Adam Baus

Needle exchange programs for the prevention of hepatitis C virus infection in people who inject drugs: a systematic review with meta-analysis

BackgroundPrevious research on the effectiveness of needle exchange programs (NEP) in preventing hepatitis C virus (HCV) in people who inject drugs (PWID) has shown mixed findings. The purpose of this study was to use the meta-analytic approach to examine the association between NEP use and HCV prevention in PWIDs.MethodsStudy inclusion criteria were (1) observational studies, (2) PWIDs, (3) NEP use, (4) HCV status ascertained by serological testing, (5) studies published in any language since January 1, 1989, and (6) data available for measures of association. Studies were located by searching four electronic databases and cross-referencing. Study quality was assessed using the Newcastle Ottawa (NOS) scale. A ratio measure of association was calculated for each result from cohort or case–control studies and pooled using a random effects model. Odds ratio (OR) and hazard ratio (HR) models were analyzed separately. Results were considered statistically significant if the 95% confidence interval (CI) did not cross 1. Heterogeneity was estimated using Q and I2 with alpha values for Q ≤ 0.10 considered statistically significant.ResultsOf the 555 citations reviewed, 6 studies containing 2437 participants were included. Studies had an average NOS score of 7 out of 9 (77.8%) stars. Concerns over participant representativeness, unclear adjustments for confounders, and bias from participant nonresponse and loss to follow-up were noted. Results were mixed with the odds ratio model indicating no consistent association (OR, 0.51, 95% CI, 0.05–5.15), and the hazard ratio model indicating a harmful effect (HR, 2.05, 95% CI, 1.39–3.03). Substantial heterogeneity (p ≤ 0.10) and moderate to large inconsistency (I2 ≥ 66%) were observed for both models.ConclusionsThe impact of NEPs on HCV prevention in PWIDs remains unclear. There is a need for well-designed research studies employing standardized criteria and measurements to clarify this issue.Trial registrationPROSPERO CRD42016035315

Use of the triglyceride to HDL cholesterol ratio for assessing insulin sensitivity in overweight and obese children in rural Appalachia.

Abstract Background: Studies have suggested that triglyceride to HDL-cholesterol ratio (TRG/HDL) is a surrogate marker of insulin resistance (IR), but information regarding its use in pediatric patients is limited. This study investigated the ability of TRG/HDL ratio to assess IR in obese and overweight children. Methods: The sample consisted of de-identified electronic medical records of patients aged 10–17 years (n=223). Logistic regression was performed using TRG/HDL ratio as a predictor of hyperinsulinemia or IR defined using homeostasis model assessment score. Results: TRG/HDL ratio had limited ability to predict hyperinsulinemia (AUROC 0.71) or IR (AUROC 0.72). Although females had higher insulin levels, male patients were significantly more likely to have hypertriglyceridemia and impaired fasting glucose. Conclusions: TRG/HDL ratio was not adequate for predicting IR in this population. Gender differences in the development of obesity-related metabolic abnormalities may impact the choice of screening studies in pediatric patients.

Using i2b2 to bootstrap rural health analytics and learning networks

We demonstrate that the open-source i2b2 (Informatics for Integrating Biology and the Bedside) data model can be used to bootstrap rural health analytics and learning networks. These networks promote communication and research initiatives by providing the infrastructure necessary for sharing data and insights across a group of healthcare and research partners. Data integration remains a crucial challenge in connecting rural healthcare sites with a common data sharing and learning network due to the lack of interoperability and standards within electronic health records. The i2b2 data model acts as a point of convergence for disparate data from multiple healthcare sites. A consistent and natural data model for healthcare data is essential for overcoming integration issues, but challenges such as those caused by weak data standardization must still be addressed. We describe our experience in the context of building the West Virginia/Kentucky Health Analytics and Learning Network, a collaborative, multi-state effort connecting rural healthcare sites.

Qualitative case study of needle exchange programs in the Central Appalachian region of the United States

Background The Central Appalachian region of the United States is in the midst of a hepatitis C virus epidemic driven by injection of opioids, particularly heroin, with contaminated syringes. In response to this epidemic, several needle exchange programs (NEP) have opened to provide clean needles and other supplies and services to people who inject drugs (PWID). However, no studies have investigated the barriers and facilitators to implementing, operating, and expanding NEPs in less populous areas of the United States. Methods This qualitative case study consisted of interviews with program directors, police chiefs, law enforcement members, and PWID affiliated with two NEPs in the rural state of West Virginia. Interview transcripts were coded inductively and analyzed using qualitative data analysis software. Final common themes related to barriers and facilitators of past program openings, current program operations, and future program plans, were derived through a consensus of two data coders. Results Both NEPs struggled to find existing model programs, but benefited from broad community support that facilitated implementation. The largest operational barrier was the legal conundrum created by paraphernalia laws that criminalize syringe possession. However, both PWID and law enforcement appreciated the comprehensive services provided by these programs. Program location and transportation difficulties were additional noted barriers. Future program operations are threatened by funding shortages and bans, but necessitated by unexpected program demand. Conclusion Despite broad community support, program operations are threatened by growing participant volumes, funding shortages, and the federal government’s prohibition on the use of funds to purchase needles. Paraphernalia laws create a legal conundrum in the form of criminal sanctions for the possession of needles, which may inadvertently promote needle sharing and disease transmission. Future studies should examine additional barriers to using clean needles provided by rural NEPs that may blunt the effectiveness of NEPs in preventing disease transmission.

Challenges of enforcing cell phone use while driving laws among police: a qualitative study

Background Cell phone use while driving laws do not appear to be heavily enforced in the USA. This study seeks to gain law enforcements’ perspective and learn potential barriers to cell phone law enforcement. Methods Qualitative interviews (ie, focus groups) were conducted with officers (N=19) from five West Virginia law enforcement agencies. The officers who participated were >18 years of age, sworn into their departments and employed in law enforcement for >1 year. Focus group sessions lasted 45–60 min and followed a standardised, pilot-tested script. These sessions were audio recorded and transcribed. Qualitative content analysis was employed among three researchers to determine themes surrounding enforcement. Results Four themes emerged including current culture, the legal system, the nature of police work and issues with prevention. Specific barriers to enforcement included cultural norms, lack of perceived support from courts/judges, different laws between states, the need for a general distracted driving law, unclear legislation, officers’ habits and perceived risk, wanting to maintain a positive relationship with the public, not being able to see the driver (impediments of vehicle design, time of day), phones having multiple functions and not knowing what drivers are actually doing, risk of crashing during traffic stops and lack of resources. Prevention activities were debated, and most felt that technological advancements implemented by cell phone manufacturers may deter use. Conclusions Numerous barriers to cell phone law enforcement exist. Legislation could be amended to facilitate enforcement. Prevention opportunities exist to deter cell phone use while driving.