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SIGNpost 00726

*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *

Post00726 Good News/Bad News + Abstracts + Market + News 18 December 2013

CONTENTS
0. Moderators Note + Good News and Bad News
1. Abstract: Evolution of the global use of unsafe medical injections,
2000-2010
2. Abstract: EXPO-S.T.O.P.: A national survey and estimate of sharps
injuries and mucocutaneous blood exposures among healthcare workers in
USA
3. Abstract: The management of needlestick injuries
4. Abstract: Under-reporting of accidents involving biological material by
nursing professionals at a brazilian emergency hospital
5. Abstract: Lessons learned from a community based intervention to
improve injection safety in Pakistan
6. Abstract: Geographical and temporal variation of injection drug users
in Pakistan
7. Abstract: Risk factors for HIV, viral hepatitis, and syphilis among
heroin users in northern Taiwan
8. Abstract: Does informing people who inject drugs of their hepatitis C
status influence their injecting behaviour? Analysis of the Networks II
study
9. Abstract: Contamination rates between smart cell phones and non-smart
cell phones of healthcare workers
10. Abstract: Improved hand hygiene technique and compliance in healthcare
workers using gaming technology
11. Abstract: Local injection versus surgery in carpal tunnel syndrome:
Neurophysiologic outcomes of a randomized clinical trial
12. Abstract: Measles immunity and measles vaccine acceptance among
healthcare workers in Paris, France
13. Abstract: The Effect of Brief Functional Relaxation on College
Students’ Needle Anxiety During Injected Vaccinations
14. Abstract: Rice-based oral antibody fragment prophylaxis and therapy
against rotavirus infection
15. Global prefilled syringe market to reach $4.98 Billion in 2019
16. Announcement: WHO/EPELA e-learning courses for 2014 – Apply now
17. News
– India: Indian start-up set to revolutionise biopsy
– Canada: Inmates need needle-exchange programs, better access to HIV
treatment: study
– Oceania: NZers warned over HIV at Sydney clinic
– Australia: Prison for woman who wielded syringe with “blood in it”
– USA: Age and sharing of needle injection equipment in a cohort of
Massachusetts injection drug users: an observational study
– Australia: Sydney hair replacement clinic patients urged to screen for
HIV infection

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__________________________________________________________________
________________________________*_________________________________

0. Moderators Note + Good News and Bad News
__________________________________________________________________
Good news and Bad news

Please read the Abstract posted below as Item 1 and the link to the
complete open access article by Jacques Pepin et.al.

” Evolution of the global use of unsafe medical injections, 2000-2010″

The article suggests that we have made real and important progress,
particulary in reducing syringe and needle reuse in most parts of the
world. Congratulations for all of the hard work!

” From 2000 to 2010, in developing countries and transitional economies,
the average number of injections per person per year decreased from 3.40
to 2.88, while the proportion of re-use of injection devices dropped from
39.8% to 5.5%.

Combining both factors the number of unsafe injections per person per year
decreased from 1.35 to 0.16.

Even if substantial progress has been made, the Eastern Mediterranean
region remains problematic, with 0.57 unsafe injections per person per
year.

In sub-Saharan Africa and Latin America, people now receive on average
only 0.04-0.05 unsafe injections per year. ”

**** SIGNpost will resume on 8 January 2014 ****

Very best wishes for a safer New Year!

allan
__________________________________________________________________
________________________________*_________________________________

1. Abstract: Evolution of the global use of unsafe medical injections,
2000-2010
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24324650

PLoS One. 2013 Dec 4;8(12):e80948.

Evolution of the global use of unsafe medical injections, 2000-2010.

Pépin J, Abou Chakra CN, Pépin E, Nault V.

OBJECTIVE: Since 1999, substantial efforts have been made by the
international community to reduce the risks associated with unsafe
injections, through ministries of health, international donors, the World
Health Organization and the Safe Injection Global Network. The present
study attempted to measure the progress, or lack thereof, made over the
2000-2010 decade in reducing unsafe injections in ten regions of the world
corresponding to developing and transitional economies.

METHODS: Data about the number of injections per person per year and the
proportion of re-use of syringes and needles were obtained for 2010,
mainly from population surveys, and compared with previous estimates for
2000 which had used various sources of information including injection
safety assessments, population surveys and published studies on injection
practices.

RESULTS: From 2000 to 2010, in developing countries and transitional
economies, the average number of injections per person per year decreased
from 3.40 to 2.88, while the proportion of re-use of injection devices
dropped from 39.8% to 5.5%. Combining both factors the number of unsafe
injections per person per year decreased from 1.35 to 0.16. Even if
substantial progress has been made, the Eastern Mediterranean region
remains problematic, with 0.57 unsafe injections per person per year. In
sub-Saharan Africa and Latin America, people now receive on average only
0.04-0.05 unsafe injections per year.

CONCLUSION: Substantial progress has been made in reducing the number of
unsafe injections in developing countries and transitional economies,
essentially through a reduction in the re-use of injection devices. In
some regions, elimination of unsafe injections might become a reasonable
goal.

Free Full Article
http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0080948
__________________________________________________________________
________________________________*_________________________________

2. Abstract: EXPO-S.T.O.P.: A national survey and estimate of sharps
injuries and mucocutaneous blood exposures among healthcare workers in
USA
__________________________________________________________________
Terry Grimmond <tg[at]gandassoc.com>
“sign.moderator@gmail.com” <sign.moderator@gmail.com>
subject: EXPO-STOP U.S. Blood Exposure Survey

Hi Alan,

I hope I can make last SIGNpost for Dec. This month the J of the U.S.
Assoc of Occupational Professionals in Healthcare (JAOHP) published a
study I co-authored on blood exposure among U.S. HCW (largest study
conducted in U.S.).

Attached is the abstract and the article is available to non-members at
info@aohp.org for US$20, or non-industry colleagues may request an
author’s copy from me at tg@gandassoc.com.

Best regards, Terry

Terry Grimmond FASM, BAgrSc, GrDpAdEd
Consultant Microbiologist
Grimmond and Associates
Ph/Fx (NZ): +64 7 856 4042
Mob (NZ): +64 274 365 140
E: tg[at]gandassoc.com
__________________________________________________________________
Journal of the Association of Occupational Health Professionals in
Healthcare (Fall Issue) 2013;33(4):31-36

EXPO-S.T.O.P.: A national survey and estimate of sharps injuries and
mucocutaneous blood exposures among healthcare workers in USA

Grimmond T* FASM, BAgrSc, GrDpAdEd and Good L^ RN, PhD, COHN-s

*Director, Grimmond and Associates, Microbiology Consultants, Hamilton New
Zealand. ^Director, Employee Occupational Services, Scripps Health, San
Diego, CA.

Purpose: Blood exposure (BE) among healthcare workers (HCW), either from
percutaneous sharps injury (SI) or mucocutaneous (MC) exposure, is a
serious occupational risk that healthcare facilities (HCF) strive to
reduce. Large exposure-rate databases assist in benchmarking this goal
however currently in the United States no nation-wide, annual surveys are
conducted.

In 2012 The Association of Occupational Health Professionals in Healthcare
(AOHP) commissioned a new Exposure Study of Occupational Practice (EXPO-
S.T.O.P.) among its members to establish a nationally representative BE
database and benchmark resource.

Design: A nine-item electronic survey was developed and distributed to
AOHP members to ascertain BE incidence and denominator data.

Methods: 2011 data was requested on: Total SI and MC incidence in the HCF
and during surgical procedures; full-time equivalent (FTE) staff; average
daily census, adjusted patient days (APD); teaching status, medical staff
inclusion; and state. Incidence rates per 100 FTE, per 100 Occupied Beds
(OB), and per 1000 APD were calculated and compared with relevant US
databases. Best practices from the top 10 lowest-exposure teaching and
non-teaching hospitals were also ascertained.

Survey results were used to calculate a national estimate of BE exposures
in hospital and non-hospital settings.

Findings: Responses from 125 hospitals in 29 states were received making
the survey the largest in the United States. Overall SI incidence rates
were: 24.0/100 OB (17.8 in non-teaching and 27.4 in teaching hospitals);
1.89/100 FTE; and 0.53/1000 APD. Overall MC incidence rates were 9.0/100
OB (7.1 in non- teaching and 10.1 in teaching hospitals); 0.69/100 FTE;
and 0.20/1000 APD.

Effective reduction strategies in low-incidence, “sharps aware” hospitals
include: intense and repeated competency education; monthly institutional
emails; easy incident reporting; management involvement; immediate action
on ‘trends’; and zero as goal.

Extrapolation of survey results indicate that in U.S. hospital and non-
hospitals settings, 321,907 SI HCW sustain SI and 119,437 sustain MC, thus
441,344 HCW sustain BE annually.

———————————————————————

The full definitive version of this article has been published in the
Journal of the Association of Occupational Health Professionals in
Healthcare (Fall Issue) 2013;33(4):31-36 and copies may be purchased by
emailing info@aohp.org.
__________________________________________________________________
________________________________*_________________________________

3. Abstract: The management of needlestick injuries
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23437024

Dtsch Arztebl Int. 2013 Feb;110(5):61-7.

The management of needlestick injuries.

Himmelreich H, Rabenau HF, Rindermann M, Stephan C, Bickel M, Marzi I,
Wicker S.

BACKGROUND: An estimated 1 million needlestick injuries (NSIs) occur in
Europe each year. The Council Directive 2010/32/EU on the prevention of
NSIs describes minimum requirements for prevention and calls for the
implementation of local, national and Europe-wide reporting systems. The
Directive is to be implemented by all EU member states by 11 May 2013. The
purpose of this study was to assess (and improve) the procedures for the
reporting and treatment of needlestick injuries in a German tertiary-care
hospital.

METHODS: We carried out a prospective observational study of the NSI
reporting system in the hospital over a period of 18 months and determined
the incidence of NSIs, the prevalence of blood-borne pathogens among index
patients, the rate of initiation of post-exposure prophylaxis, and the
rate of serological testing of the affected health care personnel.

RESULTS: 519 instances of NSI were reported to the accident insurance
doctor over the period of the study, which consisted of 547 working days.
86.5% of the index patients underwent serological study for hepatitis B
and C (HBV and HCV) and for the human immune deficiency virus (HIV); this
resulted in two initial diagnoses (one each of active hepatitis B and
hepatitis C) in the index patient. 92 of 449 index patients, or one in
five, was infected with at least one blood-borne pathogen. HIV post-
exposure prophylaxis was initiated in 41 health care workers. One case of
hepatitis C virus transmission arose and was successfully treated. Other
than that, no infection was transmitted.

CONCLUSION: Complete reporting of NSIs is a prerequisite for the
identification of risky procedures and to ensure optimal treatment of the
affected health care personnel. The accident insurance doctor must possess
a high degree of interdisciplinary competence in order to treat NSI
effectively.

Comment in
In reply. [Dtsch Arztebl Int. 2013]

Index patient’s details are important. [Dtsch Arztebl Int. 2013]

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576594/
__________________________________________________________________
________________________________*_________________________________

4. Abstract: Under-reporting of accidents involving biological material by
nursing professionals at a brazilian emergency hospital
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24321641

Int J Occup Saf Ergon. 2013;19(4):623-9.

Under-reporting of accidents involving biological material by nursing
professionals at a brazilian emergency hospital.

Facchin LT, Gir E, Pazin-Filho A, Hayashida M, da Silva Canini SR.

Background. Pathogens can be transmitted to health professionals after
contact with biological material. The exact number of infections deriving
from these events is still unknown, due to the lack of systematic
surveillance data and under-reporting.

Methods. A cross-sectional study was carried out, involving 451 nursing
professionals from a Brazilian tertiary emergency hospital between April
and July 2009. Through an active search, cases of under-reporting of
occupational accidents with biological material by the nursing team were
identified by means of individual interviews. The Institutional Review
Board approved the research project.

Results. Over half of the professionals (237) had been victims of one or
more accidents (425 in total) involving biological material, and 23.76% of
the accidents had not been officially reported using an occupational
accident report. Among the underreported accidents, 53.47% were
percutaneous and 67.33% were bloodborne. The main reason for nonreporting
was that the accident had been considered low risk.

Conclusions. The under-reporting rate (23.76%) was low in comparison with
other studies, but most cases of exposure were high risk.
__________________________________________________________________
________________________________*_________________________________

5. Abstract: Lessons learned from a community based intervention to
improve injection safety in Pakistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23607289

BMC Res Notes. 2013 Apr 22;6:159.

Lessons learned from a community based intervention to improve injection
safety in Pakistan.

Altaf A, Shah SA, Shaikh K, Constable FM, Khamassi S.

BACKGROUND: A national study in 2007 revealed that in Pakistan the
prevalence of hepatitis B is 2.5% and for hepatitis C it is 5%. Unsafe
injections have been identified as one of the reasons for the spread of
these infections. Trained and untrained providers routinely perform unsafe
practices primarily for economic reasons i.e. they reuse injection
equipment on several patients. The patients, do not question the provider
about the need for an injection because of social barriers or whether the
syringe is coming from a new sterile packet due to lack of knowledge. The
present paper represents an intervention that was developed to empower the
community to improve unsafe injection practices in rural Pakistan.

METHODS: In a rural district of Pakistan (Tando Allahyar, Sindh) with a
population of approximately 630,000 a multipronged approach was used in
2010 (June to December) to improve injection safety. The focus of the
intervention was the community, however providers were not precluded. The
organization of interventions was also carefully planned. A baseline
assessment (n=300) was conducted prior to the intervention.

The interventions comprised large scale gatherings of the community (males
and females) across the district. Smaller gatherings included teachers,
imams of mosques and the training of trained and untrained healthcare
providers. The Pakistan Television Network was used to broadcast messages
recorded by prominent figures in the local language. The local FM channel
and Sunday newspaper were also used to disseminate messages on injection
safety.

An end of project assessment was carried out in January 2012. The study
was ethically reviewed and approved.

RESULTS: The interventions resulted in improving misconceptions about
transmission of hepatitis B and C. In the baseline assessment (only 9%) of
the respondents associated hepatitis B and C with unsafe injections which
increased to 78% at the end of project study. In the baseline study 15% of
the study participants reported that a new syringe was used for their most
recent injection. The post-intervention findings showed an increase to 29%
(n=87).

CONCLUSION: It is difficult to assess the long-term impact of the
intervention but there were several positive indicators. The duration of
intervention is the key to achieving a meaningful impact. It has to be at
least 18-24 months long.

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637594/
__________________________________________________________________
________________________________*_________________________________

6. Abstract: Geographical and temporal variation of injection drug users
in Pakistan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23314301

Sex Transm Infect. 2013 Sep;89 Suppl 2:ii18-28.

Geographical and temporal variation of injection drug users in Pakistan.

Archibald CP, Shaw SY, Emmanuel F, Otho S, Reza T, Altaf A, Musa N,
Thompson LH, Blanchard JF.

OBJECTIVES: We describe the characteristics of injecting drug users (IDU)
in Pakistan in 2006 and 2011, and assess the heterogeneity of IDU
characteristics across different cities and years as well as factors
associated with HIV infection.

METHODS: Cross-sectional, integrated behavioural-biological surveys of IDU
were conducted in 10 cities across Pakistan in 2006 and 2011. Univariate
and multivariable analyses were used to describe the differences in HIV
prevalence and risk behaviours between cities and over time.

RESULTS: Large increases in HIV prevalence among injection drug users in
Pakistan were observed, with overall HIV prevalence increasing from 16.2%
in 2006 to 31.0% in 2011; an increase in HIV prevalence was also seen in
all geographic areas except one. There was an increase in risk behaviours
between 2006 and 2011, anecdotally related to a reduction in the
availability of services for IDU. In 2011, larger proportions of IDU
reported injecting several times a day and using professional injectors,
and fewer reported always using clean syringes. An increase in the
proportion living on the street was also observed and this was associated
with HIV infection. Cities differ in terms of HIV prevalence, risk
profiles, and healthcare seeking behaviours.

CONCLUSIONS: There is a high prevalence of HIV among injection drug users
in Pakistan and considerable potential for further transmission through
risk behaviours. HIV prevention programs may be improved through
geographic targeting of services within a city and for involving groups
that interact with IDU (such as pharmacy staff and professional injectors)
in harm reduction initiatives.

KEYWORDS: Epidemiology (General), HIV, Injecting Drug Use

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3756445/
__________________________________________________________________
________________________________*_________________________________

7. Abstract: Risk factors for HIV, viral hepatitis, and syphilis among
heroin users in northern Taiwan
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23077983

Subst Use Misuse. 2013 Jan;48(1-2):89-98.

Risk factors for HIV, viral hepatitis, and syphilis among heroin users in
northern Taiwan.

Wang LJ, Lin SK, Chiang SC, Su LW, Chen CK.

A total of 125 heroin users were recruited from a detention center and two
psychiatric hospitals in northern Taiwan during 2006 in order to
investigate the prevalence and correlates of blood-borne infections among
heroin users.

The seroprevalence rates of the human immunodeficiency virus (HIV),
hepatitis C virus (HCV), HBV, HDV, and syphilis were 15.2%, 74.4%, 15.2%,
6.4%, and 8%, respectively. Injection risk behaviors were associated with
HIV, HCV, and syphilis infections, but not with HBV infections.

Meanwhile, HCV and HBV infections were correlated with the duration of
heroin use and age of the subjects, respectively.

The results of this study suggest that a comprehensive public health
program is needed to prevent transmission of these blood-borne infections.
The study’s limitations are noted.
__________________________________________________________________
________________________________*_________________________________

8. Abstract: Does informing people who inject drugs of their hepatitis C
status influence their injecting behaviour? Analysis of the Networks II
study
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24315504

Int J Drug Policy. 2013 Sep 8. pii: S0955-3959(13)00129-1.

Does informing people who inject drugs of their hepatitis C status
influence their injecting behaviour? Analysis of the Networks II study.

Aspinall EJ, Weir A, Sacks-Davis R, Spelman T, Grebely J, Higgs P,
Hutchinson SJ, Hellard ME.

BACKGROUND: People who inject drugs (PWID) are at risk of hepatitis C
virus (HCV). It is plausible that PWID who receive a diagnosis of HCV will
reduce their injecting risk out of concern for their injecting partners,
although evidence for this is currently limited. The aim of this study was
to investigate whether informing PWID of their HCV diagnosis was
associated with a change in injecting behaviour.

METHODS: Prospective, longitudinal study of PWID recruited from street
drug markets across Melbourne, Australia. Interviews and HCV testing were
conducted at 3-monthly intervals. The association between receiving a
diagnosis of HCV and (i) injecting frequency and (ii) injecting equipment
borrowing, was examined using generalized estimating equations (GEE)
analysis.

RESULTS: Thirty-five individuals received a diagnosis of HCV during the
study period. Receiving a diagnosis of HCV was associated with a decrease
of 0.35 injections per month (p=0.046) but there was no change in
injecting equipment borrowing (p=0.750).

CONCLUSIONS: A small reduction in injecting frequency was observed in PWID
who received a diagnosis of HCV. This finding should be investigated
further in larger studies examining a wider range of injecting risk
behaviours.

Copyright © 2013 Elsevier B.V. All rights reserved.

KEYWORDS: Diagnosis, Hepatitis C virus, People who inject drugs, Risk
behaviours, Testing
__________________________________________________________________
________________________________*_________________________________

9. Abstract: Contamination rates between smart cell phones and non-smart
cell phones of healthcare workers
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23418134

J Hosp Med. 2013 Mar;8(3):144-7. doi: 10.1002/jhm.2011.

Contamination rates between smart cell phones and non-smart cell phones of
healthcare workers.

Lee YJ, Yoo CG, Lee CT, Chung HS, Kim YW, Han SK, Yim JJ.

BACKGROUND: Healthcare workers’ mobile phones are easily contaminated with
pathogenic bacteria and could be vehicles of transmission. Smart phones
are increasingly used in the hospital. The objective of this study was to
compare the contamination rate of bacteria with pathogenic potential
between smart phones and non-smart phones.

METHODS: We screened mobile phones of healthcare workers in three teaching
hospitals in South Korea. The identification of cultivated micro-organisms
and assessment of antibiotic susceptibility were performed.

RESULTS: One hundred fifteen (56.7%) participants used smart phones, and
88 (43.3%) used non-smart phones. Bacteria with pathogenic potential were
isolated from 58 (28.6%) mobile phones, more often from smart phones than
from non- smart phones (34.8% vs 20.5%, P=0.03). Multivariate analysis
including various characteristics to determine risk factors revealed that
only smart phones (vs non-smart phones) were a significant risk factor for
contamination by bacteria with pathogenic potential (adjusted odds ratio
[OR], 4.02; 95% confidence interval [CI], 1.43-11.31). Also, in a
multivariate model including phone size, the smart phone was still a
significant risk factor for the pathogen contamination (OR, 4.17; 95% CI,
1.07-16.33; P=0.04).

CONCLUSION: The smart phones of healthcare workers were contaminated with
bacteria with pathogenic potential to a greater extent than were non-smart
phones.

Copyright © 2013 Society of Hospital Medicine.
__________________________________________________________________
________________________________*_________________________________

10. Abstract: Improved hand hygiene technique and compliance in healthcare
workers using gaming technology
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23498360

J Hosp Infect. 2013 May;84(1):32-7.

Improved hand hygiene technique and compliance in healthcare workers using
gaming technology.

Higgins A, Hannan MM.

BACKGROUND: In 2009, the World Health Organization recommended the use of
a ‘multi- faceted, multi-modal hand hygiene strategy’ (Five Moments for
Hand Hygiene) to improve hand hygiene compliance among healthcare workers.
As part of this initiative, a training programme was implemented using an
automated gaming technology training and audit tool to educate staff on
hand hygiene technique in an acute healthcare setting.

AIM: To determine whether using this automated training programme and
audit tool as part of a multi-modal strategy would improve hand hygiene
compliance and technique in an acute healthcare setting.

METHODS: A time-series quasi-experimental design was chosen to measure
compliance with the Five Moments for Hand Hygiene and handwashing
technique. The study was performed from November 2009 to April 2012. An
adenosine triphosphate monitoring system was used to measure handwashing
technique, and SureWash (Glanta Ltd, Dublin, Ireland), an automated
auditing and training unit, was used to provide assistance with staff
training and education.

FINDINGS: Hand hygiene technique and compliance improved significantly
over the study period (P < 0.0001).

CONCLUSION: Incorporation of new automated teaching technology into a hand
hygiene programme can encourage staff participation in learning, and
ultimately improve hand hygiene compliance and technique in the acute
healthcare setting.

Copyright © 2013 The Healthcare Infection Society. Published by Elsevier
Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

11. Abstract: Local injection versus surgery in carpal tunnel syndrome:
Neurophysiologic outcomes of a randomized clinical trial
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24321619

Clin Neurophysiol. 2013 Nov 23. pii: S1388-2457(13)01184-X.

Local injection versus surgery in carpal tunnel syndrome: Neurophysiologic
outcomes of a randomized clinical trial.

Andreu JL, Ly-Pen D, Millán I, de Blas G, Sánchez-Olaso A.

OBJECTIVE: The aim of our study was to characterize the neurophysiologic
outcomes in a randomized clinical trial comparing local corticosteroid
injection and decompressive surgery in idiopathic carpal tunnel syndrome.

METHODS: Clinical and neurophysiologic assessments were done at baseline
and 12months after treatment. Four parameters were evaluated in the nerve
conduction study (NCS): distal motor latency, motor amplitude, sensory
conduction velocity and sensory amplitude. Statistic signification was
established by the Student’s t test, independent and paired samples, and
Mann-Whitney test. Repeated measures analysis of variance was used by the
three domains of symptoms. Correlations between the changes showed in
clinical parameters and those evidenced by electromyography were
calculated by the Pearson’s test.

RESULTS: Both groups of therapy were comparable at baseline. In 95 wrists,
a second NCS was done 12months post-treatment. Although clinical outcome
improved in a similar way in both groups, we found statistically
significant improvement in three (distal motor latency, sensory conduction
velocity and sensory amplitude) of four neurophysiologic parameters only
in the surgery group, when compared to baseline values.

CONCLUSIONS: Although local corticosteroid injection and decompressive
surgery are clinically effective in reducing symptoms of carpal tunnel
syndrome, only surgery results in an improvement of the neurophysiologic
parameters, at 12-months follow-up.

SIGNIFICANCE: Only decompressive surgery allows resolution of
neurophysiologic changes. The symptoms of the syndrome are resolved with
corticosteroid injections.

Copyright © 2013 International Federation of Clinical Neurophysiology.
Published by Elsevier Ireland Ltd. All rights reserved.

KEYWORDS: Carpal tunnel syndrome, Corticosteroid injection,
Electromyography, Randomized clinical trial, Surgical decompression
__________________________________________________________________
________________________________*_________________________________

12. Abstract: Measles immunity and measles vaccine acceptance among
healthcare workers in Paris, France
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23433868

J Hosp Infect. 2013 May;84(1):38-43.

Measles immunity and measles vaccine acceptance among healthcare workers
in Paris, France.

Freund R, Krivine A, Prévost V, Cantin D, Aslangul E, Avril MF, Claessens
YE, Rozenberg F, Casetta A, Baixench MT, Dumaine V, Launay O, Loulergue P.
Author information

BACKGROUND: In Europe, including France, a measles outbreak has been
ongoing since 2008. Unprotected healthcare workers (HCWs) may contract and
spread the infection to patients.

AIM: The objective of this study was to evaluate HCWs’ measles immunity
and vaccine acceptance in our setting.

METHODS: In a survey-based study conducted in three university hospitals
in Paris, 351 HCWs were included between April and June 2011. The
following data were collected at enrolment: age, hospital unit,
occupation, history of measles infection and vaccination, previous measles
serology and acceptance of a measles vaccination in case of
seronegativity. Sera were tested for the presence of specific anti-measles
IgG antibodies using the CAPTIA(®) measles enzyme-linked immunosorbent
assay.

FINDINGS: The mean age of the participating HCWs was 36 years (range:
18-67) and 278 (79.2%) were female. In all, 104 four persons (29.6%)
declared a history of measles, and 90 (25.6%) declared never having
received a measles vaccination. Among the 351 HCWs included in the study,
322 (91.7%) were immunized against measles (IgG >90 mIU/mL). The risk
factors for not being protected were age [18-29 years, adjusted odds
ratio: 2.7 (95% confidence interval: 1.1-6.9) compared with =30 years], no
history of measles infection or vaccination. The global acceptance rate
for a measles vaccination, before knowing their results, was 78.6%.

CONCLUSION: In this cohort of HCWs, 8.3% were susceptible to measles; the
group most represented were aged <30 years. Acceptance of the measles
vaccine was high. A vaccination campaign in healthcare settings should
target specifically healthcare students and junior HCWs.

Copyright © 2013 The Healthcare Infection Society. Published by Elsevier
Ltd. All rights reserved.
__________________________________________________________________
________________________________*_________________________________

13. Abstract: The Effect of Brief Functional Relaxation on College
Students’ Needle Anxiety During Injected Vaccinations
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/24313663

J Am Coll Health. 2013 Dec 7.

The Effect of Brief Functional Relaxation on College Students’ Needle
Anxiety During Injected Vaccinations.

McWhorter L, Gil-Rivas V.

Objective: This study examined the effect of brief functional relaxation
(FR) training on needle anxiety (NA) during vaccinations.

Participants: From October, 2010 through May 2012, 48 undergraduates were
recruited through the Psychology Participant Pool.

Methods: Students (N = 48) were randomly assigned to a 15-minute brief FR
session delivered via MP3 player, or a standard care condition (15-minutes
of sitting quietly) prior to receiving injections at the immunization
clinic. Measures were completed before (T1) and after (T2) the assigned
condition, assessing expected NA, state anxiety, blood pressure and heart
rate; and after the injection (T3), self-reported NA during the injection.

Results: Unexpectedly, the groups did not differ at T2. However, during
the injection, brief FR participants indicated lower self-reported NA (T3)
than standard care.

Conclusions: Brief FR is a simple, inexpensive technique that may reduce
NA in college health settings and help decrease delays in treatment
seeking.
__________________________________________________________________
________________________________*_________________________________

14. Abstract: Rice-based oral antibody fragment prophylaxis and therapy
against rotavirus infection
__________________________________________________________________
http://www.ncbi.nlm.nih.gov/pubmed/23925294

J Clin Invest. 2013 Sep 3;123(9):3829-38. d

Rice-based oral antibody fragment prophylaxis and therapy against
rotavirus infection.

Tokuhara D, Álvarez B, Mejima M, Hiroiwa T, Takahashi Y, Kurokawa S,
Kuroda M, Oyama M, Kozuka-Hata H, Nochi T, Sagara H, Aladin F, Marcotte H,
Frenken LG, Iturriza-Gómara M, Kiyono H, Hammarström L, Yuki Y.

Rotavirus-induced diarrhea is a life-threatening disease in
immunocompromised individuals and in children in developing countries.

We have developed a system for prophylaxis and therapy against rotavirus
disease using transgenic rice expressing the neutralizing variable domain
of a rotavirus-specific llama heavy-chain antibody fragment (MucoRice-
ARP1). MucoRice-ARP1 was produced at high levels in rice seeds using an
overexpression system and RNAi technology to suppress the production of
major rice endogenous storage proteins.

Orally administered MucoRice-ARP1 markedly decreased the viral load in
immunocompetent and immunodeficient mice. The antibody retained in vitro
neutralizing activity after long-term storage (>1 yr) and boiling and
conferred protection in mice even after heat treatment at 94°C for 30
minutes.

High-yield, water-soluble, and purification-free MucoRice-ARP1 thus forms
the basis for orally administered prophylaxis and therapy against
rotavirus infections.

Comment in
Infection: Rice yields new oral therapy for rotavirus infection. [Nat Rev
Gastroenterol Hepatol. 2013]

Biotechnology: Rice-derived rotavirus antibody shows promise. [Nat Rev
Drug Discov. 2013]

Free PMC Article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3754275/
__________________________________________________________________
________________________________*_________________________________

15. Global prefilled syringe market to reach $4.98 Billion in 2019
__________________________________________________________________
http://tinyurl.com/kcl69xg

Global prefilled syringe market to reach $4.98 Billion in 2019

Transparency Market Research report says growth will be triggered by
biologics and other potent injectable drugs, as well as technical advances
in prefilled syringe manufacturing and packaging.

By Jim Butschli, Editor-in-chief

Prefilled syringes represent one of the fastest-growing segments among the
injectable drug delivery devices market. It is mainly due to the various
advantages associated with the use of prefilled syringes, such as ease of
administration, reduced risk of cross contamination, less overfill, and
ease of handling.

According to a new market report published by Transparency Market Research
“Prefilled Syringes Market (Glass and Plastic)—Global Industry Analysis,
Size, Volume, Share, Growth, Trends and Forecast, 2013-2019,” the global
prefilled syringes market was valued at US$ 2.09 billion in 2012 and is
expected to grow at a Compound Annual Growth Rate (CAGR) of 13.3% from
2013 to 2019, to reach an estimated value of US$ 4.98billion in 2019.

Major drivers expected to contribute to this market growth include
increasing awareness regarding benefits of prefilled syringes and presence
of a large number of biopharmaceuticals under clinical development
targeted for parenteral administration. In addition, the high growth
economies of emerging nations such as India, China, Brazil, Russia, and
Mexico are attracting manufacturers to invest in these lucrative markets.
Japan is a well-established market for prefilled syringes among Asian
countries.

Geographically, the market for prefilled syringes has been classified into
four regions—North America, Europe, Asia-Pacific, and Rest of the World
(RoW). Europe constituted the largest market share for prefilled syringes
in 2012, owing to the high adoption rate of these delivery devices in the
region. However, the North American market is predicted to grow at a
higher CAGR (15%) than Europe during the forecast period to reach a value
similar to that of the European market.

The two major segments described in the study are glass-based and plastic-
based prefilled syringes. Each of these segments has been analyzed on the
basis of their current and future market size in terms of USD million and
market volume in terms of million units, considering the macro and micro
environmental factors. In addition, the CAGR of the overall market and the
above segments has also been provided in the report for the forecast
period 2013 to 2019, considering 2012 as the base year.

Prefilled syringes are advanced drug delivery devices filled with a single
measured dose of high-end injectable drugs. These syringes are gradually
becoming the most preferred delivery devices for various categories of
injectable drugs, mainly due to the advantages offered to drug
manufacturers, healthcare providers, and patients over conventional vial
and ampule packaging systems.

To drug manufacturers, they are important because they reduce overfill to
4% to 5% from 20% in vials, and thus, are preferred for dispensing
therapeutic classes (mainly biologics), which are expensive. With respect
to healthcare providers and patients, prefilled syringes help with factors
such as ease of operation, low risk of contamination, and accurate dosing.

Glass has been the most preferred material over decades for syringe
manufacturing, owing to its properties such as non-reactive nature,
robustness, transparency and tolerability against heat. Consequently,
glass-based prefilled syringes accounted for the larger share (more than
90%) of the total market in 2012, both by revenue as well as volume.

In the past few years, however, the industry is witnessing a shift towards
the use of plastic in place of glass in response to some significant
disadvantages associated with glass, such as high risk of breakability and
increased level of leachability from silicone layer in the presence of
biologics. Under the influence of continued development in the area of
polymer technology, the market for plastic-based syringes is expected to
grow at a CAGR more than double of that of glass syringes during the
forecast period from 2013 to 2019. Nevertheless, glass syringes will still
dominate the total global market for prefilled syringes in 2019, in terms
of percent share by revenue as well as volume.

Market growth during the forecasted period will be triggered by drivers
including a boost in the use of biologics and other potent injectable
drugs, technical advances in prefilled syringe manufacturing and
packaging, rising demand for self-administration, and increasing elderly
population suffering from various chronic diseases that require frequent
parenteral dosing.

On the other hand, burgeoning concerns regarding needlestick safety and
prevention, rising manufacturing costs, and issues with drug stability are
some of the challenges likely to affect the growth of the global prefilled
syringes market.

The report concludes with a market share analysis of the leading players
in the market for prefilled syringes, in terms of percentage share in the
year 2012, and company profiles of the key players. The market players
profiled in this report are Becton, Dickinson and Company, Gerresheimer
AG, Nipro Corp., Schott AG, Stevanato Group, Baxter, International, Inc.,
Unilife Corp., West Pharmaceutical Services, Inc., Bespak, Ypsomed Holding
AG, and Vetter Pharma International GmbH.
__________________________________________________________________
________________________________*_________________________________

16. Announcement: WHO/EPELA e-learning courses for 2014 – Apply now

Crossposted from Technet-21 with thanks

The new WHO/EPELA e-VVM based vaccine management course will go live in
January 2014.
__________________________________________________________________
WHO/EPELA e-learning courses for 2014 – Apply now

The new WHO/EPELA e-VVM based vaccine management course will go live in
January 2014. The course dates for 2014 are as follows:

27 January–28 March 2014 (beta-course)
21 April–20 June 2014
6 October–5 December 2014

This authentic e-learning experience will take you to a virtual journey
through different levels of the vaccine supply chain. We offer authentic
tasks taking place at international arrival, storage, in-country
distribution of vaccines, health centre level, and outreach. These tasks
are arranged mainly as group activities. You’ll benefit a lot from this
collaborative learning.

We offer you the tools to easily connect with other participants so you
can discuss and work together as a team. You will be able to work with
real VVMs and observe how they react to different temperature scenarios
throughout the course. Within this unique learning environment we assess
our learning by self, peer, and expert reviews. Most importantly, nobody
will lecture you in our course… but we’ll make available to you all the
resources that have been specifically produced for this course, including
the video and document library.

The course will be mentored by Umit Kartoglu, Julie Milstien, Ticky
Raubenheimer and Denis Maire. Mentors will provide timely feedback to you
whenever necessary and be there to assist you.

The course objectives:

By the end of this learning event, participants will be able to:

1. Explain the relation between the VVM categories and reaction
rates.
2. Given five different situations over a time, observe and read
status of four VVM types.
3. Given five different situations, explain differences in VVM
reactions rates.
4. Given a situation of an international arrival, decide whether to
accept or reject the shipment.
5. Create a decision tree for examination of shipment on arrival to
decide whether to accept it.
6. Given a storage situation, analyse factors contributing exposure
of vaccines to temperature exposure and suggest corrective actions to
reduce the risks.
7. Develop a standard operating procedure (SOP) for checking the
status of vaccines during their storage time.
8. Given a stock situation with different vaccines, various expiry
periods and batches and VVM status, decide which products to be dispatched
against a requisition order.
9. Create a decision tree for dispatch of vaccines involving all
relevant factors.
10. Given a situation of refusal of an in-country shipment, communicate
the reasoning behind your selection of a particular batch with certain
temperature exposure.
11. Given two different scenarios of temperature exposure, expiry date,
VVM status and opened/unopened multi dose vials, judge whether the
vaccines are suitable for use.
12. Given a stock situation of vaccines with different VVM status in
open/unopened multi-dose vials and expiry dates, decide which vaccines to
be used first in fixed immunization session and short/long outreach
activities.
13. Develop a plan of action to adopt VVM policies for national use
based on the analysis of vaccine management practices in your own country.

Participant profile:

Primary target audience:
§ Representatives from the national immunization programme in the areas
of: handling of vaccines, immunization planning, logistics, and monitoring
§ Representatives from WHO, UNICEF and other partner organizations:
technical officers responsible for immunization cold chain management
activities at regional level, intercountry logisticians, health officers,
EPI officers, as well as immunization advisers, whose involvement in
immunization cold chain is confirmed by their organizations.
§ Representatives from the government sector involved in pharmaceutical
cold chain in the areas of: regulation, inspection, planning and
monitoring.

Secondary target audience
§ Representatives from the pharmaceutical/biopharmaceutical/vaccine
industry in the areas of: supply, packaging, distribution, logistics and
cold chain management. Manufacturers who already supply WHO-prequalified
products are encouraged to participate.
§ Representatives from the equipment and device manufacturing industry in
the areas of: active cooling, passive cooling, temperature monitoring, and
track and trace. Manufacturers who already supply WHO PQS prequalified
products, or who wish to enter this market, are encouraged to participate.
§ Representatives from logistics providers.
§ Members of higher education institutions in health professions.
§ Independent consultants.

If you would like take part in beta course 27 January–28 March 2014,
please send your CV to info@epela.net

e-Pharmaceutical cold chain management course

After two successful courses, WHO/EPELA e-pharmaceutical cold chain
management course will continue to be offered in 2014. The 2014 course
dates are:

3 February–25 April 2014
5 May–25 July 2014
8 September–28 November 2014

For details of the course please go to
http://epela.net/epela_web/introduction.html.

As for applying online go to http://epela.net/epela_web/apply_online.html.
__________________________________________________________________
________________________________*_________________________________

17. News

– India: Indian start-up set to revolutionise biopsy
– Canada: Inmates need needle-exchange programs, better access to HIV
treatment: study
– Oceania: NZers warned over HIV at Sydney clinic
– Australia: Prison for woman who wielded syringe with “blood in it”
– USA: Age and sharing of needle injection equipment in a cohort of
Massachusetts injection drug users: an observational study
– Australia: Sydney hair replacement clinic patients urged to screen for
HIV infection

Selected news items reprinted under the fair use doctrine of international
copyright law: http://www4.law.cornell.edu/uscode/17/107.html
__________________________________________________________________
http://tinyurl.com/k5wzqfw

India: Indian start-up set to revolutionise biopsy

Business Standard, IANS, Bangalore India (17.12.13)

The threat of a “silent” liver disease epidemic looms over India, with the
problem compounded by the absence of safe, reliable and affordable
diagnostics – especially biopsies.

Now IndioLabs (IL), a Bangalore-based start-up, has come up with
‘BioScoop’, a cutting-edge, cost-effective procedure that could
revolutionise the way a biopsy is done.

A biopsy is done to diagnose the extent and type of damage to the liver
caused by hepatitis, cirrhosis or cancer, by extracting a tissue sample
with a needle, especially after a chronic or abnormal condition is
indicated by blood tests, an X ray or ultrasound.

Although biopsy is a key tool and a “gold standard” in diagnostics, the
risk of internal bleeding, contamination, or infection cannot be ruled
out, which could lead to sudden death.

“BioScoop extracts tissue automatically, eliminating the possibility of
contamination and other problems associated with conventional biopsy, all
in three seconds,” Siraj Bagwan, IndioLabs MD who co-invented the device,
told IANS.”Also in a conventional biopsy, the needle has to be inserted a
second time, if the first attempt fails to extract a tissue sample. When
the second attempt fails, doctors have to perform a laproscopy guided
biopsy. But BioScoop overcomes these problems,” added Bagwan. Bagwan
worked on the project under the Stanford-India Biodesign (SIB), a flagship
biomedical programme of the All India Institute of Medical Sciences
(AIIMS), the Indian Institute of Technology, Delhi and Stanford
University, US, sponsored by the Union Ministry of Science and Technology.

“The device consists of a multi-functional needle that pierces the skin
and cuts soft liver tissue in one clean ‘scooping’ action. It is
integrated with a ‘BxSeal’ system, which delivers a sealant directly to
the spot from where the tissue is removed to prevent blood-loss and
complications,” Bagwan said.

A WHO report said the “silent” epidemic is likely to affect one out of
every 10 Indians over the next decade, even as the hepatitis B variant
alone kills an estimated 100,000 people in the country every year.

IndioLabs, the research arm of the Bangalore-based Omya Healthcare Ltd.,
has filed Indian and international patents for both technologies through
Biotech Consortium India Ltd. and is pursuing regulatory approval for
marketing clearance by 2014.

This device is expected to sell at half the price of its current closest
competitor, enabling a cost-effective and definitive diagnosis for Indian
patients and hospitals to curtail the silent epidemic, according to Tetali
Murali Krishna Reddy, chairman of Omya Healthcare.

“The conservative estimate of the market size is of Rs.300 crore to Rs.500
crore for liver biopsy in India alone, even though this device can easily
be extended to breast, kidney, lungs and prostate soft-organ biopsies,
among others,” said Reddy.

“IndioLabs is likely to launch ‘BioScoop’ in India by March 2015, followed
by a phased global launch in the Asia-Pacific region, Europe and the
United States,” added Reddy.

BioScoop co-inventor Jonathan Pillai, said: “We are actively pursuing
regulatory approvals in Europe and the US in a phased manner, with an
initial focus on CE (European Conformity) approval and then the US-FDA
clearance.”

Hepatitis A, B, C, D and E, is caused by a group of viruses known as
hepatitis viruses. They are usually spread by eating food or drinking
contaminated water, or through sex, blood transfusions or needle sharing
by intravenous drug-users. Biopsy may be done in the case of Hepatitis B,
C and D.

This technology was presented at the VIIth Medtech Summit in New Delhi Dec
7.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/k5tfmdc

Canada: Inmates need needle-exchange programs, better access to HIV
treatment: study

Camille Bains, The Canadian Press (16.12.13)

VANCOUVER — Needle exchange programs and increased access to HIV
treatment are essential to curb infection rates among Canadian prisoners,
says the lead author of a new study calling for immediate action.

Dr. M-J Milloy of the B.C. Centre for Excellence in HIV/AIDS said other
jurisdictions, including some American states, have reduced HIV rates
among inmates and protected public health in the communities they return
to when they’re released.

“We are really in favour of collaborating with the prison system to try
and find better ways to deliver harm reduction — whether that’s
supervised injection, a needle exchange, improved access to methadone,”
Milloy said Monday.

“We think scientifically there’s a good argument for these sorts of things
and what happens next, I think, is a political question and a question
that should best be answered by the people who are in charge of our prison
system.”

The study, published in the journal BioMedical Central Infectious
Diseases, was conducted between May 1996 and March 2012 involving
interviews every six months with 657 inmates who were HIV positive and
used injection drugs.

Milloy said it found that HIV could be detected in a prisoner’s
bloodstream 83 per cent of the time, meaning they’re more likely to pass
on the infection.

But when those same people were not behind bars, the study found the
infection rate fell to 62 per cent because they received treatment.

Milloy said that although some inmates chose not to disclose they were HIV
positive to prevent being stigmatized, others could not access specific
medications they’d started before they were incarcerated or experienced
delays in getting their prescriptions filled.

He said institutions in Rhode Island, Connecticut and Washington, D.C.,
have been successful in reducing HIV rates but the strongest case for
change comes from Switzerland, which pioneered needle-exchange programs 20
years ago before that prevention strategy was adopted by other countries
including Germany, Spain, Iran and central Asia.

Richard Elliott, executive director of the Canadian HIV/AIDS Legal
Network, said it’s long been known that the sharing of drug-injection
equipment by illicit drug users in prisons causes the spread of blood-
borne infections but policies have not changed to protect their health.
“So far, governments in Canada are unwilling, despite repeated calls from
all over the place, to act to introduce access to sterile injection
equipment in prisons,” said Elliott, adding HIV rates are 10 times higher
in jails and prisons.

In September 2012, the network launched a lawsuit in Ontario Superior
Court against Corrections Canada, along with several groups including the
Canadian Aboriginal AIDS Network, the Prisoners with HIV-AIDS Support
Action Network and an individual who allegedly contracted hepatitis C
while incarcerated.

“It’s not a lawsuit for damages,” Elliott said from Toronto. “It’s a
lawsuit seeking constitutional remedies, seeking recognition that there
are constitutional rights that are being violated here when the government
withholds an essential evidence-based health service from people in
prison.”

Infectious disease specialist Dr. Wendy Wobeser, who treats current and
former HIV inmates in Ontario, said it’s clear that in the past,
Correctional Service of Canada acknowledged the use of illicit drugs in
jails and prisons by setting up bleach programs to clean needles.
Wobeser, who is also an associate professor at Queens University in
Kingston, said she’s not holding out hope for any change in policy on the
federal level.

“I’m not sure the current government can even accept the phraseology ‘harm
reduction,”‘ she said. “But it would be hopeful that the authorities could
have an open mind about what is needed to adequately care for people with
HIV in prisons, particularly those who have drug-use challenges.”

Correctional Service of Canada spokeswoman Sara Parkes said in an email
response that the department is committed to controlling and managing
infectious diseases to protect the health of inmates, staff, and
ultimately the community.

However, she did not provide any specifics, nor any information on whether
a bleach program is still being used in some facilities to clean infected
needles.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/l34v4ab

Oceania: NZers warned over HIV at Sydney clinic

NZN, NZ City, New Zealand (16.12.13)

New Zealanders who visited a hair treatment clinic in Sydney are being
asked to contact Healthline as they may have been at risk of a blood borne
disease.

New Zealanders who visited a central Sydney hair treatment and clinic have
been warned they could have been exposed to HIV or hepatitis B or C due to
poor infection control.

A warning was issued in New South Wales last week, asking anyone who was
treated at the clinic of Dr Angela Campbell in Macquarie St, Sydney
between December 2010 and February 2013 to have tests for blood-borne
diseases.

The warning has now been extended to New Zealand after the Ministry of
Health was notified by Australian authorities.

Among the problems found were issues with the cleaning and sterilisation
of surgical instruments and equipment.

While the overall risk is regarded as very low, the patients could have
been exposed to blood-borne infections such as hepatitis C, hepatitis B or
HIV, said Professor Mark Ferson, the director of the public health unit in
South Eastern Sydney.

Former patients in Sydney are being advised to see their GP to be
screened, and New Zealand public health director Dr Darren Hunt recommends
New Zealanders who attended the clinic contact Healthline.

A Ministry of Health spokesman told NZ Newswire it’s not confirmed New
Zealanders were treated at the clinic but there was a possibility as it is
believed some patients came from outside NSW or overseas.

Dr Campbell has been suspended from practice since February.
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/o3pmh4l

Australia: Prison for woman who wielded syringe with “blood in it”

Geoff Egan, The Sunshine Coast Daily, Australia (14.12.13)

A HEPATITIS C positive woman who held up another woman in the toilets of
the Redbank Plaza cinemas last year has been sentenced to eight years
prison.

Maree Sharelle Leighton, 43, yesterday pleaded guilty at the Ipswich
District Court to attempted robbery, enter premises with intent to commit
an indictable offence, assault occasioning bodily harm, possessing drug
utensils, receiving tainted property, to counts of stealing and three
counts of robbery with actual violence.

The court heard Leighton’s attack on the woman in the cinema toilets was
the last in a string of robberies and attempted robberies she had
conducted with syringes, believed to be filled with blood.

On May 14, 2012, Leighton, who has served a period of jail for holding up
taxi drivers with syringes, and another woman held up a lawyer in an
elevator in Post Office Square in the Brisbane city.

In the lift they pulled out syringes and told the woman they had AIDS and
would stab her if she didn’t give them money, and threatened to hurt her
children if she called the police.

Three days later Leighton followed a 59-year-old female medical doctor to
her car in Roma St in central Brisbane. She pulled out a needle the doctor
believed was filled with blood and threatened her. “Give me your money,
I’m Hep C positive and have a needle with blood in it,” the court heard
Leighton said.

A struggle between the two ensued at the end of which the doctor noticed
her hand had been scratched by the needle. She had blood tests which came
back negative for Hepatitis C.

Two days following the attack at Roma St, Leighton snatched $200 from a
75-year-old woman with a walking stick at an ATM. When the woman protested
Leighton pulled out a syringe and threatened her.

Later that same day at the toilet of the Reading Cinemas in Redbank Plaza,
Leighton stuck a needle in the shoulder blade of a woman washing her
hands.

She took the woman’s handbag and told her not to leave for five minutes.
The woman left the toilets as soon as Leighton was gone and found her
husband, who tracked down and stopped Leighton. She was arrested by police
following the Redbank attack.

Judge Greg Koppenol said Leighton’s actions were “despicable” and
“protracted” attacks.

“The (victims) were vulnerable woman, away from the general public,” he
said.

Leighton was sentenced to eight years prison, and will be eligible for
parole after serving two years behind bars.
__________________________________________________________________
__________________________________________________________________
USA: Age and sharing of needle injection equipment in a cohort of
Massachusetts injection drug users: an observational study

7thSpace Interactive (press release) USA (13.12.13)

Hepatitis C infection (HCV) among individuals aged 15-24 years has
increased in Massachusetts, likely due to injection drug use. The
prevalence of injection equipment sharing (sharing) and its association
with age was examined in a cohort of out-of-treatment Massachusetts
substance users.

Methods: This analysis included baseline data from a behavioral
intervention with substance users.

Younger and older (<25 versus >=25 years) injection drug users were
compared on demographic characteristics, substance use practices,
including factors present during the most recent sharing event (“event-
level factors”), and HCV testing history.

Results: Sharing was reported by 41% of the 484 individuals who reported
injection drug use in the past 30 days. Prevalence of sharing varied by
age (50% <25 years old versus 38% >=25 years, p = 0.02).

In a multivariable logistic regression model younger versus older
individuals had twice the odds of sharing (95% CI = 1.26, 3.19). During
their most recent sharing event, fewer younger individuals than older had
their own drugs available (50% versus 75%, p <0.001); other injection
event-level factors did not vary by age.

In the presence of PTSD, history of exchanging sex for money, or not being
US born, prevalence of sharing by older users was higher and was similar
to that of younger users, such that there was no association between age
and sharing.

Conclusions: In this cohort of injection drug users, younger age was
associated with higher prevalence of sharing, but only in the absence of
certain stressors. Harm reduction efforts might benefit from intervening
on mental health and other stressors in addition to substance use.

Study findings suggest a particular need to address the dangers of sharing
with young individuals initiating injection drug use.

Author: Katherine TassiopoulosJudith BernsteinEdward Bernstein
Credits/Source: Addiction Science &Clinical Practice 2013, 8:20
__________________________________________________________________
__________________________________________________________________
http://tinyurl.com/ktqrrzy

Australia: Sydney hair replacement clinic patients urged to screen for HIV
infection

Xinhua News Agency (12.12.13)

SYDNEY, Dec. 12 (Xinhua) — Australia’s New South Wales (NSW) health
authorities have warned that hundreds of people who underwent hair
treatment at a Sydney hair replacement clinic could have been exposed to
HIV and other infectious diseases, local media reported on Thursday.

The Public Health Unit of South Eastern Sydney Local Health District has
found there was poor infection control at Doctor Angela Campbell’s clinic
in Macquarie Street, Sydney, between December 2010 and February 2013,
according to the Australian Broadcasting Corporation (ABC).

The Medical Council of NSW has suspended Dr. Campbell from practice since
February this year, the South Eastern Sydney Public Health Unit said.

A public health assessment of the clinic showed problems with the cleaning
and sterilization of surgical instruments and equipment at the practice.

The NSW Health Blood Borne Viruses Advisory Panel has advised that
patients of the practice could have been exposed to blood- borne viruses
with potential for infection with hepatitis C, hepatitis B and human
immunodeficiency (HIV) viruses.

Professor Mark Ferson, director of the South Eastern Sydney Public Health
Unit has urged former patients of the clinic to see their doctors for
screening.

“The overall risk to an individual patient is very low,” Ferson said in a
public health announcement.

“As a precaution, we are recommending that former patients attend their
local general practitioner for screening for hepatitis C, hepatitis B and
HIV infection.”

Ferson said NSW Health has notified other states and territories of
Australia as some patients may have come from interstate and overseas.

Copyright 2013 Xinhua News Agency.
__________________________________________________________________
________________________________*_________________________________
* SAFETY OF INJECTIONS brief yourself at: www.injectionsafety.org

A fact sheet on injection safety is available at:
http://www.who.int/mediacentre/factsheets/fs231/en/index.html

* Visit the WHO injection safety website and the SIGN Alliance Secretariat
at: http://www.who.int/injection_safety/en/

* Download the WHO Best Practices for Injections and Related Procedures
Toolkit March 2010 [pdf 2.47Mb]:
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Facsimile: +41 22 791 4836 E- mail: sign@who.int
__________________________________________________________________
________________________________*_________________________________

The 2010 annual Safe Injection Global Network meeting to aid collaboration
and synergy among SIGN network participants worldwide 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:
http://www.who.int/entity/injection_safety/toolbox/sign2010_meeting.pdf

The report is navigable using bookmarks and is searchable. Viewing
requires the free Adobe Acrobat Reader at: http://get.adobe.com/reader/

Translation tools are available at: http://www.google.com/language_tools
or http://www.freetranslation.com
__________________________________________________________________
________________________________*_________________________________
All members of the SIGN Forum are invited to submit messages, comment on
any posting, or to use the forum to request technical information in
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The comments made in this forum are the sole responsibility of the writers
and does not in any way mean that they are endorsed by any of the
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Use of trade names and commercial sources is for identification only and
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The SIGN Forum welcomes new subscribers who are involved in injection
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* Subscribe or un-subscribe by email to: sign.moderator@gmail.com, or to
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of all SIGNposts, meeting reports, field reports, documents, images such
as
photographs, posters, signs and symbols, and video.

We would like your help in building this archive. Please send your old
reports, studies, articles, photographs, tools, and resources for posting.

Email mailto:sign.moderator@gmail.com
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The SIGN Internet Forum was established at the initiative of the World
Health Organization’s Department of Essential Health Technologies.

The SIGN Secretariat home is the Department of Health Systems Policies and
Workforce, Geneva Switzerland.

The SIGN Forum is moderated by Allan Bass and is hosted on the University
of Queensland computer network. http://www.uq.edu.au
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