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PubMed2005

Determination of phenols in water samples by single-drop microextraction followed by in-syringe derivatization and gas chromatography-mass spectrometric detection.

Trace analysis of phenolic compounds in water was performed by coupling single-drop microextraction (SDME) with in-syringe derivatization of the analytes and GC-MS analysis. The analytes were extracted from a 3ml sample solution using 2.5microl of hexyl acetate. After extraction, derivatization was carried out in syringe barrel using 0.5microl of N,O-bis(trimethylsilyl)acetamide. The influence of derivatizing reagent volume, derivatization time and temperature on the yield of the in-syringe silylation was investigated. Derivatization reaction is completed in 5min at 50 degrees C. Experimental SDME parameters, such as selection of organic solvent, sample pH, addition of salt, extraction time and temperature of extraction were studied. Analytical parameters, such as enrichment factor, precision, linearity and detection limits were also determined. The limits of detection were in the range of 4-61ng/l (S/N=3). The relative standard deviations obtained were between 4.8 and 12% (n=5).

Acetates↗
PubMedDate not supplied

Safer injection facility use and syringe sharing in injection drug users.

Safer injection facilities provide medical supervision for illicit drug injections. We aimed to examine factors associated with syringe sharing in a community-recruited cohort of illicit injection drug users in a setting where such a facility had recently opened. Between Dec 1, 2003, and June 1, 2004, of 431 active injection drug users 49 (11.4%, 95% CI 8.5-14.3) reported syringe sharing in the past 6 months. In logistic regression analyses, use of the facility was independently associated with reduced syringe sharing (adjusted odds ratio 0.30, 0.11-0.82, p=0.02) after adjustment for relevant sociodemographic and drug-use characteristics. These findings could help inform discussions about the merits of such facilities.

Blood-Borne Pathogens↗
PubMed1997

Extrashot-ODS, a syringe-type minicolumn sample injector for a reversed-phase high-performance liquid chromatographic column. Application to antiepileptics in human sera.

Extrashot-ODS (EXS-ODS) is a syringe-type minicolumn developed for sample injection into reversed-phase high-performance liquid chromatographic columns. EXS-ODS consists of (a) a stainless-steel needle fitted to an ordinary syringe-loading sample injector for HPLC, (b) a 45-microl minicolumn tube made of polytetrafluoroethylene (PTFE) and packed with ODS-silica and (c) a minicolumn holder made of polystyrene, which is connected to the needle on one side and the other side is shaped so as to be fitted with a solvent syringe. Using the device, we simultaneously analyzed three antiepileptics in 20 microl of human sera. First, we introduced a 20-microl serum specimen diluted with 100 microl of buffer solution into the device and, second, 100 microl of distilled water. Then the device was attached to the HPLC injector and 130 microl of methanol were introduced into the HPLC column through the device. Then, reversed-phase HPLC was conducted in the usual manner, with the chromatogram reading at a wavelength of 210 nm for the assays of 5,5-diphenylhydantoin, phenobarbital and carbamazepine. The results obtained by direct peak-height calibration were comparable to those given by the immunological method.

Anticonvulsants↗
PubMed1999

Knowledge of tuberculosis among drug users. Relationship to return rates for tuberculosis screening at a syringe exchange.

Tuberculosis is an important health issue among drug users. We sought to evaluate active drug users' (DUs) knowledge of tuberculosis (TB) and to assess the relationship between TB knowledge and attitudes and tuberculin skin test (TST) return rates at a syringe exchange program. DUs were recruited at a syringe exchange program in New York City, were interviewed and offered TSTs, and received $15.00 upon returning for TST reading. The questionnaire evaluated knowledge of TB transmission, prevention, and treatment. From March 13, 1995 to January 31, 1996, 610 of 650 (94%) of DUs approached agreed to participate. Of these, 80% had previous TSTs within the past 2 years and 20% were known to be HIV infected. Almost all knew that TB is contagious and more than two thirds knew that TB is treatable and that TB preventive therapy existed. However, fewer than half knew that HIV-related TB could be treated, 30% thought TB could be treated without a medical doctor, and the majority (70%) thought a reactive TST implied infectivity. The rate of return for TST reading was 93%. In multivariate analysis, those who knew that HIV-related TB was curable were more likely to return for TST reading (odds ratio 2.0; 95% confidence interval 1.04 to 3.95; p = .03). The high acceptance and return rates suggest that TB services can be incorporated into syringe exchange programs. However, several important gaps in TB knowledge existed in this population at high risk of TB, which may impact on adherence and which support the need for TB education for drug users.

Adult↗
PubMed2000

Provision of influenza and pneumococcal vaccines to injection drug users at a syringe exchange.

The objective of this study was to evaluate the feasibility, acceptance, and utility of administering influenza and pneumococcal vaccines to active injection drug users at a syringe exchange program (SEP) in New York City. Influenza and pneumococcal vaccines were offered for 1 month. Data on demographics, health status, vaccine awareness, and prior vaccination status were collected using a staff-administered questionnaire. Of 199 participants interviewed 167 (86%) agreed to one or both vaccinations; 24% of study participants had a chronic condition for which vaccination was indicated and 53% had no regular source of medical care; 95% were aware of influenza vaccine while 25% were aware of pneumococcal vaccine (p <.0001). Of those offered the influenza vaccine, 86% accepted it and 70% of those offered pneumococcal vaccine accepted it (p <.001). Influenza and pneumococcal vaccinations were well-accepted by active drug users at a syringe exchange although there was both greater awareness of and acceptance of influenza. Many SEP participants with chronic medical conditions for which these vaccines are indicated did not have a regular source of health care. Syringe exchange programs may be valuable sites to administer respiratory vaccines and other public health interventions to drug injectors not engaged in medical care in other settings.

Adult↗
PubMed1990

Growth of bacteria in prefilled syringes stored in home refrigerators.

Insulin was examined for the rate of bacterial growth after being stored in prefilled syringes in home refrigerators and in a controlled laboratory refrigerator. Home refrigerators were used to simulate conditions that exist in client homes to establish the safety of storing insulin in prefilled syringes in uncontrolled environments. Insulin from each source was inoculated on three different media and incubated at three temperatures in three oxygen environments. A total of 768 cultures were examined. It was found that temperature had a significant effect on the incidence of bacteria. The difference in incident of bacteria between syringes stored in the controlled versus uncontrolled environments was not statistically significant.

Bacteria↗
PubMed1987

Blood glucose and free insulin levels after the administration of insulin by conventional syringe or jet injector in insulin treated type 2 diabetics.

UNLABELLED: The levels of blood glucose and free insulin were compared in 20 diabetic subjects (type 2) receiving one dose of a combination of fast-acting and intermediary-acting insulins in the morning by means of a needle syringe or a jet injector (SICIM, Italy), using minimum possible injecting power. A shift to the left in the free insulin profile, consequential to different pharmacokinetic characteristics of insulin when administered by means of a jet injector, was observed, although no significant differences were seen for free insulin levels. Statistically significantly higher blood glucose values (P less than 0.05) were recorded 6 and 9 h after insulin administration by means of a jet injector, as well as statistically significant higher MBG values (P less than 0.05), thus indicating a faster and shorter effect achieved in comparison to that produced by the syringe injected insulin. CONCLUSIONS: 1. When switching the method of insulin administration in patients from needle syringe to jet injections the power of the jet injector should be increased (it can be set in three different levels). If that is not possible, because of patient skin characteristics then the dose of intermediary acting insulin should be slightly increased. 2. No local or general side-effects were registered using minimum injecting power of jet injector. 3. The results of the controlled poll have shown that this method of insulin administration is less painful and simpler for patients. The great majority of the patients would like to possess a jet injector.

Adult↗
PubMed1997

Professional ideologies and the development of syringe exchange: Wales as a case study.

This paper is derived from an evaluative study of HIV prevention programs for drug injectors across Wales. It considers how different professional territories and ideologies, concepts of drug misuse and models of HIV prevention may influence policy development. The research involved monitoring the introduction and development of agency and community based syringe exchange schemes and initiatives taken by community pharmacists. Interviews with staff, managers and administrators, and descriptions of service history, development and delivery inform the discussion. HIV prevention varied in different areas of Wales depending on the particular professional group involved, local ideologies regarding drug use treatment, and the extent to which HIV prevention was seen either as a specialist area of expertise and specific remit of drug workers or a generic health care task. Drug agencies with an abstinence policy rejected syringe exchange; instead, prevention in those areas developed in ad hoc ways as health care workers and pharmacists attempted to develop a community based service. Drug agencies with a pre-existing harm minimisation model easily integrated syringe exchange into their work and played the major part in establishing the service, but there was difficulty in extending it beyond their professional caseloads. As there were disincentives to use treatment agencies, and their catchment areas were limited, these factors influenced effective service provision.

Attitude of Health Personnel↗
PubMedDate not supplied

Public citizens, marginalized communities: the struggle for syringe exchange in Springfield, Massachusetts.

Syringe exchange programs, which, in order to prevent HIV infections, provide injection drug users with sterile syringes in exchange for used ones, operate at the intersection of conflicting social and political beliefs about disease, drugs, the common good, and the law. This paper describes community opposition that emerged from diverse quarters in response to a proposed syringe exchange program (SEP) in Springfield, Massachusetts. White suburban residents and inner-city African-Americans both drew on concepts of personal responsibility and self-sufficiency as they described their opposition to SEP. Through archival research and in-depth interviews with key community figures, I show how their similar political positions resulted from highly divergent views on the role of government in caring for citizens and communities. These arguments about addiction, HIV, and community both index and turn on the unique relationships with government experienced by a range of social actors.

Adult↗
PubMed2006

Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence.

This first international review of the evidence that needle syringe programs reduce HIV infection among injecting drug users found that conservative interpretation of the published data fulfills six of the nine Bradford Hill criteria (strength of association, replication of findings, temporal sequence, biological plausibility, coherence of evidence, and reasoning by analogy) and all six additional criteria (cost-effectiveness, absence of negative consequences, feasibility of implementation, expansion and coverage, unanticipated benefits, and application to special populations). The Bradford Hill criteria are often used to evaluate public health interventions. The principal finding of this review was that there is compelling evidence of effectiveness, safety, and cost-effectiveness, consistent with seven previous reviews conducted by or on behalf of U.S. government agencies. Authorities in countries affected or threatened by HIV infection among injecting drug users should carefully consider this convincing evidence now available for needle syringe programs with a view to establishing or expanding needle syringe programs to scale.

Cost-Benefit Analysis↗
PubMed1997

History of syringe sharing in prison and risk of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection among injecting drug users in Berlin.

BACKGROUND: Injecting drug users (IDU) are at risk of parenterally transmitted diseases such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection. We investigated whether a history of syringe sharing in prison is a risk factor for these infections. In the longitudinal part of the study, HBV, HCV, and HIV seroincidence rates were determined. METHODS: The participants were recruited by multisite-sampling at different agencies for IDU. Data on risk behaviour were obtained by a standardized questionnaire. Serological markers for HBV, HCV, and HIV were determined. Logistic regression analysis was performed to adjust for confounding effects. RESULTS: A history of syringe sharing in prison was significantly associated with HBV (adjusted prevalence odds ratio [POR] = 3.9, 95% confidence interval [CI]: 2-10), HCV (POR = 9.7, 95% CI: 3-33), and HIV infection (POR = 10.4, 95% CI: 4-29). The HIV seroincidence rate was 5.9 per 100 person-years. None of the IDU receiving methadone maintenance treatment (MMT) seroconverted whereas the HIV incidence was 8.5 among IDU not in MMT (P = 0.01). CONCLUSIONS: The increased risk of HBV, HCV, and HIV infection among IDU who had shared syringes in prison warrants specific preventive action. The longitudinal data suggest that IDU in MMT have a lower risk of HIV infection.

Adult↗
PubMed2003

Secondary syringe exchange among injection drug users.

Syringe-exchange programs (SEPs) have proven to prevent the spread of bloodborne pathogens, primarily human immunodeficiency virus (HIV), among injection drug users (IDUs). In the United States, only about 7% of IDUs have access to and use SEPs. Some IDUs engage in secondary syringe exchange (SSE), meaning that one IDU (a "provider") obtains syringes at an SEP to distribute to other IDUs ("recipients"). This formative qualitative research was conducted to understand why and how IDUs engage in SSE to aid in the development of a large-scale peer HIV prevention intervention. Interviews with 47 IDUs in Oakland and Richmond, California, indicated that SSE was embedded in existing social networks, which provided natural opportunities for peer education. SSE providers reported a desire to help other IDUs as their primary motivation, while recipients reported convenience as their primary reason for using SSE. Building SSE into SEP structures can facilitate an effective provision of risk reduction supplies and information to IDUs who do not access SEPs directly.

Attitude to Health↗
PubMed2003

Impact of monetary incentives on adherence to referral for screening chest x-rays after syringe exchange-based tuberculin skin testing.

INTRODUCTION: Syringe-exchange programs (SEPs) have proven to be valuable sites to conduct tuberculin skin testing among active injection drug users. Chest x-rays (CXRs) are needed to exclude active tuberculosis prior to initiating treatment for latent tuberculosis infection. Adherence of drug users to referral for off-site chest x-rays has been incomplete. Previous cost modeling demonstrated that a monetary incentive to promote adherence could be justified on the cost basis if it had even a modest effect on adherence. METHODS: We compared adherence to referral for chest x-rays among injection drug users undergoing syringe exchange-based tuberculosis screening in New York City before and after the implementation of monetary incentives. RESULTS: From 1995 to 1998, there were 119 IDUs referred for CXRs based on tuberculin skin testing at the SEP. From 1999 to 2001, there were 58 IDUs referred for CXRs with a $25 incentive based on adherence. Adherence to CXR referral within 7 days was 46/58 (79%) among individuals who received the monetary incentive versus 17/119 (14%) prior to the implementation of the monetary incentive (P<.0001; odds ratio [OR]=23; 95% confidence interval [CI]=9.5-57). The median time to obtaining a CXR was significantly shorter among those given the incentive than among those referred without the incentive (2 vs. 11 days, P<.0001). In multivariate logistic regression analysis, use of the incentive was highly independently associated with increased adherence (OR=22.9; 95% CI=10-52). CONCLUSIONS: Monetary incentives are highly effective in increasing adherence to referral for screening CXRs to exclude active tuberculosis after syringe exchange-based tuberculin skin testing. Prior cost modeling demonstrated that monetary incentives could be justified on the cost basis if they had even a modest effect on adherence. The current data demonstrated that monetary incentives are highly effective at increasing adherence in this setting and therefore are justifiable on a cost basis. When health care interventions for drug users require referral off site, monetary incentives may be particularly valuable in promoting adherence.

Adult↗
PubMed2004

Sexual relationships, secondary syringe exchange, and gender differences in HIV risk among drug injectors.

Injection drug use continues to place women at risk for human immunodeficiency virus (HIV) through both risky injecting practices and risky sexual behavior with male injection drug users (IDUs). Although attendance at syringe-exchange programs (SEPs) is protective against HIV, a recent study found that women attending SEPs who exchanged syringes for other people (secondary exchange) were at greater risk for HIV seroconversion, potentially through risky sexual behavior. We examined this question in a sample of 531 IDUs (175 women and 356 men) attending 23 SEPs in California in 2001. Findings indicated that women were more likely than men to engage in secondary exchange and were more likely to have IDU sexual partners. In multivariate analysis among women, secondary exchange was independently associated with distributive syringe sharing, not engaging in receptive sharing, and not exchanging sex for money or drugs. Multivariate analysis among men found that having an IDU sexual partner was associated with secondary exchange. Women's sexual risk behavior was not associated with secondary exchange, and although women's secondary exchange was associated with individual protection for injection-related behaviors, it may increase network risk. More information on network members is needed to understand gender differences in secondary exchange.

Adult↗
PubMed1999

Syringe exchange and risk of infection with hepatitis B and C viruses.

The authors utilized a cohort study among Seattle injection drug users (IDUs) to assess whether participation in a syringe exchange program was associated with incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Susceptible IDU subjects (187 seronegative for antibody to HCV, and 460 seronegative for core antibody to HBV) were identified in drug treatment, corrections, and social service agencies from June 1994 to January 1996, and followed for seroconversion one year later. The subjects included in the analysis were Seattle-King County (Washington State) area IDUs enrolled in a larger multipurpose cohort study, the Risk Activity Variables, Epidemiology, and Network Study (RAVEN Study). There were 39 HCV infections (20.9/100/year) and 46 HBV infections (10.0/100/year). There was no apparent protective effect of syringe exchange against HBV (former exchange users, relative risk (RR) = 0.68, 95% confidence interval (CI) 0.2-2.5; sporadic exchange users, RR = 2.4, 95% CI 0.9-6.5; regular users, RR = 1.81, 95% CI 0.7-4.8; vs. RR = 1.0 for nonusers of the exchange; adjusted for daily drug injection). Neither did the exchange protect against HCV infection (sporadic users, RR = 2.6, 95% CI 0.8-8.5; regular users, RR = 1.3, 95% CI 0.8-2.2; vs. RR = 1.0 for nonusers; adjusted for recent onset of injection and syringe sharing prior to enrollment). While it is possible that uncontrolled confounding or other bias obscured a true beneficial impact of exchange use, these data suggest that no such benefit occurred during the period of the study.

Adult↗
PubMed2001

Cost-effectiveness of syringe exchange as an HIV prevention strategy.

OBJECTIVE: To analyze the cost-effectiveness of New York State-approved syringe exchange programs (SEPs) and estimate the cost-saving potential of these programs. DESIGN AND METHODS: The cost-effectiveness analysis used cost and process data provided by seven SEPs for the calendar year 1996 or the most recent 12-month period available at the time of the study. Alternative estimates of the number of HIV infections prevented were calculated using published data and a simplified circulation model. HIV treatment costs were taken from the literature. RESULTS: A cost-effectiveness ratio of $20,947 per HIV infection averted was calculated based on an estimated 87 HIV infections averted across the seven programs and total program costs of $1.82 million (all amounts given in US dollars). Sensitivity analyses were also performed. Using imputed costs for donated services and estimates of lifetime costs to treat an HIV infection, syringe exchange was demonstrated to be a cost-saving strategy from a societal perspective. CONCLUSIONS: This research demonstrates that syringe exchange is a cost-effective and cost-saving strategy for reducing HIV transmission.

Cost-Benefit Analysis↗
PubMed1993

Effect of loading and syringing on void formation in automixed addition silicone elastomers.

The effect of loading and syringing on void formation in five automixed addition silicones was evaluated by determining the voids created in the first and second halves of material loaded and dispensed from a metal syringe. Impressions were made of a model with six stainless-steel cylinders. The voids were counted at a predetermined site on 3 separate days using a binocular microscope at x 7 magnification. Automixed addition silicones did not confirm the 'last out-fewer bubbles' phenomenon and specific loading and syringing technique did not appear to have a consistent effect on void formation in automixed elastomers.

Dental Impression Materials↗
PubMed1997

The rate of antigenic variation in fly-transmitted and syringe-passaged infections of Trypanosoma brucei.

Rates of antigenic variation were measured in vivo in several populations of cloned lines of Trypanosoma brucei before and after cyclical transmission through tsetse flies. Two cloned lines were adapted for use in laboratory conditions by extensive syringe passaging and rates of antigenic switching/cell/generation were less than 3 x 10(-6) and 1 x 10(-4) in each line. Rates of switching were then determined after fly transmission of the first line and generated per capita rate values of greater than 2 x 10(-3) in three of four populations examined. In the fourth population the switch rate was lower: less than 7 x 10(-5) switches/ cell/generation. These data show that rates of antigenic variation are several orders of magnitude lower in syringe-passaged lines, such as those routinely used in the majority of laboratory studies, compared with most recently fly-transmitted lines. They also show that the reduction in switching rate associated with syringe passaging is reversible and is thus unlikely to be caused by mutation.

Animals↗