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At least 811 records · Page 45Linked to original sources
PubMed1996

HIV incidence among injecting drug users in New York City syringe-exchange programmes.

BACKGROUND: There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non-participants. METHODS: We used meta-analytic techniques to combine HIV incidence data from injecting drug users in three studies: the Syringe Exchange Evaluation (n = 280), in which multiple interviews and saliva samples were collected from participants at exchange sites; the Vaccine Preparedness initiative cohort (n = 133 continuing exchanges and 188 non-exchangers, in which participants were interviewed and tested for HIV every 3 months; and very-high-seroprevalence cities in the National AIDS Demonstration Research (NADR) programme (n = 1029), in which street-recruited individuals were interviewed and tested for HIV every 6 months. In practice, participants in the NADR study had not used syringe exchanges. FINDINGS: HIV incidence among continuing exchange-users in the Syringe Exchange Evaluation was 1.58 per 100 person-years at risk (95% CI 0.54, 4.65) and among continuing exchange-users in the Vaccine Preparedness Initiative it was 1.38 per 100 person-years at risk (0.23, 4.57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5.26 per 100 person-years at risk (2.41, 11.49), and in the NADR cities, 6.23 per 100 person-years at risk (4.4, 8.6). In a pooled-data, multivariate proportional-hazards analysis, not using the exchanges was associated with a hazard ratio of 3.35 (95% CI 1.29, 8.65) for incident HIV infection compared with using the exchanges. INTERPRETATION: We observed an individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs.

Adult↗
PubMed1994

Methodology for data collection to study prehospital cardiac arrest in New York City: the PHASE methodology. PreHospital Arrest Survival Evaluation Group.

STUDY OBJECTIVE: To describe an effective methodology for the investigation of prehospital cardiac arrest in large cities. DESIGN: Observational cohort study. SETTING: New York City emergency medical services system. PARTICIPANTS: All cardiac arrests dispatched by the 911 system between October 1, 1990, and March 31, 1991. INTERVENTIONS: Trained paramedics performed immediate postarrest interviews with prehospital and hospital care providers using a standardized data collection instrument. RESULTS: Of 3,239 consecutive, confirmed cardiac arrests in which resuscitation was attempted, 2,329 (72%) were of cardiac etiology. Information was sought for 15 of the 17 core events and times recommended by the Utstein Consensus Conference Data were obtained in more than 98% of cases for all except one of these core events and times. One core time yielded data in 96% of cases. All patients were followed until death or discharge home. None were lost to follow-up. CONCLUSION: Concurrent, interactive acquisition of prehospital cardiac arrest data in a large urban setting captured over 98% of the core data recommended for completion of the Utstein template. This methodology may be a suitable means of investigating prehospital cardiac arrest in large cities.

Adult↗
PubMed1996

Factors associated with unrecognized HIV-1 infection in an inner-city emergency department.

STUDY OBJECTIVE: To determine the prevalence of and risk factors associated with unrecognized HIV-1 infection among medical patients presenting to an inner-city emergency department. METHODS: We conducted anonymous HIV-1 testing in subjects interviewed for risk behaviors and knowledge of HIV status at an inner-city ED in the Bronx, New York. Our subjects were consecutive adult medical patients in noncritical condition (N = 1,744) who were evaluated by three physicians providing primary emergency care. Each patient was given a structured interview for demographic characteristics, risk behaviors, and knowledge of HIV status. Excess serum, drawn for clinical purposes, was linked without identifiers to responses and tested for antibodies to HIV-1. In subjects who denied HIV infection, we tested associations with seropositivity using univariate analyses and logistic-regression techniques (multivariate). RESULTS: Of the 1,744 patients interviewed, 656 (37.6%) reported HIV risk behaviors. Of 970 tested for HIV-1 antibodies, 125 (12.9%) were seropositive. The prevalence of HIV-1 infection among those who denied known infection was 4.0% (35 of 875). In the multivariate model, independent predictors of unrecognized HIV-1 infection were age 35 to 44 years, crack cocaine use, history of syphilis, and ED diagnosis of an infection not necessarily related to HIV infection. Unrecognized HIV-1 infection was more likely among patients admitted to the hospital, but 21 of the 35 with unrecognized infection (60%) were not admitted and in 9(25.7%) no risk factors were identified. CONCLUSION: More than one third of patients who visited one inner-city ED acknowledged HIV risk behaviors. One quarter of patients with unrecognized HIV-1 infection reported no identifiable risk factors. Easily accessible HIV counseling and testing should be considered in EDs in areas serving persons at risk for HIV infection.

Adolescent↗
PubMed2001

Assessment of air pollution in Nagasaki City: determination of polycyclic aromatic hydrocarbons and their nitrated derivatives, and some metals.

Air pollutants such as polycyclic aromatic hydrocarbons (PAHs), their nitrated derivatives (NPAHs), and some metals on airborne particles in Nagasaki city, Japan were determined over a period of 12 months by high-performance liquid chromatography with chemiluminescence, fluorescence and flameless atomic absorption spectrometry. The average concentrations (range) were 18.24 (4.07-41.54) ng/m3 for total PAHs, 0.91 (0.23-4.10) pg/m3 for NPAHs, 7.95 (1.71-16.31) ng/m3 for Pb, 11.56 (3.35-24.96) ng/m3 for Mn and 3.79 (0.97-14.71) ng/m3 for Ni (n = 136). The toxic equivalency factors adjusted concentration of total PAHs determined in Nagasaki city area was 2.33 ng/m3. Concentrations of total PAHs and NPAHs in winter were higher than those in summer. In a weekly variations study, total PAHs and NPAHs concentrations, as well as traffic volume showed a similar tendency with all values higher during weekdays and lower at the weekend. The correlation coefficients between total PAHs or NPAHs and traffic volume were 0.781 and 0.818, respectively. These results suggested that one of the main sources for NPAHs and PAHs in a city area might be motor vehicles.

Air Pollutants↗
PubMed1998

Residential segregation and mortality in New York City.

The objective of this research was to determine the effect of residential racial segregation on all-cause and cardiovascular disease mortality in New York City. A cross-sectional study of residents in New York City was conducted linking mortality records from 1988 through 1994, to the 1990 United States Census data stratified by zipcode. All-cause and cardiovascular disease mortality rates for non-Hispanic blacks and whites were estimated by zipcode. Zipcodes were aggregated according to the degree of residential segregation (predominantly (> or = 75%) white and black areas) and mortality rates were compared. Multiple regression analysis was used to associate population characteristics with mortality. In New York City, although overall mortality rates of blacks exceed whites, these rates varied substantially by locality according to the pattern of racial segregation. Whites living in the higher (mainly white) socioeconomic areas had lower mortality rates than whites living in predominantly black areas (1473.7 vs 1934.1 for males, and 909.9 vs 1414.7 for females for all-cause mortality). This was true for all age groups. By contrast, elderly blacks living in black areas, despite their less favorable socioeconomic status, had lower mortality rates for all-cause, total cardiovascular disease, and coronary heart disease, than did those living in white areas, even after adjusting for available socioeconomic variables. Racial segregation in residence is independently associated with mortality. Within racially segregated areas, members of the dominant group, for all age, among whites and elderly blacks, enjoy outcomes superior both to members of the minority racial group of their community, and to members of the same race residing in other areas, where they are in the minority, independent of socio-economic status.

Adult↗
PubMed2003

Common predictors of cigarette smoking, alcohol use, aggression, and delinquency among inner-city minority youth.

The present study examined the prevalence rates and common predictors of substance use, aggression, and delinquency among inner-city minority youth entering middle school. A survey was administered to sixth grade students (N=5442) from 42 New York City schools. Aggressive behaviors were reported most frequently, followed by delinquent behaviors, alcohol use, and cigarette smoking. Across all behavioral outcomes, social and environmental influences explained the largest proportion of variance, followed by individual characteristics and skills, bonding to conventional institutions, and demographic variables. For the majority of predictor variables, there was substantial overlap in patterns of prediction across outcomes. These findings indicate that several factors that correspond to the predominant psychosocial theories of adolescent development explain variation across different problem behavior outcomes among inner-city minority youth.

Adolescent↗
PubMed1991

Time trends in neonatal mortality among twins and singletons in New York City, 1968-1986.

The objective of this study was to compute yearly neonatal mortality rates (NMRs) in twins and compare these to rates in singletons during the same time period. The focus was on time trends in birthweight-specific twin mortality in the birth population of New York City during the years 1968 to 1986. The study population was all twin livebirths greater than or equal to 500 g birthweight (N = 45,605), with a comparison group of all singleton livebirths in the same birthweight range (N = 2,191,144). Data came from the New York City Department of Health's computerized vital records on livebirths and infant deaths. Between 1968 and 1986 the crude NMR declined 39% in twins and 47% in singletons. In twins there were birthweight-specific declines of 69% to 84% between 1000 g and 2499 g. However, there was only a 19% decline in the twin NMR over 2499 g. This contrasts with a 50% decline in the singleton NMR over 2499 g. In New York City, modern medical care has been remarkably successful in lowering the NMR in low birthweight twins. However, more effort must be made to understand the etiology of perinatal problems in twins with birthweights greater than 2500 g.

Birth Weight↗
PubMed2004

Community outreach to patients with AIDS at the end of life in the inner city: reflections from the trenches.

Indigenous community health outreach workers (CHWs), who serve as a bridge between underserved, difficult-to-reach minority populations and health professionals, can play a critical role in bringing palliative care to patients dying of AIDS and other illnesses in the inner city. Although the contribution of CHWs in the delivery of "curative" and preventive services has been well established, little attention has been given to CHWs in palliative care. Integrating the medical literature with experiences of a team providing HIV palliative care in the Bronx, a descriptive typology of critical stages and components in the work of CHWs in end-of-life care in the inner city is presented. A longitudinal case narrative, told from the perspective of the CHW, is used to demonstrate the richness and complexity of the CHW's role. The article concludes with a description of the experience of the CHW, straddling two worlds--the world of the inner city patient and the world of the health care providers--and explores the special characteristics of the individuals who can fill this vital role in palliative care.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Micrometeorological measurements of the urban heat budget and CO2 emissions on a city scale.

Direct measurements of urban CO2 emissions and heat fluxes are presented, made using the eddy covariance technique. The measurements were made from the top of a tower, approximately 65 m above the street level of Edinburgh, Scotland, and the fluxes are representative of footprint source areas of several square kilometers. The application of a stationarity test and spectral analysis techniques shows that at this height, the stationarity criterion for eddy covariance is fulfilled for wind directions from the city center for 93% of the time, while for other wind directions this declines to 59%, demonstrating that pollutant fluxes from urban areas can be measured. The average CO2 emission from the city center was 26 micromol m(-2) s(-1) (10 kt of C km(-2) yr(-1)), with typical daytime peaks of 50-75 and nighttime values of 10 micromol m(-2) s(-1). The correlation between CO2 emission and traffic flow is highly significant, while residential and institutional heating with natural gas are estimated to contribute about 39% to the emissions during the day and 64% at night. An analysis of the energy budget shows that, during the autumn, fossil fuel combustion within the city contributed one-third of the daily anthropogenic energy input of 3.8 MJ m(-2) d(-1), with the remainder coming from other energy sources, dominated by electricity. Conversely, the total energy input in late spring (May/June) was found to be approximately half this value.

Air Pollutants↗
PubMed2004

Co-control of urban air pollutants and greenhouse gases in Mexico City.

This study addresses the synergies of mitigation measures to control urban air pollutant and greenhouse gas (GHG) emissions, in developing integrated "co-control" strategies for Mexico City. First, existing studies of emissions reduction measures--PROAIRE (the air quality plan for Mexico City) and separate GHG studies--are used to construct a harmonized database of options. Second, linear programming (LP) is developed and applied as a decision-support tool to analyze least-cost strategies for meeting co-control targets for multiple pollutants. We estimate that implementing PROAIRE measures as planned will reduce 3.1% of the 2010 metropolitan CO2 emissions, in addition to substantial local air pollutant reductions. Applying the LP, PROAIRE emissions reductions can be met at a 20% lower cost, using only the PROAIRE measures, by adjusting investments toward the more cost-effective measures; lower net costs are possible by including cost-saving GHG mitigation measures, but with increased investment. When CO2 emission reduction targets are added to PROAIRE targets, the most cost-effective solutions use PROAIRE measures for the majority of local pollutant reductions, and GHG measures for additional CO2 control. Because of synergies, the integrated planning of urban-global co-control can be beneficial, but we estimate that for Mexico City these benefits are often small.

Air Pollutants↗
PubMed2004

Vehicle traffic as a source of particulate polycyclic aromatic hydrocarbon exposure in the Mexico City metropolitan area.

Surface properties of aerosols in the Mexico City metropolitan area have been measured in a variety of exposure scenarios related to vehicle emissions in 2002, using continuous, real-time instruments. The objective of these experiments is to describe ambient and occupational particulate polycyclic aromatic hydrocarbon (PAH) concentrations associated with vehicular traffic and facilities using diesel vehicles. Median total particulate PAH concentrations along Mexico City's roadways range from 60 to 910 ng m(-3), averaged over a minimum of 1 h. These levels are approximately 5 times higher than concentrations measured in the United States and among the highest measured ambient values reported in the literature. The ratio of particulate PAH concentration to aerosol active surface area is much higher along roadways and in other areas of fresh vehicle emissions, compared to ratios measured at sites influenced more by aged emissions or noncombustion sources. For particles freshly emitted by vehicles, PAH and elemental carbon (EC) concentrations are correlated because they both originate during the combustion process. Comparison of PAH versus EC and active surface area concentrations at different locations suggests that surface PAH concentrations may diminish with particle aging. These results indicate that exposure to vehicle-related PAH emissions on Mexico City's roadways may present an important public health risk.

Aerosols↗
PubMed2002

H. pylori infection and genotyping in patients undergoing upper endoscopy at inner city hospitals.

Kings County Hospital (KCH), and St. John's Episcopal Hospital (SJH) are inner-city hospitals in New York City serving predominantly minority populations. Staten Island University Hospital (SIUH) serves a predominantly middle-class Caucasian population. We examined H. pylori (HP) infection in patients undergoing upper endoscopy at these hospitals. Two gastric biopsies were obtained from each patient. One biopsy was examined by histology or the rapid urease test for the presence of HP. The other was subjected to analysis by PCR to detect HP DNA and to identify putative HP virulence factors. Of 200 subjects, 54% were African-American, 10% were Hispanic, and 36% were Caucasian. HP infection rates in African-American, Hispanic, and Caucasian patients were 43%, 20%, and 11%, respectively. Many of the African-American patients are recent immigrants from the Caribbean Islands. In these patients, an inverse relationship was observed between HP infection and the number of years living in the United States. Higher levels of HP infection were observed in patients with duodenitis and peptic ulcer disease. With respect to HP virulence factors, the vacA s1b and m1 alleles, as well as the iceA2 allele were the predominant alleles expressed in HP-positive samples obtained from African-Americans. The cagA gene was detected in 81% of HP-positive samples. However, CagA positivity was not related to any specific gastrointestinal disorder. Our findings indicate that among several ethnic groups served by three hospitals, African-American patients have the highest rate of HP infection. Moreover, in AfricanAmerican patients undergoing endoscopy: (1) HP infection was inversely related to the number of years the patients have been living in the USA; (2) HP infection rates were higher in patients diagnosed with duodenitis and peptic ulcer disease versus other disorders; (3) expression of the CagA gene was not associated with any specific gastroduodenal disorder; and (4) there was little allelic heterogeneity with respect to VacA and IceA subtypes. These findings suggest that inner-city African-Americans are more likely to be infected with HP and suffer from more serious gastroduodenal disorders than other ethnic groups.

Black or African American↗
PubMed2001

Immune and interferon status in schoolchildren living in cities with different anthropogenic load.

Examinations of 6-11-year healthy children living in industrial cities of the Orenburg region revealed a close relationship between ecological status of the territory and some immunity parameters such as immune deficiency, interferon content, and formation of postvaccinal immunity with live measles vaccine. The most pronounced changes in the immune status and decreased postvaccinal immunity were found in a city with the greatest anthropogenic load. Changes in interferon status were similar in all cities: a 2-fold increase of serum interferon and suppressed production of interferon-alpha and interferon-gamma.

Air Pollutants↗
PubMed2002

Did Nile flooding sink two ancient cities?

The discovery of the two cities of Herakleion and East Canopus under the waters of the Bay of Abu Qir (east of Alexandria, Egypt) stirred worldwide attention when it was first announced in the summer of 2000. Their disappearance some 1,250 years ago has been ascribed by Stanley, Goddio and Schnepp to a strong Nile flood that caused riverbank failure and the destruction of the two cities, rather than to the action of earthquakes, as was first proposed when the ruins were discovered. But I believe that this interpretation is flawed, because no flood could have reached the Abu Qir Bay at the time of the disappearance of the two cities, as the Canopic branch of the Nile, along whose banks they were situated, had dried to a trickle more than 200 years earlier.

Archaeology↗
PubMed1999

The effect of wind direction on the observed size distribution of particle adsorbed polycyclic aromatic hydrocarbons on an inner city sampling site.

An investigation of the variability in the size distribution of particle adsorbed polycyclic aromatic hydrocarbons (PAHs) on an inner city sampling site showed differences depending on the wind direction. Particle size distributions of PAHs from outdoor air sampling were measured in Munich from 1994 to 1997. The sampling site is located northeast of a crossing with heavy traffic and southwest of a large inner city park. Depending on the wind direction, three different size distributions of particle adsorbed PAHs were observed. The maximum PAH concentration on very small particles (geometric mean diameter 75 nm) was observed with wind from west to southwest coming directly from the crossing area or the roads with heavy traffic. The maximum PAH concentration on particles with geometric mean diameter of 260 nm was found on days with wind from the built-up area north of the sampling site. On particles with geometric mean diameter of 920 nm the maximum PAH concentration was found on days with main wind directions from northeast to east. On these days the wind is blowing from the direction of the city park nearby. The distribution of particle adsorbed PAHs within different particle size classes is substantially influenced by the distance of the sampling site from strong sources of PAH loaded particulate matter.

Cities↗
PubMed2006

Variability in concentrations of potentially toxic elements in urban parks from six European cities.

Use of a harmonised sampling regime has allowed comparison of concentrations of copper, chromium, nickel, lead and zinc in six urban parks located in different European cities differing markedly in their climate and industrial history. Wide concentrations ranges were found for copper, lead and zinc at most sites, but for chromium and nickel a wide range was only seen in the Italian park, where levels were also considerably greater than in other soils. As might be expected, the soils from older cities with a legacy of heavy manufacturing industry (Glasgow, Torino) were richest in potentially toxic elements (PTEs); soils from Ljubljana, Sevilla and Uppsala had intermediate metal contents, and soils from the most recently established park, in the least industrialised city (Aveiro), displayed lowest concentrations. When principal component analysis was applied to the data, associations were revealed between pH and organic carbon content; and between all five PTEs. When pH and organic carbon content were excluded from the PCA, a distinction became clear between copper, lead and zinc (the "urban" metals) on the one hand, and chromium and nickel on the other. Similar results were obtained for the surface (0-10 cm depth) and sub-surface (10-20 cm depth) samples. Comparisons with target or limit concentrations were limited by the existence of different legislation in different countries and the fact that few guidelines deal specifically with public-access urban soils intended for recreational use.

Cities↗
PubMed1978

Medicaid-funded private psychiatric care in New York City. The role of foreign-trained physicians.

Data were obtained from the tax records and the Professional Registry maintained by the New York City Department of Health as well as from the Biographical Directory of the American Psychiatric Association to determine which psychiatrists were providing care under the Medicaid Program and how they compare with the pool of psychiatric practitioners in New York City. The data reveal that psychiatrists educated in foreign medical schools provide disproportionately more care to Medicaid recipients than would be anticipated from their numbers, and are a majority of those who received more than +30,000 in payments in 1976. Furthermore, these psychiatrists account for 80 per cent of those delivering care at the two largest "shared health facilities," commonly referred to as "Medicaid mills." These findings indicate that although the Title XIX Program has facilitated the access of the poor to the private psychiatric sector, in New York City their access is biased toward treatment by foreign-educated psychiatrists.

Foreign Medical Graduates↗
PubMed1993

The emergence of drug-resistant tuberculosis in New York City.

BACKGROUND: In the past decade the incidence of tuberculosis has increased nationwide and more than doubled in New York City, where there have been recent nosocomial outbreaks of multidrug-resistant tuberculosis. METHODS: We collected information on every patient in New York City with a positive culture for Mycobacterium tuberculosis during April 1991. Drug-susceptibility testing was performed at the Centers for Disease Control and Prevention. RESULTS: Of the 518 patients with positive cultures, 466 (90 percent) had isolates available for testing. Overall, 33 percent of these patients had isolates resistant to one or more antituberculosis drugs, 26 percent had isolates resistant to at least isoniazid, and 19 percent had isolates resistant to both isoniazid and rifampin. Of the 239 patients who had received antituberculosis therapy, 44 percent had isolates resistant to one or more drugs and 30 percent had isolates resistant to both isoniazid and rifampin. Among the patients who had never been treated, the proportion with resistance to one or more drugs increased from 10 percent in 1982 through 1984 to 23 percent in 1991 (P = 0.003). Patients who had never been treated and who were infected with the human immunodeficiency virus (HIV) or reported injection-drug use were more likely to have resistant isolates. Among patients with the acquired immunodeficiency syndrome, those with resistant isolates were more likely to die during follow-up through January 1992 (80 percent vs. 47 percent, P = 0.02). A history of antituberculosis therapy was the strongest predictor of the presence of resistant organisms (odds ratio, 2.7; P < 0.001). CONCLUSIONS: There has been a marked increase in drug-resistant tuberculosis in New York City. Previously treated patients, those infected with HIV, and injection-drug users are at increased risk for drug resistance. Measures to control and prevent drug-resistant tuberculosis are urgently needed.

Acquired Immunodeficiency Syndrome↗