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PubMed2001

Investigation of a secondary syringe exchange program for homeless young adult injection drug users in San Francisco, California, U.S.A.

This study investigated an HIV prevention program for homeless young adult injection drug users (IDUs) that combined a secondary syringe exchange program (SEP) with community-level activities. Homeless young IDUs were recruited from street-based settings in San Francisco, and a structured questionnaire was administered. The secondary SEP operated in a circumscribed geographic area, and for analytic purposes respondents were assigned to the intervention site group if they primarily spent time in this area (n = 67), or the comparison site group if they primarily spent time elsewhere (n = 55). Almost all (96%) intervention site youth had used the secondary SEP in the past 30 days and were significantly more likely to regularly use SEP. In bivariate analysis, comparison site IDUs were more likely to share syringes, reuse syringes, share the cotton used to filter drugs, and use condoms with casual sex partners only inconsistently. In multivariate analysis, comparison site remained positively associated with sharing syringes (adjusted odds ratio [AOR], 3.748; 95% confidence interval [CI], 1.406-9.988), reusing syringes (AOR, 2.769; 95% CI,1.120-6.847), and inconsistent condom use with casual sex partners (AOR, 4.825; 95% CI, 1.392- 16.721). This suggests that the intervention was effective in delivering SEP services to homeless young adult IDUs, and that IDUs who frequented the intervention site had a lower HIV risk than comparison group IDUs.

Adult↗
PubMed1991

Influence of concentration and injection volume on the bioavailability of subcutaneous growth hormone: comparison of administration by ordinary syringe and by injection pen.

In order to study whether the bioavailability of subcutaneously injected growth hormone (GH) is dependent on the concentration/volume injected, the relative GH bioavailability was evaluated in 14 GH-deficient patients. In a cross-over study the patients received, in random order two separate subcutaneous GH injections (Norditropin) 4 IU administered by means of an ordinary syringe (4 IU ml) and an injection pen with cartridge (Nordiject 24) (12 IU/ml). Blood samples were drawn over a 14 hr period and assayed for serum concentrations of GH and IGF-I. The mean value (+/- S.D.) of the relative absorption fraction (Fpen/sy) was 1.09 +/- 0.39. Mean values of Cmax were 8.6 ng/ml +/- 4.8 and 8.3 ng/ml +/- 7.5 for syringe and pen respectively. Corresponding values for Tmax were 311 min. +/- 131 for syringe and 309 min. +/- 104 for pen. Although a considerable interindividual variation was seen, the relative absorption fraction did not differ significantly from 1 (2 P = 0.78). Further there was no significant difference in neither Cmax (2 P = 0.39) nor Tmax (2 P = 0.55). IGF-I serum profiles tended to be higher following syringe compared to pen injection (2 P = 0.054). On the basis of this study we conclude that in this dosage regimen. GH bioavailability following pen injection equals that of injection by syringe (i.e. no effect of a three fold increase/decrease in GH concentration/volume respectively).

Adult↗
PubMedDate not supplied

Intraductal collagenase delivery into the human pancreas using syringe loading or controlled perfusion.

Effective intraductal delivery of the enzyme collagenase into the pancreas is crucial to the subsequent ability to isolate viable islets. Most clinical islet transplant centers load the enzyme into the pancreas by retrograde injection using a syringe following cannulation of the pancreatic duct. An alternative approach is to perfuse the pancreas via the pancreatic duct with collagenase solution using a recirculating perfusion device system. This provides control over perfusion pressures and collagenase temperature. This study reports on our evaluation of the delivery of Liberase-HI into the pancreas of 14 consecutive adult multiorgan cadaveric donors. Alternate glands were procured and processed using an identical protocol with the exception of collagenase delivery. The first group of pancreases was loaded using the perfusion technique where cold (4 degrees C) Liberase-HI was perfused at 80 mmHg for 5 min after which the pressure was increased to 180 mmHg. The collagenase solution was then slowly warmed to 35 degrees C, transferred to the dissociation chamber and mechanically dissociated, and then purified using discontinuous gradients of Ficoll. Pancreases in the second group were loaded with collagenase (28-32 degrees C) using the syringe technique before mechanical dissociation and purification. There were no significant differences in pancreas cold ischemia, donor age, body mass index, maximum blood glucose, or serum amylase of the donors between the two groups. Mean collagenase digestion time in the digestion chamber was not different between the two groups; however, the amount of undigested tissue remaining after dissociation was significantly higher in the syringe-loaded group (15.3 +/- 2.6 g vs. 4.6 +/- 2.1 g, mean +/- SEM, p < 0.05). Postdigestion recovery of islets was 471 +/- 83 x 10(3) IE in the perfusion group compared with 391 +/- 57 x 10(3) IE for the syringe-loaded group. Postpurification recovery was higher in the perfused group (379 +/- 45 vs. 251 +/- 28 x 10(3) IE, p < 0.05, two-tailed paired t-test). No difference in in vitro islet viability was observed between the two groups following glucose perifusion with the calculated stimulation index of 4.6 +/- 0.6 for the perfusion group and 4.2 +/- 0.7 for the syringe-loaded group. Controlled perfusion via the pancreatic duct allows the effective delivery of the enzyme achieving maximal distension to all regions of the pancreas leading to an increased recovery of the islets with no detrimental effect on subsequent in vitro islet function.

Adenosine↗
PubMed2004

Long-term effects of syringe exchange on risk behavior and HIV prevention.

The purpose of this study was to assess stability of population-level injection risk behavior over time among participants in a syringe exchange program and compare factors affecting syringe sharing at two points in time. Participants of the Tacoma Syringe Exchange Program were interviewed in 1997 and 2001 using audio computer assisted self-interviewing technology. In each wave of data collection, a random cross section of participants was recruited and interviewed, with no attempt made to follow respondents over time. Rates of injection risk behavior remained stable across the 4-year period, despite increases in factors associated with syringe sharing. Homelessness, rates of depression symptoms, and injection of amphetamines all increased from 1997 to 2001. The central factors associated with syringe sharing in both 1997 and 2001 were depression symptoms and the interaction of younger age with amphetamine injection. The data indicate that the exchange has been able to stabilize risk among a high-risk population for a substantial period of time. This study confirms previous findings that SEPs can play a significant role in the prevention of HIV in marginal and impoverished communities in the United States.

Adult↗
PubMed1995

Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs.

One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Syringe disposal options for injection drug users: a community-based perspective.

This study was a qualitative exploration of syringe disposal interventions for injection drug users (IDUs). Data were collected through in-depth interviews with 26 community members who injected drugs and 32 noninjecting community members in Atlanta, Georgia. Both groups supported syringe exchange programs as syringe disposal interventions, while noninjecting community members favored a one-way drop box. IDUs identified fear of arrest for possession of syringes as the most salient barrier to safe syringe disposal, revealing the negative consequences of drug paraphernalia laws.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Bloody needles: the volumes of blood transferred in simulations of needlestick injuries and shared use of syringes for injection of intravenous drugs.

Residual HIV-infected blood in needles and syringes is a source of HIV infection. Using radiolabelled blood we have stimulated needlestick injuries and sharing of syringes by intravenous drug users and quantified the volumes of blood which could be transferred to recipients in these situations. Up to 0.75 microliters of blood was transferred in needlestick simulations, but there was a large variation. In simulations of needlesharing, seven to ten times more blood was transferred from the index user to the first sharer when 2 ml syringes were used compared with 1 ml syringes. Washing with water was not effective in removing 'infected' blood from a syringe.

HIV Infections↗
PubMedDate not supplied

[Abortion at 10 to 12 weeks using a plastic syringe or electric aspirator].

The study included 170 women subjected to menstrual regulation. The double-valve band syringe was used in 96 and the electric pump (the vacuum source usually used at the Department) in 74 cases. Nearly all the procedures were performed under general anesthesia, using 8 mm, 10 mm or 12 mm plastic rigid cannulae. Three abortions with the hand syringe also required dilatation and curettage, and all three women suffered blood loss exceeding 100 ml. There was one cervical laceration surgically repaired and a case of adnexitis reported among the hand syringe group. Immediate complications occurred in 7.3% of the cases using the hand syringe and in 4.1% of using the electric pump. The mean procedural time was 4.2 minutes and 4.0 minutes, respectively, with the hand syringe and the electric pump. Only three women reported complications or complaints at the follow-up visit, all of them from the electric pump group.

Abortion, Induced↗
PubMed1981

Leaching of 2-(2-hydroxyethylmercapto) benzothiazole into contents of disposable syringes.

A contaminant was found to leach into the contents of two brands of disposable syringes. It was identified as 2-(2-hydroxyethylmercapto) benzothiazole and is believed to be formed during manufacture of the syringes as a result of a reaction between 2-mercaptobenzothiazole, a rubber vulcanization accelerator, and ethylene oxide, used for sterilization. The contaminant was isolated form the rubber plunger-seal and identified using mass, NMR, and UV spectroscopic methods. The amount of contaminant appearing in the contents of syringes was measured; up to 140 micro g was found under clinically relevant conditions. This finding has important implications with respect to the use of these syringes for drug administration and for the collection of blood for drug analyses.

Adsorption↗
PubMed1994

A syringe-based gradient former for linear and exponential gradients.

This report describes a reliable and inexpensive gradient former constructed from disposable plastic syringes. The dual-chamber device produces both linear and exponential gradients which are very reproducible and essentially identical to the theoretical curve. Two identical syringes which serve as a mixing chamber and reservoir chamber are heat sealed at the bottom and glued to a flat plastic support plate. Small holes are drilled into the side walls of the syringes to accommodate an outlet tube and mixing tube. To form linear gradients, equal volumes of solution are placed in both chambers. The solution in the mixing chamber is stirred with a small magnetic stir bar. As starting solution is drawn from the mixing chamber, ending solution is gradually drawn into the mixing chamber to produce a linear gradient. To form exponential gradients a syringe plunger is placed into the mixing chamber to form a fixed volume of starting solution. Ending solution is placed into the reservoir chamber and may be replenished at any time during gradient formation. This allows small gradient formers to produce large volume exponential gradients. These gradient formers, which require only about 10 min to construct, are durable enough to be used many times and inexpensive enough to discard if desired.

Centrifugation, Density Gradient↗
PubMed1986

Follicular aspiration using a syringe suction system may damage the zona pellucida.

The incidence of the formation of cracks in the zona pellucida during aspiration was assessed by comparing two methods of aspirating follicular contents by suction: manual aspiration by syringe and mechanical aspiration by pump. Of 36 patients whose follicles were evacuated manually using syringes, 18 had at least one damaged oocyte. Of 38 other patients whose follicles were aspirated by pump, only one had an oocyte with a cracked zona pellucida. Four patients had their oocytes aspirated by both syringe and pump. In all four, the oocytes were intact when aspirated by the pump, but one oocyte was damaged in three of four cases when the follicles were aspirated using syringes.

Cell Separation↗
PubMed1991

Syringe liposculpture: a two-year experience.

Syringe liposculpture is a method that combines two relatively new techniques of plastic surgery: syringe liposuction and fat grafting. We can reshape the face and the body by removing localized fat deposits and reinjecting this fat where needed. When we do not reinject, we call the technique reduction liposculpture. In 1989 we introduced a new technique--superficial syringe liposculpture--to treat patients with flaccid skin, superficial irregularities or depressions, "cellulite," and liposuction sequelae. The technique combines syringe liposculpture, superficial liposuction, and our method of treating skin irregularities by breaking the fibrous adherences and injecting fat superficially.

Adipose Tissue↗
PubMed1993

Derangement of composite filler distribution inside syringe-type delivery systems.

Used and almost emptied syringes of two brands of composites contained material close to the pestle-head that appeared to be more granular and dry, as compared to the composite obtained from unused syringes. The present results suggest that a derangement of filler and matrix phases occurred inside the used syringes when compared to unused controls. Stress imposed on the composite material inside the unused syringes resulted in a comparable derangement of filler and matrix phases. Although this derangement was limited, the effect could contribute to intra- and interlaboratory scattering of data.

Analysis of Variance↗
PubMed1992

Sterility of refrigerated injectable collagen syringes after injection of patient.

BACKGROUND: Injectable collagen has been used for more than 15 years to correct soft tissue cosmetic defects. After injection, the collagen remaining in the syringe is often refrigerated for later use in the same patient, despite manufacturer and Food and Drug Administration recommendations to discard the unused collagen. OBJECTIVE: This study examined the incidence of bacterial contamination of stored collagen. METHODS: Syringe needle tips and collagen from 50 previously used syringes containing either Zyderm I, Zyderm II, or Zyplast were cultured separately under aerobic and anaerobic conditions. Bacterial isolates were identified. RESULTS: Propionibacterium acnes was cultured from 7 of 50 needle tips. One positive needle tip culture grew both P. acnes and Staphylococcus aureus. Bacteria were isolated from only one collagen sample that grew a nonhemolytic streptococcus that may have represented a laboratory contaminant. CONCLUSION: Syringes of collagen stored for repeated use rarely become contaminated with bacteria despite frequent contamination of their needle tips. Skin abscesses after collagen injection should be cultured under anaerobic, as well as aerobic, conditions so that infections caused by P. acnes will not be missed.

Collagen↗
PubMed1996

Syringe-mediated drug sharing among injecting drug users: patterns, social context and implications for transmission of blood-borne pathogens.

Drug injectors are at risk for infection with human immunodeficiency virus (HIV) and other blood-borne pathogens through the exchange of (infected) blood resulting from unhygienic injecting practices. Research attention and public discussion have focused primarily on the sharing of syringes and needles. While the focus on syringe sharing has sparked important interventions (bleach distribution, syringe exchange) it may have obscured the social relationship in which injecting equipment is used. Drug sharing plays a crucial role in the social organization of the drug using subculture. In this paper, various drug sharing practices and other distinguishable aspects of the injecting process-collectively termed Syringe-Mediated Drug Sharing (SMDS)-are described. All of these behaviors may put injecting drug users (IDUs) at risk for infection. The purpose of this paper is to stimulate scientific inquiry into SMDS behaviors and the social contexts which shape them. Descriptions are based primarily on field studies in Rotterdam and New York City. Recommendations for safer injecting training and education are proposed, as are directions for future research.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Lack of syringe toxicity to amniotic fluid cells in culture.

Toxicity to amniotic fluid from many brands of syringes has been reported in the past few years. Thirty amniocentesis samples were exposed to Becton-Dickinson syringes for varying lengths of time and evaluated for growth rate. Six amniocentesis samples were exposed to the syringes for prolonged periods at varying temperatures and also evaluated for growth rate. No evidence of syringe toxicity was found for exposure periods up to 24 h, regardless of storage temperature.

Amniotic Fluid↗
PubMed2006

A pilot study to measure the compressive and tensile forces required to use retractable intramuscular safety syringes.

BACKGROUND: A pilot study was conducted at the Tampa Veterans Administration Patient Safety Center. The objective was to determine the forces required to operate retractable safety syringes to evaluate potential adverse occupational health and patient safety issues. METHODS: Four brands (100 each) of retractable syringes were tested, using a digital force gauge, in air and in a simulated patient material (SPM). Compressive and tensile forces were measured while activating the retraction mechanism and withdrawing saline into the syringe barrel, respectively. RESULTS: The mean compressive force was greater in SPM than in air in all 4 devices. There was a statistically significant compressive force difference between activation in air and SPM in devices 1 and 2 (P </= .05). The tensile forces for all devices were lower than the compressive forces. Analysis of variance was used to compare the groups, and the results showed that the means were significantly different (P < .001). CONCLUSION: This pilot study has implications for device selection, training for users, design issues for manufacturers, and patient safety, as well as potential for future needlestick and ergonomic injuries. We recommend replication of this study with a computer-controlled force testing apparatus, and by testing multiple needle and syringe sizes.

Accidents, Occupational↗
PubMed2006

Lack of autodisable syringe use and health care indicators are associated with high HIV prevalence: an international ecologic analysis.

PURPOSE: A growing body of evidence strongly suggests that unsafe health care is an important factor driving the human immunodeficiency virus (HIV) epidemic in sub-Saharan Africa. We investigate whether nonuse of autodisable syringes and other health care indicators predict national HIV prevalence. METHODS: These ecologic analyses use countries as study units in descriptive analyses and regression analyses. Two sets of observations are used: (i) all low- and lower-middle-income countries, and (ii) all sub-Saharan African countries with available data. RESULTS: In the descriptive analysis, health care indicators (health expenditures, vaccination coverage, and use of autodisable syringes) have a U-shaped relationship with HIV prevalence in the larger sample. Greater density of physicians is associated with lower HIV prevalence. In sub-Saharan Africa, antenatal care coverage is associated with increasing HIV prevalence. In regression analyses, nonuse of autodisable syringes is associated robustly with greater HIV prevalence in all models. For the larger sample, greater HIV prevalence also is associated with higher Gini Index, less female economic activity, less urbanization, and less percentage of Muslims. In sub-Saharan Africa, tetanus vaccination coverage has a U-shaped association with HIV prevalence. Low physician density and percentage of Muslims are associated with HIV prevalence. Other economic and health care indicators and epidemic age are not significant correlates of HIV prevalence. CONCLUSIONS: This analysis adds to the other sources of evidence for health care transmission of HIV (in sub-Saharan Africa and regions with similar epidemiologic characteristics) by showing that health care indicators (failure to use autodisable syringes and greater tetanus coverage) are associated robustly with greater HIV prevalence. We recommend that resources be reallocated to address health care transmission of HIV/acquired immunodeficiency syndrome.

Africa South of the Sahara↗