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PubMed2002

Extended attributes of event monitor systems for criteria-based notification modalities.

The efficacy of event monitors (EMs) at reducing morbidity and mortality of certain clinical conditions (CCs) is well established. In addition, studies have shown that user inverted exclamation mark s preferences on the modality of notification are correlated to the type of reminder or alert. Nonetheless, few institutions have implemented large scale automated monitoring of a considerable number of distinct CCs, and to our knowledge, none of these sizable projects also offer user-customizable communication modalities (CMs) over all monitored conditions. As both the numbers of CMs and CCs increase, the complexity of customizing user preferences amplifies following a geometric progression. This paper demonstrates an automated approach, based on generic notification attributes (NAs) and notification criteria (NC), which significantly simplifies the management and personalization of the CMs for institutions where the manual assignment of a CM for every alert is forbidding. The methods by which these NAs were developed, their significance for existing CCs and their implementation using the Arden Syntax and Guideline interchange format (GLIF) are described. The proposed Criteria-Based Notification is shown to improve two facets of the management of event monitors: 1) the assignment of CMs becomes independent from clinical conditions, de-facto removing institution-specific CMs from the knowledge bases of the event monitors and inserting CC-specific and institution-independent NAs, thus increasing their reusability and sharability; 2) knowledge-based independent NAs facilitate both institution-level management and user-level preference configuration.

Decision Making, Computer-Assisted↗

PubMed1991

Under-reporting in hepatitis B notifications.

Notification and laboratory data for the period January 1985-December 1988 were compared in order to estimate: (i) the minimum level of under-reporting of hepatitis B; and (ii) the consistency of the level of under-reporting, both regionally and nationally. Ratios between hepatitis B notifications and positive hepatitis B laboratory tests (reporting ratios) were calculated to quantify the discrepancy between these parameters. There were at least 7 positive hepatitis B laboratory results for each notified case of hepatitis B during each year studied. The differences between the national reporting ratios for each of the study years were small, indicating that nationally the level of reporting of hepatitis B is fairly consistent. The Cape region had the highest and most constant level of hepatitis B reporting compared with other regions. We conclude that the national incidence of hepatitis B is at least 7 times higher than that calculated from notification data. Further, the inter-year analysis of hepatitis B notification data to identify trends nationally and within the Cape region is valid. However, caution is called for when comparing the incidence rates between regions due to inter-region and region-specific inter-year inconsistencies in reporting levels.

Hepatitis B↗

PubMed1985

Notification of a cohort of workers at risk of bladder cancer.

Surviving members of occupational cohorts studied in retrospective analyses of mortality usually are not notified individually of positive study results. However, concern has arisen that such results may contain risk information pertinent to study subjects. To evaluate the effects and implications of individually notifying survivors of such cohorts, we conducted a pilot notification study. Members of a cohort of 1,385 chemical workers who had handled carcinogenic amines were notified by mail that they were likely to be at increased risk of bladder cancer. Also a bladder cancer screening and follow-up program was established. The study demonstrated that notification is a complex action and that much care needs to be taken when communicating information on risk. Notification requires development of (1) criteria as to what constitutes a notifiable risk and (2) programs to meet the medical and social needs of the various parties involved in notification.

Carcinogens↗

PubMed1982

The geographical distribution of tuberculosis notifications in a national survey of England and Wales (1978-79). Report from the Medical Research Council Tuberculosis and Chest Diseases Unit.

A survey of tuberculosis notifications from 1 October 1978 to 31 March 1979 has provided a special opportunity to estimate annual notification rates in different ethnic groups for the 8 administrative areas of England and the 33 boroughs of Greater London. In addition it has been possible to calculate for each of the 54 counties and 403 local authorities of England and Wales the relative proportions of cases that were of White and non-White ethnic origin. Much of the considerable variation in the rates between the administrative areas of England, ranging from 5.2 per 100 000 in Anglia to 23.7 in the West Midlands, could be accounted for by the varying proportions of persons of Indian subcontinent ethnic origin for whom the notification rates were very high. Nevertheless the White rates also varied widely, from 4.2 per 100 000 in Anglia to 14.5 in the Northern area. The notification rate in Greater London was twice the national average, due in part to the fact that 40% of all non-White patients in the survey were resident there. Within the boroughs of Greater London the rates for all ethnic groups combined ranged from 7.0 in Bromley to 114.3 in Brent, a 16-fold difference. The highest rates occurred in the more densely populated areas. A large number of cases of Indian subcontinent ethnic origin was not necessarily associated with a high rate in the White population, nor vice versa.

Bangladesh↗

PubMed1998

The outreach-assisted model of partner notification with IDUs.

OBJECTIVE: This analysis describes the Outreach-Assisted Model of Partner Notification, an innovative strategy for encouraging seropositive injecting drug users (IDUs) to inform their partners of shared human immunodeficiency virus (HIV) exposure. The analysis focuses on two core components of the notification process: the identification of at-risk partners and preferences for self-tell vs. outreach assistance in informing partners of possible exposure to the virus. METHODS: Using community outreach techniques, 386 IDUs were recruited for HIV pretest counseling, testing, and partner notification over a 12-month period. Of these, 63 tested HIV seropositive, and all but three returned for their test results. The 60 who were informed of their serostatus were randomly assigned to either a minimal or an enhanced intervention condition. Participants assigned to the minimal (self-tell) group were strongly encouraged to inform their partners of possible exposure. Those assigned to the enhanced (outreach-assisted) group had the option of either informing one or more of their partner(s) themselves or choosing to have the project's outreach team do so. RESULTS: Together, the 60 index persons who received their results provided names or at least one piece of locating information for a total of 142 partners with whom they perceived having shared possible exposure to the virus within the past five years. By itself, drug use accounted for half of all partners named. Sexual behavior alone accounted for 25% of named partners. Eighty-two percent of the enhanced group preferred to have the outreach team tell at least one partner; the team was requested to notify 71% of the total number of partners whom this group named. CONCLUSIONS: Findings suggest that IDUs want to notify their partners of shared HIV exposure. Outreach assistance was the preferred mode in the majority of cases. Expanding traditional community-based HIV outreach activities to include delivering street-based counseling, test, a partner notification appears to be a positive and workable prevention strategy.

Adult↗

PubMed2005

Parental notification laws for minors' access to contraception: what do parents say?

BACKGROUND: Recent years have seen new challenges to laws protecting minors' confidential access to reproductive health services. Little research has explored parental views on the issue. OBJECTIVE: To examine parents' views about laws requiring parental notification (PNLs) when minor children seek to obtain prescription contraceptives, the exceptions parents would endorse, and the consequences they would expect. DESIGN: Fifteen-minute telephone surveys conducted in 2002. SETTING: Minnesota and Wisconsin. PARTICIPANTS: Population-based sample of 1069 parents of adolescents aged 13 to 17 years with a working telephone number. An additional 1095 eligible parents declined and 360 were not available to participate. MAIN OUTCOME MEASURES: Views about PNLs ("Do you think a law requiring notification of parents when a teen requests birth control from a clinic is a good idea, a bad idea, or neither a good nor a bad idea?"). RESULTS: Of the eligible parents, 42.4% completed the survey. More than half (55.1%) of participants thought PNLs were a good idea. However, 96.1% of parents expected at least 1 negative consequence and 47.6% expected 5 or more negative consequences to result with the enactment of PNLs. For exceptions to PNLs, 85.5% of parents endorsed at least 1, and 29.7% endorsed 5 to 6. Each additional anticipated positive consequence of enacting PNLs was significantly associated with more than twice the odds of favoring PNLs (odds ratio [OR], 2.28), and each additional negative consequence was associated with lower odds of supporting PNLs (OR, 0.87). Likewise, each additional exception endorsed was associated with lower odds of supporting PNLs (OR, 0.71). CONCLUSIONS: Many parents hold complex views on the need for confidentiality and the appropriate involvement of parents in adolescent health care services. Educating parents about the potential negative consequences of parental notification could change their support of PNLs.

Adolescent↗

PubMed2003

A systems overview of the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE II).

The Electronic Surveillance System for the Early Notification of Community-Based Epidemics, or ESSENCE II, uses syndromic and nontraditional health information to provide very early warning of abnormal health conditions in the National Capital Area (NCA). ESSENCE II is being developed for the Department of Defense Global Emerging Infections System and is the only known system to combine both military and civilian health care information for daily outbreak surveillance. The National Capital Area has a complicated, multijurisdictional structure that makes data sharing and integrated regional surveillance challenging. However, the strong military presence in all jurisdictions facilitates the collection of health care information across the region. ESSENCE II integrates clinical and nonclinical human behavior indicators as a means of identifying the abnormality as close to the time of onset of symptoms as possible. Clinical data sets include emergency room syndromes, private practice billing codes grouped into syndromes, and veterinary syndromes. Nonclinical data include absenteeism, nurse hotline calls, prescription medications, and over-the-counter self-medications. Correctly using information marked by varying degrees of uncertainty is one of the more challenging aspects of this program. The data (without personal identifiers) are captured in an electronic format, encrypted, archived, and processed at a secure facility. Aggregated information is then provided to users on secure Web sites. When completed, the system will provide automated capture, archiving, processing, and notification of abnormalities to epidemiologists and analysts. Outbreak detection methods currently include temporal and spatial variations of odds ratios, autoregressive modeling, cumulative summation, matched filter, and scan statistics. Integration of nonuniform data is needed to increase sensitivity and thus enable the earliest notification possible. The performance of various detection techniques was compared using results obtained from the ESSENCE II system.

Bioterrorism↗

PubMed1997

Incompleteness of statutory notification of bacterial gastro-intestinal infection.

A study was made of all potentially statutorily notifiable bacterial infections diagnosed in faecal samples submitted from symptomatic patients to a single microbiology laboratory during a six-month period. Salmonella spp, Campylobacter spp or Shigella spp were isolated from 167 patients and 51% of these were formally notified (54% of general practice patients and 47% of hospital patients). Forty-seven percent of cases of food-poisoning (Salmonella spp. and Campylobacter spp) were notified as were 70% of cases of shigella infections. Notification was made on average 9.4d after sending a specimen to the laboratory. A questionnaire used to ascertain the reasons for non-notification in 80 of 85 cases elicited replies in respect of 78 patients. Four patients infected with Salmonella spp or Campylobacter spp were said not to have been suffering from food-poisoning. A variety of reasons was given for failing to notify the others, the most common were forgetfulness, not receiving the result of the specimen, or believing someone else had made the notification.

Campylobacter Infections↗

PubMed2003

[Evaluation of adherence to the regulations for declaration of notification of transfusion reactions with fever and chills. A study of the Association Inter-Régionale du Sud-Est d'Hémovigilance (AIRSEH)].

Febrile non-hemolytic transfusion reactions (FNHTR) are the most frequently reported acute adverse effects of blood products, and should be notified within 48 h according to the hemovigilance regulation. In order to study the conformity of these notifications and to search for factors associated with non-conformity, we retrospectively studied all FNHTR notified by voluntary centers of the AIRSEH group from 1st September 1994 to 31st December 1999. Seven hundred and sixty-one FNHTR were registered by 10 centers, most of them were benign (grade 1); 67.8% were non-conform. The non-conformity was associated with the number of biological investigations performed (median number, respectively, 4.24 and 2.94--P = 0.038--in non-conform and conform notifications--P = 0.038) in univariate analysis. Using a logistic regression model, center and severity were the only two factors significantly associated with non-conformity. Different center practices, and in particular the interface between the hospital and the blood bank, may be responsible for the effect center. Moreover, the non-conformity concerns first of all benign FNHTR. A stronger separation between alert and epidemiological surveillance is proposed in order to improve the notifications' conformity.

Adult↗

PubMed1998

Notification of tuberculosis in patients with AIDS.

BACKGROUND: In the early 1990s cases of tuberculosis in people with HIV infection and AIDS were undernotified. A study to evaluate changes in notification rates in two inner London local authorities was undertaken for the period January 1993-June 1996 inclusive. METHODS: For residents of the two local authorities, tuberculosis notifications were identified using a local database, and cases of AIDS with a recorded diagnosis of tuberculosis were identified from AIDS case reports. RESULTS: During the study period, only 13 (32 per cent) of the 41 AIDS cases with a recorded diagnosis of tuberculosis were also notified as a case of tuberculosis. However, the proportion of notified cases rose from 0 per cent (0 of 11) in 1993 to 50 per cent (5 of 10) in 1995 and 63 per cent (5 of 8) in early 1996. CONCLUSION: The increase in the tuberculosis notification rate for people with AIDS is encouraging, but scope for improvement remains.

AIDS-Related Opportunistic Infections↗

PubMed2002

Recent increases in tuberculosis notifications in England and Wales--real or artefact?

BACKGROUND: In light of recent increases in tuberculosis notifications in England and Wales, this study examines data on the occurrence of tuberculosis from other sources to see if the increase seen in notifications is corroborated. METHODS: Tuberculosis notifications for 1988-2000 were compared with laboratory reports of Mycobacterium tuberculosis complex isolates (1994-2000), national survey data for 1988, 1993 and 1998, and enhanced tuberculosis surveillance data for 1999 and 2000. RESULTS: Data from all three sources reveal a similar overall trend, with the increase most marked in 1999 and 2000 and a steady increase in the number of cases reported from London. The largest increase is seen in the 15-34 year age group. National survey and enhanced surveillance data show a continuing increase in the proportion of tuberculosis patients born abroad, and in number of patients from most non-White ethnic groups. All sources show an increased number of patients with extra-pulmonary disease. CONCLUSION: A similar level in the overall increase in cases, and their distribution by geographic region, age, sex and site of disease, observed using data from all three sources, suggests that much of the increase is likely to be real. Data from additional continuous years of enhanced surveillance will permit more accurate assessment of trends in population subgroups.

Adolescent↗

PubMedDate not supplied

STD partner notification and referral in primary level health centers in Nairobi, Kenya.

BACKGROUND: Controlling sexually transmitted diseases requires that partners of patients with a sexually transmitted disease be notified and treated. However, many countries in the developing world lack the infrastructure and resources for effective partner referral. GOAL OF THIS STUDY: To provide information on rates of partner referral in primary-level health centers in Kenya, to identify characteristics of patients with sexually transmitted diseases who inform their partners about the need for treatment, and to evaluate the impact of a brief counseling intervention on rates of partner notification. STUDY DESIGN: Two-hundred-fifty-four patients presenting for treatment of a sexually transmitted disease were given 5 to 10 minutes of additional counseling on the importance of referring partners for sexually transmitted disease treatment. All patients who returned for follow-up 1 week later were interviewed to determine whether they had notified their sex partners. RESULTS: Sixty-eight percent of patients who returned for follow-up reported they had referred their partners for treatment of a sexually transmitted disease. The highest rates of partner notification occurred among women attending maternal child health/family planning clinics and married men and women attending general outpatient clinics. CONCLUSION: Strengthening and directing counseling toward women in maternal child health/family planning clinics and married men and women in general clinics may be an effective and inexpensive way to increase partner notification in the developing world.

Adult↗

PubMed2003

Internet-based intervention to promote organ donor registry participation and family notification.

BACKGROUND: Little is known regarding the potential of Internet-based educational interventions to increase organ donor registry participation and family notification of donation wishes. We studied the effects of an Internet-based multimedia intervention (www.journey.transweb.org) on donor registry participation and family notification. METHODS: Visitors to a specially designed web site were studied between December 14, 2000, and March 31, 2002. Demographic characteristics were requested, and a pretest was administered to one half of the participants (selected randomly) before web site content exposure. All visitors were offered a posttest. Eight knowledge questions (true/false), three attitude questions (7-point scale), and three behaviors (yes/no) were assessed. RESULTS: A total of 10,884 visitors provided demographic data. Correct answers to knowledge questions increased from 85.1% to 87.0% overall (pretest vs. posttest; P<0.001) and from 80.6% to 82.0% for teenagers (P<0.001). Willingness to donate increased (scores of 6.34 vs. 6.39; P<0.001), as did willingness to join a donor registry (scores of 5.53 vs. 5.67; P<0.001). Willingness measures were less positive among teenagers but increased significantly after exposure to the intervention. Almost 10% of visitors directly linked to an online registry and 2,489 (23%) used the web site facilities to communicate donation wishes. Increases in knowledge were not associated with changes in attitudes, but an increase in pro-donation attitude was a significant predictor of donor registry participation (P<0.001). CONCLUSIONS: Increases in donation attitudes among visitors to an organ donation web site resulted in positive behaviors, such as enrollment in a donor registry and family notification. Future efforts should focus on using Internet-based interventions to improve attitudes toward donation and to facilitate pro-donation behaviors.

Adolescent↗

PubMed2000

Partner notification of pregnant women infected with syphilis in Nairobi, Kenya.

We examined partner notification among syphilitic pregnant women in Nairobi. At delivery, 377 women were found to be rapid plasma reagin (RPR) reactive. Data were available for 94% of the partners of women who were tested during pregnancy; over 67% of the partners had received syphilis treatment while 23% had not sought treatment mainly because they felt healthy. Six per cent of the women had not informed their partners as they feared blame and/or violence. Adverse pregnancy outcome was related to lack of partner treatment during pregnancy (7% versus 19%, odds ratio (OR) 3.0, 95% confidence interval (CI) 0.9-10.0). Our data suggest that messages focusing on the health of the unborn child have a positive effect on partner notification and innovative and locally adapted strategies for partner notification need more attention.

Adult↗

PubMedDate not supplied

Infectious diseases: statutory notification and surveillance.

The notification of infectious diseases has evolved over a number years and will continue to do as practices change or are modified. This article gives an insight into how the system for notification has developed. It outlines the process and purpose for notification and how the accumulation of data gathered can help nurses, midwives and health visitors make strategic plans for intervention and prevention of further outbreaks of disease. The nurse, midwife or health visitor has a central role to play in ensuring that diseases are notified to the 'proper officer'. Furthermore, if nurses, midwives and health visitors were given the power to notify diseases, the number of diseases notified may increase. This would result in a clearer and truer account of the number of notifiable diseases.

Data Collection↗

PubMed1987

The impact of a parental notification law on adolescent abortion decision-making.

In 1984, we investigated the impact of a parental notification statue with judicial bypass procedures in Minnesota. Subjects were interviewed on the day of their abortion at four Minnesota and two Wisconsin clinics. Relatively few were aware of the statute in Minnesota. Parental notification rates were similar in Minnesota and Wisconsin, which has no parental notification statute.

Abortion, Legal↗

PubMed1999

Meningococcal disease and the law: does non-notification really happen?

In Victoria, legislation clearly makes the notification of clinical or confirmed cases of meningococcal disease mandatory. Statistical modelling suggests that meningococcal disease is significantly under-notified, and that incorrect codes might be being ascribed to some in-patient episodes. The aims of this study were (i) to test the assumption that cases identified as non-notified cases were true cases, and (ii) to identify the reasons for non-detection on the hospital separation database and non-notification to the infectious diseases unit. Of 26 cases not identified on the in-patient dataset, the main causes were either being given completely incorrect ICD-9-CM codes (11 cases) or being given codes for a different type of meningitis (8 cases). Of 29 non-notified admissions, most were clinically (17) or microbiologically (6) confirmed cases, although 5 were coded in error and were not cases of meningococcal disease. Therefore, although the allocation of incorrect ICD-9-CM codes at separation was a major reason for discrepancy, non-notification was a real and recent problem. It is also possible that some clinical staff did not understand the relationship between Neisseria meningitidis and meningococcal disease, the public health implications of this infection, or the law relating to it.

Disease Notification↗

PubMed2000

Review of leptospirosis notifications in Queensland and Australia: January 1998-June 1999.

The World Health Organization/Food and Agricultural Organization Collaborating Centre for Reference and Research on Leptospirosis, Western Pacific Region, accredited since 1958, is part of Queensland Health Scientific Services, which provide tertiary level support in epidemiology, surveillance, training and diagnosis for hospitals and pathology laboratories across the State. Databases for leptospirosis on a global, Australian and State-wide basis are maintained on site and support public health authorities in Australia, WHO and the International Leptospirosis Society. Queensland data collated and analysed from leptospirosis questionnaires, and a brief overview of Australian data based on questionnaire responses for notified cases from 1998 to June 1999, are summarised. The increase in leptospirosis notifications (77%) during 1998 possibly signalled greater awareness of the disease by clinicians. There was a significant increase in leptospirosis notifications for children and students and a high rate of hospitalisation of cases. An outbreak in North Queensland during the first half of 1999 resulted in 184 notifications with over 50% of cases hospitalised. Polymorphic presentation of the disease with severe pulmonary haemorrhage is associated in particular with the serovar australis. Serovar zanoni continues to be a major cause of severe clinical leptospirosis. Several cases were diagnosed in tourists. One of these cases presented with severe respiratory distress and required 14 days in hospital.

Adult↗