RESUMEN
Current literature on aging in place highlights the socioemotional components that act as barriers to remaining in the home, but it often neglects actionable safety features of the home which may also pose a threat. Furthermore, this literature often neglects self-reported barriers to aging in place. Utilizing grounded theory, a retrospective review of home safety assessments completed in Philadelphia analyzed older adult reports to determine what factors older adults view as barriers to their aging in place plans. Overarching categories that were discovered through the data analysis process included barriers related to home mobility and safety, personal health, access to community services, home improvement and maintenance needs, general safety concerns, and bathroom safety. Results indicate that older adults can identify many barriers to aging within their home, but that accessing support and services to overcome these barriers requires additional resources and funding.
Asunto(s)
Envejecimiento , Vida Independiente , Anciano , Humanos , Estudios Retrospectivos , AutoinformeRESUMEN
We assessed relations among neighborhood characteristics and sexual intimate partner violence against women (SIPVAW), among low-income, drug-involved, women (n = 360) and men (n = 670) in New York City between 2005 and 2009. Six percent of women (n = 22) and 5% of men (n = 33) reported experiencing and perpetrating SIPVAW in the past year with a main partner. In adjusted mixed models among women, neighborhood ethnic heterogeneity was significantly negatively associated with SIPVAW victimization. In adjusted logistic models among men, neighborhood collective efficacy was significantly positively associated with SIPVAW perpetration. Novel theoretical frameworks are needed to guide research on neighborhoods and partner violence.
Asunto(s)
Víctimas de Crimen/estadística & datos numéricos , Consumidores de Drogas/estadística & datos numéricos , Violencia de Pareja/estadística & datos numéricos , Áreas de Pobreza , Características de la Residencia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Factores de RiesgoRESUMEN
OBJECTIVES: The objective of this study was to describe the demographics of out-of-hospital cardiac arrests (OOHCAs) in children younger than 18 years and characteristics associated with survival among these children in New York City (NYC). METHODS: A prospective observational cohort of all children younger than 18 years with OOHCA in NYC between April 1, 2002, and March 31, 2003. Data were collected from prehospital providers by trained paramedics utilizing a previously validated telephone interview process. Data included Pediatric Utstein core measures and critical prehospital time intervals. Analyses utilized descriptive statistics and bivariate association with survival. RESULTS: Resuscitation was attempted on 147 pediatric OOHCA patients in NYC during the study period; outcome data were collected on these patients. The median age was 2 years; most (58%) were male. The majority of arrests occurred at home (69%). Lay bystanders witnessed 33% of all OOHCA; 68% of witnesses were family members. Bystander cardiopulmonary resuscitation (CPR) was performed on 30% of children. Median emergency medical services response time was 3.6 minutes (range, 0.4-14.4 minutes). Initial rhythm was as follows: ventricular fibrillation, 2%; asystole, 50%; pulseless electrical activity, 9.5%; other rhythms, 11.6%; no rhythm recorded, 26%. Survival was 4% to hospital discharge and was present only among witnessed arrests (6/58 witnessed vs 0/70 unwitnessed, P < 0.05). CONCLUSIONS: Pediatric OOHCA survival rate is low. Witnessed arrest was the most important determinant of survival. Ventricular fibrillation was an uncommon rhythm measured by emergency medical services. The majority of arrests occurred at home. The rate of bystander CPR was low. Strategies to increase the rate of bystander CPR for children, especially by family members, are needed.
Asunto(s)
Reanimación Cardiopulmonar , Servicios Médicos de Urgencia/organización & administración , Paro Cardíaco Extrahospitalario/terapia , Adolescente , Distribución de Chi-Cuadrado , Niño , Preescolar , Demografía , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Ciudad de Nueva York/epidemiología , Paro Cardíaco Extrahospitalario/epidemiología , Prevalencia , Estudios Prospectivos , Factores Sexuales , Tasa de SupervivenciaRESUMEN
OBJECTIVE: The objective of this study was to describe the demographics, epidemiology, and characteristics associated with survival of children younger than 18 years who had an out-of-hospital respiratory arrest (OOHRA) during a 1-year period in a large urban area. METHODS: A prospective observational cohort of consecutive children younger than 18 years with OOHRA cared for by the New York City 911 emergency medical services (EMS) system from April 12, 2002, to March 31, 2003. Following resuscitative efforts, data were collected from prehospital providers by trained paramedics using a previously validated telephone interview process. Data included Pediatric Utstein core measures and critical prehospital time intervals. Analyses used descriptive statistics and bivariate association with survival. RESULTS: Resuscitation was attempted on 109 OOHRAs during the study period. The median age was 7 years, 52% were male. Lay bystanders witnessed 56%. Most occurred at home (77%). Witnesses were family members in 59%. Bystander cardiopulmonary resuscitation (CPR) was performed in 31% of all respiratory arrests (RAs). A chronic medical condition existed in 28%. Median EMS response time was 4.4 minutes (range, 0-12 min). Overall survival was 79% to hospital discharge. Time interval to EMS arrival, witnessed arrest, bystander CPR, and ventilation method were not associated with survival. CONCLUSIONS: Most OOHRAs occurred at home, and bystander CPR occurred infrequently. The majority of children in OOHRA survived. Strategies to increase the rate of bystander CPR, especially by family members, are needed. Out-of-hospital RAs are a large proportion of all arrests in children. Future studies of pediatric arrest should include RA as well as cardiac arrest.
Asunto(s)
Reanimación Cardiopulmonar , Servicios Médicos de Urgencia/organización & administración , Insuficiencia Respiratoria/terapia , Adolescente , Distribución de Chi-Cuadrado , Niño , Preescolar , Demografía , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Ciudad de Nueva York/epidemiología , Estudios Prospectivos , Insuficiencia Respiratoria/epidemiología , Tasa de SupervivenciaRESUMEN
OBJECTIVES: To determine support of in-pharmacy human immunodeficiency virus (HIV) testing among pharmacy staff and the individual-level characteristics associated with in-pharmacy HIV testing support. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: New York City (NYC) from January 2008 to March 2009. PARTICIPANTS: 480 pharmacy staff, including pharmacists, owners/managers, and technicians/clerks. INTERVENTION: 131 pharmacies registered in the Expanded Syringe Access Program (ESAP) completed a survey. MAIN OUTCOME MEASURE: Support of in-pharmacy HIV testing. RESULTS: Support of in-pharmacy HIV testing is high among pharmacy staff (79.4%). Pharmacy staff who supported in-pharmacy vaccinations were significantly more likely to support in-pharmacy HIV testing. Pharmacy staff who thought that selling syringes to injection drug users (IDUs) caused the community to be littered with dirty syringes were significantly less likely to support in-pharmacy HIV testing. CONCLUSION: Support for in-pharmacy HIV testing was high among our sample of ESAP pharmacy staff actively involved in nonprescription syringe sales. These findings suggest that active ESAP pharmacy staff may be amenable to providing HIV counseling and testing to IDUs and warrants further investigation.
Asunto(s)
Actitud del Personal de Salud , Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , VIH/aislamiento & purificación , Farmacéuticos , Farmacia/métodos , Estudios Transversales , Femenino , Infecciones por VIH/sangre , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Técnicas de Diagnóstico Molecular/métodos , PersonalidadRESUMEN
New York State (NYS) passed legislation authorizing pharmacists to administer immunizations in 2008. Racial/socioeconomic disparities persist in vaccination rates and vaccine-preventable diseases such as influenza. Many NYS pharmacies participate in the Expanded Syringe Access Program (ESAP), which allows provision of non-prescription syringes to help prevent transmission of HIV, and are uniquely positioned to offer vaccination services to low-income communities. To understand individual and neighborhood characteristics of pharmacy staff support for in-pharmacy vaccination, we combined census tract data with baseline pharmacy data from the Pharmacies as Resources Making Links to Community Services (PHARM-Link) study among ESAP-registered pharmacies. The sample consists of 437 pharmacists, non-pharmacist owners, and technicians enrolled from 103 eligible New York City pharmacies. Using multilevel analysis, pharmacy staff who expressed support of in-pharmacy vaccination services were 69% more likely to support in-pharmacy HIV testing services (OR, 1.69; 95% CI 1.39-2.04). While pharmacy staff who worked in neighborhoods with a high percent of minority residents were less likely to express support of in-pharmacy vaccination, those in neighborhoods with a high percent of foreign-born residents were marginally more likely to express support of in-pharmacy vaccination. While educational campaigns around the importance of vaccination access may be needed among some pharmacy staff and minority community residents, we have provided evidence supporting scale-up of vaccination efforts in pharmacies located in foreign-born/immigrant communities which has potential to reduce disparities in vaccination rates and preventable influenza-related mortality.
Asunto(s)
Disparidades en el Estado de Salud , Farmacias , Farmacéuticos , Rol Profesional , Características de la Residencia , Vacunación/estadística & datos numéricos , Servicios de Salud Comunitaria , Etnicidad , Femenino , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Masculino , Análisis Multivariante , Ciudad de Nueva York/epidemiología , Aceptación de la Atención de Salud , Grupos Raciales , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To determine the individual- and neighborhood-level predictors of frequent nonprescription in-pharmacy counseling. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: New York City (NYC) during January 2008 to March 2009. INTERVENTION: 130 pharmacies registered in the Expanded Syringe Access Program (ESAP) completed a survey. PARTICIPANTS: 477 pharmacists, nonpharmacist owners/managers, and technicians/clerks. MAIN OUTCOME MEASURES: Frequent counseling on medical conditions, health insurance, and other products. RESULTS: Technicians were less likely than pharmacists to provide frequent counseling on medical conditions or health insurance. Regarding neighborhood-level characteristics, pharmacies in areas of high employment disability were less likely to provide frequent health insurance counseling and pharmacies in areas with higher deprivation were more likely to provide counseling on other products. CONCLUSION: ESAP pharmacy staff members are a frequent source of nonprescription counseling for their patients in disadvantaged neighborhoods of NYC. These findings suggest that ESAP pharmacy staff may be amenable to providing relevant counseling services to injection drug users and warrant further investigation.
Asunto(s)
Servicios Comunitarios de Farmacia , Consejo , Programas de Intercambio de Agujas , Medicamentos sin Prescripción , Farmacéuticos , Actitud del Personal de Salud , Estudios Transversales , Recolección de Datos , Femenino , Humanos , Masculino , Ciudad de Nueva York , Características de la Residencia , Medio Social , Abuso de Sustancias por Vía Intravenosa , JeringasRESUMEN
There is growing evidence that the neighborhood environment influences sexual behavior and related outcomes, but little work has focused specifically on men who have sex with men (MSM). Using interview data from a probability sample of 385 young MSM living in New York City, recruited at public venues in 1999 and 2000 as part of the Young Men's Survey-New York City, and data on neighborhood characteristics obtained from the U.S. Census 2000, we conducted multi-level analyses of the associations between neighborhood-level characteristics and consistent condom use during anal intercourse, while controlling for individual-level sociodemographic and other factors. After adjusting for individual-level factors, neighborhood-level gay presence remained significantly and positively associated with consistent condom use during anal intercourse. This finding suggests that neighborhoods with a significant gay presence may have norms that act to discourage high risk sexual activity.
Asunto(s)
Condones/estadística & datos numéricos , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Parejas Sexuales , Medio Social , Adulto , Infecciones por VIH/transmisión , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina/psicología , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Análisis Multinivel , Ciudad de Nueva York , Factores de Riesgo , Asunción de Riesgos , Factores Socioeconómicos , Adulto JovenRESUMEN
OBJECTIVE: To characterize the influence of the residential neighborhood of older adults on the prevalence of disability. METHODS: We combined Census data on disability in older adults living in New York City with environmental information from a comprehensive geospatial database. We used factor analysis to derive dimensions of compositional and physical neighborhood characteristics and linear regression to model their association with levels of disability. Measures of neighborhood collective efficacy were added to these models to explore the impact of the social environment. RESULTS: Low neighborhood socioeconomic status, residential instability, living in areas with low proportions of foreign born and high proportions of Black residents, and negative street characteristics were associated with higher prevalence of both "physical" disability and "going outside the home" disability. High crime levels were additionally associated with physical disability, although this relationship disappeared when misdemeanor arrests were removed from the crime variable. Low levels of collective efficacy were associated with more going-outside-the-home disability, with racial/ethnic composition dropping out of this model to be replaced by an interaction term. CONCLUSION: The urban environment may have a substantial impact on whether an older adult with a given level of functional impairment is able to age actively and remain independent.
Asunto(s)
Personas con Discapacidad/estadística & datos numéricos , Características de la Residencia , Población Urbana/estadística & datos numéricos , Anciano , Crimen/estadística & datos numéricos , Estudios Transversales , Diversidad Cultural , Evaluación de la Discapacidad , Planificación Ambiental , Femenino , Humanos , Masculino , Análisis Multivariante , Ciudad de Nueva York , Factores de Riesgo , Controles Informales de la Sociedad , Factores SocioeconómicosRESUMEN
OBJECTIVES: We investigated the relationship between the depressive symptoms of older adults over time and the characteristics of the neighborhoods in which they live. METHODS: We surveyed a random sample of 1325 New York City residents aged 50 years or older in 2005 and conducted 808 follow-up interviews in 2007. We assessed the compositional characteristics of the respondents' neighborhoods at a census-tract level and determined the relationships between these characteristics and changes in respondents' depressive symptoms. RESULTS: In multivariable models that adjusted for individual-level covariates including income, a range of neighborhood characteristics predicted worsening depressive symptoms. Factor analysis suggested that these characteristics operated in 3 clusters: neighborhood socioeconomic influences, residential stability, and racial/ethnic composition, with positive neighborhood socioeconomic influences being significantly protective against worsening symptoms. Life stressors, personality trait neuroticism, African American race, and daily baseline contact with social networks were also associated with worsening symptoms. CONCLUSIONS: An older adult's neighborhood of residence is an important determinant of his or her mental health. Those making efforts to improve mental health among the elderly need to consider the role of residential context in improving or impairing mental health.
Asunto(s)
Depresión/psicología , Características de la Residencia , Anciano , Anciano de 80 o más Años , Depresión/epidemiología , Depresión/etnología , Femenino , Estado de Salud , Humanos , Renta , Entrevistas como Asunto , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Ciudad de Nueva York/epidemiología , Factores de Riesgo , Factores Socioeconómicos , Encuestas y CuestionariosRESUMEN
OBJECTIVES: We sought to determine whether the work of a community-based participatory research partnership increased interest in influenza vaccination among hard-to-reach individuals in urban settings. METHODS: A partnership of researchers and community members carried out interventions for increasing acceptance of influenza vaccination in disadvantaged urban neighborhoods, focusing on hard-to-reach populations (e.g., substance abusers, immigrants, elderly, sex workers, and homeless persons) in East Harlem and the Bronx in New York City. Activities targeted the individual, community organization, and neighborhood levels and included dissemination of information, presentations at meetings, and provision of street-based and door-to-door vaccination during 2 influenza vaccine seasons. Participants were recruited via multiple modalities. Multivariable analyses were performed to compare interest in receiving vaccination pre- and postintervention. RESULTS: There was increased interest in receiving the influenza vaccine postintervention (P<.01). Being a member of a hard-to-reach population (P=.03), having ever received an influenza vaccine (P<.01), and being in a priority group for vaccination (P<.01) were also associated with greater interest in receiving the vaccine. CONCLUSIONS: Targeting underserved neighborhoods through a multilevel community-based participatory research intervention significantly increased interest in influenza vaccination, particularly among hard-to-reach populations. Such interventions hold promise for increasing vaccination rates annually and in pandemic situations.
Asunto(s)
Relaciones Comunidad-Institución , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Programas de Inmunización/organización & administración , Gripe Humana/prevención & control , Áreas de Pobreza , Población Urbana/estadística & datos numéricos , Femenino , Educación en Salud/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Ciudad de Nueva York , Evaluación de Programas y Proyectos de Salud , Factores de Riesgo , Factores SocioeconómicosRESUMEN
Little is known about the impact of vaccine shortages on vaccination rates among disadvantaged populations in the United States. We compared factors associated with influenza vaccination rates during a vaccine shortage (2004-2005) and a non-shortage (2003-2004) year among adults in predominantly minority New York City neighborhoods. Thirty-one percent of participants received influenza vaccine during the non-shortage year compared with 18% during the shortage. While fewer people received the influenza vaccine during the shortage, a higher proportion of the vaccinated were in a high-risk group (68% vs. 52%, respectively). People were less likely to have been vaccinated during the shortage if they were Black. This study suggests that vaccination rates were lower during the shortage period among Blacks and those who are not explicitly a focus of national vaccination outreach campaigns. Such groups are less likely to be vaccinated when vaccines are scarce.
Asunto(s)
Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/provisión & distribución , Áreas de Pobreza , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Disparidades en Atención de Salud , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Grupos Raciales , Factores de Riesgo , Factores Socioeconómicos , Estados UnidosRESUMEN
In October 2004, one of the major producers of the U.S. influenza vaccine supply announced that their vaccine would not be available because of production problems, resulting in approximately half of the anticipated supply suddenly becoming unavailable. This study was part of a larger effort using community-based participatory research (CBPR) principles to distribute influenza vaccine to hard-to-reach populations. Given the extant literature suggesting economic and racial disparities in influenza vaccine access in times of adequate supply and our inability to distribute vaccine due to the shortage, we sought to examine vaccine access as well as awareness of the vaccine shortage and its impact on health-seeking behaviors in eight racially-diverse and economically-disadvantaged neighborhoods in New York City (NYC) during the shortage. In our study few people had been vaccinated, both among the general community and among high risk groups; vaccination rates for adults in priority groups and non-priority groups were 21.0% and 3.5%. Awareness of the 2004 vaccine shortage was widespread with over 90% being aware of the shortage. While most attributed the shortage to production problems, almost 20% said that it was due to the government not wanting to make the vaccine available. Many respondents said they would be more likely to seek vaccination during the current and subsequent influenza seasons because of the shortage. The target neighborhoods were significantly affected by the national influenza vaccine shortage. This study highlights the challenges of meeting the preventive health care needs of hard-to-reach populations in times of public health crisis.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Programas de Inmunización/estadística & datos numéricos , Vacunas contra la Influenza/provisión & distribución , Vacunación/estadística & datos numéricos , Poblaciones Vulnerables/etnología , Adulto , Anciano , Participación de la Comunidad , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Medios de Comunicación de Masas , Persona de Mediana Edad , Ciudad de Nueva York , Áreas de PobrezaRESUMEN
BACKGROUND: Ambulance response time is typically reported as the time interval from call dispatch to arrival on-scene. However, the often unmeasured "vertical response time" from arrival on-scene to arrival at the patient's side may be substantial, particularly in urban areas with high-rise buildings or other barriers to access. OBJECTIVES: To measure the time interval from arrival on-scene to the patient in a large metropolitan area and to identify barriers to emergency medical services arrival. METHODS: This was a prospective observational study of response times for high-priority call types in the New York City 9-1-1 emergency medical services system. Research assistants riding with paramedics enrolled a convenience sample of calls between 2001 and 2003. RESULTS: A total of 449 paramedic calls were included, with a median time from call dispatch to arrival on-scene of 5.2 minutes. The median on-scene to patient arrival interval was 2.1 minutes, leading to an actual response interval (dispatch to patient) of 7.6 minutes. The median on-scene to patient interval was 2.8 minutes for residential buildings, 2.7 minutes for office complexes, 1.3 minutes for private homes (less than four stories), and 0.5 minutes for outdoor calls. Overall, for all calls, the on-scene to patient interval accounted for 28% of the actual response interval. When an on-scene escort provided assistance in locating and reaching the patient, the on-scene to patient interval decreased from 2.3 to 1.9 minutes. The total dispatch to patient arrival interval was less than 4 minutes in 8.7%, less than 6 minutes in 28.5%, and less than 8 minutes in 55.7% of calls. CONCLUSIONS: The time from arrival on-scene to the patient's side is an important component of overall response time in large urban areas, particularly in multistory buildings.
Asunto(s)
Ambulancias/estadística & datos numéricos , Servicios Médicos de Urgencia/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios Urbanos de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ambulancias/provisión & distribución , Niño , Preescolar , Sistemas de Comunicación entre Servicios de Urgencia , Servicios Médicos de Urgencia/provisión & distribución , Arquitectura y Construcción de Instituciones de Salud , Vivienda , Humanos , Lactante , Persona de Mediana Edad , Ciudad de Nueva York , Estudios Prospectivos , Factores de Tiempo , Estudios de Tiempo y Movimiento , Servicios Urbanos de Salud/clasificación , Servicios Urbanos de Salud/provisión & distribuciónRESUMEN
OBJECTIVES: Research has indicated that there is minimal use of pharmacies among injection drug users (IDUs) in specific neighborhoods and among Black and Hispanic IDUs. We developed a community-based participatory research partnership to determine whether a multilevel intervention would increase sterile syringe access through a new policy allowing nonprescription syringe sales in pharmacies. METHODS: We targeted Harlem, NY (using the South Bronx for comparison), and disseminated informational material at community forums, pharmacist training programs, and counseling or outreach programs for IDUs. We compared cross-sectional samples in 3 target populations (pre- and postintervention): community members (attitudes and opinions), pharmacists (opinions and practices), and IDUs (risk behaviors). RESULTS: Among community members (N = 1496) and pharmacists (N = 131), negative opinions of IDU syringe sales decreased in Harlem whereas there was either no change or an increase in negative opinions in the comparison community. Although pharmacy use by IDUs (N=728) increased in both communities, pharmacy use increased significantly among Black IDUs in Harlem, but not in the comparison community; syringe reuse significantly decreased in Harlem, but not in the comparison community. CONCLUSIONS: Targeting the individual and the social environment through a multilevel community-based intervention reduced high-risk behavior, particularly among Black IDUs.
Asunto(s)
Negro o Afroamericano/educación , Planificación en Salud Comunitaria , Infecciones por VIH/prevención & control , Educación en Salud , Investigación sobre Servicios de Salud , Hispánicos o Latinos/educación , Farmacias/organización & administración , Abuso de Sustancias por Vía Intravenosa/etnología , Jeringas/provisión & distribución , Servicios Urbanos de Salud/organización & administración , Adolescente , Adulto , Actitud del Personal de Salud , Actitud Frente a la Salud , Consejo , Femenino , Infecciones por VIH/etnología , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Farmacias/estadística & datos numéricos , Conducta de Reducción del Riesgo , Asunción de Riesgos , Medio Social , Abuso de Sustancias por Vía Intravenosa/virología , Servicios Urbanos de Salud/estadística & datos numéricosRESUMEN
Effective January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), allowing syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to adults. A concern in the assessment of ESAP is its effects on syringe disposal practices. Syringe use data regarding the last injection episode were combined from three projects (N = 1,030) recruiting injection drug users. Disposal of syringes by methods known to be safe decreased significantly over time after the implementation of ESAP. Syringes obtained either from syringe exchange programs or ESAP sources were more likely to be disposed of safely than syringes obtained from other sources. Efforts to enlist pharmacists and others involved in ESAP implementation to encourage safe disposal are needed. More detailed information on disposal practices is needed to capture the continuum from least to most safe practices and variation within individuals.
Asunto(s)
Programas de Intercambio de Agujas , Eliminación de Residuos , Abuso de Sustancias por Vía Intravenosa , Jeringas , Adolescente , Adulto , Anciano , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Ciudad de Nueva YorkRESUMEN
We compared sexual behaviors/partnerships and determined sexual risk correlates associated with HIV by gender among street-recruited drug users using chi-square tests and logistic regression. Men reported higher risk sexual behaviors, yet fewer high-risk sexual partners than women. After adjustment, HIV seropositive men were more likely than seronegatives to be older, MSM, use condoms, and have an HIV-infected partner. HIV seropositive women were more likely to be older, have an HIV-infected partner, and not use non-injected heroin. IDU was not associated with HIV. Prospective studies are needed to determine how gender-specific sexual behaviors/partnerships among drug users affect HIV acquisition.
Asunto(s)
Seroprevalencia de VIH , Homosexualidad Femenina/psicología , Homosexualidad Masculina/psicología , Conducta Sexual , Abuso de Sustancias por Vía Intravenosa/psicología , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Homosexualidad Femenina/estadística & datos numéricos , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Ciudad de Nueva York/epidemiología , Estudios Prospectivos , Distribución por Sexo , Parejas Sexuales/psicologíaRESUMEN
Methadone and buprenorphine are treatments for heroin-dependent patients. Methadone is available through highly-regulated treatment centers while buprenorphine was approved in 2002 for prescription by certified physicians. Just prior to the approval of buprenorphine, we conducted a random postal survey of 770 physicians in New York City to determine willingness to prescribe methadone or buprenorphine for heroin-dependent patients to be picked up at a pharmacy. Among 247 respondents, 36.3% would consider prescribing methadone and 17.9% were unsure, while 25.8% would consider prescribing buprenorphine and 31.8% were unsure. Willingness to prescribe methadone or buprenorphine was associated with more recent year of licensure (p = 0.044; p = 0.033), working in a hospital or clinic as opposed to an office setting (p = 0.009; p = 0.024), and being the director of a clinic or program (p = 0.031; p = 0.008). This preliminary study suggests that a substantial proportion of New York City physicians would prescribe methadone or buprenorphine to heroin-dependent patients.
Asunto(s)
Actitud del Personal de Salud , Buprenorfina/uso terapéutico , Prescripciones de Medicamentos , Dependencia de Heroína/tratamiento farmacológico , Metadona/uso terapéutico , Antagonistas de Narcóticos/uso terapéutico , Médicos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Effective on January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), which allows syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to persons 18 years of age or older and permits the possession of those syringes for the purposes of injecting drugs. OBJECTIVE: To assess changes in receptive syringe sharing since the inception of the ESAP. METHODS: Sociodemographic characteristics and syringe use data regarding the last injection episode were combined from 3 projects (n = 1181) recruiting injection drug users in ongoing studies in Harlem and the Bronx in New York City from January 2001 through June 2003. These data were analyzed as serial cross sections by calendar quarter. RESULTS: Receptive sharing decreased significantly over time, from 13.4% in the first quarter to 3.6% in the last quarter. Obtaining the last injection syringe from an ESAP source (mostly pharmacies) increased significantly over time, from 7.5% in the first quarter to 25.0% in the last quarter. In multiple logistic regression analysis, variables that were significantly associated with less receptive sharing were syringe exchange and ESAP syringe source as well as time since ESAP inception. Female gender and white race/ethnicity were significantly associated with greater receptive sharing. CONCLUSIONS: The increase in the use of pharmacies and other ESAP syringe sources in this sample has been accompanied by a decline in receptive sharing.
Asunto(s)
Compartición de Agujas/tendencias , Programas de Intercambio de Agujas , Jeringas , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Oportunidad Relativa , Análisis de Regresión , Abuso de Sustancias por Vía IntravenosaRESUMEN
The purpose of this analysis was to determine the prevalence and correlates of HIV infection among a street-recruited sample of heroin- and cocaine-using men who have sex with men (MSM). Injection (injecting Asunto(s)
Trastornos Relacionados con Cocaína/complicaciones
, Seronegatividad para VIH
, Seropositividad para VIH/epidemiología
, Seroprevalencia de VIH
, Dependencia de Heroína/complicaciones
, Homosexualidad Masculina
, Adolescente
, Adulto
, Trastornos Relacionados con Cocaína/etnología
, Estudios de Cohortes
, Vías de Administración de Medicamentos
, Etnicidad
, Seropositividad para VIH/complicaciones
, Seropositividad para VIH/etnología
, VIH-1
, Dependencia de Heroína/etnología
, Humanos
, Masculino
, Ciudad de Nueva York/epidemiología
, Asunción de Riesgos
, Conducta Sexual