*SAFE INJECTION GLOBAL NETWORK* SIGNPOST *SAFE INJECTION GLOBAL NETWORK* SIGN 2009 30 November to 2 December 2009 at WHO HQ Geneva Post00512 GAVI INS Evaluation + Abstracts + Job + News 9 September 2009 CONTENTS 1. GAVI Alliance support is putting injection safety at the sharp end of developing countries’ immunisation programmes. 2. Abstract: A study on the insoluble microparticulate contamination at ampoule opening 3. Abstract: Sharps injury and body fluid exposure among health care workers in an Australian tertiary hospital 4. Abstract: Healthcare waste management in Asia 5. Abstract: Systematic review and meta-analysis of epidemiology, prophylaxis and therapy of infections with viral hepatitis B and C in Polish paediatric oncology centres 6. Abstract: Health care worker-to-patient transmission of hepatitis C virus in the health care setting: Many questions and few answers 7. Abstract: Needle and syringe sharing among Iranian drug injectors 8. Abstract: Assessing a drop box programme: A spatial analysis of discarded needles 9. Abstract: Serosorting for hepatitis C status in the sharing of injection equipment among Seattle area injection drug users 10. Abstract: Inhaled therapeutics for prevention and treatment of pneumonia 11. Abstract: The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations 12. Abstract: Hepatitis B control by 2012 in the WHO Western Pacific Region: rationale and implications 13. Abstract: Where did all the aid go? An in-depth analysis of increased health aid flows over the past 10 years 14. Abstract: Epicutaneous allergen administration as a novel method of allergen-specific immunotherapy 15. Abstract: Foreign body granulomas after injection of Bio-alcamid for lip augmentation 16. Abstract: Injectable collagenase clostridium histolyticum for Dupuytren's contracture 17. Abstract: Long-term effects of botulinum toxin treatment 18. Abstract: Corticosteroid injections for trigger finger. 19. No Abstract: Safe disposal of used sharp objects 20. No Abstract: Reuse of single-use critical medical devices 21. No Abstract: US AIDS chief lays out priorities 22. No Abstract: US health secretary pledges renewed fight against HIV 23. Position Vacant: Essential Drugs Logistician Vanuatu 24. CREATE: Waste Disposal Unit (WDU): A WHO-Compliant Total Healthcare Waste Management Solution 25. New USAID award for HIV prevention research 26. Kuwait Lab Technology Conference & ExhibitionKuwait Lab Technology Conference & Exhibition 27. News - Australia: HIV, STIs on rise in Australia - China: China to send 'harmony makers' to Urumqi - India: Orissa Police arrests fake doctor for administering vaccine to children - Kuwait: Hepatitis B in Kuwait: Immunizations Making an Impact - China: Chinese doctors say some claims of needle-stabbings are mistaken - China: Thousands of harmony makers sent to Urumqi communities while authorities vow harsh punishment against syringe attackers - China: Chinese medical experts examine Urumqi syringe attacks victims - Researchers Analyze The Recipients Of A Decade Worth Of Health Aid - China: China TV: 476 People Stabbed With Hypodermic Needles - Vietnam: PEPFAR To Continue Funding Projects In Vietnam - UNICEF Could Lose Up To 10% Of Budget Over Next 2 Years - India: Police Arrest Six for Supplying Blood Tainted with Hepatitis B, C to Hospitals in Northern India This edition of SIGNpost is located at: http://uqconnect.net/signfiles/Archives/SIGN-POST00512.txt and is printer friendly. If your email reader truncates your SIGNpost - click on the link above to download the complete posting. Please send your requests, notes on progress and activities, articles, news, and other items for posting to: sign@uq.net.au Normally, items received by Tuesday will be posted in the Wednesday edition. Subscribe or un-subscribe by email to: sign@uq.net.au, sign@who.int More information follows at the end of this SIGNpost! Visit the WHO injection safety website and the SIGN Alliance Secretariat at: http://www.who.int/injection_safety/en/ __________________________________________________________________________ _____________________________________*____________________________________ 1. GAVI Alliance support is putting injection safety at the sharp end of developing countries’ immunisation programmes. Download the evaluation at: http://tinyurl.com/GAVI-INS-evaluation This is a 1,626 Kb pdf file. Requires Adobe Acrobat Reader: http://get.adobe.com/reader/ __________________________________________________________________________ __________________________________________________________________________ GAVI Alliance support is putting injection safety at the sharp end of developing countries’ immunisation programmes. Geneva, 13 May 2009 -The GAVI Alliance’s commitment to protecting the world’s poorest women and children from needle-induced infection has encouraged a growing number of developing countries to put safer injection practices at the forefront of their immunisation programmes. A recently published report, commissioned by the Alliance, concluded that more than half of the countries to have received funding through GAVI’s Injection Safety Support (INS) programme now cover the cost of auto- disable syringes and safety boxes out of their Health Ministry budgets. Catalyst GAVI has allocated some US $110 million to purchasing an estimated 2.5 billion auto-disable syringes for countries applying for INS. "The report underlines GAVI’s unique role as a catalyst for change in developing countries," said Julian Lob-Levyt, GAVI Alliance CEO. When the Alliance introduced INS in 2000, support was specifically limited to three years to help prompt developing countries to find sustainable sources of funding for injection safety. Eight years later, 30 out of the 58 countries receiving INS fully fund their own injection safety programmes. An additional 11 rely on a mix of their own funding and donor support. Fifteen countries continue to rely on donor funding. Only two countries have been unable to sustain support. Bangladesh In Bangladesh, the government’s commitment to safer injection practices resulted in the construction of a factory near Dhaka in 2006 to produce all the country’s auto-disable syringes and safety boxes (see image). "We have different factors coming together: government commitment, good planning, advocacy from UNICEF and WHO as well as local production," says UNICEF’s immunisation specialist in Dhaka, Dr Ataur Rahman. "Our government felt it was in the best interest of Bangladeshis, especially women and children, to have a secure injection safety policy in place," said Dr. A.B.M. Jahangir Alam of the Ministry of Health and Family Welfare. Beyond immunisation The study also found that developing countries’ growing emphasis on injection safety is spreading beyond basic immunisation to other medical services and programmes, such as curative care, HIV/AIDS programmes and family planning. Over 90 percent of the countries consulted for the study stated that GAVI’s INS was instrumental in their decision to widen injection safety practices. According to the report, the use of disposable technology has also contributed to a heightened awareness of the need for better healthcare waste management. In several cases, countries used GAVI’s cash support for injection safety to fund the construction and maintenance of incinerators. __________________________________________________________________________ _____________________________________*____________________________________ 2. Abstract: A study on the insoluble microparticulate contamination at ampoule opening __________________________________________________________________________ Yakugaku Zasshi. 2009 Sep;129(9):1041-7. A study on the insoluble microparticulate contamination at ampoule opening. Kawasaki Y. Department of Pharmacy, Okayama University Hospital. The hazardous effects due to the insoluble microparticles generated in the injections have been pointed out. To our knowledge, however, there have been no reports about insoluble microparticulate contamination at ampoule opening. Therefore, we performed this study to evaluate the relationship between time and glass particulate sedimentation to examine the effect of swabbing the ampoule neck on particle generation to clarify the relationship between the inner-diameter size of an ampoule and the amount of glass particulate sedimentation to find out the effect of methods for ampule opening, and compare particle contamination in glass ampoule and that of plastic, after ampoule opening and assessed the contribution of material of ampoule to the particle generation. We observed that the glass particulate contamination of accumulation value at a size over 2 mum increased significantly after 60 seconds, the swabbing the neck of the ampoule prior to opening had a negative effect on prevention of glass particulate contamination, the glass particulate contamination was positively influenced by the inner-diameter size of the ampoule, but not by the thickness of the ampoule walls, the particulate contamination derived from glass significantly increased by general method as well as using ampoule open adaptor compared with our method, and the insoluble microparticulate contamination in plastic ampoule was significantly lower than that in glass ampoule. The present findings might provide an useful information to reduce glass particules after ampoule opening performed in clinical practice. __________________________________________________________________________ _____________________________________*____________________________________ 3. Abstract: Sharps injury and body fluid exposure among health care workers in an Australian tertiary hospital __________________________________________________________________________ Asia Pac J Public Health. 2008;20(2):139-47. Sharps injury and body fluid exposure among health care workers in an Australian tertiary hospital. Peng Bi, Tully PJ, Boss K, Hiller JE. Discipline of Public Health, The University of Adelaide, Adelaide, South Australia 5005, Australia. peng.bi@adelaide.edu.au To examine sharps injury and body fluid exposure among health care workers, a descriptive epidemiological study was conducted in a 1000-bed tertiary hospital between 2000 and 2003 using surveillance data of all reported sharps injuries and body fluid exposures. A total of 640 sharps injuries and body fluid exposures were reported from hospital and nonhospital staff, although no seroconversions to HIV, hepatitis B virus, or hepatitis C virus were observed during the study period. Nurses reported 47% of sharps injuries and 68% of body fluid exposures, medical staff reported 38% and 16%, and other nonmedical staff notified 5% and 4%, respectively, while nonhospital staff reported the rest. Hollow-bore needles accounted for 56% of sharps injuries, while 11% of the incidents were sustained during recapping and inappropriate disposal. Further research into Australian work practices, disposal systems, education strategies, and the use of safety sharps should be emphasized to implement strategies to reduce work-related injuries among health care workers. __________________________________________________________________________ _____________________________________*____________________________________ 4. Abstract: Healthcare waste management in Asia __________________________________________________________________________ Waste Manag. 2009 Aug 31. Healthcare waste management in Asia. Prem Ananth A, Prashanthini V, Visvanathan C. Environmental Engineering and Management Program, School of Environment, Resources and Development, Asian Institute of Technology, P.O. Box 4, Klong Luang, Pathumthani 12120, Thailand. The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management. __________________________________________________________________________ _____________________________________*____________________________________ 5. Abstract: Systematic review and meta-analysis of epidemiology, prophylaxis and therapy of infections with viral hepatitis B and C in Polish paediatric oncology centres __________________________________________________________________________ Med Wieku Rozwoj. 2008 Oct-Dec;12(4 Pt 2):1056-61. [Systematic review and meta-analysis of epidemiology, prophylaxis and therapy of infections with viral hepatitis B and C in Polish paediatric oncology centres] [Article in Polish] Styczynski J, Kruszewska N, Wysocki M. Katedra i Klinika Pediatrii, Hematologii i Onkologii, Collegium Medicum im. Ludwika Rydygiera w Bydgoszczy, Uniwersytet im. Mikolaja Kopernika, ul. Curie-Sklodowskiej 9, 85-094 Bydgoszcz, Poland. jstyczynski@cm.umk.pl OBJECTIVE: Summary of published data on epidemiology, prophylaxis and therapy of HBV and HCV infections in Polish paediatric oncology centres. METHODS: Metaanalysis of available data from 1985-2008. RESULTS: 1. Epidemiology of HBV/HCV infections in 2070 patients. HBV infections in 716/1735 (41.3%), HCV in 497/1557 (31.9%), dual HBV+HCV in 76/707 (10.7%) patients. 2. Documented vaccinations against HBV infections before introduction of neonate vaccination in 1995 were carried out in 1056 children. In 614/985 (62.3%) patients seroconversion was detected, but 62/792 (7.8%) patients became infected. 3. Therapy with interferon was introduced in 188 patients; 89 with HBV, 41 with HCV and 58 with HBV+HCV. Response to interferon therapy defined as inhibition or decrease of viral replication or elimination of viral markers was documented in 37/188 (19.6%) patients. Alanine transaminase normalization occurred in 127/168 (75.6%) patients. 4. Protective effect against HBV infection after neonates/infants vaccination in 1995 was analyzed in 392 patients. Protective effect was obtained in 339/392 (86.5%) children, while infection with HBV occurred in 28/392 (7.1%) patients. During this period HCV infection was detected in 1/159 patients. No dual infections were found. CONCLUSIONS: Introduction of active immunoprophylaxis against HBV infections in haematology/oncology wards in 1989-1992, has led to 10-fold (p<0.00001), decrease of risk of HBV infection, and obligatory vaccination of infants/neonates in l995 additionally decreased the risk by 4-fold (p<0.00001). After introducing all prophylaxis measures, the risk of HBV infection decreased 38-fold (p<0.00001). Vaccination of neonates/infants has decreased 8-fold (p<0.00001), the risk of lack of anti-HBV. The risk of HCV infection decreased 74-fold (p<0.00001) in the same period. No risk of dual HBV+HCV infections was found currently. __________________________________________________________________________ _____________________________________*____________________________________ 6. Abstract: Health care worker-to-patient transmission of hepatitis C virus in the health care setting: Many questions and few answers __________________________________________________________________________ J Clin Virol. 2009 Aug;45(4):272-5. Health care worker-to-patient transmission of hepatitis C virus in the health care setting: Many questions and few answers. Raggam RB, Rossmann AM, Salzer HJ, Stauber RE, Kessler HH. Molecular Diagnostics Laboratory, Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Universitaetsplatz 4, 8010 Graz, Austria. Hepatitis C virus (HCV) infection represents a substantial risk to both, health care workers and patients. It is of major importance to detect health care workers with HCV infection and to establish regulations how to deal with infected individuals working in specific health care settings. Currently, there are no consistent recommendations, regulations or guidelines concerning prevention of health care worker-to-patient transmission of HCV. Questions arising include: Should health care workers be screened or tested individually on HCV infection and what kind of assay(s) should be used? When and how often should health care workers be tested? How should health care workers with HCV infection be managed? Based on these questions, this article reviews the most relevant published literature. Furthermore, suggestions for establishing a future common regulatory framework are provided. __________________________________________________________________________ _____________________________________*____________________________________ 7. Abstract: Needle and syringe sharing among Iranian drug injectors __________________________________________________________________________ Harm Reduct J. 2009 Jul 30;6:21. Needle and syringe sharing among Iranian drug injectors. Rafiey H, Narenjiha H, Shirinbayan P, Noori R, Javadipour M, Roshanpajouh M, Samiei M, Assari S. Iranian Research Center for Substance Abuse and Dependence (IRCSAD), University of Social Welfare and Rehabilitation Science, Tehran, Iran. rafieyah@yahoo.com. ABSTRACT: OBJECTIVE: The role of needle and syringe sharing behavior of injection drug users (IDUs) in spreading of blood-borne infections - specially HIV/AIDS - is well known. However, very little is known in this regard from Iran. The aim of our study was to determine the prevalence and associates of needle and syringe sharing among Iranian IDUs. METHODS: In a secondary analysis of a sample of drug dependents who were sampled from medical centers, prisons and streets of the capitals of 29 provinces in the Iran in 2007, 2091 male IDUs entered. Socio-demographic data, drug use data and high risk behaviors entered to a logistic regression to determine independent predictors of lifetime needle and syringe sharing. RESULTS: 749(35.8%) reported lifetime experience of needle and syringe sharing. The likelihood of lifetime needle and syringe sharing was increased by female gender, being jobless, having illegal income, drug use by family members, pleasure/enjoyment as causes of first injection, first injection in roofless and roofed public places, usual injection at groin, usual injection at scrotum, lifetime experience of nonfatal overdose, and history of arrest in past year and was decreased by being alone at most injections. CONCLUSION: However this data has been extracted from cross- sectional design and we can not conclude causation, some of the introduced variables with association with needle and syringe sharing may be used in HIV prevention programs which target reducing syringe sharing among IDUs. __________________________________________________________________________ _____________________________________*____________________________________ 8. Abstract: Assessing a drop box programme: A spatial analysis of discarded needles __________________________________________________________________________ Int J Drug Policy. 2009 Sep 1. Assessing a drop box programme: A spatial analysis of discarded needles. de Montigny L, Moudon V, Leigh B, Young K. McGill University, The Surveillance Lab, McGill Clinical and Health Informatics, 1140 Pine Avenue West, Montreal, QC, Canada H3A 1A3. BACKGROUND: Distributing sterile injection equipment to injection drug users is one of few proven ways of lowering the transmission rate of blood borne viruses. Distribution of equipment has also been linked to increased needle discarding, which is a public health risk for both injectors and their host communities. Drop boxes (anonymous and public-access sharps containers) are a promising and increasingly popular means of reducing unsafe disposal, yet there is little empirical research to support or guide their implementation. METHODS: Using a dataset containing the locations of 7274 discarded needles and syringes collected monthly in the non-park open spaces of a 2.5km(2) neighbourhood of Montréal, Canada for a period of five years, we compared levels of discards before and after the installation of 12 drop boxes. We used quasi-Poisson regression to test the effects of drop boxes on monthly counts of collected discards for areas within a walking distance of 25, 50, 100 and 200m of a drop box. We adjusted for known time-dependent covariates linearly and unknown time- dependent covariates using a smoothing function. RESULTS: We found strong evidence of reduced discarding following the installation of drop boxes; drop boxes were associated with reductions of up to 98% (95% CI: 72-100%) and significant reductions for areas up to 200m from a drop box. Reductions were inversely proportional to walking distance from drop boxes. No measure of weather or use of needle exchange programmes (NEPs) had a consistent relationship with discard counts. CONCLUSION: Our research suggests that IDUs changed their needle-disposal behaviour in response to increased safe disposal options. In addition to being relatively low-threshold, economical and rapid, drop boxes appear to be a highly effective intervention to reduce discarded needles. __________________________________________________________________________ _____________________________________*____________________________________ 9. Abstract: Serosorting for hepatitis C status in the sharing of injection equipment among Seattle area injection drug users __________________________________________________________________________ Drug Alcohol Depend. 2009 Aug 29. Serosorting for hepatitis C status in the sharing of injection equipment among Seattle area injection drug users. Burt RD, Thiede H, Hagan H. Public Health - Seattle & King County, 400 Yesler Way, Seattle, WA 98104, United States. BACKGROUND: Hepatitis C virus (HCV) is a major health problem among injection drug users (IDU). One potential means of reducing risk of HCV transmission among IDU is serosorting, whereby IDU preferentially share injection equipment with persons of like HCV status. METHODS: We surveyed Seattle area IDU recruited by respondent-driven sampling as part of the National HIV/AIDS Behavioral Surveillance system in 2005. RESULTS: Of 337 participants, 91% reported ever having been tested for HCV. Fifty-three percent of participants who shared any injection equipment in the last 12 months reported knowing the HCV status of the last person with whom they shared injection equipment. Thirty-seven percent of self-reported HCV- positive participants reported that their last injection equipment sharing partner was also HCV-positive and 7% reported a HCV-negative partner. Among self-reported HCV-negative participants, 11% reported a HCV-positive partner and 23% a negative partner. The disproportionate tendency to share injection equipment with a partner of like HCV status persisted after control for characteristics associated with HCV positivity in stratified and logistic regression analyses. Among participants sharing injection equipment, 39% reported that they had intentionally shared injection equipment with a partner based on knowledge of their concordant HCV status. CONCLUSIONS: We conclude that a measurable degree of serosorting by HCV status is occurring among Seattle area IDU. Promotion of serosorting among HCV-positive IDU may be a useful harm reduction strategy for IDU who continue to practice sharing injection equipment. If judged efficacious, serosorting would provide a further rationale to encourage and support HCV testing among IDU. __________________________________________________________________________ _____________________________________*____________________________________ 10. Abstract: Inhaled therapeutics for prevention and treatment of pneumonia __________________________________________________________________________ Expert Opin Drug Saf. 2009 Jul;8(4):435-49. Inhaled therapeutics for prevention and treatment of pneumonia. Safdar A, Shelburne SA, Evans SE, Dickey BF. The University of Texas, Department of Infectious Diseases, M. D. Anderson Cancer Center, Infection Control and Employee Health, 402, 1515 Holcombe Boulevard, Texas 77030, Houston, USA. asafdar@mdanderson.org The lungs are the most common site of serious infection owing to their large surface area exposed to the external environment and minimum barrier defense. However, this architecture makes the lungs readily available for topical therapy. Therapeutic aerosols include those directed towards improving mucociliary clearance of pathogens, stimulation of innate resistance to microbial infection, cytokine stimulation of immune function and delivery of antibiotics. In our opinion inhaled antimicrobials are underused, especially in patients with difficult-to-treat lung infections. The use of inhaled antimicrobial therapy has become an important part of the treatment of airway infection with Pseudomonas aeruginosa in cystic fibrosis and the prevention of invasive fungal infection in patients undergoing heart and lung transplantation. Cytokine inhaled therapy has also been explored in the treatment of neoplastic and infectious disease. The choice of pulmonary drug delivery systems remains critical as air-jet and ultrasonic nebulizer may deliver sub-optimum drug concentration if not used properly. In future development of this field, we recommend an emphasis on the study of the use of aerosolized hypertonic saline solution to reduce pathogen burden in the airways of subjects infected with microbes of low virulence, stimulation of innate resistance to prevent pneumonia in immunocompromised subjects using cytokines or synthetic pathogen-associated molecular pattern analogues and more opportunities for the use of inhaled antimicrobials. These therapeutics are still in their infancy but show great promise. __________________________________________________________________________ _____________________________________*____________________________________ 11. Abstract: The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations __________________________________________________________________________ Infect Control Hosp Epidemiol. 2009 Jul;30(7):611-22. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Pittet D, Allegranzi B, Boyce J; World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. Collaborators (16) Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. didier.pittet@hcuge.ch The World Health Organization's Guidelines on Hand Hygiene in Health Care have been issued by WHO Patient Safety on 5 May 2009 on the occasion of the launch of the Save Lives: Clean Your Hands initiative. The Guidelines represent the contribution of more than 100 international experts and provide a comprehensive overview of essential aspects of hand hygiene in health care, evidence- and consensus-based recommendations, and lessons learned from testing their Advanced Draft and related implementation tools. __________________________________________________________________________ _____________________________________*____________________________________ 12. Abstract: Hepatitis B control by 2012 in the WHO Western Pacific Region: rationale and implications __________________________________________________________________________ Bulletin of the World Health Organization (BLT) Volume 87, Number 9, September 2009, 645-732 Hepatitis B control by 2012 in the WHO Western Pacific Region: rationale and implications Manju Rani, Baoping Yang & Richard Nesbit In 2005, the WHO Western Pacific Region adopted the hepatitis B control goal of reducing the hepatitis B surface antigen seroprevalence in children at least 5 years of age to less than 2% by 2012. Universal infant immunization with three doses of hepatitis B vaccine, including a timely birth dose, is the key recommended strategy. Measuring seroprevalence in children at least 5 years of age takes into account the period when the risk of acquiring a chronic infection is highest and provides an indicator that can be monitored in the short term, within 5 years of vaccine introduction, and which correlates strongly with the long-term consequences of hepatitis B. A time-bound supranational hepatitis B control goal was chosen to create a sense of political urgency for strengthening routine immunization services and improving access to delivery care as well as providing resources for hepatitis B vaccination. Consequently, the programme strategies selected are not stand-alone but also contribute to strengthening health systems. Independent certification of achievement of the control goal, hitherto used mainly for eradication goals, is planned for all countries. Early assessment showed that adopting the regional goal led to greater political commitment, with reduced inequalities in hepatitis B vaccination between and within countries. Previous declining trends in routine immunization coverage also show signs of reversal and there is major progress in providing timely birth doses. A similar approach may be relevant to countries in Africa and South Asia, that have a high hepatitis B disease burden faltering routine immunization and poor access to skilled delivery care. __________________________________________________________________________ _____________________________________*____________________________________ 13. Abstract: Where did all the aid go? An in-depth analysis of increased health aid flows over the past 10 years __________________________________________________________________________ Publication: Bulletin of the World Health Organization; Type: Research Bull World Health Organ 2009;87:XXX-XXX. http://www.who.int/bulletin/volumes/87/08-058677.pdf Where did all the aid go? An in-depth analysis of increased health aid flows over the past 10 years Paolo Pivaa and Rebecca Doddb a Health System Governance and Service Delivery, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland. b World Health Organization, Hanoi, Viet Nam. Correspondence to Paolo Piva (e-mail: pivap@who.int). Objectives To examine how health aid is spent and channelled, including the distribution of resources across countries and between subsectors. Our aim was to complement the many qualitative critiques of health aid with a quantitative review and to provide insights on the level of development assistance available to recipient countries to address their health and health development needs. Methods We carried out a quantitative analysis of data from the Aggregate Aid Statistics and Creditor Reporting System databases of the Organisation for Economic Co-operation and Development, which are the most reliable sources of data on official development assistance (ODA) for health from all traditional bilateral and multilateral sources and from partnerships such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Findings The analysis shows that while health ODA is rising and capturing a larger share of total ODA, there are significant imbalances in the allocation of health aid which run counter to internationally recognized principles of "effective aid". Countries with comparable levels of poverty and health need receive remarkably different levels of aid. Funding for Millennium Development Goal 6 (combat HIV/AIDS, malaria and other diseases) accounts for much of the recent increase in health ODA, while many other health priorities remain insufficiently funded. Aid is highly fragmented at country level, which entails high transaction costs, divergence from national policies and lack of coherence between development partners. Conclusion Although political momentum towards aid effectiveness is increasing at global level, some very real aid management challenges remain at country level. Continued monitoring is therefore necessary, and we recommend that a review of the type presented here be repeated every three years. __________________________________________________________________________ _____________________________________*____________________________________ 14. Abstract: Epicutaneous allergen administration as a novel method of allergen-specific immunotherapy __________________________________________________________________________ J Allergy Clin Immunol. 2009 Sep 4. Epicutaneous allergen administration as a novel method of allergen- specific immunotherapy. Senti G, Graf N, Haug S, Rüedi N, von Moos S, Sonderegger T, Johansen P, Kündig TM. Unit for Experimental Immunotherapy, University Hospital of Zurich, Zurich, Switzerland; Clinical Trials Center, University Hospital of Zurich, Zurich, Switzerland. BACKGROUND: Subcutaneous allergen-specific immunotherapy is an effective treatment of IgE-mediated allergies, but it requires repeated allergen injections with a risk of systemic allergic reactions. Transcutaneous immunotherapy may improve patient compliance and safety. OBJECTIVE: To assess the safety and efficacy of epicutaneous allergen immunotherapy. METHODS: This monocentric, placebo-controlled, double-blind trial was conducted from March 2006 to December 2007 at the University Hospital Zurich. Thirty-seven adult patients with positive skin prick and nasal provocation tests to grass pollen were randomized to receive patches containing either allergen (n = 21) or placebo (n = 16). Treatment took place before and during the pollen season 2006, and follow-up visits took place before (n = 26) and after the pollen season 2007 (n = 30). The primary outcome measures were nasal provocation tests. RESULTS: Allergen- treated patients showed significantly decreased scores in nasal provocation tests in the first (P < .001) and second year (P = .003) after treatment. In contrast, placebo-treated patients had decreased scores in the first treatment year, 2006 (P = .03), but the effect diminished in the second year (P = .53). Although improvement of nasal provocation test scores was not significantly better in the verum versus placebo group, the overall treatment success was rated significantly higher by the allergen- treated group than by the placebo group (2006, P = .02; 2007, P = .005). No severe adverse events were observed. Occurrence of eczema after allergen patch applications proved stimulation of specific T-cell responses, but was noted as an adverse effect of the treatment. CONCLUSION: Epicutaneous allergen immunotherapy is a promising strategy to treat allergies and merits further investigation. __________________________________________________________________________ _____________________________________*____________________________________ 15. Abstract: Foreign body granulomas after injection of Bio-alcamid for lip augmentation __________________________________________________________________________ Am J Otolaryngol. 2009 Sep-Oct;30(5):356-9. Foreign body granulomas after injection of Bio-alcamid for lip augmentation. Akrish S, Dayan D, Taicher S, Adam I, Nagler RM. Department Oral Pathology and Medicine, School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. Bio-alcamid is one of the newest agents on the market for soft tissue augmentation. Seven studies were documented in the medical literature that examined the safety of Bio-alcamid (Polymekon, Brindisy, Italy); all reported no cases of tissue migration, foreign body granulomas, allergenicity, or interference with the control of cell proliferation. On 2 separate occasions, a woman who had recently undergone lip augmentation presented at our hospital with submucosal nodules of the lip. Histologic examination revealed multiple foreign body-type granulomas composed of giant cells, epithelioid cells, and chronic inflammation of the lip. Efforts to produce a cosmetic material that fulfills all the criteria as an "ideal" agent has not yet been found because all injectable foreign agents have the potential to induce adverse reactions. Caution must be exercised in all cases and the risks explained to the patient before its use. __________________________________________________________________________ _____________________________________*____________________________________ 16. Abstract: Injectable collagenase clostridium histolyticum for Dupuytren's contracture __________________________________________________________________________ N Engl J Med. 2009 Sep 3;361(10):968-79. Injectable collagenase clostridium histolyticum for Dupuytren's contracture. Hurst LC, Badalamente MA, Hentz VR, Hotchkiss RN, Kaplan FT, Meals RA, Smith TM, Rodzvilla J; CORD I Study Group. Collaborators (17) Department of Orthopaedics, SUNY at Stony Brook, Health Science Center, Level 18, Rm. 020, Stony Brook, NY 11794-8181, USA. lhurst@notes.cc.sunysb.edu BACKGROUND: Dupuytren's disease limits hand function, diminishes the quality of life, and may ultimately disable the hand. Surgery followed by hand therapy is standard treatment, but it is associated with serious potential complications. Injection of collagenase clostridium histolyticum, an office-based, nonsurgical option, may reduce joint contractures caused by Dupuytren's disease. METHODS: We enrolled 308 patients with joint contractures of 20 degrees or more in this prospective, randomized, double-blind, placebo-controlled, multicenter trial. The primary metacarpophalangeal or proximal interphalangeal joints of these patients were randomly assigned to receive up to three injections of collagenase clostridium histolyticum (at a dose of 0.58 mg per injection) or placebo in the contracted collagen cord at 30-day intervals. One day after injection, the joints were manipulated. The primary end point was a reduction in contracture to 0 to 5 degrees of full extension 30 days after the last injection. Twenty-six secondary end points were evaluated, and data on adverse events were collected. RESULTS: Collagenase treatment significantly improved outcomes. More cords that were injected with collagenase than cords injected with placebo met the primary end point (64.0% vs. 6.8%, P < 0.001), as well as all secondary end points (P < or = 0.002). Overall, the range of motion in the joints was significantly improved after injection with collagenase as compared with placebo (from 43.9 to 80.7 degrees vs. from 45.3 to 49.5 degrees, P < 0.001). The most commonly reported adverse events were localized swelling, pain, bruising, pruritus, and transient regional lymph-node enlargement and tenderness. Three treatment-related serious adverse events were reported: two tendon ruptures and one case of complex regional pain syndrome. No significant changes in flexion or grip strength, no systemic allergic reactions, and no nerve injuries were observed. CONCLUSIONS: Collagenase clostridium histolyticum significantly reduced contractures and improved the range of motion in joints affected by advanced Dupuytren's disease. (ClinicalTrials.gov number, NCT00528606.) 2009 Massachusetts Medical Society __________________________________________________________________________ _____________________________________*____________________________________ 17. Abstract: Long-term effects of botulinum toxin treatment __________________________________________________________________________ Ann Dermatol Venereol. 2009 May;136 Suppl 4:S86-8. [Long-term effects of botulinum toxin treatment] [Article in French] Krystkowiak P. Service de neurologie, CNRS UMR 8160, CHU d'Amiens, 80054 Amiens cedex. krystkowiak.pierre@chu-amiens.fr Long-term BoNT treatment administration has been assessed in various treatment settings (especially in neurology), with the level and duration of BoNT efficacy response being maintained with no major safety problems. Most side effects are local one and are transient. The incidence of antibody development is low and does not induce significant concerns in clinical practice. __________________________________________________________________________ _____________________________________*____________________________________ 18. Abstract: Corticosteroid injections for trigger finger. __________________________________________________________________________ Am Fam Physician. 2009 Sep 1;80(5):454. Corticosteroid injections for trigger finger. Chambers RG Jr. Methodist Hospital of Sacramento, Department of Family Medicine, Sacramento, CA, USA. ronald.chambers@chw.edu BACKGROUND: Trigger finger is a disease of the tendons of the hand leading to triggering (locking) of affected fingers, dysfunction, and pain. Available treatments include local injection with corticosteroids, surgery, or splinting. OBJECTIVES: To summarize the evidence on the effectiveness and safety of corticosteroid injections for trigger finger in adults using the following endpoints: treatment success, frequency of triggering or locking, functional status of the affected fingers, and severity of pain of the fingers. SEARCH STRATEGY: The databases CENTRAL, DARE, Medline (1966 to November 2007), EMBASE (1956 to November 2007), CINAHL (1982 to November 2007), AMED (1985 to November 2007), and PEDro (a physiotherapy evidence database) were searched. SELECTION CRITERIA: The authors selected randomized and controlled clinical trials evaluating effectiveness and safety of corticosteroid injections for trigger finger in adults. DATA COLLECTION AND ANALYSIS: The databases were searched for titles of eligible studies. After screening abstracts of these studies, full text articles of studies that fulfilled the selection criteria were obtained. Data were extracted using a predefined electronic form. The methodologic quality of included trials was assessed by using items from the checklist developed by Jadad and the Delphi list. The authors planned to extract data regarding information on the primary outcome measures: treatment success, frequency of triggering or locking, functional impairment of fingers, and severity of the trigger finger; and the secondary outcome measures: proportion of patients with side effects, types of side effects, and patient satisfaction with injection. MAIN RESULTS: Two randomized controlled studies were found that involved 63 participants: 34 were allocated to corticosteroids and lidocaine (Xylocaine), and 29 were allocated to lidocaine alone. Corticosteroid injection with lidocaine was more effective than lidocaine alone on treatment success at four weeks (relative risk = 3.15; 95% confidence interval, 1.34 to 7.40). The number needed to treat to benefit was 3. No adverse events or side effects were reported. AUTHORS' CONCLUSIONS: The effectiveness of local corticosteroid injections was studied in only two small randomized controlled trials of poor methodologic quality. Both studies showed better short-term effects of corticosteroid injection combined with lidocaine compared with lidocaine alone on the treatment success outcome. In one study, the effects of corticosteroid injections lasted up to four months. No adverse effects were observed. The available evidence for the effectiveness of intratendon sheath corticosteroid injection for trigger finger can be graded as a silver level evidence for superiority of corticosteroid injections combined with lidocaine over injections with lidocaine alone. __________________________________________________________________________ _____________________________________*____________________________________ 19. No Abstract: Safe disposal of used sharp objects __________________________________________________________________________ Indian Pediatr. 2009 Jun;46(6):539. Safe disposal of used sharp objects. Virmani A. __________________________________________________________________________ _____________________________________*____________________________________ 20. No Abstract: Reuse of single-use critical medical devices __________________________________________________________________________ Gastroenterol Nurs. 2009 May-Jun;32(3):228-9. Reuse of single-use critical medical devices. Society of Gastroenterology Nurses and Associates, Inc. __________________________________________________________________________ _____________________________________*____________________________________ 21. No Abstract: US AIDS chief lays out priorities __________________________________________________________________________ Nature. 2009 Jul 9;460(7252):162. US AIDS chief lays out priorities. Check Hayden E. __________________________________________________________________________ _____________________________________*____________________________________ 22. No Abstract: US health secretary pledges renewed fight against HIV __________________________________________________________________________ BMJ. 2009 Aug 28;339:b3522. doi: 10.1136/bmj.b3522. US health secretary pledges renewed fight against HIV. Roehr B. __________________________________________________________________________ _____________________________________*____________________________________ 23. Position Vacant: Essential Drugs Logistician Vanuatu Crossposted from E-drug@healthnet.org with thanks. To subscribe or unsubscribe via the World Wide Web, visit http://list.healthnet.org/mailman/listinfo/e-drug __________________________________________________________________________ Position Vacant: Essential Drugs Logistician Vanuatu Date: Sun, 6 Sep 2009 The Pacific Technical Assistance Mechanism (PACTAM) is managed by Australian Volunteers International on behalf of the Australian Government through it's official aid agency, AusAID. PACTAM places skilled personnel to work with host organisations in the Pacific to assist them in meeting their human resources needs and to respond to emerging development priorities. Australian Volunteers International is an Australian-based non-government development organisation involved with the provision of technical assistance to developing countries. The Government of Vanuatu (in the western Pacific region) has requested assistance in recruiting and supporting the following position through PACTAM. CONTEXT AND PURPOSE OF ROLE Vanuatu Ministry of Health (MOH) and AusAID are seeking a Logistics Specialist to strengthen pharmaceutical and other health logistics. AusAID has previously provided an in-line Principal Pharmacist, based at the Central Medical Store (CMS). Responsibility for in line management has returned to the Ministry of Health, with CMS staff now at a level where they are able to take on routine management of the system. However, substantial opportunities exist to improve the supply chain, as well as reinforce performance and skills of the staff responsible. ASSIGNMENT OBJECTIVE/S: To improve the management of procurement and distribution of pharmaceuticals for the health sector in Vanuatu. To build staff capacity at the Central Medical Store to manage the supply chain effectively in the future. START DATE AND DURATION: The assignment will commence from approximately November 2009 for a duration of 18 months. Please note that assignment start dates may vary. ESSENTIAL EXPERIENCE Degree in logistics or relevant field or equivalent work experience. DESIRABLE: University degree in pharmacy or one of the health sciences, public health, public health administration or a clinical field. For the full position description go to: http://www.australianvolunteers.com/work/index.asp?menuid=170&artid=3576 Recruitment Services Australian Volunteers International PO Box 350 Fitzroy VIC 3065 Australian Fax: (61 3) 9419 0976 E-mail: recruit@australianvolunteers.com __________________________________________________________________________ _____________________________________*____________________________________ 24. CREATE: Waste Disposal Unit (WDU): A WHO-Compliant Total Healthcare Waste Management Solution __________________________________________________________________________ Waste Disposal Unit (WDU): A WHO-Compliant Total Healthcare Waste Management Solution Mismanagement of healthcare waste puts healthcare workers, patients and the community at risk from pathogens and from pollution due to burning in open pits or badly maintained incineration equipment. Primary health facilities require health care waste management systems to minimize the risk of contamination of patients, health workers and the general public from infectious waste. In this regard, Waste Disposal Unit (WDU) with Small Scale Incinerator (SSI), when used according to Best Practices, can be a cheap and comparatively less hazardous way of disposing of health care waste. This system was designed with funding and guidance from PATH and WHO. http://www.create.org.in/wdu_glance.htm Waste Disposal Unit (WDU) at a glance Health Care Waste Management WDU installer and operator training An efficient health care waste solution Healthcare waste is hazardous and disposal poses a serious health risk to local communities and their environment. A well-planned waste management system should be an integral part of any health facility. In developing countries, medical waste is typically disposed of by burial, open-pit burning, barrel burning, artisanal ovens, incineration, and chemical decomposition. The WDU is a small -scale incinerator appropriate in size for rural hospitals and primary health care facilities. Unlike most incinerators ,the WDU can tolerate up to100% plastic (safety boxes) which makes it ideal for not only routine curative waste from facilities, but also from overflow of waste from immunization campaigns. Of the small-scale autocombustion incinerators available on the market, the WDU has shown improved efficiency on a number of crucial levels: Reduced hazardous emissions including particulates Increased levels of destruction Operational safety Cost efficiency 100% plastic tolerance Durability A small-scale auto-combustion solution for sharp and non-sharp combustible medical waste Handles waste produced at smaller health facilities and rural clinics. Ideal for the management of waste, and in particular, safety boxes from immunization campaigns. Consumes 25+ five-litre safety boxes in 4 hours (approximately 25 kg of waste). The rate of burning is about 8-10 kg/hr if operated according to best practices. Adheres to WHO-recommended practices for rural Health Care Waste Management __________________________________________________________________________ _____________________________________*____________________________________ 25. New USAID award for HIV prevention research Crossposted from HIF-net" with thanks __________________________________________________________________________ From: "David Hock" Subject: [hif-net] New USAID award for HIV prevention research Five-Year Cooperative Agreement for Up to $175 Million to Support Research on New HIV-AIDS Prevention Technologies and Strategies Research Triangle Park, NC, September 3, 2009 - Family Health International (FHI) announced that the US Agency for International Development (USAID) has awarded the organization the Preventive Technologies Agreement (PTA), providing up to $175 million in funding over five years to continue FHI's evaluation of innovative HIV-AIDS prevention technologies and strategies. The award, which continues nearly 40 years of USAID support for prevention research leveraging FHI's scientific expertise, involves the completion of two clinical trials of antiretroviral drugs for prevention, and the development of new trials and other research and scientific support activities that advance USAID's global agenda for HIV prevention, including the integration of family planning and HIV services. For the full press release, see: http://www.fhi.org/en/AboutFHI/Media/Releases/res_Prevention_Technologies_ Agreement.htm David Hock Family Health International dhock@fhi.org [HIF-net profile: David Hock works for Family Health International where he is responsible for electronic dissemination of information on FHI's research and publications through mass e-mails, listserv postings and the corporate Web site. dhock@fhi.org] HIF-net: working together to improve access to reliable information for health researchers and health professionals in developing and transitional countries. Send list messages to hif-net@dgroups.org. To join or leave the list, send an email to hif-net@dgroups.org. If joining, please include name, organization, country, and brief description of professional interests. Archive at: http://www.dgroups.org/groups/HIF-net/ __________________________________________________________________________ _____________________________________*____________________________________ 26. Kuwait Lab Technology Conference & ExhibitionKuwait Lab Technology Conference & Exhibition Event Brochure: http://www.kuwaitlabex.com/Lab_Expo_2009.pdf __________________________________________________________________________ From: "Dr. Ute Pieper" To: "'SIGN Moderator'" Subject: announcme conference in kuwait - biosafety in labs Hi Allan, Enclosed an announcement of the Kuwait Lab Technology Conference & Exhibition will held on 4 - 5 November 2009 including a 2 days workshop on biosafety in laboratories- maybe this is something which can be issued in at SIGNPOST? Best regards, ute .......................................................................... __________________________________________________________________________ Under the patronage of H.E. Dr. Helal Al-Sayer Minister of Health, Kuwait Dear Colleague, Kuwait Lab Technology Conference & Exhibition will held on 4 - 5 November 2009 at the Radisson SAS Hotel. It is now only a few weeks away - don’t miss your opportunity to learn from an interactive case study led agenda, network with laboratory industry professionals and meet with our distinguished faculty of expert speakers. Register now to avoid disappointment. Conference Topics: · Modern Laboratory Management · Lab Safety Management · Laboratory Accreditation and Training · Instrumentation and Automation · Measurement, Testing and Quality Control · Laboratory Technology · Biotechnology and Life-Sciences · Oil, Gas and Petrochemical · Environmental Science · Materials Science · Food & Water Analysis · Medical and Pharmaceutical sciences · Nanotechnology Don't miss this landmark event! To ensure your place call +965 24342828 or email Hudhaib Al-Allatti at hudhaib@kuwaitlabex.com Keynote Speakers Dr. Ali Bumajdad, Kuwait University, Kuwait Dr. Ute Pieper, Health EnviroTech & Logistics, Germany Dr. Mohammad A. Aljafar, United Laboratories Co., Kuwait Dr. Markus Laeubli, Metrohm International, Switzerland Dr. Abubaker Hamed Ali Salem, Sebha University, Libya Mr. Andy Saleh, MedLabs Consultancy Group, Jordan Dr. M. A. Gondal, King Fahd University of Petroleum & Minerals, Saudi Arabia Dr. Nina Parkinson, Bapco, Bahrain Event Brochure: http://www.kuwaitlabex.com/Lab_Expo_2009.pdf __________________________________________________________________________ _____________________________________*____________________________________ 27. News - Australia: HIV, STIs on rise in Australia - China: China to send 'harmony makers' to Urumqi - India: Orissa Police arrests fake doctor for administering vaccine to children - Kuwait: Hepatitis B in Kuwait: Immunizations Making an Impact - China: Chinese doctors say some claims of needle-stabbings are mistaken - China: Thousands of harmony makers sent to Urumqi communities while authorities vow harsh punishment against syringe attackers - China: Chinese medical experts examine Urumqi syringe attacks victims - Researchers Analyze The Recipients Of A Decade Worth Of Health Aid - China: China TV: 476 People Stabbed With Hypodermic Needles - Vietnam: PEPFAR To Continue Funding Projects In Vietnam - UNICEF Could Lose Up To 10% Of Budget Over Next 2 Years - India: Police Arrest Six for Supplying Blood Tainted with Hepatitis B, C to Hospitals in Northern India Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html __________________________________________________________________________ Australia: HIV, STIs on rise in Australia ScienceAlert University of New South Wales (09.09.09) Aboriginal people, injecting drug users and men who have sex with other men are increasingly affected by conditions including HIV/AIDS, viral hepatitis and other sexually transmissible infections, according to new research released on Wednesday 9 September. Three linked 2009 Annual Surveillance Reports, to be presented at the Australasian HIV/AIDS Conference 2009 in Brisbane, are compiled by the National HIV Research Centres based at the University of New South Wales (UNSW). They track the effectiveness of Australia’s public health programs in these areas. The report "HIV/AIDS, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2009" indicates that the annual number of new HIV diagnoses has remained relatively steady at about 1,000 over the past three years. This level of HIV diagnoses was last recorded in Australia in 1994, indicating the need for strengthening safer sexual and injecting messages to minimise the risk of HIV infection. Despite the number of new infections, HIV prevalence in Australia remains one of the lowest in the world, at about 0.1 percent. The pattern of HIV transmission in the Aboriginal and Torres Strait Islander population differs from that in the non-Indigenous population. The report "Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander People: Surveillance and Evaluation Report 2009", also to be released today, indicates that HIV infection among Aboriginal and Torres Strait Islander people was attributed to injecting drug use in 22 per cent of cases over the past five years. "We are following the path of the Canadian Indigenous population, where HIV and huge numbers of hepatitis C diagnoses are reported following increased drug injecting patterns," said James Ward, head of the Aboriginal and Torres Strait Islander Health Program at the National Centre in HIV Epidemiology and Clinical Research (NCHECR). "We need to act urgently to bring down injecting drug use rates and high rates of bacterial STIs in Aboriginal communities before HIV becomes entrenched." The Annual Surveillance Report on HIV/AIDS provides the good news that rates of hepatitis C infections have declined by about half in the past decade, particularly in younger age groups. However despite this, hepatitis C prevalence remains high among injecting drug users across Australia and the burden of advanced liver disease continues to grow among infected people. Greater numbers of people are progressing into more advanced stages of fibrosis of the liver. Levels of HCV treatment uptake have plateaued over the last 2 years, despite this growing burden of disease. Diagnoses of chlamydia have continued their steady rise, particularly among young Australians aged 15 to 25. "This could be due to increases in testing but chlamydia continues to affect young people having unprotected sex," said Associate Professor David Wilson, head of the Surveillance and Evaluation Program for Public Health at the National Centre in HIV Epidemiology and Clinical Research. "We have also had an epidemic of infectious syphilis in men having sex with men over the past five years, which has started to stabilise but remains at high and concerning levels." During 2008 the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) Project was launched, funded through the Department of Health and Ageing Chlamydia Pilot Program, and the first findings from this project are released today. Over 80 clinical sites are involved in the ACCESS project. Importantly, this system will provide the first national chlamydia surveillance system among priority populations such as young heterosexuals, Aboriginal and Torres Strait Islander people, men who have sex with men, and sex workers. Rates of gonorrhoea, chlamydia and infectious syphilis are much higher in Aboriginal communities compared with the non-Indigenous population, particularly among the 15 to 19 year age group, partly reflecting poor access to appropriate primary health care services for many Aboriginal people in remote and regional communities. The third report released today, the "Annual Report of Trends in Behaviour 2009" by the National Centre in HIV Social Research, indicates that an increase in unprotected sex with casual partners may have contributed to an increase in diagnoses of HIV among Queensland men who have sex with men. "Unprotected sex remains risky for acquiring HIV infection and other sexually transmissible diseases," said the director of the National Centre in HIV Social Research, Professor John de Wit. "Using condoms consistently with sexual partners is still the best strategy for minimizing risk." Unprotected sex with casual partners remains stable high among gay men in other jurisdictions, as does unprotected sex with regular partners, underscoring the importance of continued behavioural surveillance and prevention. The report of trends in behaviour also shows that the sharing of injection equipment remains high among some people who inject drugs, which suggests that access to sterile needles and syringes remains less than ideal. Particularly concerning is that more than 40 per cent of young people who attended music festivals in Sydney, Melbourne and the Gold Coast had been offered drugs to inject or had a partner or friend who injected drugs. .......................................................................... __________________________________________________________________________ China: China to send 'harmony makers' to Urumqi CNN (08.09.09) (CNN) -- China is sending 7,000 officials to the western city of Urumqi after last week's deadly protests over a strange series of syringe stabbings, state-run media reported. Chinese troops march in Urumqi, the capital of the Xinjiang Uyghur autonomous region, on September 5. The officials, known as "harmony makers," are meant to ease tensions after demonstrators, demanding better police protection, clashed with police for two days. The unrest left five people dead and 14 injured. "The officials will go door to door to explain policies and solve disputes," said Wang Lequan, secretary of Xinjiang Uyghur Autonomous Regional Committee of the Communist Party of China, according to the Xinhua news agency. Minority Uyghurs are accused of stabbing majority Han Chinese with syringes. The syringe attacks started August 17, a month after long-simmering resentment between the Uyghurs and the Han Chinese erupted into riots and killed more than 200 people. By Thursday, hospitals in the area had dealt with 531 suspected victims of syringe stabbings, 106 of whom showed obvious signs of needle attacks, state media said. Don't Miss Chinese doctors say some claims of needle-stabbings are mistaken Five killed as police face syringe protesters in Chinese city Police received an additional 77 reports of attacks between Sunday and Monday evenings. But the report by Xinhua did not specify whether they were new attacks or ones that had just been brought to the attention of officials. Authorities said they had detained 45 suspects in connection with the attacks, 12 of whom were taken into custody. The punishment for the attacks will be harsh: life imprisonment in some cases; the death penalty in others, government officials said. The Han Chinese are the country's dominant ethnic group. The Uyghurs are a Turkic-speaking Muslim minority who consider Xinjiang their homeland. .......................................................................... __________________________________________________________________________ India: Orissa Police arrests fake doctor for administering vaccine to children Orissadiary.com - Bhubaneswar,Orissa,India (07.09.09) Report by Ratnakar Barik , Salepur : The Nemalo police on arrested a fake Doctor on the charge of administering vaccine to several children in the villages of Luna-Chitroptala and Mahanadi-Chitroptala Islands at Hepatitis-B immunisation camp organised by the Mahala-based Pabitra organisation at Kalamishri village with the help of some Asha workers and ANMs. Police seized two Hetatitis-B vaccine bottles, one spirit bottle and more than 50 syringes from the camp. The fake doctor, identified as Bhaskar Jena (34), son of Kanda Jena of Gopei village under Karilopatna Gram Panchayat of Kendrapada district, was produced before the local court at Salepur where his bail petition was rejected and he was remanded to jail custody. The arrested person on Thursday administered Hepatitis -B vaccine to more than 20 children of Lendura Bhagabanpur, by charging Rs 60 for providing vaccine to a child. On Friday, Bhaskar Jena came to Kalamishri village for administering Hepatitis -B vaccine by opening a camp in the village. This came to the notice of a Doctor in Santapur Health Centre Dr Kishore Das who with the help of the villagers, detained the fake Doctor and informed the police. A police team led by the IIC Nemalo reached the spot and arrested the youth along with seizing the vaccine, spirit bottle and injection syringes from the camp. While a number of NGOs are organizing Hepatitis-B immunization camps, it is alleged administer substandard vaccine drops by charging an unreasonably high price. It is a clear nexus between the drug manufacturers and some NGOs to make a fast buck in adopting a fear- inducing tactics, alleged locals. These dubious organizations charge Rs 50 for a child and Rs 100 for an adult, whereas the actual cost should not exceed Rs eight. Contacted, a senior district health official said that it is illegal on the part of NGOs to organize such health camps without obtaining permission from the health officials. .......................................................................... __________________________________________________________________________ Kuwait: Hepatitis B in Kuwait: Immunizations Making an Impact Gov Monitor - Delray Beach,Florida,USA (07.09.09) Source: U.S. Department of Housing and Urban Development The Public Health Matters blog welcomes requests from its readers. Recently, a reader asked us to address the issue of Hepatitis B in Kuwait. Dr. Frank Mahoney, a CDC medical epidemiologist who has worked extensively in the Middle East, wrote this response: The global burden of disease due to cirrhosis (hardening) of the liver and hepatocellular carcinoma (HCC-liver cancer) is high (~ 2% of all deaths) and expected to increase over the next 20 years. Liver cancer is already the 4th leading cause of cancer deaths worldwide. Studies of patients with cirrhosis and HCC in the Eastern Mediterranean Region indicate more than 75% is caused by hepatitis B virus (Hep B) or hepatitis C virus (Hep C) infection. The World Health Organization (WHO) estimates approximately 4.3 million persons are infected each year with Hep B and 800,000 persons with HCV in the Eastern Mediterranean Region. Numerous studies suggest that most Hep B and Hep C infections in the Eastern Mediterranean Region are acquired due to unsafe injections and medical procedures. The cost to treat patients with chronic Hep B or Hep C infection far outweighs the cost of implementing prevention programs (like immunizations and infection control). A wide-ranging strategy is urgently needed to prevent spread of these blood-borne pathogens throughout the Eastern Mediterranean Region and other parts of the world. Kuwait is a small country within the Eastern Mediterranean Region, located between Iraq and Saudi Arabia and bordered on one side by the Persian Gulf. In 1990, Kuwait was one of the first countries in the Eastern Mediterranean Region to introduce Hep B vaccine in their national immunization program. Before vaccine introduction, ~ 25% of adults had evidence of Hep B infection, including 2.5% with chronic (lifelong) infection. Hep B vaccination began with infant immunizations and included the delivery of a dose at birth to prevent Hep B transmission from mother to child. Kuwait reports high numbers of children receiving the Hep B vaccine. While no formal studies have been conducted to document the impact of introducing Hep B vaccine in Kuwait, it is likely that the program has significantly protected children born since 1990, resulting in a reduced prevalence of chronic Hep B infection and associated morbidity and mortality (chronic liver disease and HCC). Kuwait also offers Hep B vaccination to health care workers with occupational exposure to blood. WHO estimates about 1.8% of the Kuwait population have evidence of Hep C infection. The epidemiology of Hep C infection in Kuwait is not well- studied. .......................................................................... __________________________________________________________________________ China: Chinese doctors say some claims of needle-stabbings are mistaken Wen-Chun Fan, CNN (06.09.09) URUMQI, China (CNN) -- Reports of alleged syringe stabbings in a restive western Chinese city are generating a bit of panic, but doctors say some people have incorrectly concluded they were attacked with needles. "In the patients we have seen in the last couple of days, there are many which we believe were not actually punctured with needles," Wang Hanbin, a Peoples' Liberation Army doctor examining people in Urumqi, told reporters on Saturday at a briefing. Wang said about 20 cases are being investigated closely and samples were being taken to laboratories in Beijing for more testing. But, he said, "many of the patients we have seen were mainly influenced by psychological factors." Wang, a member of a six-person military medical panel reviewing the syringe-stabbing claims, attributes the false reports to widespread fear and lack of medical knowledge. "Many of the patients did not actually see their attacker or the act of others attacking them with needles. Some patients who had needle puncture wounds experienced some discomfort in the area of the wound, and showed some symptoms, but couldn't give an accurate account of what they perceived to have been a needle attack." This is the latest crisis plaguing Xinjiang province and its capital city of Urumqi, where tensions have boiled over between Uyghurs and Han Chinese. The Han Chinese are the country's dominant ethnic group, and the Uyghurs are a Turkic-speaking Muslim minority who consider Xinjiang their homeland. Ethnic Uyghurs have been blamed for the alleged syringe stabbings, and demonstrators clashed with police in Urumqi for two days this week over the issue. Protesters were demanding better police protection and a crackdown on the Uyghurs. The latest unrest left five people dead and 14 injured, according to Urumqi's deputy mayor, and the Communist party chief in the city has been dismissed from his job amid the crisis, according to state-run media reported. Watch report on unrest in Urumqi from CNN's John Vause » The Urumqi Public Prosecutors Office on Saturday said four ethnic Uyghurs were arrested in connection with three syringe-wielding incidents. At the press conference held by military medical personnel, the doctors said puncture wounds could not be found "in a large percentage of the patients." "Some could have been bitten by insects such as mosquitoes, and in other cases there were moles, or skin pigmentation, and we couldn't find a needle puncture wound," said Wang, speaking at the news conference. "Maybe they heard something from someone, then they discovered that they had a growth on their body. So, then they suspect that they may have been attacked with a needle and came to seek treatment. Some patients who came to seek treatment had some red marks or rash on their skin, but we didn't find any needle puncture wounds." Wang urged people not to panic and urged them to immediately seek medical treatment if they think they were stabbed. He also said people need to educate themselves about medical care. Rumors have abounded in Urumqi of recent syringe stabbers trying to spread AIDS and other diseases. But another doctor, Duan Qing, explained at the briefing that would be impossible for there to be any such cases of AIDS, Hepatitis B, Hepatitis C, or syphilis because there is a lengthy incubation period. "Even if there are cases of such illnesses, they are unrelated to incidents. This is basic medical knowledge," she said. The three incidents that led to the arrests occurred in late August. A man admitted stabbing a female shopper with a pin on August 28. Authorities said a man and woman on August 29 stole money from a taxi driver after threatening him with a syringe. And in the third incident, a man resisting arrest stabbed a police officer with a syringe on August 31 .......................................................................... __________________________________________________________________________ China: Thousands of harmony makers sent to Urumqi communities while authorities vow harsh punishment against syringe attackers Xinhua, www.chinaview.cn (06.09.09) URUMQI, Sept. 6 (Xinhua) -- Authorities in China's far western Xinjiang said Sunday they will send more than 7,000 officials to 110 communities in the regional capital of Urumqi to help ease panic and tension after syringe attacks led to mass protests. They also vowed to give syringe attackers harsh punishment according to the law, ranging from three years in prison to life sentence or even death penalty. "The officials will go door to door to explain policies and solve disputes," said Wang Lequan, secretary of Xinjiang Uygur Autonomous Regional Committee of the Communist Party of China (CPC) late Sunday. The regional government had earlier sent 1,500 such officials and police officers to communities densely populated by Uygurs in wake of a deadly riot on July 5. "These officials have done a great deal of face-to-face educational work in communities and maintain social orders," he said. The move is an important "treasure" to smash the separatist sabotage of the "three forces" of extremism, separatism and terrorism both at home and abroad, the regional party chief said. Wang made the remarks at a meeting for mobilizing civil servants to go to the grassroot neighborhoods to help solve public disputes and maintain social stability. He reviewed the unrest in Urumqi since the riot on July 5, which left nearly 200 people dead, mostly ethnic Han people. He said four suspects stabbed a Han woman with syringe needles in Xiaoximen Shopping Area in Urumqi on Sept. 3, sparking mass protests that demanded security guarantees. The protests left four dead and 14 others hospitalized. "The incident has seriously affect the normal public life, and caused social disturbance," he said. The situation in Urumqi is on the whole stable, but it is also fragile as demands of some residents have not been met and the sporadic occurrence of needle attacks continue to ignite sentiments, Wang said. The control and mandatory measures, which bring inconvenience and ignite people's sentiment, could spark mass gatherings anytime, he said. By Friday, local health and police authorities had confirmed 531 victims of hypodermic syringe stabbings, 171 of whom showed obvious signs of needle attacks. The majority of the victims are of the Han ethnic group and the minority are from the ethnic groups including Uygur, Hui and Kazak, Wang said. Medical experts have ruled out the possibility that radioactive substances, anthrax and toxic chemicals were used in recent needle attacks. He also called on local residents not to believe and spread rumors and to express their demands through legal channels. The social order had returned to normal after the July 5 riot, but the enemies at home and abroad were not reconciled to failure and so they conducted the needle attacks to spark public panic and anger, Wang said. The mass protests have affected normal life and production in Urumqi and put to test the unity, stability and harmony that people of all ethnic groups have been seeking and longing for for years, the official said. RETURNING TO NORMALCY Security presence remained heavy in Urumqi on Sunday while signs of normalcy returned to the city. Hundreds of armed police were seen in the People's Square at the city center. Police were still blocking Xinmin Road, which links to a viaduct leading to the southern part of the city, an area densely populated by Uygurs. A fleet of six flower-decorated wedding cars passed a downtown street as police eased traffic restrictions imposed in the wake ofpublic protests. Ba Bayisilong, a Uygur student in Xinjiang Education Institute, came back to school on Sunday, after a two-month summer vacation. "I'm back from my home in southern Xinjiang. All my classmates have returned," said the computer science major. China Mobile, the nation's largest telecom carrier, opened a sales booth on the school campus. A large crowd of students, including both Han and Uygur students, patronized the stall to buy phone cards. Vehicles were back on the streets and residents were out for shopping. Tianshan Shopping Mall and Carrefour Supermarket at downtown streets were thronged, while public security staff asked customers to open their bags for security checking. Newly-inaugurated Communist Party chief of Urumqi Zhu Hailun said Saturday his top priority is to restore public security. Zhu's predecessor Li Zhi was removed from post, along with Xinjiang's police chief Liu Yaohua, on Saturday. HARSH PUNISHMENT Syringe attackers will be given harsh punishment in accordance with the law, said a notice jointly released by the city's court, prosecutor's office and police department late Sunday. Those who stabbed others with syringe needles containing poisonous or harmful substances or contaminated with drugs may be sentenced to three years and more in prison, or life imprisonment and even death penalty, if convicted, said the notice. Such acts constitute the crime of deploying dangerous substances to harm others as described in China's penal code, which is punishable by death if the consequence is grave, the document said. Those who spread fake information about stabbing cases, which disturbed the social order, will also be detained or jailed. Citizens are allowed to seize and turn over the people stabbing or having stabbed others to police stations. The punishment of those who surrender themselves or squeal on others may be lightened or exempted. .......................................................................... __________________________________________________________________________ China: Chinese medical experts examine Urumqi syringe attacks victims www.chinaview.cn (05.09.09) URUMQI, Sept. 5 (Xinhua) -- Chinese military medical experts on Saturday said that it was too early to say victims in recent syringe attacks in Urumqi City had contracted diseases related to radioactive substance, anthrax and toxic chemical as rumors had it. Normally, the latent period of these diseases range from months to half a year, said Qian Jun, director of Disease Control and Biological Security Office with China's Academy of Military Medical Sciences, at a press conference here. "They should be closely observed." Qian said he, along with other five medical experts with the General Logistics Department of Chinese People's Liberation Army, had examined 217 medical records of victims since Friday. "So far, no evidence showed that they had contracted diseases related to radioactive substance, anthrax, toxic chemical, microorganism, hepatitis A, hepatitis B or AIDS," he said. Syringe attacks carried out since Aug. 20 have resulted in panic and resentment from the public By Thursday, local hospitals had dealt with 531 victims of hypodermic syringe stabbings, 106 of whom showed obvious signs of needle attacks. "To spread such diseases, there must be a large amount of blood of the infected persons in the syringe," said Li Jingyun, an expert on AIDS. "But such things are very difficult to get." Experts said that some of those who said they had been stabbed actually suffered from mosquitoes' stings or other psychogenic reasons. They also urged Urumqi citizens not to panic. Qian said further identification was underway and they were giving psychological counseling to some victims. Investigation had showed those involved in the syringe attacks were from the Uygur ethnic group while those attacked included people from Han and other ethnic groups. Xinjiang police has captured 25 syringe attackers, of whom seven are in police custody, four were arrested and four others were referred for criminal prosecution, the Xinjiang regional government sources said Friday. .......................................................................... __________________________________________________________________________ Researchers Analyze The Recipients Of A Decade Worth Of Health Aid A review of 10 years of health aid appearing in the WHO Bulletin (.pdf) revealed "significant imbalances in the allocation of health aid which run counter to internationally recognized principles of 'effective aid,'" and "[c]ountries with comparable levels of poverty and health need receive remarkably different levels of aid." Additionally, the authors write, "our findings suggest that control over spending decisions at the country level is limited, as global and regional priorities dominate aid allocation" (Piva/Dodd, 8/25). .......................................................................... __________________________________________________________________________ China: China TV: 476 People Stabbed With Hypodermic Needles Associated Press (03.09).09) Sept. 3: Chinese protesters push against a line of paramilitary police on the streets of Urumqi in western China's Xinjiang province. BEIJING - Hundreds of Chinese protested deteriorating public safety Thursday after a series of mysterious syringe attacks further unnerved residents in the western Chinese city of Urumqi where ethnic rioting in July killed nearly 200 people. People living near the city center reached by telephone said hundreds, possibly thousands, of members of China's Han majority marched peacefully in the city center. They waved Chinese flags, confronted local Communist Party leaders demanding they step down, and shouted "severely punish the hooligans" - a reference to the July 5 rioters. The demonstration underscored public jitters and lingering grievances despite the city's still-high police presence. It also posed a challenge for the Beijing leadership and a propaganda drive portraying Urumqi and all of China as harmonious ahead of the 60th anniversary of communist rule Oct. 1. July's riot - in which ethnic Muslims first set upon Hans who then retaliated with vigilante attacks - was the worst communal violence in a decade in Xinjiang, an often tense Central Asian frontier region with valuable oil and gas deposits. Thursday's protest came after days of rumors that gangs roamed the city stabbing mostly Han people with hypodermic needles, scaring residents. City officials and state media confirmed the attacks, saying 21 had been detained. A report read on Xinjiang TV's newscast Thursday said 476 people sought treatment for stabbing, though only 89 had obvious signs of being pricked. While no motivations for the attacks were given, the report gave a breakdown of the victims showing almost all, 433, were Han Chinese with the rest drawn from eight other ethnic groups. The tally suggested the attacks were ethnically motivated and indicated the breadth of unease in the city. Concerns about the stabbings may be high because Xinjiang has the highest rate of AIDS virus infections in China, with about 25,000 cases of HIV reported last year. The problem is fueled by needle-sharing among drug users. As Thursday's protests gathered steam, demonstrators headed for the site of the Urumqi Trade Fair, where staff was evacuated. Protesters pushed and shoved police and a few in the crowd were beaten, said resident Zhao Jianzhuang. A Han, Zhao said he joined the demonstrators at a downtown intersection where they were blocked by riot police from marching on People's Square 1 mile (1.6 kilometers away). The mostly Han demonstrators seemingly took care not to rile ethnic grievances, calling out "maintain ethnic unity" and venting their anger on local officials. They called for the ouster of Xinjiang party secretary Wang Lequan, an ally of President Hu Jintao. Trying to head off trouble, Wang and the Urumqi party secretary Li Zhi separately talked to the demonstrators, who called for better police protection and demanded they step down, an editor at a local newspaper said, requesting his name not be used because he works for the government. "Am I that silly? Do I not know that I should protect my brothers and sisters?" Li told them, according to footage the editor said was aired on Urumqi's TV station. The official Xinhua News Agency confirmed the protest, saying people assembled at several places, including more than 1,000 in the central residential area of Xiaoximen, to demand a "security guarantee" from authorities after the syringe attacks. Protests have become a spiraling concern for Chinese leaders, with tens of thousands annually and growing larger and more violent in recent years. Fueled by local grievances over corruption, widening income gaps and mismanagement, they challenge the legitimacy of a government that has promised to deliver social fairness. Beijing has so far sought only piecemeal, rather than systematic remedies, calling on officials to be honest public servants, ease social tensions and not use force. "If you try to deal with demonstrators, that is one thing, that's a security concern. But on the other hand, you really have to find social measures to make sure there is not further anger among residents," said Bo Zhiyue, a China politics expert at National University of Singapore's East Asian Institute. Troubles in Xinjiang are magnified by ethnic resentments. The Uighurs, an ethnic Muslim group that sees the region as its homeland, complain about being displaced by the Han, who have poured into the area in recent years. The Han resent government affirmative action policies for official jobs and university spots given to Uighurs. At the first word of trouble Thursday, tensions spiked in the traditional Uighur neighborhood near Urumqi's Grand Bazaar. "Earlier, a lot of people ran over saying 'something's happened, something's happened,' so I quickly closed my shop and rushed home," said a Uighur woman. She did not want to give her name for fear of government reprisals. Thursday is the 15th day of the seventh lunar month - an important day when Han Chinese honor the dead by inviting them back for meals. The date may have been cause for agitation as most of the victims in the July violence were Han Chinese. Zhao, the Chinese demonstrator, said anger was stoked by a perceived delay in trials for those arrested over the July riot as well as by the syringe stabbings. "This is communal violence and people are frustrated because over 200 people were killed and almost 1,700 were injured. And of course you have friends, relatives and children who were attacked. So the people are not happy," said Bo, the politics expert. .......................................................................... __________________________________________________________________________ Vietnam: PEPFAR To Continue Funding Projects In Vietnam KFF.ORG (02.09.09) PEPFAR will continue to fund HIV/AIDS programs in Vietnam, Hoang Thanh Hai, a spokesperson, said on Tuesday at a memorial for 100 people who died as a result of complications from the disease, Bernama reports. "Since 2004, PEPFAR has provided $320 million to help Vietnam provide comprehensive services on taking precautionary measures against the disease and care and treatment of HIV" patients, the news service writes (9/2). The Kaiser Daily Global Health Policy Report © 2009 Henry J. Kaiser Family Foundation. .......................................................................... __________________________________________________________________________ UNICEF Could Lose Up To 10% Of Budget Over Next 2 Years KFF.ORG (02.09.09) UNICEF, which is funded through voluntary contributions mostly from governments, could lose up to 10 percent of its budget in 2010 and 2011 because of the global recession, Ann Veneman, head of the agency, said in an interview, Reuters reports. "We haven't seen the increases year to year that we have been seeing in some previous years but we actually haven't seen a decline," Veneman said, adding that the agency is "not anticipating increases in our budget," but that it is expecting "slight declines, maybe up to 10 percent." (Dmitracova, 9/1). The Kaiser Daily Global Health Policy Report © 2009 Henry J. Kaiser Family Foundation. .......................................................................... __________________________________________________________________________ India: Police Arrest Six for Supplying Blood Tainted with Hepatitis B, C to Hospitals in Northern India Biswajeet Banerjee, Canadian Press (01.09.09) A doctor and five other people are facing charges of spreading infectious diseases after they supplied blood contaminated with hepatitis B and C to blood banks in northern India. In raids last month on blood banks in Lucknow, police seized 60 units of blood ready to be delivered to hospitals and private clinics. According to Paresh Pandey, superintendent of police, the samples had a low hemoglobin count due to dilution with saline solution. Some also tested positive for hepatitis B and C viruses. Pandey said the blood was bought from professional donors. The suspected ringleader is a doctor employed at a state-run hospital. Vinjay Chandra, a senior police official, said the men were arrested Sunday, face multiple charges, and could be sentenced to life in prison. The alleged crimes came to light last month after a woman who had received a blood transfusion during surgery at a Lucknow clinic later tested positive for hepatitis B. __________________________________________________________________________ _____________________________________*____________________________________ __________________________________________________________________________ * 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 latest injection safety Best Practices review at: http://www.uqconnect.net/signfiles/Files/BestPracticesJul2003.pdf Use the Toolbox at: http://www.who.int/injection_safety/toolbox/en/ Subscribe or un-subscribe by email to: sign@uq.net.au, sign@who.int or on subscribe online at: http://www.who.int/injection_safety/sign/en/ Get SIGN files on the web at: http://www.uqconnect.net/signfiles/Files/ get SIGNpost archives at: http://www.uqconnect.net/signfiles/Archives/?M=D The SIGN Secretariat, the Department of Essential Health Technologies, WHO, Avenue Appia 20, CH-1211 Geneva 27, Switzerland. Telephone: +41 22 791 3680, Facsimile: +41 22 791 4836, E- mail: sign@who.int _____________________________________*____________________________________ __________________________________________________________________________ SIGN meets annually to aid collaboration and synergy among SIGN network participants worldwide. The 2009 SIGN annual meeting will be held from 30 November to Wednesday 2 December 2009 at WHO Headquarters in Geneva Switzerland. The PQS (performance Quality and Safety) consultative meeting with the industry, will be held back to back with the SIGN meeting on 3rd and 4th December 2009. Get the final report of the SIGN Meeting 2008, Moscow, Russian Federation [2.36Mb] at: http://www.who.int/injection_safety/2008MeetingReport.pdf Many SIGN files can be opened in Acrobat Reader. To access all the features in Adobe Acrobat documents download the Acrobat Reader at: http://www.adobe.com/products/acrobat/readstep2.html 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 relation to injection safety. 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 organizations and agencies to which the authors may belong. Use of trade names and commercial sources is for identification only and does not imply endorsement. Contributions to: sign@uq.net.au or use your reply button! The SIGN Forum welcomes new subscribers who are involved in injection safety. Please subscribe by sending an email to: sign@who.int _____________________________________*____________________________________ The SIGN Internet Forum was established at the initiative of the World Health Organization's Department of Essential Health Technologies. The SIGN Forum is moderated by Allan Bass and is hosted on the University of Queensland computer network. http://www.uq.edu.au __________________________________________________________________________