To determine how the city-run New Haven syringe exchange program (SEP) expedited requests, for entry into treatment, records of the SEP's drug treatment coordinator were analyzed. During the study period, a majority of those requesting treatment did not use the SEP to obtain sterile syringes. Comparisons between the people requesting treatment and those exchanging syringes revealed that those requesting treatment were more likely female and less like White. Factors associated with failure to enter treatment included long lag times, worse insurance, cocaine use, and requesting primary detoxification only. Majorities of the requests, appointments, and entries came from individuals whose treatment was to be paid through city welfare. A managed care initiative from the city welfare department, which excluded the SEP, halved requests or entries. Subsequent addition of the SEP to the initiative did not significantly increase requests or entries. Although the SEP initially acted as a conduit to treatment its effectiveness was curtailed by the imposition of bureaucratic restrictions.

Adolescent↗

PubMedDate not supplied

Binding of synovial fluid proteins to monosodium urate crystals in vitro.

Sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS PAGE) and western blot techniques were used to analyze proteins adsorbed in vitro to synthetic monosodium urate crystals (MSUC) from a variety of gouty biologic fluids. Distinct differences in adsorbed proteins were found in comparing synovial fluid (SF) with serum or plasma, particularly at 220 kD and below 19 kD. Further studies should consider the importance of the synovial milieu. Patterns of proteins adsorbed to MSUC from the SF of all 12 patients with gout were similar. A considerable number of polypeptides appeared to be selectively adsorbed. Of these, polypeptides associated with fibronectin, C1q and IgM were identified by immunotransblotting. The experiments also demonstrated that the overall polypeptide patterns obtained by SDS PAGE of eluates from MSUC exposed to SF were unaffected by heating MSUC to 180 degrees C, as well as by the volume of SF in the incubation mixture.

Adsorption↗

PubMedDate not supplied

'Dropouts' or 'drop-ins'? Client retention and participation in New Haven's needle exchange program.

Although evidence is accumulating that needle exchange programs can lower the risk of parenterally transmitted infections, their effectiveness is compromised if they suffer from low client participation. A legal needle exchange in New Haven, CT, has been studied since its inception in November 1990, employing a tracking system to analyze the characteristics of clients participating during the first 20 months of the program. Thirty-four percent of injection drug users who enrolled in the program during the study period made only a single visit. Younger clients were more likely to be in the single visit group. For clients who visited the program more than once, the retention fraction, defined as the ratio of total client-specific observed person-days to full enrollment person-days during the 20-month study period was 67.7 percent, with a median duration of participation of 333 days. Further analysis of the client characteristics, based on surveys completed upon enrollment in the program, revealed several predictors of continuing participation. Most significant were the observations that (a) those injecting for 10 years or longer participated longer than clients who injected drugs for less than 10 years and (b) nonwhite injectors participated longer than whites. The longest duration of participation (median = 501 days) was among nonwhite injectors with 10 years or more of injecting history. There have been limited data on client participation in needle exchange programs. This gap in information must be overcome to allow thorough evaluations of such programs.

Adult↗