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PubMed1994

Human immunodeficiency virus (HIV) infection. American College of Physicians and Infectious Diseases Society of America.

Knowledge about the epidemiology, diagnosis, and treatment of human immunodeficiency virus (HIV) infection gained since 1988 has necessitated an update of our previously published policies. Important advances have been made in the treatment of HIV infection and the acquired immunodeficiency syndrome (AIDS), resulting in a prolongation of the symptom-free period. Transmission of HIV infection from a dentist to several of his patients is believed to have occurred. Heterosexual transmission of HIV infection is increasing in importance. This statement emphasizes the ethical imperative to care for all patients; the need for health care professionals to adhere scrupulously to universal precautions because of the low but definite risk for transmission of HIV in the health care setting; the expanded recommendations for HIV testing to identify infected persons as early as possible; and the need for national leadership in public education, public policy development, and health care funding.

AIDS-Related Opportunistic Infections↗
PubMed1998

With HIV prevalence among women increasing, more provinces encourage prenatal testing.

Testing of pregnant women for antibodies to HIV remains a thorny medical and ethical issue. On the one side are children who stand to benefit if their mothers' HIV status is determined. On the other is women's right to determine what tests they will receive. A majority of provinces now have counselling programs in place to encourage women to undergo testing. However, testing remains voluntary and informed consent is required before a test is done--policies that have CMA support.

AIDS Serodiagnosis↗
PubMed1990

A single TLD dose algorithm to satisfy federal standards and typical field conditions.

Modern whole-body dosimeters are often required to accurately measure the absorbed dose in a wide range of radiation fields. While programs are commonly developed around the fields tested as part of the National Voluntary Accreditation Program (NVLAP), the actual fields of application may be significantly different. Dose algorithms designed to meet the NVLAP standard, which emphasizes photons and high-energy beta radiation, may not be capable of the beta-energy discrimination necessary for accurate assessment of absorbed dose in the work environment. To address this problem, some processors use one algorithm for NVLAP testing and one or more different algorithms for the work environments. After several years of experience with a multiple algorithm approach, the Dosimetry Services Group of Yankee Atomic Electric Company (YAEC) developed a one-algorithm system for use with a four-element TLD badge using Li2B4O7 and CaSO4 phosphors. The design of the dosimeter allows the measurement of the effective energies of both photon and beta components of the radiation field, resulting in excellent mixed-field capability. The algorithm was successfully tested in all of the NVLAP photon and beta fields, as well as several non-NVLAP fields representative of the work environment. The work environment fields, including low- and medium-energy beta radiation and mixed fields of low-energy photons and beta particles, are often more demanding than the NVLAP fields. This paper discusses the development of the algorithm as well as some results of the system testing including: mixed-field irradiations, angular response, and a unique test to demonstrate the stability of the algorithm. An analysis of the uncertainty of the reported doses under various irradiation conditions is also presented.

Algorithms↗
PubMed2002

Participation in a public insurance program: subsidies, crowd-out, and adverse selection.

This paper examines how varying the level of subsidies affects participation in a public insurance program, crowd-out of private insurance, and adverse selection. We study the experience in Washington's Basic Health program in 1997. Findings show that adverse selection is not a problem in voluntary public programs. Increasing subsidies have only modest effects on participation in subsidized programs, though the gains are not at the expense of the private market. Overall participation in the subsidized plan is also modest, even though participants benefit from it. The challenge to policymakers is to find program design characteristics, beyond subsidies, that attract the uninsured.

Adolescent↗
PubMed1997

Patterns of reassault in batterer programs.

A comparative multisite evaluation was conducted of four "well-established" batterer programs in geographically distributed cities to assess the pattern of reassault. Eight hundred and forty batterers were recruited and tested at program intake from each site (210 per site). The batterers and their partners were interviewed by phone every 3 months for 15 months after intake with a response rate for the female partners of nearly 70% for the full follow-up. According to initial victims, 31% of the men reassaulted during the follow-up. The reassault rate varies only slightly when adjusting for new partners (32%) or no partner contact (32%), but substantially more when adjusting for reports from the batterers (36%) and batterers plus arrest record (39%). Rates of verbal abuse (70%) and threats (43%) are much higher, but 73% of the women report feeling "very safe." Nearly half of the men who reassaulted did so within 3 months after program intake. "Voluntary" participants were significantly more likely to reassault (44% vs. 29%), as were program dropouts (40% vs. 28%). The "well-established" batterer programs appear to contribute to a short-term cessation of assault in the majority of batterers. However, a small portion of the men are unaffected by or unresponsive to the intervention.

Adult↗
PubMed1996

Youth access to tobacco: the effects of age, gender, vending machine locks, and "it's the law" programs.

OBJECTIVES: This study evaluated the influence of age, gender, vending machine lockout devices, and tobacco industry-sponsored voluntary compliance programs ("It's the Law" programs) on underage youths' ability to purchase tobacco. METHODS: Twelve youths made 480 attempts to purchase tobacco in Massachusetts from over-the-counter retailers and vending machines with and without remote control lockout devices. Half the vendors were participating in It's the Law programs. RESULTS: In communities with no requirements for lockout devices, illegal sales were far more likely from vending machines than from over-the-counter sources (odds ratio [OR] = 5.9, 95% confidence interval [CI] = 3.3, 10.3). Locks on vending machines made them equivalent to over-the-counter sources in terms of illegal sales to youths. Vendors participating in It's the Law programs were as likely to make illegal sales as nonparticipants (OR = 0.87, 95% CI = 0.57, 1.35). Girls and youths 16 years of age and older were more successful at purchasing tobacco. CONCLUSIONS: The It's the Law programs are ineffective in preventing illegal sales. While locks made vending machines equivalent to over-the-counter sources in their compliance with the law, they are not a substitute for law enforcement.

Adolescent↗
PubMed2005

Scaling up HIV voluntary counseling and testing in Africa: what can evaluation studies tell us about potential prevention impacts?

Although there is a widespread belief that scaling up HIV voluntary counseling and testing (VCT) programs in Africa will have large prevention benefits through reductions in risk behaviors, these claims are difficult to establish from existing evaluations of VCT. Considerations from behavioral models and the available data suggest that as VCT coverage expands, marginal program effects are likely to decline owing to changes in the degree of client selectivity, and that potential uptake among those at highest risk is uncertain. The article also assesses two other common perceptions about VCT in Africa: that a policy of promoting couples-oriented VCT would be more successful than one emphasizing individual testing and that VCT demand and prevention impacts will be enhanced where scaling up is accompanied by the provision of antiretroviral drugs.

AIDS Serodiagnosis↗
PubMed2000

Involuntary treatment of eating disorders.

OBJECTIVE: Involuntary treatment of any psychiatric disorder has always been controversial, especially for eating disorders. Patients with an eating disorder of life-threatening severity frequently refuse hospitalization. In this study, the authors compared individual characteristics and treatment outcomes of patients admitted to an inpatient program for voluntary or involuntary treatment of their eating disorder. METHOD: This study examined 397 patients admitted to an inpatient treatment program over 7 years. Demographic measures, length of illness, weight history, and treatment response of patients admitted for voluntary treatment and those legally committed for involuntary treatment were compared. RESULTS: The two groups were similar in age, gender ratio, and marital status, but those legally committed for involuntary treatment had a longer illness duration and significantly more previous hospitalizations. At admission, the patients legally committed for involuntary treatment were lower in weight and required a significantly longer hospitalization to attain a healthy discharge weight. However, there was no statistically significant difference between involuntary and voluntary patients in rate of weight restoration (2.6 versus 2.2 lb/week, respectively). The groups did not differ in history of comorbid substance abuse or clinical depression but did differ significantly on all admission IQ measures. Eating disorder severity, as assessed by the Eating Attitudes Test-26, Eating Disorder Inventory, and MMPI-II, was similar for both patient groups. CONCLUSIONS: This study suggests that a substantial minority of patients with severe eating disorders will not seek treatment unless legally committed to an inpatient program. Despite the involuntary initiation of treatment, the short-term response of the legally committed patients was just as good as the response of the patients admitted for voluntary treatment. Further, the majority of those involuntarily treated later affirmed the necessity of their treatment and showed goodwill toward the treatment process. Only a long-term follow-up study will indicate whether these two populations differ in the enduring nature of their treatment response.

Adult↗
PubMed2001

HIV surveillance among injecting drug users.

Injecting drug users (IDUs) should be considered a 'partially hidden population' at high risk for HIV infection. In almost all locations it should be possible to locate and conduct research with IDUs, but it will probably never be possible to enumerate or draw random samples from an IDU population. Surveillance research studies with IDUs should include risk behaviors, as surveillance of HIV infection only will not be sufficiently time sensitive, and be used to develop and refine HIV prevention programming for the population. Contacts with IDUs can be developed at multiple settings, including voluntary treatment programs, law enforcement settings, and through 'street outreach.' Each type of setting has different advantages, disadvantages and ethical concerns. HIV testing as part of surveillance also raises additional important ethical concerns. The primary risk behaviors that should be included in surveillance studies are 'sharing' of drug injection equipment, the potential for rapid partner change among risk partners, and sexual risk behavior. Additional important objectives for surveillance research include: (1) the size of the local IDU population, (2) patterns of drug use, (3) availability injection equipment, (4) participation in prevention activities, and (5) access to and use of anti-retroviral treatments. HIV incidence is an ultimate objective for surveillance research, but there are no currently available cost-efficient methods for studying HIV incidence, so estimation from indirect measurements is usually required.

HIV Infections↗
PubMed1990

Review of the teaching of medical ethics in London medical schools.

The study examined the influence of the Pond Report on the teaching of medical ethics in the London medical schools. A questionnaire was given to both medical students and college officers. All medical colleges reported that ethics was included in the curriculum. However, from students' replies, it seems that attendance of optional courses is low and that not all current final year medical students have had any formal teaching in medical ethics. Stronger guidelines are necessary to ensure appropriate ethical training in London medical schools.

Curriculum↗