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SIGNpost 00684

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00684 Waste + HR + HCV + Abstracts + News 6   February 2013

CONTENTS
0. Moderators Note
1. Nepal: Medical Waste Awareness at an All-time High in Nepal
2. WHO: Human resources for universal health coverage: a call for papers
3. Detonating a viral time bomb—the hepatitis C pandemic
4. Abstract: Evaluating the implementation of health and safety innovations
under a regulatory context: A collective case study of Ontario’s safer
needle regulation
5. Abstract: Prevalence and risk factors of hepatitis B and C virus
infections among the general population and blood donors in Morocco
6. Abstract: Prevalence of hepatitis C infection among children with ß-
thalassaemia major in Mid Delta, Egypt: a single centre study
7. Abstract: Epidemiology of hepatitis C virus infection in highly endemic
HBV areas in china
8. Abstract: A Fatal Case of Streptococcal Toxic Shock Syndrome due to
Streptococcus dysgalactiae subsp. equisimilis Possibly Caused by an
Intramuscular Injection
9. Abstract: Prophylaxis against infections after needle stick injuries
10. Abstract: Analysis of the health and environmental status of
sterilizers in hospital waste management: a case study of hospitals in
Tehran
11. Abstract: New evidence on the HIV epidemic in Libya: why countries must
implement prevention programmes among people who inject drugs
12. Abstract: An Overview of HIV Prevention Interventions for People Who
Inject Drugs in Tanzania
13. Abstract: Hepatitis C virus in American Indian/Alaskan Native and
Aboriginal peoples of North America
14. Abstract: Decreased injecting is associated with increased alcohol
consumption among injecting drug users in northern Vietnam
15. Abstract: Infectivity of blood products from donors with occult
hepatitis B virus infection
16. Abstract: Compliance of health care workers with hand hygiene
practices: independent advantages of overt and covert observers
17. Abstract: Hand hygiene of medical and nursing students during clinica
rotations: a pilot study on knowledge, attitudes and impact on
bacterial contamination
18. Abstract: Microbicidal effect of weak acid hypochlorous solution on
various microorganisms
19. Abstract: Priming after a fractional dose of inactivated poliovirus
vaccine
20. Abstract: Effectiveness of two flavored topical anesthetic agents in
reducing injection pain in children: a comparative study
21. Abstract: Efficacy of subcutaneous and sublingual immunotherapy with
grass allergens for seasonal allergic rhinitis: a meta-analysis-based
comparison
22. News
– Technology: Slow-release jelly means fewer insulin shots for diabetics
– Spread of hepatitis C pinpointed
– India: Hepatitis-C epidemic in Kokernag village, 300 positive
– Technology: Syringe Design Change Could Cut HIV Transmission
– USA: Hepatitis C Cases Climbing in Northern Kentucky (NKY)
– USA: Arizona Bill Seeks Felony Charge for Intentionally Exposing Others
to HIV, STDs
– USA: Second NY Hospital Warns Patients About Potential HIV, Hepatitis
Exposure From Insulin Pens
– USA: Hepatitis C Linked to Tattoo Ink
– Nepal: Govt warns hospitals to strictly manage waste

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________________________________*_________________________________

0. Moderators Note
__________________________________________________________________

Moderators apologies!

Due to a severe weather event and 4 day power outage last Wednesday’s
edition of SIGNpost was not posted. The website and Facebook page stayed
online as they are hosted elsewhere.

This edition should bring SIGNpost readers up to date on abstracts, news,
and more.

allan
__________________________________________________________________
________________________________*_________________________________

1. Nepal: Medical Waste Awareness at an All-time High in Nepal
__________________________________________________________________
Medical Waste Awareness at an All-time High in Nepal
Ruth Stringer, International Science & Policy Coordinator at Health Care
Without Harm http://www.noharm.org/global/issues/waste/

Health Care Without Harm has been working with strategic partners
Healthcare Foundation Nepal (HECAF) since 2008 and the issue has never been
hotter.

A front-page news article in the Himalayan – one of Nepal’s leading English
language newspapers – reports the government warning that hospitals that do
not treat their waste will lose their licences and be forced to shut down.
http://www.noharm.org/lib/downloads/waste/Himalayan_news.pdf

A team lead by a representative from the Prime Minister’s office visited
three Kathmandu Hospitals in December and found that only one was treating
their waste properly. That one hospital was Bir, where HECAF has created a
sustainable waste management system with support from HCWH and the World
Health Organisation.

A short HECAF video about the progress at Bir, by filmmaker Russ Pariseau,
can be seen here.

The Prime Minister and the Minister of Science and Technology also came to
the Energy Week Workshop organised by the Alternative Energy Promotion
Centre and visited HECAF’s stall, where they were raising awareness about
HCWH’s Global Green and Healthy Hospital’s, and the potential of
biodigestion to treat waste and generate renewable energy in hospitals.
Biodigestion is just one of the innovative technologies that are being
piloted at Bir, and plans for other hospitals are under development.

Outside of the capital, the Chitwan District Public Health Office, a
government institution responsible for Public Health, is also backing HECAF
and HCWH’s work. The District Public Health Officer is supporting our
project to develop waste systems suitable for the small healthposts that so
many of the rural population depend on. Suitable pilot facilities have
already been identified and the next step will be to raise awareness with
facility bosses across the region and field testing some of the priority
technologies.

Ruth Stringer, International Science & Policy Coordinator at Health Care
Without Harm http://www.noharm.org/global/issues/waste/
__________________________________________________________________
________________________________*_________________________________

2. WHO: Human resources for universal health coverage: a call for papers

The deadline for submissions is 10 March 2013.

Manuscripts should respect the Bulletin’s Guidelines for contributors
(available at: http://submit.bwho.org) and mention this call for papers in
the cover letter. All submissions will be reviewed by peers.
__________________________________________________________________
Bulletin of the World Health Organization 2013;91:84-84A.

Website: http://www.who.int/bulletin/volumes/91/2/13-117200/en/index.html

Human resources for universal health coverage: a call for papers

Mubashar Sheikh,a Ties Boerma,b Giorgio Cometto,a & Robbert Duviviera

a. Global Health Workforce Alliance Secretariat, 20 avenue Appia, 1211
Geneva 27, Switzerland.
b. World Health Organization, Geneva, Switzerland.

Correspondence to Giorgio Cometto (e-mail: comettog@who.int).

An adequate, performing health workforce is vital for improving health
service coverage and health outcomes.1 Yet the availability, distribution,
capacity and performance of human resources for health (HRH) varies widely
and many countries have fewer health workers than needed for high coverage
of essential health services, according to the World health report 2006.2
Signs of progress are emerging, though; several countries are successfully
addressing their problems in the area of HRH, resulting in improvements in
health outcomes.3 These gains are, however, vulnerable: shortages of and
inequitable access to health workers still thwart many countries’ attempts
to achieve the Millennium Development Goals (MDGs) and their efforts to
scale up their response against noncommunicable diseases and attain
universal health coverage.

Universal Health Care (UHC) was defined by the World Health organization in
2005.4 Since then it has gained increased recognition as a framework for
embracing various global health priorities. New evidence, policy options
and advocacy5 in support of the progressive achievement of UHC have been
the focus of the World health report: health systems financing6 and of
numerous global health events.7,8 In 2011 the World Health Assembly adopted
a resolution on UHC,9 and in 2012 a United Nations General Assembly
resolution bolstered political momentum in support of UHC and underscored
the need for an “adequate, skilled, well-trained and motivated
workforce”.10 In this context ensuring that appropriate HRH strategies and
priorities are embedded in the UHC and post-MDG agenda becomes crucial.

As health systems progressively broaden their scope to cover
noncommunicable diseases and other priorities, health workers will face new
demands for more comprehensive and equitable service delivery. The
challenge lies in addressing past and present gaps while simultaneously
anticipating future actions to strengthen the health workforce as an
integral part of health systems.

The HRH needs demand renewed attention, strategic intelligence and action.
Gaps in health worker distribution, competency, quality, motivation and
performance need to be addressed in addition to sheer numbers. Fundamental
changes in the way in which health workers are trained, managed, regulated
and supported and in the role of the public sector in shaping labour market
forces will be necessary.

Against this background, the Bulletin will publish a theme issue on HRH and
universal health coverage to provide an opportunity to identify the changes
in HRH investment, production, deployment and retention required to achieve
UHC. Its publication will coincide with the Third Global Forum on Human
Resources for Health, to be held in Recife, Brazil, on 10–13 November 2013.

The Third Global Forum is convened by the Global Health Workforce Alliance
(GHWA) – a multisectoral partnership established in 2006 to spearhead the
response to HRH challenges – in conjunction with WHO, the Pan American
Health Organization and the Government of Brazil. The First Global Forum
(Uganda, 2008) resulted in the development of a global HRH roadmap;11 at
the Second Global Forum (Thailand, 2011), countries and stakeholders
reconvened to review progress and renew their commitments towards increased
investment, sustained leadership and the adoption of effective HRH
policies.

The Third Global Forum will provide an opportunity to update the HRH
agenda, to make it more relevant to the current global health policy
discourse, including the focus on achieving the health MDGs, the objective
of UHC and the emerging debate on the post-2015 agenda. Additionally,
countries and HRH stakeholders will be invited to explicitly commit to HRH
actions as the basis for an inclusive accountability framework.

The Third Global Forum’s programme will position health workforce
development as a critical requirement for effective UHC and will be
designed around one overarching theme – “human resources for health:
foundation for universal health coverage and the post-2015 development
agenda” – as well as five sub-themes and their corresponding tracks: (i)
leadership, partnerships and accountability for HRH development; (ii)
impact-driven HRH investments towards UHC; (iii) a supportive HRH legal and
regulatory landscape for UHC; (iv) empowerment of health workers by
overcoming policy, social and cultural barriers; (v) the harnessing of HRH
innovation and research through new management models and technologies. 12

To provide a solid evidence base and background to the Third Global Forum’s
proceedings, the theme issue will feature commissioned as well as
independently submitted articles that will set the scene for and generate
innovative thinking on HRH for UHC. GHWA and WHO welcome contributions on
the Forum’s general theme, five sub-themes and tracks, especially those
emphasizing aspects of HRH directly related to achieving UHC. Submission of
relevant country experiences is particularly encouraged.

The deadline for submissions is 10 March 2013. Manuscripts should respect
the Bulletin’s Guidelines for contributors (available at:
http://submit.bwho.org) and mention this call for papers in the cover
letter. All submissions will be reviewed by peers.

References

Anand S, Bärnighausen T. Human resources and health outcomes: cross-country
econometric study. Lancet 2004; 364: 1603-9 doi: 10.1016/S0140-6736(04)
17313-3 pmid: 15519630.

Working together for health: the world health report 2006. Geneva: World
Health Organization; 2006. Available from: http://www.who.int/whr/2006
[accessed 10 January 2013].

Global Health Workforce Alliance. Reviewing progress, renewing commitments;
2011. Available from:
http://www.who.int/workforcealliance/knowledge/resources/kdagaprogressrepor
t [accessed 3 January 2013].

Resolution WHA58.33. Sustainable health financing, universal coverage and
social health insurance. In: Resolutions and decisions [Internet]. Geneva:
World Health Organization; 2005. Available from:
http://www.who.int/gb/ebwha/pdf_files/WHA58/WHA58_33-en.pdf [accessed 3
January 2013].

Holmes D. Margaret Chan: committed to universal health coverage. Lancet
2012; 380: 879- doi: 10.1016/S0140-6736(12)61493-7 pmid: 22959376.

World health report: health systems financing, the path to universal
coverage. Geneva: World Health Organization; 2010. Available from:
http://www.who.int/whr/2010 [accessed 3 January 2013].

World Health Organization [Internet]. Mexico International Forum on
Universal Health Coverage: sustaining universal health coverage, sharing
experiences and promoting progress. Geneva: WHO; 2012. Available from:
http://www.who.int/healthsystems/topics/financing/hsf_uc_mexicodeclaration
[accessed 3 January 2013].

African Development Bank Group [Internet]. High level ministerial dialogue
on value for money, sustainability and accountability in the health sector.
Tunis: ADBG; 2012. Available from:
http://www.afdb.org/en/news-and-events/article/high-level-ministerial-
dialogue-on-value-for-money-sustainability-and-accountability-in-the-
health-sector-9251/ [accessed 3 January 2013].

Resolution WHA 64.9. Sustainable health financing structures and universal
coverage. In: Resolutions and decisions [Internet]. Geneva: World Health
Organization; 2011. Available from:
http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_R9-en.pdf [accessed 10
January 2013].

A/RES/63/33. Global health and foreign policy. In: United Nations
documentation: research guide [Internet]. New York: United Nations General
Assembly; 2012. Available from:
http://www.un.org/ga/search/view_doc.asp?symbol=A/67/L.36 [accessed 3
January 2013].

Kampala declaration and agenda for global action. Geneva: World Health
Organization; 2008. Available from:
http://www.who.int/workforcealliance/knowledge/resources/kampala_declaratio
n [accessed 10 January 2013].

World Health Organization [Internet]. Third Global Forum on Human Resources
for Health. Available from:
http://www.who.int/workforcealliance/forum/2013/3gflatestnews [accessed 11
January 2012].
__________________________________________________________________
________________________________*_________________________________

3. Detonating a viral time bomb—the hepatitis C pandemic
__________________________________________________________________
www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60070-7/

The Lancet, Volume 381, Issue 9862, Page 178, 19 January 2013

Detonating a viral time bomb—the hepatitis C pandemic

The Lancet

On Jan 15, the Economist Intelligence Unit supported by Janssen
Pharmaceuticals published a report: The Silent Pandemic: Tackling hepatitis
C with policy innovation. The report examines the health challenge posed by
the hepatitis C virus (HCV), and how comprehensive approaches that reflect
the local needs and available resources can improve the health-care
response to this deadly virus worldwide.

Hepatitis C is a blood-borne infectious disease, but the infection is often
asymptomatic for years, even decades, and so many people are unaware of
their condition. By the time they fall ill and seek help, considerable
damage has been done to their liver, resulting in end-stage conditions that
are complex to treat and impose huge medical and societal costs. The report
notes that the lack of robust epidemiological data means the magnitude of
the problem is unknown, but the number of people with chronic HCV is set to
rise substantially in the future.

The report calls for effective disease surveillance to create an accurate
picture of the problem and to ensure appropriate policies can be developed.
Greater public and physician awareness of the disease is crucial,
especially to combat the associated stigma the disease has with injecting
drug use. Measures are needed to prevent transmission through unsafe
health-care practices, which is the major route of HCV transmission in
developing countries. And innovative ways are required to reach out to
patients to ensure those who need treatment receive it before end-stage
conditions develop. For example, in Australia, use of hepatology nurse
practitioners within the liver service has streamlined care in a patient-
centred way.

As seen in the response to HIV, strong leadership in the clinical and
patient communities is key to raising the profile of a disease and securing
government investment. Stronger and more coherent leadership from the many
clinicians, public health specialists, and patient groups who are committed
to tackling HCV would go a long way to alerting the public to the risks of
the virus and the importance of screening and diagnosis, and gaining an
effective political response.
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Evaluating the implementation of health and safety innovations
under a regulatory context: A collective case study of Ontario’s safer
needle regulation
__________________________________________________________________
Implement Sci. 2013 Jan 22;8:9. doi: 10.1186/1748-5908-8-9.

Evaluating the implementation of health and safety innovations under a
regulatory context: A collective case study of Ontario’s safer needle
regulation.

Chambers A, Mustard CA, Breslin C, Holness L, Nichol K.

Dalla Lana School of Public Health, University of Toronto, 55 College
Street, Toronto, ON, M5T 3M7, Canada. achambers@iwh.on.ca.

BACKGROUND: Implementation effectiveness models have identified important
factors that can promote the successful implementation of an innovation;
however, these models have been examined within contexts where innovations
are adopted voluntarily and often ignore the socio-political and
environmental context. In the field of occupational health and safety,
there are circumstances where organizations must adopt innovations to
comply with a regulatory standard. Examining how the external environment
can facilitate or challenge an organization’s change process may add to our
understanding of implementation effectiveness. The objective of this study
is to describe implementation facilitators and barriers in the context of a
regulation designed to promote the uptake of safer engineered medical
devices in healthcare.

METHODS: The proposed study will focus on Ontario’s safer needle regulation
(2007) which requires healthcare organizations to transition to the use of
safer engineered medical devices for the prevention of needlestick
injuries. A collective case study design will be used to learn from the
experiences of three acute care hospitals in the province of Ontario,
Canada. Interviews with management and front-line healthcare workers and
analysis of supporting documents will be used to describe the
implementation experience and examine issues associated with the
integration of these devices. The data collection and analysis process will
be influenced by a conceptual framework that draws from implementation
science and the occupational health and safety literature.

DISCUSSION: The focus of this study in addition to the methodology creates
a unique opportunity to contribute to the field of implementation science.
First, the study will explore implementation experiences under
circumstances where regulatory pressures are influencing the organization’s
change process. Second, the timing of this study provides an opportunity to
focus on issues that arise during later stages of implementation, a phase
during the implementation cycle that has been understudied.

This study also provides the opportunity to examine the relevance and
utility of current implementation science models in the field of
occupational health where the adoption of an innovation is meant to enhance
the health and safety of workers. Previous work has tended to focus almost
exclusively on innovations that are designed to enhance an organization’s
productivity or competitive advantage.

Open Access: http://www.implementationscience.com/content/8/1/9
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Prevalence and risk factors of hepatitis B and C virus
infections among the general population and blood donors in Morocco
__________________________________________________________________
http://www.biomedcentral.com/1471-2458/13/50/abstract

BMC Public Health. 2013 Jan 18;13(1):50.

Prevalence and risk factors of hepatitis B and C virus infections among the
general population and blood donors in Morocco.

Baha W, Foullous A, Dersi N, They-They TP, Alaoui K, Nourichafi N, Oukkache
B, Lazar F, Benjelloun S, Ennaji MM, Elmalki A, Mifdal H, Bennani A.

BACKGROUND: Viral hepatitis is a serious public health problem affecting
billions of people globally. Limited information is available on this issue
in Morocco. This cross-sectional study was undertaken with the aim of
determining the seroprevalence and risk factors of hepatitis B virus (HBV)
and hepatitis C virus (HCV) among the general population and among blood
donors.

METHODS: Blood samples from volunteers, have been screened with ELISA tests
for detecting the hepatitis-B surface antigen (HBsAg) and anti-HCV. Within
the seroreactive patients for HCV in the general population, RT-PCR was
performed by the Cobas Ampliprep/Cobas Amplicor.

RESULTS: HCV and HBV-seropositivity was documented in 1.58% and 1.81% out
of 41269 and 23578 participants respectively from the general population.
Two patients were found to be co-infected. HCV-RNA was detected by PCR in
70.9% of the 195 anti-HCV positive subjects. The anti-HCV prevalence was
not different among males and females (P = 0.3). It increased with age; the
highest prevalence was observed among subjects with >50 years old (3.12%).
Various risk factors for acquiring HCV infection were identified; age,
dental treatment, use of glass syringes and surgical history. In addition
to these factors, gender and sexual risk behaviors were found to be
associated with higher prevalence of hepatitis B. The HBV positivity was
significantly higher among males than females participants in all age
groups (P < 0.01). The peak was noticed among males aged 30–49 years
(2.4%). None of the 152 persons younger than 20 years had HBsAg or anti-
HCV. The prevalence of anti-HCV and HBsAg among 169605 blood donors was
0.62% and 0.96% respectively.

CONCLUSIONS: Our study provided much important information concerning
hepatitis B and C prevalence and risk factors; it confirmed the
intermediate endemicity for HCV infection and pointed to a decreasing trend
of HBV incidence, which might reclassify Morocco in low HBV endemicity
area. This could be attributed primarily to the universal HBV vaccination
among infants and healthcare workers over the past 13 years. HCV and HBV
infections in the present survey were mainly associated with nosocomial
exposures. Prevention and control of HBV infection are needed to reduce HBV
transmission between adults.

Free full text http://www.biomedcentral.com/1471-2458/13/50/abstract
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Prevalence of hepatitis C infection among children with ß-
thalassaemia major in Mid Delta, Egypt: a single centre study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23343507

Trans R Soc Trop Med Hyg. 2013 Jan 22.

Prevalence of hepatitis C infection among children with ß-thalassaemia
major in Mid Delta, Egypt: a single centre study.

El-Shanshory MR, Kabbash IA, Soliman HH, Nagy HM, Abdou SH.

Paediatric, Faculty of Medicine, Tanta University, Egypt.

BACKGROUND: Transfusion dependant patients are at a higher risk of
acquiring bloodborne infections even under conditions of safe transfusion.
This study was designed to determine sero-prevalence of hepatitis C
infection and possible associated risk factors in thalassaemic children.

METHODS: One hundred and twenty five children with ß thalassaemia major (ß-
TM) were recruited from the Haematology/Oncology Unit, Paediatric
Department, Tanta University Hospital, Egypt, between April 2010 and
October 2011. Patients underwent history taking, full clinical examination,
routine investigations and venous blood sampling. Serum was stored at -20°C
till tested for hepatitis C (HCV Ab) and B (HBsAg) by ELISA. HCV Ab
positive cases were confirmed by PCR.

RESULTS: All patients were HBsAg negative. HCV Ab ELISA was positive in
76%, negative in 20% and equivocal in 4%. Fifty patients (40%) had positive
PCR for HCV. PCR showed low viraemia in 78%, moderate viraemia in 20% and
high viraemia in 2%. A positive family history of HCV, history of minor
operative intervention and/or dental procedures were significantly
associated with higher frequency of HCV infection in thalassaemic children,
while amount and frequency of transfused blood, age at transfusion and
chelation state were not.

CONCLUSION: HCV infection is highly prevalent in children with ß-TM in
Egypt despite strict pre-transfusion blood testing. This should arouse the
attention for environmental and community acquired factors. Quality
management to insure infection control in minor operative procedures and
adding more sensitive tests for blood screening are recommended.
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Epidemiology of hepatitis C virus infection in highly endemic
HBV areas in china
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23372775

PLoS One. 2013;8(1):e54815.

Epidemiology of hepatitis C virus infection in highly endemic HBV areas in
china.

Li D, Long Y, Wang T, Xiao D, Zhang J, Guo Z, Wang B, Yan Y.

Department of Epidemiology, and the Ministry of Education Key Lab of Hazard
Assessment and Control in Special Operational Environment, School of Public
Health, Fourth Military Medical University, Xi’an, China.

BACKGROUND: Wuwei City has the highest prevalence of hepatitis B virus
(HBV) in China. From 2007 to 2011, the average reported incidence rate of
hepatitis B was 634.56/100,000 people. However, studies assessing the
epidemic features and risk factors of HCV in the general population of
Wuwei City are limited.

METHODS: A total of 7189 people were interviewed and screened for HCV
antibodies. HCV RNA and HCV genotypes were analyzed by PCR. Relevant
information was obtained from the general population using a standardized
questionnaire, and association and logistic regression analyses were
conducted.

RESULTS: The anti-HCV prevalence was 1.64% (118/7189), and HCV-RNA was
detected in 37.29% (44/118) of the anti-HCV positive samples. The current
HCV infection rate was 0.61% (44/7189) in the Wuwei general population.
Hepatitis C infection rate was generally higher in the plains regions
(?(2)?=?27.54,P<0.05), and the most predominant HCV genotypes were 2a
(59.1%) and 1b (34.1%). The concurrent HCV and HBV infection rate was
1.37%, and a history of blood transfusion (OR?=?17.9, 95% CI: 6.1 to 52.6,
p<0.001) was an independent risk factor for HCV positivity.

CONCLUSIONS: Although Wuwei is a highly endemic area for HBV, the anti-HCV
positive rate in the general population is low. More than one-third of HCV-
infected people were unaware of their infection; this may become an
important risk factor for hepatitis C prevalence in the general population.
Maintaining blood safety is important in order to help reduce the burden of
HCV infection in developing regions of China.

Free Article
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0054815
__________________________________________________________________
________________________________*_________________________________

8. Abstract: A Fatal Case of Streptococcal Toxic Shock Syndrome due to
Streptococcus dysgalactiae subsp. equisimilis Possibly Caused by an
Intramuscular Injection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23370754

Intern Med. 2013;52(3):397-402.

A Fatal Case of Streptococcal Toxic Shock Syndrome due to Streptococcus
dysgalactiae subsp. equisimilis Possibly Caused by an Intramuscular
Injection.

Hagiya H, Okita S, Kuroe Y, Nojima H, Otani S, Sugiyama J, Naito H,
Kawanishi S, Hagioka S, Morimoto N.

Emergency Unit and Critical Care Center, Tsuyama Central Hospital, Japan.

An 88-year-old man died of streptococcal toxic shock syndrome due to a
group G streptococcus infection that was possibly caused by an
intramuscular injection given 30 hours earlier in his right deltoid muscle.
The causative pathogen was later identified to be Streptococcus
dysgalactiae subsp. equisimilis (stG485). Although providing intramuscular
injections is an essential skill of health care workers that is performed
daily worldwide, it may constitute a port of entry for pathogens via skin
breaches that can cause life-threatening infections. All invasive
procedures should be carefully performed, especially when immunologically
compromised patients are involved.

Free full text
www.jstage.jst.go.jp/article/internalmedicine/52/3/52_52.8846/_article
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Prophylaxis against infections after needle stick injuries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/21327547

Unfallchirurg. 2012 Aug;115(8):708-16.

[Prophylaxis against infections after needle stick injuries].

[Article in German]

Frickmann H, Reisinger E, Mittlmeier T, Schütt G, Podbielski A.

Institut für Mikrobiologie, Virologie und Hygiene, Universitätsklinikum
Rostock, Hamburg, Deutschland. Frickmann@bni-hamburg.de

BACKGROUND: Needle stick injuries are associated with a risk of infection.
The aim of this study was to collate the reasons for the failure to carry
out prophylactic measures from the perspective of those affected.

METHODS: An anonymous internet questionnaire was designed to record the
experiences of health care workers at the University Hospital Rostock with
secondary infection prophylaxis after needle stick injuries.

RESULTS: During the investigation period 106 questionnaires were returned.
There were deficiencies in the acceptance of prophylactic measures due to
job- associated lack of time and social pressure.

CONCLUSION: The study suggests reorganization of work-flows and additional
educational measures about the necessity of prophylactic procedures after
needle stick injuries.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Analysis of the health and environmental status of
sterilizers in hospital waste management: a case study of hospitals in
Tehran
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23359406

Waste Manag Res. 2013 Jan 28.

Analysis of the health and environmental status of sterilizers in hospital
waste management: a case study of hospitals in Tehran.

Aghapour P, Nabizadeh R, Nouri J, Monavari M, Yaghmaeian K.

Department of Environmental Management, Graduate School of the Environment
and Energy, Tehran Science and Research Branch, Islamic Azad University,
Tehran, Iran.

According to the first article of the waste management rule ratified in
2004, healthcare facilities are responsible for sterilizing their own
infectious wastes. Nowadays non-incineration techniques are preferred
internationally owing to toxic emissions caused by incinerators.

Surveys have been conducted in Iran, resulting in ratification of an
executive code by the Iranian Board of Ministers, which imposed a ban on
incinerators; furthermore, it emphasized, instead, the use of sterilizers.

The main objective of this research was evaluating the present status of
these facilities to figure out which ones have less effect on the
community, personnel and on the environment. A questionnaire was used to
collect the data.

The results showed that biological tests had not been conducted for most of
the sterilizers.

As biological testing is the most important factor in assessing autoclave
accuracy, a comprehensive program should be initiated to perform these
tests to improve functioning of the sterilizers so that the best treating
process can be achieved.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: New evidence on the HIV epidemic in Libya: why countries must
implement prevention programmes among people who inject drugs
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23337363

J Acquir Immune Defic Syndr. 2013 Jan 18.

New evidence on the HIV epidemic in Libya: why countries must implement
prevention programmes among people who inject drugs.

Mirzoyan L, Berendes S, Jeffery C, Thomson J, Ben Othman H, Danon L, Turki
AA, Saffialden R, Valadez JJ.

1Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA,
United Kingdom 2Mathematics Institute, University of Warwick, Coventry, CV4
7AL, United Kingdom 3National Centre for Diseases Control, National AIDS
Programme, Tripoli, Libya.

BACKGROUND: Libya had one of the world’s largest nosocomial HIV outbreaks
in the late 1990s leading to the detention of six foreign medical workers.
They were released in 2007 after the Libyan Government and the European
Union agreed to humanitarian cooperation that included the development of
Libya’s first National HIV-Strategy and the research reported in this
paper. Despite the absence of sound evidence on the status and dynamics of
Libya’s HIV- epidemic, some officials posited that injecting drug use (IDU)
was a main mode of transmission. We therefore sought to assess HIV-
prevalence and related risk factors among people who inject drugs (PWID) in
Tripoli.

METHODS: We conducted a cross-sectional survey among 328 PWID in Tripoli
using respondent-driven sampling. We collected behavioural data and blood
samples for HIV, hepatitis C virus (HCV) and hepatitis B virus (HBC)
testing. RESULTS: We estimate an HIV-prevalence of 87%, HCV-prevalence of
94% and HBV- prevalence of 5%. We detected IDU-related, and sexual risk
factors in the context of poor access to comprehensive services for HIV-
prevention and mitigation. For example, most respondents (85%) reported
having shared needles.

CONCLUSION: In this first bio-behavioural survey among PWID in Libya we
detected one of the highest (or even the highest) levels of HIV infection
worldwide in the absence of a comprehensive harm-reduction programme. There
is urgent need to implement an effective National HIV-Strategy informed by
the results of this research, especially because recent military events,
and related socio-political disruption and migration might lead to a
further expansion of the epidemic.
__________________________________________________________________
________________________________*_________________________________

12. Abstract: An Overview of HIV Prevention Interventions for People Who
Inject Drugs in Tanzania
__________________________________________________________________
http://www.hindawi.com/journals/apm/2013/183187/

Adv Prev Med. 2013;2013:183187. doi: 10.1155/2013/183187.

An Overview of HIV Prevention Interventions for People Who Inject Drugs in
Tanzania.

Ratliff EA, McCurdy SA, Mbwambo JK, Lambdin BH, Voets A, Pont S, Maruyama
H, Kilonzo GP.

Division of Health Promotion and Behavioral Sciences, University of Texas
School of Public Health, University of Texas Health Science Center at
Houston (UTHealth), 26th Floor, 7000 Fannin Street, Houston, TX 77030, USA.

In the past decade, Tanzania has seen a rapid rise in the number of people
who inject drugs (PWID), specifically heroin. While the overall HIV
prevalence in Tanzania has declined recently to 5.6%, in 2009, the HIV
prevalence among PWID remains alarmingly high at 35%.

In this paper, we describe how the Tanzania AIDS Prevention Program (TAPP),
Médecins du Monde France (MdM-F), and other organisations have been at the
forefront of addressing this public health issue in Africa, implementing a
wide array of harm reduction interventions including medication-assisted
treatment (MAT), needle and syringe programs (NSP), and “sober houses” for
residential treatment in the capital, Dar es Salaam, and in Zanzibar.

Looking toward the future, we discuss the need to (1) extend existing
services and programs to reach more PWID and others at risk for HIV, (2)
develop additional programs to strengthen existing programs, and (3) expand
activities to include structural interventions to address vulnerabilities
that increase HIV risk for all Tanzanians.

Free Full Article http://www.hindawi.com/journals/apm/2013/183187/
__________________________________________________________________
________________________________*_________________________________

13. Abstract: Hepatitis C virus in American Indian/Alaskan Native and
Aboriginal peoples of North America
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528296/

Viruses. 2012 Dec;4(12):3912-31.

Hepatitis C virus in American Indian/Alaskan Native and Aboriginal peoples
of North America.

Rempel JD, Uhanova J.

Section of Hepatology, Department of Medicine, Department of Immunology,
University of Manitoba, 804D-715 McDermot Ave, Winnipeg, MB, USA.
julia.rempel@med.umanitoba.ca

Liver diseases, such as hepatitis C virus (HCV) infection, are “broken
spirit” diseases. The prevalence of HCV infection for American
Indian/Alaskan Native (AI/AN) in the United States and Canadian Aboriginals
varies; nonetheless, incidence rates of newly diagnosed HCV infection are
typically higher relative to non-indigenous people.

For AI/AN and Aboriginal peoples risk factors for the diagnosis of HCV
infection can reflect that of the general population: predominately male, a
history of injection drug use, in midlife years, with a connection with
urban centers. However, the face of the indigenous HCV infected individual
is becoming increasingly female and younger compared to non-indigenous
counterparts.

Epidemiology studies indicate that more effective clearance of acute HCV
infection can occur for select Aboriginal populations, a phenomenon which
may be linked to unique immune characteristics. For individuals progressing
to chronic HCV infection treatment outcomes are comparable to other racial
cohorts. Disease progression, however, is propelled by elevated rates of
co-morbidities including type 2 diabetes and alcohol use, along with human
immunodeficiency virus (HIV) co-infection relative to non-indigenous
patients. Historical and personal trauma has a major role in the
participation of high risk behaviors and associated diseases.

Although emerging treatments provide hope, combating HCV-related morbidity
and mortality will require interventions that address the etiology of
broken spirit diseases.

Free Full Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3528296/
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Decreased injecting is associated with increased alcohol
consumption among injecting drug users in northern Vietnam
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23332981

Int J Drug Policy. 2013 Jan 16. pii: S0955-3959(12)00198-3.

Decreased injecting is associated with increased alcohol consumption among
injecting drug users in northern Vietnam.

Go VF, Minh NL, Frangakis C, Ha TV, Latkin CA, Sripaipan T, Davis W, Zelaya
C, Ngoc NP, Quan VM.

Johns Hopkins Bloomberg School of Public Health, Department of
Epidemiology, 615 N. Wolfe St., Baltimore, MD 21205, USA. Electronic
address: vgo@jhsph.edu.

BACKGROUND: Reducing injecting frequency may reduce the risk of HIV
infection and improve health outcomes among injection drug users (IDUs).
However, the reduction of one risk behavior may be associated with an
increase in other risk behaviors, including the use of other risk-
associated substances. Our objective was to determine if an association
exists between a reduction in injecting and level of alcohol use among IDU.

METHODS: We conducted a longitudinal analysis of data collected for a
randomized controlled trial examining the efficacy of a peer education
intervention in reducing HIV risk among IDU and their network members in
Thai Nguyen, Vietnam. Our analysis included active male injectors (n=629)
who were study participants and attended both baseline and 3-month visits.
Frequency of alcohol consumption was assessed as the number of alcoholic
drinks in the past 30days. Change in risk and outcome behaviors was
calculated as the difference in frequencies of behaviors between baseline
and 3-month follow- up visits. The outcome of interest was concurrent
decreased drug injection and increased alcohol consumption.

RESULTS: The mean difference between baseline and 3-month follow-up of
alcohol consumption and injection frequency in the past 30days was 19.03
drinks (93.68 SD) and 20.22 injections (35.66 SD), respectively.
Participants who reported reduced injection frequency were almost three
times as likely to report increased alcohol consumption (OR 2.8; 95% CI,
2.0, 4.0). The proportion that both decreased injecting and increased
alcohol by any amount in the past 30days was 35.6%. In multivariate
analysis higher education was significantly associated with an increase in
alcohol and decrease in injecting of any amount.

CONCLUSION: Male IDU may be at risk for increasing alcohol consumption when
they reduce injection frequency. Interventions with male IDU that encourage
reduction of injection may need to review specific strategies to limit
alcohol consumption.

Copyright © 2012 Elsevier B.V. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

15. Abstract: Infectivity of blood products from donors with occult
hepatitis B virus infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23362802

Transfusion. 2013 Jan 30. doi: 10.1111/trf.12096.

Infectivity of blood products from donors with occult hepatitis B virus
infection.

Allain JP, Mihaljevic I, Gonzalez-Fraile MI, Gubbe K, Holm-Harritshøj L,
Garcia JM, Brojer E, Erikstrup C, Saniewski M, Wernish L, Bianco L, Ullum
H, Candotti D, Lelie N, Gerlich WH, Chudy M.

Department of Haematology, University of Cambridge, Cambridge, UK; Croatian
Institute of Transfusion Medicine, Zagreb, Croatia; Centro de Hemoterapia
de Castilla y León, Valladolid, Spain; German Red Cross, Institute of
Transfusion Medicine, Plauen, Germany; Department of Clinical Immunology,
Rigshospitalet, Copenhagen, Denmark; Regional Blood Center, Oviedo, Spain;
Institute of Hematology and Transfusion Medicine, Warsaw, Poland;
Department of Clinical Immunology, Arhus University Hospital, Arhus,
Denmark; Institute of Medical Virology, Justus Liebig University, Giessen,
Germany; MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK;
National Health Service Blood and Transplant England, Cambridge, UK; Paris,
France; Paul Ehrlich Institute, Langen, Germany.

BACKGROUND: Occult hepatitis B virus (HBV) infection (OBI) is identified in
1:1000 to 1:50,000 European blood donations. This study intended to
determine the infectivity of blood products from OBI donors.

STUDY DESIGN AND METHODS: Recipients of previous donations from OBI donors
were investigated through lookback (systematic retrieval of recipients) or
traceback (triggered by clinical cases). Serologic and genomic studies were
undertaken on consenting donors and recipients. Multiple variables
potentially affecting infectivity were examined.

RESULTS: A total of 45 of 105 (42.9%) donor-recipients pairs carried
antibodies to HBV core (anti-HBc) as evidence of previous HBV infection.
Subtracting 15% of anti-HBc population background, the adjusted
transmission rate was 28%. Anti-HBc prevalence increased to 28 of 44
(63.8%) in unvaccinated recipients receiving anti-HBs-negative OBI blood
products. In contrast, four of 26 (15.4%) recipients of anti-HBs-positive
products were anti-HBc positive. Transmission with anti-HBs-negative
products depended on volume of plasma transfused (85%-100% with 200?mL of
fresh frozen plasma [FFP], 51% with 50?mL in platelet concentrates [PCs],
and 24% with 20?mL in red blood cells [RBCs], p?<?0.0001 FFP vs. RBCs). The
50% minimum infectious dose of OBI HBV DNA was estimated at 1049 (117-3441)
copies. Donor and recipient strains sequence homology of at least 99%
confirmed transfusion- transmitted infection in 10 cases and excluded it in
one case.

CONCLUSION: Blood products from donors with OBI carry a high risk of HBV
transmission by transfusion. This risk is dependent on presence of anti-HBs
and viral dose. This may justify safety measures such as anti-HBc and HBV
nucleic acid test screening depending on epidemiology.

© 2013 American Association of Blood Banks.
__________________________________________________________________
________________________________*_________________________________

16. Abstract: Compliance of health care workers with hand hygiene
practices: independent advantages of overt and covert observers
__________________________________________________________________
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053746

PLoS One. 2013;8(1):e53746.

Compliance of health care workers with hand hygiene practices: independent
advantages of overt and covert observers.

Pan SC, Tien KL, Hung IC, Lin YJ, Sheng WH, Wang MJ, Chang SC, Kunin CM,
Chen YC.

Center for Infection Control, National Taiwan University Hospital, Taipei,
Taiwan ; Department of Internal Medicine, National Taiwan University
Hospital, Taipei, Taiwan.

BACKGROUND: Evaluation and feedback of hand hygiene (HH) compliance are
important elements of the WHO multimodal strategy for hospital infection
control. Overt observation is recommended, but it may be confounded by
Hawthorne effect. Covert observation offers the opportunity to decrease
observer bias. In this study we conducted a one year hospital-wide HH
promotion program that included medical students (MS) as covert observers.

METHODS: HH compliance for the five WHO indications was determined by
trained and validated observers. The overt observers consisted of eleven
infection control nurses (ICNs) and two unit HH ambassadors (UAs) in each
of 83 wards. The covert observers consisted of nine MS during their
rotating clinical clerkships. Feedback was provided to department heads and
staff each quarter.

RESULTS: Of the 23,333 HH observations 76.0% were by MS, 5.3% by ICNs and
18.7% by UAs. The annual compliance rates were MS 44.1%, ICNs 74.4% and UAs
94.1%; P<0.001. The MS found significantly lower annual compliance rates
for 4/5 HH indications compared to ICNs and UAs; P<0.05. The ICNs reported
significantly improvement from the first to the fourth quarter; P<0.001.
This was associated with feedback from the MS of very poor compliance by
nurses during the first quarter.

CONCLUSIONS: Based on these findings we recommend a two-pronged approach to
HH programs. The role of ICNs and UAs is to educate, serve as role models,
establish, sustain good HH practices and provide direct feedback. The role
of the covert observers is to measure compliance and provide independent
feedback.

Free Article
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0053746
__________________________________________________________________
________________________________*_________________________________

17. Abstract: Hand hygiene of medical and nursing students during clinica
rotations: a pilot study on knowledge, attitudes and impact on
bacterial contamination
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23164964

Assist Inferm Ric. 2012 Jul-Sep;31(3):123-30.

[Hand hygiene of medical and nursing students during clinica rotations: a
pilot study on knowledge, attitudes and impact on bacterial contamination].

[Article in Italian]

Bargellini A, Borella P, Ferri P, Ferranti G, Marchesi I.

Dipartimento di Scienze di Sanitá Pubblica, Università degli Studi di
Mondena e Reggio Emilia.

Hand hygiene in nursing and medical students during training: a pilot study
on knowledge, practices and impact on bacterial contamination.

INTRODUCTION: Despite exhaustive guidelines on hand hygiene (HH),
compliance in health care professionals is reported to be low. In order to
improve adherence with HH, interventions on students’ education should be
effective.

AIM: To describe the knowledge, behavior and hand hygiene (HH) practices in
nursing and medical students. The results of the pilot study are presented.

METHODS: A questionnaire designed to investigate knowledge on HH and its
practical implementation was administered to a sample of 50 nursing and 50
medical students. Data collected were associated with hand contamination
measured at the beginning and at the end of the training shift.

RESULTS: All nursing students performed HH with a significantly higher
frequency compared to medical students. At the end of training, total
bacterial counts were significantly reduced in both groups, but more in
nursing students. Total bacterial count increased in absence of hygienic
practices and the most effective procedure was the alternate use of
conventional hand washing and alcohol-based hands rubs. The knowledge of
both groups was adequate, although some differences were observed.

CONCLUSIONS: At the beginning of their course, nursing students are
educated to correct practices that implement during practical training.
Medical students receive information on HH later in their education and pay
less attention to these aspects, also due to the limited number of physical
contacts with patients. Thus, the contents on HH should be anticipated
before the start of the training activity.
__________________________________________________________________
________________________________*_________________________________

18. Abstract: Microbicidal effect of weak acid hypochlorous solution on
various microorganisms
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23007104

Biocontrol Sci. 2012;17(3):129-33.

Microbicidal effect of weak acid hypochlorous solution on various
microorganisms.

Ono T, Yamashita K, Murayama T, Sato T.

Research and Technology Development Division, HSP company, 56-5 Ezaki,
Okayama-shi, Okayama 702-8005, Japan. ono@hsp-net.co.jp

We investigated the microbicidal effect of weak acid hypochlorous solutions
of pH 5.0 – 6.0, produced by mixing NaClO and HCl in water, against various
bacteria, fungi, and virus in vitro.

The weak acid hypochlorous solution had excellent microbicidal effect
against a broad microbicidal spectrum of standard strains and clinical
isolates in a short time. The microbicidal effects of hypochlorous
solutions did not depend on the available chlorine concentration but on the
HClO concentration.

These results show that the weak acid hypochlorous solution has practical
applicability in such places as hospitals and establishments related to the
food industry.

Free full text
https://www.jstage.jst.go.jp/article/bio/17/3/17_129/_article
__________________________________________________________________
________________________________*_________________________________

19. Abstract: Priming after a fractional dose of inactivated poliovirus
vaccine
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23363495

N Engl J Med. 2013 Jan 31;368(5):416-24.

Priming after a fractional dose of inactivated poliovirus vaccine.

Resik S, Tejeda A, Sutter RW, Diaz M, Sarmiento L, Alemañi N, Garcia G,
Fonseca M, Hung LH, Kahn AL, Burton A, Landaverde JM, Aylward RB.

Pedro Kouri Institute, Havana, Cuba.

BACKGROUND: To reduce the costs of maintaining a poliovirus immunization
base in low- income areas, we assessed the extent of priming immune
responses after the administration of inactivated poliovirus vaccine (IPV).

METHODS: We compared the immunogenicity and reactogenicity of a fractional
dose of IPV (one fifth of a full dose) administered intradermally with a
full dose administered intramuscularly in Cuban infants at the ages of 4
and 8 months. Blood was collected from infants at the ages of 4 months, 8
months, 8 months 7 days, and 8 months 30 days to assess single-dose
seroconversion, single-dose priming of immune responses, and two-dose
seroconversion. Specimens were tested with a neutralization assay.

RESULTS: A total of 320 infants underwent randomization, and 310 infants
(96.9%) fulfilled the study requirements. In the group receiving the first
fractional dose of IPV, seroconversion to poliovirus types 1, 2, and 3
occurred in 16.6%, 47.1%, and 14.7% of participants, respectively, as
compared with 46.6%, 62.8%, and 32.0% in the group receiving the first full
dose of IPV (P<0.008 for all comparisons). A priming immune response to
poliovirus types 1, 2, and 3 occurred in 90.8%, 94.0%, and 89.6% of
participants, respectively, in the group receiving the fractional dose as
compared with 97.6%, 98.3%, and 98.1% in the group receiving the full dose
(P=0.01 for the comparison with type 3). After the administration of the
second dose of IPV in the group receiving fractional doses, cumulative two-
dose seroconversion to poliovirus types 1, 2, and 3 occurred in 93.6%,
98.1%, and 93.0% of participants, respectively, as compared with 100.0%,
100.0%, and 99.4% in the group receiving the full dose (P<0.006 for the
comparisons of types 1 and 3). The group receiving intradermal injections
had the greatest number of adverse events, most of which were minor in
intensity and none of which had serious consequences.

CONCLUSIONS: This evaluation shows that vaccinating infants with a single
fractional dose of IPV can induce priming and seroconversion in more than
90% of immunized infants.

(Funded by the World Health Organization and the Pan American Health
Organization; Australian New Zealand Clinical Trials Registry number,
ACTRN12610001046099.).
__________________________________________________________________
________________________________*_________________________________

20. Abstract: Effectiveness of two flavored topical anesthetic agents in
reducing injection pain in children: a comparative study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23342561

J Clin Pediatr Dent. 2012 Fall;37(1):15-8.

Effectiveness of two flavored topical anesthetic agents in reducing
injection pain in children: a comparative study.

Deepika A, Rao CR, Vinay C, Uloopi KS, Rao VV.

Department of Pediatric Dentistry, Vishnu Dental College, Andhra Pradesh,
India.

Topical anesthesia is widely advocated in pediatric dentistry practice to
reduce pain and anxiety produced by administration of local anesthesia.
There are different combinations of topical anesthetic agents that are
marketed worldwide. However, sparse literature reports exist regarding
clinical efficacy of these agents.

AIM: To compare the clinical effectiveness of two strawberry flavored
topical anesthetics viz. Precaine (8% Lidocaine + 0.8% Dibucaine) and
Precaine B (20% Benzocaine) in children before intra oral local anesthetic
injections and for extraction of mobile primary teeth.

STUDY DESIGN: This triple blind clinical study included sixty children
divided equally under three techniques–palatal injections, inferior
alveolar nerve block and extraction of mobile primary teeth. Both the
products were used alternately using split mouth design in two visits and
the child’s pain response was assessed using VAS and SEM pain scale. The
scores obtained were subjected to statistical analysis.

RESULTS: Precaine has shown lower mean scores in all the techniques under
both the pain scales, but were statistically insignificant. Gender wise
comparison has also shown lower mean scores for Precaine for both males and
females, however these were statistically insignificant. On visit wise
comparison, Precaine B reported significant lower scores (p < 0.05) in
visit 2 compared to visit 1 for inferior alveolar nerve block and
extraction of mobile primary teeth under SEM pain scale.

CONCLUSION: Precaine (8% Lidocaine + 0.8% Dibucaine) can be used as
effectively as Precaine B (20% Benzocaine).
__________________________________________________________________
________________________________*_________________________________

21. Abstract: Efficacy of subcutaneous and sublingual immunotherapy with
grass allergens for seasonal allergic rhinitis: a meta-analysis-based
comparison
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23021885

J Allergy Clin Immunol. 2012 Nov;130(5):1097-1107.e2.

Efficacy of subcutaneous and sublingual immunotherapy with grass allergens
for seasonal allergic rhinitis: a meta-analysis-based comparison.

Di Bona D, Plaia A, Leto-Barone MS, La Piana S, Di Lorenzo G.

Dipartimento di Biopatologia e Biotecnologie Mediche e Forensi, Universit
degli Studi di Palermo, Palermo, Italy.

BACKGROUND: Subcutaneous (SCIT) and sublingual (SLIT) immunotherapy are the
2 most prescribed routes for administering allergen-specific immunotherapy.
They were shown to be effective in control of symptoms and in reducing
rescue medication use in patients with allergic diseases, but their
effectiveness has to be balanced against side effects. In recent years,
SLIT has been increasingly prescribed, instead of SCIT, because of improved
safety and easy administration.

OBJECTIVE: We assessed which route is the most effective in the treatment
of patients with seasonal allergic rhinitis to grass pollen.

METHODS: An indirect meta-analysis-based comparison between SCIT and SLIT
was performed. Treatment efficacy was determined as the standardized mean
difference (SMD) in symptom and medication scores obtained with active
treatment, SCIT or SLIT, compared with placebo. Studies were included if
they were double-blind randomized controlled trials comparing SCIT or SLIT
with placebo. Thirty-six randomized controlled trials (3014 patients; 2768
controls) were analyzed.

RESULTS: The overall effect size of SCIT for symptom score (SMD, -0.92;
95%CI, -1.26 to -0.58) was significantly higher than SLIT, both
administered via drops (SMD, -0.25; 95% CI, -0.45 to -0.05) and tablets
(SMD, -0.40; 95%CI, -0.54 to -0.27). Similar results were reported for
medication score (SCIT: SMD, -0.58; 95% CI, -0.86 to -0.30. SLIT drops:
SMD, -0.37; 95% CI, -0.74 to -0.00. SLIT tablets SMD, -0.30; 95% CI, -0.44
to -0.16).

CONCLUSIONS: Our results provide indirect but solid evidence that SCIT is
more effective than SLIT in controlling symptoms and in reducing the use of
antiallergic medications in seasonal allergic rhinoconjuntivitis to grass
pollen.

Copyright © 2012 American Academy of Allergy, Asthma & Immunology.
Published by Mosby, Inc. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

22. News

– Technology: Slow-release jelly means fewer insulin shots for diabetics
– Spread of hepatitis C pinpointed
– India: Hepatitis-C epidemic in Kokernag village, 300 positive
– Technology: Syringe Design Change Could Cut HIV Transmission
– USA: Hepatitis C Cases Climbing in Northern Kentucky (NKY)
– USA: Arizona Bill Seeks Felony Charge for Intentionally Exposing Others
to HIV, STDs
– USA: Second NY Hospital Warns Patients About Potential HIV, Hepatitis
Exposure From Insulin Pens
– USA: Hepatitis C Linked to Tattoo Ink
– Nepal: Govt warns hospitals to strictly manage waste

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
Technology: Slow-release jelly means fewer insulin shots for diabetics
By Janet Fang, Smartplanet.com (03.02.13)

Biomedical engineers have developed a novel delivery method for a new class
of drugs called peptide drugs – these very small proteins that can help
regulate metabolism and treat diabetes.

But peptide drugs rapidly degrade in the bloodstream, and their rapid
clearance from the body means multiple, frequent injections. Because of
this, their concentrations in the blood spike right after injection then
fall dramatically, causing unwanted side effects.

To overcome these hurdles, a team led by Ashutosh Chilkoti of Duke
University came up with a new delivery system they’re calling POD, for
protease-operated depot:

Multiple copies of a peptide drug are fused to a polymer, which creates a
‘fusion protein.’

The molecule, which is sensitive to body heat, is a liquid in a syringe; it
transforms into a jelly when injected under the skin.
Enzymes in the skin attack the POD, freeing up the copies of the peptide,
which go on to provide a constant and controllable release of drug over
time.

To test the method, the team fused glucagon-like peptide-1 (GLP-1), a
hormone that regulates the release of insulin, with a genetically
engineered heat sensitive polymer to create the POD.

A single injection of the GLP-1 POD reduced blood glucose levels in mice
for up to five days — that’s 120 times longer than an injection of the
peptide alone. “For a patient with type 2 diabetes, it would be much more
desirable to inject such a drug once a week or once a month rather than
once or twice a day,” Chilkoti says.

More than 40 peptide drugs are approved for human use and more than 650 are
being tested in clinical studies.

The work was published in the Proceedings of the National Academy of
Science last week.

[Via Duke University]
__________________________________________________________________
__________________________________________________________________
http://www.bbc.co.uk/news/health-14314347

Spread of hepatitis C pinpointed
BBC, UK (1.02.13)

Scientists say they have, for the first time, worked out the pattern of
spread of hepatitis C, showing early diagnosis is key to preventing
epidemics.

A study in injecting drug users in Greece indicated that each infected
person spread the disease to 20 others – 10 of these in the first two
years.

The researchers said their results would help tackle the disease’s spread.

Globally up to 180 million people live with the virus, most are unaware
that they have it.

Those infected do not develop symptoms for up to 20 years and spread it to
others without realising.

Study leader Dr Gkikas Magiorkinis, from Oxford University, said when
people were infected with something such as flu it was very easy to work
out where it had come from, because people knew they were infected within
days.

But with hepatitis C, no-one has been able to pin down how the virus
spreads, because cases occur months or years apart.

Genetic signature To overcome this problem, the researchers looked at four
hepatitis C epidemics in Greece, using data from 943 patients collected
between 1995 and 2000.

But to provide more detail on how it spreads, they also included genetic
information on the virus taken from 100 samples.

Plugging the details into a computer model, they calculated that injecting
drug users were “super-spreaders”, each transmitting the virus to 20 other
people.

Most importantly they discovered that most of the transmissions occurred in
the first couple of years, they report in PLoS Computational Biology.

The researchers said that people were more infectious at in the early days
of catching hepatitis C because they had higher levels of virus.

The evidence they have produced suggests programmes targeting the diagnosis
and treatment of hepatitis C in high-risk groups as early as possible would
prevent many new infections and associated health care costs many years
down the line.

About 20% of those infected will develop cancer or liver scarring after 20
years of infection, at which point the only treatment is liver
transplantation, which costs about £100,000 ($160,000).

Dr Magiorkinis, who did the work in collaboration with the University of
Athens and Imperial College London, said the model had helped build a
“solid argument” to improve early diagnosis and antiviral treatment in drug
users.

“Working out how many people are likely to be infected by each super-
spreader of Hepatitis C, as well as how soon they will be infected, has
been a puzzle for over 20 years,” he said.

“Our research has resolved this issue and paves the way for a modelling
study to show what kind of public health interventions could really make a
difference.”

He added the approach could be useful in other infections such as HIV.

Charles Gore, chief executive of The Hepatitis C Trust and president of the
World Hepatitis Alliance, said: “This study is potentially very important.

“If we are better able to identify where the majority of transmission is
happening in many Western countries, we will be able to improve and more
cost effectively target interventions.

“It needs to be said, however, that globally hepatitis C is not ‘a drug
users’ disease.

“Of the 150 million people living with the virus, only about 10 million are
people who inject drugs, according to The Lancet. The vast majority of
infections are the result of unsafe healthcare and we equally need to
target prevention there.”
__________________________________________________________________
__________________________________________________________________
http://www.kashmirtimes.com/newsdet.aspx?q=11631

India: Hepatitis-C epidemic in Kokernag village, 300 positive
Shabir Ahmad, Kashmir Times, Jammu Kashmir, India (27.01.13)

SRINAGAR, Jan 27: The outbreak of hepatitis C in a remote village of
Takiya-Magam, Kokernag has not only created panic among the residents of
the area but has also left the health experts in a state of worry as they
are yet to find out its exact cause.

After the reports that out of more than 1000 samples taken from the village
during last two weeks 300 people have tested positive a team of health and
drug officials today visited the village and educated the people about the
precautions to be taken to avoid the catching of the virus.

Chief Medical Officer, Anantnag, Dr Gulzar confirming the outbreak of the
viral disease in the village said they are trying to arrive at the exact
source of the epidemic. “There could be many reasons for the spread of the
disease including the use of needles and sexual intercourse but as far as
the number of people having been infected so far is concerned we cannot
conclude that these could be the only reasons. We too are surprised over
the spread of the virus at such an alarming pace,” CMO said.

He further said 30 percent of the cases having acquired the virus have
never been administered injection. “We talked to most of the people
suffering from the disease but most of them said that they have never been
injected in their lives. So we too are surprised as to what actually led to
it,” CMO added.

He said that he along with a team of experts today rushed to the village to
educate the people about the do’s and don’ts. “Keeping the alarming
situation in consideration we have started a campaign in the whole area to
make the people aware about the precautions to be taken,” CMO said.

Though the chemists operating in the area are being blamed for the spread
of epidemic by some locals, yet the officials say that they have not found
any evidence against the chemists which could suggest their involvement.
“After the detection of several cases of hepatitis-C in the village earlier
this month a team of drug officials headed by assistant drug controller,
Anantnag rushed there and suspended the licenses of all the three medicates
of the village for ten days. However during the investigations none of them
was found involved in kind of mischief.

Later it was on the demand of the people of the village all the three
medical shops had to be unlocked by the district drug authorities,” said a
drug official wishing anonymity.

Meanwhile, the Pharmacists Association Anantnag, said the pharmacists are
being targeted under a well planned conspiracy. “Some cases have been
detected in the area three years back and the health authorities were in
slumber during all these years. Now when the epidemic has engulfed the
whole village, the authorities in order to save their neck started putting
blame on the pharmacists. If any of the pharmacists is found involved in
kind of mischief, the association will not leave it to the government but
will itself burn down his shop. I can tell you with confidence that it is
only an attempt to victimise the pharmacists of the village,” said
president of the Pharmacist Association, Majid Majeed.

Villagers have accused the authorities of leaving the entire populace of
the village at the mercy of the chemists. “The village is comprising of at
least 7000 population but so far the authorities have not bothered to
establish even a small dispensary in the area. Last time when their shops
were closed by the authorities we had to approach the administration for
unlocking their shops as there is no other option for the patients of the
area. Now if the authorities blame them for the spread of epidemic then why
did not they bother to set up even a small health center in the village,”
said Sarpanch of the village.
__________________________________________________________________
__________________________________________________________________
Technology: Syringe Design Change Could Cut HIV Transmission
Gretchen Cuda Kroen, Scientific American, usa (28.01.13)

To prevent HIV and other blood-borne infections, syringes should never be
shared. However, many injecting drug users ignore this warning, thus
significantly contributing to the spread of HIV and other infectious
diseases. In a recently released study, William A. Zule and several other
researchers contend that changing the current syringe design could almost
completely eliminate HIV transmission caused by needle sharing.

The researchers show that when the plunger on a syringe is fully depressed,
a small amount of fluid remains in an area called the “dead space.”
Researchers believe that a new syringe design with less dead space can
reduce the amount of blood trapped in the dead space by a factor of a
thousand. In this way, they are reducing the amount of virus left to
transmit the disease. The researchers used a simulation model, to
illustrate that changing to low-dead-space syringes could reduce annual HIV
infections acquired by sharing syringes to almost zero in eight years.

The researchers acknowledge that there are barriers to making the new
syringes available worldwide, but they maintain that changing to low-dead-
space syringes could reduce transmission of disease to injecting drug users
and their families.

The study, “Are Major Reductions in New HIV Infections Possible with People
Who Inject Drugs? The Case for Low Dead-Space Syringes in Highly Affected
Countries,” was published in the International Journal of Drug Policy
(2013; 24 (1): 1-7).
__________________________________________________________________
__________________________________________________________________
USA: Hepatitis C Cases Climbing in Northern Kentucky (NKY)
Terry DeMio, Cincinnati.com (26.01.13)

The rate of people infected with hepatitis C in Northern Kentucky (NKY) is
far higher than the state or national rate. NKY’s infection rate was three
times the state’s in 2011 and approximately 10 times above the US rate when
compared to CDC’s 2010 rates. National data is not yet available for 2011.
According to health department records, NKY reported 23 cases of acute
hepatitis C in 2010, but the number increased to 42 in 2011.The likely
cause for the high rate is the region’s heroin epidemic.

To combat the problem, the Independent Health Department District is
participating in a pilot program that targets high-risk groups and offers
free testing. The department offers counseling, education, and direction in
how to get care to those who test positive for the disease. Emily Gresham
Wherle, NKY health department spokesperson, says health officials hope that
through testing they will gain a better understanding of the extent of the
problem. The first round of free testing began in May 2012. The NKY health
district includes Grant, Kenton, Campbell, and Boone counties. In
September, CDC extended the testing program; by year’s end, the health
department had recorded 44 cases of acute hepatitis C. Jennifer Hunter, the
health department’s director of clinical services, said that testing will
continue at least until March 2013 when CDC will evaluate results. She
notes that the program could be extended again if CDC agrees.

Hunter declares, “Almost 88 percent (of those tested) had a history of IV
drug use.” Hepatitis C is very often transferred by sharing needles,
syringes, or other equipment used to inject drugs. Many of those being
tested are in the 20-29 age range and are from treatment centers or
transitional housing. Public health departments have also advised baby
boomers to be tested. Dr. Lynne Saddler, district director of health,
explains that the current high rate of new hepatitis C cases can be
partially credited to the health department’s effort to identify and test
high-risk people. No vaccine exists for the disease; however, health
officials encourage testing to prevent new cases and to make certain those
with the disease are treated by a physician.
__________________________________________________________________
__________________________________________________________________
USA: Arizona Bill Seeks Felony Charge for Intentionally Exposing Others to
HIV, STDs
KTAR.com, Arizona USA (25.01.13)

Ariz. Rep. Lela Alston (D-Phoenix) has proposed HB2218, a bill that would
make it a felony to intentionally expose others to sexually transmitted
diseases (STDs), including gonorrhea, chlamydia, and syphilis. Alston
explained that she wrote the bill after she heard about a woman in her
district who had contracted an STD from a man who did not inform her of his
infection. According to Alston, this behavior constitutes criminal intent.

The bill would make it a Class 6 felony for an individual who knows he or
she is infected with HIV or one of eight listed STDs to intentionally
expose others to the disease. The bill would also redefine exposure to
include engaging in sexual intercourse or sodomy; selling or donating
tissue, organs, or bodily fluids; and sharing needles or syringes. Ariz.

Rep. Sally Ann Gonzales (D-Tucson), who is a primary sponsor of the bill,
commented that it is important for the bill to “cover other things that are
not yet protected or that we’re not holding people accountable (for),” as
individuals are also transmitting diseases in ways other than sexual
intimacy.

Anthony Paik, associate professor of sociology and gender, women’s and
sexuality studies at the University of Iowa, noted that it is difficult to
know how often people intentionally expose others to HIV or STDs. He stated
that he was not aware of any research on the matter, but he has heard of
anecdotal accounts. Also, Adina Nack, a senior research fellow for the
Council on Contemporary Families, said that the bill could be “potentially
quite dangerous,” depending on how the emphasis on knowledge of being
infected is interpreted. Nack felt that this type of legislation could
discourage people from getting tested, treated, and diagnosed.

Veda Collmer, Robert Wood Johnson Foundation Visiting Attorney at Arizona
State University’s Sandra Day O’Connor College of Law, stated that in the
late 1980s and early 1990s there was a trend to criminalize this type of
behavior, but the laws that were passed then have almost all been repealed.
She said that it is very difficult to prosecute individuals under such a
law as “it would be hard to meet the burden of proof.”

Alston remarked that she is cautiously optimistic about the prospects for
her bill. She hoped that reasonable people would see it as an important
issue, which is very devastating to the person involved. The bill was
referred to the House Judiciary Committee, but so far a hearing has not
been scheduled.
__________________________________________________________________
__________________________________________________________________
USA: Second NY Hospital Warns Patients About Potential HIV, Hepatitis
Exposure From Insulin Pens
Associated Press (24.01.13)

Olean General Hospital is the second western New York hospital to notify
patients that they may have been exposed to HIV or hepatitis through the
improper sharing of insulin pens. The hospital says it is mailing letters
recommending blood screening to 1,915 patients who received insulin there
from November 2009 through last week.

According to hospital officials, the notifications follow an internal
review conducted after the recent news of insulin pen-sharing at Buffalo’s
Veterans Affairs hospital. In the Buffalo case, more than 700 patients may
have been exposed to blood-borne pathogens over a two-year period after
multi-use pens intended for use on a single individual may have been used
on more than one person.
__________________________________________________________________
__________________________________________________________________
USA: Hepatitis C Linked to Tattoo Ink
Fox News (24.01.13)

Fritz Francois, MD, a researcher from New York University Langone Medical
Center, reports that people with hepatitis C are four times more likely to
have tattoos, regardless of other risk factors. The estimate is based on a
study of 2,000 hepatitis C-infected people who had not received a blood
transfusion before 1992 or reported a history of injecting drugs.

According to CDC, 3.2 million people in the United States have hepatitis C,
although some may not realize it because they have not yet developed
symptoms. Injected drug use is responsible for 60 percent of new hepatitis
C diagnoses each year; 70 percent of those infected develop chronic liver
disease, the leading U.S. cause of liver transplants and liver cancer. CDC
reports that 20 percent of hepatitis C-infected people say they have no
history of injected drug use. A 2012 Harris poll estimated that 20 percent
of people have a tattoo.

CDC spokesperson Scott Holmberg, MD recommends that people who want to be
tattooed go to a trained professional for piercings or tattooing. Because
there are no federal regulations for tattoo parlors and standards vary from
state to state, Francois urges people to research tattoo parlors carefully.
According to the Alliance for Professional Tattooists, it is important to
find a tattooist who uses disposable gloves, “a clean workspace without
blood spatters, and single-use, disposable needles.”

The full report, “Association of Tattooing and Hepatitis C Virus Infection:
A Multicenter Case-Control Study,” was published online in the journal
Hepatology (2013; doi: 10.1002/hep.26245).
__________________________________________________________________
__________________________________________________________________
Nepal: Govt warns hospitals to strictly manage waste
HIMALAYAN NEWS SERVICE, Kathmandu Nepal (31.12.12)

KATHMANDU: The government has warned that it would shut hospitals failing
to set up waste treatment plant.

Krishna Hari Baskota, Secretary at the Prime Minister’s Office, today said
at an interaction that the government would be forced to shut the hospitals
if they failed to set up medical waste treatment plant in accordance with
the existing laws. The interaction was organised by Solid Waste Management
Technical Support Centre.

A team led by Baskota had inspected hospitals and health care institution
in the Kathmandu Valley starting December 20. The team monitored Bir
Hospital, Kathmandu Medical College and Nepal Medical College on December
20 and 21 and found that only Bir Hospital was managing medical waste in a
proper manner.

Baskota also mentioned some interesting findings. He said a 300-bed private
hospital in the Capital has added 400 hundred beds in the last four years.
“But the hospital management told us it did not have enough funds to
establish waste treatment plant,” said Baskota but stopped short of
revealing the name of the hospital. “If hospitals fail to abide by the law,
they will be closed down, and doctors can go to their home districts. No
one is above the law and no one will be excused for flouting the law,” he
added.

There are 4,526 health institutions, 332 private hospitals and nursing
homes, 18 medical colleges, nine dental hospitals and four academies in
Nepal. But both government and private hospitals have been found to be
mixing general waste with medical waste. “Are the hospitals treating
patients or making more people sick?” questioned Sumitra Amatya, Executive
Director of SWMTSC.

Parliament in May last year approved the bill on the Solid Waste Management
Act 2011 that provisions a fine of Rs 500-100,000 and jail sentence of
15-180 days for violating the waste law. After implementation of the Act,
SWMTSC issued circulars to all the medical institutions in the Kathmandu
Valley about a year ago, calling for them to abide by rules.

Dr TR Burlakoti, Joint Secretary, MoHP, said the government will not renew
licences of those hospitals that fail to meet the standards as per laws by
March 31. “We notified them about a year ago. If they fail to maintain the
standards, their operation will be deemed illegal from April 1 and they
will be closed down,” said Dr Burlakoti.

http://www.noharm.org/lib/downloads/waste/Himalayan_news.pdf
__________________________________________________________________
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