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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↗
PubMed1988

Concerns of medical and pediatric house officers about acquiring AIDS from their patients.

To assess the degree of house officers' concerns about acquiring AIDS (acquired immunodeficiency syndrome) from their patients, we surveyed 263 medical and pediatric interns and residents in four housestaff training programs affiliated with seven New York City hospitals with large AIDS patient populations; 258 questionnaires (98 per cent) were returned. Thirty-six per cent of medical and 17 per cent of pediatric house officers reported percutaneous exposures to needles contaminated with blood of AIDS patients. Forty-eight per cent of medical and 30 per cent of pediatric house officers reported a moderate to major concern about acquiring AIDS from their patients. Greater concern about personal risk was noted in those house officers who were earlier in their residency training, who reported having treated a greater number of AIDS patients, and who were in medicine rather than pediatrics programs. Twenty-five per cent of all respondents reported that they would not continue to care for AIDS patients if given a choice. The results demonstrate a substantial degree of concern about acquiring AIDS among house officers caring for AIDS patients and suggest the need for housestaff program administrators for formally address these concerns.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Retention of court-referred youths in residential treatment programs: client characteristics and treatment process effects.

The juvenile justice system relies heavily on residential treatment services for adolescents. Because treatment dropout limits the likely effectiveness of these services, in this study we examine the client and program characteristics associated with program retention among a sample of adolescent probationers referred to residential rehabilitation by the Juvenile Court in Los Angeles. Participants in the present study (n = 291) are a subset of those in the Adolescent Outcomes Project, conducted within RAND's Drug Policy Research Center, to examine the outcomes of youths entering treatment at seven residential treatment programs. Three months after a preadmission interview, youths were asked about their perceptions of counselors at the program, other residents, and their feelings of safety in the program. In addition, they were asked whether they needed and had received various services (e.g., job training, legal advice, family counseling). Results of a multivariate survival analysis revealed that pretreatment characteristics including motivation and substance use severity, as well as treatment program factors including safety, and perceived over- and underprovision of services, contribute significantly to the prediction of retention. Pretreatment environmental risk factors and ratings of program counselor and resident support were marginally significant. These results imply that changes in adolescent residential program delivery may serve to increase retention rates, thus improving long-term outcomes.

Adolescent↗
PubMed2006

Health services research as a source of legislative analysis and input: the role of the California Health Benefits Review Program.

This article examines the role of the California Health Benefits Review Program (CHBRP) as a source of information in state health policy making. It explains why the California benefits review process relies heavily on university-based researchers and employs a broad set of criteria for review, which set it apart from similar programs in other states. It then analyzes the politics of health insurance mandates and how independent research and analysis might alter the perceived benefits and costs of health insurance mandates and thus political outcomes. It considers how research and analysis is typically used by policy makers, and illustrates how participants inside and outside of state government have used the reports prepared by CHBRP as both guidance in policy design and as political ammunition. Although there is consensus that the review process has reduced the number of mandate bills that are passed out of the legislature, both supporters and opponents favor the new process and generally believe the reports strengthen their case in legislative debates over health insurance mandates. The role of the CHBRP is narrowly defined by statute at the present time, but the program may well face pressure to evolve from its current academic orientation into a more interactive, advisory role for legislators in the future.

California↗
PubMed1990

Expanding health insurance coverage: who will pay?

Recent discussions on extending health insurance to the more than thirty million uninsured Americans have focused on two strategies: expanding the Medicaid program and mandating that employers sponsor coverage for their employees. This analysis, using a microsimulation model of the U.S. health care financing system, suggests that these two options would result in very different distributions of financial burden. Employer-sponsored coverage is financed in a highly regressive fashion, in contrast to the Medicaid program, which is proportional to income. Furthermore, the burden of paying for health care under Medicaid varies little among generations, whereas the cost of employer-sponsored care is lowest in households headed by persons over sixty-five years old. Low health status populations do not pay disproportionately higher taxes or premiums to finance either the Medicaid program or employer-sponsored coverage. Their incomes, however, are more effectively protected by Medicaid, because it offers more comprehensive benefits.

Costs and Cost Analysis↗
PubMed1999

A systematic overview of interventions to reduce physical restraint use in long-term care settings.

PURPOSE: The purpose of this systematic integrative review was to summarize the empirical evidence regarding the effectiveness of interventions or programs to reduce physical restraint use in long-term care facilities. CONCLUSIONS: Research findings indicate that physical restraint reduction programs which included an educational component, restraint removal, and interventions individualized to residents' specific needs were successful in decreasing restraint use. There were no significant negative consequences for residents or staff associated with the implementation of restraint reduction programs or interventions. Educational programs had a positive impact on nurses' knowledge, attitudes, and practices regarding restraint use. Findings, however, must be considered in light of the methodological weaknesses noted in the studies. IMPLICATIONS: The practice goal of achieving least-restraint or restraint-free long-term care facilities is an appropriate and achievable one. This objective can be facilitated through ongoing mandatory educational programs for staff, individualized assessment and implementation of appropriate interventions for residents, and adequate administrative support. Well-designed research studies investigating the efficacy of specific interventions, cross-cultural issues, and longitudinal outcomes would all contribute to the further development of evidence-based practice regarding restraint use in long-term care facilities.

Journal Article↗
PubMed2001

Xenotransplantation: consent, public health and charter issues.

There is a growing body of literature and commentary analyzing the ethical and public policy concerns associated with xenotransplantation. While this technology holds great promise to provide an almost limitless supply of organs for transplantation, there remains grave concern about possible public health ramifications. As a result, it has been recommended that patients who undergo xenotransplantations will need to agree, inter alia, to a lifetime of close health monitoring, participation in an international database and autopsy upon death. It has been suggested that this agreement would transform the nature of informed consent into a "binding contract." Though such draconian measures are understandable given the magnitude of the risks involved, would existing common law and legislation allow their implementation? This paper analyzes relevant Canadian consent and public health law in the context of the xenotransplantation. Canada is a country with a particularly rich body of informed consent jurisprudence--jurisprudence firmly rooted (rightly or not) in the ethical principle of autonomy. In this climate, many of the suggested monitoring strategies would find little support from Canadian law. Before xenotransplantations proceed, policy makers must be sensitive to the legal barriers which exist to the implementation [of] effective public health measures. Effective surveillance programs will require novel approaches to consent and the enactment of specific public health laws.

Animals↗
PubMed1991

Compulsory treatment for drug-dependent persons: justifications for a public health approach to drug dependency.

Compulsory treatment for drug users is often rejected as neither an effective nor an acceptable exercise of state authority. Recent research studies indicate that compulsory treatment can work and that, if carefully put into effect, it can represent an important public health component of the response to drug use. Finally, a program of compulsory treatment can be shaped with concerns for due process in mind, so that civil liberties will not be violated.

Behavior Control↗
PubMed2004

Gene therapy, fundamental rights, and the mandates of public health.

Recent and near-future developments in the field of molecular biology will make possible the treatment of genetic disease on an unprecedented scale. The potential applications of these developments implicate important public policy considerations. Among the questions that may arise is the constitutionality of a state-mandated program of gene therapy for the purpose of eradicating certain genetic diseases. Though controversial, precedents of public health jurisprudence suggest that such a program could survive constitutional scrutiny. This article provides an overview of gene therapy in the context of fundamental rights and the mandates of public health.

Abortion, Induced↗
PubMed2003

A preventable outbreak of pneumococcal pneumonia among unvaccinated nursing home residents in New Jersey during 2001.

OBJECTIVE: To characterize risk factors for invasive pneumococcal infection in a nursing home outbreak. DESIGN: Outbreak investigation, case-control study. SETTING: A 114-bed nursing home in New Jersey. PARTICIPANTS: Case-patients were nursing home residents hospitalized with febrile respiratory illness and radiographic findings consistent with pneumonia, and either sputum specimens positive for diplococci or blood cultures positive for Streptococcus pneumoniae, with illness onset during April 3-24, 2001. Control-patients were selected randomly from remaining residents without respiratory symptoms. METHODS: Chart reviews were performed for case-patients and control-patients. Serotyping and susceptibility testing were performed on S. pneumoniae isolates. Long-term-care facilities (LTCFs) were surveyed to assess compliance with a state regulation mandating pneumococcal vaccination of residents 65 years and older. RESULTS: Nine case-patients were identified, with a median age of 86 years (range, 78 to 100 years). The median age of control-patients was 86 years (range, 58 to 95 years). No case-patients versus 9 (50%) control-patients received pneumococcal vaccine before the outbreak (OR, 0; CI95, 0-0.7). Recent antibiotic use, pneumonia history, and physical functioning were not associated with illness. Illness attack rate was 16% among all unvaccinated residents versus 0 among vaccinated residents. S. pneumoniae serotype 14, included in pneumococcal vaccine, was isolated from blood cultures of 7 case-patients. Of 361 LTCFs (42%) that replied to the survey, 28 (8%) were not complying with state immunization regulations. CONCLUSIONS: This outbreak occurred in an LTCF with low vaccine coverage. Implementing standing order programs, enforcing regulations, documenting vaccinations, and providing education might increase coverage among nursing home residents.

Aged↗
PubMed1990

HIV infection, pregnant women, and newborns: A policy proposal for information and testing.

As the public health impact of human immunodeficiency virus (HIV) infection in women and children has increased, so has interest in screening pregnant women and newborns for evidence of HIV infection. However, screening of pregnant women and newborns raises profound moral, legal, and policy issues. In this article, we present and defend a detailed 10-point program of policy recommendations for both pregnant women and newborns. We advocate informing all pregnant women and new mothers about the HIV epidemic and the availability of testing.

AIDS Serodiagnosis↗
PubMedDate not supplied

Evidence-based program requirements: evaluation of statistics as a required course.

A retrospective student record review was conducted to determine how achievement in a prerequisite statistics course related to achievement in nursing research courses and the overall program for undergraduate and graduate nursing students. For undergraduate students (n=218 generic, n=111 RN/BS), the statistics grade was associated with 4.3 percent of the variance in research course grades and 6.8 percent of the variance in graduating grade point average (GPA), controlling for entering GPA. For students in accelerated second-degree programs (n=33), there were minimal differences in mean research course grades and graduating GPA between students with and without prior statistics courses. For master's degree students (n=160), higher statistics grades were not associated with graduate research course grades. At best, the amount of prediction associated with statistics course grades was found to be small and not educationally meaningful. The value of statistics as a program requirement for undergraduate or graduate nursing students cannot be supported by these analyses.

Analysis of Variance↗