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PubMedDate not supplied

Insurance for the insurers. The use of genetic tests.

Genetic testing raises concerns that individuals will be denied health insurance (and thus, effectively, access to health care), or that employers will screen to eliminate potentially costly workers. Although we as a society do not yet concur on the degree to which private businesses have a responsibility to promote social justice, several different policy alternatives might allow us to weigh the interests of insurers, as businesses, against the interests of citizens in a responsible manner.

Eligibility Determination↗
PubMed1989

Screening for HIV.

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AIDS Serodiagnosis↗
PubMed1989

AIDS: social, legal, and ethical issues of the "third epidemic".

The "first" and "second" epidemics of AIDS are considered to be the spread of HIV infection and subsequent development of AIDS cases; what has been termed the "third epidemic" is the widespread economic, social, and cultural reaction to the disease, raising crucial social, humanitarian, and legal issues. This article deals with four questions arising from these issues: (1) What is the best public health approach to people with HIV/AIDS, and what rights should they have? (2) Who should be subjected to mandatory testing? (3) Who has a right to know or be warned if someone has HIV/AIDS? and (4) How can society be protected against people who irresponsibly or deliberately set out to infect others? It is concluded that, as recommended by the World Health Organization, policies which balance concern for public health with respect for individual rights are both the most humane and the most effective ways to control the spread of AIDS.

AIDS Serodiagnosis↗
PubMed1986

The future of public health law.

Developments in medicine and constitutional law dictate modification of public health legislation in the United States. Traditionally overlooked by legislators, present public health laws provide inadequate decision-making criteria and inappropriate procedures for dealing with issues. Revised legislation should provide health care officials and agencies with the tools to balance individual rights against public health necessities. This Article makes four recommendations for legislative reform: (1) remove artificial legislative distinction between venereal and other communicable diseases; (2) provide criteria defining "public health necessity" to limit discretionary exercise of police power by health officials; (3) provide strong confidentiality protections in the collection and storage of public health information; (4) empower public health officials to select from a graded series of less restrictive alternatives in dealing with public health problems.

Civil Rights↗
PubMed1983

Ethical issues in testing for differential sensitivity to occupational hazards.

This study examines the ethical aspects of designing preventive health strategies in the workplace that rely on biochemical indexes of worker susceptibility. It analyzes the benefits and risks of this type of occupational testing, and stresses the desirability of guidelines for the use of hypersusceptibility testing in preemployment screening. The primary value of using such programs to identify previously unsuspected hazards in working environments is underscored. The report proposes elements for effective guidelines that can permit the orderly development of hypersusceptibility tests. Further study is needed to validate these technologies; to review the legal elements of consent and disclosure requirements; to assure continuation of equal employment opportunity; to provide legally enforceable protections of workers as research subjects; and to identify the extent, if any, of possible social and psychological harms imposed by such testing.

Beneficence↗
PubMed2001

Control of octopus arm extension by a peripheral motor program.

For goal-directed arm movements, the nervous system generates a sequence of motor commands that bring the arm toward the target. Control of the octopus arm is especially complex because the arm can be moved in any direction, with a virtually infinite number of degrees of freedom. Here we show that arm extensions can be evoked mechanically or electrically in arms whose connection with the brain has been severed. These extensions show kinematic features that are almost identical to normal behavior, suggesting that the basic motor program for voluntary movement is embedded within the neural circuitry of the arm itself. Such peripheral motor programs represent considerable simplification in the motor control of this highly redundant appendage.

Animals↗
PubMed1981

Principles of early detection of cancer.

Screening for the early detection of cancer offers the potential of increasing the number of patients whose cancer is diagnosed in a localized, curable stage. The operation of an efficient and effective early detection program requires that a number of conditions be fulfilled, some of which are difficult to attain. First, the target population for screening should be defined demographically and epidemiologically so that the screening program is designed to be responsive to the needs of that group, e.g., age, ethnic composition, special occupational or environmental circumstances. Furthermore, an appropriate means of communicating with the reference population must be established so that the group can be educated regarding cancer prevention and detection and motivated to use early detection programs. Screening for early detection should be carried out on two levels: primary screening for the identification of risk factors, and prescriptive screening for additional procedures ordered according to the patterns of risk factors, and prescriptive screening for additional procedures ordered according to the patterns of risk factors identified. The screening encounter should be an opportunity for health education regarding primary prevention, as well as early detection of cancer. Screening without follow-up for diagnosis and treatment is likely to be counterproductive; the patient must be provided with a means of entering the health care system when this is indicated by the screening examination. Follow-up of suspicious findings must also be carried out for end-result evaluation. Primary screening can be carried out successfully by allied health personnel under most circumstances. A program employing these principles is now being utilized by a number of independent clinics in a voluntary collaborative program called "CANSCREEN." Examples of the operational modes of this program will be presented.

Community Health Centers↗
PubMed1987

Attitudes of persons at risk for Huntington disease toward predictive testing.

Attitudes of 69 persons at risk for Huntington disease (HD) were obtained by means of semistructured interviews and questionnaires. About 79% of the individuals said that they would use a presymptomatic predictive test if it were available. All believed that the test should be made available even though there was no cure for HD. Nearly 2/3 of subjects would use the test for prenatal diagnosis, and of these 71% would terminate a pregnancy if the fetus was found to carry the HD gene. Most subjects believed that pretest counseling should be mandatory and many said that testing should be withheld from persons who were psychologically unstable or were threatening self-harm. The data suggest that about 2-6% of persons at risk for HD may have severe psychiatric or suicidal responses to a positive outcome of predictive testing. This underscores the need for adequate pretest counseling and the availability of professional and community resources to deal with the impact of predictive testing on individuals and their relatives.

Adult↗
PubMed2002

Vaccination policies in the military: an insight on influenza.

Influenza, despite its generally benign clinical course, is accompanied by absenteeism from work, acute suffering and even mortality, mainly in the elderly and in subjects who have high-risk medical conditions. Its prevention consists of strain specific vaccination, which must be repeated annually due to the high antigenic variability of the influenza virus. Influenza may represent an important obstacle to military readiness, particularly when considering its infectivity within closed communities. Despite such epidemiological situations, influenza vaccination is seldom included in the compulsory vaccination programme of the military on a global level. This may be due to several reasons, namely, a lack of confidence in the vaccine's effectiveness, the need for annual administrations (with expansion of economic and organisational efforts), false assumption that influenza is a disease with a minor impact, contradictory results of cost-effectiveness analyses (examples of which have yet to be made specifically for the military environment). The availability of more effective, economic and easy to administer vaccines, together with detailed and tailored cost-effectiveness analyses, may have a beneficial effect on the role the military plays in the fight against influenza across the globe.

Cost-Benefit Analysis↗
PubMed1988

AIDS public health law.

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Acquired Immunodeficiency Syndrome↗