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PubMed2004

Stigmatizing attitudes about mental illness and allocation of resources to mental health services.

This study tests a social psychological model (Skitka & Tetlock, 1992). Journal of Experimental Social Psychology, 28, 491-522; [1993]. Journal of Personality & Social Psychology, 65, 1205-1223 stating that policy maker decisions regarding the allocation of resources to mental health services are influenced by their attitudes towards people with mental illness and treatment efficacy. Fifty four individuals participated in a larger study of education about mental health stigma. Participants completed various measures of resource allocation preferences for mandated treatment and rehabilitation services, attributions about people with mental illness, and factors that influence allocation preferences including perceived treatment efficacy. Results showed significant attitudinal correlates with resource allocation preferences for mandated treatment, but no correlates to rehabilitation services. In particular, people who pity people with mental illness as well as those that endorse coercive and segregated treatments, were more likely to rate resource allocation to mandated care as important. Perceived treatment efficacy was also positively associated with resource allocation preferences for mandated treatment. A separate behavioral measure that involved donating money to NAMI was found to be inversely associated with blaming people for their mental illness and not being willing to help them. Implications of these findings on strategies that seek to increase resources for mental health programs are discussed.

Adult↗
PubMed1988

AIDS and public health.

After briefly stating the significance of acquired immunodeficiency syndrome (AIDS) for public health, this paper considers programs or proposals to control the spread of AIDS in the following eight general areas: (a) education; (b) distribution of sterile needles; (c) screening and treatment of blood, blood products, and other tissues; (d) voluntary and mandatory screening of persons for evidence of infection; (e) reporting; (f) contact tracing; (g) isolation and other restrictions on freedom of movement or association; and (h) physical marking of persons with AIDS. Significant moral issues within each of these areas are discussed, and the overall justifiability of various proposals is examined.

Acquired Immunodeficiency Syndrome↗
PubMed1977

State supplementation under SSI, 1975.

This article summarizes State supplementation activities under SSI for 1975. It discusses changes in the State programs that occurred during 1975 and presents some comparisons with data for 1974--the initial year of the SSI program. A slight shift occurred in the distribution of recipients by eligibility category for Federal and State supplementation from 1974 to 1975. During 1975 a few States changed from Federal administration to State administration of their mandatory supplementation programs while a few others initiated or expanded their optional supplementation programs. Several States also increased their supplements during the year.

Financing, Government↗
PubMed1992

The feasibility of mandatory HIV testing for health professionals and other special populations.

Infection with the human immunodeficiency virus (HIV) has become an increasingly important public health problem. Due to the profound increase in the incidence of the disease, testing has become an important tool in prevention efforts as well as treatment. In view of the dire prognosis associated with the diagnosis of HIV infection, there is a great deal of interest in mandatory HIV testing of special groups. Mandatory testing has been implemented for several groups such as the United States military. However, there are a number of issues to be considered before implementing a mandatory testing program. These include the predictive value and accuracy of the tests themselves, confidentiality and the social ramifications of breaches in confidentiality, the likelihood of forcing high risk persons underground to avoid testing, and the constitutionality of a mandatory testing policy. Since the discovery of the apparent transmission of HIV infection from a dentist to his patients, there has been increasing interest in a policy mandating the testing of health professionals. However, in view of the low risk of transmission to patients, it would be ill-advised to require HIV testing of health care workers. In general, the benefits of a mandatory testing policy do not outweigh the human and financial costs it would engender.

AIDS Serodiagnosis↗
PubMed2004

The effect of an education program on the incidence of central venous catheter-associated bloodstream infection in a medical ICU.

OBJECTIVE: To determine whether an education initiative could decrease the rate of catheter-associated bloodstream infection. DESIGN: Preintervention and postintervention observational study. SETTING: The 19-bed medical ICU in a 1,400-bed university-affiliated urban teaching hospital. PATIENTS: Between January 2000 and December 2003, all patients admitted to the medical ICU were surveyed prospectively for the development of catheter-associated bloodstream infection. INTERVENTION: A mandatory education program directed toward ICU nurses and physicians was developed by a multidisciplinary task force to highlight correct practices for the prevention of catheter-associated bloodstream infection. The program consisted of a 10-page self-study module on risk factors and practice modifications involved in catheter-related bloodstream infections and in-services at scheduled staff meetings. Each participant was required to complete a pretest before reviewing the study module and an identical test after completion of the study module. Fact sheets and posters reinforcing the information in the study module were also posted throughout the ICU. MEASUREMENTS AND MAIN RESULTS: Seventy-four episodes of catheter-associated bloodstream infection occurred in 7,879 catheter-days (9.4 per 1,000 catheter-days) in the 24 months before the introduction of the education program. Following implementation of the intervention, the rate of catheter-associated bloodstream infection decreased to 41 episodes in 7,455 catheter days (5.5 per 1,000 catheter-days) [p = 0.019]. The estimated cost savings secondary to the decreased rate of catheter-associated bloodstream infection for the 24 months following introduction of the education program was between $103,600 and $1,573,000. CONCLUSIONS: An intervention focused on the education of health-care providers on the prevention of catheter-associated bloodstream infections may lead to a dramatic decrease in the incidence of primary bloodstream infections. Education programs may lead to a substantial decrease in medical-care costs and patient morbidity attributed to central venous catheterization when implemented as part of mandatory training.

Bacteremia↗
PubMed1990

Technical workshop report: Working Group II: agricultural occupational health and safety services for farmers and ranchers.

This work group felt that there is compelling evidence that effective occupational health services are essential to improve the serious occupational safety and health problems in agriculture. Program initiatives may be stimulated by federal and state governments, but development and implementation must involve the grassroots farm community and local resources. Other countries (Sweden, Finland, Canada) are far ahead of the United States in this area and serve as examples. Developing services should be comprehensive and should include clinical, technical, and educational efforts. Marketing programs to the public must include grassroots involvement. Surveillance and program evaluation are essential in any new program efforts. Funding such programs must be shared by federal, state, local, and private resources. Regulatory options should be a minimal part of such a program, but mandatory rollover protective devices and mandatory reporting seems to be one feasible regulatory option.

Accidents, Occupational↗
PubMed2003

Educating researchers: ethics and the protection of human research participants.

To improve the protection of human participants in research, the federal government has mandated education and training in bioethics and issues relevant to human research. Despite the large time and financial commitments involved with such education, little is known about whether these efforts will actually improve the protection of human subjects. In this article, I review the history of ethics education in research leading up to the 2000 mandate. I then explore ethics education and its evaluation in the biological sciences and medicine and describe the previous successes and failures of these efforts. Many objectives can be the focus of educational interventions and evaluation. Some interventions in these fields had small, though statistically significant, effects on moral reasoning skills, knowledge, and confidence. Interventions are more likely to have lasting impact on moral reasoning if they were of moderate duration and involved small group discussion of dilemmas. Whether these measurable differences lead to changes in behavior or real-time application of moral reasoning skills remains to be determined. By having a clear understanding of the specific objectives, strengths, and limitations of an educational intervention, educators can design programs that may have an increased likelihood of improving protection of human research participants.

Ethics, Research↗
PubMed1980

Antabuse: medication in exchange for a limited freedom--is it legal?

Recidivism among alcohol offenders--drunken drivers in particular--has led courts to experiment with programs that attempt to rehabilitate problem drinkers. One such program, in El Cajon, California, offers defendants the choice of going to jail or of submitting to a year of treatment with Antabuse, a potent drug that reacts with alcohol to produce intensely painful physical symptoms. In addition, Antabuse subjects the recipient to the risk of toxic side effects. According to the authors, the El Cajon program fails to inform defendants of the full risks and effects of Antabuse. Further, the authors maintain that the program uses the threat of a jail sentence to coerce defendants into consenting to Antabuse therapy. The authors conclude that defendants' consent is so tained by these factors that the program amounts to involuntary treatment. Consequently, the authors suggest that the El Cajon program violates defendants' constitutional right to privacy. Finally, the severity of the Antabuse-alcohol reaction leads the authors to contend that the program constitutes cruel and unusual punishment.

Accident Prevention↗
PubMed1992

The stigma of disease: implications of genetic screening.

As the field of human genetics successfully continues to unravel the secrets of an individual's genetic makeup, the social processes of stigmatization and ostracism of those with "undesirable" traits have the potential to increase. An historical example that may shed light on the problems of applying genetic technology to disease prevention is the institution of quarantine. This essay discusses the concept of "quarantine mentality" and the desire for healthy society to separate itself from those labeled "ill" or abnormal, and addresses two episodes in American history when genetics was applied to the formulation of social policy toward the "diseased": the eugenics movement of the early 20th century and the early attempts of genetic screening programs for sickle cell anemia during the 1970s.

Anemia, Sickle Cell↗
PubMed2004

Effectiveness of mandatory license testing for older drivers in reducing crash risk among urban older Australian drivers.

Most licensing jurisdictions in Australia maintain mandatory assessment programs targeting older drivers, whereby a driver reaching a specified age is required to prove his or her fitness to drive through medical assessment and/or on-road testing. Previous studies both in Australia and elsewhere have consistently failed to demonstrate that age-based mandatory assessment results in reduced crash involvement for older drivers. However studies that have based their results upon either per-population or per-driver crash rates fail to take into account possible differences in driving activity. Because some older people maintain their driving licenses but rarely if ever drive, the proportion of inactive license-holders might be higher in jurisdictions without mandatory assessment relative to jurisdictions with periodic license assessment, where inactive drivers may more readily either surrender or lose their licenses. The failure to control for possible differences in driving activity across jurisdictions may be disguising possible safety benefits associated with mandatory assessment. The current study compared the crash rates of drivers in Melbourne, Australia, where there is no mandatory assessment and Sydney, Australia, where there is regular mandatory assessment from 80 years of age onward. The crash rate comparisons were based on four exposure measures: per population, per licensed driver, per distance driven, and per time spent driving. Poisson regression analysis incorporating an offset to control for inter-jurisdictional road safety differences indicated that there was no difference in crash risk for older drivers based on population. However drivers aged 80 years and older in the Sydney region had statistically higher rates of casualty crash involvement than their Melbourne counterparts on a per license issued basis (RR: 1.15, 1.02-1.29, p=0.02) and time spent driving basis (RR: 1.19, 1.06-1.34, p=0.03). A similar trend was apparent based on distance travelled but was of borderline statistical significance (RR: 1.11, 0.99-1.25, p=0.07). Collectively, it can be inferred from these findings that mandatory license re-testing schemes of the type evaluated have no demonstrable road safety benefits overall. Further research to resolve this on-going policy debate is discussed and recommended.

Accidents, Traffic↗
PubMedDate not supplied

Newborn genetic screening: ethical and social considerations for the nineties.

As we head into the next decade, the impact of the use of genetic screening programs for immunological surveillance purposes (such as for HIV) and for possible DNA typing should not be underestimated. The authors present ten principles which seek to reaffirm the basic tenents of neonatal screening programs -- the benefit of newborns. These principles are both protective and yet open to the complex ethical and social considerations raised by such new uses of newborn genetic screening programs.

Coercion↗
PubMed2002

Drug treatment courts, British style: the drug treatment court movement in Britain.

There has been an uneven pattern of development of drug treatment courts throughout Britain. The Republic of Ireland has a drug treatment court and Scotland will have one by the end of 2001, but there are no drug treatment courts in England and Wales, or Northern Ireland, although in the latter there is a growing interest. It is suggested the Drug Treatment and Testing Order (DTTO) in England and Wales has acted as an impediment as this is a very weak version of drug treatment court and was proposed by the Prime Minister when Shadow Home Secretary. Drug treatment courts in Eire and Scotland have adapted their program to fit local conditions, although neither have opted for a fully fledged drug user treatment court on the Miami model.

Crime↗
PubMed2005

Problem-based learning in medical informatics for undergraduate medical students: an experiment in two medical schools.

PURPOSE: The objective of this work was to assess problem-based learning (PBL) as a method for teaching information and communication technology in medical informatics (MI) courses. A study was conducted in the Schools of Medicine of Rennes and Rouen (France) with third-year medical students. METHODS: The "PBL-in-MI" sessions included a first tutorial group meeting, then personal work, followed by a second tutorial group meeting. A problem that simulated practice and was focused on information technology was discussed. In Rouen, the students were familiar with PBL, and they enrolled on a voluntary basis, while in Rennes, the students were first-ever participants in PBL courses, and the program was mandatory. One hundred and seventy-seven students participated in the PBL-in-MI sessions and were given a questionnaire in order to evaluate qualitatively the sessions. RESULTS AND DISCUSSION: The response rate was 92.1%. The overall opinion of the students was good. 69.8% responded positively to the program. In Rouen, where the students participated in PBL-in-MI sessions on a voluntary basis, the students were significantly more enthusiastic about PBL-in-MI. Moreover, attitudes and opinions of students are plausibly related to differences in previous PBL skills. The fact that the naïve group had two tutors, one trained and one naïve as the students, has been investigated. Teacher naivety was an explanatory factor for the differences between Rennes and Rouen.

Consumer Behavior↗
PubMed2003

Prior Alcoholics Anonymous (AA) affiliation and the acceptability of the Twelve Steps to patients entering UK statutory addiction treatment.

OBJECTIVE: The study investigates levels of affiliation with AA and beliefs about the organization and its philosophy among a cohort of alcoholics entering a UK (non-AA) alcohol treatment service. METHOD: A total of 150 consecutive admissions (75% men) were interviewed by an independent researcher within 5 days of their entry into a residential alcohol treatment unit. RESULTS: Although about three quarters of these patients had previously attended AA meetings, levels of affiliation were low, with only 16% having worked any of the Twelve Steps. Previous AA attenders were more likely to be older, drinking greater daily quantities prior to treatment and to have first sought alcohol treatment at a younger age. Roughly equal groups expressed "positive," "neutral" and "negative" current attitudes towards AA (38%, 36% and 26%, respectively). Each of these three AA-attitude groups expressed greater endorsement of "Personal Responsibility" steps than of "Higher Power mediated" steps. CONCLUSIONS: Few participants were universally negative to AA or the Twelve Steps--most regarded some of the steps as positive, but many rejected those referring to a Higher Power. Most also regarded some aspects of the organization and its philosophy worthwhile, with attitudes spread across the continuum of opinion. As AA remains one of the most widely sought forms of help for alcohol problems, a clearer understanding is needed of its impact on patients and the appropriateness of its integration within substance misuse programs which are not explicitly Twelve Step in orientation.

Adult↗
PubMedDate not supplied

Motivational interviewing in a group setting with mandated clients: a pilot study.

Some clients who are court-ordered to undergo substance abuse treatment are not able or willing to identify treatment-related goals. This situation can cause difficulties in the therapeutic relationship and compromise treatment. To address this problem, we offered a group-based motivational enhancement program prior to standard treatment. Over 2 years, 73 clients attended the motivation group while 94 did not. Compared to those who did not, those who attended the motivation group were significantly less likely to meet criteria for substance abuse dependence, they attended a higher proportion of their treatment sessions, and they were more likely to have completed treatment. After controlling for diagnosis, employment, and age, attending the motivation group was still related to higher rates of attendance and treatment completion. A motivation group may promote better participation in substance abuse treatment programs among persons who do not identify treatment goals. Additional research is needed to draw firm conclusions.

Adult↗
PubMedDate not supplied

[On patient's advocacy within the framework of health insurance].

According to statistics, every second registered petition filed by citizens is acknowledged as substantiated in the Omsk Region. The authors' data demonstrate that the main reason for such petitions with complaints submitted by citizens to various institutions is preconditioned by inaccessibility or limitations in receiving the free-of-charge medical care guaranteed by legislation. Methodological approaches to solving the problem of protecting the rights of citizens to receiving the free-of-charge medical care within the framework of the Compulsory Medical Insurance (CMI) territorial program and practical mechanisms of their realization are described by using the example of the Omsk Region.

Health Services↗