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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↗

PubMed1998

Partner notification techniques.

This article aimed to cover the range of techniques used in partner notification for sexually transmitted infections, including HIV. Many of the current methods were developed over the past 50 years, and very little operational research has since been undertaken to refine them. More work is needed to evaluate inexpensive strategies to improve patient referral, to determine the psychological and behavioral impact of partner notification and methods of incorporating social networks in partner notification programs.

Confidentiality↗

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↗

PubMed1998

Partner notification with HIV-infected drug users: results of formative research.

The authors conducted formative research on the use of partner notification with HIV-infected drug users (i.e. those who use/abuse injectable drugs, crack or cocaine) in order to guide the development of an effective intervention for this population in New York City. Structured focus group and personal interviews were conducted with 25 in- and out-of-treatment drug users, 23 counsellors from a sexually transmitted disease (STD) clinic and a methadone maintenance treatment programme (MMTP), and nine experts in the field of HIV partner notification and/or substance abuse prevention and treatment. Results revealed factors associated with HIV-positive disclosure, the strengths and barriers of existing partner notification programmes and issues that should be considered in designing an effective intervention with HIV-infected drug users. Further research and planning activities are recommended before piloting and evaluating such a programme.

Ambulatory Care↗

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↗

PubMed1997

Gonorrhoea in Coventry 1991-1994: epidemiology, coinfection and evaluation of partner notification in the STD clinic.

The aim of this study is to analyse the epidemiology of gonorrhoea in the Coventry area between 1991-1994 and the implementation and outcome of partner notification. A total of 404 episodes in 382 patients comprised the study group. In Coventry, 97% of episodes were managed in the STD clinic. There was a decrease in female and heterosexual male cases from 172 cases in 1991 to 37 cases in 1994 and increase in homosexual male cases from 8 in 1991 to 13 in 1994 (P<0.0001). Chlamydial coinfection was found in 38%. Among patients with gonorrhoea, 33% were asymptomatic and 40% with gonorrhoea and chlamydia were asymptomatic. Ten per cent of index cases were asymptomatic as were 83% of contact cases (P<0.0001). The health advisers (HAs) interviewed 82% immediately and 94% at some time after diagnosis. Of the average 1.5 partners per patient identified, 0.31 partners per patient were already screened, another 0.4 partners per patient were traced, 0.37 partners per patient were not traced, and for 0.41 partners per patient notification outcome was unknown or unconfirmed. Partner notification of 278 index cases traced 163 primary or tertiary contacts, 115 were new cases of gonorrhoea.

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↗

PubMed1996

Partner notification program and possibility of including it in the HIV prevention strategies in Japan.

This article discusses the possibility of implementing partner notification program as a part of HIV prevention strategy in Japan. Relevant factors, like HIV seroprevalence, general population attitudes toward HIV, legislation, resources, barriers, behavioral changes, cost and effectiveness are analyzed in Japanese perspectives. Effectiveness of this program is also predicted based on the two informal contact tracing program in Japan. At the same time a review was made on the global perspectives of partner notification program and operational procedures are also outlined. Published literatures were investigated regarding prevalence of new HIV infection among the partners who underwent testing (11-39%), cost per new HIV positive case found (US $810-3,205), and secondary infection rate (11-20%) in Japan. Having considered all relevant factors we recommend that the partner notification program be implemented, initially in a limited area, then all over Japan. Further analysis on cost-benefit of this program remains to be done.

Adult↗

PubMed1998

Tuberculosis notifications in Australia, 1996. Communicable Diseases Network Australia New Zealand.

Since the implementation of the National Mycobacterial Surveillance System (NMSS) in 1991, the epidemiology and trends of tuberculosis in Australia have been described in a series of annual reports. This article presents an analysis of the data for tuberculosis notifications for 1996. A total of 1,037 notifications of tuberculosis were received for the year 1996, and the crude rates of new and relapsed disease were reported at 5.37 per 100,000 and 0.29 per 100,000 respectively. Rates of tuberculosis have remained stable over the last decade and the majority of notifications and highest rates of disease continue to occur in the overseas-born population.

Adolescent↗

PubMed1993

Human immunodeficiency virus notifications for aborigines and Torres Strait Islanders in Queensland.

OBJECTIVE: To describe the epidemiology of HIV infection based on notifications of HIV infection in Aboriginal and Torres Strait Islander people in Queensland and to review their implications for Aboriginal and Torres Strait Islander communities. DESIGN: Descriptive study of data obtained through HIV notifications to the AIDS Medical Unit, Specialised Health Services, Queensland Health from 1 July 1985 to 31 August 1991. SUBJECTS: Aboriginal and Torres Strait Islander people of Queensland. MAIN OUTCOME MEASURES: Centers for Disease Control (CDC) classification of HIV infection, as at 31 August 1991. RESULTS: Twenty-nine individuals identified as Aboriginal or Torres Strait Islander were notified as positive for HIV antibodies in the period 1 July 1985 to 31 August 1991. Of those diagnosed, three were female and 26 male. At 31 August 1991, only 10 were asymptomatic (CDC Group II, III), eight were symptomatic (AIDS-related complex) and 11 were diagnosed as having AIDS. Seven of those with a diagnosis of AIDS had died by the end of the study period. By comparison, 1158 non-Aboriginal or Torres Strait Islander people were notified for the same time period. Of these, 48 were female, 1105 were male and five were transsexual. In the non-Aboriginal and Torres Strait Islander group, 633 were asymptomatic and 297 were diagnosed with AIDS. By the end of the study period, 228 had died. CONCLUSIONS: The data show an estimated prevalence of diagnosed HIV infection in Aboriginal and Torres Strait Islander people in Queensland comparable with the rest of the population. Cases are distributed throughout the State, though some clustering is evident. There has been a stable pattern of notifications over the past five years. The proportion of asymptomatic (CDC groups II, III) HIV-positive Aboriginal and Torres Strait Islander clients was significantly lower than for the non-Aboriginal and Torres Strait Islander group. These data have implications in terms of projections of total cases, diagnosed and undiagnosed, and relative access to the advantages attending early diagnosis.

Acquired Immunodeficiency Syndrome↗

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↗