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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↗

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↗

PubMed1990

Exercise intervention attenuates emotional distress and natural killer cell decrements following notification of positive serologic status for HIV-1.

The impact of aerobic exercise training as a buffer of the affective distress and immune decrements which accompany the notification of HIV-1 antibody status in an AIDS risk group was studied. Fifty asymptomatic gay males with a pretraining fitness level of average or below (determined by predicted VO2 max) were randomly assigned to either an aerobic exercise training program or a no-contact control condition. After five weeks of training, at a point 72 hours before serostatus notification, psychometric, fitness and immunologic data were collected on all subjects. Psychometric and immunologic measures were again collected one-week postnotification. Seropositive controls showed significant increases in anxiety and depression, as well as decrements in natural killer cell number following notification whereas, seropositive exercisers showed no similar changes and in fact, resembled both seronegative groups. These findings suggest that concurrent changes in some affective and immunologic measures in response to an acute stressor might be attenuated by an experimentally manipulated aerobic exercise training intervention.

Adult↗

PubMed1992

Limitations of the OPCS congenital malformation notification system illustrated by examination of congenital malformations of the cardiovascular system in districts within the Trent Region.

Data are presented from OPCS notification statistics and other sources on rates of congenital cardiovascular malformations in the Trent Health Region and in its constituent Districts. While Trent in general, and some of its districts in particular, show high notification rates, other data sources suggest that the underlying malformation rate may not be raised compared with that seen nationally. Reasons for this discrepancy are discussed and the OPCS notification system is compared with that in Scotland.

Heart Defects, Congenital↗

PubMed1992

Results of a randomized trial of partner notification in cases of HIV infection in North Carolina.

BACKGROUND: We sought to compare two methods of notifying sex partners of subjects infected with the human immunodeficiency virus (HIV) or persons who had shared needles with them (needle-sharing partners): "patient referral," in which the responsibility for notifying partners was left to the patient, and "provider referral," in which providers attempted to notify partners. METHODS: Names of sex partners and needle-sharing partners and information on how to locate them were obtained from consenting HIV-infected subjects identified in the HIV-testing programs at three public health departments in North Carolina. The subjects were randomly assigned to a patient-referral group (in which patients had the initial responsibility for notifying their partners) or a provider-referral group (in which the study counselor notified the partners). The success of attempts to notify partners was monitored by means of interviews with counselors conducted both in the field and at the health department. RESULTS: Of 534 HIV-positive persons identified at the health departments, 247 (46 percent) did not return for counseling after the test, 8 were counseled outside the study, and 117 (22 percent) were ineligible. Of the 162 invited to participate, 88 (54 percent) declined and 74 (46 percent) agreed. The subjects were mostly male (69 percent), black (87 percent), homosexual or bisexual (76 percent of the men), and had a median age of 30 years. Thirty-nine were assigned to the provider-referral group and 35 to the patient-referral group. In the provider-referral group 78 of 157 partners (50 percent) were successfully notified, whereas in the patient-referral group only 10 of 153 (7 percent) were notified. Of the partners notified by the counselors, 94 percent were not aware that they had been exposed to HIV. Overall, 23 percent of the partners notified and tested were HIV-positive. CONCLUSIONS: In this trial, leaving the notification of partners up to the subjects (patient referral) was quite ineffective, despite the North Carolina law requiring that partners be notified. Partner notification by public health counselors (provider referral) was significantly more effective. Although the effectiveness of notification procedures is constrained by the accuracy of the information provided by HIV-infected patients, counselors who notify the partners of an infected patient can refer them to educational, medical, and support services targeted to persons at high risk for HIV infection and may encourage the adoption of less risky behavior.

Adult↗

PubMed1992

Partner notification as a tool for research in HIV epidemiology: behaviour change, transmission risk and incidence trends.

OBJECTIVE: To assess whether routinely collected data from partner notification for HIV infection could be used to study HIV epidemiology. The issues addressed were measures of contact patterns and behaviour change, variables influencing transmission risks, and indications of HIV incidence. DESIGN: We collected anonymous questionnaire data from all partner notifications performed from seropositive patients diagnosed in Sweden between 1 January 1989 and 30 June 1990. METHOD: A structured questionnaire was completed by the physician or counsellor interviewing newly diagnosed seropositive patients and counselling their reported partners. The questions focused on temporal and behavioural aspects of all contacts between index patients and partners. RESULTS: Questionnaires were completed for 365 of the 403 (91%) index patients diagnosed during the study period, for 350 of the 390 (90%) located partners, and for 274 of the 297 (92%) relationships where results of HIV testing were known for index patient and partner. Seropositive individuals diagnosed in 1989 or later reported less risk behaviour than those diagnosed earlier. Risk of transmission in sexual contact increased when the infectious partner developed symptoms of HIV infection. Anal intercourse was found to be approximately twice as infectious as vaginal, and transmission risk from a seropositive insertive partner approximately twice as high as from a receptive. The total HIV incidence in Sweden appears to be declining, as does the number of newly diagnosed infected homosexual men. CONCLUSION: Carefully collected data acquired from a partner notification programme are well suited to describe and follow the epidemiology of HIV infection.

Contact Tracing↗

PubMedDate not supplied

Partner notification and the control of human immunodeficiency virus infection. Two years of experience in San Francisco.

To evaluate partner notification of opposite-sex sexual partners of AIDS patients as a means of limiting sexual and vertical transmission of human immunodeficiency virus (HIV), the authors examined the first 27 months of their experience with partner notification. Overall, of 145 AIDS patients eligible to participate, 51 (35%) were interviewed and identified 135 opposite-sex sexual partners. Of the 135 partners, 59 (44%) were interviewed and 34 (25%) were tested, resulting in the diagnosis of 7 (5%) HIV-infected partners. Refusal rates for index patients and partners were low (9% and 12%, respectively). Costs for the program were $454 per partner interviewed and $2,203 per seropositive partners identified. The authors conclude that although partner notification is more expensive than more widely targeted AIDS prevention and education efforts, its ability to target case finding, education, and counseling to women at highest risk of infection makes it potentially cost-effective for prevention of vertically transmitted HIV infection.

Contact Tracing↗

PubMed1992

National survey of notifications of tuberculosis in England and Wales in 1988. Medical Research Council Cardiothoracic Epidemiology Group.

BACKGROUND: A survey was undertaken to determine the distribution of tuberculosis in England and Wales and, by comparison with the findings of similar surveys in 1978-9 and 1983, to study trends in the incidence of the disease by ethnic group over the decade. METHODS: The survey included all cases of tuberculosis in England and Wales newly notified to the medical officers for environmental health during the six months from 2 January to 1 July 1988. Notification rates were calculated from population estimates from the 1988 Labour Force Survey. RESULTS: Clinical details were obtained from the clinician for 2149 (99.4%) of the 2163 newly notified and previously untreated patients. Over 90% were either white (53%) or of Indian, Pakistani, or Bangladeshi ethnic origin (39%). The notification rate in the white population was 4.7/100,000/year, a decline of 7.2% per year since 1978. The rate was 134.6/100,000/year in the population of Indian ethnic origin, and 100.5/100,000/year in that of Pakistani or Bangladeshi ethnic origin, a decline of 6% a year since 1978 for the two groups combined (standardised for age, country of birth, and length of time in the UK). In all ethnic groups rates of disease were much higher in the elderly than in the young. Bacteriological results were available in 1161 (80%) of the 1443 pulmonary cases. In 939 (81%) Mycobacterium tuberculosis was cultured; 614 cases (53%) also had positive smears, of which 424 (69%) were from white patients. CONCLUSIONS: Notification rates for tuberculosis in England and Wales declined over the decade, but major differences remained between ethnic groups.

Adolescent↗

PubMedDate not supplied

Partner notification and patient education for cases of Chlamydia trachomatis infection in a rural Nova Scotia health unit.

From September 1990 to March 1991, 47 of 52 patients with genital C. trachomatis infections in a rural health unit in Nova Scotia were interviewed about preventive education by physicians partner notification, past history, and treatment. Seventy-six percent of those with partners of the previous month were instructed by physicians to notify these partners. Twenty-five of 37 partners were notified. Of those not notified, 83% could have been reached. Reasons for cases not notifying partners included not being informed of test results, embarrassment, and not considering notification important. Fifty-two percent of cases were advised to practise safer sex; this was generally limited to advice to use condoms. Twenty-three percent had had a previous sexually transmitted disease. Treatment was appropriate in all cases where it could be determined. More preventive education by physicians and public health involvement in partner notification for such patients are required.

Adult↗

PubMed1990

Partner acceptance of health department notification of HIV exposure, South Carolina.

To determine the acceptability of health department notification of sex and needle-sharing partners of persons infected with human immunodeficiency virus (HIV), we administered an anonymous questionnaire to partners notified of their exposure to HIV during the previous 2 years. Of the 202 partners notified, 132 (65%) were locatable and completed the questionnaire. Only 12 (9%) thought they may have been exposed to HIV before health department notification. When the 132 partners were asked if they thought the health department did the right thing in telling them about their exposure, 87% responded "yes;" when asked if the health department should keep notifying persons exposed to HIV, 92% responded "yes." Responses were similar for homosexual-bisexual men, heterosexuals, and intravenous drug users; men and women; and whites and blacks. We conclude that health department notification is acceptable to persons exposed to HIV in this rural South Carolina district.

Adolescent↗

PubMed1989

Adolescent contraceptive use and parental notification.

Little research exists regarding the relationship between family communication and the sexual behavior and contraceptive use of adolescent females. A self-administered questionnaire was used to survey 196 adolescent females regarding communication with their parents about sexual issues and their reaction to proposed parental notification of the dispensing of prescription contraception. Parents of 80% of the subjects who were sexually experienced were aware of this activity. Parents of 80% of those subjects who had used contraception were aware of this use; 59% of these subjects informed their parents before their family planning visit. The majority of female adolescents (57%) were unwilling to communicate with their parents about sexual issues; 64% felt they should be able to receive prescription contraception without parental knowledge. Communication regarding sexual issues was related to lifetime contraceptive use. Eighteen percent of the sexually experienced subjects would not allow their parents to be notified of their family planning visit; 86% would use less effective contraception if family planning services were not sought. Our findings suggest that a parental notification policy will not compel all adolescents to inform parents about their contraceptive use; most adolescents will resort to less effective contraceptive methods.

Adolescent↗

PubMed1991

Impact of the Minnesota Parental Notification Law on abortion and birth.

BACKGROUND: The impact of the Minnesota Parental Notification Law on abortion and birth was examined. METHODS: Using linear models, outcome parameters were compared before and after enactment of the law. Time by age group interactions also were examined. RESULTS: The pre-enactment to post-enactment change in the Minnesota abortion rate reflected a greater decline for minors (less than or equal to 17 years old) than for 18-19 year-olds (who were not under the law). An increase in abortion rate occurred for women ages 20-44. The law appeared to have had no impact on birth rate in minors. Following the enactment of the law, the rate of early abortions (less than or equal to 12 weeks) declined among minors more than the rate of late abortions (greater than 12 weeks). This resulted in a pre-enactment to post-enactment increase in the ratio of late-to-early abortions among minors. CONCLUSIONS: These data suggest that parental notification facilitated pregnancy avoidance in 15-17 year-old Minnesota women. Abortion rates declined unexpectedly while birth rates continued to decline in accordance with a long-term trend.

Abortion, Legal↗

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↗

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↗

PubMed1986

Economics of notification and medical screening for high-risk workers.

Measuring the economic impact of notification and intervention programs for workers at high risk of disease from workplace exposure has been virtually nonexistent for several reasons, which will be discussed, and should include a comprehensive view of costs and benefits. A framework for analysis is proposed defining four major clients: the business community, workers and their families, the local and regional public sector, and the federal government. For each client, the positive and negative, quantitative and nonquantitative, direct and indirect, short-run and long-run effects are probed and a summary analysis is made. To illustrate the process, the notification and screening program conducted by the National Institute for Occupational Safety and Health and the Workers' Institute for Safety and Health, Augusta, Georgia, for workers exposed to beta-naphthylamine is described.

Cost-Benefit Analysis↗