[Notification of occupational diseases in general practice. Patient acceptance of notification].
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Denmark↗
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[Notification of cancer in breast cancer patients].
The notification of the name of disease is a premise for making the system of informed consent more complete in case of cancer treatment. In Japan, however, the notification of cancer can hardly be said to have an attained social consensus. Considering that the notification can ultimately improve patients quality of life (QOL), the breast cancer group of our department informs all breast cancer patients of their diseases in principle. This paper reports and discusses the results of a survey by questionnaire on the notification of cancer in 100 patients with breast cancer. The notification of cancer was received favorably in 83% of the patients. For those who answered, the explanation on the notification was convincing and it accounted for 81%. An examination of background factors of patients who had not been convinced revealed that many of them were suffered from advanced cancer. After the notification, a human relationship with the family and friends aggravated few of them and improved in 30% (family) and 18% (friends), respectively. The notification of cancer was thus suggested to contribute to the improvement of QOL. Although 83% well received the notification of their own diseases, only 21% were affirmative for the notification of cancer in case of a member of the family. We medical professionals should make a further effort not to make the notification of cancer the pronouncement death but to make it an aid for patients to live better.
Breast Neoplasms↗
Trends in hepatitis B notifications 1976-87.
This paper considers trends in hepatitis B notifications in New Zealand during the period 1976 to 1987. It attempts also to demonstrate the fact that although notifications are never comprehensive, even incomplete statistics can give a reasonable and useful indication of trends. Since 1985 most districts have shown a gradual and persistent decline in notification rates. High notification rates are observed from Whangarei, Auckland, South Auckland, Rotorua, Gisborne and Hutt health districts. With a notification rate of 54 per 100,000 population in 1984 Whangarei health district gave the highest rate during this period. These observations are consistent with what is known from other studies about the geographical distribution of hepatitis B markers. Peak notification rates occur in the 15 to 25 age group with highest rates in groups of nonEuropean ethnicity. Notification rates within each district over the eleven year period are compared to the national rates. Further analyses by demographic factors based on information available for the year 1987 are presented. Again the highest rates are observed in groups of nonEuropean ethnicity with the Maori and Pacific Island populations showing rates of 27.2 and 23.0 per 100,000 population respectively. For the eleven year period notification rates for all types of infectious hepatitis are compared to identify secular trends. It is seen that hepatitis A notification rates have declined since the mid-1970s while rates for nonA nonB hepatitis and acute nonspecific hepatitis rose sharply in the early 1980s and have since declined slightly in 1986 and 1987.
Adolescent↗
Reactions of asbestos-exposed workers to notification and screening.
In the wake of efforts to pass legislation mandating notification of workers at high risk of developing occupational disease, considerable controversy exists regarding the potential costs and benefits of such notification efforts. It has been suggested that individual notification would cause undue psychological distress, especially when primary prevention efforts are no longer possible. In this study, we assessed reactions of asbestos-exposed workers to a letter notifying them of their risk for asbestos-related illnesses and the availability of a medical screening program. Two hundred forty-seven workers who attended the screening program and 53 who chose not to attend completed a questionnaire that tapped reactions to notification. Workers reported neither undue psychological distress nor avoidance behavior in response to notification, and many respondents reported engaging in active and appropriate coping behaviors. Workers who first learned of their risk through the notification letter (33.7%) were no more likely to report distress or denial than were workers who had learned previously through other sources. Individuals who chose not to attend the screening program were less likely than attenders to report experiencing distress upon learning of their risk status, more likely to engage in minimization of risk, and less likely to have taken direct action. Our results suggest that the psychological costs of notifying workers of increased risk for asbestos-related illness appear to be outweighed by the benefits of notification and screening.
Asbestos↗
Notification of tuberculosis: how many cases are never reported?
BACKGROUND: Notification of tuberculosis is essential for local contact tracing and for assessing the national incidence of tuberculosis. The accuracy of notification figures is uncertain. This study examined the notification rates of all patients diagnosed as having tuberculosis at two hospitals in the East End of London over five years. METHODS: In a retrospective survey of all patients aged 16 years or more presenting with tuberculosis to the London Chest Hospital or the Royal London Hospital from 1 January 1985 to 31 December 1989, cases of tuberculosis were identified from microbiology and histology records, statutory notifications, necropsy reports, coroners' records, hospital activity data, and death certificates. Clinical data were obtained from case notes and notification was determined from the local authority notification lists. RESULTS: Six hundred and nine adult patients with tuberculosis were identified. Notes were available for 580 cases (95%), of which 426 (73%) had been notified. The proportion of cases notified varied according to the specialty of the clinician in charge of the patient at diagnosis. Patients with a past history of tuberculosis and those who died within one year were less likely to have had their tuberculosis notified. Age, race, and lack of microbial or histological confirmation of diagnosis did not influence the proportion of cases notified. One hundred and eighty five patients had smear positive sputum, but 25 of these cases (14%) were not notified. Eighty five patients who had presented with pulmonary tuberculosis did not have their disease notified; 20 (24%) had smear positive sputum. CONCLUSIONS: Many cases of tuberculosis are not notified (27%). Fourteen per cent of all sputum smear positive cases of tuberculosis were not notified, and these patients are a considerable public health risk. The true incidence of tuberculosis in the area studied is at least one third higher than current notification figures suggest.
Adolescent↗
Timeliness of notification in infectious disease cases.
Records of notification in cases of eight infectious diseases in the "Servei Territorial de Salut Publica" of the Province of Barcelona, Spain, between 1982 and 1986 were reviewed. Time from onset of symptoms to notification, time from notification to completion of data collection, and time from onset to completion of the case investigation were analyzed. For the period from onset to notification, the shortest mean was registered for meningococcal infection (6.31 days) and the longest was for pulmonary tuberculosis (54.79 days). For time from notification to complete investigation, the shortest value was for pulmonary tuberculosis (12.20 days) and the longest for rickettsioses (35.79 days). Time from onset to completion of data collection was 22.87 days for meningococcal infection and 72.34 days for tuberculosis of other organs (probably because of the long period of time that elapses between the onset of the first symptoms and notification). It would appear that both physicians and the general population must be educated so that lay-men can identify early signs and symptoms of disease and physicians can realize that statutory notification of infectious diseases is strongly linked to community health care.
Communicable Disease Control↗
The geographical distribution of tuberculosis notifications in a national survey of England and Wales in 1983. Report from the Medical Research Council Tuberculosis and Chest Diseases Unit.
A survey of all tuberculosis notifications in England and Wales for the first 6 months of 1983 has made it possible to estimate the annual notification rates for that year for the White and the Indian subcontinent (Indian, Pakistani and Bangladeshi) ethnic groups for the nine regions of England and Wales and for the 33 boroughs of Greater London. The rates have been compared with those estimated from an earlier 6-month survey in 1978/79. However, for the 53 counties and the 370 local authority areas outside Greater London only the overall rates could be calculated because population data by ethnic group were not available. There was considerable variation between the 9 regions in the notification rates for all ethnic groups combined (range 28.1 per 100,000 in Greater London to 4.5 per 100,000 in Anglia) and for the White ethnic group (range 13.1 per 100,000 in Greater London to 3.1 per 100,000 in Anglia). The rates for the Indian subcontinent (ISC) ethnic group were high in all the regions and were 15-60 times higher than the corresponding rates for the White ethnic group. Between 1978/79 and 1983 there was a decline in all of the regions in the notification rates for all ethnic groups combined and the White group. For the ISC ethnic group there was a decline in all regions apart from Anglia (where the number of cases was small). The difference in rates for the London boroughs, from 92.3 per 100,000 for Brent to 5.7 per 100,000 for Havering, were associated not only with the proportion of the population who were of ISC ethnic origin but also with indices of socio-economic class for the borough. There was, however, no evidence to suggest that high rates in the White population were a consequence of the presence of a large number of infectious patients of ISC ethnic origin. Notification rates for the 53 counties apart from Greater London ranged from 23.7 per 100,000 for the West Midlands to 3.1 per 100,000 for Surrey and with few exceptions there was a decline in rates between the surveys. Considering the 370 local authorities outside Greater London, the number with a notification rate of less than 5 per 100,000 increased from 73 in 1978/79 to 105 in the 1983 survey and the number of local authorities in which no cases were notified in the 6-month survey period increased from 32 to 41.
Bangladesh↗
Differences in trends of measles notifications by age and race in the western Cape, 1982-1986.
Measles remains a major health problem in the Cape Western Region of the Department of National Health and Population Development. During the 5-year period 1982-1986, 5,089 notifications were received and analysed for the Cape Town Metropolitan area and for the rest of the region. Of the 3,682 notifications for Cape Town, 60.6% of the patients were under 2 years old, compared with 15.4% of the 1,407 notifications for the rest of the region. The black population in Cape Town accounted for 58.3% of the notifications, and the coloured population in the rest of the region for 51.5%. White notifications for both areas were low, except in the latter half of 1986, when widespread outbreaks affected mainly the white population. Age-adjusted notification rates varied between the two areas, the highest being for blacks in Cape Town, ranging up to 302.3/100,000, and the lowest being for whites, at 1.6/100,000 in the rest of the region. The implications of these different trends are discussed, and a possible reason for the outbreaks in whites is postulated. The most effective way of dealing with the problem is for every effort and available resource to be put into immunising every child at 9 months of age, and any older children who have not yet been immunised.
Black or African American↗
Changes in annual tuberculosis notification rates between 1978/79 and 1983 for the population of Indian subcontinent ethnic origin resident in England.
In two national surveys of tuberculosis notifications in England conducted in 1978/79 and 1983 the estimated annual notification rates for the Indian subcontinent (Indian, Pakistani, and Bangladeshi) ethnic groups were considerably higher than the rate for the white ethnic group. The mean annual decline in rates between the surveys appeared to be greater for the Indian and the Pakistani and Bangladeshi ethnic groups, 15% and 16% respectively, than for the white ethnic group (7%). Data from two small sample population surveys, the National Dwelling and Housing Survey in 1978 and the Labour Force Survey in 1983, were used to calculate the rates. However, comparison of the estimates for the population of Indian subcontinent ethnic origin in England from these surveys revealed discrepancies between them. Additional information from the Labour Force Survey on the year of first entry to the United Kingdom (UK) permitted the calculation of new estimates for the 1978 population, and based on these estimates the annual notification rates for 1978/79 were 287 per 100,000 for the Indian and 286 per 100,000 for the Pakistani and Bangladeshi ethnic groups. The rates for 1983 were 178 and 169 respectively, and the mean annual decline between the surveys was 11% for the Indian and 12% for the Pakistani and Bangladeshi ethnic groups. There were important changes in the characteristics of the population of Indian subcontinent ethnic origin in England between 1978 and 1983, and therefore the rates for both surveys have been standardised by the method of direct standardisation to a common reference population. Standardizing for year of entry to the UK, place of birth (UK or abroad), age, and sex reduced the mean annual decline in the notification rate to 4% for the Indian and 9% for the Pakistani and Bangladeshi ethnic groups. The much greater reduction in the rate of decline in the Indian ethnic group is due to the substantial decline between the surveys in the proportion of recent immigrants, the group with the highest annual notification rate, in that population. Future trends will continue to be influenced by immigration patterns, but it will also be important to monitor the rates among the increasing proportion of the population born in the UK or resident in England for more than five years.
Bangladesh↗
Auditing and improving notification and chemoprophylaxis in bacterial meningitis.
STUDY OBJECTIVE: The aim was to audit, against agreed standards, the control of bacterial meningitis, in particular completeness of notification and appropriateness of distribution of chemoprophylaxis to contacts; and to implement appropriate changes and monitor their impact. DESIGN: The first phase involved determination, for the years 1983 and 1984, of completeness of notification by comparison with a comprehensive case register. Information about chemoprophylaxis was obtained from case notes, questionnaires to general practitioners and other records. The second phase involved introducing a programme of clinician education in the hospital with the poorest observed notification performance and re-examining performance during 1988. Districtwide education regarding chemoprophylaxis was undertaken and the situation re-examined in 1988. SETTING: The study took place in Mid Glamorgan Health Authority (population 536,000), with four acute hospitals. POPULATION: Consisted of all the residents of Mid Glamorgan Health Authority. MAIN RESULTS: During the first phase of the audit only 28 out of 79 cases of bacterial meningitis were notified (35%). Performance in one hospital was significantly worse than in the other three. Chemoprophylaxis was distributed to 20 out of 26 (77%) cases of meningococcal meningitis but inappropriate drugs were used in four cases and prophylaxis was distributed more widely than is recommended in 10 cases. In the phase 2 re-examination, a significant improvement in notification was observed in the hospital where special measures were taken, with no change in a "control" hospital. Chemoprophylaxis improved throughout the District, although rifampicin continued to be distributed too widely. CONCLUSIONS: As a result of this audit, measurable improvements in both infectious disease notification and chemoprophylaxis practice were obtained by the education of clinicians. The study provides a good example of a completed audit cycle in public health medicine.
Communicable Disease Control↗
Notification of tuberculosis in the south-west health region of Norway: incidence and trends.
A survey of tuberculosis notification from the south-west health region of Norway showed a decrease from 17.7 cases of tuberculosis per 100,000 population during 1969-1973 to 12.3 cases per 100,000 during 1979-1983. The notification rate linearly increased with age from the age of 20 years on a logarithmic scale. The downward trend in notification was less marked in the last 5-year period compared with the first 5-year period probably due to changes in notification procedures in 1976, an epidemic of tuberculosis in the health region and on oil platforms in the North Sea in 1980 and an increased immigration of people from areas with high incidence of tuberculosis. Tuberculosis of the extrathoracic lymph nodes was during 1979-1983 the most frequent location of non-respiratory tuberculosis.
Adolescent↗
[Evaluation of the information provided by the system of compulsory notification of diseases].
In order to assess activities of epidemiological surveillance resulting from the statutory notification system, a total of 17,394 notification records of eight infectious diseases (brucellosis, bacillary dysentery, typhoid fever, viral hepatitis, meningococcal infection, rickettsioses other than exanthematous typhus, pulmonary tuberculosis, and tuberculosis of other organs) together with 10,503 epidemiological surveys submitted to the "Servei Territorial de Salut Pública" of the province of Barcelona between 1982 and 1986 were reviewed. In notification records, data to locate physicians were the most commonly found (between 92.6% and 99.4% according to disease), whereas in epidemiological surveys, clinical and analytical data were the most frequently encountered. The inclusion of data of epidemiological interest ranged from 3.6 to 68.6%. In order to improve efficacy of the statutory notification system a proposal is made to reduce the extension of epidemiological surveys in terms of requesting only necessary data to establish appropriate measures in each case.
Communicable Disease Control↗
A survey of hepatitis B surface antigen-positive blood donors: degree of understanding and action taken after notification.
All blood donors in the United States are tested for hepatitis B surface antigen (HBsAg) upon donation; if the test result is positive, the primary method of notification is by letter. To assess the effectiveness of this notification methods in stimulating HBsAg-positive donors to seek medical care and take preventive measures, 54 donors who tested HBsAg-positive on donation at the American Red Cross Blood Services. Atlanta Region, from January 1987 to July 1989 were interviewed. Thirty-nine donors (72%) had sought medical care after notification; the only motivating factor was that the letter told the donor to consult with his or her physician. Compared with donors who did not seek medical care, donors who did so were more likely to understand that the blood test was abnormal or that they were infected, and they were more likely to understand how hepatitis B virus is transmitted and that a vaccine is available. The differences were not significant, however. Of those donors who sought medical care, less than half received appropriate recommendations for protection of contacts, and of those who did, only one-third received prophylaxis. In-person and telephone interviews with donors, revision of the notification letter, and hepatitis B education programs targeted at medical care providers are suggested.
Blood Donors↗
Changes in tuberculosis notification rates in the white ethnic group in England and Wales between 1953 and 1983.
Since the early 1960s notification rates for tuberculosis in England and Wales for the whole population have been influenced by high rates in certain ethnic groups. Using data based on country of birth from the British (Thoracic and) Tuberculosis Association surveys of 1965 and 1971, and based on ethnic origin from the Medical Research Council surveys in 1978/79 and 1983, rates for the white ethnic group have been estimated at those four times, and compared with the published rates for the whole population in 1953, when only a very small proportion was of non-white ethnic origin. Between 1953 and 1983 the notification rate for the white ethnic group fell from 122.2 to 11.3 per 100,000 for males, an annual decline of 7.7%, the corresponding rates for females being 90.1 and 5.8, an annual decline of 8.8%. The greatest annual declines occurred between 1953 and 1965, 9.4% for males and 11.2% for females. The annual declines in the most recent period, 1978/79 to 1983, were 6.9% for males and 7.3% for females. In both sexes the decline was greatest in the 15-24 year age group and least in the oldest age group, and this has led to a change in the age pattern of annual notification rates. The highest rates in both sexes occurred in young adults in 1953 but in the oldest age groups in 1983. There is however no evidence of any cohort experiencing an increase in notification rate with increasing age.
Adolescent↗
Partner notification in the control of human immunodeficiency virus infection.
Partner notification should be standard public health practice in the control of human immunodeficiency virus (HIV) infection. A universal partner notification program for the United States is affordable, operationally manageable, and can effectively reach high-risk persons. Such a focused approach personalizes the epidemic and probably enhances the efficacy of risk reduction messages. Confidentiality protections are attainable. Voluntary partner notification is acceptable to our constituents; while counseling is "mandatory," testing is optional. Evidence of partner notification's usefulness as a case prevention tool should be a by-product of program outcomes and not a prerequisite for its implementation.
Acquired Immunodeficiency Syndrome↗
Under-reporting in hepatitis B notifications.
Notification and laboratory data for the period January 1985-December 1988 were compared in order to estimate: (i) the minimum level of under-reporting of hepatitis B; and (ii) the consistency of the level of under-reporting, both regionally and nationally. Ratios between hepatitis B notifications and positive hepatitis B laboratory tests (reporting ratios) were calculated to quantify the discrepancy between these parameters. There were at least 7 positive hepatitis B laboratory results for each notified case of hepatitis B during each year studied. The differences between the national reporting ratios for each of the study years were small, indicating that nationally the level of reporting of hepatitis B is fairly consistent. The Cape region had the highest and most constant level of hepatitis B reporting compared with other regions. We conclude that the national incidence of hepatitis B is at least 7 times higher than that calculated from notification data. Further, the inter-year analysis of hepatitis B notification data to identify trends nationally and within the Cape region is valid. However, caution is called for when comparing the incidence rates between regions due to inter-region and region-specific inter-year inconsistencies in reporting levels.
Hepatitis B↗
Notification of a cohort of workers at risk of bladder cancer.
Surviving members of occupational cohorts studied in retrospective analyses of mortality usually are not notified individually of positive study results. However, concern has arisen that such results may contain risk information pertinent to study subjects. To evaluate the effects and implications of individually notifying survivors of such cohorts, we conducted a pilot notification study. Members of a cohort of 1,385 chemical workers who had handled carcinogenic amines were notified by mail that they were likely to be at increased risk of bladder cancer. Also a bladder cancer screening and follow-up program was established. The study demonstrated that notification is a complex action and that much care needs to be taken when communicating information on risk. Notification requires development of (1) criteria as to what constitutes a notifiable risk and (2) programs to meet the medical and social needs of the various parties involved in notification.
Carcinogens↗
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↗