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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↗
PubMed2002

An inverse correlation between estimated tuberculosis notification rates and asthma symptoms.

BACKGROUND: A recent ecological analysis demonstrated a strong inverse relationship between tuberculosis notification rates and the prevalence of asthma symptoms in 13-14-year-old children as obtained from the International Study of Asthma and Allergies in Childhood (ISAAC). However, the analysis was confined to the 23 countries in which the tuberculosis notification rates were considered to be of sufficient validity. METHODS: A similar analysis was performed using estimated tuberculosis incidence rates obtained from the World Health Organization Global Tuberculosis Programme and asthma symptom prevalence data from ISAAC for both the 6-7 and 13-14 years age groups in 38 and 55 countries, respectively. RESULTS: For the 6-7-year-old children, there was a significant inverse relationship between estimated tuberculosis incidence and the prevalence of key asthma symptoms. However, in the 13-14 year age group, a significant inverse relationship was only demonstrated for 'asthma ever'. CONCLUSION: The present study extends the inverse relationship between tuberculosis rates and asthma prevalence to the 6-7-year-old age group and suggests that the association, if causal, may be stronger at this younger age.

Adolescent↗
PubMed1999

Return rates and partner notification in HIV-positive men seeking anonymous versus confidential antibody testing.

This study investigated whether HIV-positive men who seek confidential versus anonymous HIV counseling and testing differ in demographic variables, risk behaviors, return rates for posttest appointments, and agreement to partner notification. chi 2 tests were not statistically significant for return rates for post-test appointments or partner notification between the two groups. HIV-positive individuals in the confidential groups were more likely to utilize medical and follow-up services than those in the anonymous group. Anonymous and confidential counseling and testing both appear to achieve the public health objectives of HIV case finding and referral. Hypotheses are offered regarding what may be a progression of testing behaviors (i.e., from anonymous to confidential) with suggestions for future research are suggested.

Adult↗
PubMed2001

Recently diagnosed sexually HIV-infected patients: seroconversion interval, partner notification period and a high yield of HIV diagnoses among partners.

We collected data on the outcome of partner notification (PN) for 356 index patients (iPs) newly diagnosed with HIV, all sexually infected, in six European countries, 1995-96. The PN period (the period during which exposed partners should be notified about their risk of being HIV infected) could be defined on the basis of last negative HIV test in 170/356 (48%), from other key dates for 12, and for 14 more on the sole basis of known HIV exposure (total 196/356, 55%). However, of the 170 iPs with a last negative HIV test date, PN period was not defined in 52 (31%), even though 28/52 were recent seroconverters (negative HIV test within 24 months of HIV diagnosis). Discrepancies in PN period evaluation were common: of the 85 iPs for whom PN period was reportedly defined as '3 months before last HIV-negative date', the period actually used was equal to this in only 12. A user-friendly worksheet would simplify the task of eliciting and using key dates to define the PN period. Forms on PN outcome were received for 166/200 (83%) reported current partners, but only 124/508 (24%) ex-partners. Fifty-two of 290 (18%) notified partners already knew they were HIV-positive, and 38/130 (29%) notified partners for whom pre-PN status was negative or unknown were HIV-positive on post-PN testing. Results of HIV tests (if any) after PN were unknown for 37/133 (28%) current partners not already known to be HIV-positive, and for 71/105 (68%) ex-partners-a doubling of the information loss rate. Notification of 133 current and 105 ex-partners not previously identified as HIV-positive thus produced 28 (21%) and 10 (10%) new HIV diagnoses, respectively. The total yield of HIV diagnoses was 38/100 (38%) partners of recent seroconverters (22 already known plus 16 PN-diagnosed), compared with 52/190 (27%) partners of other iPs (30 already known plus 22 PN-diagnosed). We propose prioritization for PN of partners of recent seroconverters, augmented surveillance for HIV diagnoses and recurrence in PN networks of at-risk, non-notified partners, and new measures that preserve anonymity to alert potential and past sexual contacts of HIV-diagnosed individuals who are unable or unwilling to assist in PN.

Adult↗
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↗
PubMed2002

STD screening, testing, case reporting, and clinical and partner notification practices: a national survey of US physicians.

OBJECTIVES: This study presents results from a national survey of US physicians that assessed screening, case reporting, partner management, and clinical practices for syphilis, gonorrhea, chlamydia, and HIV infection. METHODS: Surveys were mailed to a random sample of 7300 physicians to assess screening, testing, reporting, and partner notification for syphilis, gonorrhea, chlamydia, and HIV. RESULTS: Fewer than one third of physicians routinely screened men or women (pregnant or nonpregnant) for STDs. Case reporting was lowest for chlamydia (37 percent), intermediate for gonorrhea (44 percent), and higher for syphilis, HIV, and AIDS (53 percent-57 percent). Physicians instructed patients to notify their partners (82 percent-89 percent) or the health department (25 percent-34 percent) rather than doing so themselves. CONCLUSIONS: STD screening levels are well below practice guidelines for women and virtually nonexistent for men. Case reporting levels are below those legally mandated; physicians rely instead on patients for partner notification. Health departments must increase collaboration with private physicians to improve the quality of STD care.

Adult↗
PubMed2003

Foodborne disease in Australia: incidence, notifications and outbreaks. Annual report of the OzFoodNet network, 2002.

In 2002, OzFoodNet continued to enhance surveillance of foodborne diseases across Australia. The OzFoodNet network expanded to cover all Australian states and territories in 2002. The National Centre for Epidemiology and Population Health together with OzFoodNet concluded a national survey of gastroenteritis, which found that there were 17.2 (95% C.I. 14.5-19.9) million cases of gastroenteritis each year in Australia. The credible range of gastroenteritis that may be due to food each year is between 4.0-6.9 million cases with a mid-point of 5.4 million. During 2002, there were 23,434 notifications of eight bacterial diseases that may have been foodborne, which was a 7.7 per cent increase over the mean of the previous four years. There were 14,716 cases of campylobacteriosis, 7,917 cases of salmonellosis, 505 cases of shigellosis, 99 cases of yersiniosis, 64 cases of typhoid, 62 cases of listeriosis, 58 cases of shiga toxin producing E. coli and 13 cases of haemolytic uraemic syndrome. OzFoodNet sites reported 92 foodborne disease outbreaks affecting 1,819 persons, of whom 5.6 per cent (103/1,819) were hospitalised and two people died. There was a wide range of foods implicated in these outbreaks and the most common agent was Salmonella Typhimurium. Sites reported two outbreaks with potential for international spread involving contaminated tahini from Egypt resulting in an outbreak of Salmonella Montevideo infection and an outbreak of suspected norovirus infection associated with imported Japanese oysters. In addition, there were three outbreaks associated with animal petting zoos or poultry hatching programs and 318 outbreaks of suspected person-to-person transmission. Sites conducted 100 investigations into clusters of gastrointestinal illness where a source could not be identified, including three multi-state outbreaks of salmonellosis. OzFoodNet identified important risk factors for foodborne disease infection, including: Salmonella infections due to chicken and egg consumption, bakeries as a source of Salmonella infection, and problems associated with spit roast meals served by mobile caterers. There were marked improvements in surveillance during 2002, with all jurisdictions contributing to national cluster reports, increasing use of analytical studies to investigate outbreaks and 96.9 per cent of Salmonella notifications on state and territory surveillance databases recording complete information about serotype and phage type. During 2002, there were several investigations that showed the benefits of national collaboration to control foodborne disease. Sharing surveillance data from animals, humans and foods and rapid sharing of molecular typing information for human isolates of potentially foodborne organisms could further improve surveillance of foodborne disease in Australia.

Adolescent↗
PubMed2000

[Measles epidemiology in the Netherlands: a exploratory analysis of notification].

OBJECTIVE: Explorative analysis of the effects of vaccination policy on measles incidence. DESIGN: Retrospective study and mathematical modelling. METHOD: Analysis of national and regional case notifications of measles provided by the Inspectorate of Health in the Netherlands over the period from January 1976 (when vaccination was started) through September 1999. Also computer simulations with a mathematical epidemic model of measles were used to calculate the incidence of measles from 1976 onwards. RESULTS: According to the model results, measles should not persist with the current vaccination programme. However, the case notification data showed that measles appeared to persist at a nation-wide level. At a regional level, measles did not persist, not even in regions with low vaccine coverage. A possible cause of the unexpected persistence at the national level is the asynchronous regional course of the 6-year epidemic cycle of measles, where measles infection 'jumps' from one region to the other.

Child↗
PubMedDate not supplied

Development of a computer linkage system for a blood recipient notification program in Nova Scotia.

OBJECTIVES: To assess the potential uses of computer-assisted record linkage in the surveillance of infectious diseases, using the Nova Scotia blood recipient notification program as the example. METHODS: We developed a computer-assisted, multiple-pass, probabilistic record linkage to link records for blood recipients identified by the Nova Scotia notification program (Nova Scotia Phase I Blood Bank File information) with corresponding Nova Scotia Health Card Registration File records to obtain current mailing addresses to contact potentially living recipients. We used variables available from both files (e.g., name, date of birth, gender, and health care registration number) to link records, after eliminating duplicates/deceased cases. RESULTS: Among 23,925 eligible records in the Nova Scotia Phase I Blood Bank File (1984-1990), there were 1,818 (7.8%) duplications and 8,675 deceased cases, leaving 13,432 cases for linkage. 8,713 (65%) cases were successfully linked to the 1998 Health Card Registration Data File for current mailing addresses. INTERPRETATION: Multiple-pass linkage seems acceptable for maximizing detection of correctly matched records for look-back projects. To overcome quality/lack of information obstacles, future look-back linkages should explore the use of supplementary data files (tax files, voter lists, license files, other provincial databases) to obtain most current addresses.

Disease Notification↗