The law on the streets: Evaluating the impact of Mexico's drug decriminalization reform on drug possession arrests in Tijuana, Mexico.

BACKGROUND: In 2009, Mexican Federal Government enacted "narcomenudeo" reforms decriminalizing possession of small amounts of drugs, delegating prosecution of retail drug sales to the state courts, and mandating treatment diversion for habitual drug users. There has been insufficient effort to formally assess the decriminalization policy's population-level impact, despite mounting interest in analagous reforms across the globe. METHODS: Using a dataset of municipal police incident reports, we examined patterns of drug possession, and violent and non-violent crime arrests between January 2009 and December 2014. A hierarchical panel data analysis with random effects was conducted to assess the impact of narcomenudeo's drug decriminalization provision. RESULTS: The reforms had no significant impact on the number of drug possession or violent crime arrests, after controlling for other variables (e.g. time trends, electoral cycles, and precinct-level socioeconomic factors). Time periods directly preceding local elections were observed to be statistically associated with elevated arrest volume. CONCLUSIONS: Analysis of police statistics parallel prior findings that Mexico's reform decriminalizing small amounts of drugs does not appear to have significantly shifted drug law enforcement in Tijuana. More research is required to fully understand the policy transformation process for drug decriminalization and other structural interventions in Mexico and similar regional and international efforts. Observed relationship between policing and political cycles echo associations in other settings whereby law-and-order activities increase during mayoral electoral campaigns.

Measuring improvement in knowledge of drug policy reforms following a police education program in Tijuana, Mexico.

BACKGROUND: Mexico's 2009 "narcomenudeo reform" decriminalized small amounts of drugs, shifting some drug law enforcement to the states and mandating drug treatment diversion instead of incarceration. Data from Tijuana suggested limited implementation of this harm reduction-oriented policy. We studied whether a police education program (PEP) improved officers' drug and syringe policy knowledge, and aimed to identify participant characteristics associated with improvement of drug policy knowledge. METHODS: Pre- and post-training surveys were self-administered by municipal police officers to measure legal knowledge. Training impact was assessed through matched paired nominal data using McNemar's tests. Multivariable logistic regression was used to identify predictors of improved legal knowledge, as measured by officers' ability to identify conceptual legal provisions related to syringe possession and thresholds of drugs covered under the reform. RESULTS: Of 1750 respondents comparing pre- versus post training, officers reported significant improvement (p < 0.001) in their technical understanding of syringe possession (56 to 91%) and drug amounts decriminalized, including marijuana (9 to 52%), heroin (8 to 71%), and methamphetamine (7 to 70%). The training was associated with even greater success in improving conceptual legal knowledge for syringe possession (67 to 96%) (p < 0.001), marijuana (16 to 91%), heroin (11 to 91%), and methamphetamine (11 to 89%). In multivariable modeling, those with at least a high school education were more likely to exhibit improvement of conceptual legal knowledge of syringe possession (adjusted odds ratio [aOR] 2.6, 95% CI 1.4-3.2) and decriminalization for heroin (aOR 2.7, 95% CI 1.3-4.3), methamphetamine (aOR 2.2, 95% CI 1.4-3.2), and marijuana (aOR 2.5, 95% CI 1.6-4). CONCLUSIONS: Drug policy reform is often necessary, but not sufficient to achieve public health goals because of gaps in translating formal laws to policing practice. To close such gaps, PEP initiatives bundling occupational safety information with relevant legal content demonstrate clear promise. Our findings underscore additional efforts needed to raise technical knowledge of the law among personnel tasked with its enforcement. Police professionalization, including minimum educational standards, appear critical for aligning policing with harm reduction goals.

[Effects of ozurdex on intraocular pressure. A real life clinical practice study]. / Efectos de ozurdex en la presión intraocular. Estudio en la práctica clínica.

OBJECTIVE: The dexamethasone biodegradable implant, ozurdex, is approved by the US Food and Drug Administration and by the European Medical Agency for the treatment of intermediate and posterior uveitis, and for the treatment of macular edema following retinal vein occlusion and diabetic macular edema. The aim of this study was to assess the effects of intraocular pressure in a cohort of patients from a real-life clinical practice. METHODS: Retrospective review was performed on the clinical records of patients treated with Ozurdex in Hospital Universitario Cruces in a 6 month period. The following variables were recorded: age, gender, diagnosis and history of glaucoma; intraocular pressure, antihypertensive treatment and macular thickness were recorded before the injection, and in the 1st, 2nd, 4th, and 6th months after the injection. STATISTICAL TESTS: Mann-Whitney U test, Chi square test (with Fisher correction when needed) and Wilcoxon test. The level of statistical significance was set at P<.05. RESULTS: The effects of 75 injections given to 67 patients (35 women: 52%; mean age: 62) were evaluated. Mean intraocular pressure before the injection was 15.9 mmHg and at 1st, 2nd, 4th and 6th months after de injection it was 18.80 (P=.627), 18.84 (P=.494), 17.02 (P=.796) and 15.5 (P=.829), respectively. No statistically significant differences were observed in intraocular pressure measurements at the mentioned follow-up visits between patients with and without a history of glaucoma. CONCLUSIONS: In real-life clinical practice, ozurdex shows an excellent safety profile in terms of intraocular hypertension. Patients with a history of glaucoma may also show this profile, with ozurdex being a good option to treat retinal diseases in these patients.

An integrated methodology to assess the benefits of urban green space.

The interrelated issues of urban sprawl, traffic congestion, noise, and air pollution are major socioeconomic problems faced by most European cities. A methodology is currently being developed for evaluating the role of green space and urban form in alleviating the adverse effects of urbanisation, mainly focusing on the environment but also accounting for socioeconomic aspects. The objectives and structure of the methodology are briefly outlined and illustrated with preliminary results obtained from case studies performed on several European cities.

Central nervous system abscesses due to Coccidioides species.

Meningitis occurs in one-third to one-half of patients with disseminated coccidioidomycosis, but mass lesions have rarely been described; these lesions are usually found at autopsy. We report six cases of disseminated coccidioidomycosis with central nervous system (CNS) abscesses. Four patients had cerebellar involvement, and two had spinal cord involvement. Four patients were diabetic, and two subsequently died. Review of the literature on CNS coccidioidomycosis indicated that parenchymal brain involvement occurs in 1%-33% of cases, and < 40 cases with mass lesions have been reported since 1905. Almost all patients were male and had other active disseminated foci of coccidioidomycosis. In approximately one-third of all cases, meningitis was absent. Brain lesions may be superficial or deep and multiple or single. In the absence of meningitis, serology of cerebrospinal fluid is negative. Hematogenous origin appears to be more common than direct extension from the meninges. Spinal cord involvement is rare. Diabetes was present in several cases, thus suggesting a vascular predisposition. We hope our experience will increase awareness of this entity, which appears to be more common than previously appreciated, and will facilitate diagnosis.

Peno-scrotal transposition.

Peno-scrotal transposition is an infrequent genital malposition due to a defect in the caudal migration of the inchoate scrotum during intrauterine life. It is frequently associated with urogenital and/or gastrointestinal malformations. Glenn and Anderson (1973) have classified the abnormality into the following categories, according to severity: Bifid scrotum Incomplete or partial peno-scrotal transposition Complete peno-scrotal transposition or pre-penile scrotum Ectopic scrotum We analyse corrective surgical techniques for this malposition and we present our experience.

[Assessment of five laboratory tests for differential diagnosis in bacterial and viral meningoencephalitides]. / Evaluación de cinco pruebas de laboratorio para el diagnóstico diferencial entre meningoencefalitis purulenta y viral.

The usefulness of five different laboratory tests for differential diagnosis in bacterial and viral meningoencephalitides was assessed. The clinical manifestations and cytochemical alterations of cerebrospinal fluid (CSF) were used as criteria for diagnostic selection. The causal agent was identified by means of CSF cultures in 47.8 per cent of bacterial meningoencephalitis cases; Gram stain was postive in CSF smear in 34.8 per cent and protein electrophoresis in CSF did not show significant differences when compared to cases of bacterial or viral etiology and the control group. PH and CSF lactate determinations allowed diagnosis of all cases of bacterial meningoencephalitis and was not modified in those cases where this disease was of a viral origin. We suggest to add these determinations to the initial cytochemical study of CSF in all cases where meningoencephalitis is suspected.

Expandable silicone implants for scleral buckling. IV. Experiments with an explant for macular breaks.

A new expandable silicone rubber explant used to indent the sclera at the macula was tested experimentally in rabbits. The device consists of a Dacron-reinforced silicone rubber strip that has an expandable portion (or balloon) at its midpoint connected to a silicone filling tube. The explant was expanded with 0.03 to 0.06 ml of an antibiotic solution. Smooth, round buckles that exerted even indentation were produced. A decrease in height of 20% to 50% was observed ophthalmoscopically during six months of follow-up. The degree of buckling can be easily controlled during operation and may be modified postoperatively.

Expandable silicone implants for scleral buckling. III. Experiments in vivo.

Experimental scleral buckling was obtained in rabbits by using expanded silicone rubber implants under scleral trap doors. Buckle heights ranged from 2.3 to 4mm after injection of 0.05 to 0.15 ml of fluid into the implants. Therate of decrease in buckle height followed up opthalmoscopically for five months, was found to be slow and continous and was caused mainly by loosening by the scleral flaps rather than by the diffusion of fluid from the implants. Implants expanded with chorampenicol solutions provided sustained release of the antibiotic in the area of the operation. This was confirmed in agar plantes by inhibition of the growth of Sarcina lutea around subimplant tissues and the expanded implants that were recovered post mortem. These implants provided an opportunity of modify the buckle height easily, either during the procedure or postoperatively.