Donald S. Gann

A qualitative study of overdose responses among Chicago IDUs

BackgroundOpioid overdose is a leading cause of death among injection drug users. Over half of injection drug users report at least one nonfatal overdose during their lifetime. Death from opioid overdose rarely occurs instantaneously, but rather over the course of one to three hours, allowing ample time for providing life-saving measures. In response to the prevalence of overdoses in the U.S., there are a growing number of overdose prevention and naloxone distribution programs targeting the injection drug using community.MethodsWe explored injection drug users experiences with opioid overdose response, examining differences between overdose responses in which naloxone was and was not used. The current study is based upon qualitative interviews (N = 31) with clients of the Chicago Recovery Alliance needle exchange program who had witnessed an overdose in the past six months. The interviews explored participants drug use history, personal overdose experiences, and details concerning their last witnessed overdose. Verbatim transcripts were coded and analyzed thematically to address major study questions.ResultsParticipants were 81% were male, their median age was 38. They reported having injected a median of 10 years and having witnessed a median of six overdoses in their lifetime. All described overdoses were recognized and responded to quickly. None of the overdoses resulted in a fatality and naloxone was successfully administered in 58% of the last witnessed overdoses. Administering naloxone for the first time was characterized by trepidation, but this feeling dissipated as the naloxone quickly took effect. Emergency medical personnel were called in 10 of the 31 described overdoses, including four in which participants administered naloxone. The overwhelming majority of experiences with police and paramedics were positiveConclusionOverall, our small study found that the overdose prevention efforts build on extensive knowledge possessed by IDUs. Teaching IDUs how to use naloxone is an effective risk reduction strategy.

???The life they save may be mine???: Diffusion of overdose prevention information from a city sponsored programme

BACKGROUNDnOverdose remains the leading cause of death among injection drug users (IDUs) in the United States. Overdose rates are consistently high in Baltimore, MD, USA. The current qualitative study examines diffusion of information and innovation among participants in Staying Alive, an overdose prevention and naloxone distribution programme in Baltimore, MD.nnnMETHODSnIn-depth interviews were conducted between June 2004 and August, 2005 with 25 participants who had completed the Staying Alive training and had reported using naloxone to revive an overdose victim. Interviews were taped and transcripts were transcribed verbatim.nnnRESULTSnParticipants were 63% male, 63% African American, and the median age was 41 years old. Participants successfully shared information on overdose prevention and management, particularly the use of naloxone, to their peers and family.nnnCONCLUSIONSnThe current study demonstrates IDUs interest in and ability to diffuse overdose prevention information and response skills to the injection drug use community. The study underscores the importance of promoting the diffusion of information and skills within overdose prevention programmes.

Cortisol Secretion after Hemorrhage: Multiple Mechanisms

Multiple mechanisms appear to be involved in mediation of increased secretion of cortisol after hemorrhage. Signals from cardiovascular receptors are transmitted to the hypothalamus through ascending neural pathways to release ACTH. Angiotensin II stimulates release of ACTH by an action on the median eminence, but does not stimulate adrenal secretion of cortisol directly. However, secretion of cortisol can increase rapidly after hemorrhage without changes in ACTH. Common afferent pathways probably mediate all these mechanisms.

A qualitative study of sexual behaviours among methamphetamine users in Chiang Mai, Thailand: a typology of risk

INTRODUCTION AND AIMSnMethamphetamine (MA) has become the leading drug of abuse in northern Thailand over the past several years, particularly among youth. The current qualitative study explores the relationship between sexual behaviours and MA.nnnDESIGN AND METHODSnBetween March 2002 and January 2003, 48 in-depth interviews with young MA users aged 15-2 years in Chiang Mai. Interviews were transcribed verbatim in Thai and translated into English. Data were analysed inductively using the constant comparative method common to grounded theory methods. Atlas-ti was used for data management. The current analysis was stratified by gender.nnnRESULTSnParticipants were 44% male and the median age was 20 years. At the time of the interviews, 70% were not using MA. A typology of experiences with and feelings about MAs relationship to sexual activity emerged: (1) enhanced libido--individuals who found that MA enhances their sexual experiences (n = 13); (2) decreased libido or no effect--individuals who found that MA detracted from sexual desire (n = 22); and (3) virgins (n = 13).nnnDISCUSSION AND CONCLUSIONSnParticipants reported several distinct patterns of relationship between MA and sex. Tailored interventions are needed that address specific patterns of sexual behaviors among youth in order to promote sustainable safer sex behaviours in this population.

Levels of histaminase and L-DOPA decarboxylase activity in the transition from C-cell hyperplasia to familial medullary thyroid carcinoma.

The distribution of calcitonin, L‐dopa decarboxylase, and histaminase is studied in sectioned total thyroid glands from patients with different stages of familial medullary thyroid carcinoma. In 5 glands with gross carcinoma and in 3 with early microscopic carcinoma the distribution of all three parameters positively correlates (p < .01 for each correlation). In contrast, in 6 glands with C‐cell hyperplasia6 only the distribution of calcitonin and L‐dopa decarboxylase correlates (r = 0.64, p < .01) while those for histaminase vs. calcitonin (r = .17, p = N.S.) and histaminase vs. dopa decarboxylase (r = .03, p = N.S.) do not. In the glands with microscopic carcinoma the peak levels of histaminase occur in the areas of disease as defined by immunohistochemical staining of calcitonin; mean histaminase activity is the only one of the three parameters measured that distinguishes between C‐cell hyperplasia and microscopic carcinoma (p < .005). Immunohistochemical staining of histaminase shows positive cells in glands with gross and microscopic carcinoma, but in none of the glands with hyperplasia alone. Histaminase is thus found in high amounts in some malignant C‐cells only and may be a useful marker to distinguish between hyperplasia and malignancy in thyroids with early C‐cell proliferative disorders.

Ethnographic Process Evaluation: Piloting an HIV Prevention Intervention Program among Injection Drug Users

This study demonstrates an ethnographically critically informed process evaluation of piloting an HIV intervention program targeting injection drug users. The authors used systematic ethnographic methods to identify and evaluate the factors that facilitated or inhibited message diffusion. Findings indicated that communication patterns and strategies advocated in training sessions did not translate immediately into the outreach encounter in the drug use communities. The intervention program was refined and developed based on findings from the ethnographic process evaluation. The authors argue that ethnographic methods provided a dynamic, flexible, and iterative process for evaluating the interventions development and ensuring its cultural relevance.

Health services research as a management tool in the emergency department

Researchers at Johns Hopkins University School of Medicine, with a grant under section 1205 of the Emergency Medical Services Systems (EMSS) Act of 1973 from the National Center for Health Services Research (DHEW), are doing three research projects pertaining to the quality and effectiveness of care and management in the emergency department. Project 1 concerns assessing the impact of categorization of facilities and ambulance and communication improvements on the use of emergency departments and ambulances. Project 2 assesses the impact of triage nursing, patient exit interviews, patient advocacy, nursing audit, walk-in clinics and education of asthmatic patients on emergency department care. Project 3 investigates the effect of specific clinical procedures on patient outcome.

The Control of Adrenal Secretion of Cortisol

Publisher Summary This chapter discusses the control of adrenal secretion of cortisol. The adrenal cortex may be viewed as a combination of at least two endocrine glands, one concerned primarily with the secretion of cortisol and the other primarily with the secretion of aldosterone. The secretion of cortisol is primarily the function of the zona fasciculata, whereas the secretion of aldosterone is primarily the function of the zona glomerulosa. The chapter discusses the control of secretion of cortisol. The adrenal cortex increases its secretion of cortisol in response to a signal of increased presentation of adrenocorticotropin (ACTH) released by the anterior pituitary gland. The control of release of ACTH by the anterior pituitary may best be viewed as a set of nested negative feedback control systems. The secretion of ACTH may be stimulated by a wide variety of inputs and may be inhibited by increased concentrations within the brain or within the pituitary gland itself of cortisol or of ACTH. The chapter describes the median eminence of the hypothalamus, the distribution of ACTH, and the adrenal gland and its secretions.

On the description of physiological systems: Epistemological considerations

Various points of view concerning what is required for a description to be adequate have appeard in the history of physiology since mathematics began to be used for that description. Three main themes are described in the present paper, and the criteria underlying them are examined. Certain additional criteria are considered for judging among the descriptive themes. The proposition is advanced that questions of heuristic value and questions of relevance to major current themes in the discipline tend to dominate consideration. Judged by these criteria, the suggestion is made that an instrumentalist position may be the most satis-factory epistemological one, and that the application to physiology of finite level models may represent a successful example of the application of this position to physiological description.