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PubMed2004

Hepatitis C core antigen in Polish blood donors.

BACKGROUND: The goal of this study was to evaluate the feasibility of adopting the HCV core antigen ELISA (HCVcAg) for routine screening of Polish blood donors. STUDY DESIGN AND METHODS: A total of 133,279 donor samples were tested by ORTHO HCVcAg. All repeatedly reactive (RR) samples were tested by neutralization test for confirmation, RIBA HCV for anti-HCV, and by Cobas Amplicore for HCV RNA. All donations were tested for ALT level. RESULTS: The HCVcAg test specificity was 99.94 percent. In total, 1499 donations (1.12%) were initially reactive and 124 (0.09%) were RR. Antibodies to HCV were found in 22 out of 124 donors and HCV RNA was detected in 19 out of 22. In 10 out of the 19 HCV-RNA-positive donors, the HCVcAg neutralization test was positive. Among the 102 HCVcAg RR/anti-HCV-negative donors, there were 6 neutralization-test-positive individuals, and all were HCV RNA positive. Elevated ALT level was observed in one of them. During the follow-up studies of three HCVcAg RR/HCV-RNA-positive donors, seroconvertion was observed 5 to 7 weeks after the initial HCVcAg-positive result. In all, HCVcAg results became negative once antibodies to HCV were detected. CONCLUSION: The HCVcAg test proved to be feasible for routine screening in the Polish Blood Transfusion Service. Six HCVcAg RR/anti-HCV-negative donors were identified. The calculated residual risk in this study of donors in the preseroconversion window was 45 per million. Mandatory testing of every blood and plasma donation for HCVcAg or HCV RNA was recommended as of January 2, 2002.

Blood Donors↗
PubMed1997

HIV counseling and testing: its evolving role in HIV prevention.

The development of an enzyme-linked immunosorbent assay (ELISA) for screening blood for antibodies to HIV was a major milestone in the history of AIDS prevention and treatment. Since early 1985, the Centers for Disease Control and Prevention (CDC) has provided public funds to state and local health departments to support a national HIV counseling-and-testing (HIV CT) program directed toward persons at risk of transmitting or becoming infected with HIV. The implementation and ongoing development of this national program has often been marked by intense policy debate, especially in the area of mandatory testing. Furthermore, the lessons learned during its 11-year program history are highly relevant to understanding the challenges that might arise when implementing other new biomedical or behavioral HIV prevention technologies. Using the construct of public health infrastructure, this article describes key features, events, lessons learned, and future challenges of this evolving national prevention program.

AIDS Serodiagnosis↗
PubMed1976

A mycobacteriology proficiency testing program using simulated sputum specimens.

The New York State Department of Health proficiency testing program in mycobacteriology determines the ability of a laboratory to isolate the acid-fast bacillus present in a simulated specimen and to identify the strain. Until 1964 the specimens were autoclaved normal sputa seeded with mycobacteria. When mandatory testing was introduced by law in 1964, more specimens were needed. These have been prepared in simulated sputum bases, first skimmed milk, then granulated hog gastric mucin. The bases are seeded with Mycobacterium tuberculosis and other mycobacteria; Pseudomonas aeruginosa is added to simulate the contamination in clinical specimens. Laboratory performance in general has improved as a result of the proficiency testing and the concomitant educational program, but laboratories processing more than 200 specimens a year continue to perform best.

Animals↗
PubMed1995

HIV infection in Malaysia: a report of cases seen at the University Hospital, Kuala Lumpur.

The spread of HIV infection into Malaysia is estimated to have occurred in the early 1980's. The first case of AIDS was reported here in 1986. As of March 31, 1994, the numbers have increased to 8049 HIV positive individuals detected in the country. The risk behaviours among those tested positive were intravenous drug use in 77.2%, sexual transmission in 4.5%, while the remainder are still under investigation. Pediatric AIDS constitutes 0.2% of positives. The high prevalence among intravenous drug users (IVDU) is likely to be due to mandatory testing for HIV upon entry to rehabilitation centres. The trend of HIV infection in this country seems to be highest amongst the intravenous drug users. The increasing number of HIV infected prostitutes and heterosexuals in our population is worrying. Since 1986, a total of 104 HIV positive individuals have been treated at the University Hospital, Kuala Lumpur, Malaysia. Of these, 25 have died and of those still alive, 5 have symptomatic disease. The most common AIDS-defining illness is Pneumocystis carinii pneumonia. Education programmes have been developed targeting the various high risk groups and the general population.

Adolescent↗
PubMed1989

[Examination strategies in the preparative phase for cataract operations and artificial lens implantation].

The extraordinary increase in the number of posterior chamber intraocular lenses (IOLs) implanted in recent years has completely changed our attitude towards cataract patients. A few years ago, the goal of preoperative evaluation was to select ideal candidates for implantation. In the meantime, contraindications to IOLs have become very rare and many tests have been developed to objectify and quantify lens opacities in patients with good visual acuity (glare disability tests, contrast sensitivity tests), or to predict the functional clinical result (macular function tests). The value of these tests is reduced by the rate of false-positive or false-negative results. A meticulously recorded history and careful enlightenment of the patient are indispensable to avoid postoperative disappointment. Slit-lamp observation and biometry are the only mandatory tests for establishing the presence of a cataract and planning the surgical approach. All modern tests attempt to substitute automatic or semi-automatic measurements for clinical judgment, but indication for cataract surgery nevertheless remains a clinical act.

Humans↗
PubMed2003

Voluntary HIV testing among inmates: sociodemographic, behavioral risk, and attitudinal correlates.

We sought to determine the prevalence and correlates of self-reported HIV testing among inmates in correctional centers in Ontario, Canada. A cross-sectional survey was conducted with a stratified random sample of 597 male and female adult inmates. The participation rate was 89%. Descriptive statistics and multiple logistic regression were used to analyze HIV testing. Fifty-eight percent had ever been tested, and 21% had voluntarily tested while incarcerated in the past year. Having ever been tested was more common among those at risk for HIV through injection drug use (IDU) or sexual behavior. Testing while incarcerated in the past year was independently associated with being single (OR = 2.6), frequent IDU (OR = 4.0), not having casual sex partners prior to incarceration (OR = 0.53), a history of hepatitis (OR = 2.4), previous HIV testing (OR = 3.7), a close relationship with an HIV-positive person in the outside community (OR = 1.7), knowing an HIV-positive person inside (OR = 2.7), a perceived chance of being infected during incarceration (OR = 2.2), and support of mandatory testing (OR = 2.0). The predominant motivations for testing while incarcerated were IDU or fears of infection inside, possibly through contact with blood, during fights, or even by casual contact. Voluntary HIV testing in prison should be encouraged, and inmates should receive appropriate counseling and information to allow realistic assessment of risk.

AIDS Serodiagnosis↗
PubMed1997

A risk index for pregnancy during anesthesia.

STUDY OBJECTIVE: To determine the validity of limiting pregnancy testing only to females older than 14 years, hypothesizing that (1) if this recommendation were valid, we would find no incidence of pregnant patients receiving anesthesia in our department under age 15, and (2) by identifying all patients receiving anesthesia while pregnant versus those who are not pregnant might allow calculation of a relative risk index for pregnancy per age group. DESIGN: A retrospective chart review. SETTING: Department of Anesthesiology at Louisiana State University Medical Center in Shreveport. MEASUREMENTS AND MAIN RESULTS: The relative numbers and ages of 1) all male versus female patients treated, 2) females presenting with viable pregnancy receiving anesthetic care, and 3) ages of conception in the youngest females were quantified to 4) correlate relative rates for pregnancy/anesthetic at each age. Of 16,033 anesthetics administered, 1,849 pregnant patients ages 13 to 44 years received 1,968 anesthetics (12.5% of total). One patient conceived at the age of 12. The rates of pregnant 13 (n = 4) and 14 (n = 24) year-olds in our anesthetized population equaled rates found with patients in the third and fourth decades of life, respectively. CONCLUSIONS: Louisiana State University Medical Center's current departmental guideline to preoperatively test all patients aged 12 to 44 years is supported by the desire to identify pregnancy prior to anesthesia and the encountered pregnancy distribution and incidence. Although radiation is a known danger to fetal development, our radiology department tests only females who "fail to confirm in writing a nonpregnant state." While females younger than 15 years deserve the same consideration as 30- and 40-year-old patients, multiple ethical, pragmatic, economic, and theoretical considerations may mitigate the need for mandatory testing of all patients.

Adolescent↗
PubMed2003

Evaluation of the vehicle inspection/maintenance program in the Metropolitan Area of Mexico City.

The Inspection/Maintenance Program in the Metropolitan Area of Mexico City (MAMC) mandates a test every 6 months for all gasoline motor vehicles as one of the strategies to decrease emissions of vehicular pollutants. FTP-75 and ASM procedures were performed in our facilities to a fleet of 108 in-use motor vehicles before and after the approval of the I/M mandatory test When our laboratory-simulated ASM data were compared with those of the official certificate, a large difference was observed between them. On the other hand, audits at the test-only centers indicate poor maintenance of the analytical instruments and dynamometers. On the basis of our FTP results, an estimation of the emissions change for the MAMC fleet shows a net 4% decrease in CO emissions, while total hydrocarbons and NOx increased 9 and 8%, respectively. Our results indicate that the I/M system in the MAMC lacks the technical capability and investment to ensure that software and hardware are properly maintained, calibrated, and upgraded. Sometimes limited attention is paid to ensure adequate training of inspectors, auditors, and quality control staff.

Air Pollutants↗
PubMed1981

Repeal of mandated premarital tests for syphilis: a survey of state health officers.

Statistics on the mandated premarital tests for syphilis (PMSTs) in the United States for the year 1978 were analyzed to determine whether this program is epidemiologically and economically effective. Overall close to four million PMSTs contributed 1.27 per cent of the tests found positive for infectious syphilis in the 44 states where PMSTs are mandated. Of all mandated PMSTs, only one in 8,461 was positive for infectious syphilis. In a companion study, venereal disease control officers were canvassed for their opinions regarding the retention or abolition of the mandatory tests. Out of 44 states which mandated tests, only 13 respondents favored retention while 31 found the program unsatisfactory, preferred abolition or changes, or were undecided.

Cost-Benefit Analysis↗
PubMed2004

Voluntary HIV counseling and testing of pregnant women--an assessment of compliance with Michigan public health statutes.

OBJECTIVES: First, to evaluate compliance with Michigan's laws mandating universal, voluntary HIV counseling and testing (VCT) of all pregnant women who provide informed consent (ie, the "opt-out strategy"). Second, to assess the acceptability of and agreement to VCT. METHODS: Women who delivered a live infant at a large, urban academic medical center were interviewed before hospital discharge. Obstetric and prenatal medical records were abstracted to document that VCT was offered, accepted, or declined and that pre- and posttest counseling were provided and test results noted. RESULTS: Our survey of 491 postpartum women interviewed from February 1998 through January 1999 revealed that 83% reported that they were offered VCT; of those, 95% reported that they had agreed to testing. Uninsured women were least likely to undergo VCT; no other demographic, social, or behavioral characteristics were associated with VCT. Nor was VCT more likely to occur according to providers' different practice settings (ie, "private" vs publicly funded). Most women reported that they did not find VCT offensive or threatening, although only 49% reported that they felt "very comfortable," refusing testing. CONCLUSION: These results suggest the opt-out strategy for VCT, as currently practiced in Michigan, can effectively promote the US Public Health Service testing goals. Offering VCT with the understanding that it may be refused without risk is essential. Additional educational interventions about HIV infection during pregnancy and perinatal HIV-transmission interruption were requested by women in our study and should be widely promoted. Given that 95% of women agreed to VCT, mandatory testing without consent is not needed to achieve federal testing benchmarks and seems ethically problematic.

AIDS Serodiagnosis↗
PubMed1993

Hyperammoniemic coma in an adolescent girl: an unusual case of ornithine transcarbamylase deficiency.

Ornithine transcarbamylase deficiency (OTCD) is caused by an alteration of urea synthesis, linked with partial modification of the X-chromosome, whose clinical manifestations are: lethargy, nausea, vomiting and cerebral edema. While in newborn males OTCD presents with hyperammoniemia leading to cerebral palsy with profound neurological impairment and eventually death, in women who are healthy carriers, it is possible to detect the disorder only through specific tests, since heterozygote women are rarely symptomatic. We describe the case of a young woman admitted to the hospital after an episode of mental confusion with vomiting and psychomotor restlessness, which had previously occurred several times during the premenstruum and lasted a few hours. A 2 day history of stupor made admission mandatory. Tests carried out during the hospital stay showed marked hyperammoniemia and unconjugated hyperbilirubinemia, marked cerebral edema documented by a CT scan. Liver biopsy and CSF test were normal. Screening of plasma and urinary aminoacids, level of orotic acid in the urine and OTC activity in the liver, confirmed the diagnosis of OTCD. The possibility of early diagnosis and therapy of a disease which otherwise leads to death, emphasizes the importance of precise evaluation of a possible organic cause of anorexia and behaviour disorders in young women.

Adolescent↗
PubMedDate not supplied

Comprehensive medical care among HIV-positive incarcerated women: the Rhode Island experience.

Our objective was to characterize the clinical presentation of human immunodeficiency virus (HIV) infection among incarcerated women in a program that provides HIV testing and primary care to all state prisoners in Rhode Island. A retrospective medical chart review on all HIV-seropositive women who were incarcerated between 1989 and 1994 and had at least two medical visits with an HIV medical care provider was used. At the Rhode Island Adult Correctional Institution (ACI), under mandatory testing laws between 1989 and 1994, 28% (172 of 623) of all women were identified with HIV infection. Of the 172 women who tested seropositive in prison, 110 were included in the study. Of the 110 women followed, 84% reported injection drug use (IDU) as their primary risk factor, and 30% reported both IDU and sex work. The median CD4 count was 596/mm3, with 60% having a CD4 count >500 cells/mm3. The most common medical conditions were vaginal candidiasis, oral candidiasis, and bronchitis. Antiretroviral therapy was well accepted and followed community standards. Continuity of medical care after release was facilitated by the same physician caring for the patient in the community setting, with 83% of women following up for HIV care after release. The medical conditions noted reflect that these women are early in the course of their HIV disease when they are initially diagnosed. This comprehensive program in Rhode Island's state prison plays a central role in the diagnosis of HIV-seropositive women and provides counseling, primary medical and gynecological care, and linkage to community resources after release.

Adult↗
PubMed1992

LPTP's (Laboratory Proficiency Testing Program) educational assistance program (EAP)--a review.

The Educational Assistance Program (EAP) of the Laboratory Proficiency Testing Program (LPTP) in Ontario, Canada, provides at-the-bench in-service education to the technological staff in smaller, remote or rural hospital laboratories. This service is provided to laboratories which have either been identified by LPTP as experiencing problems or on direct request. The tutorials are conducted by experienced volunteer technologists. LPTP carries out mandatory testing and proficiency evaluation in Ontario. Funded by the Ministry of Health of Ontario, EAP is offered voluntarily and without charge as part of LPTP's educational component of external quality assessment. Preliminary post-tutorial proficiency testing results show improved performance and recipient evaluation forms express an enthusiastic response. Both support continuation of this unique program.

Clinical Competence↗
PubMed2000

Technical, genetic, and ethical issues in screening and testing of African-Americans for hemochromatosis.

To define more precisely populations in which hemochromatosis is frequent to rare, problems of racial classification are introduced, with particular reference to Europeans and African-Americans. Because the category "Caucasian" includes a multitude of dissimilar peoples, the categories Europeans and European-Americans have been substituted for Caucasian, which is archaic. The background of discrimination in sickle hemoglobin programs for African-Americans are then analyzed, including, discrimination by employers, life insurance, and selective mandatory testing. Discrimination and selective testing of African-American employees of the Lawrence Livermore Laboratory continues today without prior consent, as it has since the 1970s. Dissimilarities between the genetics of hemochromatosis in Europeans and their descendants, Africans, and African-Americans are briefly analyzed. Finally, it is concluded that because hemochromatosis is unlike sickle hemoglobin in that it is potentially preventable and treatable, prevention and treatment principles should apply as in other diseases. Furthermore, because hemochromatosis is so common in European-Americans, discrimination, if practiced, would not be selective for African-Americans.

Black or African American↗
PubMed2002

[Recent blood gas analysis as emergency testing].

Laboratory specimen tests, histological exams, physiological tests and image diagnoses are routinely conducted on medical premises. These include emergency specimen testing such as hematological exams, partial biochemical exams and partial immunology exams. Emergency tests, especially those carried out by doctors and nurses in the operating theatre, nurse's station and bedside are called Point Of Care Tests or Near Patient Tests. The purpose is to facilitate quick, accurate diagnosis, thereby increasing the effectiveness of critical care. POCT/NPT was started due to an increasing requirement in the USA for faster turnaround times, and made possible with the development of high quality portable medical devices with sensor technology. In this article, the history and most recent information, diagnosis and treatment using Blood Gas Analysis, a mandatory test for critically ill patients, is described.

Blood Gas Analysis↗
PubMedDate not supplied

HIV and interventional radiology: a national survey of physician attitudes and behaviors.

PURPOSE: The frequency of parenteral and cutaneous exposure to blood or body fluid during interventional radiologic procedures, current use of barrier precautions by interventional radiologists, and physician attitudes about testing for the human immunodeficiency virus (HIV) and related issues were assessed. MATERIALS AND METHODS: An anonymous survey of interventional radiologists was conducted by mail in November 1991. RESULTS: Of 1,530 surveys, 819 (54%) were returned and 806 (53%) were completed and evaluable. Ninety-six percent of respondents (763 of 794) perform procedures in patients infected with HIV. Sixty-nine percent oppose mandatory testing of physicians for HIV. Eighty-seven percent (693 of 797) reported at least one procedure-related injury (range, 0-99; mean, four). Fifty-eight percent of injuries occurred with use of a sharp instrument (381 of 662), 20% were due to needle recapping (133 of 662), and 7% (44 of 662), to improper disposal of a sharp instrument. Contact between a physician's blood and a patient was reported in only one case (0.2%). Eighty-five percent of respondents (671 of 789) changed their use of barrier precautions in the last 10 years; concerns about HIV were cited by 96% as a reason for change. Reported use of barrier measures was highly variable. CONCLUSION: Exposure to patients' blood or body fluid is not infrequent during interventional radiologic procedures. Exposure of patients to the blood or body fluid of health care workers is rare. Use of recommended precautions in interventional radiology is variable, and practices that could lead to preventable injury remain common. Strategies should be developed to reduce risks even further and to encourage universal compliance with government guidelines.

AIDS Serodiagnosis↗
PubMedDate not supplied

Prevalence of beta-thalassemia trait in premarital screening in Al-Hassa, Saudi Arabia.

BACKGROUND: The Al-Hassa area is one of the regions in Saudi Arabia where hemoglobinopathies are prevalent. The Saudi Ministry Of Heath designed a protocol for premarital testing after the royal decree in December 2003. The protocol was implemented in a February 2004 order. The aim of this study was to determine the prevalence of beta-thalassemia trait among subjects coming for premarital screening in the Al-Hassa area. SUBJECTS AND METHODS: From February 2004 to November 2004, healthy subjects coming to six marriages consultation centers in the Al-Hassa area underwent routine mandatory tests. Subjects were considered to have beta-thalassemia trait if they had a mean corpuscular volume (MCV) <80 fL and/or a mean corpuscular hemoglobin (MCH) <27 pg and a hemoglobin A2 level >3.2%. Venous blood was taken into an EDTA tube and the complete blood count and red blood cell indices were measured by a Coulter automated cell counter on the same day of hemoglobin collection. Electrophoresis was done on cellulose acetate. RESULTS: All Saudi participants (n=8918), including 4218 (47.3%) males and 4700 (52.7%) females were screened. The prevalence of beta-thassemia trait with high hemoglobin A2 and microcytic hypochromic anemia was 3.4% (307/8918). CONCLUSION: In countries with a high prevalence of hemoglobinopathies, a premarital screening program is helpful for identification and prevention of high-risk marriages. With a 3.4% prevalence of beta-thalassemia trait in premarital couples, future comprehensive programs are needed to know the actual prevalence of beta-thalassemia in Al-Hassa.

Adult↗