Intersections between syndemic conditions and stages along the continuum of overdose risk among women who inject drugs in Mexicali, Mexico.

BACKGROUND: Research on women who inject drugs is scarce in low- and middle-income countries. Women experience unique harms such as sexism and sexual violence which translate into negative health outcomes. The present work aims to provide insight into the experiences of women who inject drugs at the US-Mexico border to identify social and health-related risk factors for overdose to guide harm reduction interventions across the Global South. METHODS: We recruited 25 women ≥ 18 years of age accessing harm reduction and sexual health services at a non-governmental harm reduction organization, "Verter", in Mexicali, Mexico. We employed purposeful sampling to recruit women who inject drugs who met eligibility criteria. We collected quantitative survey data and in-depth interview data. Analyses of both data sources involved the examination of descriptive statistics and thematic analysis, respectively, and were guided by the syndemic and continuum of overdose risk frameworks. RESULTS: Survey data demonstrated reports of initiating injection drug use at a young age, experiencing homelessness, engaging in sex work, being rejected by family members, experiencing physical violence, injecting in public spaces, and experiencing repeated overdose events. Interview data provided evidence of stigma and discrimination toward women, a lack of safe spaces and support systems, risk of overdose-related harms, sexual violence, and the overall need for harm reduction services. CONCLUSION: Women who inject drugs in Mexicali describe experiences of violence, overdose, and public injecting. Women are particularly vulnerable in the Mexicali context, as this area faces a noticeable lack of health and social services. Evidenced-based harm reduction strategies such as safe consumption sites and overdose prevention strategies (e.g., naloxone distribution and training) may benefit this population. Evidence from local organizations could help close the gap in service provision in low-resource settings like Mexico, where government action is almost nonexistent.

Behavior change after fentanyl testing at a safe consumption space for women in Northern Mexico: A pilot study.

BACKGROUND: Fentanyl has led to an increased number of overdose deaths in North America. Testing substances for fentanyl may be a harm reduction strategy to prevent overdose. Little is known about behavior change after fentanyl testing and the attitudes around fentanyl knowledge and testing along the US-Mexico border in the context of a safe consumption site. METHODS: This was a pilot quantitative and qualitative study with 30 women who use drugs at an unsanctioned safe consumption site in Mexicali, Mexico. Women participated in a quantitative survey, a semi-structured interview, and fentanyl testing of substances. Injection behavior was observed after fentanyl testing results were provided. Qualitative data were collected to explore the meanings participants attributed to fentanyl and fentanyl testing. RESULTS: Half of the substances tested positive for fentanyl (n=15, 50%), and all of them were in samples of black tar heroin. Among those participants who tested positive for fentanyl, 7 (47%) subsequently used less of the intended substance, 1 did not use the intended substance, and 7 (47%) did not change their behavior (i.e., used as originally intended). In qualitative interviews, a predominant theme was a description of fentanyl as dangerous and deadly and fentanyl testing as being helpful for modifying drug use behaviors. However, participants recognized that there could be no change in behavior following a positive fentanyl test in the context of not being able to find substances free of fentanyl. CONCLUSION: We observed mixed results related to behavior change after women's intended substance for use tested positive for fentanyl. Fentanyl testing was acceptable to women, but behavior change was hampered by the inability to find substances free of fentanyl. Further research is needed to maximize the potential of fentanyl testing as a harm reduction tool especially in the context of a changing drug supply.

Impact of an overdose reversal program in the context of a safe consumption site in Northern Mexico.

Background: Drug overdoses are prevalent in low- and middle-income countries but are scarcely reported in the literature. We report on an opioid overdose reversal and naloxone distribution program that was instituted at the first safe consumption site in Latin America. Methods: A cross-sectional analysis of witnessed drug overdoses and naloxone distribution between 1 June 2019 and 31 May 2021 in Mexicali, Mexico. Case report forms were entered in an electronic database. Trends in overdose and naloxone distribution were described. Comparisons were made before and after the COVID-19 pandemic was declared in the city. Maps were created to represent the geographic distribution of overdose in the city. Results: During the study period 1,534 doses of naloxone were distributed throughout the community. In addition, there were 464 overdoses reported during this period, of which 4 were fatal. There was a 30% increase in reported overdoses from the period before the COVID-19 pandemic to the period after the pandemic was declared (p = 0.03). Most common substance reported included heroin (93%), sedatives (21%), methamphetamine (16%) and fentanyl (14%). Naloxone was given in 96% of cases (median 1 dose, IQR 1-2 doses) and emergency services were called in 20% of cases. Conclusions: An opioid overdose reversal program in Mexicali, Mexico was able to distribute naloxone and register drug overdoses between 2019 and 2021 as a harm reduction strategy. This adds to the growing body of literature on the impact of community-based programs on preventing fatal overdoses and the potential for implementation in low-resource settings.

Influencia de la nacionalidad en la prevalencia de enfermedades frecuentes en Atención Primaria / Influence of nationality on the prevalence of frequent diseases in Primary Health Care

INTRODUCCIÓN: la prevalencia de determinadas enfermedades es diferente en función de factores socioeconómicos o culturales. El objetivo del estudio es describir la frecuencia registrada de exceso de peso, caries, anemia ferropénica (AF) y eccema atópico (EA) en nuestra población infantil en función del país de origen y analizar si existen diferencias entre las diversas nacionalidades. MATERIAL Y MÉTODOS: se realizó un estudio descriptivo de los diagnósticos registrados en la historia clínica de Atención Primaria. Se valoró la edad, género, nacionalidad y nivel socioeconómico. RESULTADOS: la población total fue de 81 541 niños de 0 a 14 años. La mayoría eran españoles (84,1%), seguidos de magrebíes (6,9%) e indopakistaníes (3%). La prevalencia de exceso de peso fue del 14,2%, sin diferencias entre españoles e inmigrantes, excepto los iberoamericanos que tenían una mayor prevalencia (22,47%). La prevalencia de caries fue del 17,8% con diferencias significativas entre la población española y la de otros orígenes (15,13 frente a 28,4%). La prevalencia de AF fue del 0,75% apreciándose diferencias en función de la nacionalidad; la AF era diez veces más frecuente en población indopakistaní (5,4%). La prevalencia de EA fue del 15,46%, con diferencias en función de la nacionalidad; el EA era significativamente más frecuente en la población china (20,46%) y magrebí (18,58%). CONCLUSIÓN: existen diferencias importantes en la prevalencia de las enfermedades estudiadas en función del país de origen del niño. La Atención Primaria debería abordar la implementación de estrategias preventivas adaptadas a la realidad multicultural de nuestros centros

INTRODUCTION: prevalence of certain diseases varies depending on socioeconomic and cultural factors. The aim of our study was to describe the documented frequency of excess weight, dental caries, iron-deficiency anaemia (IDA) and atopic dermatitis (AD) in the local paediatric population by country of origin, and to assess whether there were differences based on national origin. MATERIAL AND METHODS: we conducted a descriptive study of the diagnoses recorded in the primary care health records database. We analysed age, sex, nationality and socioeconomic status. RESULTS: The population under study consisted of 81 541 children aged 0 to 14 years. The majority were Spanish (84.1%), followed in frequency by children from Northwest Africa (6.9%) and children from India and Pakistan (3%). The prevalence of excess weight was 14.2%, with no differences between the Spanish and the immigrant population with the exception of a higher prevalence in children of Latin American descent (22.47%). The overall prevalence of caries was 17.8%, with significant differences between the Spanish population and children from other regions (15.13% vs. 28.4%). The prevalence of IDA was 0.75%, and we found differences based on country of origin, with a 10-fold prevalence of IDA in children of Indian or Pakistani descent (5.4%). The overall prevalence of AD was 15.46%, with differences based on national origin; AD was significantly more frequent in children of Chinese (20.46%) and Northwest African (18.58%) descent. CONCLUSIONS: We found considerable differences in the prevalence of the diseases under study based on the country of origin of the child. The primary care system should implement preventive strategies adapted to the multicultural populations served by our primary care centres

La gestión de la demanda urgente en losequipos de atención primaria del Maresme / Management of urgent demand in Primary Care teams of the Maresme

Objetivo: valorar el grado de resolución del profesional enfermero en laatención urgente de los equipos de Atención Primaria del Maresme (Barcelona)mediante la aplicación del triage en el año 2007.Material y método: diseño descriptivo retrospectivo realizado sobre las visitasgeneradas en 13 áreas básicas de salud del Servicio de Atención PrimariaMataró-Maresme. Los sujetos del estudio fueron los pacientes de cualquieredad que acudieron al centro con autopercepción de urgencia y fueron visitadosel mismo día por la enfermera, durante el período comprendido entreenero y diciembre de 2007. Las variables estudiadas fueron el sexo, la edad,resolución de la visita (resolución enfermera o derivación a su médico de familia/pediatra pasadas 24 horas o derivación al médico de familia/pediatra).Resultados: se analizaron un total de 53.962 visitas que fueron atendidascomo urgentes por parte de la enfermera. La media de edad de los pacientesfue de 39,9 años y un 54,1% eran mujeres. El 84,6% de los pacientes teníanmás de 14 años. El porcentaje de resolución fue del 42%, el cual disminuíasignificativamente (p < 0,000) a 31,4% si el paciente era menor de 15 años.Conclusiones: el elevado grado de resolución enfermero obtenido, evidenciaque la enfermera puede ser la puerta de entrada al sistema sanitario,dando respuesta a la demanda urgente, ya sea resolviendo o gestionándola (AU)

Objective: to assess the degree in which nursing staff of the primary careteams of the Maresme area (Barcelona) resolve urgent care demand by applyingtriage in 2007.Material and methods: retrospective descriptive design performed on visitsgenerated in 13 basic health areas of the Mataro-Maresme Primary Careservice. The study subjects were patients of any age who attended the centrewith self-perceived urgency and were seen the same day by the nurse, duringthe period ranging from January to December 2007. Studied variableswere sex, age, how the visit was resolved (by the nurse or by referral to thepatient’s family doctor/pediatrician).Results: a total of 53,962 visits that were managed as urgent by nurseswere analysed. The patient mean age was 39.9 years and 54.1% werewomen. 84.6% of patients were over the age of 14. 42% of cases were resolved,which decreased significantly (p < 0.000) to 31.4% if the patient wasunder the age of 15.Conclusions: the high degree in which nurses resolved urgent visits is evidencethat the nurse may be the first point of entry into the health care system,responding to urgent needs, whether it is by resolving the consultationor managing it (AU)