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PubMed1996

Evaluation of the notification procedure for physician-assisted death in the Netherlands.

BACKGROUND: In the Netherlands, a notification procedure for physician-assisted death has been in use since 1991. It requires doctors to report each case to the coroner, who in turn notifies the public prosecutor. Ultimately, the Assembly of Prosecutors General decides whether to prosecute. Although physician-assisted death remains technically illegal, doctors are extremely unlikely to be prosecuted if they comply with the requirements for accepted practice. In 1995, the ministers of health and justice commissioned an evaluation to determine the adequacy of the notification procedure. METHODS: A random sample of 405 physicians were interviewed. We also interviewed 147 physicians who had reported cases of physician-assisted death and 116 coroners, and we reviewed 353 judicial files of reported cases. In addition, we interviewed 48 public prosecutors and reviewed the minutes of the Assembly of Prosecutors General for 1991 to 1995 and all published court decisions from 1981 through 1995. RESULTS: In 1995, about 41 percent of all cases of euthanasia and physician-assisted suicide were reported. There were no major differences between reported and unreported cases in terms of the patients' characteristics, clinical conditions, or reasons for the action. Most patients had cancer and were described as suffering "unbearably" and 'hopelessly." Of the 6324 cases reported during the period from 1991 through 1995, only 13 involved prosecution of the physician. The majority of respondents in the groups interviewed thought that all cases of physician-assisted death should be reviewed, although most doctors thought the review should be performed by other doctors, and there was substantial concern about the burden associated with the reporting procedure. CONCLUSIONS: Substantial progress in the oversight of physician-assisted death has been achieved in the Netherlands. The reporting procedure could be more streamlined and less threatening.

Attitude of Health Personnel↗

PubMed1990

Death notification.

Family notification in sudden, unexpected, and violent death is a major responsibility of law enforcement, medical examiner, and coroner offices. This report reviews and discusses the process and procedures utilized in death notification and provides suggestions to accomplish this difficult task more effectively.

Attitude to Death↗

PubMedDate not supplied

Notification of the sex and needle-sharing partners of individuals with human immunodeficiency virus in rural South Carolina: 30-month experience.

The authors conducted a confidential and voluntary partner notification program to identify and educate the sex and needle-sharing partners of individuals with the human immunodeficiency virus (HIV) in a rural health district in South Carolina. During the first 30 months, of 485 named contacts, 290 (60%) were residents of the health district and were contacted and offered testing. Of the 290 contacted, 280 (97%)--53 women and 227 men; age range 14-74 years--accepted counseling and testing and 49 (18%) were HIV-antibody positive. Only 3 of the 49 (6%) had been previously tested. All HIV-infected individuals received appropriate physician, laboratory, and public health referrals. During the study, the mean number of sex partners per 6-month period decreased from 5.6 to 1.1 (80% reduction) for HIV-antibody positive persons and from 4.0 to 2.0 (50% reduction) for HIV-antibody negative persons. The authors conclude that in a rural setting, partner notification of HIV exposure can accurately target education and testing and can produce positive behavior change.

Adolescent↗

PubMedDate not supplied

Human immunodeficiency virus partner notification in a low incidence urban community.

BACKGROUND: Notification of the partners of a person newly diagnosed with human immunodeficiency virus (HIV) is legally mandated in Missouri. METHODS: In a four-year period, the Kansas City Health Department tested for HIV antibodies in 61,464 of 61,700 (99.6%) eligible persons using the sexually transmitted disease clinic. RESULTS: A total of 366 newly diagnosed HIV cases were identified of whom 291 named 662 sex or needle-sharing partners. Only 447 partners could be located, counseled and/or tested. Of these partners, 165 were HIV infected, but only 33 represented newly diagnosed cases. CONCLUSION: HIV partner notification can be successfully conducted in an urban community.

AIDS Serodiagnosis↗

PubMed1999

Establishing efficient partner notification periods for patients with chlamydia.

OBJECTIVES: To delineate chlamydia partner notification periods with high proportions of infected, untreated sexual partners, and to evaluate relevant Centers for Disease Control (CDC) recommendations. METHODS: Disease Intervention Specialists (DIS) offered contact tracing services to all chlamydia patients (N = 1,309) reported in Colorado Springs between July 1996 and June 1997. Patients were asked to identify sexual partners during the 180 days preceding treatment. Partners were actively sought by DIS and offered DNA amplification testing. RESULTS: Of 1,309 patients, 1,109 were interviewed, resulting in 2,293 named partners. Two fifths of eligible partners were located; inability to examine partners was related to time of last exposure and to frequency of sexual exposure. Of located partners, 95% were tested with DNA amplification technology. Adherence to CDC criteria identified 88% of infected, untreated partners; the other 12% consisted mainly of epidemiologically important asymptomatic men whose infection is seldom identified by current public health interventions. CONCLUSIONS: The chlamydia partner notification recommendations of the CDC are adequate, but miss men with long-standing infection. These men contribute to entrenched chlamydia endemicity; targeted programs to screen high-risk men merit serious consideration.

Adult↗

PubMed2003

Partner notification for HIV and syphilis: effects on sexual behaviors and relationship stability.

BACKGROUND: Partner notification (PN), originally designed for syphilis control, has been used to control the spread of HIV since 1985. Because HIV infection is noncurable, the benefit of contact tracing and treatment demonstrated for the control of syphilis may not apply to HIV. For HIV, PN must facilitate behavior change that will reduce the spread of the infection. One concern is that HIV PN can promote the breakup of old partnerships and increase the acquisition of new partners, thereby spreading HIV infections. GOAL: The purpose of this study was to determine the effect of partner notification (PN) on sexual behavior and relationship stability among HIV partnerships, with use of syphilis partnerships for comparison. STUDY DESIGN: Partnerships were eligible if the index case was interviewed by a disease intervention specialist (DIS) for PN and named at least one sex partner. Partnership information was reported by index cases interviewed at baseline and 3 and 6 months post-PN. Trends in partnership dissolution and acquisition, sexual abstinence, condom use, emotional abuse, and physical violence reported by HIV infection and syphilis index cases were compared. RESULTS: A total of 157 index cases (76 HIV infection and 81 syphilis) reported 220 partnerships (94 HIV and 126 syphilis). The PN process was completed for 32.7% of partnerships and it was completed more often for partnerships that were classified as main and cohabiting. After PN, 46.8% of partnerships dissolved, 15.9% of cases acquired a new partner, and emotional abuse and physical violence decreased significantly. HIV index cases were somewhat more likely to report using condoms at last sex act and less likely to acquire a new sex partner after PN compared to syphilis index cases. There was no difference post-PN between HIV infection and syphilis partnerships for partnership dissolution, physical violence, emotional abuse and abstention from sex. CONCLUSION: HIV PN did not appear to cause greater partnership dissolution, new partner acquisition, or violence compared with syphilis PN.

Adolescent↗

PubMed2003

Changes in partnerships and HIV risk behaviors after partner notification.

BACKGROUND AND OBJECTIVE: Few studies have examined the effect of partner notification (PN) on behavior change and partnerships. This study investigated both. GOAL: The goal was to examine the effect of PN on sexual behaviors and partnership dissolution and formation. STUDY DESIGN Subjects included HIV-positive persons interviewed to identify partners for notification, partners notified of exposure, and HIV-negative persons receiving HIV counseling and testing (controls). Subjects were interviewed about behaviors and relationships at baseline and at 3- and 6-month visits. Partnerships in which both subject and partner received PN were compared to partnerships in which only the subject received PN and to control partnerships. RESULTS: Partnerships where both persons received PN were less likely to break up or acquire new partners and more likely to use condoms at follow-up. CONCLUSION: PN did not increase partnership dissolution or formation and was associated with higher condom use, suggesting the value of PN in HIV prevention.

Adolescent↗

PubMed1997

Early physician notification of patient disability risk and clinical guidelines after low back injury: a randomized, controlled trial.

STUDY DESIGN: Back-injured workers with high disability risk scores on a predictive questionnaire participated in a randomized, controlled trial of physician notification, with outcomes follow-up 3 months after injury. OBJECTIVES: To test whether physician intervention improves return to work and self-assessment outcomes for people at relatively high risk for disability. SUMMARY OF BACKGROUND DATA: Only a small number of back-injured workers suffer significant disability. Quick identification of these people would facilitate more efficient targeting and trials of interventions. Controlling variations in practice through practice guidelines has been recommended as a promising strategy for improving care and reducing disability. METHODS: Workers filing back injury reports responded to a disability prediction questionnaire. Those with high risk scores were randomly assigned to control or intervention groups. Patient-designated physicians in the intervention group received two letters identifying the patient's risk and making recommendations for care, including the Agency for Health Care Policy and Research's algorithms for acute low back pain. Predictive accuracy of the questionnaire and efficacy of physician intervention were evaluated on the basis of work status and self-assessments 3 months after injury. RESULTS: Of the 268 workers completing the questionnaire portion of the study, 32 (12%) were out of work because of back pain 3 months after injury. The questionnaire's predictive accuracy included maximum kappa of 0.277 and a receiver operating curve area of 0.78. Fifty-three people completed the physician intervention trial. The intervention had no significant impact on return to work, self-assessed pain, or satisfaction with health care. CONCLUSIONS: Stratification of back-injured people according to disability risk can can increase intervention efficiency by identifying those who require treatment and sparing those who do not. The apparent failure of risk notification and practice guidelines to reduce disability in this study may be improved by different application methods in the future.

Adolescent↗

PubMed1986

Economics of notification and medical screening for high-risk workers.

Measuring the economic impact of notification and intervention programs for workers at high risk of disease from workplace exposure has been virtually nonexistent for several reasons, which will be discussed, and should include a comprehensive view of costs and benefits. A framework for analysis is proposed defining four major clients: the business community, workers and their families, the local and regional public sector, and the federal government. For each client, the positive and negative, quantitative and nonquantitative, direct and indirect, short-run and long-run effects are probed and a summary analysis is made. To illustrate the process, the notification and screening program conducted by the National Institute for Occupational Safety and Health and the Workers' Institute for Safety and Health, Augusta, Georgia, for workers exposed to beta-naphthylamine is described.

Cost-Benefit Analysis↗

PubMed1996

A qualitative evaluation of the post accident notification system to health visitors.

Childhood accidental injuries are a major public health problem, whether measured in terms of morbidity or mortality, and accident prevention is subsequently a priority issue. The Accident and Emergency Notification System to health visitors provides them with vital information and statistics with which to plan accident prevention work, both on an individual basis or in group work. This small study aimed to look at this system from the health visitor's perspective and explore the action taken. The grounded theory approach was used to uncover the processes used by the health visitors. Data were collected using unstructured interviews and by writing notes. These were transcribed on the same day as recorded. Nine categories were identified and an analysis of the processes involved when receiving the notification slip is presented. The categories included 'knowing the family', 'age and development', 'pressure of work' and 'gut feeling/extra sensory perception'. This study is a small contribution to our understanding of the processes involved in everyday health visiting practice.

Accidents↗

PubMed2003

Attitudes of emergency department patients and visitors regarding emergency exception from informed consent in resuscitation research, community consultation, and public notification.

OBJECTIVE: To assess public views on emergency exception to informed consent in resuscitation research, public awareness of such studies, and effective methods of community consultation and public notification. METHODS: A face-to-face survey was conducted in two academic Level I trauma center emergency departments (EDs) in Oregon and Minnesota from June through August 2001. RESULTS: Five hundred thirty people completed the survey, with an 82% response rate. The mean age of the respondents was 41 years (range 18-95) with a standard deviation of 14.5; 46% were female and 64% white. Most (88%) believed that research subjects should be informed prior to being enrolled, while 49% believed enrolling patients without prior consent in an emergency situation would be acceptable and 70% (369) would not object to be entered into such a study without providing prospective informed consent. Informing and consulting the community as a substitute for patient consent in emergency research was thought to be reasonable by 45% of the respondents. Most respondents would prefer to be informed about a study using emergency exception from informed consent by radio and television media (42%). Two hundred fifty-eight respondents (49%) stated they would attend a community meeting; the less educated were more likely to attend than those with college degrees (OR = 0.53; 95% CI = 0.33 to 0.85, p = 0.008). However, only 5% knew of ongoing studies in their community using emergency exception from informed consent. CONCLUSIONS: Most respondents disagreed with foregoing prospective informed consent for research participation even in emergency situations; however, many would be willing to participate in studies using emergency exception from informed consent. Most respondents would not attend community meetings, and would prefer to rely upon the media for information. Very few were aware of emergency exception from informed consent studies in their community. This suggests that current methods of community notification may not be effective.

Adolescent↗

PubMed1989

The case for worker notification.

There is currently a heated debate about whether the U.S. Congress should enact the High Risk Occupational Disease Notification and Prevention Act. This Act would set up an orderly system for identifying, notifying, and assisting workers at high risk of occupational disease. Significant underpinning for this legislation comes from three pilot projects conducted by the National Institute for Occupational Safety and Health and the Workers' Institute for Safety and Health. These projects demonstrate that notification and intervention for occupational high-risk groups can be implemented feasibly within the existing structures of community health and labor management relations. These projects also suggest that, contrary to the views of opponents of current legislation, it is the absence of systematic programs that leads to massive litigation and high costs. At present, these costs are borne by workers and society.

Humans↗

PubMed2003

Sex offender registration and community notification: emerging legal and research issues.

Sex offender registration and community notification laws, now in effect nationwide, have inspired considerable controversy. This article examines the variety of legal challenges brought against the laws since the mid-1990s and surveys issues likely to receive judicial attention in the immediate future. The article also provides an overview of the limited empirical work done to date on registration and notification, and the major areas that warrant additional research, including, most notably, inquiry into efficacy, costs, and consequences.

Community Networks↗

PubMed1988

Tuberculosis in children: a national survey of notifications in England and Wales in 1983. Medical Research Council Tuberculosis and Chest Diseases Unit.

A survey of all notifications of tuberculosis in children (aged less than 15 years) in England and Wales in 1983 showed a decline of 35% in the estimated annual number of previously untreated children notified since the previous survey in 1978-9. Of the 452 children in the 1983 survey, 217 (48%) were of white, 79 (17%) of Indian, and 104 (23%) of Pakistani or Bangladeshi ethnic origin. The decline in the number of Indian children notified (46%) was much greater than that for Pakistani and Bangladeshi children (16%). In both surveys the estimated annual notification rate was much higher for the Indian and the Pakistani and Bangladeshi ethnic groups (32 and 52/100,000, respectively in 1983) than for the white group (2.4/100,000 in 1983). The mean annual decline in rate between the two surveys was 14% for the Indian, 10% for the Pakistani and Bangladeshi, and 7% for the white children. In both surveys the rates for the children of Indian subcontinent (Indian, Pakistani, and Bangladeshi) ethnic origin born in the United Kingdom were considerably lower than for those born abroad. Of the 452 children in the 1983 survey, 342 (76%) had respiratory disease (including 26 (6%) with a non-respiratory lesion as well). Less than half (134, 45%) had a pulmonary lesion at independent assessment of chest radiographs, a further 115 (38%) had only enlarged intrathoracic nodes. Only 60 (19%) of the children with respiratory disease only had a positive culture from a respiratory specimen, but the culture positivity rate in those tested was 45%. Almost two thirds of the children with non-respiratory disease had lesions of the extrathoracic nodes, nearly all cervical. There were 20 children with tuberculosis meningitis in the 12 months, including 12 (6%) of the 217 white and six (3%) of the 183 children of Indian subcontinent ethnic origin.

Adolescent↗

PubMed1976

Completeness of statutory notification for acute bacterial meningitis.

Several different sources of data, including statutory notifications, were used to identify cases of acute bacterial meningitis in childhood in a defined population. Only half the cases of meningococcal meningitis and less than one quarter of ofther types of bacterial meningitis had been notified. Notified cases differed from the remainder with respect to causative organism, age, outcome, and type of hospital of admission. Thus notifications are an unreliable measure of incidence for this disease, and studies of infectious disease based on notified cases alone should be interpreted with considerable reserve. It is suggested that infectious-disease surveillance should be both clinical and microbiological and that data from different sources need to co-ordinated. The reason for reporting each disease (or organism) should be specified and and reviewed periodically.

Bacterial Infections↗

PubMed1980

National survey of tuberculosis notifications in England and Wales 1978--9. Report from the Medical Research Council Tuberculosis and Chest Diseases Unit.

A survey of all tuberculosis notifications in England and Wales for a six-month period showed that 70% of 3732 newly notified, previously untreated patients had respiratory disease only, 23% had non-respiratory disease only, and 7% had both. Fifty-seven per cent of patients were of white and 35% were of Indian subcontinent (Indian, Pakistani, or Bangladeshi) ethnic origin, the latter group contributing over half the cases of non-respiratory disease. The estimated overall annual notification rate per 100 000 population for 1978--9 was 16.4 for England and 13.5 for Wales. The rates differed considerably between the different ethnic groups in England, the highest rates occurring in the Indian and in the Pakistani and Bangladeshi groups and the lowest in the white group; the differences in the non-respiratory rates were the more striking. Nearly a quarter of patients with respiratory disease had large pulmonary lesions, the proportion being higher for the white group than for the Indian subcontinent group. Over half the patients had positive cultures for tubercle bacilli and over a third had positive smears; both proportions were higher for the white group. This survey has identified many of the problems which tuberculosis presents in England and Wales today. These include the substantial number of patients with sputum-positive disease, the considerable variation in the rates in the different ethnic groups, and the not uncommon occurrence of childhood tuberculosis.

Adolescent↗

PubMed1985

National survey of notifications of tuberculosis in England and Wales in 1983. Medical Research Council Tuberculosis and Chest Diseases Unit.

In a survey of all notifications of tuberculosis in England and Wales for the first six months of 1983 56% of the 3002 newly notified patients who had not been treated before were of white and 37% were of Indian subcontinent (Indian, Pakistani, or Bangladeshi) ethnic origin, findings similar to those of a survey in 1978-9. In the four and a quarter years between the surveys the number of patients notified had declined by 26%, the decline being 28% among those of white and 23% among those of Indian subcontinent ethnic origin. The white patients were on average older than the patients of Indian subcontinent ethnic origin, and a higher proportion of them had respiratory disease (82% compared with 66%). The pulmonary lesions were on average larger and more often bacteriologically positive in the white patients. There were considerable differences between the ethnic groups in the estimated yearly rates of notifications per 100 000 population in England in 1983. The highest rates occurred in the Indian (178) and the Pakistani and Bangladeshi (169) populations and were roughly 25 times the rate in the white population (6 X 9). In the Indian subcontinent ethnic groups the highest rates occurred among those who had arrived in the United Kingdom within the previous five years.

Age Factors↗

PubMed1988

The value of England and Wales congenital malformation notification scheme data for epidemiology: male genital tract malformations.

Data from the England and Wales national congenital malformation notification scheme were examined for associations of male genital tract malformations. For some of the malformations comparison of notification rates with the literature suggested gross undernotification. There was also evidence suggesting bias: examination of the relationships of the malformations to birth weight, maternal parity, and maternal age at delivery showed some highly significant trends in risk, most of which were at variance with findings in the literature, and several potential mechanisms for bias could be adduced. Direct investigation is needed, for this and other similar data sets, of the extent and mechanisms of biased undernotification.

Birth Weight↗