Journal of urban health : bulletin of the New York Academy of Medicine
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The surname of coauthor Lynn Michalopoulos was misspelled (as "Michalopolous") in this originally published. The original article has been corrected.
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Sanitation delivery in the urban areas of sub-Saharan African countries has been a chronic issue, particularly difficult to tackle. Under the Millennium Development Goals, the sanitation target in urban sub-Saharan Africa was missed by a wide margin and witnessed almost no improvement. After 2 years of review, the WHO/UNICEF Joint Monitoring Programme published a new measure of access to sanitation as a baseline for the Sustainable Development Goals. ⋯ In sum, it is not a surprise that a Working Group recommended that the measure should be changed to include some shared facilities. Following the Working Group's recommendation would have avoided the adverse consequences of continued reliance on a key component of the methodology used for monitoring sanitation improvements under the Millennium Development Goals. The paper discusses the limitations of this methodology in the context of urban sub-Saharan Africa, where current sanitation conditions are seriously lacking, and the significant future urban population growth will add more pressure for the delivery of vital sanitation services.
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After remaining stable from 2010 to 2014, the rate of cocaine-involved overdose death increased sharply from 2015 to 2016. This study aims to determine the contribution of opioids, and fentanyl in particular, to the increase in cocaine-involved overdose death from 2015 to 2016. ⋯ Age-adjusted rates per 100,000 residents were calculated for 6-month intervals from 2010 to 2016. Data suggest that increased deaths involving opioids, specifically fentanyl, accounted for most of the increase in cocaine-involved deaths from 2015 to 2016.
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Opioid overdoses (OD) cause substantial morbidity and mortality globally, and current emergency management is typically limited to supportive care, with variable emphasis on harm reduction and addictions treatment. Our urban setting has a high concentration of patients with presumed fentanyl OD, which places a burden on both pre-hospital and emergency department (ED) resources. From December 13, 2016, to March 1, 2017, we placed a modified trailer away from an ED but near the center of the expected area of high OD and accepted low-risk patients with presumed fentanyl OD. ⋯ The primary outcome was the proportion of patients requiring transfer to an ED for clinical deterioration, while secondary outcomes were the proportion of patients initiated on opioid agonists and provided take-home naloxone kits. We treated 269 patients with opioid OD, transferred three (1.1%) to a local ED, started 43 (16.0%) on opioid agonists, and provided 220 (81.7%) with THN. Our program appears to be safe and may serve as a model for other settings dealing with a large numbers of opioid OD.
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This report documents a successful intervention by a community-based naloxone distribution program in San Francisco. The program and its partner organizations, working with participants who use drugs, first identified the appearance of illicitly made fentanyl and increased outreach and naloxone distribution. Distribution of naloxone and reported use of naloxone to reverse opioid-involved overdoses increased significantly while the number of opioid-involved and fentanyl-involved overdose deaths did not. Community-based programs that provide training and naloxone to people who use drugs can serve as an early warning system for overdose risk and adaptively respond to the rapidly changing overdose risk environment.