The Epidemiology of Blood-Contaminated Needlestick Injuries Among Veterinarians in Portugal

ABSTRACT

Needlestick injuries (NIs) are considered a substantial occupational health and safety hazard in contemporary health care practice. Unlike human medicine where much effort has been devoted to reduce the incidence of these events, the same aggressive approach has not been used in veterinary medicine. This study investigated the occurrence of blood-contaminated NIs in Portuguese veterinarians. Participants of a veterinary meeting were asked to complete a questionnaire-based survey. Univariate and multivariate logistic regression analyses were performed to produce predicted probabilities for NI episodes in veterinarians. From the total of 373 enrolled veterinarians, 293 (78.5%) reported having had at least one NI during their professional life. Veterinarians working with dogs were more likely to have experienced a NI (adjusted odds ratio [aOR]: 145.74, P < .001). The high level of NIs observed in these professionals shows that NIs are a potential occupational health problem in Portuguese veterinarians, with the possibility for transmission of haematogenous zoonosis.     

Veterinary medicine and public health at CDC

People readily associate the role of veterinarians with private veterinary practice focused on pets and farm animals, but the true dimensions and contributions of veterinary medicine are much broader and reflect expanding societal needs and contemporary challenges to animal and human health and to the environment. Veterinary medicine has responsibilities in biomedical research; ecosystem management; public health; food and agricultural systems; and care of companion animals, wildlife, exotic animals, and food animals. The expanding role of veterinarians at CDC reflects an appreciation for this variety of contributions. Veterinarians' educational background in basic biomedical and clinical sciences compare with that of physicians. However, unlike their counterparts in human medicine, veterinarians must be familiar with multiple species, and their training emphasizes comparative medicine. Veterinarians are competent in preventive medicine, population health, parasitology, zoonoses, and epidemiology, which serve them well for careers in public health. The history and tradition of the profession always have focused on protecting and improving both animal health and human health.     

Cancer in veterinarians

OBJECTIVES—Veterinarians come into contact with several potentially carcinogenic exposures in the course of their occupation. These exposures include radiation, anaesthetic gases, pesticides (particularly insecticides), and zoonotic organisms. This review aims to summarise what is known about the carcinogenic risks in this profession.
METHODS—The levels of exposure to potential carcinogens in the veterinary profession are examined and evidence is reviewed for carcinogenesis of these substances in humans at doses similar to those experienced by veterinarians. The few published studies of cancer in veterinarians are also summarised.
RESULTS—Veterinarians have considerable potential for exposure to several known and potential carcinogens. Risks may be posed by work in clinics with poorly maintained x ray equipment, by use of insecticides, and from contact with carcinogenic zoonotic organisms. The few studies available suggest that veterinarians have increased mortality from lymphohaematopoietic cancers, melanoma, and possibly colon cancer.
CONCLUSIONS—The exposures examined in this review are not unique to the veterinary profession, and, as a consequence, information gathered on the carcinogenic risks of these exposures has implications for many other occupations such as veterinary nurses, animal handlers, and some farmers, as well as dentists, radiographers, and anaesthetists.


Keywords: cancer; veterinarians; occupation     

Veterinary public health capacity in the United States: opportunities for improvement

Objectives

In 2006, the Association of American Veterinary Medical Colleges reported that the shortage (≥1,500) of public health veterinarians is expected to increase tenfold by 2020. In 2008, the Centers for Disease Control and Prevention (CDC) Preventive Medicine Fellows conducted a pilot project among CDC veterinarians to identify national veterinary public health workforce concerns and potential policy strategies.

Methods

Fellows surveyed a convenience sample (19/91) of public health veterinarians at CDC to identify veterinary workforce recruitment and retention problems faced by federal agencies; responses were categorized into themes. A focus group (20/91) of staff veterinarians subsequently prioritized the categorized themes from least to most important. Participants identified activities to address the three recruitment concerns with the highest combined weight.

Results

Participants identified the following three highest prioritized problems faced by federal agencies when recruiting veterinarians to public health: (1) lack of awareness of veterinarians'' contributions to public health practice, (2) competitive salaries, and (3) employment and training opportunities. Similarly, key concerns identified regarding retention of public health practice veterinarians included: (1) lack of recognition of veterinary qualifications, (2) competitive salaries, and (3) seamless integration of veterinary and human public health.

Conclusions

Findings identified multiple barriers that can affect recruitment and retention of veterinarians engaged in public health practice. Next steps should include replicating project efforts among a national sample of public health veterinarians. A committed and determined long-term effort might be required to sustain initiatives and policy proposals to increase U.S. veterinary public health capacity.Effective public health systems require an interdisciplinary approach to public health disease surveillance, prevention, and control. Given that approximately 75% of emerging human infectious diseases are zoonosis-related,¹ veterinarians are critical partners when addressing public health challenges, especially considering emerging pathogens that might have a zoonotic component (e.g., avian influenza, severe acute respiratory syndrome, and Ebola hemorrhagic fever).^2,3 Veterinarians in state, federal, and uniformed services often fill these roles; in 2006, a total of 3,312 (3.9%) of 84,946 U.S. veterinarians were employed in public health (i.e., government and uniformed service employees).⁴Although veterinarians engaged in public health activities traditionally have worked in a regulatory capacity on animal health problems affecting agriculture, plant and animal health, human and animal food safety, biologic and homeland security, and wildlife and zoonotic disease prevention and control,³ others have sought to work in applied public health roles usually associated with medical doctors, nurses, and people trained in epidemiology. In addition, veterinarians in public health careers have not limited themselves to the zoonotic pathogens and often apply their population medicine knowledge to other roles of human disease or injury prevention and control, environmental health, and vaccine-preventable diseases.A 2006 report by the Association of American Veterinary Medical Colleges (AAVMC) identified a shortage of ≥1,500 veterinarians fulfilling public health responsibilities; by 2020, this shortage is expected to increase tenfold.⁵ The 2007–2008 Centers for Disease Control and Prevention (CDC) Preventive Medicine Fellows (PMFs) conducted a veterinary public health workforce focus group project by using the community mobilization and group facilitation skills learned in the PMF training program.⁶ The objective of this project was to gain insight into key areas of recruitment and retention that might reduce the national shortage of public health veterinarians.     

The National Order of Veterinary Doctors of Madagascar and the quality control of private veterinarians

Veterinary medicine was introduced into Madagascar with the arrival of French settlers in the early 1900s. At first, veterinary practitioners were all French, and they trained Madagascan veterinary auxiliaries. The first Madagascan veterinarians were trained in French veterinary schools. The idea of organising the profession dates back to the 1970s, but only in 1991 was the Animal Health Law, covering the veterinary profession, adopted by the National Assembly; it was promulgated by President Ratsiraka on July 25 of that same year. Thus, the National Order of Veterinary Doctors of Madagascar (ONDVM: Ordre national des docteurs vétérinaires malagasy) was instituted by a decree in February 1992. All veterinarians and paraprofessionals were employed in the public sector at the time and this new structure proved vital for the private exercise of the veterinary profession. With the adoption of a new national livestock policy, vaccination against major cattle and swine diseases became a profitable activity. One of the objectives of the sectoral livestock programme was that a total of 90 new posts for veterinarians should be created and located throughout the different regions and rural townships of the country. The Centre de promotion vétérinaire (Centre for Veterinary Promotion), which was created in 1992, was the organisation charged with carrying out this task. In 1998, once the private veterinarians were installed, a survey was undertaken with the aim of making an exhaustive assessment of all private veterinarians, collecting data from the public veterinary stations in zones covered by private veterinarians, and establishing a programme of disengagement and withdrawal of the decentralised services, particularly the public veterinary stations. More recently, the Administration and the ONDVM have been facing various organisational problems, notably with regard to the different levels of animal health staff working in the field. Thus, the Order is currently waging a mobilisation and awareness campaign for the adoption of a new animal health law. All new measures would be aimed at strengthening the management of artificial insemination centres and border protection and improving the work of all those involved in animal health: official and private veterinarians and members of the Order of Veterinary Doctors and the Order of Veterinary Paraprofessionals.     

Trends in exposure of veterinarians to physical and chemical hazards and use of protection practices

Objectives To determine whether exposure to physical and chemical occupational hazards and use of protective practices has changed in recent veterinary graduates, and to describe trends in exposure to occupational hazards and use of protective practices over time. Methods This paper reports on a retrospective cohort study of veterinarians who graduated from any of the four Australian veterinary schools between 1960 and 2000 and were currently in clinical practice. A self-completed postal questionnaire was used to collect personal details, professional history since graduation, and details of occupational hazards and protective practices used. The prevalence of occupational hazards and use of protective practices was examined by decade of graduation adjusting for gender, type of practice and number of hours worked. Results After adjusting for other factors, recent graduates tended to take more X-rays than early graduates—graduates since 1990 were 2.59 times more likely to take more than seven X-rays a week compared with graduates before 1970. Recent graduates were also more likely to personally restrain animals during X-rays but were more likely to use X-ray protection. Of those who undertook surgery, recent graduates were more likely to use anaesthetic waste gas scavengers. Over time, veterinary jobs have become more likely to involve longer hours of surgery, but shorter periods of driving. The use of scavengers for waste anaesthetic gas has increased markedly over time from 3.8% of jobs commencing in the 1960s to over 70% for jobs commencing since 1997. Conclusions This survey is, to our knowledge, the first to examine trends in the occupational health and safety practices of veterinarians. We have shown that occupational health issues are still important in veterinary practice, with most veterinarians exposed to a number of physical and chemical hazards and many using inadequate protection.     

Standardization or tailorization of veterinary vaccines: a conscious endeavour against infectious disease of animals

Protecting animals from infection is a major obligation of every veterinarian's work in order to preserve animal welfare while assuring human health. Highly infectious animal diseases can reduce the performances of food producing animals and may have a great economical impact on many industries. Some animal diseases can be transmitted to humans, and control of these types of diseases, is beneficial to public health. In the wild, animal populations reduced by disease can dramatically affect the ecological balance of an area. Vaccination is one part of an effective health program as it helps to prevent disease and, in most cases, is more cost-effective than treating sick animals. Veterinarians have succeeded in greatly reducing the incidence of important diseases by taking advantage from improved technologies in vaccines production and by planning vaccination schedules based on the different characteristics of available products. Today, veterinarians can recommend and plan to use vaccines designed for a specific herd or flock or class of animals and even for individual treatments.     

High risk for nasal carriage of methicillin-resistant Staphylococcus aureus among Danish veterinary practitioners

OBJECTIVES: Due to their multiple antibiotic resistance properties, methicillin-resistant Staphylococcus aureus (MRSA) are a major public health problem. After the recently described emergence of MRSA in animals, the authors investigated the risk of nasal MRSA carriage among people with professional contact with animals. METHODS: Nasal swabs and information on animal exposure and known MRSA risk factors were obtained from participants (N=702) at five conferences organized by national veterinary and farmer associations and students at a business school in Denmark. All of the participants were screened by standard microbiological techniques for MRSA detection and characterization. RESULTS: MRSA carriage was significantly (P<0.02) higher among the veterinary practitioners (3.9%) than among the participants not professionally exposed to animals (0.7%). Six of the nine MRSA strains isolated from veterinary practitioners belonged to clonal complexes (CC) previously associated with horses (CC8), small animals (CC22), and pigs (CC398). Although four of the nine positive veterinarians carried the CC associated with pigs, exposure to small animals, cattle, or horses, but not to pigs, was found to be a significant risk factor. CONCLUSIONS: The results indicate that veterinarians are at risk of MRSA carriage. Veterinary professionals should be informed about this emerging occupational health risk and educated about preventive measures. Collaboration between national medical and veterinary institutions is urgently needed to control the spread of these unwanted bacteria in the community.     

History of veterinary public health in the Eastern Mediterranean and Africa

Brucellosis, rabies, salmonellosis, anthrax and hydatidosis are among the main zoonotic diseases which constitute a threat to human health and welfare. Surveillance, prevention and control of such zoonoses and related food-borne diseases are problems of considerable magnitude. Despite their obvious importance, relatively few systematic control efforts have been made by national authorities. Major constraints include the scarcity of public health veterinarians and related sub-professional staff to plan and implement adequate surveillance and control of zoonoses, and the lack of appropriate legislation and adequate laboratory services. Veterinarians have been contributing to public health for many years, but despite considerable efforts by the World Health Organisation (WHO), the Food and Agriculture Organisation of the United Nations (FAO) and other organisations in establishing veterinary public health (VPH) programmes over several decades, the veterinarian as a career specialist in public health is a relatively new phenomenon. In the last decade, emphasis has been placed on: --supporting the training and development of human resources to promote VPH services and cover all its components --promoting and upgrading national epidemiological surveillance and control programmes for the major zoonotic and food-borne diseases --cooperating and assisting in local production of safe and effective vaccines, primarily for the control of rabies and brucellosis. The most encouraging aspects of the present situation is the growing awareness among governments of the need to develop programmes for the control of zoonoses and related food-borne diseases.     

The World Veterinary Association and animal welfare

The World Veterinary Association, as the global representative of the veterinary profession, recognises the global influences on animal welfare and the changing role of the veterinarian in response to the changing attitudes of the human population. While urban populations are now dictating animal welfare standards, many practices still have a cultural and even religious basis. Veterinarians recognise these influences, but base their recommendations for animal welfare on scientifically justified practices. Veterinarians work not only for urban clients with their companion animals, but also very importantly with rural clients who provide the source of animal-based foodstuffs and goods sought by an increasingly demanding human population. The controversial areas of intensive animal production and the transportation that is required to move large numbers of animals around the world require veterinary supervision to ensure that animal welfare is preserved. The development of animal welfare standards is an ongoing process, with the major international effort being led by the World Organisation for Animal Health.     

Injury in Australian veterinarians

BACKGROUND: There are a number of risk factors for traumatic injury in veterinary practice but there is little information on the prevalence of injuries or the factors associated with injury in this profession. AIMS: To identify the prevalence of injuries sustained by veterinarians and the groups most at risk for different types of injury. METHODS: Cross-sectional survey of Australian veterinarians. Subjects were asked whether they had ever had a significant work-related injury, a less serious acute work injury in the last 12 months, a work-related chronic musculoskeletal problem or dog or cat bites. The prevalence of injuries by gender, practice type and decade of graduation were reported and multivariate logistic regression was used to examine the risk of each type of injury. RESULTS: Of 2800 veterinarians, over half (51%) reported a significant work-related injury during their career while 26% of practitioners reported having at least one injury in the previous 12 months. Chronic work-related musculoskeletal problems were reported by 49% of respondents. Dog and cat bites were also very common. After adjusting for graduation year and university, males were more likely than females to have experienced cat or dog bites or have a chronic or significant injury, and large animal veterinarians were most likely to have chronic or significant injuries. CONCLUSIONS: A high injury prevalence was found among Australian veterinarians with large animal practitioners at highest risk. This is the largest study of Australian veterinarians to have been reported and has shown that injuries are common and serious in the profession.     

Misuse of Over-the-Counter Cough or Cold Medications Among Adolescents: Prevalence and Correlates in a National Sample

The current research examines the misuse of over-the-counter cough/cold medications among adolescents with data from the 2006 National Survey on Drug Use and Health. Findings indicate that age, gender, family income, physical and mental health, and the use of alcohol and other drugs are correlates of the misuse of over-the-counter cough/cold medications.     

History of the scientific relationships of veterinary public health.

The origin of veterinary public health (VPH), as the term is understood today, dates back to the late 1940s and early 1950s with the creation of new responsibilities and a broader range of career openings for veterinarians within some public health agencies, especially in disease intelligence aspects of the newly developing science of epidemiology. Other well-established scientific relationships of veterinary medicine to human health (e.g. food safety, pathogenic microbiology, comparative pathology) experienced renewed vigour as a result of these innovations, the latter also in connection with VPH-facilitated development and support of a new veterinary clinical practice specialty of laboratory animal biology and medicine. Through these expanded interprofessional and intersectoral communication, liaison and cooperation channels, new academic programmes arose within veterinary schools. These programmes brought a number of innovations to the world of veterinary medicine, including newly developed methodologies. A variety of new biomedical research career roles for veterinarians within both veterinary and other medically oriented institutions were identified and filled during this overall process. Also related to these developments was the identification of new roles for veterinarians in environmental science research and practice, beyond those traditionally associated with veterinary food hygiene. Proposals have since been made for significant new intersectoral functions for agriculture-based governmental Veterinary Services in connection with these new aspects of environmental science and with the aims of recent primary health care programmes within public health.     

Role of Gender,Insurance Status and Culture in Attitudes and Health Behavior in a US Chinese Student Population

Introduction Asians are an understudied population in health research. Often their lower utilization of health care services and low participation in clinical trials has been attributed to socioeconomic factors and cultural beliefs. However, the role of gender and perceptions of health beliefs across generations in determining access have not been studied in this population. Objective This study seeks to examine the relationship of gender to the health beliefs and health utilization patterns of a group of undergraduate Chinese students in regard to their own use and what they perceived as their parents' use. Design Seventy-eight Chinese students responded to a health belief and utilization survey. They were asked to provide information on their perceptions and attitudes of health as well as what they perceived to be their parents' health attitudes and behavior. Results. Findings indicated that female students were more proactive in their health beliefs towards preventive care and getting regular check-ups than male students. This difference between genders remained true in the students' perceptions of their mothers being more likely to seek preventive care and to get regular check-ups than their fathers. Cultural factors including privacy and modesty were important factors in determining use of health care by Chinese women. Insurance status played an important role in determining health behavior among Chinese men. Uninsured fathers were perceived as more likely to use complementary and alternative therapies (CAM) than mothers. Male students and fathers who had private insurance were perceived to access and utilize health services equally as the women. Gender differences are seemingly less apparent among parents who are using CAM. Language difficulty was identified most frequently as the major barrier to accessing care among this population. Conclusions Considerations of socioeconomic factors, cultural and language barriers need to be made with particular focus on gender differences in attitudes and health behavior when making policy decisions for the Asian American population. Further studies are also needed on intergenerational attitudes and health behavior of older Asian Americans.     

Introducing telemedicine technology to rural physicians and settings

OBJECTIVE: The researchers investigated rural health providers' perceptions of telemedicine, developed a framework for assessing their readiness to adopt this type of technology, and offered a guide for its implementation. STUDY DESIGN: Qualitative data were collected from semistructured interviews with thematic analysis. POPULATION: The study population included physicians, nurses, and administrative personnel located in 10 health care practices in 4 communities in 3 rural Missouri counties. OUTCOMES MEASURED: The researchers measured how often health providers used telemedicine technology and their perceptions of the advantages, disadvantages, barriers, and facilitators involved in adopting it. RESULTS: Participants varied widely in their perceptions of telemedicine. Providers in practices affiliated with the university's tertiary center were more likely to use it than were those in private practice. Interviews and other data yielded 6 themes related to a provider's receptivity to technological change: These themes were turf, efficacy, practice context, apprehension, time to learn, and ownership. Each theme applies to the computer and videoconferencing components of telemedicine, and each may operate as a perceived barrier or facilitator of change. CONCLUSIONS: Care providers and administrators consider a range of factors, including economic ramifications, efficacy, social pressure, and apprehension, when deciding whether and how fast to adopt telemedicine. Since adopting this technology can be a major change, agencies trying to introduce it into rural areas should take all these factors into account in their approach to health care providers, staff, and communities.