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PubMed1992

The ever-evolving epidemiologic concepts of human immunodeficiency virus infections.

Human immunodeficiency virus infection has now reached epidemic proportions in both industrialized and nonindustrialized countries. Two preventive measures remain of questionable benefit: mandatory testing and partner notification. Sexually transmitted diseases and cervical ectopy may be risk factors for heterosexual transmission, now the most frequent mode of transmission of human immunodeficiency virus worldwide. Smokable freebase cocaine, the use of which is increasing in many cities in industrialized countries, is associated with acquisition of sexually transmitted diseases and human immunodeficiency virus infection. In addition to perinatal transmission of human immunodeficiency virus, postnatal transmission via breastfeeding has been demonstrated in association with a recent acquisition of human immunodeficiency virus by the mother. Intriguingly, in multiple pregnancies, first-born twins of human immunodeficiency virus-infected mothers could be at higher risk of infection than second-born twins. Nosocomial transmission of human immunodeficiency virus, both from infected patients to health professionals and from infected health professionals to patients, is a matter of concern and justifies preventive measures.

AIDS Serodiagnosis↗
PubMed1992

Family physician attitudes about HIV screening.

This study examined why and for whom family physicians are likely to require HIV screening according to general policies or procedures, based on a national survey of 2,660 family practice physicians. Of those contacted, 1,678 responded, yielding a response rate of 63.7%. The study also examined whether attitudes toward screening differed for physicians in different types of practices, of varying educational backgrounds, and with differing opinions regarding treating persons with AIDS (PWAs). The results showed that required screening was most strongly endorsed for pregnant women who had other risk factors and for i.v. drug users. Those physicians who most favored mandatory screening were also most likely to favor the mandatory reporting of AIDS cases to public health officials. They also had the least formal medical training (were not residency trained or board certified) and expressed the greatest apprehension regarding their own and their staff's preparedness and willingness to treat PWAs. A major implication of the findings is that family physicians and others who do mandatory testing should be provided opportunities, through residency training, board-certification preparation, or continuing medical education, to learn how to care for those patients they test who turn out to be seropositive.

AIDS Serodiagnosis↗
PubMed1996

A Model for a Policy on HIV/AIDS and Athletics.

Human immunodeficiency virus (HIV)-infected athletes exist at the collegiate level and are engaging in competitive sports, as was revealed by a 1993 NCAA survey. Unfortunately, there is a void when the issue of policy for the HIV- positive athlete and his or her participation rights at the collegiate level is addressed. Given the controversial nature of opinion on HIV and the resultant acquired immunodeficiency syndrome (AIDS), it is recommended that a policy be in place for an HIV-infected athlete before it is needed. Ithaca College has recently developed such a policy, and it is offered here to other educational institutions as a model. It is emphasized throughout the policy that HIV-positive athletes should not be restricted from athletic participation for the reason of infection alone, that strict confidentiality guidelines should be followed, and that mandatory testing of athletes for HIV is not justified.

Journal Article↗
PubMed2006

Post-Perruche: what responsibilities for professionals?

Damage compensation relating to handicapped new-borns, the wrongful life law, was put in place after a great controversy in France by the Perruche ruling of November 13th 2000. The French parliaments have voted a special law against wrongful life action. But questions about medical liability are not answered by the new law. For wrongful life, what are now the medical errors likely to directly provoke a handicap or aggravate it or obstruct measures to alleviate it? For a wrongful birth claim it limits parental damages to psychological damages only, due to a lack of mental preparation, whilst denying economic losses, thus preventing complete compensation arising from medical malpractice for all the other types of difficulty suffered by the parents. Why does it give a new definition of medical malpractice as a "characterized fault" and insist upon the qualification 'blatant" in the field of medical liability? For health professionals, it is a question of knowing and being acquainted with the errors that fall under their liability with regard to handicapped persons and a "characterized fault" with regard to parents. It is through a review of past and present case law that we will try to answer these medical questions. All court rulings that awarded monetary damages to the child were reviewed. We include only three decisions after the new law, which do not allow damage compensation in respect of a handicapped new-born. The rulings incorporate decisions taken by the French Supreme Court, of the council of state as well as by courts of appeal. Failure of voluntary termination of pregnancy, missing rubella immune antibody, omission of mandatory tests during pregnancy, typical medical fetal malpractice, were and are professional faults.

Compensation and Redress↗
PubMed2006

Prevalence & significance of hepatitis C virus (HCV) seropositivity in blood donors.

BACKGROUND & OBJECTIVES: The clinical significance of anti HCV antibodies in healthy blood donors remains uncertain. These donors are usually asymptomatic and it is difficult to elicit risk factors of acquiring HCV infection during pre-donation questioning. Limited information on donor recall and follow up studies on anti HCV positive blood donors have been reported from India. Paucity of data which is likely to have an impact on safe blood transfusion programme has prompted us to undertake this study to assess the significance of HCV seropositivity in blood donors with respect to their clinical, biochemical and virological profile. METHODS: A total of 16,250 blood units were screened for the mandatory tests using third generation ELISA (anti HIV 1&2, anti HCV, HBsAg), VDRL and peripheral smear for malaria. Donors reactive for anti HCV were informed. Repeat anti HCV reactive donors were subjected to detailed clinical history focusing on risk factors for HCV transmission. The blood tests included liver function tests (LFT), coagulation and autoimmune profile, qualitative serum cryoglobulins and HCV RNA detection. These donors were followed at 2-3 monthly intervals for a minimum period of six months by LFT. RESULTS: An overall seropositivity of 0.44 per cent (72/16,250) was observed in our donors which was significantly lower in first time, young voluntary donors as compared to replacement donors (0.27 vs. 0.60%). In contrast to drug abuse (6.4%) we found minor percutaneous routes like sharing of shaving kits or visit to a road side barber (32%) as the major risk factor for HCV transmission. There was no prior history of blood transfusion in any of these donors; however history of some surgical procedures was present in 25.8 per cent. Raised transaminases and HCV viraemia were observed in 87 and 71 per cent donors respectively. An association was observed between HCV RNA when the ELISA ratio was >5. INTERPRETATION & CONCLUSION: Voluntary donors form a safe source of blood supply and efforts should be made to increase this precious source to 100 per cent. Abbreviated behavioural donor screening questionnaire for repeat donors is not advisable. Awareness and education of donors is required regarding modes of HCV transmission. HCV positive donors should be informed about their disease, counselled and referred to hepatologist, and permanently deferred for future donations.

Adolescent↗
PubMedDate not supplied

Attitudes of selected radiographers toward AIDS.

Acquired Immune Deficiency Syndrome (AIDS) has become one of the most important public health issues in America. This study examined the attitudes of 300 radiographers toward the medical and social issues of AIDS. Respondents supported disclosure of AIDS results to persons having contact with AIDS patients and mandatory testing for certain groups at risk to infection by the AIDS virus. Those having more exposure to AIDS patients appeared to have more tolerant attitudes toward the issues.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Anabolics and sports].

Anabolics (anabolic steroids and, in recent years, recombinant human growth hormone) are used to enhance athletic performance. Although there is no definite proof of a performance enhancing effect of anabolic steroids (ethical difficulties and blinding problems with high dose steroid treatment), evidence suggests that steroids may increase muscular strength in some subgroups of athletes. Unfortunately, numerous side effects and (in some cases at any rate) permanent damage may occur as a consequence of abuse of anabolics. This is chiefly the case in adolescents and women. As long as athletes and their trainers believe in the efficacy of anabolics, and no mandatory testing in the training periods is imposed, the abuse of anabolics by athletes will distort fair competition in sport.

Anabolic Agents↗
PubMed1989

Activated peripheral blood mononuclear cells a possible substitute to B-lymphocytes in HLA-DR determination.

The serological determination of class II antigens is still a mandatory test prior to allotransplantation. It is known that these antigens are normally expressed on B-lymphocytes and monocytes. The B-lymphocytes that constitute 10-15% of total blood lymphocytes are the cells currently used for HLA-DR typing. To avoid HLA-DR typing difficulties, or even impossibilities that are frequently encountered among some patient groups, we studied the response of peripheral blood mononuclear cells (PBMNC)--as an alternative source of cells for class II antigen typing--to in vitro mitogen and interleukin-2 activation and propagation. Although the patients included in this study were selected having pre-known HLA-DR typing difficulties, all of them could be adequately typed by this method.

B-Lymphocytes↗
PubMed1995

Human immunodeficiency virus disease in pregnancy.

Since the early 1990s, the number of women diagnosed with the human immunodeficiency virus (HIV) has exploded. Heterosexual women have become one of the fastest-growing populations of newly diagnosed cases. However, the full impact of HIV infection and acquired immunodeficiency syndrome (AIDS) on women's health and the optimal management of symptomatic and asymptomatic cases have yet to be delineated. The urgency to establish effective management protocols is underscored by the fact that AIDS has recently become the leading cause of death for minority women in many urban areas. The administration of antepartum and intrapartum zidovudine (azidothymidine, AZT) has advanced efforts to minimize perinatal transmission and produced promising results. However, important issues pertaining to prevention of HIV infection in women, mandatory testing of women of reproductive age, and the management of HIV-positive women during the interconceptional period remain controversial. Addressing HIV throughout the continuum of reproductive health is a major priority and a concern of all health care providers. Women's health care must assume the lead in counseling all women about their risk of HIV, ensuring that HIV-positive women make informed decisions about their reproductive health and that HIV-negative women modify high-risk behavior to avoid becoming infected. Since obstetricians and gynecologists, nurse practitioners, and midwives are often the first care providers whom at-risk and HIV-infected women contact, they must be able to identify, assess, and optimally manage these patients. This article reviews the epidemiology, virology, pathology, preconceptional counseling/testing, and management of women with HIV infection in pregnancy, thereby providing the practitioner with information and tools to enhance women's health.

Female↗
PubMed1995

Effectiveness of mandatory transmissible diseases screening in Indian blood donors.

This study was undertaken to determine the prevalence of transfusion transmitted diseases (TTDs) among local blood donors, the safety offered by the four mandatory tests (for HIV, HBsAg, syphilis and malaria) and to assess alanine aminotransferase (ALT) as a surrogate test. A total of 313 blood donors were tested for HBsAg, hepatitis B core (HBc) antibody, hepatitis C (HCV) antibody, HIV antibody, and IgM antibody to cytomegalovirus (CMV-IgM). The serum alanine aminotransferase levels were also done on each unit of blood. The prevalence of various markers was 7(2.2%) for HBsAg, 57 (18.2%) for anti HBc (total), 1 (0.3%) for anti HCV, 16 (5.1%) for anti CMV. None of the donors were positive for HIV, VDRL or malaria. ALT level was raised in 16.5 per cent of donors and showed no correlation with hepatitis markers. ALT was not found to be useful as a surrogate marker for routine screening of donors. Sensitive tests like ELISA and immunofluoresence for malaria antigen should be applied for screening for malaria. VDRL test may be used to detect high risk donors rather than detection of syphilis when stored blood is used. HBsAg and HIV tests should be routinely done on every unit of blood and anti HCV tests should be done regularly, if possible.

Adult↗
PubMed1995

Cost effectiveness of diagnosis of deep vein thrombosis in symptomatic patients.

BACKGROUND: The most widely used noninvasive test for deep vein thrombosis is Doppler ultrasonographic imaging of the lower extremities. The best evaluated of the noninvasive approaches are ascending contrast venography, impedance plethysmography, Doppler ultrasonography with B-mode imaging. Economic evaluation is aimed at helping decision makers to reach their goal of maximizing the health of the population served, subject to the available resources. METHODS: The data that provided the basis for this cost effectiveness analysis were derived from a prospective study of approximately 500 patients referred to a regional thromboembolism program with a first episode of clinically suspected deep vein thrombosis. The application of cost effectiveness analysis to the diagnosis of deep vein thrombosis is readily accomplished using cost minimization. This cost effectiveness technique makes it possible to rank the diagnostic approaches from "worst" to "best", with the best approach defined as that which accomplishes the desired health effect at minimum cost. Effectiveness (health benefit) may be defined in this context as the number or proportion of patients with deep vein thrombosis correctly identified by objective testing or, the number or proportion in whom treatment was correctly withheld. RESULTS: Clinical diagnosis is cost ineffective; $1,590,784 Canadian, $2,624,220 US. Outpatient diagnosis using noninvasive testing was the most cost effective. Serial Doppler ultrasonography is more costly ($618,265 Canadian, $1,326,180 US) than serial impedance plethysmography ($527,165 Canadian, $1,052,880 US). Combined Doppler ultrasonography and serial impedance plethysmography offers a less costly strategy ($551,065 Canadian, $1,124,580 US) than serial ultrasonography alone. DISCUSSION: Objective testing is mandatory. Outpatient testing is preferred, avoiding unnecessary hospital admissions. Noninvasive testing is the most cost effective. The most widely used test, serial Doppler ultrasonography, is less cost effective than serial impedance plethysmography. The combined approach of initial Doppler ultrasonography followed by serial impedance plethysmography combines the advantage of an initial ultrasound image with less costly serial impedance plethysmography.

Adolescent↗
PubMed1998

Impact of a mandatory syphilis delivery test on reported cases of congenital syphilis in Upstate New York.

A regulation mandating a syphilis serology test at delivery was implemented on December 6, 1989. To assess any impact on congenital syphilis reporting, we compared all cases reported in Upstate New York for the year directly preceding the regulation (n = 69) to those born in the three-year period following its implementation (n = 239). After implementation, the percentage of cases not tested at delivery decreased from 10 percent to 1 percent and reports of syphilitic stillbirths tripled. Asymptomatic infection of both mothers and babies increased significantly and at-birth detection of cases in women with negative prenatal serologies increased by 43 percent. Delivery screening failed to identify seven cases due to incubating maternal infection.

Adolescent↗
PubMed2001

Transmission and postexposure management of bloodborne virus infections in the health care setting: where are we now?

There has been considerable debate about the need for mandatory serologic testing of individuals who are the source of bloodborne pathogen exposures in health care and other occupational settings. The transmission of hepatitis B (HBV), hepatitis C (HCV) and HIV between patients and health care workers (HCWs) is related to the frequency of exposures capable of allowing transmission, the prevalence of disease in the source populations, the risk of transmission given exposure to an infected source and the effectiveness of postexposure management. Transmission of HBV from patients to HCWs has been substantially reduced by vaccination and universal precautions. The transmission of HCV and HIV to HCWs does occur, although postexposure prophylaxis (PEP) is available to reduce the risk of HIV transmission. Transmission of bloodborne pathogens from infected HCWs to patients has also been documented. Policy-making concerning the mandatory postexposure testing of patients who may be the source of infection must weigh the relative infrequency of patients' refusals to be tested and the consequences for PEP recommendations with the ethical and legal considerations of bypassing informed consent and mandating testing. Mandatory postexposure testing of HCWs who are the source of infection will have a limited impact on reducing transmission because of the lack of recognition and reporting of exposures. Comprehensive approaches have been recommended to reduce the risk of transmission of bloodborne virus infections.

Blood-Borne Pathogens↗
PubMed1994

The cost-effectiveness of HIV testing of physicians and dentists in the United States.

OBJECTIVE: To evaluate the cost-effectiveness of alternative policies for human immunodeficiency testing (HIV) testing of physicians and dentists. METHODS: Decision analysis and cost-effectiveness analysis from a societal perspective were used. Data were derived from extensive literature review and consultation with experts. We conducted sensitivity analyses and also performed a cost-benefit analysis. ANALYSES: We analyzed policies for mandatory or voluntary testing of all physicians, surgeons, and dentists; for those testing positive, we analyzed mandatory or voluntary exclusion from practice, restriction from performance of invasive procedures, or requirements to inform patients of serostatus. MAIN OUTCOME MEASURE: Cost per patient infection averted. RESULTS: Although one-time mandatory testing of surgeons and dentists with mandatory restriction of those found to be HIV-positive is more cost-effective than other policies, the cost-effectiveness varies tremendously under different scenarios. Results were highly sensitive to several data inputs, especially HIV seroprevalence of surgeons and dentists and transmission risk. For example, under a medium seroprevalence and transmission risk scenario, mandatory testing of all surgeons might avert 25 infections at a total cost of $27.9 million or $1,115,000 per infection averted and an incremental cost of $291,000 compared with current testing; however, the incremental cost-effectiveness per patient infection averted ranges from $29,807,000 under a low-risk scenario to a savings of $81,000 under a high-risk scenario. CONCLUSION: Our analysis neither justifies nor precludes a mandatory testing policy. Further research on the key data inputs is needed. Given the ethical, social, and public health implications, mandatory testing policies should not be implemented without greater certainty as to their cost-effectiveness.

AIDS Serodiagnosis↗