Journal of urban health : bulletin of the New York Academy of Medicine
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Hepatitis C virus (HCV) infection is transmitted by injection drug use and associated with psychiatric conditions. Patients with drug use or significant psychiatric illness have typically been excluded from HCV treatment trials noting the 1997 National Institutes of Health Consensus Statement on HCV that indicated active drug use and major depressive illness were contraindications to treatment of HCV infection. However, the 2002 NIH Consensus Statement recognized that these patients could be effectively treated for HCV infection and recommended that treatment be considered on a case-by-case basis. ⋯ Few programs or treatment models are designed to manage co-occurring substance use, psychiatric illness, and HCV infection and therapy. The National Institute on Drug Abuse convened a panel of experts to address the current status and the long-range needs through a 2-day workshop, Co-occurring Hepatitis C, Substance Abuse, and Psychiatric Illness: Addressing the Issues and Developing Integrated Models of Care. This conference report summarizes current data, medical management issues, and strategies discussed.
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Children living in poverty not only have disproportionately more health problems, but also have disproportionately lower health care service utilization. Change, whether in health care delivery system or in family living situation, may interfere with or jeopardize insurance status and thereby influence access to health care services. We hypothesized that children who have maintained Medicaid insurance compared to those who have not will be more likely to have preventive care visits and less likely to have emergency room visits. ⋯ In addition, the change into a managed-care delivery system also increased loss of coverage. Loss of coverage may be a barrier to preventive care services. To ensure optimal preventive care services, the onus is on the providers and plans to facilitate continued insurance coverage.
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Lack of diversity in the health, science, and medical professions has been documented as a contributor to health disparities in the United States, and early intervention is essential for the recruitment of underrepresented students into the health professions. The Junior Fellows Program, a partnership between the New York Academy of Medicine, New York City public schools, and regional academic medical centers, is designed to stimulate students' interest in health, science, medicine, and research. ⋯ Surveys of program graduates indicate the program has been influential in creating a high level of motivation to pursue careers related to health, science, and medicine. The program continues to work on enhancing educational opportunities for urban public school students and promoting career awareness for the health professions, with a special emphasis on improving the proportion of minorities and women who enter these fields.
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Within the next 30 years, the proportion of urban dwellers will rise from under half to two thirds of the world's population. Such a shift will entail massive public health consequences, and most of this urban transition will occur in low-income regions of the world. Urban populations face very different health risks compared to those in rural areas, particularly in terms of malaria. ⋯ Decision makers are increasingly seeing remote sensing as a cost-effective solution to monitoring urbanization at a range of spatial scales. This review focuses on the progress made within the field of remote sensing on mapping, monitoring, and modeling urban environments and examines existing challenges, drawbacks, and future prospects. We conclude by exploring some of the particular relevance of these issues to malaria and note that they are of more general relevance to all those interested in urban public health.
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This article estimates the population prevalence of current injection drug users (IDUs) in 96 large US metropolitan areas to facilitate structural analyses of its predictors and sequelae and assesses the extent to which drug abuse treatment and human immunodeficiency virus (HIV) counseling and testing are made available to drug injectors in each metropolitan area. We estimated the total number of current IDUs in the United States and then allocated the large metropolitan area total among large metropolitan areas using four different multiplier methods. Mean values were used as best estimates, and their validity and limitations were assessed. ⋯ Proportions of drug injectors in treatment varied from 1.0% to 39.3% (median 8.6%); and the ratio of HIV counseling and testing events to the estimated number of IDUs varied from 0.013 to 0.285 (median 0.082). Despite limitations in the accuracy of these estimates, they can be used for structural analyses of the correlates and predictors of the population density of drug injectors in metropolitan areas and for assessing the extent of service delivery to drug injectors. Although service provision levels varied considerably, few if any metropolitan areas seemed to be providing adequate levels of services.