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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↗

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↗

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↗

PubMed1995

Assessing the completeness of tuberculosis notification in a health district.

We have estimated the completeness of tuberculosis notification in Bolton health district by combining notification data with information from prescriptions issued by general practitioners and hospital admission data. From 1 January 1991 to 31 December 1993, 307 cases of tuberculosis were notified in Bolton. Thirty-four cases were identified using general practitioners' prescriptions: 27 of these had been notified between January 1991 and December 1993, and seven had not been notified during this period. Although prescriptions may be used as a marker for tuberculosis, they would not be an adequate alternative to notification of cases. One hundred and forty-eight cases of tuberculosis were identified between 1 October 1992 and 30 September 1993 by combining data from the three sources: 138 cases had been notified (93.2%), 28 identified from prescriptions (23.0%), and 54 identified from hospital data (36.5%).

Antitubercular Agents↗

PubMed1994

Behaviour, knowledge and reactions concerning sexually transmitted diseases: implications for partner notification in Lusaka.

Available data show that STDs and their consequences are a major health problem in Zambia. This study focuses on factors which could have implications for partner notification, as a tool for prevention. Fifty women and fifty men with STD were interviewed at two outpatient clinics in Lusaka, where partner notification is not functioning optimally. A majority of the sexual partners during the last three months were known by the patients who also stated a willingness to bring more partners than they were asked to do. Women had symptoms for a longer period than men before they came for treatment. They were less aware of symptoms connected with STD and a majority of them did not know that they were receiving treatment for STD. The communication between the health care provider and the patients about disease, treatment and partner notification needs to be improved especially for women.

Adolescent↗

PubMedDate not supplied

Notification of meningococcal disease and Haemophilus influenzae meningitis: a requirement for public health action.

------------------------------------------------------------------------ ------------------------------------------------------------------------ ------------------------------------------------------------------------ ---------------------------meningitis was ascertained for the years 1987-1991. Laboratory record review identified positive blood culture and cerebro-spinal fluid isolates for 4 Dublin hospitals serving the paediatric population of the Eastern Health Board. Infectious disease registers, inspected for evidence of notification, revealed than only 44% of culture positive cases had been notified. The notification rate for Haemophilus meningitis (33%) was significantly lower than that for meningococcal disease (53%). All laboratory identified cases should have been notified. Public health assessment is required for each condition as rifampicin prophylaxis can prevent secondary cases in close contacts of both diseases. Improved notification is essential, not just to comply with the law but more importantly, for better management of these diseases.

Child↗

PubMed1993

Is the medical community ready for worker notification?

Although the potential for early detection of disease has been of central importance in the evolution of worker notification policy and practice, it is not the only positive outcome of medical intervention. The provider-patient encounter also creates an important opportunity for patient-centered risk communication that may result in workplace modifications as well as lifestyle changes to reduce the likelihood of subsequent illness and injury--both work and nonwork related. At the same time, it may signal the beginning of a series of social, legal, and political actions that may have positive or negative consequences for notified workers. This article identifies several important roles for members of the medical community relating to worker and community notification programs and explores the readiness of health care professionals in assuming these roles. It is suggested that health care providers lack both the training and sociopolitical sensitivity needed for meaningful participation in the notification process. This article addresses possible short-term and long-term approaches to enhancing the readiness of health care providers and suggests that effective intervention with notified workers requires a willingness to step beyond the confines of the medical model.

Communication↗

PubMed1993

Content of notification: exposure to the pesticide chlordimeform.

A notification about exposure requires a detailed search of records and interviews with personnel to properly identify potentially exposed groups. Next, these potentially exposed groups must be examined to determine which groups had the potential for highest exposures. The notification should address three key questions: Why am I receiving this notification? What problems are associated with exposure to the chemical? What am I supposed to do? Consideration should be given to notifying lesser-exposed groups, as to why they are not considered to be at increased risk.

Chlorphenamidine↗

PubMed1993

Experiences of a state-sponsored notification and screening program for asbestos workers.

Worker notification can involve a broad range of activities including medical screening, personal and mass communications, cohort identification and tracing, and even litigation. The inclusion or exclusion of various supporting activities in a worker notification program may pose significant medical, public health, financial, logistical, and even legal implications for targeted individuals as well as for the agencies involved. This report describes some experiences in a state-sponsored notification and screening program of approximately 4,500 asbestos workers in Minnesota. In this program, a variety of factors led to the decision to provide medical screening to 1,101 workers and 451 spouses. It is anticipated that another 3,400 workers will be notified but not screened. A follow-up survey of notified workers showed overwhelming support for this program. It is estimated that this program will cost more than $650,000 by its completion. The decision to institute medical screening and other support activities should be made with careful consideration of the diverse implications of these activities to the individuals, communities, and agencies involved.

Asbestos↗

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↗

PubMed1993

Surveillance of measles in Scotland 1983-1991; a comparison of statutory notification and laboratory reporting.

The epidemiology of measles in Scotland for the period 1983-1991, based on statutory notification and laboratory reporting, is described. There were 34,823 notifications compared to only 690 laboratory reports. This suggests that for less than 1 in 50 notifications of measles was the clinical diagnosis confirmed by laboratory testing. Both sets of data show a declining incidence of measles (in keeping with rising rates of immunisation) but a statistically significant shift in the age distribution of cases towards the over 15 years age group. There were differences, however, between the two sets of data in the sex ratio within various age groups. In particular, among notified cases, there was a highly significant but unexplained preponderance of males in the over 15 years age group (59.7% vs. 40.3%, P < 0.001). Discrepancies between the two sets of data were also evident from comparisons among Health Boards. Possible sources of bias are suggested for each set of data. The relevance of this surveillance to the current debate about the need for a two stage Measles/Mumps/Rubella (MMR) immunisation policy is briefly discussed. In order that this debate be reliably informed, it is highly desirable that the clinical diagnosis in each case of apparent vaccine failure is confirmed by laboratory testing.

Adolescent↗

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↗

PubMed1984

A new approach to tuberculosis notification.

A tuberculosis notification system was initiated which used several sources--the doctor, the diagnostic services of bacteriology, histopathology and radiology, and the pharmacy. The results of six months' notifications have shown that the pharmacy was by far the most complete source (74% of all new cases); doctors notified only 21% of all new cases. The combination of both doctors and the pharmacy was the most complete pair, notifying 85% of all new cases. It is suggested that consideration should be given to the use of pharmacies as a source of notification both in other settings and for other diseases.

Bacteriology↗

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↗

PubMed1995

The risk of domestic violence and women with HIV infection: implications for partner notification, public policy, and the law.

Partner notification has emerged as an important strategy in the fight against acquired immunodeficiency syndrome (AIDS), and states have now adopted a plethora of laws that encourage or mandate notification, often without the patient's consent. As human immunodeficiency virus (HIV) infection continues to spread among women, the future development of AIDS control strategies and public health laws must be shaped by concern for the safety and autonomy of patients who face a risk of domestic violence. Three distinct recommendations flow from this premise. First, all HIV-infected women should be assessed for the risk of domestic violence and offered appropriate interventions. Second, where a risk of abuse is indicated, partners should never be notified without the patient's consent. State laws that presently permit involuntary notification should be repealed or amended. Third, laws that punish a patient's refusal to notify partners should also be modified or repealed.

Acquired Immunodeficiency Syndrome↗