Journal of urban health : bulletin of the New York Academy of Medicine
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Comparative Study
Preventing HIV in injection drug users: choosing the best mix of interventions for the population.
Injection drug users (IDUs) transmit the human immunodeficiency virus (HIV) via both needle sharing and sex. This analysis explores the effects of population risk behaviors, intervention effectiveness, intervention costs, and budget and capacity constraints when allocating funds between two prevention programs to maximize effectiveness. The two interventions, methadone maintenance and street outreach, address different types of risk behavior. ⋯ In late 1980s New York City, the difference is five-fold (2.6% vs. 0.44%, respectively). Our analyses suggest that, even though prevention works better in higher risk scenarios, the choice of intervention mix is more important in the lower risk scenarios. Models and analyses such as those presented here may help decision makers adapt individual prevention programs to their own communities and to reallocate resources among programs to reflect the evolution of their own epidemics.
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Young people's fears of victimization and feelings of unsafety constitute a serious and pervasive public health problem and appear to be associated with different factors than actual victimization. Our analysis of a population-based telephone survey of youths aged 10-18 years in five economically distressed cities and their suburbs reveals that a substantial minority of youths feel unsafe on any given day, and that an even greater number feel unsafe in school. ⋯ Disorderliness may thus be the school's version of "broken windows," which serve to signal to students a lack of consistent adult concern and oversight that can leave them feeling unsafe. We suggest that fixing the broken windows of school disorderliness may have a significant, positive impact on adolescents' feelings of safety.
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Comparative Study
Nonfatal heroin overdoses in Queensland, Australia: an analysis of ambulance data.
In the past decade, the utilization of ambulance data to inform the prevalence of nonfatal heroin overdose has increased. These data can assist public health policymakers, law enforcement agencies, and health providers in planning and allocating resources. This study examined the 672 ambulance attendances at nonfatal heroin overdoses in Queensland, Australia, in 2000. ⋯ Police were present in only 1 of 6 cases, and 28.1% of patients reported using drugs alone. Ambulance data are proving to be a valuable population-based resource for describing the incidence and characteristics of nonfatal heroin overdose episodes. Future studies could focus on the differences between nonfatal heroin overdose and fatal heroin overdose samples.
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The promise of syndromic surveillance extends beyond early warning for bioterrorist attacks. Even if bioterrorism is first detected by an astute clinician, syndromic surveillance can help delineate the size, location, and tempo of the epidemic or provide reassurance that a large outbreak is not occurring when a single case or a small, localized cluster of an unusual illness is detected. ⋯ The challenge is to allow these systems to flower without burdening them with unrealistic expectations, centralized control, and unbalanced funding. To help syndromic surveillance systems reach their full potential, we need data standards, guidance to the developers of clinical information systems that will ensure data flow and interoperability, evaluations of best practices, links to improved laboratory diagnostics, regulations that protect privacy and data security, and reliable sustained funding for public health infrastructure to ensure the capacity to respond when the alarm sounds.