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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↗

PubMed1995

Minimizing aminoglycoside toxicity by prescriber notification of prolonged therapy.

The development of aminoglycoside toxicity has been reported related to duration of exposure. To potentially reduce the duration of exposure to aminoglycosides, pharmacists documented, via a permanent note in the patient health record, the exposure and potential associated risks of any patient who received greater than 10 consecutive days or 20 days total within 3 months of aminoglycoside therapy at this institution. The impact of the notification on further aminoglycoside exposure was evaluated over two 6-month periods. Notification was successful in ending further aminoglycoside exposure in 25 of 57 patients. Continued aminoglycoside therapy primarily involved treatment of febrile neutropenia and endocarditis. Prevention of toxicity was suggested in the second evaluation period in which none of the patients, having therapy altered by the notification, developed toxicity versus 13 of the 40 other patients who developed a rise in serum creatinine concentration or a reduction in hearing acuity. The methodology that produced these positive results should be easily transferable to other institutions.

Aminoglycosides↗

PubMed1998

"Guidance for industry: current good manufacturing practice for blood and blood components: (1). Quarantine and disposition of units from prior collections from donors with repeatedly reactive screening test for antibody to hepatitis C virus (anti-HCV); (2). Supplemental testing, and the notification of consignees and blood recipients of donor test results for anti-HCV;" availability--FDA. Notice.

The Food and Drug Administration (FDA) is announcing the availability of a guidance document (dated September 1998) entitled "Guidance for Industry: Current Good Manufacturing Practice for Blood and Blood Components: (1) Quarantine and Disposition of Units From Prior Collections From Donors With Repeatedly Reactive Screening Test for Antibody to Hepatitis C Virus (Anti-HCV); (2) Supplemental Testing, and the Notification of Consignees and Blood Recipients of Donor Test Results for Anti-HCV." The guidance document provides recommendations for donor screening and supplemental testing for antibody to hepatitis C virus (HCV), notification of consignees and quarantine of prior collections from a donor who later tests repeatedly reactive for antibody to HCV, notification of recipients of blood and blood components at increased risk for transmitting HCV.

Blood Banks↗

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↗

PubMedDate not supplied

Partner notification for sexually transmitted diseases: an overview of the evidence.

OBJECTIVE: To compare the effectiveness of alternative partner notification strategies for gonorrhea, chlamydia, syphilis, HIV and hepatitis B. DATA SOURCES: Studies were identified using MEDLINE, EMBASE, SCISEARCH and other databases, review of reference lists and personal contact with over 80 international experts. STUDY SELECTION: Studies with at least two comparison groups exposed to different partner notification strategies were included. DATA EXTRACTION: Methodological rigor was assessed, and information regarding study populations, interventions and outcomes was extracted independently by two reviewers. MAIN RESULTS: Twelve studies met our inclusion criteria; five were methodologically strong; seven provided data on the referral process; four provided data on trained interviewers compared with routine care providers; and three provided data on the interview process. CONCLUSIONS: Only limited, broad conclusions regarding the effectiveness of various partner notification approaches could be drawn from these comparative studies. Until newer data become available, practice guidelines must be based to a large extent on other grounds.

Contact Tracing↗

PubMed1997

Design of a general clinical notification system based on the publish-subscribe paradigm.

We describe the design and initial implementation of a notification sub-system, as a component of a modern information management architecture. The system, based on the publish-subscribe paradigm, provides a framework of event-based communications for the implementation of various important clinical applications including the notification of alerts and reminders with escalation algorithms, the reliable distribution of documents, and the implementation of intelligent patient-specific monitoring processes. The initial implementation of the system, providing the notification of the unit staff about new orders, indicates that the model is viable both in terms of functionality and ability to scale up.

Algorithms↗

PubMedDate not supplied

Critical limits (alert values) for physician notification: universal or medical center specific limits?

The concept of critical limits (alert values), defined as an imminent life threatening laboratory result requiring immediate physician notification, has been widely adopted as a standard of good laboratory practice. Although virtually all laboratories have tests with critical limits, surveys have shown that there is no universal alert value list. Recently, nine VA medical centers in the New England region, which now constitute one consolidated entity, were surveyed with the objective of summarizing critical limits. Universal (100 percent) critical limit tests for clinical chemistry were: Calcium; mean low/high, 6.5/12.4 mg/dL: Glucose 48/432 mg/dL: Potassium 2.8/6.1 mmol/L: Sodium 121/159 mmol/L. Universal hematology tests included: Hematocrit 22.2/59.7 percent: Platelet count 61K/983K: white blood count 1.9K/29K. Although there was universal agreement that abnormal coagulation tests (PT, PTT) should be included on the hematology critical limit list, there was wide variation in the reporting of coagulation tests (seconds and INR) and patient therapeutic status (anticoagulant or no-anticoagulant). Universal alert values for microbiology were: Positive blood culture: Positive cerebral spinal fluid (CSF) culture: Positive CSF Gram stain. There was no universal agreement regarding critically high (potentially toxic) therapeutic drugs, with two medical centers declining to notify physicians of any abnormally high therapeutic drug level. No other qualitative critical limits for other laboratory sections, such as physician notification of an unexpected malignancy (surgical pathology) were universal. Medical center specific critical limits, designed to meet the clinical needs of each facility, are the norm in the nine medical centers. Laboratories do need periodically to review their critical limit lists with appropriate clinical input to avoid including critical limits for laboratory tests not required for urgent physician notification and patient evaluation and treatment.

Chemistry, Clinical↗

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↗

PubMed1994

Delay in the diagnosis, notification and initiation of treatment and compliance in children with tuberculosis.

SETTING: The mortality and morbidity from childhood tuberculosis may be influenced by the delay from the time of first symptoms until the start of and compliance with treatment. OBJECTIVE: This study investigated these delay periods and the compliance with therapy in children with tuberculosis. DESIGN: During the study period there were 49 children with probable and 123 with confirmed pulmonary tuberculosis (WHO criteria). The mean period from first symptoms until presentation was 4.3 weeks, from presentation until notification 5 weeks and from notification until therapy 0.9 weeks. 16% of children notified as having tuberculosis never received therapy. Significantly fewer children in the urban squatter communities received therapy than in urban settled (P = 0.02), rural agricultural (P = 0.0001) and rural settled (P = 0.09) communities. 12% of children did not complete their therapy. CONCLUSION: The delay in presentation ('patient delay') was shorter than the delay in diagnosis ('doctor delay'). Failure to trace children and to complete therapy was particularly likely to occur in urban squatter communities. Easier access to health care facilities may shorten the 'patient delay' while greater awareness of tuberculosis and proper investigation of children may shorten the 'doctor delay'.

Child↗

PubMed1996

Deaths from active tuberculosis: can we rely on notification and mortality figures?

SETTING: Notification rates and mortality are the main indicators in the epidemiology of tuberculosis. While errors in case notification are known to be considerable, the quality of the data on deaths is largely unknown. OBJECTIVE: To validate the quality of data on deaths from active tuberculosis. DESIGN: We compared deaths from active tuberculosis in Statistics Norway with the National Tuberculosis Register (NTR) and cases found by autopsy in two Norwegian counties in 1977-1989. We also assessed the diagnostic classification and inclusion criteria for tuberculosis. RESULTS: 110 patients were entered into the study. We excluded 30 of 106 patients in Statistics Norway, primarily because of inactive tuberculosis (16) or minimal lesions (7). We found an additional 20 patients in the NTR and 14 more from autopsy reports. These missing cases were registered in Statistics Norway with a different diagnosis (28), inactive tuberculosis (4) or not found (2). Nineteen of them were diagnosed with tuberculosis by autopsy and five by cultures reported after death. We altered the diagnostic classification of underlying cause in 14% and found tuberculosis to be the underlying cause in 65 patients. CONCLUSION: The mortality rate from active tuberculosis in Statistics Norway was fairly correct, but one-third were under-reported and one-third over-reported. The mortality rate includes only half of all the deaths from active tuberculosis. All the cases in which active tuberculosis is mentioned on the death certificate are a clearer indication of tuberculosis deaths.

Autopsy↗

PubMed1998

Occupational skin diseases: reliability and utility of the data in the various registers; the course from notification to compensation and the costs. A case study from Denmark.

Occupational diseases affect many people and may have serious social and economic consequences. In 1984, the National Labour Inspection Service established the Register of Occupational Diseases (ROD). The purpose of the central register was to provide information about injury-causing factors and risk groups, etc., changes in risk factors (ongoing monitoring and warning system), and to document the effects of preventive activities. However, we are dealing with several uncertain factors (i.e., whether the number of notified cases is too high or too low), and although the ROD contains a lot of information, it basically represents only notified (suspected) cases, until otherwise proven. Therefore, the utility and reliability of the data in the ROD may be questionable. The National Board of Industrial Injuries and the insurance companies represent recognized and compensated (genuine) cases, but their registers in general contain little information on variables. Thus, it is difficult to obtain exact information of occupational diseases (i.e., the real frequency and causes). What is known, is the number of cases that are notified, recognized and compensated, and the costs. Clearly, the higher the frequency of recognition, the more representative the data in the ROD of the recognized (genuine) cases. Therefore, the course from notification to recognition, and from recognition to compensation was calculated, and, for each step, the importance of skin diseases was considered. Only in the case of skin diseases, was the frequency of recognition high (2/3), and the data in the ROD were considered in more detail, and, where possible, compared with recognized and compensated cases. The various registers concurrently showed that nearly all occupational skin diseases were eczematous in nature (98%), most cases belonged to the younger age group (2/3), women (2/3) predominated over men, and the dominant type of occupational eczema was irritant (2/3). It has not been possible to get further information about exposure sources, occupations and trades from the other registers. However, considering the high frequency of recognition for skin diseases (eczemas), it is likely that the information in the ROD is also to some extent representative of the recognized (genuine) cases. As regards the importance of various disease categories, skin diseases (eczemas) ranked 1st (numerically) among both recognized and compensated cases, and were the most expensive. Therefore preventive activities are mandatory, and because of the high frequency of recognition, the data in the ROD may provide a basis for establishment of the most relevant preventive activities. For other disease categories, the frequency of recognition was low, and the utility and reliability of the data in ROD is in questionable. Therefore, in general, an improvement in the notification system is desirable, but a system that takes into account the many uncertain factors is extremely difficult to set up. Linking of the registers is in progress, and this will be useful during everyday situations.

Adolescent↗

PubMed1995

The impact of the first notification of positive blood cultures on antibiotic therapy. A one-year survey.

The impact on antibiotic therapy of the first notification of positive blood cultures was assessed for 735 episodes of bacteraemia detected during 1992 in the County of Northern Jutland, Denmark. A primary focus of infection was defined in 498 episodes, the urinary tract being the most frequent (n = 182, 25%). Twenty-nine patients (3.5%) had died prior to the initial contact. In 12 episodes antibiotic therapy had either been stopped or data were not available, leaving 694 episodes for further assessment. In 567 episodes antibiotic therapy had been started prior to the initial contact, the most frequent regimen being ampicillin or an ampicillin-aminoglycoside combination (295 episodes), whereas cephalosporins, thienamycin, and fluoroquinolones were seldom used (41 episodes). The ongoing antibiotic coverage was deemed appropriate in 418 episodes (60%), non-optimal in 90 (13%), and lacking in 186 (27%). The notification of positive blood cultures elicited changes in antibiotic therapy in 315 episodes (45%), including commencement of antibiotic therapy in 127 (18%). Thus, blood culture results have a measurable impact on antibiotic therapy.

Adult↗

PubMed1999

Social factors associated with increases in tuberculosis notifications.

This study assessed the contribution of immigration and deprivation to the changes in tuberculosis notifications in Liverpool over the last 20 yrs. Ethnic origin was retrospectively assigned to all named cases from 1974 to 1995. Average tuberculosis rates were calculated for the 33 council wards in Liverpool for 1981-1985 and 1991-1995. Multiple regression was used to determine the independent effects of socioeconomic and population measures from the 1981 and 1991 censuses in explaining these ward-based rates. Since 1974, there has been a steady increase in the percentage of non-Caucasian cases of tuberculosis, from 8.7% in 1975-1977, 15.1% in 1981-1983, 17.5% in 1987-1989 to 28.0% in 1993-1995. Multiple regression analysis showed that in 1981 only unemployment had a significant independent relationship with tuberculosis rates, but in 1991 two indices of deprivation and ethnicity had a significant influence. The increasing proportion of non-Caucasian tuberculosis cases, both while the number of notifications was declining before 1987 and increasing afterwards, is not necessarily consistent with the concept that immigration has influenced the recent increase. However, the fact that ethnicity now independently explains some of the council ward variations but did not in the early 1980s suggests that immigration does influence the distribution of disease within the city.

Adolescent↗

PubMed1996

[Compulsory notification of cysticercosis in Ribeiräo Preto-SP, Brazil].

Cysticercosis is a severe public health problem in several regions of Asia, Africa and Latin America. Epidemiologic studies based on the frequency of cases observed in specialized neurology, neurosurgery and computed tomography services, at autopsy and in seroepidemiologic studies do not permit the determination of the true prevalence of the disease in the population. The objective of the present study was to investigate the prevalence of cysticercosis by compulsory notification. The coefficient of prevalence was 54 cases/100,000 inhabitants in the municipality of Ribeirão Preto. The results also indicated that cysticercosis is not under control in our region since 21% of cases presented the active form of the disease. Compulsory notification proved to be a valuable resource for the epidemiologic study of cysticercosis, also permitting the mapping of more affected areas for a better direction of prevention strategies.

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↗