frequent transportation barriers predicted unmet need (OR = 1.16, 95% CI = 1.02-1.31). CONCLUSION These longitudinal findings support the importance of neighborhood environments and transportation access in shaping unmet need and suggest that improvements in these exposures reduce unmet need for medical care in this vulnerable population.
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Medical Respite and Linkages to Outpatient Health Care Providers among Individuals Experiencing Homelessness. J Community Health Nurs 2016; 33:81-9. [DOI: 10.1080/07370016.2016.1159439] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Risk Environments, Race/Ethnicity, and HIV Status in a Large Sample of People Who Inject Drugs in the United States. PLoS One 2016; 11:e0150410. [PMID: 26974165 PMCID: PMC4790920 DOI: 10.1371/journal.pone.0150410] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 02/13/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION We analyzed relationships between place characteristics and being HIV-negative among black, Latino, and white people who inject drugs (PWID) in the US. METHODS Data on PWID (N = 9077) were from the Centers for Disease Control and Prevention's 2009 National HIV Behavioral Surveillance. Administrative data were analyzed to describe the 968 ZIP codes, 51 counties, and 19 metropolitan statistical areas (MSAs) where they lived. Multilevel multivariable models examined relationships between place characteristics and HIV status. Exploratory population attributable risk percents (e-PAR%s) were estimated. RESULTS Black and Latino PWID were more likely to be HIV-negative if they lived in less economically disadvantaged counties, or in MSAs with less criminal-justice activity (i.e., lower drug-related arrest rates, lower policing/corrections expenditures). Latino PWID were more likely to be HIV-negative in MSAs with more Latino isolation, less black isolation, and less violent crime. E-PAR%s attributed 8-19% of HIV cases among black PWID and 1-15% of cases among Latino PWID to place characteristics. DISCUSSION Evaluations of structural interventions to improve economic conditions and reduce drug-related criminal justice activity may show evidence that they protect black and Latino PWID from HIV infection.
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Racialized risk environments in a large sample of people who inject drugs in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 27:43-55. [PMID: 26342272 PMCID: PMC4715941 DOI: 10.1016/j.drugpo.2015.07.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 06/27/2015] [Accepted: 07/31/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID) in many countries. To strengthen efforts to understand the causes of disparities in HIV-related outcomes and eliminate them, we expand the "Risk Environment Model" to encompass the construct "racialized risk environments," and investigate whether PWID risk environments in the United States are racialized. Specifically, we investigate whether black and Latino PWID are more likely than white PWID to live in places that create vulnerability to adverse HIV-related outcomes. METHODS As part of the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance, 9170 PWID were sampled from 19 metropolitan statistical areas (MSAs) in 2009. Self-reported data were used to ascertain PWID race/ethnicity. Using Census data and other administrative sources, we characterized features of PWID risk environments at four geographic scales (i.e., ZIP codes, counties, MSAs, and states). Means for each feature of the risk environment were computed for each racial/ethnic group of PWID, and were compared across racial/ethnic groups. RESULTS Almost universally across measures, black PWID were more likely than white PWID to live in environments associated with vulnerability to adverse HIV-related outcomes. Compared to white PWID, black PWID lived in ZIP codes with higher poverty rates and worse spatial access to substance abuse treatment and in counties with higher violent crime rates. Black PWID were less likely to live in states with laws facilitating sterile syringe access (e.g., laws permitting over-the-counter syringe sales). Latino/white differences in risk environments emerged at the MSA level (e.g., Latino PWID lived in MSAs with higher drug-related arrest rates). CONCLUSION PWID risk environments in the US are racialized. Future research should explore the implications of this racialization for racial/ethnic disparities in HIV-related outcomes, using appropriate methods.
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Contextual Predictors of Injection Drug Use Among Black Adolescents and Adults in US Metropolitan Areas, 1993-2007. Am J Public Health 2015; 106:517-26. [PMID: 26691126 DOI: 10.2105/ajph.2015.302911] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to determine whether contextual factors shape injection drug use among Black adolescents and adults. METHODS For this longitudinal study of 95 US metropolitan statistical areas (MSAs), we drew annual MSA-specific estimates of the prevalence of injection drug use (IDU) among Black adolescents and adults in 1993 through 2007 from 3 surveillance databases. We used existing administrative data to measure MSA-level socioeconomic status; criminal justice activities; expenditures on social welfare, health, and policing; and histories of Black uprisings (1960-1969) and urban renewal funding (1949-1974). We regressed Black IDU prevalence on these predictors by using hierarchical linear models. RESULTS Black IDU prevalence was lower in MSAs with declining Black high-school dropout rates, a history of Black uprisings, higher percentages of Black residents, and, in MSAs where 1992 White income was high, higher 1992 Black income. Incarceration rates were unrelated. CONCLUSIONS Contextual factors shape patterns of drug use among Black individuals. Structural interventions, especially those that improve Black socioeconomic security and political strength, may help reduce IDU among Black adolescents and adults.
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Changes in Exposure to Neighborhood Characteristics are Associated with Sexual Network Characteristics in a Cohort of Adults Relocating from Public Housing. AIDS Behav 2015; 19:1016-30. [PMID: 25150728 DOI: 10.1007/s10461-014-0883-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ecologic and cross-sectional multilevel analyses suggest that characteristics of the places where people live influence their vulnerability to HIV and other sexually-transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African-American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater post-relocation improvements in economic disadvantage, violent crime, and male:female sex ratios would experience greater reductions in perceived partner risk and in the odds of having a partner who had another partner (i.e., indirect concurrency). Baseline data were collected from 172 public housing residents before relocations occurred; three waves of post-relocation data were collected every 9 months. Participants who experienced greater improvements in community violence and in economic conditions experienced greater reductions in partner risk. Reduced community violence was associated with reduced indirect concurrency. Structural interventions that decrease exposure to violence and economic disadvantage may reduce vulnerability to HIV/STIs.
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63 * 'KEEP TAKING THE TABLETS': DOES BRIEF TELEPHONE NURSE-LED INTERVENTION IMPROVE ADHERENCE TO OSTEOPOROSIS THERAPY? Age Ageing 2014. [DOI: 10.1093/ageing/afu036.63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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AB0821 'Keep Taking the Tablets? A Pilot Study of the Scale of the Potential Problem from Long-Term Bisphosphonate Prescribing in South Wales. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
In response to the National HIV/AIDS Strategy (NHAS) and as part of CDC's Enhanced Comprehensive HIV Prevention Plan (ECHPP) project, Maryland developed a comprehensive local HIV prevention plan for the Baltimore-Towson Metropolitan Statistical Area and identified a series of priority HIV prevention and service goals. The current project sought to: (1) determine how well National HIV Behavioral Surveillance (NHBS) indicators were aligned with NHAS/ECHPP-informed local HIV prevention goals (2) facilitate on-going NHBS data utilization to inform on-going local HIV prevention and service planning, and (3) build a foundation for future NHBS data utilization in local HIV decision-making. Project activities identified key HIV-related indicators in NHBS that are directly or indirectly related to local HIV priorities as informed by NHAS/ECHPP, which can be used for HIV prevention planning in the Baltimore area. Areas for enhancing NHBS and local data collection to further inform HIV prevention priorities are highlighted.
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Individual, network, and neighborhood correlates of exchange sex among female non-injection drug users in Baltimore, MD (2005-2007). AIDS Behav 2013; 17:598-611. [PMID: 22983502 DOI: 10.1007/s10461-012-0305-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The "HIV risk environment" has been characterized as a dynamic interplay between structural and network factors. However, most HIV prevention research has not examined the independent and combined impact of network and structural factors. We aimed to identify individual, network, and neighborhood correlates of exchange sex (≥1 exchange sex partner, past 90 days) among female non-injection drug users (NIDUs). We used baseline data from 417 NIDUs enrolled in a randomized HIV prevention trial in Baltimore (2005-2007). Surveys ascertained demographic variables, drug/sex risk behaviors, neighborhood perceptions, and social/sexual network characteristics. Correlates of exchange sex were identified with descriptive statistics and log-binomial regression. Our findings suggest that sex and drug relationships among female NIDUs are interlinked and may be difficult to modify without altering social norms. Strengthening ties that provide social support but not drug support and reducing ties that provide both drug and social support may facilitate reductions in individual-level HIV-risk behaviors.
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'Sink or swim': an evaluation of the clinical characteristics of individuals with high bone mass. Osteoporos Int 2012; 23:643-54. [PMID: 21455762 PMCID: PMC3261396 DOI: 10.1007/s00198-011-1603-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 01/31/2011] [Indexed: 01/31/2023]
Abstract
SUMMARY High bone mineral density on routine dual energy X-ray absorptiometry (DXA) may indicate an underlying skeletal dysplasia. Two hundred fifty-eight individuals with unexplained high bone mass (HBM), 236 relatives (41% with HBM) and 58 spouses were studied. Cases could not float, had mandible enlargement, extra bone, broad frames, larger shoe sizes and increased body mass index (BMI). HBM cases may harbour an underlying genetic disorder. INTRODUCTION High bone mineral density is a sporadic incidental finding on routine DXA scanning of apparently asymptomatic individuals. Such individuals may have an underlying skeletal dysplasia, as seen in LRP5 mutations. We aimed to characterize unexplained HBM and determine the potential for an underlying skeletal dysplasia. METHODS Two hundred fifty-eight individuals with unexplained HBM (defined as L1 Z-score ≥ +3.2 plus total hip Z-score ≥ +1.2, or total hip Z-score ≥ +3.2) were recruited from 15 UK centres, by screening 335,115 DXA scans. Unexplained HBM affected 0.181% of DXA scans. Next 236 relatives were recruited of whom 94 (41%) had HBM (defined as L1 Z-score + total hip Z-score ≥ +3.2). Fifty-eight spouses were also recruited together with the unaffected relatives as controls. Phenotypes of cases and controls, obtained from clinical assessment, were compared using random-effects linear and logistic regression models, clustered by family, adjusted for confounders, including age and sex. RESULTS Individuals with unexplained HBM had an excess of sinking when swimming (7.11 [3.65, 13.84], p < 0.001; adjusted odds ratio with 95% confidence interval shown), mandible enlargement (4.16 [2.34, 7.39], p < 0.001), extra bone at tendon/ligament insertions (2.07 [1.13, 3.78], p = 0.018) and broad frame (3.55 [2.12, 5.95], p < 0.001). HBM cases also had a larger shoe size (mean difference 0.4 [0.1, 0.7] UK sizes, p = 0.009) and increased BMI (mean difference 2.2 [1.3, 3.1] kg/m(2), p < 0.001). CONCLUSION Individuals with unexplained HBM have an excess of clinical characteristics associated with skeletal dysplasia and their relatives are commonly affected, suggesting many may harbour an underlying genetic disorder affecting bone mass.
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Local residents trained as 'influence agents' most effective in persuading African couples on HIV counseling and testing. Health Aff (Millwood) 2011; 30:1488-97. [PMID: 21821565 DOI: 10.1377/hlthaff.2009.0994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Couples in sub-Saharan Africa are the largest group in the world at risk for HIV infection. Couples counseling and testing programs have been shown to reduce HIV transmission, but such programs remain rare in Africa. Before couples counseling and testing can become the norm, it is essential to increase demand for the services. We evaluated the effectiveness of several promotional strategies during a two-year program in Kitwe and Ndola, Zambia. The program attracted more than 7,600 couples through the use of radio broadcasts, billboards, and other strategies. The most effective recruiting technique was the use of local residents trained as "influence agents" to reach out to friends, neighbors, and others in their sphere of influence.
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A comparison of the antimicrobial efficacy of two silver-containing wound dressings on burn wound isolates. J Wound Care 2011; 20:580-2, 584-6. [PMID: 22240884 DOI: 10.12968/jowc.2011.20.12.580] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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517 Is the ischemic cascade relevant during myocardial contrast stress echocardiography? Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
OBJECTIVE To test the antimicrobial effectiveness of a silver alginate dressing on opportunistic pathogens, namely meticillin-sensitive Staphylococcus aureus (MSSA) and meticillin-resistant Staphylococcus aureus (MRSA), Klebsiella spp., Enterococcus faecalis, Enterococcus faecium, Pseudomonas aeruginosa, Escherichia coli, Enterobacter sakazakii, Enterobacter cloacae, Serratia marcescens, Chryseobacterium indologenes, Proteus vulgaris and Acinetobacter baumannii. METHOD In total, 40 microorganisms were isolated from patients attending three burn centres in the US and evaluated for their susceptibility to a silver alginate wound dressing, employing a corrected zone of inhibition assay, conducted on Mueller Hinton agar (MHA). RESULTS The sizes of the corrected zones of inhibition varied between and within genera. For example, all Acinetobacter baumannii strains were found to be sensitive to ionic silver at pH 7, with a mean of 2.8mm, compared with 3.5mm at pH 5.5. The silver alginate dressing also demonstrated activity on all strains of Enterobacter and Escherichia coli, with susceptibility to the silver alginate dressing enhanced at pH 5.5. For Enterococcus spp. the average corrected zone of inhibition at pH 7 was 3.6mm, versus 4.9mm at pH 5.5. All strains of Pseudomonas aeruginosa were found to be sensitive to the silver alginate dressing. The average corrected zone of inhibition was 6.9mm at pH 7, compared with 8mm at pH 5.5. For MRSA and Staphylococcus aureus, it ranged from 4.5mm to 7.5mm at pH 7. When the pH was decreased to 5.5, the corrected zone of inhibition increased. CONCLUSION This study demonstrates the activity of a silver alginate dressing on a wide range of burn isolates, including antibiotic-resistant bacteria, isolated from three different burn centres in the US. It also highlights the possible importance of pH and its potential effects on antimicrobial performance and microbial susceptibility. However, more extensive testing is required to substantiate this. CONFLICT OF INTEREST SLP is employed by Advanced Medical Solutions Ltd.
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Rheumatoid Arthritis: Treatment [151-201]: 151. Should we be Looking More Carefully for Methotrexate Induced Liver Disease? Rheumatology (Oxford) 2010. [DOI: 10.1093/rheumatology/keq725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Evaluation of work-related psychosocial factors and regional musculoskeletal pain: results from a EULAR Task Force. Ann Rheum Dis 2008; 68:885-91. [PMID: 18723563 DOI: 10.1136/ard.2008.090829] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Judgment under emotional certainty and uncertainty: the effects of specific emotions on information processing. J Pers Soc Psychol 2001; 81:973-88. [PMID: 11761319 DOI: 10.1037/0022-3514.81.6.973] [Citation(s) in RCA: 356] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors argued that emotions characterized by certainty appraisals promote heuristic processing, whereas emotions characterized by uncertainty appraisals result in systematic processing. The 1st experiment demonstrated that the certainty associated with an emotion affects the certainty experienced in subsequent situations. The next 3 experiments investigated effects on processing of emotions associated with certainty and uncertainty. Compared with emotions associated with uncertainty, emotions associated with certainty resulted in greater reliance on the expertise of a source of a persuasive message in Experiment 2, more stereotyping in Experiment 3, and less attention to argument quality in Experiment 4. In contrast to previous theories linking valence and processing, these findings suggest that the certainty appraisal content of emotions is also important in determining whether people engage in systematic or heuristic processing.
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Abstract
Organisms produce reactive oxygen species (ROS) throughout their lives. The activities of a number of key antioxidant enzymes, such as catalase, superoxide dismutase and glutathione peroxidase, which protect against the damaging effects of ROS, have been reported to decrease with increasing age, though this is not unequivocal. In contrast, sacrificial antioxidants such as ascorbate, thiols and tocopherol do not appear to decrease with increasing age. It is also possible that ROS production increases with age as a result of poorer coupling of electron transport components, and an increased level of redox-active metal ions that could catalyse oxidant formation. As a result of this decrease in antioxidant defences, and increased rate of ROS formation, it is possible that the impact of ROS increases with age. ROS are known to oxidise biological macromolecules, with proteins an important target. If the argument that the impact of ROS increases with age is true, then proteins would be expected to accumulate oxidised materials with age, and the rate of such accumulation should increase with time, reflecting impaired inefficiency of homeostasis. Here we review the evidence for the accumulation of oxidised, or modified, extra- and intra-cellular proteins in vivo.
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A comparison of two methods for identifying surgical site infections following orthopaedic surgery. J Hosp Infect 2001; 48:261-6. [PMID: 11461126 DOI: 10.1053/jhin.2001.1012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Many infection control practitioners (ICPs) dedicate a significant amount of time and resources to surveillance of surgical site infections (SSIs). Alternative surveillance methods need to be explored to reflect the changes to the healthcare system and the increasing economic constraints placed on infection control units. This study was undertaken to compare two methods of identifying SSIs in orthopaedic surgery. Surveillance data collected routinely by ICPs was compared with data obtained from the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) coding in the medical record. Concordant results between the two methods were obtained. The use of ICD-9-CM coding, as stored in hospital patient administration system databases, has the ability to enhance routine surgical site surveillance programmes. These systems can be used as the basis for screening large data sets for SSIs and identifying where SSIs resulted in patient re-admission. A reduction in the duplication of data and time spent by the ICP on the collection of information for surveillance purposes can be achieved.
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Abstract
The initial description of murine strains deficient in complement component C5 has been followed by the recognition in a range of animal species of a variety of natural complement component deficiencies, many of which have been characterized at the molecular level. The use of such species in inflammatory and infectious experimental models has led to significant progress in understanding the role of specific complement factors (and pathways) in disease pathogenesis. Deficiencies of early complement factors are characterized by impairment of immune response, possibly due to defective processing of immune complexes. Complete (but not partial) deficiency of the central component C3 predisposes affected animals to significant risk of infection and renal disease. Studies in species deficient in the terminal pathway component C6 are particularly relevant for investigating the pathogenetic role of the terminal membrane attack complex (MAC), implicating it as a causative agent in diverse inflammatory insults such as reperfusion injury, glomerular damage, and xenograft hyperacute rejection. Further investigations in such naturally deficient strains, added to results derived from studies in knockout animals, are likely to expand our understanding of the role of the activated complement system in experimental inflammatory disease, with significant potential implications for the treatment of human disease.
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Abstract
Following the initial description of natural C5 deficiency in inbred mice, a growing number of complement component deficiencies in animals have been described, caused by a variety of genetic defects. Studies on such animals have contributed greatly to an understanding of the specific roles of classical, alternative and terminal pathway activation and inhibition in many infectious and inflammatory diseases. Further investigations in the more recently described models, in combination with the use of genetically engineered knockout mice (with targeted disruption of individual complement components and inhibitors), should continue to provide a fertile source of information regarding the role of complement in such experimental situations. This information is likely to have significant therapeutic implications for human disease.
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Digital arterial occlusive disease. Lancet 2000; 356:1111. [PMID: 11009166 DOI: 10.1016/s0140-6736(05)74552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Serious opportunistic infection associated with gold-induced panhypogammaglobulinaemia. BRITISH JOURNAL OF RHEUMATOLOGY 1998; 37:914-6. [PMID: 9734688 DOI: 10.1093/rheumatology/37.8.914b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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A national center for biocomputation: in search of a patient-specific interactive virtual surgery workbench. Stud Health Technol Inform 1997; 50:323-8. [PMID: 10180561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
This report describes the three-dimensional imaging and virtual environment technologies developed in NASA's Biocomputation Center for scientific purposes that have now led to applications in the field of medicine. A major goal is to develop a virtual environment surgery workbench for planning complex craniofacial and breast reconstructive surgery, and for training surgeons.
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Abstract
PURPOSE To assess the value of raised serum angiotensin converting enzyme (ACE) levels in making a clinical diagnosis of ocular sarcoidosis in patients with intraocular inflammation, compatible with sarcoidosis, in whom tissue biopsy is either not practical or not possible. METHODS The ocular manifestations and clinical course of 22 patients with intraocular inflammation compatible with sarcoidosis and elevated ACE level (including 11 patients with abnormal chest radiograph) were compared with those of a group of 18 patients with intraocular inflammation due to biopsy-proven sarcoidosis. The mean follow-up (+/- SD) was 4.5 +/- 3.4 years in the presumed ocular sarcoidosis group and 7.8 +/- 5.3 years in the biopsy-proven sarcoidosis group. RESULTS There was no difference in sex, race and age distribution between the two groups. No statistically significant difference could be found between the ocular manifestations seen in each group. The most common finding was retinal vasculitis with panuveitis, seen in 86.4% of the presumed ocular sarcoidosis group and in 83.3% of the biopsy-proven sarcoidosis group. CONCLUSIONS These results suggest that intraocular inflammation compatible with sarcoidosis in conjunction with raised ACE levels would be accordant with a diagnosis of sarcoidosis in patients in whom histological diagnosis is either not practical or not possible.
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Urate deposits in the gecarcinid land crab Gecarcoidea natalis are synthesised de novo from excess dietary nitrogen. J Exp Biol 1997; 200:2347-54. [PMID: 9320269 DOI: 10.1242/jeb.200.17.2347] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The urate content of the gecarcinid land crab Gecarcoidea natalis was correlated to the amount of nitrogen assimilated. Crabs fed a high-nitrogen diet (ad libitum amounts of soy beans and fig leaves, Ficus macrophylla) for 6 weeks assimilated approximately 23 times more nitrogen (33.9±5.6mmolkg-1day-1) than animals fed a diet low in nitrogen (fig leaves alone) (1.5±0.7mmolkg-1day-1). Animals maintained on a high-nitrogen diet accumulated urate (67.1±29.4mmolkg-1drymass), while animals fed the low-nitrogen diet did not accumulate significant amounts of urate compared with the control animals killed at the beginning of the dietary period. The urate deposits clearly originate from the excess dietary nitrogen ingested on the high-nitrogen diet. The intake of preformed dietary purine was low (0.028±0.005mmolkg-1drymass) and at most could only account for 0.04% of the urate accumulated by crabs fed the high-nitrogen diet. This indicates that the urate was synthesised de novo. When crabs were fed a high-nitrogen diet supplemented with [15N]glycine, the 15N heavy isotope was incorporated into urate. This provided direct evidence that the urate was synthesised de novo.
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[Occupational musculoskeletal diseases. Early rehabilitation is not unambiguously positive]. LAKARTIDNINGEN 1994; 91:969-972. [PMID: 8139321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
OBJECTIVES Examination of the locomotor system is frequently neglected. Therefore, the GALS locomotor screen (Gait, Arms, Legs, Spine) has been proposed by Doherty et al as a practical method of identifying functionally important problems. This study was designed to test whether this screen reflects functional impairment, as measured by accepted health status measures. METHODS Two observers performed the GALS screen in a total of 83 patients with a variety of musculoskeletal conditions. The examination components of GALS were rated by a simple 0 to 3 scale. Physical ability was further assessed by Health Activity Questionnaire (HAQ), Barthel index and Steinbrocker's ARA classification. RESULTS For the total patient group, Spearman correlations between GALS and the three functional indices were good (r = 0.62 to 0.71, p < 0.001). Correlations were equally good for rheumatoid arthritis patients alone (r = 0.65 to 0.70, p < 0.001), but less good although still significant for the other miscellaneous rheumatic conditions (r = 0.31 to 0.46, p < 0.05). Observed proportional agreement between the two observers for the individual scores was > 70%, with a kappa statistic k = 0.49 to 0.74. CONCLUSIONS The GALS screen is a reliable and valid measure of functional ability, compared with standard accepted indices in a variety of musculoskeletal diseases. This supports the proposal for its use as a screening test by general practitioners and medical students.
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Effects of graded levels of dietary phosphorus on bone mineralization in the very young poult. Poult Sci 1986; 65:1018-20. [PMID: 3725720 DOI: 10.3382/ps.0651018] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
An experiment was conducted to determine the effects of graded levels of dicalcium phosphate on bone mineralization in 1 and 3-week-old poults. Corn-soybean meal diets calculated to contain 1.5% calcium and either .35, .55, .75, .95, or 1.15% available phosphorus were fed to battery brooder reared poults for 3 weeks. Body weights and percent tibia ash were determined at 1 and 3 weeks. Body weight was not significantly affected by dietary phosphorus at either 1 or 3 weeks of age. Percent tibia ash was significantly greater in 1-week-old poults receiving a minimum of .75% available phosphorus. In 3-week-old poults, maximum tibia ash was obtained with with a minimum of .55 available phosphorus. This study suggests the level of dietary phosphorus necessary to achieve maximum tibia ash in 3-week-old poults is not sufficient for maximum tibia ash in 1-week-old poults.
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A child is born. THE NEW ZEALAND NURSING JOURNAL. KAI TIAKI 1979; 72:25-6. [PMID: 295094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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