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PubMed1997

Prenatal HIV screening in pregnant women: a medical-legal review.

Identifying pregnant women's human immunodeficiency virus (HIV) infection status provides them with the opportunity to seek appropriate treatment and to take measures to prevent vertical and horizontal transmission. Prenatal screening program options include targeting at-risk women, testing on a voluntary basis, or mandating prenatal HIV screening. When examining these options, the number of cases identified, programmatic costs, long-term health care costs, and legal implications must all be considered. Research indicates that targeting at-risk women misses a significant percentage of seropositive women, although programmatic costs may be lower. It is difficult to ascertain the difference between voluntary and mandatory programs with respect to the number of cases identified and treated. As a result, long-term savings are difficult to calculate. Mandatory programs would have the greatest direct costs and place the greatest burden on the woman's constitutional rights. By making HIV counseling and testing a routine component of prenatal care, voluntary programs could achieve the benefits of prenatal HIV screening without violating the woman's civil liberties.

AIDS Serodiagnosis↗
PubMed1998

[The quality assurance program of mandatory social security in the realm of medical rehabilitation. Concept, status of implementation and prospects].

The quality improvement programme aims at the comparison of clinics in charge of the statutory pension insurance. The programme has been implemented successively in 1994, supported by researchers and teams of experts on specific subjects. Instruments and procedures have been developed to all programme items including a clinic comparing and information system, thus permitting routine use in practice. Performing regular clinic-comparisons analysing structural quality (equipment, staff, clinical concept, management), procedural quality (recording of rehabilitation process), and outcome quality (success of the rehabilitation estimated by physician and patient) of rehabilitation facilities shall initiate quality competition and stimulate a constant improvement of quality. significant basis, therefore, is a clinic-comparing information and reporting system. The developed instruments and procedures are available for all institutes providing rehabilitation.

Germany↗
PubMed1990

Prevalence of psychiatric disorders in a mandatory screening program for infection with human immunodeficiency virus: a pilot study.

Ninety-five randomly selected human immunodeficiency virus (HIV)-seropositive Air Force personnel were psychiatrically examined during a routine medical evaluation. Of the 95, 95% did not have acquired immunodeficiency syndrome and were largely asymptomatic; 61.1% had clinical axis I diagnoses, which included simple phobia, adjustment disorders, hypoactive sexual desire disorder, alcohol use disorder, major depression, and organic mental disorders; 30.5% had personality disorders. Significantly higher frequencies (p less than 0.05) of simple phobia and hypoactive sexual desire disorder were noted with knowledge of HIV seropositivity. Disorders that occurred more commonly than in age-matched Epidemiologic Catchment Area (ECA) participants included: simple phobia, antisocial personality disorder, alcohol abuse, and organic mental disorders. The high prevalence of major psychiatric illness in this sample supports the notion that screening for psychiatric illness, and counseling where indicated, should be integral to HIV screening programs.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Shriners' challenge. A game format for a mandatory inservice program.

Traditional methods of reviewing required material on Infection Control and Risk Management are boring, time-consuming, and costly. Traditionally, several annual presentations each year review already known material. In this article, the author describes an innovative approach--a game show format--that involves the active participation of every staff member. Each employee is required to attend only once a year, resulting in significant savings to the hospital.

Games, Experimental↗
PubMed2003

Barriers to interlock implementation.

This commentary reviews current and past vehicle interlock programs for impaired driving offenders with a focus on the challenges that courts and motor vehicle departments face in attempting to implement mandatory programs as required by current federal legislation. There are few offenders in interlock programs compared to the large number of impaired drivers arrested each year. This suggests that, to increase participation, courts will have to threaten more severe sanctions for those offenders who reject interlock programs. A combination of electronic house arrest with interlock programs is suggested as a method of maximizing interlock use.

Accidents, Traffic↗
PubMed1988

Determinants of provider selection or assignment in a mandatory case management program and their implications for utilization.

Mandatory managed-care programs for Medicaid beneficiaries typically require enrollees to select the provider who will act as gatekeeper to the medical care system. A substantial number of beneficiaries, however, do not exercise this choice and are assigned a gatekeeper. Using consumer survey data from the Missouri Managed Health Care Project, we examined characteristics and use experiences of assignees compared with selectors. We found that the assignees enjoyed better health than the selectors and were less likely to have had a regular source of care prior to the program. The utilization experience was similar for both groups. We conclude that the basis for not making a choice is one of indifference.

Adult↗
PubMed1982

The current status of surgical second opinion programs.

Second opinion programs proliferated in the 1970s, and most of these were voluntary programs. Until more complete evaluations of voluntary and mandatory programs are done, it seems likely that second opinion programs will continue to be on a voluntary basis. Second opinion programs have been shown to identify potential surplus surgery and are designed to contain costs.

Attitude of Health Personnel↗
PubMed1986

Physical training programs for public safety personnel.

The nature of public safety jobs often reflects sudden strenuous exertion at a moment's notice. In the 1970s, police and fire departments became acutely aware of high numbers of on-the-job injuries and illnesses related to coronary heart disease. Disability payments for premature cardiovascular problems were being linked to cardiovascular risk factors accrued while on the job. This prompted public safety departments to initiate fitness programs for their employees. The fitness level of public safety personnel is not high. Job-related benefits have been linked to consistent physical training; high aerobic capacity, high muscular strength and endurance, above-average lean body weight, and minimal body fat are necessary for efficient job performance. In light of the physical benefits gained through regular exercise, pioneer departments began exercise programs for their personnel. These included the fire departments in Lawrence, Kansas, Alexandria, Virginia and Los Angeles, and the Dallas police department. Mealey documents psychologic improvements with exercise. Pioneer fitness programs such as that of the Los Angeles fire department have noted evidence of risk-factor reduction following institution of a mandatory program. The Alexandria department has instituted mandatory entrance requirements for their recruits, such as a no-smoking policy while on the job and mandatory exercise participation. Many community departments are not able to justify the institution of fitness programs. They may cite cost, lack of space, or lack of administrative support for the inability to initiate these programs. Legal and union ramifications may also deter the effort of program implementation. Considerations when implementing programs should involve cost of equipment, space, employee input, and determination of mandatory versus voluntary status. Preliminary medical screening and fitness evaluations should reliably evaluate an employee's physical ability to perform job-related tasks. The tests should be performed on a regular basis during employment. It is important, therefore, to convey the benefits of exercise to administrators. Frequent exercise testing should record progress of participants during exercise training and goals should be constantly updated. Pioneer programs should be used as models to follow when implementing a public safety physical training program. However, individual departments should evaluate the needs of their own personnel with respect to equipment, exercise schedule and type, and place of training.(ABSTRACT TRUNCATED AT 400 WORDS)

Accidents, Occupational↗
PubMed1996

Results of a Program to Control Phosphorus Discharges from Dairy Operations in South-Central Florida, USA

During 1987-1992, a mandatory program to control phosphorus discharges was implemented at dairy operations located to the north of Lake Okeechobee, Florida, USA. Thirty of 48 dairies participated in this program and implemented best management practices (BMPs), which included the construction of intensive animal waste management systems. Eighteen dairies closed their milk-producing operations under a government-funded buyout program. In this paper, we compare trends in runoff total phosphorus (TP) concentrations among the dairies that remained active and implemented BMPs. A central feature of the dairy waste management system is the high intensity area (HIA), defined as the milking barn and adjacent vegetation-free land, encircled by a drainage ditch and dike. Animal waste from the HIA is diverted into anaerobic lagoons and storage ponds, from which water is periodically removed and used for irrigation of field crops. The impacts of BMP construction on runoff TP concentrations were immediate and, in most cases, dramatic. Average TP concentrations declined significantly (P<0.001), from 9.0 to 1.2 mg TP liter-1 at dairies in one basin (Lower Kissimmee River), and from 2.6 to 1.0 mg TP liter-1 in another (Taylor Creek/Nubbin Slough). Some sites experienced greater declines in TP than others. To elucidate possible causes for the difference in response, a multivariate statistical model was utilized. Independent variables included soil pH, soil drainage characteristics, spodic horizon depth, and the areas of different BMP components (pasture, HIA, spray fields). The analysis significantly separated dairies with the highest and lowest runoff TP concentrations. Lowest TP occurred at dairies having particular soil characteristic (shallow spodic horizon) and certain BMP features (large HIA and small heard pastures).

Journal Article↗
PubMed1995

Client interests in premarital counseling: a further analysis.

A survey was conducted of over 150 college students concerning their attitudes toward premarital preparation. In general, the students valued brief, high-quality, low-cost, voluntary programs led by well-trained clergy or mental health professionals. However, females, students with more supportive family backgrounds, and religious students were more willing to participate in longer-than-average programs. Students with more supportive family backgrounds were also willing to pay more for such programs and to participate earlier in their relationship's development and were more willing to accept mandatory programs. Religious students were more interested in those led by clergy and less interested in those led by mental health or social workers. Female students were more interested in in-depth programs that focus on awareness and skill-building.

Adolescent↗
PubMed1990

Premarital screening for antibodies to human immunodeficiency virus type 1 in the United States. The Premarital Screening Study Group.

To evaluate premarital human immunodeficiency virus (HIV) screening as an approach to AIDS prevention in the United States, we determined the HIV antibody seroprevalence in marriage license applicants in eight areas by blinded testing of blood specimens routinely collected for syphilis serology. The seroprevalences were 0.0-0.4 percent in women and 0.0-1.1 percent in men. We also examined the impact of mandatory premarital HIV screening on marriage rates in Louisiana and Illinois. In 1988, after screening began, 9 percent and 16 percent fewer marriage licenses than in the previous two years were issued in Louisiana and Illinois, respectively. We estimated that mandatory premarital screening, if adopted nationally, would cost $167,230,000. We conclude that compared with other HIV prevention programs mandatory premarital screening would be expensive and would probably have a minor impact on the HIV epidemic.

AIDS Serodiagnosis↗
PubMed2003

Barriers to interlock implementation.

This commentary reviews current and past vehicle interlock programs for impaired driving offenders with a focus on the challenges that courts and motor vehicle departments face in attempting to implement mandatory programs as required by current federal legislation. There are few offenders in interlock programs compared to the large number of impaired drivers arrested each year. This suggests that, to increase participation, courts will have to threaten more severe sanctions for those offenders who reject interlock programs. A combination of electronic house arrest with interlock programs is suggested as a method of maximizing interlock use.

Accidents, Traffic↗
PubMed2001

[History of continuing medical education in the United States].

Continuing medical education came into being in the United States in the late twenties when the mediocrity of the initial medical training of practicing physicians was recognized. Medical schools created a classical system of continuing education; the first mandatory program was initiated in urology in 1934. By 1957, the first set of guidelines for good medical practice were published by the American Medical Association (AMA). The mandatory nature of continuing education was widespread by the end of the sixties with variable regulations from state to state. At the same time, the AMA created an honorary diploma for physicians who complete 150 h post-graduate training within 3 years. Starting in 1970, the political predominance of the AMA in continuing education was questioned by other professional associations (hospitals, medical schools). After much discussion and opposing debate, a common association for continuing education was created in 1981. The AMA remained a leader in the early nineties and now has started programs targeted to patients.

American Medical Association↗
PubMed1977

Cost effectiveness of laboratory improvement programs: the viewpoint from the private sector.

The costs of participating in laboratory improvement programs are categorized and presented from the viewpoint of the laboratory. These include: prevention costs, appraisal costs, and compliance costs. Costs of participating in voluntary vs. mandatory programs are compared. Reduction of costs could be achieved by reducing duplication and overlapping of programs. In conclusion, it is difficult to identify the exact costs in any program, but it is estimated that for the individual laboratory it may represent 10-15% of the operating costs.

Cost-Benefit Analysis↗