Needlestick injuries: a density-equalizing mapping and socioeconomic analysis of the global research.

BACKGROUND: Needlestick injuries have caused a deleterious effect on the physical and mental health of millions of health-care workers over the past decades, being responsible for occupational infections with viruses such as HIV or hepatis C. Despite this heavy burden of disease, no concise studies have been published on the global research landscape so far. METHODS: We used the New Quality and Quantity Indices in Science platform to analyze global NSI research (n = 2987 articles) over the past 115 years using the Web of Science and parameters such as global versus country-specific research activities, semi-qualitative issues, and socioeconomic figures. RESULTS: Density-equalizing mapping showed that although a total of n = 106 countries participated in NSI research, large parts of Africa and South America were almost invisible regarding global participation in NSI research. Average citation rate (cr) analysis indicated a high rate for Switzerland (cr = 25.1), Italy (cr = 23.5), and Japan (cr = 19.2). Socioeconomic analysis revealed that the UK had the highest quotient QGDP of 0.13 NSI-specific publications per bill. US-$ gross domestic product (GDP), followed by South Africa (QGDP = 0.12). Temporal analysis of HIV versus hepatitis research indicated that NSI-HIV research culminated in the early 1990s, whereas NSI-hepatitis research increased over the observed period from the 1980s until the last decade. CONCLUSION: Albeit NSI research activity is generally increasing, the growth is asymmetrical from a global viewpoint. International strategies should be followed that put a focus on NSI in non-industrialized areas of the world.

Epidemiology of HIV, Sexually Transmitted Infections, Viral Hepatitis, and Tuberculosis Among Incarcerated Transgender People: A Case of Limited Data.

Transgender people experience a disproportionate burden of human immunodeficiency virus (HIV) and incarceration. Discrimination, victimization, poverty, and poor mental health drive vulnerability to HIV and related infections, as well as risk of arrest, detention, and incarceration. In this paper, we systematically review published data on HIV, sexually transmitted infections, viral hepatitis, and tuberculosis among incarcerated transgender people; describe potential structural determinants of HIV risk and transmission; identify gaps in the literature; and make recommendations for research and interventions to address this neglected population. We found that HIV and related infections among incarcerated transgender people have received little attention in the epidemiologic literature. The limited data available, which date from 1992, demonstrate high prevalence of HIV and sexually transmitted infections in this population internationally. Transgender people who had not had genital surgery were typically placed in jails and prisons corresponding to birth-assigned sex rather than gender identity. Once incarcerated, they routinely faced harassment, physical abuse, and sexual violence from inmates and staff and denial of access to medically necessary gender-affirming therapies. More HIV research with incarcerated transgender populations is urgently needed to inform correctional policy change that centers human rights and structural interventions, such as stigma reduction, pre-arrest diversion, and access to HIV prevention methods and gender-affirming care during incarceration.

An Autopsy Checklist: A Monitor of Safety and Risk Management.

Any autopsy has safety and risk management issues, which can arise in the preautopsy, autopsy, and postautopsy phases. The London Health Sciences Department of Pathology and Laboratory Medicine Autopsy Checklist was developed to address these issues. The current study assessed 1 measure of autopsy safety: the effectiveness of the checklist in documenting pathologists' communication of the actual or potential risk of blood-borne infections to support staff. Autopsy checklists for cases done in 2012 and 2013 were reviewed. The frequency of communication, as recorded in checklists, by pathologists to staff of previously diagnosed blood-borne infections (hepatitis B/C and human immunodeficiency virus) or the risk of infection based on lifestyle (eg, intravenous drug abuse) was tabulated. These data were compared with medical histories of the deceased and circumstances of their deaths described in the final autopsy reports. Information about blood-borne infections was recorded less frequently in the checklists compared with the final reports. Of 4 known human immunodeficiency virus cases, there was no checklist documentation in 3. All 11 hand injuries were documented. None of these cases had known infectious risks. The Autopsy Checklist is a standardized means of documenting safety and risk issues arising during the autopsy process, but its effectiveness relies on accurate completion.

The prevalence, oral manifestations and management of viral hepatitis in Saudi Arabia: an update.

The aim of this review is to update healthcare professionals about the prevalence of various hepatitis viruses in the Saudi population. A perspective on the global and regional prevalence of hepatitis A, B and C viruses has also been given. The oral manifestations of hepatitis infection, the risks of patients and healthcare workers acquiring these infections, as well as the management of dental patients with hepatitis infection in the dental clinical setting has also been discussed. The universal precautions which should be observed while treating these patients have been reiterated, whereby detailed steps as pertaining to the management of these patients have been described, so as to optimize patient treatment, and at the same time to prevent dental healthcare workers from acquiring infection. The purpose of such management is therefore to ultimately improve the quality of life of patients infected with hepatitis viruses.

Protocolo clínico e diretrizes terapêuticas para prevenção da transmissão vertical de HIV, sífilis e hepatites virais / Clinical protocol and therapeutic guidelines for prevention of vertical transmission of HIV, syphilis and viral hepatitis

INTRODUÇÃO: Este Protocolo Clínico e Diretrizes Terapêuticas para Prevenção de Transmissão Vertical de HIV, Sífilis e Hepatites Virais está estruturado em três partes: -Parte I: Transmissão Vertical do HIV; -Parte II: Transmissão Vertical de Sífilis; -Parte III: Transmissão Vertical de Hepatites Virais. PARTE I: trata da transmissão vertical do HIV e atualiza o documento de Recomendações para Profilaxia da Transmissão Vertical do HIV e Terapia Antirretroviral em Gestantes, publicado em 2010. Entre outras atualizações, consolida a estratégia B+ da Organização Mundial de Saúde, em indicar tratamento antirretroviral às gestantes vivendo com HIV/aids, independente do seu estado imunológico e apresenta o efavirenz (EFV) como droga de primeira scolha na primeira linha de tratamento, possibilitando a prescrição do esquema preferencial e primeira linha na formulação de dose fixa combinada, o que reduz significativamente o número de comprimidos diários par apenas um por dia, representando significativo impacto positivo na adesão ao tratamento. PARTE II: trata da transmissão vertical de sífilis. Esta seção recentemente foi atualizada no documento Protocolo Clínico e Diretrizes Terapêuticas para Atenção Integral às Pessoas com Infecções Sexualmente Transmissíveis, publicado em maio de 2015. Aborda as fases da infecção da sífilis, métodos diagnósticos, tratamento específico e a manejo laboratorial e terapêutico para a sífilis congênita. PARTE III: trata da transmissão vertical das hepatites virais, sobretudo a hepatite viral B. Trata dos diversos aspectos da transmissão da hepatite B, o manejo da infecção na gestante, incluindo o pções terapêuticas e condutas obstétricas.

Tratamento da infecção pelo vírus da hepatite C em candidatos a transplante renal submetidos a diálise: impacto orçamentário no SUS / Hepatitis C treatment in patients on dialysis awaiting renal transplantation: a budget impact analysis

Trata-se de uma análise de impacto orçamentário derivada dos resultados do estudo "Custo-efetividade do tratamento da infecção pelo vírus da hepatite C em candidatos a transplante renal submetidos a diálise". Teve como objetivo estimar o impacto orçamentário da ampliação da oferta do tratamento da infecção pelo vírus da hepatite C (VHC) para candidatos a transplante renal. Para tal, foi construído um modelo de Markov, a fim de estimar o custo médio do tratamento de diferentes proporções da população-alvo. Foram estimados os casos prevalentes e incidentes da infecção na população em diálise, candidata a transplante renal, em um horizonte de tempo de dez anos. Com base nestas estimativas, foi calculado o valor a ser despendido pelo SUS para tratar a população-alvo em três cenários diferenciados, caracterizados pela proporção da população submetida ao tratamento. Os valores encontrados foram comparados com o gasto do sistema para garantia de terapias de substituição renal no período de um ano, identificando-se que o custo do tratamento de toda a população candidata a transplante, infectada pelo VHC, corresponde a 0,3 por cento do valor despendido com TRS pelo SUS.

This is an analyses of the budget impact derived from the cost-effectiveness study on the hepatitis C treatment in candidates for renal transplantation under dialysis. It aims to estimate the budget impact of an offer of hepatitis C treatment for all candidates for renal transplantation. A Markov model was developed to estimate the mean cost for treatment of distinct proportions of the target population. The prevalence and incidence of hepatitis C in the candidates for renal transplantation in the dialysis population was also estimated in a horizon of ten years. Based on these estimative, we calculate the amount needed for treatment of this population in three distinct scenarios characterized by a proportion of the population under treatment. The values were compared with the expense of the system to guarantee renal replacement therapies in one year, identifying the cost of treatment of all candidates for transplant, infected with HCV, corresponding to 0.3 percent of the amount spent with renal transplantation within the SUS.

[Perceptions, knowledge and attitudes about liver disease in healthy adults attending health facilities in stratum A, B and C]. / Percepciones, conocimientos y actitudes sobre enfermedad hepática en adultos sanos que acuden a instituciones de salud de estrato A, B y C.

OBJECTIVE: To find and describe perceptions, beliefs, knowledge and attitudes adopted by healthy people regarding liver disease, who attend at three medical institutions. To estimate how the academic and socioeconomic level operate as determinant factors. MATERIAL AND METHODS: Descriptive transversal study that includes a 31 question-questionnaire made in a group of 390 healthy people who were in the waiting rooms at Hospital Cayetano Heredia (HNCH), Policlinico Peruano Japones (PPJ) and Clinica Angloamericana (CAA), reflecting low, medium and medium-high socio economic status respectively. Data was processed with SPSS software. RESULTS: We found that 218/390 (56%) people had higher education level, and 64% were women. "Eating high-fat meals" had the highest percentage (91%) among perceptions of liver disease. "Bad breath" and "heartburn" were referred as symptoms of liver disease, among people with a higher education level. Less than 50% of people knew about routes of transmission of hepatitis B, associated with its prevention and treatment. CONCLUSIONS: Beliefs and wrong perceptions about liver disease are prevalent among people; dyspepsia was inaccurately associated. There is an inappropriate knowledge about routes of transmission, preventive measures and treatment, which was reflected in people with lower education level as well as in those with higher education and socioeconomic level.

[Needlestick injuries and reporting routines]. / Stikkskader og melderutiner.

BACKGROUND: Health care workers are at risk for transmission of blood-borne agents through percutaneous exposure. Reporting of sharps injuries is essential for instigation of adequate post-exposure prophylaxis and follow-up. We aimed at providing an account of number of sharps injuries reported by type of health care worker and the reporting systems used for injuries that have an inherent risk of transmitting blood-borne agents. MATERIAL AND METHODS: The section for HSE (health, safety and environment) at Haukeland University Hospital provided us with an overview of requests for analyses of hepatitis and HIV linked to 159 sharps injuries that had not been reported otherwise. Injury reports at Haukeland University Hospital from the period 2003 - 2007 (n = 8556) were systematically reviewed. RESULTS: On average, 210 sharps injuries are reported annually at Haukeland University Hospital. In addition analyses of hepatitis and HIV linked to 159 sharps injuries that had not been reported otherwise, were requested annually. 51 % of sharps injuries were reported by nurses, 10 % by laboratory workers, 6 % by doctors and 33 % by others. INTERPRETATION: Sharps injuries are often not reported, and especially doctors fail to report them. Of health care workers, nurses report most sharps injuries. Related to numbers employed, laboratory workers report most sharps injuries.

The blood donor in sub-Saharan Africa: a review.

The high prevalence of numerous endemic and epidemic diseases such as malaria, HIV infection and viral hepatitis in some areas of sub-Saharan Africa (SSA) affects the health status of blood donors. Considering the difficulties in ensuring sufficient and safe blood supply, analysing epidemiological factors that impact blood donors in this community may further bring light on issues of supply and safety, and help in planning for its rational use. This review does not aim to propose new strategies but describes the main characteristics of blood donors in SSA as collected from different reports. Data were mainly obtained from the reports of the World Health Organization and national blood transfusion programmes and also from relevant literature and conference reports. Several characteristics are common in blood donors, such as the predominance of young adult males, the high frequency of Transmission-transmitted Infections (TTIs) and some erythrocytic phenotypes. The data indicate variations in the level of improvement of blood collection and blood safety from one area to another, particularly in the field of donor motivation or screening strategies for TTIs. These data could be useful to supplement previous reports and to provide updates for governments and international organizations' programs involved in the improvement of blood safety in Africa.

Hepatitis needs assessment among Jordanian healthcare workers.

BACKGROUND: Hepatitis infections caused by hepatitis A, B and C virus are considered to be an important health problem worldwide. Based on the available data from the Jordanian Ministry of Health, the incidence rates of hepatitis A and B in the Jordanian population in 2003 were 10.2 and 0.8 per 100,000 per year, respectively; however, data on the incidence of hepatitis C are not currently available. RESEARCH OBJECTIVE: To assess Jordanian healthcare workers' hepatitis training needs. METHODS: A total of 339 healthcare workers from private and public Jordanian healthcare settings participated in this descriptive study. The Minnesota Primary Care Practitioners Viral Hepatitis Survey was utilized for data collection. RESULTS: Two-thirds of the participants expressed that they did not have adequate and current training in issues related to hepatitis infections. Healthcare workers indicated an interest in receiving information and training about hepatitis A, B and C (83%, 71% and 80%, respectively). CONCLUSION: The results of this study showed that the majority of Jordanian healthcare workers reported a need for hepatitis training. IMPLICATION TO PRACTICE: Standardized training should be provided to healthcare workers who are working in high-risk settings.

Health risks of enteric viral infections in children.

Children are at a greater risk of infections from serious enteric viral illness than adults for a number of reasons. Most important is the immune system, which is needed to control the infection processes. This difference can lead to more serious infections than in adults, who have fully developed immune systems. There are a number of significant physiological and behavioral differences between adults and children that place children at a greater risk of exposure and a greater risk of serious infection from enteric viruses. Although most enteric viruses cause mild or asymptomatic infections, they can cause a wide range of serious and life-threatening illnesses in children. The peak incidence of most enteric viral illnesses is in children <2yr of age, although all age groups of children are affected. Most of these infections are more serious and result in higher mortality in children than adults. The fetus is also affected by enterovirus and infectious hepatitis resulting in significant risk of fetal death or serious illness. In addition to the poliovirus vaccine, the only vaccine available is for hepatitis A virus (HAV). A vaccine for rotavirus has currently been withdrawn, pending review because of potential adverse effects in infants. No specific treatment is available for the other enteric viruses. Enteric viral infections are very common in childhood. Most children are infected with rotavirus during the first 2yr of life. The incidence of enteroviruses and the viral enteric viruses ranges from 10% to 40% in children and is largely dependent on age. On average, half or more of the infections are asymptomatic. The incidence of hepatitis A virus is much lower than the enteric diarrheal viruses. There is no current evidence for hepatitis E virus (HEV) acquisition in children in the U.S. Enteric viral diseases have a major impact on direct and indirect health care costs (i.e., lost wages) and amount to several billion dollars a year in the U.S. Total direct and indirect costs for nonhospitalized cases may run from $88/case for Norwalk virus to $1,193/case for enterovirus aseptic meningitis. Direct costs of hospitalization ran from $887/case for Norwalk virus to $86,899/case for hepatitis A. These costs are based on 1997-1999 data. Generally, attack rates during drinking water outbreaks are greater for children than adults. The exception appears to be hepatitis E virus where young adults are more affected. However, pregnant women suffer a high mortality, resulting in concurrent fetal death. Also, secondary attack rates are much higher among children, probably because of fewer sanitary habits among this age group. Overall, waterborne outbreaks of viral disease have a greater impact among children than adults. To better quantify the impact on children, the literature hould be further reviewed for case studies of waterborne outbreaks where data are available on the resulting illness by age group. The EPA and/or Centers for Disease Control should attempt to collect these data as future outbreaks are documented.