Micro-sized polyethylene particles affect cell viability and oxidative stress responses in human colorectal adenocarcinoma Caco-2 and HT-29 cells.

Plastic is a widely utilized material and polyethylene is one of the most used plastic types. Microplastics are plastic particles (size <5 mm) which are primarily a micro-size range or results from degeneration of larger plastic pieces in the environment. Drinking water and food are two main human exposure sources for microplastics and consequently effects of microplastics in gastrointestinal tract are considered important. Still, only little is known how microplastics and plastic associated chemicals affect the human health. The aim of our study was to evaluate the ability of micro-sized polyethylene to cause harmful effects in human intestinal cells. Raw ultra-high molecular-weight polyethylene (size 5-60 µm) was used. In addition, polyethylene particles were extracted with ethanol to determine the effect of extraction process on toxicity of the particles. In the experiments, human colorectal adenocarcinoma Caco-2 and HT-29 cells were exposed to polyethylene (0.25-1.0 mg/ml) or extracts for 48 h. After exposure, cell viability and cytotoxicity were assessed with MTT and lactate dehydrogenase assay. Reactive oxygen species (ROS) production was measured with dichlorofluorescin diacetate and cytoplasmic production of superoxide with dihydroethidium and mitochondrial superoxide production with MitoSOX. The 48-h exposure to polyethylene decreased dose-dependently cell viability and increased oxidative stress, especially mitochondrial superoxide production, in both cell lines. Effects on ROS or cytosolic superoxide production were not observed. Also, exposure to extracts decreased cell viability and increased oxidative stress in cell cultures, but there were differences between cell lines. These effects were most probably caused by the remaining particles rather than the compounds released from the plastic during the extraction. In conclusion, our study shows that micro-sized polyethylene and ethanol-extracted polyethylene in high concentrations decreased cell viability and increased oxidative stress responses in intestinal cells. These results contribute to the existing evidence on potential adverse human health effects of microplastics.

Self-care habits among people who inject drugs with skin and soft tissue infections: a qualitative analysis.

BACKGROUND: Injection drug use is on the rise in the USA, and skin and soft tissue infections (SSTI) are a common complication, resulting in significant morbidity and mortality. Due to structural barriers to care-seeking, many people who inject drugs avoid formal care and resort to self-care techniques, but little is known about the nature of these techniques, or more generally about the accuracy or breadth of this population's knowledge of SSTIs. METHODS: Semi-structured qualitative interviews were conducted with 12 people who inject heroin in two metropolitan areas: Sacramento and Boston, USA. RESULTS: These interviews reveal a robust and accurate knowledge base regarding skin infections, including the progression from simple cellulitis to an abscess, and acknowledgment of the possibility of serious infections. Nonetheless, there remains a reticence to seek care secondary to past traumatic experiences. A step-wise approach to self-care of SSTI infections was identified, which included themes of whole-body health, topical applications, use of non-prescribed antibiotics, and incision and drainage by non-medical providers. CONCLUSIONS: The reported SSTI self-care strategies demonstrate resilience and ingenuity, but also raise serious concerns about inappropriate antibiotic consumption and complications of invasive surgical procedures performed without proper training, technique, or materials. Harm reduction agencies and health care providers should work to obviate the need for these potentially dangerous practices by improving healthcare access for this population. In the absence of robust solutions to meet the needs of this population, education materials should be developed to optimize the efficacy and minimize the harms of these practices, while empowering and supporting the autonomy of people who use drugs and providing clear guidance on when self-care should be abandoned in favor of formal medical care.

Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis.

BACKGROUND: Skin and soft tissue infections (SSTIs) are prevalent among people who inject heroin (PWIH). Delays in seeking health care lead to increased costs and potential mortality, yet the barriers to accessing care among PWIHs are poorly understood. METHODS: We administered a quantitative survey (N = 145) and conducted qualitative interviews (N = 12) with PWIH seeking syringe exchange services in two U.S. cities. RESULTS: 66% of participants had experienced at least one SSTI. 38% reported waiting two weeks or more to seek care, and 57% reported leaving the hospital against medical advice. 54% reported undergoing a drainage procedure performed by a non-medical professional, and 32% reported taking antibiotics that were not prescribed to them. Two of the most common reasons for these behaviors were fear of withdrawal symptoms and inadequate pain control, and these reasons emerged as prominent themes in the qualitative findings. These issues are often predicated on previous negative experiences and exacerbated by stigma and an asymmetrical power dynamic with providers, resulting in perceived barriers to seeking and completing care for SSTIs. CONCLUSIONS: For PWIH, unaddressed pain and withdrawal symptoms contribute to profoundly negative health care experiences, which then generate motivation for delaying care SSTI seeking and for discharge against medical advice. Health care providers and hospitals should develop policies to improve pain control, manage opioid withdrawal, minimize prejudice and stigma, and optimize communication with PWIH. These barriers should also be addressed by providing medical care in accessible and acceptable venues, such as safe injection facilities, street outreach, and other harm reduction venues.

The impact of adverse childhood experiences on an urban pediatric population.

OBJECTIVE: The goal of this study was to investigate the adverse childhood experiences (ACEs) in youth in a low-income, urban community. STUDY DESIGN: Data from a retrospective chart review of 701 subjects from the Bayview Child Health Center in San Francisco are presented. Medical chart documentation of ACEs as defined in previous studies were coded and each ACE criterion endorsed by a traumatic event received a score of 1 (range=0-9). This study reports on the prevalence of various ACE categories in this population, as well as the association between ACE score and two pediatric problems: learning/behavior problems and body mass index (BMI)≥85% (i.e., overweight or obese). RESULTS: The majority of subjects (67.2%, N=471) had experienced 1 or more categories of adverse childhood experiences (ACE≥1) and 12.0% (N=84) had experienced 4 or more ACEs (ACE≥4). Increased ACE scores correlated with increased risk of learning/behavior problems and obesity. CONCLUSIONS: There was a significant prevalence of endorsed ACE categories in this urban population. Exposure to 4 or greater ACE categories was associated with increased risk for learning/behavior problems, as well as obesity. PRACTICE IMPLICATIONS: Results from this study demonstrate the need both for screening of ACEs among youth in urban areas and for developing effective primary prevention and intervention models.