Journal of urban health : bulletin of the New York Academy of Medicine
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Comparative Study
Drug-related mortality and fatal overdose risk: pilot cohort study of heroin users recruited from specialist drug treatment sites in London.
Fatal overdose and drug-related mortality are key harms associated with heroin use, especially injecting drug use (IDU), and are a significant contribution to premature mortality among young adults. Routine mortality statistics tend to underreport the number of overdose deaths and do not reflect the wider causes of death associated with heroin use. Cohort studies could provide evidence for interpreting trends in routine mortality statistics and monitoring the effectiveness of strategies that aim to reduce drug-related deaths. ⋯ Overall, the overdose mortality rate was estimated to be at least 1.0 per 100 person-years. The standardized mortality ratio (SMR) was 17 times higher for female and male heroin users in the cohort compared to mortality in the non-heroin-using London population aged 15-59 years. The pilot study showed that these studies are feasible and ethical, and that specialist drug agencies could have a vital role to play in the monitoring of drug-related mortality.
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To minimize exposure to neurotoxins such as mercury, polychlorinated biphenyls (PCBs), dioxins, and pesticide residues, the New York State Department of Health issues health advisories about consumption of certain fish and shellfish caught from polluted local waters. Fetal exposure causes cognitive developmental deficits in children. Consumption of fish was assessed. ⋯ Statistically significant factors associated with eating local, noncommercial fish included male gender and knowledge of the health advisory. Locally caught fish and crabs are consumed; thus, in utero and childhood exposure to these neurotoxins occurs. Interventions to promote safer choices of fish are needed.
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Comparative Study
Patterns and characteristics of ambulance attendance at heroin overdose at a local-area level in Melbourne, Australia: implications for service provision.
The monitoring of heroin use and related harms is undertaken in Australia with a view to inform policy responses. Some surveillance data on heroin-related harms is well suited to inform the planning and delivery of heroin-related services, such as needle and syringe provision. ⋯ Significant local-area variations in the characteristics of nonfatal heroin overdoses were evident over the study period, including the number of heroin overdoses, the age and sex of the people attended, the time of the attendance, the likelihood of hospitalization, and the likelihood of police coattendance. The implications of the findings are discussed in terms of service provision (e.g., opening hours) within the five hot spot local government areas, and it is argued that the analyses undertaken could easily be applied to other jurisdictions for which comparable data are available.
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Data from public health surveillance systems can provide meaningful measures of population risks for disease, disability, and death. Analysis and evaluation of these surveillance data help public health practitioners react to important health events in a timely manner both locally and nationally. Aberration detection methods allow the rapid assessment of changes in frequencies and rates of different health outcomes and the characterization of unusual trends or clusters. ⋯ The primary purpose of EARS is to provide national, state, and local health departments with several alternative aberration detection methods. EARS helps assist local and state health officials to focus limited resources on appropriate activities during epidemiological investigations of important public health events. Finally, EARS allows end users to select validated aberration detection methods and modify sensitivity and specificity thresholds to values considered to be of public health importance by local and state health departments.