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PubMedDate not supplied

Risk assessment for developing type 1 diabetes: intentions of behavioural changes prior to risk notification.

BACKGROUND: Recent progress in predictive techniques allows people at risk of developing type 1 diabetes to be identified in a pre-symptomatic stage and prevention trials to be implemented. The present study examined prospectively whether participants in a screening programme anticipated behavioural changes in the event of having a high risk. METHODS: Four hundred and three first-degree relatives of people with type 1 diabetes completed a self-administered questionnaire about their views on screening and diabetes, and questionnaires on well-being and locus of control. RESULTS: Prior to risk notification, 73% reported that they intended to introduce lifestyle changes if at high risk. The vast majority of the respondents (87%) reported that eating habits would be the main changes made. Those anticipating changes believed they could take actions to reduce their risk of type 1 diabetes (p<0.001) and to have personal control over diabetes onset (p<0.001). They were also more worried about developing diabetes (p<0.01) and preoccupied with diabetes-related symptoms (p<0.01). CONCLUSIONS: Prior to risk notification, the process of being screened raised concerns and expectations about future changes. Despite the lack of any evidence, people believed lifestyle changes would be effective in reducing their risk. Since the impact of lifestyle in the development of type 1 diabetes is not yet established, accurate information about the role of health behaviour in the progression to overt diabetes is needed to avoid unrealistic expectations on the benefit of these changes and unnecessary impairment to quality of life. Personally initiated changes should be monitored since they could importantly influence the progress and outcome of prevention trials.

Adolescent↗

PubMed1994

Notification and follow-up of Pap test results: current practice and women's preferences.

BACKGROUND: This study aimed to determine women's knowledge of their Pap test results and predictors of accurate knowledge, adherence to follow-up recommendations for abnormal results, current methods of notifying women about their Pap test results, women's preferences for notification method, and women's satisfaction with the current notification system. METHOD: A telephone survey was undertaken of 315 women with a recent normal or abnormal Pap test result, drawn from pathology records in Sydney, Australia. RESULTS: Findings revealed that 61% of women with a normal result and 93% of women with an abnormal result self reported having been notified about their result. According to women's reports, 7% of those with abnormal results had not been notified and a further 11% of women with abnormal results were unaware that their result was abnormal, giving a total of 18% of abnormal results not communicated adequately to women. Self-reported adherence with follow-up recommendations among women with an abnormal result was less than optimal. The most common methods of notifying women of their results were initiated by the women such as the woman phoning the doctor or receptionist. However, women strongly preferred doctor-initiated methods, such as a written record from the doctor, the doctor phoning the woman, or consultation with the doctor. CONCLUSION: Results suggest that better methods of notifying and educating women about their Pap test results are necessary to improve women's knowledge and satisfaction and, even more importantly, to improve their level of adherence with follow-up recommendations for abnormal results.

Adult↗

PubMed1993

Effectiveness of family notification efforts and compliance with measles post-exposure prophylaxis.

Exposures to measles in medical settings have contributed to the recent resurgence of the disease in the United States. Following a measles exposure in two pediatric medical facilities serving an inner-city population, we investigated the effectiveness of a disease notification strategy and compliance of the exposed population with recommendations for post-exposure prophylaxis, two requirements of a successful intervention program. Of 106 families with children eligible for a prophylactic vaccination by standard guidelines, 64% were notified of exposure by telephone. Compliance was assessed by a brief telephone questionnaire based upon the Health Belief Model, and verified by medical records. Forty-six families were interviewed regarding their decisions to comply with the recommendations. Most (75%) families were compliant. Compliant parents perceived measles to be severe and their children to be in excellent health. In a multiple logistic regression analysis, only the perceived severity of measles significantly contributed to the model. We conclude that: infection control outreach may need to extend beyond telephone notification for an inner-city population, and that once notified, most people will comply with recommendations. The Health Belief Model explains compliance with infection control measures and may be useful in guiding public health interventions.

Communication↗

PubMed2005

[Report on Notifications pursuant to Section 21 German Transfusion Act for 2001 and 2002].

The report pursuant to Section 21 German Transfusion Act is based on data referring to 4.53 and 4.66 million allogeneous whole blood donations and 1.35 and 1.89 million apheresis donations respectively for the years 2001 and 2002. Since 2000, the quantity of plasma for fractionation from apheresis has doubled to approx. 1 million litres in 2002. At the same time, the number of private apheresis facilities has also increased. The data on plasma for fractionation (both from whole blood and from apheresis) have shown a sharp increase for both report periods, mainly due to the rise in the quantity of plasma from apheresis. In spite of this, the quantity for plasma for fractionation available to the German market declined by 43% during the report period, due to increasing export figures. The data on the manufacture of blood components are reliable, since the notifications are almost complete. In 2001, 4.32 million transfusion units of erythrocyte concentrates, the most important product derived from whole blood donations, were manufactured, compared with 4.45 million in 2002, out of these, slightly less than 77 percent were manufactured in the blood donations services of the Red Cross. The consumption values reported were clearly below the figures for the manufacture, with 3.2 million transfusion units in 2001 and 3.5 million in 2002. However, some facilities of the health service did not meet the requirement to notify their figures. As far as the data on manufacture, imports and exports of plasma derivatives are concerned, further improvements are required because of the complexity of the matter and the various implications to be taken into account. However, a statement on the supply situation cannot be yet made anyway, due to the missing notifications on the consumption figures.

Blood Component Removal↗

PubMed2006

[Are blood glucose analyzers safe? Experiences of the BfArM based on all notifications received until end of 2005].

Since implementation of the Directive 98/79/EC of the European Parliament and of the Council on in vitro Diagnostic Medical Devices (IVD Directive), issues and field corrective actions on in vitro diagnostic medical devices (IVDMD) have to be reported to the national competent authorities. In Germany these are the BfArM and the Paul Ehrlich Institute; the latter is responsible for Annex II products used for immune hematology, tissue typing and infectiology testing. Between the beginning of 1999 and the end of 2005 BfArM received n=653 notifications on IVDMD. From these n=128 concerned analyzers and sensors (test strips) for self monitoring of blood glucose. A similar quantity of cases was reported by users and manufacturers (44.5%). In n=31 of these cases a product defect was not confirmed after the investigation of the products by the manufacturers. Product failures were confirmed in n=35 cases. The remaining cases were caused by user errors (n=29) or the data were inconclusive (n=33), predominantly because the products were not or only partly available for investigation by the manufacturers. In those cases where product failure had been verified n=24 affected the sensors (test strips) and n=11 the analyzers. Corrective actions were performed by the manufacturers in n=34 cases. From these n=27 were cases in which a product failure had been detected. However, in n=7 cases the investigations of the manufacturers were followed by preventive corrective actions because the manufacturers became aware of potential causes of future product failures. The obtained results and experiences since 1999 show that the governmental system for post-marketing surveillance of products for self testing of blood glucose is an established tool to ensure product safety. Regarding the proportion of notifications concerning these over the counter (OTC) products, it becomes obvious that they are a focus for action for the competent surveillance authorities.

Blood Glucose Self-Monitoring↗

PubMed1987

National survey of tuberculosis notifications in England and Wales in 1983: characteristics of disease. Report from the Medical Research Council Tuberculosis and Chest Diseases Unit.

The number of newly notified, previously untreated patients in a survey of notifications of tuberculosis in England and Wales conducted by the MRC in 1983 was 26% lower than in the previous MRC survey in 1978/79. In both surveys the great majority of patients were of White (about half) or Indian subcontinent (Indian, Pakistani or Bangladeshi) ethnic origin (just over a third). The notification rates in the Indian subcontinent (ISC) ethnic groups were much higher than for the White group and were highest in those most recently arrived in the UK. There were a number of differences in the findings for the White and the ISC ethnic groups. Nearly two-thirds of the White patients but less than half of the ISC patients were male and the White patients were, on average, older, about half aged 55 years or more compared with 14% of the ISC patients. Respiratory disease occurred in 82% of the White patients compared with 66% of the ISC patients. Radiographically, at independent assessment, more of the White patients had pulmonary lesions, 88% compared with 63% and these were, on average, more extensive and cavitated than in the ISC patients. Isolated mediastinal lymphadenopathy, however, was more common in the ISC patients. The diagnosis was confirmed bacteriologically on culture of a respiratory specimen in a higher proportion of the White than the ISC patients (65% and 41% respectively) and more were positive on smear as well (45% and 25% respectively). The level of initial drug resistance was lower in the White patients: only 10 (1.6%) of the 623 strains tested were resistant compared to 23 (12.8%) of the 179 from ISC patients. In both White and ISC ethnic groups the commonest non-respiratory lesion was peripheral lymph node involvement, namely 37% of the 369 White and 53% of the 503 ISC patients with non-respiratory disease. The diagnosis was confirmed by bacteriological examination of the lymph node in 47% of the ISC patients compared with 29% of the White patients with a lesion. Bone or joint disease occurred in 11% of the White and 20% of the ISC patients; the commonest site in both groups was the spine. Genitourinary disease was present in 98 (27%) of White and 24 (5%) of ISC patients with a non-respiratory lesion. There were 61 patients with tuberculosis involving the central nervous system, including 55 with meningitis, the proportions being similar for the White and the ISC ethnic groups, 7% and 5% respectively.

Adult↗

PubMed1991

Efficacy of partner notification for HIV infection.

Since 1985, partner notification has been part of Swedish policy to prevent the spread of human immunodeficiency virus (HIV) infection. Potentially infected partners of a newly diagnosed seropositive patient are notified either by the index patient or by the physician and referred for counselling. The efficacy of this strategy was assessed over 18 months in 1989-90. 365 HIV-seropositive index patients (91% of the 403 patients diagnosed in Sweden during the study period) reported 564 sexual or needle-sharing contacts. 390 contacts were located and counselled and HIV test results are known for 350 of them. In 53 of the 350 cases, previously unknown seropositivity was diagnosed. Partner notification for HIV should be viewed as a strategy to offer counselling and testing to a high-prevalence group of people. In a country where general HIV prevalence is low, the strategy is cost-effective for location and counselling of unknowingly seropositive individuals.

Acquired Immunodeficiency Syndrome↗

PubMed2003

Evaluating the reliability of automated collision notification systems.

The use of an automated collision notification (ACN) device in vehicles can greatly reduce the time between crash occurrence and notification of emergency medical services (EMSs). Most ACN devices rely on cellular technology to report important crash information to the proper authorities. The objective of this study was to examine the ability of the existing western New York cellular analog system to support ACN systems. The first task was to develop a model predicting the probability of successfully completing an emergency ACN call at attenuated levels of received signal strength indicator (RSSI), a measurement of the bond between cell phone and tower. Then, empirical estimates were made of the time necessary for call completion at given levels of the RSSI. The RSSI is sampled at locations throughout Erie County, New York, and this information is used to determine the probability of successful call completion for different locations within the county. This model was then applied to historic data for selected past crashes. Finally, the findings were compared with real-world crash data obtained from the ACN Field Operational Test program, where 750 ACN devices were installed in cars and their performance examined over time. An interpolated map of the sampled RSSI values suggests that cellular coverage in Erie County is adequate to support the automated collision network technology. The models and techniques described here are applicable to other areas and regions of the country.

Accidents, Traffic↗

PubMedDate not supplied

[Comparison of two assessment tools of antidepressant side-effects: UKU scale versus spontaneous notification].

BACKGROUND AND AIM OF THE STUDY: Overall, the efficacy of the newer antidepressants: serotonin selective reuptake inhibitors (SSRI), selective serotonin/norepinephrine reuptake inhibitor (SNRI), noradrenergic and specific serotonergic antidepressant (NaSSA) and tianeptine is similar to that of the tricyclics, and so their acceptability/safety becomes a selection criterion for the clinician. However, side-effect assessment comes up against several difficulties: distinguishing between somatic symptoms caused by the depression and those caused by the treatment -- which assessment tool to use (spontaneous notification, standardized scales that are not specific for the side effects caused by psychotropic drugs, standardised scales specific for the side effects caused by psychotropic drugs, meta-analysis, etc.) -- which data sources to consult (anecdotal reports, reviews, prospective studies), and which data set to use, etc. As a result, the question of the exhaustiveness and reliability of the data consulted by the clinician can arise. We therefore conducted a comparative study in patients treated with these newer antidepressants, of 2 antidepressants side-effect assessment tools: spontaneous notification (SN) versus the UKU scale, a standardised scale specific for the side effects of psychotropic drugs. METHODOLOGY: The depressed outpatients were selected from a psychiatric unit in a French psychiatric hospital and from a non-hospital consulting room. The main inclusion criteria were: male or female subjects, suffering from major depression without melancholia or psychotic features or suffering from mood disorders (according to DSM IV criteria), who had been treated for at least 4 weeks with one of the newer antidepressants. The main exclusion criteria were: any other psychiatric disorder, a serious physical disorder, treatment with neuroleptics, mood-changing drugs or other antidepressants, and patients who were not able to understand the questionnaire. The investigation was carried out by a clinical pharmacist. RESULTS: Fifty patients were included in the study. There were 18 men and 32 women. The mean age was 53.5 15.9 years [22 - 77], the mean period of treatment was 24 30.5 months [1 - 127] and 52% of the patients received concomitant medication with anxiolitic or hypnotic drug(s). The percentage of patients who reported at least one side effect was significantly higher for the UKU scale than for SN (84% vs 58%, p<0.01). The ratio between SN and UKU scale scores was 2/3. A similar pattern was found for the total number of side effects (n=177 vs n=47, p<0.001). The ratio between the total number of side effects for the SN and UKU scale was 1/4. The side effects were divided into five subgroups: psychiatric, neurovegetative, sexual, neurological and others. In all these subgroups, the number of side effects reported was significantly higher when the UKU scale was used than when SN was used. The values were as follows: psychiatric (n=44 vs n=15, p<0.001), neurovegetative (n=59 vs n=15, p<0.001), sexual (n=36 vs n=10, p<0.001), neurological (n=11 vs n=2, p<0.001) and other side effects (n=27 vs n=5, p<0.001). Nineteen side effects were only reported when SN was used (for example: dry eyes, incompatibility with alcohol, euphoria...). Twenty-four side effects were only reported when the UKU scale was used (for example: increased libido, loss of bodyweight...). The side effects had no impact on daily life in most of 80% of the patients; there was no significant difference between the patient's assessment of the discomfort caused by side effects and the clinician's assessment. In 90% of cases, the side effects did not lead to any change in the treatment. DISCUSSION: The findings of this study show that the collection of data regarding side effects depends on the assessment tool used: the number of side effects reported was significantly higher when the UKU scale was used than when SN was used. However, this finding must viewed with caution, because it has been showed that checklists can induce symptoms in suggestible patients. Neurovegetative troubles are the most commonly reported side effects, and neurological troubles the least often reported. This matches the tolerability profile of these antidepressants. The disorders that were least frequently spontaneously reported were the neurological, sexual and "other" side effects. These emerged only when the clinician asked the patient about them. The 19 side effects that were only reported when SN was used were side effects that were not included in the UKU scale or that had not been present during the three days before we started the investigation. The 34 side effects that were only reported when the UKU scale was used were either side effects with no apparent link with the treatment (for example: micturition troubles) or embarrassing effects (such as increased libido). CONCLUSION: Our findings show that the collection of data on side effects depends on the assessment tool used. These findings need to be confirmed by large-scale comparative studies, and the standardization of the assessment of side effects is a question that needs to be raised.

Adult↗

PubMed2001

Patient notification and follow-up after suspension of treatment protocols. experience from four clinical trials of treatments for AIDS-related CMV retinitis.

We reviewed procedures for and data about patient notification of the suspension of the treatment protocol for four clinical trials. We also examined how data collected after the suspensions were used. All four trials were designed to evaluate treatments for cytomegalovirus retinitis in patients with AIDS and were conducted by the Studies of Ocular Complications of AIDS Research Group. Documentation that patients were notified of the results varied from 62--100% with three of the four studies documenting the process for > or =92% of patients. The median time between the recommendation for protocol suspension and patient notification varied from 7--49 days with three of the four trials at 12 days or fewer. Most of the analyses of data collected after the suspension of the treatment protocol did not focus on comparisons among treatment groups. Although they provided useful information about the long-term outcomes and the nature of the disease, they did not alter the conclusions about safety and efficacy from the randomized portion of the trial. Control Clin Trials 2001;22:62-68

AIDS-Related Opportunistic Infections↗

PubMed2001

Impact of parental consent and notification policies on the decisions of adolescents to be tested for HIV.

Restrictions have been placed on the ability of adolescents to obtain human immunodeficiency virus (HIV) testing independent of their parents. Although some states have given adolescents the right to consent to HIV testing independently, many states have remained silent on the issue or have compromised these rights by providing for parental consent or notification when adolescents seek testing. This article examines existing policies and explores whether policies that require adolescents to obtain parental consent, or that permit or mandate parental notification, may deter them from obtaining needed HIV testing.

Abortion, Legal↗

PubMed2000

Understanding partner notification (Patient self-referral method) by young women.

STUDY OBJECTIVE: To understand the communication process involved in the patient-self referral method among adolescent females with chlamydia and gonococcal infection. DESIGN: A cross-sectional descriptive study using a convenience sample was conducted in 54 predominantly African-American females, 13 to 20 years-old, with gonococcal and/or chlamydia cervicitis at an urban hospital based reproductive health clinic. Subjects interviewed at their treatment visit were asked what method of notification they used to tell their partner(s). Subjects who had not notified their partner were asked about their intended communication method and what they envisioned they would say to their partner. Coding methodology was used to analyze the information. In addition to qualitative information, outcome measures were the proportion of subjects who notified their partner(s), their communication method, style, and barriers to communication. RESULTS: According to the treatment visit, 57% (31/54) of subjects reported notifying their partner. Most had notified their partner by phone or face-to-face, stated basic facts about the infection, and used a "direct" and "sensitive" communication style. Of the subjects who had not notified their partner (23/54), several barriers to notification were reported, but 82% said they intend to notify their partner(s). CONCLUSIONS: Strategies to promote the patient-self referral method among young women who do not notify their partner(s) need further assessment.

Adolescent↗

PubMed2004

Public mis-notification of coastal water quality: a probabilistic evaluation of posting errors at Huntington Beach, California.

Whenever measurements of fecal pollution in coastal bathing waters reach levels that might pose a significant health risk, warning signs are posted on public beaches in California. Analysis of historical shoreline monitoring data from Huntington Beach, southern California, reveals that protocols used to decide whether to post a sign are prone to error. Errors in public notification (referred to here as posting errors) originate from the variable character of pollutant concentrations in the ocean, the relatively infrequent sampling schedule adopted by most monitoring programs (daily to weekly), and the intrinsic error associated with binary advisories in which the public is either warned or not. In this paper, we derive a probabilistic framework for estimating posting error rates, which at Huntington Beach range from 0 to 41%, and show that relatively high sample-to-sample correlations (>0.4) are required to significantly reduce binary advisory posting errors. Public mis-notification of coastal water quality can be reduced by utilizing probabilistic approaches for predicting current coastal water quality, and adopting analog, instead of binary, warning systems.

Algorithms↗

PubMed2002

Comparison of causes of death using HEMO Study and HCFA end-stage renal disease death notification classification systems. The National Institutes of Health-funded Hemodialysis. Health Care Financing Administration.

Few data are available on the accuracy of death classification in patients with end-stage renal disease (ESRD). The National Institutes of Health-funded Hemodialysis (HEMO) Study allows the opportunity to compare cause of death recorded on the Health Care Financing Administration (HCFA) Death Notification Form 2746 with death classified by the HEMO Study. The HEMO Study cause of death is determined by trained HEMO Study Outcome Review Committee physicians. In this interim analysis, there were 220 deaths coded by both classification systems. Using the HEMO Study classification system, the most common cause of death was ischemic heart disease (20.4%), followed by arrhythmia and conduction problems (10.4%), cerebrovascular disease (8.6%), and non-access-related infections (7.7%). Using the HEMO Study final death classification as the reference standard, most differences in the two classification systems were related to coding of heart disease. Sensitivity for the HCFA classification ranged from 9.1% for congestive heart failure to 91.7% for malignancy, whereas specificity values were all greater than 78%. Positive predictive values ranged from 11.8% for other heart disease and conditions to 100% for malignancy and hepatobiliary disease, whereas negative predictive values were all greater than 85%. The kappa statistic between the two death classification systems ranged from 0.12 for congestive heart failure to 0.95 for malignancy. Studies using death classification from the HCFA ESRD death notification form for deaths secondary to either cardiovascular diseases or unknown causes should be interpreted cautiously.

Aged↗

PubMed1996

Evaluation of the notification procedure for physician-assisted death in the Netherlands.

BACKGROUND: In the Netherlands, a notification procedure for physician-assisted death has been in use since 1991. It requires doctors to report each case to the coroner, who in turn notifies the public prosecutor. Ultimately, the Assembly of Prosecutors General decides whether to prosecute. Although physician-assisted death remains technically illegal, doctors are extremely unlikely to be prosecuted if they comply with the requirements for accepted practice. In 1995, the ministers of health and justice commissioned an evaluation to determine the adequacy of the notification procedure. METHODS: A random sample of 405 physicians were interviewed. We also interviewed 147 physicians who had reported cases of physician-assisted death and 116 coroners, and we reviewed 353 judicial files of reported cases. In addition, we interviewed 48 public prosecutors and reviewed the minutes of the Assembly of Prosecutors General for 1991 to 1995 and all published court decisions from 1981 through 1995. RESULTS: In 1995, about 41 percent of all cases of euthanasia and physician-assisted suicide were reported. There were no major differences between reported and unreported cases in terms of the patients' characteristics, clinical conditions, or reasons for the action. Most patients had cancer and were described as suffering "unbearably" and 'hopelessly." Of the 6324 cases reported during the period from 1991 through 1995, only 13 involved prosecution of the physician. The majority of respondents in the groups interviewed thought that all cases of physician-assisted death should be reviewed, although most doctors thought the review should be performed by other doctors, and there was substantial concern about the burden associated with the reporting procedure. CONCLUSIONS: Substantial progress in the oversight of physician-assisted death has been achieved in the Netherlands. The reporting procedure could be more streamlined and less threatening.

Attitude of Health Personnel↗

PubMed1990

Death notification.

Family notification in sudden, unexpected, and violent death is a major responsibility of law enforcement, medical examiner, and coroner offices. This report reviews and discusses the process and procedures utilized in death notification and provides suggestions to accomplish this difficult task more effectively.

Attitude to Death↗

PubMedDate not supplied

Notification of the sex and needle-sharing partners of individuals with human immunodeficiency virus in rural South Carolina: 30-month experience.

The authors conducted a confidential and voluntary partner notification program to identify and educate the sex and needle-sharing partners of individuals with the human immunodeficiency virus (HIV) in a rural health district in South Carolina. During the first 30 months, of 485 named contacts, 290 (60%) were residents of the health district and were contacted and offered testing. Of the 290 contacted, 280 (97%)--53 women and 227 men; age range 14-74 years--accepted counseling and testing and 49 (18%) were HIV-antibody positive. Only 3 of the 49 (6%) had been previously tested. All HIV-infected individuals received appropriate physician, laboratory, and public health referrals. During the study, the mean number of sex partners per 6-month period decreased from 5.6 to 1.1 (80% reduction) for HIV-antibody positive persons and from 4.0 to 2.0 (50% reduction) for HIV-antibody negative persons. The authors conclude that in a rural setting, partner notification of HIV exposure can accurately target education and testing and can produce positive behavior change.

Adolescent↗

PubMedDate not supplied

Human immunodeficiency virus partner notification in a low incidence urban community.

BACKGROUND: Notification of the partners of a person newly diagnosed with human immunodeficiency virus (HIV) is legally mandated in Missouri. METHODS: In a four-year period, the Kansas City Health Department tested for HIV antibodies in 61,464 of 61,700 (99.6%) eligible persons using the sexually transmitted disease clinic. RESULTS: A total of 366 newly diagnosed HIV cases were identified of whom 291 named 662 sex or needle-sharing partners. Only 447 partners could be located, counseled and/or tested. Of these partners, 165 were HIV infected, but only 33 represented newly diagnosed cases. CONCLUSION: HIV partner notification can be successfully conducted in an urban community.

AIDS Serodiagnosis↗