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Denver Post Examines Efforts To Establish Needle-Exchange Programs In Colorado
The Denver Post on Friday examined efforts to establish needle-exchange programs in Colorado to reduce the risk of HIV and hepatitis C among injection drug users. According to the Post, 185 cities in Colorado have needle-exchange programs, but legislation that would have legalized needle exchanges statewide did not advance in the Legislature this year. "The issue is more complex than it perhaps first appears," Evan Dreyer, a spokesperson for Gov. Bill Ritter (D), said, adding that "law enforcement and the Colorado Department of Public Health and Environment both expressed serious reservations" about a proposal that would have legalized needle-exchanges statewide. A coalition of public health officials, treatment providers and advocates are increasing efforts to establish a needle-exchange program in Denver, the Post reports. The Denver Drug Strategy Commission in February recommended that Mayor John Hickenlooper consider a pilot needle-exchange program, DDSC Director Karla Maraccini said. The commission is looking at different programs to develop a model following Hickenlooper"s request for additional research. However, Denver District Attorney Mitch Morrissey has concerns that a local needle-exchange program would violate state law, according to Morrissey"s spokesperson Lynn Kimbrough. Eric Brown, a spokesperson for Hickenlooper, added, "Anything in contradiction to city or state law would have to be carefully considered." Proponents of needle-exchange programs say they prevent HIV and hepatitis C, but opponents say they condone injection drug use. Mark Thrun, director of HIV prevention for Denver Public Health, said, adding that needle-exchange programs prevent IDUs from "getting these chronic, potentially fatal diseases" and give public health workers "an opportunity to link them into treatment; and it lessens the economic burden on the already overburdened health care system." Thrun noted that several studies have found that needle-exchange programs do not encourage or prolong injection drug use and make IDUs more likely to seek treatment. In addition, a 2005 CDC study found that 86% of exchange programs make treatment referrals and that more than 80% offer counseling and testing for HIV/AIDS and hepatitis C.Nancy Steinfurth, executive director of the Hep C Connection, noted that an estimated 10% of HIV cases and 70% of hepatitis C cases are transmitted through needles (Auge, Denver Post, 5/15).

AVMA Applauds U.S. House Of Representatives For Introducing Veterinary Public Health Legislation
The nation"s largest veterinary association applauded four members of the U.S. House of Representatives for introducing legislation that confronts public health threats by investing in the public health veterinary workforce
News of the day
Swine Flu Media Update 27 Issued At: 11am Tuesday 26 May 2009, Wales
- 0 confirmed cases in Wales.
Public Health

Policies On Organ Donation After Cardiac Death Vary Considerably Among Children's Hospitals

Although a large number of children"s hospitals have developed or are developing policies regarding organ donation after cardiac death, there is considerable variation among policies, including the criteria for declaring death, according to a study in the May 13 issue of JAMA. Donation after cardiac death (DCD) potentially permits patients who do not meet the neurological criteria for death to donate solid organs. "Controlled DCD occurs following planned withdrawal of life-sustaining treatment, and uncontrolled DCD occurs after unanticipated cardiac arrest. Potential controlled DCD donors include patients with irreversible catastrophic brain injury or end-stage neuromuscular diseases," the authors write. Although the Joint Commission requires all hospitals to address DCD, little is known about actual hospital policies. Armand H. Matheny Antommaria, M.D., Ph.D., of the University of Utah School of Medicine, Salt Lake City, and colleagues conducted a study to evaluate the development and content of DCD policies at children"s hospitals and evaluate variation among policies, which were collected between November 2007 and January 2008 from hospitals in the United States, Puerto Rico, and Canada. Of inquiries to 124 children"s hospitals, a response was received from 105 (85 percent). Of these respondents, 72 percent had DCD policies, 19 percent were developing policies, and 7 percent neither had nor were developing policies. The researchers received and analyzed 73 approved policies. Sixty-one (84 percent) specify criteria or tests for declaring death, including electrocardiogram (ECG) findings, pulselessness, apnea, and unresponsiveness. Four policies require total waiting periods prior to organ recovery at variance with professional guidelines: 1 less than 2 minutes and 3 longer than 5 minutes. Sixty-four policies (88 percent) preclude transplant personnel from declaring death and 51 percent prohibit them from involvement in premortem (taking place immediately before death) management. While 65 policies (89 percent) indicate the importance of palliative care, only 7 percent recommend or require palliative care consultation. Thirty-two policies (44 percent) preclude the use of medications with the intention to hasten death. Policies differ in the location of withdrawal of life-sustaining treatment. Sixty-eight policies (93 percent) specify the location, with the majority (54 percent) requiring withdrawal of treatment to occur in the operating room. Other potential locations include areas adjacent to the operating room (19 percent), the emergency department (4 percent), or the intensive care unit (4 percent). "This study demonstrates that, consistent with a national emphasis on increasing the supply of transplantable organs, a large number of children"s hospitals have developed or are developing DCD policies," the authors write. "The policies exhibit notable variation both within those we studied and compared with authoritative reports and statements. Further research will be required to determine the importance of variation in the tests for declaring death or the processes for withdrawing life-sustaining treatment. In the long run, public policy may need to address strategies to promote adherence to recommendations for DCD processes based on sufficient clinical evidence and/or ethical justification." JAMA. 2009;301[18]:1902-1908. Journal of the American Medical Association


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