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proper vein puncture techniques
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General Instructions:
Open needle package but do not remove needle shield. Thread needle onto holder. If drawing sterile sample, use sterile holder/needle combination.
Select tube or tubes appropriate for samples desired. If a sterile specimen is required, use a sterile VACUTAINER Tube. When collecting sterile samples, observe proper skin preperation directions.
Tubes that contain additives should be gently tapped to dislodge any additive which may be trapped around the stopper.
Inster tube into holder. Push tube sropper onto needle until leading edge of stopper meetes guideline of holder. Tubes will retract slightly. LEAVE IN THIS POSITION. When using 13mm diameter tubes, it is important to center the tubes in the holder when penetrating the stopper, to preclude sidewall penetration and resultant loss of volume.
Select site for venipuncture.
Apply tourniquet. Prepare venipuncutre site with an appropriate antiseptic. DO NOT PALPATE VENIPUNCTURE SITE AFTER CLEANSING.
Place patient's arm in a downward position.
Remove needle shield. Perform venipuncture with arm in a downard prosition and tube stopper uppermost. (see diagram)
Push tube onto holder, puncturing diaphragm of stopper.
REMOVE TOURNIQUET AS SOON AS BLOOD APPEAR IN TUBE. DO NOT ALLOW CONTENTS OF TUBE TO CONTACT THE STOPPER OR THE END OF THE NEEDLE DURING PROCEDURE. If no blood flows into tube or ceases to flow before an adequate sample is collected, the following steps are suggested to complete satisfactory collection:
Confirm correct position of needle cannula in vein;
If a multuple sample needle is being used, remove the tube and place a new tube into the holder;
If the second tube does not draw, remove needle and discard in approriate disposal device. Repeat procedure from Step 1.
When first tube is full and blood flow ceases, remove it from holder.
Place suvveeding tubes in holder, puncturing diaphragm to initiate flow. Tubes without additives are drawn before tubes with additives.
While each successive tube is filling, invert the previous tube containing additives 8-10 times. DO NOT SHAKE. Vigorous mixing can cause hemolysis.
As soon as blood stops flowing in the last tube, remove needle from vein, apply pressure to puncture site with dry, sterile swab, until bleeding stops.
Apply bandage if desired.
After the venipuncture, the top of the stopper may contain residual blood at the puncture site. Proper precautions should be take when handling tubes to avoid contact with blood droplet. Dispose of any holder that becomes contaminated with blood.
Needle Disposal: After venipuncture, dispose of needle using appropriate disposal device. DO NOT RESHIELD. If breakage of a tube containing a collected sample should occur, avoid all contance the exposed skin and follow proper pocesdures for the cleanup and disposal of infectious waste.

May 28, 2009 | 10:01 AM Comments  0 comments

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vaccines for H1N1
Related to country: Nepal

Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

Vaccines for the new influenza A(H1N1)
2 May 2009

Is an effective vaccine already available against the new influenza A(H1N1) virus?

No, but work is already under way to develop such a vaccine. Influenza vaccines generally contain a dead or weakened form of a circulating virus. The vaccine prepares the body’s immune system to defend against a true infection. For the vaccine to protect as well as possible, the virus in it should match the circulating “wild-type” virus relatively closely. Since this H1N1 virus is new, there is no vaccine currently available made with this particular virus. Making a completely new influenza vaccine can take five to six months.

What implications does the declaration of a pandemic have on influenza vaccine production?

Declaration by WHO of a pandemic alert does not by itself automatically translate into a request for vaccine manufacturers to immediately stop production of seasonal influenza vaccine and to start production of a pandemic vaccine. Since seasonal influenza can also cause severe disease, WHO will take several important considerations such as the epidemiology and the severity of the disease when deciding when to formally make recommendations on this matter. In the meantime, WHO will continue to interact very closely with regulatory and other agencies and influenza vaccine manufacturers.

How important will influenza A(H1N1) vaccines be for reducing pandemic disease?

Vaccines are one of the most valuable ways to protect people during influenza epidemics and pandemics. Other measures include anti-viral drugs, social distancing and personal hygiene.

Will currently available seasonal vaccine confer protection against influenza A(H1N1)?

The best scientific evidence available today is incomplete but suggests that seasonal vaccines will confer little or no protection against influenza A(H1N1).

What is WHO doing to facilitate production of influenza A(H1N1) vaccines?

As soon as the first human cases of new influenza A(H1N1) infection became known to WHO, the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America) took immediate action and began the work to develop candidate vaccine viruses. WHO also initiated consultations with vaccine manufacturers worldwide to facilitate the availability of all necessary material to start production of influenza A(H1N1) vaccine. In parallel, WHO is working with national regulatory authorities to ensure that the new influenza A(H1N1) vaccine will meet all safety criteria and be made available as soon as possible.

Why is WHO not asking vaccine manufacturers to switch production from seasonal vaccine to a influenza A(H1N1) vaccine yet?

WHO has not recommended stopping production of seasonal influenza vaccine because this seasonal influenza causes 3 million to 5 million cases of severe illness each year, and kills from 250 000 to 500 000 people. Continued immunization against seasonal influenza is therefore important. Moreover, stopping seasonal vaccine production immediately would not allow a pandemic vaccine to be made quicker. At this time, WHO is liaising closely with vaccine manufacturers so large-scale vaccine production can start as soon as indicated.

Is it possible that manufacturers produce both seasonal and pandemic vaccines at the same time?

There are several potential options which must be considered based on all available evidence.

What is the process for developing a pandemic vaccine? Has a vaccine strain been identified, and if so by whom?

A vaccine for the Influenza A(H1N1) virus will be produced using licensed influenza vaccine processes in which the vaccine viruses are grown either in eggs or cells. Candidate vaccine strains have been identified and prepared by the WHO Collaborating Center in Atlanta (The Centers for Disease Control and Prevention (CDC) in the United States of America)1. These strains have now been received by the other WHO Collaborating Centers which have also started preparation of vaccine candidate viruses. Once developed, these strains will be distributed to all interested manufacturers on request. Availability is anticipated by mid-May.

How quickly will influenza A(H1N1) vaccines be available?

The first doses of Influenza A(H1N1) vaccine could be available in five to six months from identification of the pandemic strain. The regulatory approval will be conducted in parallel with the manufacturing process. Regulatory authorities have put into place expedited processes that do not compromise on the quality and safety of the vaccine. Delays in production could result from poor growth of the virus strain used to make the vaccine.

How would manufacturers be selected?

There are currently more than a dozen vaccine manufacturers with licenses to produce influenza vaccines. Upon request, the vaccine strain will be available to each of them, as well as to other qualified vaccine manufacturers who are preparing to make influenza vaccine but do not yet have a licensed influenza vaccine.

What is the global manufacturing capacity for a potential influenza A(H1N1) pandemic vaccine? Is this the same as the global manufacturing capacity for H5N1?

The projections made for the production capacity of an vaccine for H5N1 cannot be automatically assumed to be the capacity to make an H1N1 vaccine. H5N1 and H1N1 viruses are different and the amount of antigen needed to make an effective H1N1 vaccines may be different than for H5N1. Therefore it is not possible to make a precise estimate. However, given these considerations, a conservative estimate of global capacity is at least 1 to 2 billion doses per year.

How is production capacity for influenza vaccines distributed geographically?

More that 90% of the global capacity today is located in Europe and in North America. However, during the past five years, other regions have begun to acquire the technology to produce influenza vaccines. Six manufacturers in developing countries have done so with technical and financial support from WHO.

What will be the storage requirements for influenza A(H1N1) vaccine?

The vaccine should be stored under refrigerated conditions at between 2°C and 8°C.

It has been impossible so far to develop vaccines for major killers such as HIV and malaria. How sure are we that there will not be scientific or other hurdles in developing an effective influenza A(H1N1) vaccine?
Typically, development of influenza vaccines has not posed a problem. Influenza vaccines have been used in humans for many years and are known to be immunogenic and effective. Each year seasonal influenza vaccines with varying composition are produced for the northern and southern hemisphere influenza seasons. Vaccine manufacturers will employ a number of different technologies to develop their vaccines. They will take advantage, notably, of novel approaches that were developed over the past years for H5N1 avian influenza vaccines. One key unknown is yield of vaccine virus production, since some strains grow better than others and the behavior of the new influenza A(H1N1) strain in manufacturers’ systems is not yet known. New recombinant technologies are under development, but have not yet been approved for use.

Will influenza A(H1N1) vaccines be effective in all population groups?

There are not data on this but there also is no reason to expect that they would not, given current information.

Will the influenza A(H1N1) vaccine be safe?

Licensed vaccines are held to a very high standard of safety. All possible precautions will be taken to ensure safety of new influenza A(H1N1) vaccines.

How can a repeat of the 1976 swine flu vaccine complications (Guillain-Barré syndrome) experienced in the United States of America be avoided?

Guillain-Barré syndrome is an acute disorder of the nervous system. It is observed following a variety of infections, including influenza. Studies suggest that regular seasonal influenza vaccines could be associated with an increased risk of Guillain-Barré syndrome on the order of one to two cases per million vaccinated persons. During the 1976 influenza vaccination campaign, this risk increased to around 10 cases per million vaccinated persons which led to the withdrawal of the vaccine.

Pandemic vaccines will be manufactured according to established standards. However, they are new products so there is an inherent risk that they will cause slightly differently reactions in humans. Close monitoring and investigation of all serious adverse events following administration of vaccine is essential. The systems for monitoring safety are an integral part of the strategies for the implementation of the new pandemic influenza vaccines. Quality control for the production of influenza vaccines has improved substantially since the 1970s.

Will it be possible to deliver new influenza A(H1N1) vaccine simultaneously with other vaccines?

Inactivated influenza vaccine can be given at the same time as other injectable vaccines, but the vaccines should be administered at different injection sites.

If the virus causes a mild pandemic in the warmer months and changes into something much more severe in, say, 6 months, will vaccines being developed now be effective?
It is too early to be able to predict changes in the influenza A(H1N1) virus as it continues to circulate in humans or how similar a mutated virus might be to the current virus. Careful surveillance for changes in the influenza A(H1N1) virus is ongoing. This close and constant monitoring will support a quick response should important changes in the virus be detected.

Will there be enough influenza A(H1N1) vaccine for everyone?

The estimated time to make enough vaccine to vaccinate the world's population against pandemic influenza will not be known until vaccine manufacturers will have been able to determine how much active ingredient (antigen) is needed to make one dose of effective influenza A(H1N1) vaccine.

In the past two years, influenza vaccine production capacity has increased sharply due to expansion of production facilities as well as advances in research, including the discovery and use of adjuvants. Adjuvants are substances added to a vaccine to make it more effective, thus conserving the active ingredient (antigen).

What is WHO's perspective on fairness and equity for vaccine availability?

The WHO Director-General has called for international solidarity in the response to the current situation. WHO regards the goal of ensuring fair and equitable access by all countries to response measures to be among the highest priorities. WHO is working very closely with partners including the vaccine manufacturing industry on this.

Who is likely to receive priority for vaccination with a future pandemic vaccine?

This decision is made by national authorities. As guidance, WHO will be tracking the evolution of the pandemic in real-time and making its findings public. As information becomes available, it may be possible to better define high-risk groups and to target vaccination for those groups, thus ensuring that limited supplies are used to greatest effect.

Will WHO be conducting mass influenza A(H1N1) vaccination campaigns?

No. National authorities will implement vaccination campaigns according to their national pandemic preparedness plans. WHO is exploring whether the vaccine can be packaged, for example, in multi-dose vials, to facilitate the rapid and efficient vaccination of large numbers of people.

Developing countries are very experienced in administering population-wide vaccination campaigns during public health emergencies caused by infectious diseases, including diseases like epidemic meningitis and yellow fever, as well as for polio eradication and measles control programmes.

How feasible will it be to immunize large numbers of people in developing countries against a pandemic virus?

Developing countries have considerable strategic and practical experience in delivering vaccines in mass campaigns. The main issue is not feasibility, but how to ensure timely access to adequate quantities of vaccine.

What is the estimated global number of doses of seasonal vaccine used annually?

The current annual demand is for less than 500 million doses per year.

Will seasonal influenza vaccine continue to be available?
At this time there is no recommendation to stop production of seasonal influenza vaccine.


May 23, 2009 | 1:48 AM Comments  0 comments

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epidemic of influnza A, virus strain H1N1
Related to country: Nepal

Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

Influenza A virus subtype H1N1, also known as A(H1N1), is a subtype of influenzavirus A and the most common cause of influenza (flu) in humans. Some strains of H1N1 are endemic in humans, including the strain(s) responsible for the 1918 flu pandemic which killed 50–100 million people worldwide. Less virulent H1N1 strains still exist in the wild today, worldwide, causing a small fraction of all influenza-like illness and a large fraction of all seasonal influenza. H1N1 strains caused roughly half of all flu infections in 2006.[1] Other strains of H1N1 are endemic in pigs and in birds.

In March, April and May 2009, thousands of laboratory-confirmed infections and a number of deaths were caused by an outbreak of a new strain of H1N1

2009 Influenza A(H1N1) outbreak

Minor outbreaks of swine influenza occurred in humans in 1976 and 1988, and in pigs in 1998 and 2007.

In the 2009 swine flu outbreak, the virus isolated from patients in the United States was found to be made up of genetic elements from four different flu viruses – North American Mexican influenza, North American avian influenza, human influenza, and swine influenza virus typically found in Asia and Europe – "an unusually mongrelised mix of genetic sequences."[14] This new strain appears to be a result of reassortment of human influenza and swine influenza viruses, in all four different strains of subtype H1N1. However, as the virus has not yet been isolated in animals to date and also for historical naming reasons, the World Organisation for Animal Health (OIE) suggests it be called "North-American influenza".[15] On April 30, 2009 the World Health Organization began referring to the outbreak as "Influenza A" instead of "swine flu".[16], and later began referring to it as "Influenza A(H1N1)". Several complete genome sequences for U.S. flu cases were rapidly made available through the Global Initiative on Sharing Avian Influenza Data (GISAID).[17][18] Preliminary genetic characterization found that the hemagglutinin (HA) gene was similar to that of swine flu viruses present in U.S. pigs since 1999, but the neuraminidase (NA) and matrix protein (M) genes resembled versions present in European swine flu isolates. The six genes from American swine flu are themselves mixtures of swine flu, bird flu, and human flu viruses.[19][20] While viruses with this genetic makeup had not previously been found to be circulating in humans or pigs, there is no formal national surveillance system to determine what viruses are circulating in pigs in the U.S.



May 23, 2009 | 1:15 AM Comments  0 comments

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Environment health
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

Environmental health
Environmental health is the branch of public health that is concerned with all aspects of the natural and built environment that may affect human health. Other terms that refer to the discipline of environmental health include environmental public health and environmental health and protection.
Environmental health is defined by the World Health Organisation as:
Those aspects of human health and disease that are determined by factors in the environment. It also refers to the theory and practice of assessing and controlling factors in the environment that can potentially affect health.
Environmental health as used by the WHO Regional Office for Europe, includes both the direct pathological effects of chemicals, radiation and some biological agents, and the effects (often indirect) on health and wellbeing of the broad physical, psychological, social and aesthetic environment which includes housing, urban development, land use and transport.

Environmental health concerns
Environmental health addresses all human-health-related aspects of both the natural environment and the built environment. Environmental health concerns include:
• Air quality, including both ambient outdoor air and indoor air quality, which also comprises concerns about environmental tobacco smoke.
• Body art safety, including tattooing, body piercing and permanent cosmetics.
• Climate change and its effects on health.
• Disaster preparedness and response.
• Food safety, including in agriculture, transportation, food processing, wholesale and retail distribution and sale.
• Hazardous materials management, including hazardous waste management, contaminated site remediation, the prevention of leaks from underground storage tanks and the prevention of hazardous materials releases to the environment and responses to emergency situations resulting from such releases.
• Housing, including substandard housing abatement and the inspection of jails and prisons.
• Childhood lead poisoning prevention.
• Land use planning, including smart growth.
• Liquid waste disposal, including city wastewater treatment plants and on-site waste water disposal systems, such as septic tank systems and chemical toilets.
• Medical waste management and disposal.
• Noise pollution control.
• Occupational health and industrial hygiene.
• Radiological health, including exposure to ionizing radiation from X-rays or radioactive isotopes.
• Recreational water illness prevention, including from swimming pools, spas and ocean and freshwater bathing places.
• Safe drinking water.
• Solid waste management, including landfills, recycling facilities, composting and solid waste transfer stations.
• Toxic chemical exposure whether in consumer products, housing, workplaces, air, water or soil.
• Vector control, including the control of mosquitoes, rodents, flies, cockroaches and other animals that may transmit pathogens.


Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments. This definition excludes behavior not related to environment, as well as behavior related to the social and cultural environment, and genetics.


May 19, 2009 | 11:46 PM Comments  0 comments

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Socio-Economic Status of Drug Abuser- A Study on Richmond Fellowship Nepal, Male Rehabilitation Centre.
Translations available in: English (original) | French | Spanish | Italian | German | Portuguese | Swedish | Russian | Dutch | Arabic

Alcohol and drug abuse refers to “self administration of this drug without medical supervision and particularly in large doses that may lead to psychological dependency, tolerance, and abnormal behavior.”
objective
 To find out the socio-economic status of drug abusers of Richmond Fellowship Nepal.

findings, discussion and conclusion

The study was conducted among the drug users of Richmond Fellowship Nepal. Among 31 drug users, 17 are having positive support from society where as 13 are having negative support. One of them was unknown to feedback from the society. Among 31 drug users, 6 used to receive drug from friends, 14 from drug dealers, 1 from senior brothers, 1 from police officer, 6 from friends and drug dealer, and 3 from all sources. Among 31 drug users, 7 of them used intra-venously, 9 of them used orally, 1 inhalation, 4 of them used intravenously and orally, 2 of them used orally and inhalation and rest of them used all methods of abusing drugs. Among 31 drug users, 16 of them were of 11 – 15 age group, 13 were of 16 – 20 age group, 1 of them was of age group 21- 25 and 1 was above 26 years of age when came first in contact with drug. Among 31 drug users 22 were encouraged to take drugs by friends, 2 considered family problem for the abuse of drug, 1 considered deficiency, 3 considered frustration, 2 considered curiosity and 1 took drugs for the entertainment. Monthly, about 7 drug abusers spent Rs 1000-10,000, 14 of the drug users spent Rs 10,000-20,000, Rs 20,000-30,000 was spent by 2 drug users. More than 50,000 were spent by 3 of them. One of drug user spent Rs 1, 00,000 monthly for the drugs. Among 31 drug users 26 were aware of HIV and AIDS during the period of their abusing drugs, while rests of them were not aware. Among 31 drug users, 25 considered themselves free from any kind of disease. 3 of them were living with HIV, 1 was suffering from pneumonia, and 1 from hepatitis c and 1 of them was suffering from diarrhea.
The drug users were taken intentionally as our study to bring light in them about the effects they are doing to themselves as well as the country. The expenses as mentioned by them are very dreadful. The expenses made by them have indirectly affected the economic condition their family as well as nation.
It reflects that the about more patients were receiving support from the society to get rid of drugs where as rest of them weren’t supported by the family. Thus, the societies in which they are living need them to recover from the addiction of drugs. The majority of the drugs users received drugs from the drug dealer and friends. So if we controlled the drug dealers it may reduce the number of drug users, while if we make good and wise friends who are free from this diseases, one can’t be addicted towards the drugs. Furthermore, in majority we found that the age when they first came in contact with drugs, were from age group 11-15 followed by 16-20. Thus if knowledge about the drugs and its harmful effects is given from primary level, it may decline the number of drug users. If the persons are aware from the junior level about the harmful effects of the drugs, they won’t keep their eye on the drugs.
Majority of the drug users spent monthly RS 10,000- 20,000 of feeding themselves with drugs which is a great sum of money. Thus this budget if spent properly will ultimately result in the development of themselves, their society as well as nation. Drug users not only harm themselves but the nation as a whole.
Here, as we know that in Nepal, most of the people suffer from HIV and AIDS due to intra-venous drug use. Thus, what we found is, among the 31 drug users, 3 of them are still living with HIV. So if we limit the number of drug users, in turn we can control the incidence of HIV and AIDS. Many of the drug users suffered from other diseases like hepatitis c, pneumonia and diarrhea. Pneumonia and diarrhea are the major public health problem in Nepal, thus in controlling the drug users, we can control many diseases.

Recent days we have found improvements among the drug users. They are conscious about the harmful effects of the use of the drugs, but still are addicted to them. Many of the drug users wanted to free from the drugs, but as they are addicted it’s very hard to escape from it. They want to quit drugs but the drugs are not ready to leave them.

In conclusion if we limit the drug users for this generation, the next generation will be aware and the further generation is free. Thus to limit the drug users support is required from the family, nation as well and there should be inter-sectoral coordination to control the use of drugs. The only need is that the nation should frame laws, rules and regulation effectively to control the use of drugs and drug addiction.

You can’t Keep It Unless You Give It Away.
SAY A BIG NO TO DRUGS!!!!!!!


Recommendation
 Awareness programs related to drugs and HIV should be conducted in all level.
 Focused studies need to be done among the children at different geographical, economic, cultural and social levels to understand fully how and to which degree the drug is affecting them
 Children should be focused on getting proper education and attend higher level of education
 Drug abuse or addiction is not a crime but a disease of negative attitude and behavior. So they need co-operation, proper counseling and love rather than punishment, custody and discrimination.



May 3, 2009 | 4:30 AM Comments  1 comments

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