The impact of legalizing syringe exchange programs on arrests among injection drug users in California.
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Legislation passed in 2000 allowed syringe exchange programs (SEPs) in California to operate legally if local jurisdictions declare a local HIV public health emergency. Nonetheless, even in locales where SEPs are legal, the possession of drug paraphernalia, including syringes, remained illegal. The objective of this paper is to examine the association between the legal status of SEPs and individual arrest or citation for drug paraphernalia among injection drug users (IDUs) in California from 2001 to 2003. Using data from three annual cross-sections (2001-03) of IDUs attending 24 SEPs in 16 California counties (N = 1,578), we found that overall, 14% of IDUs in our sample reported arrest or citation for paraphernalia in the 6 months before the interview. Further analysis found that 17% of IDUs attending a legal SEP (defined at the county level) reported arrest or citation for drug paraphernalia compared to 10% of IDUs attending an illegal SEP (p = 0.001). In multivariate analysis, the adjusted odds ratio of arrest or citation for drug paraphernalia was 1.6 [95% confidence interval (CI) = 1.2, 2.3] for IDUs attending legal SEPs compared to IDUs attending illegal SEPs, after controlling for race/ethnicity, age, homelessness, illegal income, injection of amphetamines, years of injection drug use, frequency of SEP use, and number of needles received at last visit. IDUs attending SEPs with legal status may be more visible to police, and hence, more subject to arrest or citation for paraphernalia. These findings suggest that legislative efforts to decriminalize the operation of SEPs without concurrent decriminalization of syringe possession may result in higher odds of arrest among SEP clients, with potentially deleterious implications for the health and well-being of IDUs. More comprehensive approaches to removing barriers to accessing sterile syringes are needed if our public health goals for reducing new HIV/HCV infections are to be obtained. (+info)
The impact of armed conflict on protected-area efficacy in Central Africa.
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What determines the vulnerability of protected areas, a fundamental component of biodiversity conservation, to political instability and warfare? We investigated the efficacy of park protection at Garamba National Park (Democratic Republic of Congo) before, during and after a period of armed conflict. Previous analysis has shown that bushmeat hunting in the park increased fivefold during the conflict, but then declined, in conjunction with changes in the sociopolitical structures (social institutions) that controlled the local bushmeat trade. We used park patrol records to investigate whether these changes were facilitated by a disruption to anti-poaching patrols. Contrary to expectation, anti-poaching patrols remained frequent during the conflict (as bushmeat offtake increased) and decreased afterwards (when bushmeat hunting also declined). These results indicate that bushmeat extraction was determined primarily by the social institutions. Although we found a demonstrable effect of anti-poaching patrols on hunting pressure, even a fourfold increase in patrol frequency would have been insufficient to cope with wartime poaching levels. Thus, anti-poaching patrols alone may not always be the most cost-effective means of managing protected areas, and protected-area efficacy might be enhanced by also working with those institutions that already play a role in regulating local natural-resource use. (+info)
Systematic review of the prevention incentives of insurance and regulatory mechanisms for occupational health and safety.
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OBJECTIVES: The objective of this study was to determine the strength of evidence on the effectiveness of two policy levers-the experience rating of workers' compensation insurance and the enforcement of occupational health and safety regulation-in creating incentives for firms to focus on health and safety issues. METHODS: An extensive systematic literature review was undertaken in an effort to capture both published and grey literature studies on the topic. Studies that met specific subject-matter and methods criteria underwent a quality assessment. A qualitative approach to evidence synthesis, known as "best-evidence" synthesis, was used. This method ranks the strength of evidence on a particular topic on the basis of the number, quality, and consistency of studies on the topic. RESULTS: There was moderate evidence that the degree of experience rating reduces injuries, limited to mixed evidence that inspections offer general and specific deterrence and that citations and penalties aid general deterrence, and strong evidence that actual citations and penalties reduce injuries. CONCLUSIONS: Although experience rating is a key policy lever of those providing workers' compensation insurance, there is much to be learned about its merits. Few studies have concerned the topic, and most have used crude proxy measures or exploited natural experiments. There have been many more studies on the merits of regulation enforcement, even though here too measures were often crude. Nonetheless, this synthesis indicates that general deterrence is less effective in reducing injury incidence and severity, whereas specific deterrence with regard to citations and penalties does indeed have an impact. (+info)
Do electrical stun guns (TASER-X26) affect the functional integrity of implantable pacemakers and defibrillators?
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AIMS: High voltage electric current can adversely affect pacemakers (PM) and implantable cardioverter-defibrillator (ICD). The standard shock from an electrical stun gun (TASER- X26, TASER International, Scottsdale, AZ) consists of a 5-s long application of high voltage, low current pulses at 19 pulses per second. Its effect on the functional integrity of PM and ICDs is unknown. METHODS AND RESULTS: We tested the functional integrity of nine PMs and seven ICDs in a swine model after a standard stun gun shock. A transvenous, dual coil, bi-polar ICD lead (St Jude-SP01) and a PM lead were placed in the right ventricular (RV) apex and connected to pulse generators buried in the pre-pectoral pocket. The two darts were placed at the sternal notch (SN) and apex of the heart bracketing the device pocket. Standard neuromuscular incapacitating (NMI) discharges were delivered. Functional parameters of the devices and leads were checked before and after the shocks. The mean pacing thresholds, sensing thresholds, pacing impedances, and defibrillation coil impedances of the ICD lead were similar before and after the shocks. Similarly, pacing thresholds, sensing thresholds, and impedances of the PM lead were not significantly different before and after the shocks. No significant change was noted in battery voltage and projected longevity. Implantable cardioverter-defibrillator generators detected the NMI impulses at a mean cycle length of 176 +/- 20 ms with detection to charge time of 5.9 +/- 1.5 s. Shock delivery was aborted in all tests as tachycardia detection abruptly terminated at the end of the 5 s NMI application. None of the devices exhibited power on reset (POR), elective replacement indicator (ERI), or noise mode behaviour after the shock. CONCLUSION: Pacemakers and ICD generators and leads functions were not affected by the tested standard 5 s stun gun shocks. (+info)
Vision and drivers--a South Wales survey.
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BACKGROUND: A reasonable level of visual acuity is a prerequisite not only for the safety of drivers and their passengers but also other road users. We surveyed a sample of automobile and motorbike drivers in South Wales to identify the prevalence of drivers failing to meet the visual requirements for driving as laid down by the Driver and Vehicle Licensing Agency (DVLA). METHODS: A random sample of 301 automobile and motorbike drivers was stopped under police supervision in a lay-by on a single carriageway in Gwent. A simple questionnaire was administered to 298 of them followed by an eyesight test wherein they were asked to read vehicle registration plates at set distances in daylight. This replicated the mandatory test administered during a person's driving test in the UK. RESULTS: There were five drivers among those tested whose eyesight failed to meet the DVLA standard for driving. This translates to 26,776 drivers in Wales and over half a million drivers in the UK. The failure rate was greater among drivers older than 40 years of age with one in 45 drivers failing the number plate test in that age group. CONCLUSION: There is an urgent need to raise public awareness and instigate personal responsibility among drivers to maintain the required vision for driving. The magnitude of the problem raises the debate about licence renewal based on periodic mandatory vision testing and the adequacy of the current visual standards used for drivers. (+info)
Trends in the annual incidence rates of narcotics felons arrested over the last 30 years in metropolitan Bursa, Turkey.
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Illegal substance use is a serious problem all over the world. In order to effectively combat substance abuse it is important that both the particular features of drug users and the culture-specific risk factors that go along with drug abuse be identified. The present study was carried out in Bursa, Turkey, in order to document annual changes in the frequency of felons arrested of narcotics offenses and to establish the socio-demographics of these narcotics felons. Among the 2,230 narcotics felons reviewed, 24.3% had been charged with drug dealing but not consumption (profit-driven felons [PDFs]), 19.0% were narcotics felons charged with both dealing and consumption ([hard core drug users HCDUs]), and 56.7% were narcotics felons charged only with consumption and possession (not so hard core drug users [NHCDUs]). The NHCDUs were younger (< 30 years) than both the HCDUs and PDFs, while most of the PDFs and HCDUs were married. Despite the fact that the male/female ratio of the Bursa population was nearly 1:1 for the past 30 years, 93.0%, 95.0% and 96.0% of the PDFs, HCDUs, and NHCDUs, respectively, were male. It was also found that the most commonly used illicit substance in Bursa over this period of time was cannabis. Over the course of the 30-year period examined, the annual incidence rate of narcotics felons arrested increased from 0.4257 per 10,000 to 1.2389 per 10,000. Determining the socio-demographic characteristics of HCDUs and NHCDUs would be useful in preventing substance use before substance users become addicted. (+info)
Reducing alcohol-related violence and improving community safety: the Alcohol Linking Program.
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Harm associated with the consumption of alcohol on licensed premises is an issue of increasing community concern. This paper reports on a decade-long research initiative that involved the development and implementation of police systems designed to enhance identification of, and police capacity to respond to, premises suggested to be associated with such harms. The outcomes of the Alcohol Linking Program demonstrate enhanced information regarding the occurrence and characteristics of alcohol-related incidents; there are more than 34,000 such incidents each year in rural and regional NSW. Evaluation of the impact of an educational intervention demonstrated reductions of about 15% in the number of alcohol-related incidents linked with such premises. The Program has subsequently been adopted into routine practice on a system-wide basis by the NSW Police and New Zealand Police. Opportunities exist for public health practitioners to contribute to reducing alcohol-related harm in the community through the development of equivalent surveillance systems in emergency departments, monitoring licencee compliance with the Liquor Act, and through injury prevention, health promotion and drug and alcohol practitioners enhancing the capacity of licencees to serve alcohol responsibly. (+info)
Leaving violent relationships and avoiding homelessness - providing a choice for women and their children.
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The report Staying Home/Leaving Violence describes a research study that explores how women, leaving a relationship where they experience domestic violence, can remain safely in their own homes with their children, with the violent offender being removed. In this qualitative study, 29 women were interviewed about their experiences of leaving a violent relationship. Of these 29 women, nine remained in their own home. This article describes the factors that enabled these nine women to remain in their homes and comments on the policy and practice implications for health workers. (+info)