RESUMEN

Introducción: la sobrecarga en valgo y extensión (choque posteromedial) es una lesión que se presenta con cierta frecuencia en atletas de lanzamiento, que en ocasiones puede requerir de cirugía para que el atleta pueda seguir compitiendo. Objetivos: realizar el diagnóstico y tratamiento del síndrome de sobrecarga en valgo y extensión en atletas, hacer diagnóstico precoz y el tratamiento adecuado. Métodos: se realizó un estudio longitudinal prospectivo de intervención que incluyó a deportistas de alto rendimiento operados por síndrome de sobrecarga en valgo y extensión. La muestra estuvo formada por 8 pacientes, todos masculinos, edad media 26 años (rango entre 22 y 29), deportes que practicaban: 6 béisbol (5 lanzadores y uno jardinero), un paciente de pesas y otro de jabalina. El tiempo de seguimiento mínimo fue de 6 meses y máximo de 4 años y una media de 2.3 años. Resultados: fueron operados ocho pacientes, de ellos cuatro presentaban neuropatía por compresión del nervio cubital a nivel del codo, a cuatro se les realizó además transferencia del nervio cubital, dos subcutáneo y en dos se le realizó una polea con fascia flexora pronadora. Las complicaciones que se presentaron fueron: recidiva del dolor por insuficiencia del ligamento colateral medial (1/8) pacientes. Los resultados funcionales según escala de Conway fueron excelentes (5/8), bueno (2/8) y pobre (1/8). Conclusiones: el estrés repetido, la insuficiencia de los flexores pronadores y del ligamento colateral medial son las causas desencadenantes del síndrome de sobrecarga en valgo y extensión. La cirugía favorece el retorno a la actividad deportiva en la mayoría de los atletas(AU)

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Introduction: valgus extension overload (posteromedial shock) is a type of injure that is relatively frequent in throwing athletes and may require surgical procedures to be performed so that the athlete can keep on competing. Objective: To early diagnose and adequately treat the valgus extension overload syndrome in athletes. Methods: a prospective, longitudinal and intervention study was conducted in high performance athletes operated on for valgus extension overload syndrome. The sample was made up of 8 male athletes aged 26 years as average (range of 22 to 29 years), who practiced baseball (five pitchers and one outfielder), weightlifting (one) and javelin throw (one). The minimal follow-up was 6 months and the maximum was 4 years, for a mean of 2.3 years. Results: eight patients were operated on, four of them presented with neuropathy from compressed cubital nerve at the elbow; four underwent transfer of their cubital nerve, two subcutaneous and two with a pulley with flexor pronator fascia. The most observed complication was pain relapse due to medial collateral ligament insufficiency in one patient. The functional results according to Conway's scale were excellent in 5 patients, good in two and unsatisfactory in just one patient. Conclusions: repeated stress, insufficiency in flexor pronators and in the medial collateral ligament were the causes that unleash the valgus extension overload syndrome. The surgical procedure helps most of the athletes to come back to their normal sports activity(AU)

Asunto(s)

Humanos , Masculino , Adulto Joven , Adulto , Articulación del Codo/cirugía , Neuropatías Cubitales/cirugía , Nervio Cubital/cirugía , Traumatismos en Atletas/cirugía , Estudios Prospectivos , Estudios Longitudinales

RESUMEN

Introducción: la sobrecarga en valgo y extensión (choque posteromedial) es una lesión que se presenta con cierta frecuencia en atletas de lanzamiento, que en ocasiones puede requerir de cirugía para que el atleta pueda seguir compitiendo. Objetivos: realizar el diagnóstico y tratamiento del síndrome de sobrecarga en valgo y extensión en atletas, hacer diagnóstico precoz y el tratamiento adecuado. Métodos: se realizó un estudio longitudinal prospectivo de intervención que incluyó a deportistas de alto rendimiento operados por síndrome de sobrecarga en valgo y extensión. La muestra estuvo formada por 8 pacientes, todos masculinos, edad media 26 años (rango entre 22 y 29), deportes que practicaban: 6 béisbol (5 lanzadores y uno jardinero), un paciente de pesas y otro de jabalina. El tiempo de seguimiento mínimo fue de 6 meses y máximo de 4 años y una media de 2.3 años. Resultados: fueron operados ocho pacientes, de ellos cuatro presentaban neuropatía por compresión del nervio cubital a nivel del codo, a cuatro se les realizó además transferencia del nervio cubital, dos subcutáneo y en dos se le realizó una polea con fascia flexora pronadora. Las complicaciones que se presentaron fueron: recidiva del dolor por insuficiencia del ligamento colateral medial (1/8) pacientes. Los resultados funcionales según escala de Conway fueron excelentes (5/8), bueno (2/8) y pobre (1/8). Conclusiones: el estrés repetido, la insuficiencia de los flexores pronadores y del ligamento colateral medial son las causas desencadenantes del síndrome de sobrecarga en valgo y extensión. La cirugía favorece el retorno a la actividad deportiva en la mayoría de los atletas(AU)

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Introduction: valgus extension overload (posteromedial shock) is a type of injure that is relatively frequent in throwing athletes and may require surgical procedures to be performed so that the athlete can keep on competing. Objective: To early diagnose and adequately treat the valgus extension overload syndrome in athletes. Methods: a prospective, longitudinal and intervention study was conducted in high performance athletes operated on for valgus extension overload syndrome. The sample was made up of 8 male athletes aged 26 years as average (range of 22 to 29 years), who practiced baseball (five pitchers and one outfielder), weightlifting (one) and javelin throw (one). The minimal follow-up was 6 months and the maximum was 4 years, for a mean of 2.3 years. Results: eight patients were operated on, four of them presented with neuropathy from compressed cubital nerve at the elbow; four underwent transfer of their cubital nerve, two subcutaneous and two with a pulley with flexor pronator fascia. The most observed complication was pain relapse due to medial collateral ligament insufficiency in one patient. The functional results according to Conway's scale were excellent in 5 patients, good in two and unsatisfactory in just one patient. Conclusions: repeated stress, insufficiency in flexor pronators and in the medial collateral ligament were the causes that unleash the valgus extension overload syndrome. The surgical procedure helps most of the athletes to come back to their normal sports activity(AU)

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Introduction: la surcharge en valgus et en extension (choc postéro-médial) est une lésion assez fréquente chez les sportifs de lancers exigeant parfois un traitement chirurgical pour qu'ils puissent retourner aux compétitions. Objectifs: cette étude a été visée à déterminer un diagnostic précoce et un traitement approprié du syndrome de surcharge en valgus et en extension chez des athlètes. Méthodes: une étude longitudinale prospective interventionnelle comprenant des sportifs de haut niveau, traités chirurgicalement pour syndrome de surcharge en valgus et en extension, a été effectuée. L'échantillon est composé de 8 patients, tous du sexe masculin, âge moyen de 26 ans (22-29 ans), pratiquant baseball (5 lanceurs et 1 joueur de champ), haltérophilie (1), et lancer du javelot (1), avec un suivi de 6 mois au minimum et 4 ans au maximum, et une médiane de 2.3 ans. Résultats: sur 8 patients opérés, quatre étaient atteints d'une neuropathie par pincement du nerf cubital au niveau du coude, quatre ont subi une chirurgie de transfert du nerf cubital, 2 sous-cutanés, et 2 ont subi la reconstruction de poulie par plastie autologue de fascia des fléchisseurs-pronateurs. Dans un seul cas, une complication est survenue: douleur récidivante due à un trouble du ligament collatéral médial. Selon l'échelle de Conway, les résultats sont excellents (5 patients), bons (2 patients) et faibles (1 patient). Conclusions: on conclut que le stress persistant et les troubles des fléchisseurs pronateurs et du ligament collatéral médial entraînent un syndrome de surcharge en valgus et en extension, et c'est le traitement chirurgical qui permet le retour de la plupart des athlètes affectés à la pratique de leur sport respectif(AU)

Asunto(s)

Humanos , Masculino , Adulto , Recurrencia , Levantamiento de Peso/lesiones , Fracturas por Estrés/cirugía , Fracturas por Estrés/etiología , Codo/diagnóstico por imagen , Herida Quirúrgica/cirugía , Estudios Prospectivos , Estudios Longitudinales , Terapia por Ejercicio , Atletas

RESUMEN

Despite an overall decrease in AIDS incidence in Puerto Rico, our studies continue to show high prevalence of HIV risk behaviors among injection drug users (IDUs). This study seeks to evaluate whether the occurrence of injection-related and sex-related HIV risk behaviors among IDUs in Puerto Rico varies with the presence of anxiety symptomatology. Subjects included 557 IDUs, recruited from street settings in poor neighborhoods in Puerto Rico. Symptoms of severe anxiety were reported by 37.1% of the study sample. Participants with severe anxiety symptoms were more likely to share needles, cotton, and rinse water; to pool money to buy drugs; and to engage in backloading, than those without severe anxiety symptoms. Participants with severe anxiety symptomatology were also more likely to practice unprotected vaginal or oral sex. The findings from this study alert HIV prevention and treatment programs to the need to address anxiety disorders within their programs.

Asunto(s)

Trastornos de Ansiedad/diagnóstico , Infecciones por VIH/psicología , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/psicología , Adulto , Femenino , Hispánicos o Latinos , Humanos , Masculino , Puerto Rico/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Sexo Inseguro/psicología

RESUMEN

INTRODUCTION: The characteristics of social settings are increasingly being recognized as important factors influencing the health of individuals. This study examines the association of neighborhood physical and social disorganization with alcohol consumption in a sample of adolescents 12- to 15-years-old residing in communities of the San Juan metropolitan area with high availability of illicit drugs. METHODS: The sampling frame was developed encompassing all census sectors in three municipalities of the San Juan metropolitan area with outdoor illegal drug-selling areas operating within them. Consent from parents and their adolescent offspring was obtained from 691 of these households for a response rate of 96%. Alcohol use was measured by asking adolescents if they had consumed alcohol during the last 12 months. Neighborhood social disorganization included hearing gunfire in the neighborhood, seeing neighbors selling stolen merchandise and drugs, vandalism, neighbors using alcohol and drugs, and seeing persons carrying weapons. Neighborhood physical disorganization included the presence of abandoned vehicles and buildings in the neighborhood, graffiti, and places where people go to inject drugs. RESULTS: Multiple logistic regression analysis revealed that older participants were more likely to use alcohol. Neighborhood social disorder was significantly associated with alcohol use. The strong positive gradient between neighborhood social disorder and alcohol use remained highly significant after controlling by sociodemographic characteristics. In contrast, neighborhood physical disorder was not significantly associated with alcohol use. CONCLUSION: These findings suggest that social signs of neighborhood disorganization have a more direct influence over adolescents' behaviors than the physical signs. Health professionals need to be cognizant of the strong effects that social environments have on adolescents and develop strategies to address these when intervening with adolescents.

Asunto(s)

Consumo de Bebidas Alcohólicas/epidemiología , Características de la Residencia , Adolescente , Niño , Femenino , Humanos , Masculino , Puerto Rico/epidemiología , Factores Socioeconómicos

RESUMEN

This report examines associations between homelessness and HIV risk behaviors among injection drug users (IDUs) in Puerto Rico. The study sample consisted of 557 IDUs who were not in treatment, recruited in inner-city neighborhoods of the North Metro Health Care Region. Subjects were categorized into three groups by residential status (last 30 days): housed, transitionally housed (living with friends, family, or others but considering themselves homeless), and on-the-street homeless (living on the street or in a shelter). Multiple logistic regression models were fitted to assess effects of residential status on each HIV risk behavior after adjusting for sociodemographic and drug-use related covariates. Transitionally housed and on-the-street homeless subjects made up 16% of the total sample. On-the-street homeless IDUs were more likely to test positive for HIV than were transitionally housed and housed IDUs. In the adjusted analysis, on-the-street homeless subjects were significantly more likely to share needles, share rinse water, and practice back loading than the other two groups. Sexual risk behaviors (last 30 days) were not significantly associated with residential status after adjustment. Findings from this study present an added challenge to drug treatment and HIV prevention and treatment programs, to provide services that can address the additional needs of drug users suffering the stressors of homelessness.

Asunto(s)

Infecciones por VIH/epidemiología , Personas con Mala Vivienda , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Población Urbana , Adulto , Femenino , Infecciones por VIH/etiología , Conductas Relacionadas con la Salud , Humanos , Modelos Logísticos , Masculino , Puerto Rico/epidemiología , Características de la Residencia , Abuso de Sustancias por Vía Intravenosa/complicaciones

RESUMEN

This study examined factors associated with drug treatment dropout among injection drug users (IDUs) in Puerto Rico, a group that has contributed significantly to the self-sustaining AIDS epidemic in the island since the mid-1980s. A total of 557 IDUs were recruited from communities in a semirural region of Puerto Rico, as part of a longitudinal study testing the efficacy of a two-facet intervention model, based on motivational interviewing. Of 124 IDUs who had entered drug treatment at follow-up, 33 (26.6%) dropped out before completing all recommended sessions. Multiple logistic regression analysis showed that age, homelessness, and speedball use were significantly associated with drug treatment dropout. Conversely, participants who received the two-facet intervention were significantly less likely to drop out of drug treatment. Receiving psychiatric services also reduced the odds of treatment dropout. Improving adherence to drug treatment and reducing dropout rates are complex processes that need to be addressed at the individual behavioral and social support levels, as well as the program process and resource levels.

Asunto(s)

Pacientes Desistentes del Tratamiento/psicología , Abuso de Sustancias por Vía Intravenosa/rehabilitación , Adolescente , Adulto , Factores de Edad , Trastornos Relacionados con Cocaína/psicología , Trastornos Relacionados con Cocaína/rehabilitación , Femenino , Dependencia de Heroína/psicología , Dependencia de Heroína/rehabilitación , Personas con Mala Vivienda/psicología , Humanos , Estudios Longitudinales , Masculino , Aceptación de la Atención de Salud , Puerto Rico/epidemiología , Salud Rural , Factores Socioeconómicos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/psicología

RESUMEN

This paper reports results of an analysis of the association between alcohol intoxication and injection and sexual HIV risk behaviors among 557 Hispanic heroin and cocaine injectors, not in treatment, who were recruited in poor communities in Puerto Rico. Subjects were part of a longitudinal prevention-intervention study aimed at reducing drug use and HIV risk behaviors. Participants reported a high prevalence of co-occurring conditions, particularly symptoms of severe depression (52%) and severe anxiety (37%), measured by Beck's Depression Index and Beck's Anxiety Index, respectively. Alcohol intoxication during the last 30 days was reported by 18% of participants. Associations were found between alcohol intoxication and both injection and sexual risk behaviors. In the bivariate analysis, subjects reporting alcohol intoxication were more likely to inject three or more times per day, pool money to buy drugs, share needles, and share cotton. They were also significantly more likely to have a casual or paying sex partner and to have unprotected sex with these partners. After adjustment, sharing needles and cotton, having sex with a paying partner or casual partner, and exchanging sex for money or drugs were significantly related to alcohol intoxication. HIV prevention programs, to be effective, must address alcohol intoxication and its relation to injection and sexual risk behaviors as a central issue in HIV prevention among drug injectors.

Asunto(s)

Intoxicación Alcohólica/epidemiología , Infecciones por VIH/epidemiología , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adolescente , Adulto , Intoxicación Alcohólica/complicaciones , Intervalos de Confianza , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/prevención & control , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Puerto Rico/epidemiología , Factores Socioeconómicos , Abuso de Sustancias por Vía Intravenosa/complicaciones

RESUMEN

This study examined the effectiveness of a combined counseling and case management behavioral intervention, using motivational interviewing strategies, in engaging Hispanic injection drug users in treatment and reducing drug use and injection-related HIV risk behaviors. Follow up data are presented on 440 (79.0%) of 557 randomized participants, 6 months after the initial interview. Subjects in the experimental arm were significantly less likely to continue drug injection independent of entering drug treatment, and were also more likely to enter drug treatment. Subjects in both arms who entered drug treatment were less likely to continue drug injection. Among subjects who continued drug injection, those in the experimental arm were significantly less likely to share needles. Confirming the outcomes of this study in other Hispanic sites and populations could be a critical step towards reducing factors that contribute to the self-sustaining HIV/AIDS epidemic in Puerto Rico and communities in the U.S. mainland.

Asunto(s)

Manejo de Caso , Consejo/métodos , Infecciones por VIH/prevención & control , Hispánicos o Latinos , Abuso de Sustancias por Vía Intravenosa/rehabilitación , Adulto , Femenino , Estudios de Seguimiento , Humanos , Entrevista Psicológica/métodos , Masculino , Motivación , Análisis Multivariante , Puerto Rico

RESUMEN

This study was conducted to identify factors accounting for differences in health care and drug treatment utilization between Puerto Rican drug users residing in 2 separate locations. Survey findings from 334 drug users in Puerto Rico and 617 in New York City showed that those in Puerto Rico were 6 times less likely than their counterparts in New York to have used inpatient medical services and 13 to 14 times less likely to have used outpatient medical services or methadone. They also were less likely to have health insurance or past drug treatment. After site was controlled for, health insurance and previous use of physical or mental health services remained significant predictors of health care and drug treatment utilization during the study period. Although Puerto Rican drug users in Puerto Rico are not an ethnic minority, they reported significant disparities in health services use compared with Puerto Rican drug users in New York.

Asunto(s)

Atención a la Salud/métodos , Abuso de Sustancias por Vía Intravenosa/terapia , Adolescente , Adulto , Femenino , Servicios de Salud , Humanos , Pacientes Internos , Seguro de Salud , Masculino , Compartición de Agujas , Ciudad de Nueva York/epidemiología , Pacientes Ambulatorios , Puerto Rico/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología

RESUMEN

This paper assesses mortality rate for a cohort of drug users in Puerto Rico compared with that of the Island's general population, examining causes of death and estimating relative risk of death. Date and cause of death were obtained from death certificates during 1998. Vital status was confirmed through contact with subjects, family, and friends. HIV/AIDS was the major cause of death (47.7%), followed by homicide (14.6%), and accidental poisoning (6.3%). Females had higher relative risk of death than males in all age categories. Not living with a sex partner and not receiving drug treatment were related to higher mortality due to HIV/AIDS. Drug injection was the only variable explaining relative risk of death due to overdose. Puerto Rico needs to continue developing programs to prevent HIV/AIDS among drug users. Special attention should be given to young women, who appear to be in greatest need of programs to prevent early mortality.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Hispánicos o Latinos/estadística & datos numéricos , Trastornos Relacionados con Sustancias/mortalidad , Distribución por Edad , Causas de Muerte , Estudios de Cohortes , Infecciones por VIH/mortalidad , Puerto Rico/etnología , Análisis de Regresión , Factores de Riesgo , Distribución por Sexo

RESUMEN

This paper assesses mortality rate for a cohort of drug users in Puerto Rico compared with that of the Island's general population, examining causes of death and estimating relative risk of death. Date and cause of death were obtained from death certificates during 1998. Vital status was confirmed through contact with subjects, family, and friends. HIV/AIDS was the major cause of death (47.7%), followed by homicide (14.6%), and accidental poisoning (6.3%). Females had higher relative risk of death than males in all age categories. Not living with a sex partner and not receiving drug treatment were related to higher mortality due to HIV/AIDS. Drug injection was the only variable explaining relative risk of death due to overdose. Puerto Rico needs to continue developing programs to prevent HIV/AIDS among drug users. Special attention should be given to young women, who appear to be in greatest need of programs to prevent early mortality.

Asunto(s)

Hispánicos o Latinos/estadística & datos numéricos , Trastornos Relacionados con Sustancias/mortalidad , Adulto , Distribución por Edad , Causas de Muerte , Estudios de Cohortes , Femenino , Infecciones por VIH/mortalidad , Humanos , Masculino , Puerto Rico/etnología , Análisis de Regresión , Factores de Riesgo , Distribución por Sexo

RESUMEN

OBJECTIVES: This study assessed prevalence and correlates of anergy among a cohort of drug users in communities in the San Juan metropolitan area. METHODS: In all, 719 drug injectors and crack users were recruited in neighbourhoods in the San Juan metropolitan area following a stratified cluster design of 30 copping areas (places where drugs are sold). RESULTS: Slightly more than one-third of the total proportion of participants, 34.2%, were HIV positive and 30.3% anergic. Subjects with a history of incarceration, the HIV positive, and those reporting chronic illness were more likely to be anergic than those subjects without these characteristics. CONCLUSIONS: Most studies addressing drug users' immune system dysfunction are related to HIV infection. Additional studies are needed to provide a more comprehensive understanding of drug users' immune systems.

Asunto(s)

Anergia Clonal , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/inmunología , Adulto , Femenino , Humanos , Masculino , Prevalencia , Puerto Rico/epidemiología , Estudios Seroepidemiológicos , Factores Socioeconómicos

RESUMEN

Despite available strategies to prevent sex risk behaviours in Puerto Rico, heterosexual transmission of HIV continues to increase. Since 1990, heterosexual contact has been the fastest growing infection risk category among the island's general population, and the primary transmission route for women and children. To understand change in sex risk behaviours and factors related to change, 911 drug injectors and 359 crack smokers were recruited from the San Juan metropolitan area following a stratified cluster design. This study comprised a total of 1,004 (79.1%) drug users who were assessed at follow-up. Abstinence from sex behaviour increased from 54.6% to 61.1% (p < 0.01), use of condoms during vaginal sex also increased from 26.4% to 36.9% (p < 0.01). In multivariate analysis, significant predictors of abstinence were gender, injection drug use, HIV seropositivity and not having a steady partner. Predictors of using condoms during vaginal sex were HIV seropositivity, STD diagnosis and participation in an HIV preventive programme. These findings indicate that additional HIV preventive efforts are needed to reduce sex risk behaviours among drug users who have a steady sex partner, as well as among drug users who are HIV-negative.

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PIP: Factors associated with changes in HIV risk behaviors were investigated in a prospective study of 911 injecting drug users and 359 crack smokers recruited on the basis of a stratified cluster design in metropolitan San Juan, Puerto Rico, in 1992-93. The findings presented in this paper are based on the 1004 drug users (79.1%) who were available for a follow-up interview 6 months after the baseline interview. Respondents were randomly assigned to receive a standard HIV prevention intervention (pretest counseling, optional HIV testing, and provision of HIV results) or the standard intervention plus a site-specific enhanced intervention entailing access to condoms and needle hygiene equipment, development of a personal risk reduction plan and training in the skills required to implement it, and ongoing contact with outreach workers. Overall, abstinence from sexual behavior increased from 54.6% at baseline to 61.1% at follow-up (p 0.01) while condom use during vaginal sex rose from 26.4% to 36.9% (p 0.01). In multivariate analysis, significant predictors of abstinence were male gender, injecting drug use, a positive HIV test at baseline, and not having a steady partner. Significant predictors of condom use were HIV seropositivity and a sexually transmitted disease diagnosis. Participation in the enhanced compared to the standard HIV prevention program was associated with an odds ratio of 1.29 (95% confidence interval, 0.95-1.74) for abstinence and 1.97 (95% confidence interval, 1.18-3.29) for condom use in vaginal sex.

Asunto(s)

Cocaína Crack , Infecciones por VIH/prevención & control , Conducta Sexual , Trastornos Relacionados con Sustancias/psicología , Adulto , Terapia Conductista/métodos , Condones/estadística & datos numéricos , Consejo , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Promoción de la Salud , Humanos , Masculino , Puerto Rico/epidemiología , Asunción de Riesgos , Parejas Sexuales , Abuso de Sustancias por Vía Intravenosa/epidemiología , Abuso de Sustancias por Vía Intravenosa/psicología , Trastornos Relacionados con Sustancias/epidemiología

RESUMEN

This study was designed to assess HIV risk behaviors, HIV seroprevalence, and tuberculosis (TB) infection in shooting gallery managers in Puerto Rico. The subjects were 464 injection drug users (IDUs), of whom 12.5% reported managing shooting galleries. The median frequency of drug injection was higher in shooting gallery managers than in nonmanagers. A trend was observed for purified protein derivative (PPD) reactivity to increase according to the length of time spent as a gallery manager, but this trend was not statistically significant. However, anergy rates increased significantly with increase in the number of months spent as shooting gallery manager (p = .021). Multivariate analyses showed that IDUs reporting shooting gallery management experience of > or = 25 months were more likely to be infected with HIV. Prevention programs need to emphasize strategies to protect the health of shooting gallery clients and, in particular, shooting gallery managers. Additional studies are required to determine effective strategies for reducing the risk of HIV and TB infection in shooting galleries.

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PIP: Little information is currently available on the health status of individuals who manage the settings in which drug injection-related behaviors occur. The present study investigated HIV risk behaviors, HIV seroprevalence, and tuberculosis infection among 464 injecting drug users recruited from areas in San Juan, Puerto Rico, known to have high levels of drug activity. 58 respondents (12.5%) reported having been a shooting gallery manager, for a median duration of 18 months. Managers were more likely to be female, over 35 years of age, not married, homeless, to inject only cocaine, to inject more frequently, to have a history of incarceration, and to report disability than drug users who were not managers. No differences in rates of HIV, tuberculosis, or anergy existed between managers with 1-24 months of management experience and nonmanagers. However, gallery managers with 25 or more months of experience were nearly 3 times more likely to be infected with HIV, nearly 2 times more likely to be anergic, and 2.5 times more likely to have tuberculosis than nonmanagers. 41% of nonmanagers, 48% of managers with 1-24 months of experience, and 71% of those who had been managers for 25 months or more were HIV-seropositive. The compromised health status of long-term shooting gallery managers underscores the need for public health interventions to interrupt the spread of sexually transmitted diseases, HIV, and tuberculosis in this high-risk setting.

Asunto(s)

Infecciones Oportunistas Relacionadas con el SIDA/etiología , Infecciones por VIH/transmisión , Seropositividad para VIH , Compartición de Agujas , Abuso de Sustancias por Vía Intravenosa/epidemiología , Tuberculosis/etiología , Infecciones Oportunistas Relacionadas con el SIDA/transmisión , Adulto , Cocaína/administración & dosificación , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Heroína/administración & dosificación , Humanos , Masculino , Análisis Multivariante , Narcóticos/administración & dosificación , Puerto Rico/epidemiología , Análisis de Regresión , Factores de Riesgo , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa/prevención & control , Abuso de Sustancias por Vía Intravenosa/virología , Factores de Tiempo , Tuberculosis/virología

RESUMEN

This study evaluated the effectiveness of the first needle exchange program (NEP) established in Puerto Rico. The data for this study were collected during the first months of the NEP from July 1995 to March 1996 in 13 communities of the San Juan metropolitan area. Subjects were the participants of two modalities of the NEP: a mobile team and a community-based drug treatment program. During the 3-week evaluation period, 2401 injection drug users (IDUs) were recruited, resulting in a total of 19,195 exchange contacts and 146,323 syringes exchanged. No significant change in drug injection was observed. However, the program was effective in reducing sharing of syringes and cookers. The study suggests that the NEP did help in reducing needle sharing in Puerto Rico. However, the HIV seropositivity in returned syringes suggests the need to continue aggressive prevention programs to arrest the epidemic among IDUs. However, factors related to the socio-cultural environment as well as cultural norms and traditions need to be considered when planning and expanding NEPs.

Asunto(s)

Infecciones por VIH/prevención & control , Programas de Intercambio de Agujas/normas , Abuso de Sustancias por Vía Intravenosa , Infecciones por VIH/transmisión , Investigación sobre Servicios de Salud , Humanos , Programas de Intercambio de Agujas/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Evaluación de Programas y Proyectos de Salud , Puerto Rico , Jeringas

RESUMEN

This study examines the prevalence of crack use among out-of-treatment drug users in the San Juan metropolitan area. Of the sample of 849 drug users, 310 (36.5%) were crack users only, 179 (21.1%) were drug injectors and crack users, and 360 (42.4%) were drug injectors only. To study the characteristics of crack users we selected the subjects who reported the use of crack only. Of the 310 subjects, 193 (62.3%) men and 117 (37.7%) women, the mean age was 29 years. Significant differences were observed by gender. Females reported higher education, living in a nuclear family, crack/cocaine as the first drug used, history of sexually transmitted diseases and higher rates of HIV seropositivity. Males were more likely to report income from illegal activities, incarceration, use of multiple drugs, and more years of drug use. Among those sexually active, females were more likely to practice unprotected vaginal sex, have multiple sex partners, engage in prostitution (exchange of sex for money and/or drugs) and use condoms.

Asunto(s)

Cocaína Crack , Trastornos Relacionados con Opioides/epidemiología , Salud Urbana , Adulto , Femenino , Humanos , Masculino , Prevalencia , Puerto Rico/epidemiología , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Encuestas y Cuestionarios

RESUMEN

This study aims to determine the prevalence of Mycobacterium tuberculosis infection and its association with HIV and other health risk factors among drug users. A sample of 716 IDUs and crack users were enrolled from community sites. Consenting subjects were tested for HIV serum antibody status. Drug users with an unknown PPD status were administered a PPD skin test and an anergy panel of three antigens (Candida, mumps and tetanus). Overall, 68 (10.3%) were reactive to the PPD skin test, 240 (34.7%) were HIV positive and 195 (29.5%) showed cutaneous anergy. Participants infected with tuberculosis (TB) were more likely to be HIV seropositive, and to have a history of incarceration and residential drug treatment than those not infected. In addition, TB infection was more prevalent among intravenous drug users (IDUs) and shooting gallery managers. These findings suggest that drug users should be considered at high risk for TB and HIV infection. Innovative programs to monitor both infections among drug users are needed to arrest what can become a dual epidemic of HIV and TB in the near future.

Asunto(s)

Cocaína Crack , Trastornos Relacionados con Opioides/complicaciones , Abuso de Sustancias por Vía Intravenosa/complicaciones , Tuberculosis/epidemiología , Salud Urbana , Adulto , Femenino , Seropositividad para VIH/complicaciones , Humanos , Masculino , Vigilancia de la Población , Prevalencia , Puerto Rico/epidemiología , Factores de Riesgo , Factores Socioeconómicos , Tuberculosis/complicaciones , Tuberculosis/diagnóstico

RESUMEN

OBJECTIVES: To examine the influence of knowledge of HIV serostatus on changes in risk behaviors among injecting drug users (IDU). PROCEDURES: IDU were recruited through sampling conducted at street drug-selling areas. Of 374 participants, 88.8% consented to be HIV tested and returned for their test results, and 73.5% were relocated and interviewed 6 months later. RESULTS: Of the 176 IDU who reported a seronegative test result prior to baseline, 29 tested seropositive at baseline. No significant differences were found between HIV-positive and HIV-negative IDU in needle risk behaviors. HIV-positive IDU were significantly less likely to report being sexually active [odds ratio (OR), 0.41 : 95% confidence interval (CI), 0.22-0.75] and more likely to use condoms during vaginal (OR, 4.43; 95% CI, 1.48-13.29) and oral sex (OR, 6.67; 95% CI, 1.42-31.33). CONCLUSION: The findings of this study show the importance of encouraging IDU to undergo periodic retesting. HIV testing could have an important role in reducing heterosexual transmission from IDU.

Asunto(s)

Infecciones por VIH/prevención & control , Asunción de Riesgos , Abuso de Sustancias por Vía Intravenosa , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Humanos , Masculino , Compartición de Agujas , Puerto Rico , Conducta Sexual , Factores de Tiempo

RESUMEN

This study examines the prevalence of crack use among out-of-treatment drug users in the San Juan metropolitan area. Of the sample of 849 drug users, 310 (36.5 percent) were crack users only, 179 (21.1 percent) were drug injectors and crack users, and 360 (42.4 percent) were drug injectors only. To study the characteristics of crack users we selected the subjects who reported the use of crack only. Of the 310 subjects, 193 (62.3 percent) men and 117 (37.7 percent) women, the mean age was 29 years. Significant differences were observed by gender. Females reported higher education, living in a nuclear family, crack/cocaine as the first drug used, history of sexually transmitted diseases and higher rates of HIV seropositivity. Males were more likely to report income from illegal activities, incarceration, use of multiple drugs, and more years of drug use. Among those sexually active, females were more likely to practice unprotected vaginal sex, have multiple sex partners, engage in prostitution (exchange of sex for money and/or drugs) and use condoms

Asunto(s)

Adulto , Femenino , Humanos , Cocaína Crack , Trastornos Relacionados con Opioides/epidemiología , Salud Urbana , Prevalencia , Puerto Rico/epidemiología , Factores de Riesgo , Distribución por Sexo , Factores Socioeconómicos , Encuestas y Cuestionarios

RESUMEN

This study aims to determine the prevalence of Mycobacterium tuberculosis infection and its association with HIV and other health risk factors among drug users. A sample of 716 IDUs and crack users were enrolled from community sites. Consenting subjects were tested for HIV serum antibody status. Drug users with an unknown PPD status were administered a PPD skin test and an anergy panel of three antigens (Candida, mumps and tetanus). Overall, 68 (10.3 percent) were reactive to the PPD skin test, 240 (34.7 percent) were HIV positive and 195 (29.5 percent) showed cutaneous anergy. Participants infected with tuberculosis (TB) were more likely to be HIV seropositive, and to have a history of incarceration and residential drug treatment than those not infected. In addition, TB infection was more prevalent among intravenous drug users (IDUs) and shooting gallery managers. These findings suggest that drug users should be considered at high risk for TB and HIV infection. Innovative programs to monitor both infections among drug users are needed to arrest what can become a dual epidemic of HIV and TB in the near future

Asunto(s)

Adulto , Femenino , Humanos , Cocaína Crack , Trastornos Relacionados con Opioides/complicaciones , Abuso de Sustancias por Vía Intravenosa/complicaciones , Tuberculosis/epidemiología , Salud Urbana , Seropositividad para VIH/complicaciones , Vigilancia de la Población , Prevalencia , Puerto Rico/epidemiología , Factores de Riesgo , Factores Socioeconómicos , Tuberculosis/complicaciones , Tuberculosis/diagnóstico