The Washington Times reported that New Hampshire lawmakers are working to pass more legislation to monitor medical technicians in hopes of averting a similar situation from last year when a technician replaced stolen drugs with saline water tainted with his hepatitis C virus (HCV)-infected blood. The medical technician is now serving 39 years in prison for infecting 46 patients in four states with HCV.
The state House of Representatives passed two laws in response to this case, and the Senate currently is reviewing two additional bills. One of the Senate bills would require more allied healthcare professionals, such as medical technicians, to register with a newly created board. Many states across the country require this type of regulation for nurses and doctors but not medical technicians, including four of the states that employed the HCV-infected technician. The other bill before the Senate would require healthcare facilities to implement drug-free workplace policies and to drug-test employees if there is reasonable suspicion of usage.
Rep. Tom Sherman (D-Rye), a practicing gastroenterologist and co-sponsor of both bills, wants another bill to allow immunity for hospitals that provide information about employee misconduct. Sherman and another doctor in his small practice alerted Exeter Hospital when they realized they both had patients with HCV. The ensuing investigation led to the discovery of the infected technician’s misconducts. Sherman believes the legislation is needed to prevent this type of incidence from happening again. “It was just luck,” he said. “It was the structure of the group that brought this together, and that’s just too much left to chance.”
Médecins Sans Frontières (MSF) reported on a pilot project to detect and treat TB in Cambodia. According to Jean Luc Lambert, head of Mission in Cambodia for MSF, Cambodia has the second highest TB prevalence in the world, with 800 active TB cases per 100,000 people. He explains that the Cambodian health system is limited in the number of diagnoses it can make per year. Since MSF knew that prevalence in Cambodia is three times higher in the elderly than in the general public, the project focused on screening individuals older than 55 to provide early detection and treatment and prevent further transmission.
Kim Federici, the active case finding project manager in the town of Tboung Khmum, explained that the system uses two outreach workers who go into communities to explain the project’s purpose, the reason and procedure for screening, transportation arrangements for getting individuals to the hospital for screening, and the fact that it is all free to the individuals being tested. The outreach workers also respond to questions. At the hospital, participants receive a chest X-ray and consult with doctors, who request sputum samples if they suspect active TB.
Federici found screening much easier in rural villages compared to urban areas, where it is difficult to get people away from their jobs for screening. Sometimes MSF staff walks among market stalls looking for people older than 55. They then educate the individuals about TB and the active case finding program, and distribute literature abut TB screening to encourage them to get screened.
Lambert explained that the active case finding program significantly increases the chances of locating active TB cases. Whereas the Cambodia health system’s current process will screen 100–150 people before finding one person with active TB, MSF’s active case finding will only need to screen 40 people to locate one with TB. MSF will analyze the data to confirm the program’s success and cost effectiveness.
Science Codex reported on a study to determine whether financial incentives would encourage injecting drug users to complete a course of hepatitis B vaccination. According to Professor John Strang of the National Addiction Centre at King’s College London and leader of the study, injecting drug users in the United Kingdom are at high risk for hepatitis B virus (HBV) infection and transmission. HBV affects approximately 22 percent of the injecting drug users, but participation and adherence to the vaccine program are poor.
Strang and colleagues from Imperial College London and University College London assessed whether injecting drug users who were receiving opioid substitution therapy from 12 National Health Service drug treatment programs would respond to financial incentives and complete the HBV vaccination within 28 days.
The researchers randomly assigned 210 participants to one of three groups: vaccine with no incentive (treatment as usual); a voucher for the fixed amount of £10 at each of the three vaccinations (fixed value contingency management); and increasing amounts at each vaccination beginning with £5, then £10 at second visit, and £15 at third visit (escalating value contingency management). The researchers compared the number of participants completing vaccinations relative to each approach. In the first group that received no incentives, only six of 67 participants completed all vaccinations, compared to 35 of 78 in the fixed reward group, and 32 of 65 in the escalating reward group.
Strang concluded that offering the reward improved participation and completion of HBV vaccine as part of routine clinical practice. He acknowledged that more work is necessary to improve the reward program to increase uptake and completion.
The full report, “Use of Contingency Management Incentives to Improve Completion of Hepatitis B Vaccination in People Undergoing Treatment for Heroin Dependence: A Cluster Randomised Trial” was published online in the journal The Lancet (2014; doi:10.1016/S0140-6736(14)60196-3).
The StarPhoenix reported that health officials in Canada’s Saskatoon region believe social media and phone dating apps have led to an outbreak of syphilis, an STD they once considered uncommon in the area until recently. Officials diagnosed only three syphilis cases in 2013, while they already have reported nine cases in the first quarter of 2014. The region has seen an increase in other STDs as well.
Dr. Johnmark Opondo, deputy medical health officer for the Saskatoon Health Region, believes there is a worrying trend that people who look on the Internet for casual and anonymous sexual encounters do not practice the same safe practices they otherwise might. "Even if you meet folks virtually in cyberspace, when you actually meet them in real life, the same sex precautions apply," he said.
The increase of all STDs prompted student health representatives from the University of Saskatchewan to e-mail students urging them to get tested. Lynn Kuffner, manager of student health at the university, urges, "If you haven't been tested recently or you have new partners, [the e-mail is] a reminder that testing is available." STD testing is free on campus.
Many STDs can cause serious health consequences if left untreated.
Guampdn.com reported that 60 individuals from the Guam Department of Corrections (DOC) have tested positive for TB. The department screened 187 individuals for TB after Guam Memorial Hospital admitted a DOC detainee with active TB in March. According to Jeff Limo, special assistant to the DOC director, 23 inmates, 28 detainees, and nine officers tested positive for the disease. He said DOC isolated the 23 inmates and 28 pretrial detainees and gave them masks to use.
CBC News Edmonton reported that a new video produced by Megan Lefebvre, a PhD candidate with the School of Public Health at the University of Alberta in Edmonton, Canada, features positive stories of five individuals diagnosed with HIV to encourage others with the virus to take their medication. Lefebvre believes the stories featured in the video demonstrate the value of life to others with HIV. “For our participants, they had a sense of self-worth. They had gratitude for what was in their life.” Dylan Richards of HIV Edmonton said his organization is showing the video to clients who appreciate hearing from people who are in similar medical situations.
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