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Post00679 Study + COP18 + NSI + Abstract + News 12 December 2012

CONTENTS
1. World Bank New Study: More Doctors Don’t Necessarily Lead to Better Care
2. Health Must Be Central to Climate Action: COP18 December 2012
3. Abstract: Minimizing the risk of non-vertical, non-sexual HIV infection
in children – beyond mother to child transmission
4. Abstract: Sharps injuries among nurses in a Thai regional hospital:
prevalence and risk factors
5. Abstract: Sharps injuries among medical students in the Faculty of
Medicine, Colombo, Sri Lanka
6. Abstract: Occupational exposure to blood and body fluids
7. Abstract: Scarcity of healthcare worker protection in eight low- and
middle-income countries: surgery and the risk of HIV and other
bloodborne pathogens
8. Abstract: Needlesticks injuries in dentistry
9. Abstract: Sharps disposal practices among diabetic patients using
insulin
10. Abstract: Precautions for health care workers to avoid hepatitis B and
C virus infection
11. Abstract: Personal and organizational predictors of physicians’
knowledge, attitudes and practices related to medical waste management
in Mazandaran province (northern Iran)
12. Abstract: Recommendations and current practices for the
reconstitution and storage of botulinum toxin type A
13. Abstract: Police officer anxiety after occupational blood and body
fluid exposure
14. Abstract: Net financial benefits of averting HIV infections among
people who inject drugs in Urumqi, Xinjiang, Peoples Republic of China
(2005-2010)
15. Abstract: The initial experience in supervised injecting facilities in
Denmark
16. Abstract: Prevalence of transfusion transmitted virus infection in
hemodialysis patients and injection drug users compared to healthy
blood donors in isfahan, iran
17. Abstract: Hepatitis C in Poland in 2010
18. Abstract: Hand-washing knowledge and practices among dentists and
dental specialists
19. Abstract: Safety for home care: the use of Internet video calls to
double-check interventions
20. Abstract: Efficacy and safety of high dose intramuscular or oral
cholecalciferol in vitamin D deficient/insufficient elderly
21. Abstract: In Urban And Rural India, A Standardized Patient Study Showed
Low Levels Of Provider Training And Huge Quality Gaps
22. Abstract: Women doctors’ purses as an unrecognized fomite
23. Abstract: Hepatitis-B vaccination status among dental surgeons in benin
city, Nigeria
24. No Abstract: Fatal mistakes in prehospital medicine. The laryngoscope,
the syringe and the ink pen can all cause great harm
25. The Post 2015 Health Agenda: Call for papers for the post-2015 web
consultation on health has now been extended until December 30, 2012
26. News
– USA Nevada: Aide Takes Plea in Vegas Hepatitis Exposure Case
– Australia: Health fears for ‘backyard botox’ patients
– Canada: City clarifies needle exchange zoning
– Greece: HIV Cases Increase in Greece

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1. World Bank New Study: More Doctors Don’t Necessarily Lead to Better Care

Download Study Free Full Text
http://content.healthaffairs.org/content/31/12/2774.full
__________________________________________________________________
New Study: More Doctors Don’t Necessarily Lead to Better Care
World Bank, Washington DC USA, Press Release (03.12.12)

Study uses the gold standard, standardized patients, to measure quality of
medical care.

Overall quality was low, and training, equipment and patient load didn’t
have large effects on quality.

Results show the urgent need to systematically measure the quality of care.

WASHINGTON, Dec. 3, 2012 – When we talk about strengthening health care
systems in developing countries, we often mean building hospitals, hiring
more staff or stocking up on medications. But one topic has been noticeably
missing: the quality of doctors and nurses.

That may seem baffling, given that the quality of medical professionals –
the very people taking care of the sick – can mean life or death for
patients, and that their salaries take up the bulk of a health system’s
budget. And surely, governments, donors, development institutions and non-
governmental organizations want the best results for their investment.

The problem arises in part because the quality of care is a hard thing to
measure. Every patient is different, and even with the same broad category
of diagnosis, they may warrant different treatment, which makes it
difficult to compare health outcomes. In addition, patients may not be able
to follow an optimal treatment plan, especially when it’s expensive.

In a new study led by World Bank economist Jishnu Das, those issues are
resolved by using “standardized patients,” or local people who are
recruited to memorize and present consistent symptoms of an illness during
unannounced visits to multiple health care providers. The methodology is
considered the gold standard in quality measurement.

The study, which is published today in the journal Health Affairs,
recruited 22 such patients in India, trained them for at least 150 hours
and had them make 926 visits to 305 providers in India. They presented
symptoms for unstable angina (chest pain), asthma, and dysentery
(intestinal inflammation) – which all come with well-known, textbook
treatment plans. That makes it easier to compare treatment – and providers
– across the board.

What they find is surprising. First, most providers – for example, 67% in
rural Madhya Pradesh, one of India’s poorest states – don’t have medical
degrees. Second, the overall quality is low. Each visit in the state
averaged 3.6 minutes, 33% of the providers gave a diagnosis at all and just
12% of those were correct. Only 30.4% of the visits led to correct
treatment, but 41.7% of the visits led to unnecessary or harmful treatment.
The numbers are a little better in Delhi, one of India’s wealthiest states,
with visits averaging 5.3 minutes and 48 percent of providers giving the
correct treatment.

In addition, the study shows there aren’t big differences between trained
and untrained doctors in areas such as sticking to clinical checklists,
signaling the need for better medical education. Perhaps as a result of
that, public clinics didn’t fare better in the study. In fact, when it
comes to following medical guidelines, public providers were worse than
their untrained, private counterparts.

The study could help policy makers make evidence-based decisions. In
November, the government announced a five-year plan to triple health
spending and improve the quality of health services. In 2010, India spent
4% of gross domestic product on health expenditures, compared with an
average of 10% in developed countries. Out-of-pocket expenditures account
for 70 percent of the nation’s overall health care costs.

“This study points to the need to think beyond the health infrastructure
and medical qualifications, neither of which is closely correlated with the
quality of care,” says Adam Wagstaff, a health economist and research
manager of the human development and public services team in the Bank’s
Development Research Group. “The study also casts doubt on some commonly-
held views about the quality differences between the public and private
sectors. I hope that the study will stimulate a large and systematic effort
to collect data on and monitor quality of care so that health systems can
be held accountable for delivering value for money.”

The study is the latest product from a 10-year effort by Das and colleagues
to look at how to best measure the quality of health care in several low-
income countries. One paper uses hypothetical cases to evaluate the
competence of doctors, showing that private providers in richer areas of
Delhi are significantly better than those in poorer neighborhoods. Another
paper shows that providers in private practice prescribe a lot of drugs
that aren’t necessary. In the public sector, education subsidies and
salaries don’t translate into better care at all. (Indians mostly prefer
private hospitals over public facilities, because of understaffing and
other concerns.)

The new research, funded by the Bill and Melinda Gates Foundation, was
conducted jointly with the Center for Policy Research in Delhi, with
collaborators from the World Bank, Johns Hopkins University, Duke
University, the University of Toronto and Massachusetts General Hospital.
“This study, conducted by our multi-disciplinary team, is unique in scale
and scope, and the population-based sample of providers is representative
of primary care facilities in rural Madhya Pradesh,” says Alaka Holla, a
co-author and economist in the World Bank’s Human Development Network.

The research team hopes the vigorous methodology will help jumpstart a
conversation on how to encourage doctors to provide better care. “Instead
of assuming quality is higher in facilities with more equipment or better-
trained doctors, countries should better integrate quality measures into
existing health policy,” says Das, a senior economist in the Development
Research Group. “And the quality of care can only improve after it is
measured systematically and in multiple settings.”
__________________________________________________________________
________________________________*_________________________________

2. Health Must Be Central to Climate Action: COP18 December 2012
__________________________________________________________________
http://dohadeclaration.weebly.com/

Doha Declaration on Climate, Health and Wellbeing

Health Must Be Central to Climate Action: COP18 December 2012

Health and medical organisations from around the world are calling for the
protection and promotion of health to be made the one of the central
priorities of global and national policy responses to climate change.

The protection of health and welfare is one of the central rationales for
reducing emissions in Article One of the United Nations Framework
Convention on Climate Change (UNFCCC). Article Four requires all countries
to consider the health implications of climate adaptation and mitigation.
Yet health is being overlooked in the development of responses to climate
change, and its importance undervalued by policymakers, business and the
media.

Human health and wellbeing is a basic human right and contributes to
economic and social development. It is fundamentally dependent on stable,
functioning ecosystems and a healthy biosphere. These foundations for
health are at risk from climate change and ecological degradation.

Health as a driver for mitigation and adaptation

The impact of climate change on health is one of the most significant
measures of harm associated with our warming planet. Protecting health is
therefore one of the most important motivations for climate action.

Climate change is affecting human health in multiple ways: both direct –
through extreme weather events, food and water insecurity and infectious
diseases – and indirect – through economic instability, migration and as a
driver of conflict.

The risks to health from climate change are very large and will affect all
populations, but particularly children, women and poorer people and those
in developing nations. Urgent and sustained emissions reductions as well
as effective adaptation are needed.

Climate action can deliver many benefits to health worldwide. Reducing
fossil fuel consumption simultaneously improves air quality and improves
public health. Shifting to cleaner, safer, low carbon energy systems will
save millions of lives each year. Moving to more active lifestyles and
expansion of and access to public transport systems can improve health
through increased physical activity and reduced air pollution. Improving
insulation in homes and buildings can protect people from extreme
temperatures and reduce energy consumption. All of these changes will
provide significant economic savings. Climate action that recognises these
benefits can improve the health of individuals and communities, support
resilient and sustainable development, and improve global equity.

What we seek from climate action

Recognising health in all policies and strengthening health systems
globally can advance human rights and help create safe, resilient,
adaptable, and sustainable communities.

We call for:

1. The health impacts of climate change to be taken into account
domestically and globally

Health impacts and co-benefits to be fully evaluated, costed and reflected
in all domestic, regional and global climate decisions on both mitigation
and adaptation;

Health and environmental costs to be reflected in corporate and national
accounts;

Assessment of loss and damage from climate change to include impacts on
human health, wellbeing and community resilience, as well as impacts to
health care infrastructure and systems;

2. Investment in climate mitigation and adaptation to be significantly
increased on a rapid timescale

Priority given to decarbonisation of national and global energy supplies;

Cessation of fossil fuel subsidies globally and greater funding for
renewable and clean technologies;

Funding for programs to support and protect health in vulnerable countries
to be significantly increased;

Investment in adaptation and mitigation programs that can demonstrate
health benefits to be substantially increased;

3. The health sector and the community to be engaged and informed on
climate action

The health sector to be engaged and included in the processes of designing
and leading climate mitigation and adaptation worldwide;

National and global education programs to increase public awareness of the
health effects of climate change and promote the health co-benefits of low
carbon pathways; and

More inclusive consultation processes in global climate negotiations to
reflect the views of young people, women and indigenous people.

Our Future

Human health is profoundly threatened by our global failure to halt
emissions growth and curb climate change. As representatives of health
communities around the world, we argue that strategies to achieve rapid and
sustained emissions reductions and protect health must be implemented in a
time frame to avert further loss and damage.

We recognise that this will require exceptional courage and leadership from
our political, business and civil society leaders, including the health
sector; acceptance from the global community about the threats to health
posed by our current path; and a willingness to act to realise the many
benefits of creating low carbon, healthy, sustainable and resilient
societies.

‘You cannot tackle hunger, disease, and poverty unless you can also provide
people with a healthy ecosystem’ – Gro Harlem Brundtland
__________________________________________________________________
________________________________*_________________________________

3. Abstract: Minimizing the risk of non-vertical, non-sexual HIV infection
in children – beyond mother to child transmission
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23199798

J Int AIDS Soc. 2012 Nov 15;15(2):17377.

Minimizing the risk of non-vertical, non-sexual HIV infection in children –
beyond mother to child transmission.

Cotton MF, Marais BJ, Andersson MI, Eley B, Rabie H, Slogrove AL, Dramowski
A, Schaaf HS, Mehtar S.

Division of Paediatric Infectious Diseases, Tygerberg Children’s Hospital,
Stellenbosch University, Cape Town, South Africa; mcot@sun.ac.za.

After witnessing an episode of poor injection safety in large numbers of
children in a rural under-resourced hospital in Uganda, we briefly review
our own experience and that of others in investigating HIV infection in
children considered unlikely to be through commonly identified routes such
as vertical transmission, sexual abuse or blood transfusion. In the
majority of cases, parents are HIV uninfected. The cumulative experience
suggests that the problem is real, but with relatively low frequency.

Vertical transmission is the major route for HIV to children. However,
factors such as poor injection safety, undocumented surrogate breast
feeding, an HIV-infected adult feeding premasticated food to a weaning
toddler, poor hygienic practice in the home and using unsterilised
equipment for minor surgical or traditional procedures are of cumulative
concern.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Sharps injuries among nurses in a Thai regional hospital:
prevalence and risk factors
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23022840

Int J Occup Environ Med. 2011 Oct;2(4):215-23.

Sharps injuries among nurses in a Thai regional hospital: prevalence and
risk factors.

Honda M, Chompikul J, Rattanapan C, Wood G, Klungboonkrong S.

ASEAN Institute for Health Development, Mahidol University, Thailand.

BACKGROUND: Sharps injuries (SIs) are one of the most serious occupational
accidents among nurses due to the possible severe consequences, such as the
transmission of infectious diseases and inducing of mental impairment.

OBJECTIVE: To discover the prevalence of SIs among nurses in a regional
hospital in Thailand and to identify factors associated with SIs.

METHODS: A cross-sectional study was conducted in 2011. Stratified random
sampling was used to select the respondents, with wards as the strata and
the number of nurses selected proportional to the size of the ward nurse
population. 261 self-administered questionnaires were distributed to nurses
who used needles, syringes or other sharp medical equipment in their work.
Data were analyzed using chi-square tests, correlation analysis and
multiple logistic regression analysis.

RESULTS: The prevalence of SIs for the previous 12 months was 55.5% among
the 250 nurses who returned a completed questionnaire. Of these, 91.1% were
with blood. Needles (52.8%) were the main cause of SIs. The reporting rate
of SIs to the hospital was 23.8%. SIs had a significant association with
each of marital status, work duration, work department, attitude regarding
SI prevention, and preventive management. Using multiple logistic
regression analysis, attitude was found to be the strongest predictor of
SIs when adjusted for other factors. Nurses who had negative attitudes
towards prevention of SIs were nearly two times more likely to have SIs
than those with positive attitudes (adjusted odds ratio = 1.86; 95% CI:
1.03-3.38).

CONCLUSION: The study showed a high prevalence of SIs, but a low reporting
rate. This suggests the reporting system requires simplification and also
should include a quick response management component. Promoting positive
attitudes to SI prevention, and improving the reporting system would reduce
SIs.

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__________________________________________________________________
________________________________*_________________________________

5. Abstract: Sharps injuries among medical students in the Faculty of
Medicine, Colombo, Sri Lanka
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22729497

Int J Occup Med Environ Health. 2012 Jun;25(3):275-80.

Sharps injuries among medical students in the Faculty of Medicine, Colombo,
Sri Lanka.

Liyanage IK, Caldera T, Rwma R, Liyange CK, De Silva P, Karunathilake IM.

Faculty of Medicine, General Sir John Kotelawala Defence University,
Colombo, Sri Lanka. isurujith@gmail.com

INTRODUCTION: Medical students undertake clinical procedures which carry a
risk of sharps injuries exposing them to bloodborne infections.

OBJECTIVES: To study the prevalence and correlates of sharps injuries among
4th-year medical students in the Faculty of Medicine, University of
Colombo, Sri Lanka.

MATERIALS AND METHODS: The survey was conducted among 4th-year medical
students to find out the incidence of injuries during high-risk procedures,
associated factors and practice and perceptions regarding standard
precautions. A self- administered questionnaire was administered to a batch
of 197 4th-year medical students.

RESULTS: A total of 168 medical students responded. One or more injury was
experienced by 95% (N = 159) of the students. The majority (89%) occurred
during suturing; 23% during venipuncture and 14% while assisting in
deliveries. Most of the incidents (49%) occurred during Obstetrics and
Gynecology attachments.

Recapping needles led to 8.6% of the injuries. Thirty-five percent of
students believed they were inadequately protected. In this group, adequate
protection was not available in 21% of the incidences and 24% thought
protection was not needed. Following the injury, 47% completely ignored the
event and only 5.7% followed the accepted post- exposure management.

Only 34% of the students knew about post-exposure management at the time of
the incident. Only 15% stated that their knowledge regarding prevention and
management was adequate. The majority (97%) believed that curriculum should
put more emphasis on improving the knowledge and practice regarding sharps
injuries.

CONCLUSIONS: The incidence of sharps injuries was high in this setting.
Safer methods of suturing should be taught and practiced. The practice of
standard precautions and post-injury management should be taught.
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Occupational exposure to blood and body fluids
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23022776

Int J Occup Environ Med. 2010 Jan;1(1):1-10.

Occupational exposure to blood and body fluids.

Bahadori M, Sadigh G.

Department of Infectious Diseases, Tehran University of Medical Sciences,
Tehran, Iran.

Occupational exposure to blood and body fluids is an important hazard for
health care workers, which places them at a high risk for blood-borne
infections including hepatitis B virus, hepatitis C virus and human
immunodeficiency virus and results in psychological and emotional stresses.

Several preventive measures have been proposed including pre-exposure
(e.g., education, use of standard precautions, use of needle protective
devices, and vaccination) and post-exposure (e.g., post-exposure
prophylaxis and early detection of disease) prevention.

In this article,
the importance of occupational exposure to blood and body fluids and the
basic concepts of exposure prevention and management are reviewed.

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__________________________________________________________________
________________________________*_________________________________

7. Abstract: Scarcity of healthcare worker protection in eight low- and
middle-income countries: surgery and the risk of HIV and other
bloodborne pathogens
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22035344

Trop Med Int Health. 2012 Mar;17(3):397-401.

Scarcity of healthcare worker protection in eight low- and middle-income
countries: surgery and the risk of HIV and other bloodborne pathogens.

Leow JJ, Groen RS, Bae JY, Adisa CA, Kingham TP, Kushner AL.

Surgeons OverSeas (SOS), New York, NY 10003, USA.

OBJECTIVE: In view of the substantial incidence of bloodborne diseases and
risk to surgical healthcare workers in low- and middle-income countries
(LMICs), we evaluated the availability of eye protection, aprons, sterile
gloves, sterilizers and suction pumps.

METHODS: Review of studies using the WHO Tool for the Situational Analysis
of Access to Emergency and Essential Surgical Care.

RESULTS: Eight papers documented data from 164 hospitals: Afghanistan (17),
Gambia (18), Ghana (17), Liberia (16), Mongolia (44), Sierra Leone (12),
Solomon Islands (9) and Sri Lanka (31). No country had a 100% supply of any
item. Eye protection was available in only one hospital in Sri Lanka (4%)
and most abundant in Liberia (56%). The availability of sterile gloves
ranged from 24% in Afghanistan to 94% in Ghana.

CONCLUSION: Substantial deficiencies of basic protective supplies exist in
low- and middle-income countries.

© 2011 Blackwell Publishing Ltd.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Needlesticks injuries in dentistry
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22609509

Kathmandu Univ Med J (KUMJ). 2011 Jul-Sep;9(35):208-12.

Needlesticks injuries in dentistry.

Gupta N, Tak J.

Department of Periodontics, Shree Bankey Bihari Dental College & Research
Centre, India. neha.perio@gmail.com

Needlestick injuries and other sharps-related injuries which expose health
care professionals to bloodborne pathogens continue to be an important
public health concern.

Dentists are at increased risk of exposure to bloodborne pathogens,
including Hepatitis B, Hepatitis C, and HIV. This article presents
comprehensive information on Needlestick injuries (NSI), post exposure
prophylaxis, precautions and suggestions for prevention of NSI in
dentistry.

Dentists should remember and apply many precautions to prevent the broad
spectrum of sharps and splash injuries that could occur during the delivery
of dental care.
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Sharps disposal practices among diabetic patients using
insulin
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22380912

S Afr Med J. 2012 Feb 23;102(3 Pt 1):163-4.

Sharps disposal practices among diabetic patients using insulin.

Govender D, Ross A.

Department of Family Medicine, University of KwaZulu-Natal, Durban.
shaunandmicci@hotmail.com

Insulin-dependent diabetic patients are not educated on safe sharps
disposal methods, so leading to unsafe disposal of needles. Appropriate
education on the correct disposal of sharps should be an integral part of
their diabetic counseling.

Doctors, nurses and pharmacists should all take responsibility for
educating and reinforcing information about correct sharps disposal
methods. Patients should be advised to either discard sharps into puncture
resistant containers placed into their household refuse, or return them in
secure containers for disposal by the dispensing institutions. Patients
should also be educated regarding health risks associated with used
needles.

The South African Metabolic and Endocrine (SEMDSA) Guidelines and the South
African Standard Treatment Guidelines (STG) should also give clear guidance
on the safe disposal of needles.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Precautions for health care workers to avoid hepatitis B and
C virus infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23022838

Precautions for health care workers to avoid hepatitis B and C virus
infection.

Askarian M, Yadollahi M, Kuochak F, Danaei M, Vakili V, Momeni M.

Department of Community Medicine, Shiraz University of Medical Sciences,
Iran. askariam@sums.ac.ir

The burden of exposure to blood-borne pathogens (such as hepatitis B and C
viruses) is considerable for health care workers. Hepatitis virus
transmission requires a non-immune host, an infectious source, and skin or
mucous membrane injury. These three aspects are the main fields for
preventional interventions.

We reviewed major recent studies on this topic to identify precautions
health care workers should take to avoid hepatitis B (HBV) and C virus
(HCV) infections. Accordingly, this review looks at aspects of
epidemiology, risk factors, economy, knowledge, attitudes, practice, and
ethics of HBV and HCV that affect health care workers.

The risk of transmission depends on the load of pathogen, infectious
characteristics and exposure frequency. Health care workers skill levels
and the specific hospital department involved appear to be the most
important factors in the exposure of health care workers to blood-borne
pathogens.

However, many health care workers surveyed, believed that educational
programs about standard precautions in their setting were not adequate.
Obviously, more detailed studies will be needed to clarify risks and
opportunities for health care workers precautions aimed at avoiding HBV and
HCV infection, especially in emerging health research communities.

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__________________________________________________________________
________________________________*_________________________________

11. Abstract: Personal and organizational predictors of physicians’
knowledge, attitudes and practices related to medical waste management
in Mazandaran province (northern Iran)
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22517529

Waste Manag Res. 2012 Jul;30(7):738-44. d

Personal and organizational predictors of physicians’ knowledge, attitudes
and practices related to medical waste management in Mazandaran province
(northern Iran).

Jabbari H, Farokhfar M, Jafarabadi MA, Taghipour H, Bakhshian F, Rohane S.

Department of Social Medicine, Tabriz University of Medical Sciences, and
National Public Health Management Center (NPMC), Tabriz, Iran.
hosseinhosseinj@yahoo.com

Medical waste management (MWM) is an important public health concern
worldwide. Although physicians must participate in medical waste
management, their personal and organizational predictors in this process
are unknown.

This study aimed to the determinants of physicians’ knowledge, attitudes
and practices related to MWM in eight hospitals of Mazandaran province,
northern Iran.

A validated, reliable self-administered questionnaire was used including 30
questions about the respondents’ knowledge, attitudes and practices (KAP)
and personal and professional variables. Of a total of 200 physicians, 150
persons completed the questionnaire (response rate of 75%).

The average score (± SD) for physicians’ knowledge was 6.50 (± 1.50) out of
10, whereas those for attitudes and practices were 4.44 (± 0.88) and 4.02
(± 1.35) out of 5, respectively. Surgeons and orthopaedists had the lowest
scores, whereas para-clinical specialists and internal medicine specialists
had the highest scores.

The score of knowledge showed significant differences among speciality
groups and the various speciality groups’ scores differed significantly
only for knowledge (P = 0.024) and the mean of total KAP was significantly
different between educational and non-educational hospitals (P < 0.05).

As hospital type and physician speciality was related to the KAP concerning
MWM, therefore it is recommend that all hospitals should develop
appropriate protocols for medical waste management based on the this
variables using a participatory process with teamwork and continuous
training.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Recommendations and current practices for the reconstitution
and storage of botulinum toxin type A
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22055283

J Am Acad Dermatol. 2012 Sep;67(3):373-8.

Recommendations and current practices for the reconstitution and storage of
botulinum toxin type A.

Liu A, Carruthers A, Cohen JL, Coleman WP 3rd, Dover JS, Hanke CW, Moy RL,
Ozog DM.

Department of Dermatology, Division of Mohs Micrographic Surgery, Henry
Ford Hospital, Detroit, Michigan, USA.

BACKGROUND: Current guidelines from the Centers for Disease Control and
Prevention (CDC) regarding the reconstitution and storage of botulinum
toxin type A (BT-A) differ from those of the Centers for Medicare and
Medicaid Services and current clinical practice. CDC guidelines require
single-patient use of BT-A vials. Strict adherence to these guidelines
creates waste and a significant financial impediment, and does not confer
increased protection from infection, assuming standard safe injection
practices are followed.

OBJECTIVE: This study examines current clinical practices and provides
expert consensus recommendations regarding the reconstitution and storage
of BT-A. A review of the literature on the sterility and efficacy of BT-A
stored beyond the recommended time period of 4 hours is also presented.

METHODS: An Internet-based survey was used to analyze the current practices
of physician members of the American Society for Dermatologic Surgery who
administer botulinum type A toxins.

RESULTS: After reconstitution, the majority of physicians (68.6%) routinely
store BT-A for a period of greater than 1 week and safely use each toxin
vial for more than one patient. Not a single case of infection was
observed.

LIMITATIONS: This was a single survey with a 32.2% response rate.

CONCLUSION: A single vial of BT-A can be safely administered to multiple
patients, assuming standard safe injection techniques are followed. After
reconstitution, Our data suggest that BT-A can be stored beyond the
recommended time period of 4 hours.

Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby,
Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Police officer anxiety after occupational blood and body
fluid exposure
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22764276

Occup Med (Lond). 2012 Jul;62(5):382-4.

Police officer anxiety after occupational blood and body fluid exposure.

Dunleavy K, Taylor A, Gow J, Cullen B, Roy K.

Institute for Applied Social and Health Research, School of Social Science,
University of the West of Scotland, High Street, Paisley PA1 2BE, UK.
karen.dunleavy@uws.ac.uk

BACKGROUND: In the course of their work, police staff are at risk of
exposure to blood and body fluids (BBF) and potentially at risk of
acquiring a blood-borne viral infection.

AIMS: To examine levels of anxiety among Scottish police staff following an
occupational exposure to BBF.

METHODS: Police staff who reported an incident of exposure to their
occupational health (OH) provider were invited to complete a postal
questionnaire about their levels of self-reported anxiety after the
incident and after contact with medical services (namely, OH and accident
and emergency (A&E)).

RESULTS: Seventy exposed individuals (66% of those invited to take part)
completed a questionnaire. Participants’ self-reported anxiety after the
incident varied widely. Levels of anxiety reduced over time and following
contact with medical services. A&E staff were more likely to be the first
point of medical contact for the most anxious individuals. Pre-incident
training was not associated with post-incident anxiety.

CONCLUSIONS: The findings suggest that contact with medical services helps
to alleviate post-exposure anxieties among police staff.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Net financial benefits of averting HIV infections among
people who inject drugs in Urumqi, Xinjiang, Peoples Republic of China
(2005-2010)
__________________________________________________________________
http://www.biomedcentral.com/1471-2458/12/572

BMC Public Health. 2012 Jul 29;12:572.

Net financial benefits of averting HIV infections among people who inject
drugs in Urumqi, Xinjiang, Peoples Republic of China (2005-2010).

Ni MJ, Fu LP, Chen XL, Hu XY, Wheeler K.

Xinjiang Uighur Autonomous Regional Centre for Disease Control HIV/AIDS,
Urumqi, Xinjiang Uighur Autonomous Region, Peoples’ Republic of China.
kimwheel@yahoo.com

BACKGROUND: To quantify the contribution of locally implemented prevention
programmes in contributing to reductions in treatment and care costs by
averting HIV infections among those who inject drugs this study calculates
net financial benefit of providing harm reduction programmes using
information from services being implemented in Urumqi, Xinjiang Uighur
Autonomous Region of China ( between 2005 and 2010).

METHODS: Information was collected to assess cost of providing methadone
treatment (MMT) and needle and syringe programmes (NSP). HIV incidence was
estimated among people who inject drugs (PWID). HIV infections averted were
calculated. Net benefit was assessed by estimating costs of providing
prevention programmes and comparing these to the costs of providing care.

RESULTS: An estimated 5678 (range 3982-7599) HIV infections were averted
between 2005 and 2010 and the net financial benefit of providing harm
reduction programmes compared to treatment and care costs for HIV
infections averted was USD 4.383 million during the same time period.

CONCLUSION: These results demonstrate the net and accumulating benefit of
investing in harm reduction programmes for PWID in Urumqi. The return on
investment progressively increased during the time period studied and it is
clear that these cost savings will continue to accrue with the continued
implementation of HIV prevention interventions in the community that
include harm reduction programmes targeted at PWID.

Free Article http://www.biomedcentral.com/1471-2458/12/572
__________________________________________________________________
________________________________*_________________________________

15. Abstract: The initial experience in supervised injecting facilities in
Denmark
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23006221

Ugeskr Laeger. 2012 Sep 24;174(39):2286-9.

[The initial experience in supervised injecting facilities in Denmark].

[Article in Danish]

Axelsson A, Hvam F, Bonde M, Olsen ML, Kiørboe E, Hoff-Lund O, Abildgaard
M, Iversen K.

Hjertemedicinsk Klinik B, Rigshospitalet, Blegdamsvej 9, Copenhagen.

Intravenous drug abuse is a major health concern. The National Board of
Health estimates the number of injecting drug users (IDUs) in Denmark to be
13,000. Supervised injecting facilities (SIF) reduce the risk behaviour and
bacterial infections and also increase the rate of detoxification and
access to health care.

The first SIF in Denmark is driven by volunteers and it opened in September
2011. In the first six months there were 1,139 visits. As in earlier
studies the IDUs were mainly males with a long history of drug use. Unlike
in previously published studies cocaine was the most commonly injected
drug.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Prevalence of transfusion transmitted virus infection in
hemodialysis patients and injection drug users compared to healthy
blood donors in isfahan, iran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23213328

Gastroenterol Res Pract. 2012;2012:671927.

Prevalence of transfusion transmitted virus infection in hemodialysis
patients and injection drug users compared to healthy blood donors in
isfahan, iran.

Ataei B, Emami Naeini A, Khorvash F, Yazdani MR, Javadi AA.

Infectious Diseases and Tropical Medicine Research Center, Isfahan
University of Medical Sciences, Isfahan, Iran.

Introduction. The pathogenicity and transmission routes of Transfusion
Transmitted Virus (TTV) remain unclear. The aim of this study was to
determine the prevalence of TTV in hemodialysis patients, injecting drug
users (IDUs), and healthy blood donors, in Isfahan, Iran.

Method. In a case-control study, a total of 108 subjects were put into
three groups namely Group I, 36 hemodialysis patients; Group II, 36 IDUs;
and Group III, 36 healthy blood donors as the control group. A 5 ml blood
sample was collected from each subject in an EDTA-containing tube. Samples
were tested for TTV DNA by means of real-time polymerase chain reaction
(PCR).

Results. The mean age was 38.7 ± 14.7 years. Seventy-one subjects (66%)
were male. Of the108 cases, 30 (27.8%) were TTV positive and 78 (72.2%)
were TTV negative. The prevalence of TTV in IDUs [21 (58%)] was
significantly higher than in the other groups [group I: 6 (17 %) and group
III: 3 (8%)] (P < 0.0001).

Conclusion. The prevalence of TTV in IDUs is significantly higher than in
both hemodialysis patients and general population in Isfahan, Iran. It
seems necessary to take serious measures to reduce the risk of TTV
transmission to IDUs’ close contacts and health care providers.
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Hepatitis C in Poland in 2010
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23101218

Przegl Epidemiol. 2012;66(2):287-92.

[Hepatitis C in Poland in 2010].

[Article in Polish]

Rosinska M, Radziszewski F, Stepien M.

Zaklad Epidemiologii, Narodowego Instytutu Zdrowia Publicznego –
Panstwowego Zakladu Higieny w Warszawie. mrosinska@pzh.gpv.pl

BACKGROUND: Hepatitis C is registered as a separate entity in the national
infectious diseases system in Poland beginning from 1997. All physicians
who diagnose the disease are mandated to report it and, additionally, in
the years 2006 – 2008, mandatory reporting of positive results of HCV test
by laboratories was also implemented. The initial definition adopted at the
European Union level was implemented in Poland in 2005 (2005 definition)
and it included cases with symptoms or elevated liver function tests, which
coincided with the earlier practice. The amended European definition was
implemented in 2009 (2009 definition) to require registration of all
laboratory confirmed cases. AIM. To assess epidemiological situation of
hepatitis C in Poland in 2010 in comparison to the preceding years.

MATERIAL AND METHODS: We performed descriptive analysis of data collected
through routine mandatory surveillance system. Case classification
according to 2005 definition and 2009 definition was verified based on
individual case reports.

RESULTS: In 2010 in Poland 2021 hepatitis C cases meeting 2005 definition
were registered (incidence 5.29 per 100,000), including 38 with mixed HBV-
HCV infection. As compared to 2009 (1939 cases, incidence 5.08) the
incidence increased by 4%. In consequence the decreasing trend observed
since 2006 slowed down. Overall 2212 reported cases (5.79 per 100,000) met
the 2009 definition. This number was higher than in 2009, but still several
times lower than the number of newly diagnosed HCV cases registered in 2006
– 2008. In total 167 persons died due to hepatitis C (mortality 0.44 per
100,000), including 8 due to acute hepatitis C. This constitutes the
highest hepatitis C mortality observed since 1996.

CONCLUSIONS: Low number of registered cases meeting the 2009 definition
indicates the necessity to improve the completeness of reporting, in ex.
through restoring laboratory reporting. It also justifies maintaining the
classification according to 2005 definition in order to monitor trends of
the disease, even though the number of cases meeting this definition
underestimates the real problem. The increase in mortality suggests that
further improvements in diagnosis and access to treatment are necessary.
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Hand-washing knowledge and practices among dentists and
dental specialists
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22536595

Quintessence Int. 2012 May;43(5):429-34.

Hand-washing knowledge and practices among dentists and dental specialists.

Vega OG, Janus C, Laskin DM.

Virginia Commonwealth University School of Dentistry, Richmond, Virginia
23298-0566, USA.

OBJECTIVE: Hand washing is the most important way to prevent the spread of
infection. However, studies have shown that there is a lack of knowledge
among physicians about proper hand hygiene. The purpose of this study was
to determine the knowledge of general dentists and dental specialists
regarding the correct agents to use and the appropriate times to wash
hands.

METHOD AND MATERIALS: A questionnaire asking for demographic information
and the answers to questions about proper hand hygiene practices and agents
was sent via email to a list of general dentists and dental specialists. A
total of 480 completed surveys were received (approximately 15% response).

RESULTS: None of the respondents answered all the questions correctly. Six
percent answered 4 questions correctly, 23% answered 3 questions correctly,
and 47% answered only 2 questions correctly. There was no correlation
between the number of correct answers and whether the respondent was a
general dentist or a specialist.

CONCLUSION: There is a lack of knowledge among dentists regarding proper
hand hygiene. For the benefit of both the patient and the doctor, this
situation must be remedied.
__________________________________________________________________
________________________________*_________________________________

19. Abstract: Safety for home care: the use of Internet video calls to
double-check interventions
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23209268

J Telemed Telecare. 2012 Dec 3.

Safety for home care: the use of Internet video calls to double-check
interventions.

Bradford N, Armfield NR, Young J, Ehmer M, Smith AC.

* Centre for Online Health, University of Queensland, Brisbane, Australia.

We investigated the feasibility of using Internet video calls for a double
check on medication or other complex interventions being administered in
the home. Seven nurses were recruited to the study and received training on
using laptop and tablet computers with mobile Internet connections. The
devices were taken on scheduled home visits to patient homes and video
calls with a second clinician were conducted to double-check various items
associated with the clinical care of the patient.

Over a 14-month period, 88 video calls were conducted during which a total
of 600 checks were completed. The items checked included medication names,
doses, segmentations on syringes and details of ventilator settings. The
quality of the video call was acceptable on 97% of occasions. On three
occasions (3%) it was not possible to establish a connection and the double
check was not achieved. On every occasion that the video call was
successful (n = 85), nurses were 100% confident that they were able to
carry out the full requirements of a double check.

The use of Internet video calls is feasible for double-checking and has the
potential to improve patient safety and reduce costs.
__________________________________________________________________
________________________________*_________________________________

20. Abstract: Efficacy and safety of high dose intramuscular or oral
cholecalciferol in vitamin D deficient/insufficient elderly
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/22613271

Maturitas. 2012 Aug;72(4):332-8.

Efficacy and safety of high dose intramuscular or oral cholecalciferol in
vitamin D deficient/insufficient elderly.

Tellioglu A, Basaran S, Guzel R, Seydaoglu G.

Faculty of Medicine, Department of Physical Medicine and Rehabilitation,
Cukurova University, Adana 01330, Turkey.

OBJECTIVES: To evaluate and compare the effects and safety of high dose
intramuscular (IM) or oral cholecalciferol on 25-hydroxyvitamin D [25(OH)D]
levels, muscle strength and physical performance in vitamin D
deficient/insufficient elderly.

STUDY DESIGN: Randomized prospective study.

MAIN OUTCOME MEASURES: 116 ambulatory individuals aged 65 years or older
living in a nursing home were evaluated. Eligible patients with 25(OH)D
levels <30 ng/ml (n=66) were randomized to IM or Oral groups according to
the administration route of 600,000 IU cholecalciferol. Demographic and
descriptive data were collected. Biochemical response was measured at
baseline, 6th and 12th weeks. Muscle strength was measured from quadriceps
by using a hand-held dynamometer and physical performance was evaluated by
short physical performance battery (SPPB) at the beginning and 12th week.

RESULTS: Among the screened ambulatory elderly only 5.2% (n=6) had adequate
vitamin D levels. 37.1% (n=43) were vitamin D deficient and 57.7% (n=67)
were insufficient. After administration of one megadose of vitamin D, mean
serum 25(OH)D levels increased significantly at 6th week (32.72±9.0 ng/ml)
and at 12th week (52.34±14.2 ng/ml) compared with baseline (11.76±7.6
ng/ml) in IM group (p<0.0001). In Oral group levels were 47.57±12.7 ng/ml,
42.94±13.4 ng/ml and 14.87±6.9 ng/ml, respectively (p<0.0001). At 12th week
the increase in IM group was significantly higher than Oral group (p=
0.003). At the end of the study period, serum 25(OH)D levels were =30 ng/ml
in all patients in IM group and in 83.3% of the patients in the Oral group.
Quadriceps muscle strength and SPPB total score increased significantly in
both groups and SPPB balance subscale score increased only in IM group. Six
patients (9.6%) developed hypercalciuria, no significant adverse events
were observed.

CONCLUSION: In vitamin D deficient/insufficient elderly, a single megadose
of cholecalciferol increased vitamin D levels significantly and the
majority of the patients reached optimal levels. Although both
administration routes are effective and appear to be safe, IM application
is more effective in increasing 25(OH)D levels and balance performance.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

21. Abstract: In Urban And Rural India, A Standardized Patient Study Showed
Low Levels Of Provider Training And Huge Quality Gaps
__________________________________________________________________
Health Aff December 2012 vol. 31 no. 12 2774-2784

In Urban And Rural India, A Standardized Patient Study Showed Low Levels Of
Provider Training And Huge Quality Gaps

Jishnu Das1,*, Alaka Holla2, Veena Das3, Manoj Mohanan4, Diana Tabak5 and
Brian Chan6

+ Author Affiliations

1Jishnu Das (jdas1@worldbank.org) is a senior economist at the World Bank,
in Washington, D.C., and a visiting fellow at the Centre for Policy
Research, New Delhi, India.

2Alaka Holla is an economist in the Chief Economist’s Office of the Human
Development Network at the World Bank.

3Veena Das is the Krieger-Eisenhower Professor of Anthropology and a
professor of humanities at the Johns Hopkins University, in Baltimore,
Maryland.

4Manoj Mohanan is an assistant professor of public policy and global health
at the Sanford School of Public Policy, Duke University, in Durham, North
Carolina.

5Diana Tabak is a lecturer in the Department of Family and Community
Medicine and associate director of the Standardized Patient Program at the
University of Toronto, in Ontario.

6Brian Chan is a clinical and research fellow in infectious diseases at
Massachusetts General Hospital and Brigham and Women’s Hospital, in Boston.
*Corresponding author

This article reports on the quality of care delivered by private and public
providers of primary health care services in rural and urban India. To
measure quality, the study used standardized patients recruited from the
local community and trained to present consistent cases of illness to
providers.

We found low overall levels of medical training among health care
providers; in rural Madhya Pradesh, for example, 67 percent of health care
providers who were sampled reported no medical qualifications at all.
What’s more, we found only small differences between trained and untrained
doctors in such areas as adherence to clinical checklists. Correct
diagnoses were rare, incorrect treatments were widely prescribed, and
adherence to clinical checklists was higher in private than in public
clinics.

Our results suggest an urgent need to measure the quality of health care
services systematically and to improve the quality of medical education and
continuing education programs, among other policy changes.

http://content.healthaffairs.org/content/31/12/2774.full
http://content.healthaffairs.org/content/31/12/2774.full.pdf+html
__________________________________________________________________
________________________________*_________________________________

22. Abstract: Women doctors’ purses as an unrecognized fomite
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23155949

Del Med J. 2012 Sep;84(9):277-80.

Women doctors’ purses as an unrecognized fomite.

Feldman J, Feldman J, Feldman M.

Cornell University in Ithaca, NY, USA.

OBJECTIVE: Health care associated infections are serious problems for
today’s medical community. It is generally assumed that health care workers
come in contact with pathologic bacteria and unwittingly transfer them to
patients either directly with their hands, or indirectly through some
inanimate object. If a doctor washes his or her hands before seeing a
patient and then touches a colonized object, the benefit of hand washing
may have been undone. Previous studies have identified stethoscopes, neck
ties, mobile phones, keyboards, lab coats, and other commonly worn
accessories as potential sources of disease transmission contributing to
health care associated infections. Women doctors’ purses have not
previously been studied as a potential source of disease transmission. This
study evaluated whether doctors’ purses served as a potential source of
disease transmission.

METHODS: We performed a case-control study to determine if women doctors’
purses were colonized more frequently than controls. Purses were obtained
from women doctors who visit a hospital as part of their clinical
responsibilities in the experimental group. Thirteen doctors fit the
criteria of visiting an acute care facility while bringing a purse with
them. Fourteen controls were non-health care women who had not visited a
hospital in the past six months.

RESULTS: We observed that nine of 13 doctors’ purses were colonized with
bacteria compared with two of 14 controls.

CONCLUSIONS: This statistically significant finding demonstrates that there
is a potential for a doctor’s purse to serve as a vector for disease
transmission. It is prudent for women health care workers to be aware that
their purses may be a source of bacterial contamination. We, therefore,
recommend that women practitioners use appropriate infection control
measures whenever their purses are in the health care environment.
__________________________________________________________________
________________________________*_________________________________

23. Abstract: Hepatitis-B vaccination status among dental surgeons in benin
city, Nigeria
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23209986

Ann Med Health Sci Res. 2012 Jan;2(1):24-8. doi: 10.4103/2141-9248.96932.

Hepatitis-B vaccination status among dental surgeons in benin city,
Nigeria.

Azodo C, Ehizele A, Uche I, Erhabor P.

Department of Periodontics, University of Benin, Benin City, Nigeria.
Abstract

BACKGROUND: The development of success-oriented hepatitis-B vaccine uptake
approach among dental surgeons is dependent on the availability of
comprehensive baseline data.

OBJECTIVE: To determine the hepatitis-B vaccination status among dental
surgeons in Benin City.

MATERIALS AND METHODS: This questionnaire-based cross-sectional study of
dental surgeons in Benin City was conducted in May 2011. The questionnaire
elicited information on demography, occupational risk rating of contracting
hepatitis-B infection, hepatitis-B vaccination status, barriers to uptake
of hepatitis vaccine, and suggestions on how to improve hepatitis-B
vaccination rates among dental surgeons.

RESULTS: Participation rate in the study was 93.3%. More than half (51.4%)
of the respondents were 20-30 years old and 52 (74.3%) were males. The
occupational risk of contracting hepatitis-B infection among dental
surgeons was rated as either high or very high by 51 (72.9%) of the
respondents. Amongst the respondents, 14 (20.0%) had received three doses
of the hepatitis-B vaccine, 34 (48.6%) either two doses or a single dose,
and 22 (31.4%) were not vaccinated. The major barriers reported among the
respondents who were not vaccinated were lack of opportunity and the fear
of side effects of the vaccines. The suggested ways to increase the
vaccination rate among the respondents in descending order include: Making
the vaccine available at no cost (51.4%), educating dentists on the merits
of vaccination (17.1%), and using the evidence of vaccination as a
requirement for annual practicing license renewal (14.3%) and for the
employment of dental surgeons (11.4%) and others (2.9%).

CONCLUSION: This study revealed low prevalence of complete hepatitis-B
vaccination among the respondents. Improvement in uptake following the
respondents’ recommendations will serve as a template in developing
success-oriented strategies among stakeholders.
__________________________________________________________________
________________________________*_________________________________

24. No Abstract: Fatal mistakes in prehospital medicine. The laryngoscope,
the syringe and the ink pen can all cause great harm
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23097835

EMS World. 2012 Oct;41(10):28, 30, 32 passim.

Fatal mistakes in prehospital medicine. The laryngoscope, the syringe and
the ink pen can all cause great harm.

Grayson S, Gandy WE.

Acadian Ambulance, Louisiana, USA.
__________________________________________________________________
________________________________*_________________________________

25. The Post 2015 Health Agenda: Call for papers for the post-2015 web
consultation on health has now been extended until December 30, 2012

Crossposted with thanks from the EQUIDAD listserve – PAHO/WHO Equity List
__________________________________________________________________
Call for papers for the post-2015 web consultation on health has now been
extended until December 30, 2012

The call for papers is at http://bit.ly/SUdXIt

WHO-UNICEF led global thematic consultation on health in the post-2015
development agenda http://bit.ly/W7AU00

As part of the United Nations led effort to catalyse a “global
conversation” on the post-2015 agenda through a series of global thematic
and national consultations, WHO and UNICEF, together with the Government of
Sweden, are leading the global consultation around health.

The purpose of the consultation is to:

· To stimulate wide ranging discussion at global, regional and
country levels, on progress made and lessons learnt from the present MDGs
relating to health;
· To discuss and develop a shared understanding — among Member
States, UN agencies, civil society and others — on the positioning of
health in the post 2015 development framework;
· To propose health goals and related targets and indicators for
the post-2015 development agenda, as well as approaches for implementation,
measurement and monitoring.

The consultation will involve both online and face to face consultations :

· The online global health consultation to review key documents,
submit background papers, join moderated e-discussions, and contribute to
the discussion on twitter using the hashtag #health2015.

· WHO Member States will come together in Geneva in mid-December
2012 for an initial consultation on health in the post 2015 agenda.

In March 2013, a high level meeting will be held with representatives of
government, civil society, and the private sector.
This high level meeting will discuss the findings of the online engagement
and papers and will put forward recommendations on how to address health to
the UN High Level Panel of Eminent Persons on the Post-2015 Agenda.

An initial “thinkpiece”, produced by UNAIDS, UNICEF, UNFPA and WHO, which
surveys the issues, is available at http://bit.ly/RNN903 .
* * *
PAHO/WHO Equity List http://listserv.paho.org/Archives/equidad.html
__________________________________________________________________
________________________________*_________________________________

26. News

– USA Nevada: Aide Takes Plea in Vegas Hepatitis Exposure Case
– Australia: Health fears for ‘backyard botox’ patients
– Canada: City clarifies needle exchange zoning
– Greece: HIV Cases Increase in Greece

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
USA Nevada: Aide Takes Plea in Vegas Hepatitis Exposure Case
Ken Ritter, Associated Press, USA (11.12.12)

On December 10, Keith H. Mathahs, formerly an aide at a Las Vegas
outpatient clinic, pleaded guilty to felony neglect and other charges and
agreed to testify against the former clinic owner. Authorities claim that
patients were infected with hepatitis C at the clinic in 2007. Under the
terms of the plea agreement, Mathahs could get probation or be sentenced to
28 months to six years in state prison, a prosecutor and his lawyer stated.
Mathahs pleaded guilty to insurance fraud, obtaining money under false
pretenses, criminal neglect of patients, criminal neglect of patients
resulting in death, and conspiracy to commit racketeering.

Valerie Adair, Clark County District Court Judge, delayed sentencing until
the completion of the trial of Dr. Dipak Desai and Ronald Ernest Lakeman, a
nurse anesthetist at the clinic. A former patient died early in 2012 in the
Philippines, and a second-degree murder charge was added against Desai,
Mathahs, and Lakeman. All three defendants pleaded not guilty and remained
free pending trial. Judge Adair dismissed the murder charge against Mathahs
on December 10. Desai and Lakeman will stand trial in April on 28 criminal
charges; if convicted, they could be sentenced to prison for the rest of
their lives.

Prosecutors allege that Desai oversaw a penny-pinching plan in which the
staff of the Desert Shadow Endoscopy Center and the Endoscopy Center of
Southern Nevada used left-over anesthesia in previously opened vials and
reused colonoscopy scopes and bite plates from patient to patient. In
February of 2008, Southern Nevada Health District officials contacted more
than 50,000 Desai patients to be tested for HIV and hepatitis. Nine people
contracted incurable hepatitis C, and cases involving 105 more patients may
have been related, authorities determined later. Prosecutor Michael
Staudaher and Richard Wright, Desai’s lawyer, declined to comment on
Mathahs’s plea deal.
__________________________________________________________________
__________________________________________________________________
Australia: Health fears for ‘backyard botox’ patients
AAP, Australia (10.12.12)

HEALTH officials in Western Australia are urging patients of a “backyard
Botox” clinic that they may have been exposed to a potentially deadly
infection.

WA’s Department of Health has advised all clients of registered nurse
Tiffany Fraser, of Wembley Downs, to visit their doctor for blood tests to
check for a potential blood-borne virus or bacterial infection.

The health department said it had launched an investigation into a possible
infection control breach at Ms Fraser’s home, and she had been reported to
the Australian Health Practitioner Regulation Agency.

Chief health officer Tarun Weeramanthri said the potential risk of
infection was small but real.

“While the risk of infection for individual patients is considered very
low, it is important that any potential risk, no matter how unlikely, is
ruled out,” Dr Weeramanthri said.

“Ms Fraser was conducting cosmetic procedures including the injection of
Botox and fillers in an unregulated environment, without any documentation
of infection control practices.

“Anyone who received treatment in Ms Fraser’s home involving the injection
of hyaluronic acid (Juvederm) or botulinum toxin (Botox) should visit their
GP as soon as possible to arrange a blood test.”

Dr Weeramanthri said the health department had written to all of Ms
Fraser’s known clients to advise them of the threat, but also wanted to
identify any other clients who may have visited her home for cosmetic
treatments.

“The Department of Health is continuing its investigation into this
possible infection control breach and advises people to exercise caution
before undergoing cosmetic procedures in private homes, outside a clinical
setting,” Dr Weeramanthri said.

Anyone who has received treatment from Ms Fraser at her home can contact
the Public Health Unit on 08 9380 7700 during business hour
__________________________________________________________________
__________________________________________________________________
Canada: City clarifies needle exchange zoning
By David Hutton, The Star Phoenix, Saskatoon Canada (04.12.12)

The City of Saskatoon will soon “clarify” the definition of medical clinics
to include needle exchanges, with a report saying Saskatoon’s harm
reduction efforts are working to reduce the spread of HIV.

The report – tabled Monday with city council’s executive committee – is a
response to a vocal group of residents and business owners in Caswell Hill
and Mayfair who spoke out against the 601 Outreach Centre needle exchange
operated by AIDS Saskatoon earlier this year.

The AIDS Saskatoon needle exchange has operated for 3½ years out of a
nondescript building at 33rd Street and Avenue F. A number of nearby
business owners say the needle exchange has residents and business owners
fighting perceptions the area is unsafe.

Some residents and business owners took issue with activity surrounding the
needle exchange building. Needle exchanges are better suited for medical
clinics, not drop-in centres, they told councillors.

“It’s attracting the drug trade,” business owner Lori Prostebby told the
committee.

The needle exchange has not increased crime in the area, a Saskatoon police
report said. There has been no evidence that “makes a direct connection
between criminal activities in the area to the AIDS Saskatoon office, or
the work they do, or the programs they provide for their clients,” the
report said.

Prostebby’s concerns sparked a report from administration that examined
where needle exchanges should be allowed to locate in Saskatoon.

The definition of a “medical clinic” in the city’s land-use and zoning
bylaw does not specifically mention needle exchanges, but the
administration will undertake a review with the intention of rewriting the
definition and clearing up the ambiguity.

The change will require council approval after public hearings next year.

Needle exchanges would be formally permitted in commercial areas such as
strip malls where medical clinics are allowed, but would always reside with
other health-care services.

The needle exchanges offer the only “point of contact” with formal health
care for some members of the community, Lynne Lacroix, manager of community
development for the city, said.

“We’ll be taking a look at what is already occurring in terms of where
needle exchanges are already located,” Lacroix said. “They are never a
stand-alone facility.

“They provide education and counselling and a needle exchange is one
component of what they do.”

Although critics have long op-posed giving clean needles to drug addicts on
moral grounds, the consensus among public health experts – including the
World Health Organization and the American Medical Association – is that
the strategy works to reduce the spread of HIV.

Dr. Johnmark Opondo, the Saskatoon Health Region’s deputy medical health
officer, told the committee needle exchanges and other harm reduction
efforts such as methadone clinics “must be located close to where people
live and where other complementary services exist.”

The number of new HIV infections has dropped alongside the annual number of
needles found in the community, a report to the committee said.

“Needle exchange programs are one component of a suite of comprehensive
health and social supports and need to be considered within a broader
context of the work that is occurring within our community with respect to
the issue of drug use and addressing the needs of intravenous drug users
and other vulnerable populations on multiple fronts,” the city report said.

© Copyright (c) The StarPhoenix
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Greece: HIV Cases Increase in Greece
Associated Press (01.12.12)

Health officials in Greece warned of a huge increase in HIV infection in
Athens, particularly among injecting drug users. Officials said that from
2008?2010, there were 10 to 14 new cases of HIV among drug users in Athens
each year, but that the number had increased to 206 cases in 2011 and 487
by October of 2012.

In the meantime, needle distribution programs are having difficulty finding
funds. Greece is struggling through a financial crisis, which has led to
deep cuts in health care and drug treatment programs. Marc Sprenger,
director of the European Center for Disease Prevention and Control,
commented that the situation needed to be handled quickly to prevent it
from spiraling out of control.
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SIGN meets annually to aid collaboration and synergy among SIGN network
participants worldwide.

The 2010 annual Safe Injection Global Network meeting was held from 9
to 11 November 2010 in Dubai, The United Arab Emirates.

The SIGN 2010 meeting report pdf, 1.36Mb is available on line at:
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