Blood or body fluid exposures and HIV postexposure prophylaxis utilization among first responders.

OBJECTIVES: To estimate the incidence of first-responder visits to emergency departments (EDs) for blood or body fluid exposures, elucidate any temporal patterns of these visits, and quantify human immunodeficiency virus (HIV) postexposure prophylaxis (PEP) utilization for these exposures. METHODS: This was a retrospective study of first responders presenting to Rhode Island EDs for blood or body fluid exposures from 1995 to 2001. Incidence rates for exposures with 95% confidence intervals (CIs) were estimated. Temporal trends for visits were modeled. Factors associated with HIV PEP utilization were identified using logistic regression. Odds ratios (ORs) with 95% CIs were estimated. RESULTS: The average incidence rate of ED visits for blood or body fluid exposures was 23.29 (20.07-26.52) ED visits per 100,000 ambulance runs. The incidence rose between 1995 and 1999 and then decreased. First-responder ED visits were lowest in October and highest in April and were lowest at 7 am and highest at 7 pm. First responders presenting with a percutaneous or blood-to-mucous membrane exposure had a 4.13 (1.82-8.89) greater odds and those exposed to a known HIV-infected source had a 9.03 (1.59-51.26) greater odds of being offered HIV PEP. First responders presenting to a teaching hospital had a 2.21 (1.02-4.77) greater odds of being offered prophylaxis and a 4.20 (1.08-16.32) greater odds of accepting prophylaxis when it was offered. CONCLUSIONS: First responders face a risk of blood or body fluid exposure that varies over the course of the day and the year. HIV PEP is more likely to be used if the exposures are percutaneous, or blood-to-mucous membrane, or if the source is known to be HIV-infected. Standardization of protocols across EDs for administering HIV prophylaxis appears to be needed.

HIV post-exposure prophylaxis among police and corrections officers.

BACKGROUND: Police and correctional officers face the occupational hazard of blood and body fluid exposures, which carry the risk of infection with HIV. AIMS: To estimate the incidence rate (IR) of emergency department (ED) visits for blood or body fluid exposures sustained by police and corrections officers in an entire state and to quantify the utilization of HIV post-exposure prophylaxis (PEP) in response to these exposures. METHODS: A retrospective study of police and corrections officers presenting to EDs in Rhode Island between 1995 and 2001. The investigators estimated IRs of ED visits for these exposures with 95% confidence intervals and determined factors associated with HIV PEP using bivariate Pearson's chi2 analyses. RESULTS: The average annual incidence of ED visits for blood or body fluid exposures over the study period was IR 4.41 (2.31-6.51) exposures per 1000 police and corrections personnel. Only 15% of officers sustained percutaneous injuries or blood-to-mucous membrane exposures. Sixteen officers were offered HIV PEP and 10 accepted it. Offering of HIV PEP was 3.3-fold greater for officers sustaining percutaneous and blood-to-mucous membrane exposures instead of other body fluid exposures. CONCLUSION: The incidence of ED visits for blood or body fluid exposures by police and corrections officers was low and most exposures did not have the potential for HIV transmission. HIV PEP was infrequently used for these exposures.

The neuropeptide VGF produces antidepressant-like behavioral effects and enhances proliferation in the hippocampus.

Brain-derived neurotrophic factor (BDNF) is upregulated in the hippocampus by antidepressant treatments, and BDNF produces antidepressant-like effects in behavioral models of depression. In our previous work, we identified genes induced by BDNF and defined their specific roles in hippocampal neuronal development and plasticity. To identify genes downstream of BDNF that may play roles in psychiatric disorders, we examined a subset of BDNF-induced genes also regulated by 5-HT (serotonin), which includes the neuropeptide VGF (nonacronymic). To explore the function of VGF in depression, we first investigated the expression of the neuropeptide in animal models of depression. VGF was downregulated in the hippocampus after both the learned helplessness and forced swim test (FST) paradigms. Conversely, VGF infusion in the hippocampus of mice subjected to FST reduced the time spent immobile for up to 6 d, thus demonstrating a novel role for VGF as an antidepressant-like agent. Recent evidence indicates that chronic treatment of rodents with antidepressants increases neurogenesis in the adult dentate gyrus and that neurogenesis is required for the behavioral effects of antidepressants. Our studies using [(3)H]thymidine and bromodeoxyuridine as markers of DNA synthesis indicate that chronic VGF treatment enhances proliferation of hippocampal progenitor cells both in vitro and in vivo with survival up to 21 d. By double immunocytochemical analysis of hippocampal neurons, we demonstrate that VGF increases the number of dividing cells that express neuronal markers in vitro. Thus, VGF may act downstream of BDNF and exert its effects as an antidepressant-like agent by enhancing neurogenesis in the hippocampus.