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Home HIV testing and conflicts with state HIV testing regulations.
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Home screening test for HIV approved.
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A calculator to predict maximal oxygen consumption for use with the Canadian Home Fitness Test.
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Home medical tests increase in use and popularity.
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Letter: The Canadian home fitness test.
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How accurate are home pregnancy tests?
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Anticoagulation self-testing after heart valve replacement.
The recent introduction of home testing of coagulation status offers a new opportunity for improved follow up of patients undergoing chronic anticoagulant therapy secondary to valve replacement or other conditions. A growing body of data suggests that the ability to monitor the International Normalized Ratio (INR) at home results in a greater maintenance of 'in-range' values compared to a laboratory-based testing regimen. Additional evidence suggests that this greater prevalence of 'in-range' values will translate into a lower frequency of bleeding and thrombotic complications. Thus, home INR testing appears to be developing as an important diagnostic adjunct for improving the postoperative care of patients with prosthetic heart valves, or who are receiving chronic anticoagulation therapy for other reasons.
A review of Internet-based home drug-testing products for parents.
OBJECTIVE: To review home drug-testing products and the Internet-based recommendations intended for parents. METHODS: A qualitative review of drug-testing products and structured analysis of information presented on company Internet sites were conducted. Eight Internet sites that sold home drug-testing products and contained a "parent's section" were identified by Ixquick using the search term "home drug testing." Description and prices of products sold by each Internet site and recommended indications for testing, consent, collection procedures, and follow-up of positive and negative test results were researched. RESULTS: A variety of drug-testing products were available, including breath and saliva tests for alcohol, a multidrug panel hair test, and a variety of laboratory and instant urine tests. Prices ranged from 2.75 dollars for a single alcohol test to 89.00 dollars for a multidrug combination urine/hair package. A total of 14 indications for home drug-testing were cited; all sites claimed that drug testing was a way to know with certainty whether a child has used drugs. Only 1 web site made a clear statement against testing an adolescent against his or her will. Little information was presented on valid specimen collection procedures and the risks of false-positive and false-negative tests. Only half of the sites recommended that parents consult a professional if a test is positive. CONCLUSIONS: Pediatricians should advise parents of the limitations and potential risks associated with home drug-testing products.
24-hour home pad weighing test versus 1-hour ward test in the assessment of mild stress incontinence.
Twenty-three normal volunteers and 31 women admitted for stress or mixed incontinence underwent two 24-hour home pad weighing tests. In the patients the test result was compared with the result obtained with the 1-hour ward pad weighing test. Median pad weight gain was 4 g/24-h, with an upper 99% limit of 8 g/24 h in normal women. The median urine loss was 17 g/24-h in the patients. Eighteen (58%) patients were classified as incontinent according to the result of the 1-h ward test, versus 28 (90%) according to the result of the 24-h home test. There was no significant correlation between the result of the 1-h test and the 24-h test. In the patients, test-retest analysis showed a significant variation in the result of the 24-h test. It is concluded that the better of two 24-h home tests is more sensitive for confirmation incontinence than is one 1-h ward test. Consequently, the 24-h home test is of practical use as a screening test for incontinence. The reproducibility of the test, however, seems insufficiently satisfactory to allow of its use in comparative scientific studies.
Radon awareness, testing, and remediation survey among New York State residents.
Between November 1995 and January 1997, a radon awareness, testing, and remediation survey was conducted to measure general awareness and factual knowledge about radon and prevalence of radon testing and remediation among New York State residents. The survey found that 82% of 1,209 respondents had heard of radon, but only 21% were knowledgeably aware of radon. With regard to radon testing, only 15% of respondents who were aware of radon had their homes tested. The percentage of respondents who were aware or knowledgeably aware of radon increased with increasing education level. The findings from the study suggest that the New York State public awareness programs that targeted high radon areas did show some effect both by increasing public awareness and promoting residential testing. The relatively low percentage of respondents who were knowledgeably aware of radon and the low percentage who had tested their homes strongly suggest that renewed efforts by the public health community are needed to increase knowledge about radon and its health effects and to encourage radon testing and remediation.
Use of home hemoglobin A1c test kits to monitor the effectiveness of diabetes care.
BACKGROUND: Periodic measurement of glycated hemoglobin (HbA1c) is highly recommended for people with diabetes to determine whether their blood glucose is adequately controlled. Quality improvement programs initiated by health plans often focus on ensuring that HbA1c is being monitored in members with diabetes. To focus improvement efforts on members with poor blood glucose control, health plans need to know which members have high HbA1c levels. Recent development of home test kits provides another opportunity for health plans to help members measure their HbA1c and to identify members with high levels. METHODS: A sample of members from two health plans who were sent HbA1c self-test kits in January 2000 participated in a telephone interview. To understand why members did or did not use self-test kits sent by their health plans, the survey focused on perceived ease of use, outcomes, and normative beliefs. RESULTS: In the group of 380 members who were interviewed, 170 (45%) used the kit. HbA1c values were > 8 mg/dl in 43%. Among the 170 who used the kit, 160 said that they would use the kit. Their most common reason for using the kit was to find out how well their blood glucose was being controlled (48%). Convenience (12%) was the next most frequent reason for using the kit. Among the 210 members who did not use the kit, 81 members said that they would not or were not sure if they would when interviewed. Their most frequent reason for not using the kit was duplication of tests done by physicians (34%). Others were too busy (12%), wanted to talk with their physician (11%), or had difficulty using the kit (11%). CONCLUSIONS: Because the majority of health plan members did not use the kit and the majority who did use the kit had HbA1c levels < 8 mg/dl, sending home test kits to members did not result in a high yield of members with elevated HbA1c levels. Physicians' support for use of the kits and efforts to make kits easier to use might increase use. Efforts to avoid duplication of physicians' measurements could make this strategy to identify members with poorly controlled levels of blood glucose more cost-effective, although health plans would not know which monitored members might benefit most from programs to improve care of diabetes.
Demonstrating effectiveness of passive radon-resistant new construction.
Fifty percent of homes tested for radon in Rock Island County, IL, have radon levels above the U.S. Environmental Protection Agency (EPA) action guideline of 4 picoCuries per liter (pCi/L) of air. Therefore, the county is classified by the EPA as Zone 1 on the EPA's Map of Radon Potential. Radon-resistant new construction (RRNC) strategies for new homes are recommended by the EPA in Zone 1 areas. One city in the county, East Moline, reduced the cost of building permits for contractors volunteering to build new homes incorporating modified passive RRNC. Forty-six of 124 new homes built with passive RRNC in the city were tested during this study. Only 27 of the homes tested were below 4-pCi/L, justifying the importance of testing the system to ensure levels are below the action guideline. To provide additional support to an argument in favor of changing city building codes to the required RRNC, 23 of the homes were also tested with the systems deactivated. After systems were deactivated, 73% of the homes had radon levels above the action guideline. Four homes were sampled for bioaerosols to evaluate if passive RRNC might impact other indicators of poor indoor air quality (IAQ). The results of the research will be discussed here.
Developmental exposure to chlorpyrifos alters reactivity to environmental and social cues in adolescent mice.
Neonatal mice were treated daily on postnatal days (pnds) 1 through 4 or 11 through 14 with the organophosphate pesticide chlorpyrifos (CPF), at doses (1 or 3 mg/kg) that do not evoke systemic toxicity. Brain acetylcholinesterase (AChE) activity was evaluated within 24 h from termination of treatments. Pups treated on pnds 1-4 underwent ultrasonic vocalization tests (pnds 5, 8, and 11) and a homing test (orientation to home nest material, pnd 10). Pups in both treatment schedules were then assessed for locomotor activity (pnd 25), novelty-seeking response (pnd 35), social interactions with an unfamiliar conspecific (pnd 45), and passive avoidance learning (pnd 60). AChE activity was reduced by 25% after CPF 1-4 but not after CPF 11-14 treatment. CPF selectively affected only the G(4) (tetramer) molecular isoform of AChE. Behavioral analysis showed that early CPF treatment failed to affect neonatal behaviors. Locomotor activity on pnd 25 was increased in 11-14 CPF-treated mice at both doses, and CPF-treated animals in both treatment schedules were more active when exposed to environmental novelty in the novelty-seeking test. All CPF-treated mice displayed more agonistic responses, and such effect was more marked in male mice exposed to the low CPF dose on pnds 11-14. Passive avoidance learning was not affected by CPF. These data indicate that developmental exposure to CPF induces long-term behavioral alterations in the mouse species and support the involvement of neural systems in addition to the cholinergic system in the delayed behavioral toxicity of CPF.
A case-control study to evaluate efficacy of screening for faecal occult blood.
OBJECTIVES: Faecal occult blood testing is routinely used for early detection of colorectal cancer, but evidence of its efficacy in preventing death from colorectal cancer is limited. A case-control study was carried out to evaluate whether screening for faecal occult blood is associated with a reduced risk of fatal colorectal cancer. SETTING: A health maintenance organisation in western Washington State, which has offered its members faecal occult blood testing every two years since 1983. METHODS: Cases (n = 248) were members of the health maintenance organisation who died from colorectal cancer between 1986 and 1991. For each case, two control subjects, who did not die from colorectal cancer and who were similar to each case in age, gender, and year of enrollment at the health maintenance organisation, were randomly selected from the membership list of the year in which the case was diagnosed (n = 496). Information about episodes of faecal occult blood testing (including the location and reason for the test, and the evaluation of positive tests) and potential confounders was obtained from medical records. RESULTS: Cases were less likely than controls to have ever been screened (odds ratio (OR) = 0.7, 95% confidence interval (CI) 0.5 to 1.0), consistent with a beneficial impact of screening. There was little difference, however, for screening that had taken place within a three year period before diagnosis (OR = 0.9, 95% CI 0.6 to 1.2), the maximum interval during which most tumours ought to have been detectable by faecal occult blood testing. A reduction in risk was seen for home testing but not for office testing, and in individuals aged less than 75 but not in those aged 75 or older. Although most of the 21 controls with a positive faecal occult blood test underwent some additional testing, only five (24%) were evaluated with colonoscopy or air contrast barium enema. CONCLUSIONS: While there can be uncertainty as to whether specific faecal occult blood tests were performed as screening or diagnostic tests, those performed at home and in younger persons may be relatively less likely to be diagnostic tests that were misclassified as screening. Thus the modest reduced risk associated with faecal occult blood testing in these settings/persons may reflect genuine benefit. However, the presence of a reduced risk associated with a screening faecal occult blood test received in the past, well before a tumour or polyp might bleed enough to allow detection, is compatible with uncontrolled confounding. Interpretation is further complicated by the fact that a number of individuals in the study group who had positive test results underwent limited or no diagnostic testing. Thus our results should be interpreted with considerable caution.
New methods for the detection of HIV.
In the past few years, several strides have been made in the ability to detect the presence of HIV-1 and HIV-2. This article discusses recent advances in serologic testing, including routine ELISA and Western blot tests, rapid HIV tests, home collection kits, and HIV tests using nonserum samples. The clinical application of nucleic acid-based tests also is discussed. Finally, appropriate use of these tests in both acute HIV-1 infection and in infants is reviewed.