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PubMed1999

Partner notification for chlamydial infections among private sector clinicians in Seattle-King County: a clinician and patient survey.

BACKGROUND & OBJECTIVES: To describe partner notification practices for chlamydial infections among private sector clinicians. STUDY DESIGN: Telephone interviews of clinicians and patients identified through public health case reports in Seattle-King County, August-October 1998. RESULTS: Clinicians reported advising 135 of 150 (90%) patients to notify their sex partners, but knew that all partners of only 26 (17%) patients received treatment. While 71 (57%) clinicians acknowledged ever providing medicine-to a patient to give to a partner, only 6 (4%) so treated a patient about whom they were interviewed. Most (87%) clinicians believed the health department should routinely contact all patients about partner notification. Almost all patients (72/76-95%) reported that their provider had advised them to notify their partners and 59 (78%) stated they did so. Most patients (11/17-65%) who did not notify all of their partners would have been willing to allow their clinician or the heath department to do it for them. CONCLUSION: Private sector clinicians and their patients are generally unaware of chlamydial partner notification outcomes but are receptive to expanded partner notification services.

Adult↗

PubMed2000

To notify or not to notify: STD patients' perspectives of partner notification in Seattle.

BACKGROUND AND OBJECTIVES: To obtain patients' perspectives on why only some partners are notified in partner-notification programs, the cornerstone of sexually transmitted disease (STD) control, although low proportions of partners are located and evaluated. GOALS: To describe patterns of partner notification reported by persons with STD infection. STUDY DESIGN: In-depth interviews conducted in Seattle with 60 heterosexual men and women with gonorrhea, chlamydial infection, or nongonoccocal urethritis, and 19 men with gonorrhea reporting sex with men (MSM) were tape recorded, transcribed verbatim, and content analyzed. RESULTS: The typical notification pattern was to notify a main partner but not others. Least likely to be notified were partners perceived as transmitters, contacts preceding the onset of symptoms, the oral sex and anonymous contacts of MSM, one-time partners of men, and incarcerated and former partners of women. Fears among young heterosexual participants included gossip and violence (women). Fears among MSM included rejection. CONCLUSIONS: Partner-notification programs should develop innovative approaches for partners perceived as transmitters, oral-sex only contacts of MSM, and contacts preceding symptom onset.

Adolescent↗

PubMed1983

Selection of an obstetric data base for a microcomputer and its use for on-line production of birth notification forms, discharge summaries and perinatal audit.

A microcomputer system is described which stores data for perinatal audit and produces 'on-line' the statutory birth notification form and mother and baby discharge summary. The derivation of a minimum data-base and the methods used to obtain reliable data are outlined. The results of a trial of the production of the birth notification form for 195 deliveries are reported together with those of a further trial of 86 deliveries in which the system was used to produce both the notification form and the discharge summary. A study of the accuracy of the handwritten birth notification forms revealed a high error rate which was markedly reduced by the use of the microcomputer system. The system is now in routine use and further developments are outlined.

Computers↗

PubMed2005

Partner notification of chlamydia infection in primary care: randomised controlled trial and analysis of resource use.

OBJECTIVE: To evaluate the effectiveness of a practice nurse led strategy to improve the notification and treatment of partners of people with chlamydia infection. DESIGN: Randomised controlled trial. SETTING: 27 general practices in the Bristol and Birmingham areas. PARTICIPANTS: 140 men and women with chlamydia (index cases) diagnosed by screening of a home collected urine sample or vulval swab specimen. INTERVENTIONS: Partner notification at the general practice immediately after diagnosis by trained practice nurses, with telephone follow up by a health adviser; or referral to a specialist health adviser at a genitourinary medicine clinic. MAIN OUTCOME MEASURES: Primary outcome was the proportion of index cases with at least one treated sexual partner. Specified secondary outcomes included the number of sexual contacts elicited during a sexual history, positive test result for chlamydia six weeks after treatment, and the cost of each strategy in 2003 sterling prices. RESULTS: 65.3% (47/72) of participants receiving practice nurse led partner notification had at least one partner treated compared with 52.9% (39/68) of those referred to a genitourinary medicine clinic (risk difference 12.4%, 95% confidence interval -1.8% to 26.5%). Of 68 participants referred to the clinic, 21 (31%) did not attend. The costs per index case were 32.55 pounds sterling for the practice nurse led strategy and 32.62 pounds sterling for the specialist referral strategy. CONCLUSION: Practice based partner notification by trained nurses with telephone follow up by health advisers is at least as effective as referral to a specialist health adviser at a genitourinary medicine clinic, and costs the same. Trial registration Clinical trials: NCT00112255.

Chlamydia Infections↗

PubMed1984

The quality of notification of congenital malformations.

The United Kingdom Congenital Malformations Notification Scheme began in 1964. It is based on notes added to birth notification forms. In Birmingham, a local scheme based on multiple sources has been run in parallel for the last 20 years. The national notification scheme records malformations noted up to the age of 7 days, whereas the Birmingham scheme collects information up to the age of 5 years. A case by case record linkage of the two registers was carried out. This operation revealed the essential completeness of the multiple-source register but gross defects among notifications. The extent and nature of the deficiencies are described. They include defects of ascertainment of malformed infants and of major additional malformations in those infants who are in fact notified, overnotification of infants without significant malformations, and misclassification of the major malformations that were, in fact, notified. The defects arise partly from the defective design of the national scheme and partly from defective implementation and a lack of designated supervisory responsibilities. The main requirements for a scheme that could indeed be relied upon to meet its monitoring objectives are set out.

Congenital Abnormalities↗

PubMed1988

Changes in tuberculosis notification rates in the white ethnic group in England and Wales between 1953 and 1983.

Since the early 1960s notification rates for tuberculosis in England and Wales for the whole population have been influenced by high rates in certain ethnic groups. Using data based on country of birth from the British (Thoracic and) Tuberculosis Association surveys of 1965 and 1971, and based on ethnic origin from the Medical Research Council surveys in 1978/79 and 1983, rates for the white ethnic group have been estimated at those four times, and compared with the published rates for the whole population in 1953, when only a very small proportion was of non-white ethnic origin. Between 1953 and 1983 the notification rate for the white ethnic group fell from 122.2 to 11.3 per 100,000 for males, an annual decline of 7.7%, the corresponding rates for females being 90.1 and 5.8, an annual decline of 8.8%. The greatest annual declines occurred between 1953 and 1965, 9.4% for males and 11.2% for females. The annual declines in the most recent period, 1978/79 to 1983, were 6.9% for males and 7.3% for females. In both sexes the decline was greatest in the 15-24 year age group and least in the oldest age group, and this has led to a change in the age pattern of annual notification rates. The highest rates in both sexes occurred in young adults in 1953 but in the oldest age groups in 1983. There is however no evidence of any cohort experiencing an increase in notification rate with increasing age.

Adolescent↗

PubMed1998

Partner notification for gonorrhoea: a comparative study with a provincial and a metropolitan UK clinic.

OBJECTIVE: To compare partner notification practice and outcomes at a provincial and a metropolitan clinic. DESIGN: Prospective study, following standardisation of partner notification policy. SETTINGS: Sheffield Department of Genitourinary Medicine, Royal Hallamshire Hospital and Jefferiss Wing Centre for Sexual Health, St Mary's Hospital, London. SUBJECTS: Consecutive patients with culture positive gonorrhoea between October 1994 and March 1996 who were interviewed by a health adviser. RESULTS: In Sheffield, 235 cases reported 659 outstanding contacts, of whom 129 (20%) were subsequently screened, and 65 (50%) had gonorrhoea. At St Mary's 510 cases reported 2176 outstanding contacts, of whom 98 (5%) were known to have been screened, and 53 (54%) had gonorrhoea. Patient or provider referral agreements appeared more productive in Sheffield, where 60% resulted in contact attendance, compared with 13% at St Mary's. Provider referral was used more frequently in Sheffield, for 44% of referrals, compared with 1% at St Mary's. Multivariate analysis showed that partner notification was less effective for casual and short term (< 7 days) partnerships in both centres, and for homosexual men at St Mary's. CONCLUSION: Partner notification outcomes were better in the provincial setting where contact attendance could be recorded more reliably and provider referral was used more extensively. The high proportion of contacts who remained untraced in both settings indicates the need for complementary screening and prevention initiatives.

Adult↗

PubMed2005

The educational intervention "GRIEV_ING" improves the death notification skills of residents.

BACKGROUND: Death notification is a common, difficult, and emotionally laden communication for emergency physicians. Teaching emergency medicine residents the skills for success in this communication is an important focus for educators. To accomplish this task, educators need practical, proven teaching and assessment tools focused on death notification skills. OBJECTIVES: To test the hypothesis that a teaching module, based on the mnemonic "GRIEV_ING," could improve resident confidence, competency, and communication skills when delivering a death notification. METHODS: The GRIEV_ING intervention consisted of a two-hour educational session composed of small-group, role-play, and didactic experiences. The authors used a pre-post-retention repeated-measures design to test their hypothesis immediately following and three months after training. For each assessment cycle, three quantitative measures were collected: self-confidence, relationship-communication, and competency. Relationship-communication and competency scores were collected during simulated survivor encounters. RESULTS: Complete data for 20 residents were obtained. Significant improvements were noted in resident confidence scores at the pre-post (F = 16.7, p <0.0001) and pre-retention (F = 14.0, p = 0.001) comparisons. Likewise, significant improvements were noted in resident competence scores at the pre-post (F = 4.7, p = 0.04) and pre-retention (F = 8.8, p = 0.008) comparisons. Resident relationship-communication scores were uniformly high, and there was no significant change in this score across study intervals. CONCLUSIONS: This study demonstrates that a defined educational intervention focused on the GRIEV_ING mnemonic can improve physician confidence and competence in death notification.

Adult↗

PubMed1997

Hereditary cancer risk notification and testing: how interested is the general population?

PURPOSE: Great interest in predictive testing for hereditary cancer syndromes has been reported. Prior research has focused on testing for specific hereditary syndromes and/or among individuals at high risk for positive carrier status. Given anticipated expansion of both the range of hereditary syndromes for which testing will be available, as well as the clinical settings in which testing will occur, assessment of interest in hereditary cancer risk testing and notification in the general public is warranted. METHODS: As part of an annual statewide telephone survey, adults' (N = 654) interest in hereditary cancer risk testing and notification was assessed. RESULTS: Interest in both risk testing (82%) and risk notification (87%) was high. Logistic regression analyses indicated that disinterest in risk notification was associated with female sex, performance of fewer health protective behaviors, and better perceptions of personal health. Disinterest in risk testing was associated with these same variables as well as older age, less concern over developing cancer, and a more extensive history of cancer in first degree relatives. CONCLUSION: In the absence of risk-reducing behaviors with demonstrable efficacy, hereditary risk testing programs may have difficulty attracting the interest of those at greatest risk for carrier status. In contrast, many individuals at low risk for positive carrier status might seek testing, perhaps as a means of seeking reassurance regarding their low hereditary risk.

Adult↗

PubMed2005

Partner notification methods for African American men being treated for trichomoniasis: a consideration of main men, Second Hitters, and Third Players.

This pilot study sought information on African American men's preferences for partner notification methods for a common sexually transmitted infection called trichomoniasis. Two focus groups of African American men were convened at a public STI clinic where they were being treated for trichomoniasis. The groups identified a sexual hierarchy in men's preferences for methods of partner notification. The hierarchy consisted of main men (Cake Daddies), second men (Second Hitters), and third or fourth men (Third Players), with placement depending on age, income, and social status. Health department employees affirmed the existence of a sexual hierarchy in a separate focus group. Sexual and economic bartering formed the basis of the hierarchy, and the secrecy involved in such arrangements presented a considerable challenge for STI control. Disease intervention specialists who were responsible for contact tracing spoke of cat-and-mouse methods in contacting the men without understanding fully exactly how the hierarchy influenced men's responses to partner notification. The findings suggest that STI control efforts must take the sexual hierarchy and its privacy implications into account if partner notification methods are to be acceptable to African American men.

Adult↗

PubMed2004

Sex offender notification and protective behavior.

A primary purpose of sex offender community notification statutes is to give community members the opportunity to engage in precautionary behavior to prevent victimization. This exploratory study examines the effect of notification by comparing the behavior of 87 Hamilton County, Ohio, residents receiving sex offender notification to the behavior of 149 other residents who had not received notification. The findings indicate that notified respondents are significantly more likely to engage in behaviors to protect themselves and others from victimization, and to engage in community reporting behavior.

Adult↗

PubMed1984

Notification of workers at high risk: an emerging public health problem.

During the last two decades, an increasing number of epidemiologic studies have found cohorts of workers to be at high risk of work-related chronic diseases, especially cancers. These studies frequently have led to the broad recognition of occupational hazards and eventually to the prevention of exposures to such hazards. Generally, however, the individual cohort members found to be at high risk have not been notified of study results, and programs of medical intervention or of palliative services directed at these individual workers have not been developed. Recently, the issue of whether or not workers have a right to be notified more directly about known health hazards to which they may have been exposed has emerged as a major, unresolved question in public health policy. Issues of concern include the criteria that should guide notifications; whom, when, and how to notify; and who should pay for notification and follow-up services. This commentary discusses the scientific, ethical, economic, and institutional aspects of worker notification, and describes three new demonstration projects that have provided notification and intervention for workers at high risk of bladder, colon, and lung cancer.

Ethics, Medical↗

PubMed1989

Partner notification in the control of human immunodeficiency virus infection.

Partner notification should be standard public health practice in the control of human immunodeficiency virus (HIV) infection. A universal partner notification program for the United States is affordable, operationally manageable, and can effectively reach high-risk persons. Such a focused approach personalizes the epidemic and probably enhances the efficacy of risk reduction messages. Confidentiality protections are attainable. Voluntary partner notification is acceptable to our constituents; while counseling is "mandatory," testing is optional. Evidence of partner notification's usefulness as a case prevention tool should be a by-product of program outcomes and not a prerequisite for its implementation.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Cost-effectiveness analysis of partner notification program for human immunodeficiency virus infection in Japan.

Successful implementation of partner notification program (PNP) as a part of human immunodeficiency virus (HIV) prevention strategies in some developed countries motivated the execution of cost-effectiveness analysis of this program in Japan. Total number of HIV infected individuals and best estimated number of their partners in 1995 were used to elicit incremental cost-effectiveness ratio over no partner notification program. Index cases and their HIV positive partners world change their sex practice to safer one, thus preventing HIV transmission at a certain rate. This was translated to prevention of certain number of new HIV carriers and finally life years gained were calculated for it. The incremental cost-effectiveness ratio was US$ 4,930 per life year gained. Sensitivity analysis indicated that partner notification program was cost-effective over a wide range of assumptions. These results compare favorably with other medical interventions in Japan. In conclusion, the results of this analysis strongly support the implementation of partner notification program as a part of HIV prevention strategies in Japan.

Adult↗

PubMed2000

Creating notifications tailored for individual workers by using a database: a conceptual framework and its application.

Although prevention strategies to assure good mental health in the workplace have become important, worker notification in studies using psychometric tests has rarely been discussed. Until now it has been difficult to prepare a large number of notifications that are tailored well for individual workers. We have developed a system to create notifications that explain the results for individual workers in plain language using a relational database (RDB). First, scores for each test were divided into categories and the workers' data was classified. Then, explanations were written for each category. RDB software read component files into a database file, integrated all data, and printed out notifications. After the system was developed, we realized its high potential for use in occupational health care, as well as in many other fields. We also report an example of its application.

Databases, Factual↗

PubMed1999

Tuberculosis notifications in Australia, 1997. National TB Advisory Group. Communicable Disease Network Australia and New Zealand.

Since the inception of the National Mycobacterial Surveillance System (NMSS) in 1991, annual crude notification rates for tuberculosis (TB) have remained stable at between 5 and 6 per 100,000 population. In 1997, there was a total of 1,001 TB notifications in Australia, of which 954 were new TB cases and 47 relapses. The corresponding annual crude notification rate for new and relapsed TB was 5.15 and 0.25 per 100,000 respectively. Seventy-nine per cent of notifications that had a country of birth reported were overseas born. In keeping with trends observed over recent reporting years, the populations for which notified TB rates were highest include the overseas born from high prevalence countries and indigenous Australians. The lowest rates of disease have continued to be reported in the non-indigenous, Australian born population. Surveillance reports over the last seven years indicate that the rate of disease in this population is gradually declining.

AIDS-Related Opportunistic Infections↗

PubMed1998

Medical devices; exemption from premarket notification and reserved devices; Class I--FDA. Proposed rule.

The Food and Drug Administration (FDA) is proposing to amend its classification regulations to designate class I devices that are exempt from the premarket notification requirements, subject to certain limitations, and to designate those class I devices that remain subject to premarket notification requirements under the new statutory criteria for premarket notification requirements. The devices FDA is proposing to designate as exempt do not include class I devices that have been previously exempted by regulation from the premarket notification requirements. This action is being taken under the Federal Food, Drug, and Cosmetic Act (the act), as amended by the Medical Device Amendments of 1976 (the 1976 amendments), the Safe Medical Devices Act of 1990 (SMDA), and the Food and Drug Administration Modernization Act of 1997 (FDAMA). FDA is taking this action in order to implement a requirement of FDAMA.

Anesthesiology↗

PubMed2001

Effect of urgent clinician notification of low hemoglobin values.

BACKGROUND: Urgent clinician notification of low hemoglobin values is a common practice. The effect of such notification for samples obtained during an office visit is uncertain. METHODS: We notified the attending physicians in 100 consecutive cases of outpatients with hemoglobin <80 g/L. We reviewed the medical charts of these patients with their personal physicians 1-2 months later. We considered transfusions unnecessary only when given to a clinically stable patient with probable iron deficiency anemia in the absence of chronic diseases that produce the anemia. RESULTS: Overall, 47 (47%) of the patients were referred to the emergency room (ER), and 31 of the 47 (66%) were transfused. Increasing age and decreasing hemoglobin were associated with increased referral of patients to the ER. Six of 31 transfusions were unnecessary. An emergency transfusion was clearly indicated in only 3 of the 31 patients; the other patients were clinically stable. A modified notification strategy excluding microcytic samples >50 g/L would have detected these three patients. Over the follow-up period, no patient not referred to the ER died from complications of anemia, nor were any patients hospitalized with acute symptoms of low hemoglobin. CONCLUSION: In some settings, urgent notification of medical outpatient clinics of patients with hemoglobin <80 g/L may lead to unnecessary ER visits.

Adolescent↗