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PubMed1996

Home ovulation testing in a donor insemination service.

The use of home ovulation testing kits in donor insemination (DI) has been proposed to increase patient and clinic convenience while not compromising fecundity rates. Such a system was introduced into our DI service in December 1994, and we here report an audit of experience over 6 months. Patients were offered home or laboratory luteinizing hormone (LH) testing, and those requesting home testing were asked to store an aliquot of tested urine for subsequent assay in the laboratory allowing retrospective analysis of the accuracy of cycle timing. Insemination using cryopreserved semen was performed on the day home testing predicted ovulation, or on the day an LH surge was detected in the laboratory, and on the following day. Pregnancy rates were significantly reduced in home testers: 3.4% per cycle (174 cycles, 64 women) versus 12.7% (110 cycles, 53 women) over the same time period (P < 0.005, 95% confidence interval 6.5-18.9). Urine samples from 140 cycles from 51 women using home testing were analysed. There were insufficient data in nine to allocate the cycle. Of home tested cycles, 37 (28%) were inseminated on a day other than the first day of the LH surge. In 13 of these insemination was performed after the first day of the LH surge. Incorrect treatment was associated with high baseline LH, but those with 'late' treatment had low basal LH concentrations, similar to those correctly treated. Analysis of individual urine samples showed that the positive predictive value of home testing was 72%. These results suggest that home ovulation testing results in reduced chance of pregnancy, with increased frustration for both patients and clinic staff. This may be particularly so in women with high baseline LH concentrations.

Adult↗
PubMedDate not supplied

Use of home pregnancy tests among adolescent women.

Many adolescents use home pregnancy tests when they suspect pregnancy. However, because of developmental issues and greater variation in menstrual cycles, teens are at risk for obtaining false-negative test results. Moreover, with teens, the need for a pregnancy test often accompanies the need for comprehensive reproductive care including evaluation for sexually transmitted infections and contraception. This article reviews the mechanisms of home pregnancy testing including sensitivity, accuracy, and home testing procedures. Clinical strategies for improving the accuracy of home pregnancy tests for teen users are discussed. Lastly, policy implications to improve teens' access to more accurate pregnancy testing and to reproductive health services are suggested.

Adolescent↗
PubMed1997

Anonymous HIV testing using home collection and telemedicine counseling. A multicenter evaluation.

BACKGROUND: Home human immunodeficiency virus (HIV) testing has been proposed as an alternative to conventional HIV testing. Despite debate over HIV type 1 (HIV-1) home test systems, these concerns have not to our knowledge been previously studied. OBJECTIVE: To evaluate the safety and efficacy of the Home Access Health Corp (Hoffman Estates, Ill) HIV-1 test system compared with traditional HIV-1 testing with venous blood. METHODS: A total of 1255 subjects were studied prospectively in a blinded, subject-as-control evaluation at 9 outpatient clinics using intent-to-treat analysis. Subjects were provided a home collection kit (Home Access Health Corp) to collect their own finger-stick blood spot samples for laboratory analysis. Subjects received pretest counseling by telephone and their comprehension was subsequently assessed. Subject-collected blood spot samples were compared with professionally drawn blood spot samples for adequacy (sufficient for completing the Food and Drug Administration-endorsed testing) and with venous samples for accuracy. Subjects called 3 days later for anonymous results and posttest counseling. Device safety was evaluated based on adverse events incidence. Subject comprehension of HIV information was measured. RESULTS: Subject-collected blood spot sample results were in complete agreement with venous blood sample results, demonstrating 100% sensitivity and 100% specificity compared with venous controls. Ninety-eight percent of subjects obtained testable blood spot specimens compared with phlebotomists. Following pretest counseling, subjects answered 96% of HIV risk questions correctly. There were no significant adverse events. CONCLUSION: Anonymous HIV-1 home collection kits with pretest and posttest telephone counseling can provide a safe and effective alternative to conventional venous HIV-1 antibody testing.

Adult↗
PubMed2006

Rapid HIV testing at home: does it solve a problem or create one?

The U.S. Food and Drug Administration (FDA) is considering approval of an over-the-counter, rapid HIV test for home use. To date, testimony presented before the FDA has been overwhelmingly supportive. Advocates have argued enthusiastically that there is value in empowering individuals to manage their HIV risks and have suggested that the availability of a rapid home HIV test will dramatically increase rates of disease detection in communities that have proven difficult to reach and to link to appropriate care. The authors offer a more cautious perspective. According to what is already known about the market demand for over-the-counter HIV testing kits, their costs, and the performance of rapid HIV tests in that market, the authors do not anticipate that the rapid home test will have a profound impact either on the HIV public health crisis or on the populations in greatest need. Home HIV testing will attract a predominantly affluent clientele, composed disproportionately of HIV-uninfected new couples and "worried well" persons, as well as very recently infected persons with undetectable disease. The authors illustrate how testing in these populations may have the perverse effect of increasing both false-positive and false-negative results. A poorly functioning home HIV test may thereby undermine confidence in the reliability of HIV testing more generally and weaken critical efforts to expand HIV detection and linkage to lifesaving care for the estimated 300,000 U.S. citizens with unidentified HIV infection.

Costs and Cost Analysis↗
PubMed1996

Home HIV tests: the need for regulation.

In-home testing for HIV/AIDS will be available nationwide in early 1997. Because laws regulating these over-the-counter test kits vary widely from state to state, national uniform regulations are needed to safeguard the rights of consumers and to protect health care providers from professional liability.

AIDS Serodiagnosis↗
PubMed2006

"A private little revolution": the home pregnancy test in American culture.

The home pregnancy test went from novelty to norm in twenty-five years. This article explores its cultural impact in the context of the women's health movement. Though women had long made do without it, the "private little revolution," as the test was called in an early advertisement, enabled them to take control of their reproductive health care and moved the moment of discovery from the doctor's office (back) to the home. The article introduces the test, explores its acceptance by physicians and by women, looks at the marketing of the test by drug companies, and traces its use in movies, television, and novels.

Culture↗
PubMed2003

Willingness to use instant home HIV tests: data from the California Behavioral Risk Factor Surveillance Survey.

OBJECTIVE: Although home collection HIV tests are available in the United States, home HIV tests providing instant results are not available. The objective of this study was to examine willingness to use instant home HIV tests and what test characteristics are most important to individuals. METHODS: Six questions were added to the 1999 California Behavioral Risk Factor Surveillance Survey (BRFSS) (n =2964). This state-representative survey is part of the ongoing, 50-state BRFSS sponsored by the Centers for Disease Control and Prevention. Chi-square tests and logistic regression were used to examine willingness to use instant home HIV tests and preferences for HIV test characteristics. RESULTS: Over one third (37%) of respondents would consider using an instant home HIV test. Respondents willing to use instant home tests were more likely to be Hispanic (odds ratio [OR]=1.55; confidence interval [CI]=1.03-2.34); to have not previously been tested for HIV (OR=1.72; CI=1.20-2.45); to be more likely to plan to be tested in the next 12 months (OR=1.17; CI=1.00-1.37); and to prefer urine sample collection (OR=1.56; CI=1.03-2.37). CONCLUSION: Over one third of respondents in a large, state-representative sample would consider using an instant home HIV test. Hispanics, individuals who planned to be tested in the next 12 months, and individuals who had never been tested were more willing to use instant home tests.

Adult↗
PubMed1980

The current status of the Canadian home fitness test.

The current status of the Canadian Home Fitness Test is reviewed. This simple procedure was originally conceived for the mass testing of fitness levels and for home use as a motivational tool in exercise programmes. The test is carried out on a double 8 inch step (such as a domestic staircase) at an age and sex-specific rhythm set by a long-playing record. Fitness is assessed from a combination of test-duration and the radial or carotid pulse count immediately following exercise. Use of the procedure by upwards of 500,000 Canadians is reviewed in relaltion to its safety, validity and practicality. To date, there have been no serious complications. In home use, there is inevitably limited precision, although with practice subjects can learn to count their pulse rate and step in time to the music; further, the test seems well received, achieving its prime objective of stimulating an interest in physical activity and endurance fitness. When the procedure is carried out by a paramedical worker, with e.c.g. recording of the exercise heart rate, it provides at least as good an estimate of maximum oxygen intake as other sub-maximal procedure; the main area of current controversy is interpretation of abnormal stress e.c.g. records, and it is suggested this problem could be resolved by the appropriate training and certification of interested family physicans and paramedical workers.

Adolescent↗
PubMedDate not supplied

Performance and sensitivity of modern home pregnancy tests.

We have studied the performance of three currently available home pregnancy tests. The Advance is a test based on monoclonal antibodies in an enzyme immunoassay format that specifically detects hCG in urine. The positive results are determined by the presence of a blue color in a color stick (30 minutes). The Daisy 2 and FACT are tests based on monoclonal antibodies that specifically detect hCG in urine in a hemagglutination inhibition assay; positive results are demonstrated by the deposition of a dot ring at the bottom of the test tube (45 minutes). Thirty-five patients who eventually became pregnant in that cycle collected the first morning urine specimens from day of ovulation (determined by ultrasound) in artificial insemination donor (AID) cycles, or from the date of gamete intrafallopian transfer (GIFT) for 16 consecutive days. In each specimen, the Advance, Daisy 2, and FACT tests were performed; in addition, beta-hCG levels were determined by radioimmunoassay. All the home pregnancy tests studied can detect pregnancy as early as 9 or 10 days post-conception, and they give positive results at the time of the expected onset of menses in 70%, 95%, and 88% of cases for Daisy 2, Advance, and FACT, respectively. The sensitivity of the these home pregnancy tests was determined to be about 200 mIU/mL of urine after correlating their positive or negative results with the concentrations of urinary beta-hCG determined by radioimmunoassay.

Antibodies, Monoclonal↗
PubMed2002

Peritoneal equilibration test at home.

The peritoneal equilibration test (PET) has been widely used as a standardized means for estimating solute transport. However, the procedure is rather complex, and patients must spend more than half a day in the hospital. The fast PET is an alternative method, but the results are not reliable in patients whose peritoneal catheters drain poorly. We postulated that patients could perform the PET at home if educated well about the procedure. To that purpose, we prepared three types of visual aids that introduce the PET procedure: a VCR tape, a DVD disc, and a brochure with photographs. Equilibration tests were performed using the twin-bag system. For making fluid level indicator lines (200 mL and 10 mL), patients are given a guide sheet on which the fresh dialysate bag is placed. After an 8- to 12-hour overnight dwell, the dwelled dialysate is drained completely into the empty bag. Immediately after the patient infuses 2 L of fresh 2.5% glucose dialysis solution, 200 mL of that solution is drained into the bag on which the two fluids levels were previously marked. After mixing, about 190 mL of the dialysate is re-infused, and the remaining 10 mL (the amount indicated by a guide mark at the corner) is left within the bag. After a 4-hour dwell, the dialysate is completely drained into another twin-bag. A standard PET was also performed on a different day, and the data were compared with those from the home PET. Significant correlations were seen in D/D0 and in drain volume between the home PET and the standard PET (n = 10; D/D0: 0.385 +/- 0.054 vs. 0.371 +/- 0.052 respectively, r = 0.872, p = 0.0004; drain volume: 2340 +/- 123 mL vs. 2372 +/- 90 mL respectively, r = 0.788, p = 0.0048). We conclude that the home PET is a clinically useful alternative to the standard PET, saving time and labor while maintaining accuracy.

Adult↗
PubMed2000

Prevalence of home pregnancy testing among adolescents.

OBJECTIVES: This study estimated the prevalence of home pregnancy testing among adolescents. METHODS: A survey was administered in 11 urban clinics to 600 females aged 13 to 19 years. RESULTS: The prevalence of home pregnancy test use was 34% among 474 sexually experienced youths; 77% of the users had received at least 1 negative pregnancy test result, and 48% took no further action for confirmation. Compared with those who had never used such tests, users were older, younger at sexual debut, less likely to consistently use effective birth control, and more likely to have ever been pregnant. CONCLUSIONS: Health care clinics are important sources for pregnancy prevention, but clinics may have limited opportunity to intervene with some youths who use home pregnancy tests.

Adolescent↗
PubMed2004

Teen home pregnancy test takers: more worried or more wishful?

OBJECTIVE: To test the hypothesis that teenagers who have taken home pregnancy tests are more ambivalent about remaining nonpregnant than those who have not and, for this reason, use contraceptives less consistently. METHODS: A racially diverse group of 340 inadequately contracepting, nulligravida teens, 94 (28%) of whom had taken a home pregnancy test, was studied. At enrollment, participants completed a self-administered questionnaire, were counseled about contraceptive options, and were given the opportunity to initiate their method of choice. The enrollment tool assessed traditional teen-pregnancy risk factors, expectations about the effects of childbearing, common deterrents to contraceptive use, the desirability of remaining nonpregnant, and contraceptive use and plans. RESULTS: Home pregnancy test takers were more apt to be unsure that they wanted to remain nonpregnant (relative risk [RR]:1.3; 95% confidence interval [CI]:1.1-1.6), principally because they were more likely to lack negative expectations about the effects of childbearing on their lives (odds ratio: 2.2; 95% CI = 1.2-4.0). Although no more likely to perceive deterrents to contraceptive use, pregnancy-test-kit users were more apt to have had unprotected sexual intercourse in the past (RR:1.3; 95% CI:1.1-1.5) and to plan to do so in the future (RR:1.7; 95% CI:1.1-3.3). Group differences in the desire to remain nonpregnant accounted for differences in contraceptive behavior and plans. CONCLUSION: Home pregnancy test taking should be regarded as a red flag by those who care for adolescents; although they are as capable of using contraceptives as their peers, test takers are less apt to do so because they expect less negative consequences from childbearing and, for this reason, may benefit more from discussing childbearing expectations than contraceptive options.

Adolescent↗
PubMed1991

Perceived susceptibility and self-protective behavior: a field experiment to encourage home radon testing.

Tested in a field experiment (N = 647) the hypothesis that perceptions of personal susceptibility are important in decisions to test one's home for radioactive radon gas. Experimental group subjects received a personal telephone call to tell them they lived in a high-risk area and a personal letter to reinforce the telephone message. After the intervention, experimental subjects were significantly more likely than minimal-treatment subjects to acknowledge the possibility of high radon levels in their homes. Perceptions of susceptibility and illness severity were significantly correlated with orders of radon test kits and with testing intentions. Nevertheless, there were no differences between groups in test orders or intentions. Results are discussed in terms of the difficulty of getting people to acknowledge susceptibility and the factors other than risk perceptions that influence self-protective behavior.

Air Pollutants, Radioactive↗
PubMed1998

Experimental evidence for stages of health behavior change: the precaution adoption process model applied to home radon testing.

Hypotheses generated by the precaution adoption process model, a stage model of health behavior, were tested in the context of home radon testing. The specific idea tested was that the barriers impeding progress toward protective action change from stage to stage. An intervention describing a high risk of radon problems in study area homes was designed to encourage homeowners in the model's undecided stage to decide to test, and a low-effort, how-to-test intervention was designed to encourage homeowners in the decided-to-act stage to order test kits. Interventions were delivered in a factorial design that created conditions matched or mismatched to the recipient's stage (N = 1,897). Both movement to a stage closer to testing and purchase of radon test kits were assessed. As predicted, the risk treatment was relatively more effective in getting undecided people to decide to test than in getting decided-to-act people to order a test. Also supporting predictions, the low-effort intervention proved relatively more effective in getting decided-to-act people to order tests than in getting undecided people to decide to test.

Adult↗
PubMed2006

[Pulmonary function tests in home medical care].

Home medical care for the aged has become important with the increasing population of elderly people in Japan. Home oxygen therapy (HOT) is a representative treatment for aged patients with chronic obstructive pulmonary diseases (COPD) or sequelae of pulmonary tuberculosis. In order to provide appropriate and safe home medical care, the pulmonary function tests need to be performed easily and simply at home. These tests include a pulse oximeter for arterial blood oxygen saturation monitoring in HOT, a peak flow meter or a handy-type spirometer for air way monitoring in asthmatic patients and a handy-type monitor for screening patients with sleep apnea syndrome (SAS). In using a pulse oximeter, the users need to keep in mind that the case is sometimes severe even though the oxygen saturation values are in the normal ranges, and also that, when oxygen saturation is low, high concentrated oxygen exposure sometimes deteriorates hypercapnia in patients with type II respiratory failure. A peak flow meter is not suitable for air way monitoring in patients with COPD or small air way diseases. The handy-type monitor for SAS needs to be improved not to interfere with the patient's natural sleep, and also to provide more simple analysis programs. Doctors should educate patients to go to hospital to see a doctor and to undergo close examinations whenever unexpected abnormal values are obtained. Equipment which can provide high quality test results with easier maneuver ability and analysis needs to be developed in the future.

Home Care Services↗
PubMed2006

Home anticoagulation testing: predictors of rural patient interest.

BACKGROUND: Home anticoagulation testing (HAT) may be useful for rural patients who cannot attend an anticoagulation service clinic (ASC). Interest in HAT is unknown and was the focus of this study. MATERIALS AND METHODS: Anticoagulated patients from two clinics, the ASC and vascular surgery clinic (VSC) were surveyed and compared for demographics, anticoagulation knowledge and opinions, and HAT interest. Logistic regression was performed, using the entire patient cohort, to identify factors associated with HAT interest. RESULTS: There were 211 (141 ASC, 70 VSC) patients surveyed. Differences between the ASC and VSC patients included education level (13.2 versus 12.1 years; P = 0.02), time spent testing (60.5 +/- 33.5 versus 46.4 +/- 20.7 min; P = 0.001), use of fingerstick testing (90% versus 2.9%; P < 0.001), and knowledge of the potential interaction of warfarin with medications or diet (79% versus 59% P = 0.003). HAT interest was similar (62.1% ASC versus 50% VSC; P = 0.14). Factors associated with HAT interest included employment [odds ratio (OR) 2.9, 95% confidence interval (CI) 1.2-6.7], knowledge of potential interactions between medications and warfarin (OR 3.9, 95% CI 1.9-8.1), and a willingness to check international normalized ratio values more frequently if recommended (OR 2.4, 95% CI 1.2-4.6). Patients who received family help with medications appeared less interested in HAT (OR 0.29, 95% CI 0.12-0.68). CONCLUSIONS: A slight majority of surveyed rural patients conveyed interest in HAT. Working patients and those assuming more responsibility for international normalized ratio control may be more interested in HAT. A possible association between anticoagulation knowledge and increased HAT interest was seen and should be further studied.

Aged↗