Identifying Injection Drug Users at Risk of Nonfatal Overdose

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75145/1/j.1553-2712.2007.tb01846.x.pd

Psychological Resilience After Disaster. New York City in the Aftermath of the September 11th Terrorist Attack

ABSTRACT—Research on adult reactions to potentially traumatic events has focused almost exclusively on posttraumatic stress disorder (PTSD). Although there has been relatively little research on the absence of trauma symptoms, the available evidence suggests that resilience following such events may be more prevalent than previously believed. This study examined the prevalence of resilience, defined as having either no PTSD symptoms or one symptom, among a large (n 5 2,752) probability sample of New York area residents during the 6 months following the September 11th terrorist attack. Although many respondents met criteria for PTSD, particularly when exposure was high, resilience was observed in 65.1% of the sample. Resilience was less prevalent among more highly exposed individuals, but the frequency of resilience never fell below one third even among the exposure groups with the most dramatic elevations in PTSD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40282/2/Bonanno_Psychological Resilience After Disaster_2006.pd

What predicts psychological resilience after disaster? The role of demographics, resources, and life stress

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56241/1/bonanno_what predicts psychological resilience after disaster_2007.pd

Adrenergic Myocarditis in Pheochromocytoma

The clinical presentation of pheochromocytoma is variable and many biochemical and imaging methods have been suggested to improve the diagnostic accuracy of what has been termed "the great masquerader". This case-report is of a middle-aged woman with a non-specific clinical presentation suggesting acute coronary syndrome or subacute myocarditis. Cardiovascular magnetic resonance (CMR) at presentation showed myocardial edema and intramyocardial late gadolinium enhancement (LGE). An adrenal mass was seen, which was confirmed as pheochromocytoma and surgically removed. Our case shows evidence for acute adrenergic myocarditis, with resolution of both the edema and the LGE after surgical excision

Cocaine- and opiate-related fatal overdose in New York City, 1990–2000

Background: In New York City (NYC), the annual mortality rate is higher for accidental drug overdoses than for homicides; cocaine and opiates are the drugs most frequently associated with drug overdose deaths. We assessed trends and correlates of cocaine- and opiate-related overdose deaths in NYC during 1990–2000. Methods: Data were collected from the NYC Office of the Chief Medical Examiner (OCME) on all fatal drug overdoses involving cocaine and/or opiates that occurred between 1990–2000 (n = 8,774) and classified into three mutually exclusive groups (cocaine only; opiates-only; cocaine and opiates). Risk factors for accidental overdose were examined in the three groups and compared using multinomial logistic regression. Results: Overall, among decedents ages 15–64, 2,392 (27.3%) were attributed to cocaine only and 2,825 (32.2%) were attributed to opiates-only. During the interval studied, the percentage of drug overdose deaths attributed to cocaine only fell from 29.2% to 23.6% while the percentage of overdose deaths attributed to opiates-only rose from 30.6% to 40.1%. Compared to New Yorkers who fatally overdosed from opiates-only, fatal overdose attributed to cocaine-only was associated with being male (OR = 0.71, 95% CI 0.62–0.82), Black (OR = 4.73, 95% CI 4.08–5.49) or Hispanic (OR = 1.51, 95% CI 1.29–1.76), an overdose outside of a residence or building (OR = 1.34, 95% CI 1.06–1.68), having alcohol detected at autopsy (OR = 0.50, 95% CI 0.44–0.56) and older age (55–64) (OR = 2.53 95% CI 1.70–3.75)). Conclusion: As interventions to prevent fatal overdose become more targeted and drug specific, understanding the different populations at risk for different drug-related overdoses will become more critical

Spatial analytic approaches to explaining the trends and patterns of drug overdose deaths

To effectively utilize and interpret spatial analyses, substance use researchers, public health practitioners and policy makers should be familiar with some of the available data analytic techniques, each of which comes with advantages and drawbacks. In this chapter we first discuss three cluster detection tools and their associated software applications. We then present a Bayesian hierarchical approach, briefly reviewing its theoretical underpinnings, commonly used models, and how inferences may be drawn a sample-based posterior distribution. We demonstrate the use of each approach on a set of substance abuse mortality data, comparing the results across the four tools. Our empiric illustration, considers the role of neighborhood-level socioeconomic status (SES) in explaining opiate-related overdose deaths in New York City. We end with a discussion of the implications of the choice of technique and software on interpreting spatial analyses of substance abuse and conclude that the choice of a method will be driven by the question to be answered, data and software availability and the intended audience or context in which the research is being conducted

Firearm suicide in New York City in the 1990s

Objective: Across the US, firearms are used in approximately 60% of all suicide deaths. Little research has assessed the role and determinants of firearms in suicide in major urban areas. Methods: The authors collected data on all suicide deaths between 1990 and 2000 from the Office of the Chief Medical Examiner of New York City (NYC) and assessed trends and correlates of firearm related suicide deaths. Results: During the period studied, there were a total of 6008 suicides in NYC; 1200 (20.0%) were firearm related suicides. There was a decrease in total suicides, total firearm suicides, and the proportion of firearm related suicides. In multivariable modeling, characteristics of suicide decedents associated with a greater likelihood of firearm suicide were: male, black race, residing in the outer boroughs, and use of cannabis. Conclusions: The proportion of suicides caused by firearms in NYC is low compared to other parts of the US; differential access to means of committing suicide and the differential importance of firearms in different racial and ethnic groups may contribute to this observation. Innovative, local population based interventions that target non-firearm related suicide may contribute to lower suicide mortality overall in urban areas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40352/2/Piper_Firearm Suicide in New York City in the 1990s_2006.pd

What explains the association between neighborhood-level income inequality and the risk of fatal overdose in New York City?

Accidental drug overdose is a substantial cause of mortality for drug users. Using a multilevel case-control study we previously have shown that neighborhood-level income inequality may be an important determinant of overdose death independent of individual-level factors. Here we hypothesized that the level of environmental disorder, the level of police activity, and the quality of the built environment in a neighborhood mediate this association. Data from the New York City (NYC) Mayor’s Management Report, the NYC Police Department, and the NYC Housing and Vacancy Survey were used to define constructs for the level of environmental disorder, the level of police activity and the quality of the built environment, respectively. In multivariable models the odds of death due to drug overdose in neighborhoods in the top decile of income inequality compared to the most equitable neighborhoods decreased from 1.63 to 1.12 when adjusting for the three potential mediators. Path analyses show that the association between income inequality and the rate of drug overdose mortality was primarily explained by an indirect effect through the level of environmental disorder and the quality of the built environment in a neighborhood. Implications of these findings for the reduction of drug overdose mortality associated with the distribution of income are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40292/2/Nandi_What Explains the Association Between Neighborhood-Level_2006.pd

Antidepressants and youth suicide in New York City, 1999-2002

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41247/1/leon_antidepressants and youth suicide_2006.pd

Circumstances of Witnessed Drug Overdose in New York City: Implications for Intervention

Drug users frequently witness the nonfatal and fatal drug overdoses of their peers, but often fail to intervene effectively to reduce morbidity and mortality.We assessed the circumstances of witnessed heroin-related overdoses in NewYork City (NYC) among a predominantly minority population of drug users. Among 1184 heroin, crack, and cocaine users interviewed between November 2001 and February 2004, 672 (56.8%) had witnessed at least one nonfatal or fatal heroin-related overdose. Of those, 444 (67.7%) reported that they or someone else present called for medical help for the overdose victim at the last witnessed overdose. In multivariable models, the respondent never having had an overdose her/himself and the witnessed overdose occurring in a public place were associated with the likelihood of calling for medical help. Fear of police responsewas the most commonly cited reason for not calling or delaying before calling for help (52.2%). Attempts to revive the overdose victim through physical stimulation (e.g., applying ice, causing pain) were reported by 59.7% of respondents, while first aid measures were attempted in only 11.9% of events. Efforts to equip drug users to manage overdoses effectively, including training in first aid and the provision of naloxone, and the reduction of police involvement at overdose events may have a substantial impact on overdose-related morbidity and mortality.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40301/2/Tracy_Circumstances of Witnessed Drug Overdose in_2005.pd