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PubMedDate not supplied

Individual counseling of patients with sexually transmitted diseases. A way to improve partner notification in a Zambian setting?

BACKGROUND: Sexually transmitted diseases (STD) are a major health problem in Zambia. Partner notification, which is a recommended strategy to decrease STD, must be improved. GOAL: To assess whether individual counseling of patients with STD, combined with contact slip(s), had any impact on the proportion of sex partners traced in an urban setting in Zambia. STUDY DESIGN: A randomized trial comprised of 94 women and 302 men with STD. RESULTS: Women and men in the intervention group informed more partners than did those in the control group. In the intervention group, 1.8 partners per man was treated compared to 1.2 in the control group (P < 0.001). There was no difference between the two groups of women. There was a gradual decline from numbers of partners informed to numbers of partners treated according to the patient to number of contact slips filed. CONCLUSIONS: Individual counseling of men with STD improved partner notification.

Adolescent↗
PubMed1997

[Adverse drug reactions and a program of voluntary notification: an opinion survey of primary care physicians].

OBJECTIVES: To discover the view of primary care doctors on aspects of the safety of medicines, their knowledge of the programme of automatic notification of negative side-effects of medicines (NSEM), their opinion of the programme and factors affecting low notification. DESIGN: A survey of views. SETTING: Madrid's Health Area 1. PARTICIPANTS: General practitioners and paediatricians (n = 417). MEASUREMENTS AND RESULTS: 281 doctors (67.4%) replied. 88.4% (48 + 40.4%) said they included questions on possible side-effects in the case history interview (always or almost always). 58.2% suspected at least one negative side-effect each month. CONCLUSIONS: Doctors are very interested in detecting and identifying the NSEM of their patients, and therefore believe that a centralised system to record NSEM should be set up.

Adult↗
PubMed2006

Invasive meningococcal disease in Austria 2002: assessment of completeness of notification by comparison of two independent data sources.

AIM OF THE STUDY: The notified incidence of meningococcal disease in European countries varies from <1 case per 100,000 inhabitants to approximately 7 cases per 100,000. Assessing the true burden of disease is important for setting priorities in health services and for estimating the benefit of interventions such as vaccination. Completeness and timeliness of reporting is also essential for the early recognition of outbreaks. The objective of this study was to assess the completeness of surveillance data on invasive meningococcal disease in Austria at the National Reference Center for Meningococci for the year 2002. METHODS: The data stored at the reference center was compared with an independent database containing the main diagnosis documented in the obligatory hospital discharge dataset of all Austrian hospitals (coded in ICD-10 since 2001). All mismatches were reviewed in order to exclude possible errors and identify true cases of meningococcal disease that had not been reported to the reference center. The number of cases not recorded by either data source was estimated using the capture-recapture method. RESULTS: The first comparison of the two data sources identified 50 cases not registered at the national reference center. Screening of the ICD codes from these 50 patients through the hospitals reduced the number of under-reported cases to 10, of which 6 showed symptoms compatible with meningococcal disease, although microbiological confirmation was missing. Re-evaluation of the case histories of these 6 patients by a clinical expert for meningococcal disease identified them as probable cases. The main reason for correction of the diagnosis in 27 cases was an obvious coding error: these patients had been treated in hospitals for illnesses not related to meningococcal disease. In 72 cases, the two databases were in agreement. Eleven cases of meningococcal disease were notified solely to the national reference center. Addition of the newly recognized cases of invasive meningococcal disease increased the total number of cases from 83 (incidence, 1.03/100,000) to 93 (incidence, 1.16/100,000). Estimation of the "true" number of cases of meningococcal disease, using the capture-recapture method, gave a final total of 95 cases (95% CI, 93-98) and an incidence of 1.18/100,000. The completeness (sensitivity) of the original notification at the national reference center was therefore 87.4% (83 of 95 cases). CONCLUSION: All probable cases of meningococcal disease, even those (still) lacking microbiological confirmation, should be reported to the public health authorities as soon as possible, in order to ensure the necessary prompt prophylactic action (e.g., chemoprophylaxis).

Austria↗
PubMed2004

Notification of positive HIV test results in Haiti: can we better intervene at this critical crossroads in the life of HIV-infected patients in a resource-poor country?

The current study was conducted in Port au Prince, Haiti, to determine if information collected at HIV notification during voluntary counseling and testing (VCT) can predict patients' future adherence with risk reduction counseling and medical referral. Case histories describe HIV-infected patients with signs of depression during counseling who do not return for medical care, and women afraid of economic ruin and domestic violence who do not notify their sexual partners. Quantitative predictors of seeking medical care include: denial at the announcement of HIV test results (odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-0.6), belief that HIV can be transmitted by magic (OR 0.6, 95% CI 0.3-0.9), and having symptoms at the time of HIV testing (OR 1.9, 95% CI 1.6-2.3). Predictors of refusal to notify sexual partner of HIV status include: being poor (OR 1.8, 95% CI 1.1-2.5), female (OR 2.1, 95% CI 1.7-2.5), and belief that HIV can be transmitted by magic (OR 2.3, 95% CI 1.9-2.6) In conclusion, information collected during HIV counseling and testing can predict patients' future adherence with counseling and medical referral. Counselors can use information such as signs of severe depression, economic hardship, and denial of HIV disease to identify patients at risk for nonadherence and to provide them with specialized counseling and care.

Adult↗
PubMed2003

Support among persons infected with HIV for routine health department contact for HIV partner notification.

Public health partner notification (PN) services are provided inconsistently to persons diagnosed with HIV/AIDS in the United States, and some community groups representing persons with HIV/AIDS have opposed widespread application of PN. We surveyed persons with HIV recently reported to our health department and a random sample of HIV-infected persons attending an HIV/AIDS clinic. A total of 95 persons, of whom 76 (80%) were men who have sex with men, completed an anonymous self-administered questionnaire. Eighty-four percent of participants believed the health department should routinely offer everyone diagnosed with HIV help in notifying their partners; 79% indicated they would be somewhat or very likely to provide information to a doctor, case worker, or health department employee for purposes of PN; and 20% indicated they wanted help in notifying a recent sex partner. Seventy-eight percent of participants believed the health department should contact all HIV-infected persons after diagnosis to help them access medical care and social services, and 68% wanted the health department to contact them about the availability of medical or social services. In contrast to common public perceptions, these results suggest that most persons with HIV support health departments routinely contacting people after HIV diagnosis and that many want assistance with PN.

Adult↗
PubMed1998

Notification of infectious diseases by junior doctors in accident and emergency departments.

OBJECTIVE: To assess the knowledge about notifiable infectious diseases by accident and emergency (A&E) senior house officers. METHODS: A telephone questionnaire of senior house officers was carried out over a one week period at the end of their six month attachment in A&E departments in Northern Ireland. RESULTS: 81 (91%) of the senior house officers participated in the study; 23 (29%) realised that the doctor diagnosing the notifiable disease had a statutory duty to notify that disease; nine (11%) were aware there were three statutory lists in the United Kingdom. Knowledge about which infectious diseases require notification varied from 79/81 (98%) for meningococcal disease to 15/91 (19%) for methicillin resistant S aureus. Seventy nine (98%) of the doctors thought that a poster displayed in the A&E department would be helpful. There was no significant difference between duration of qualification and performance on the questionnaire (p = 0.2). CONCLUSIONS: Despite varying experience, junior doctors in A&E do not know which infectious diseases are notifiable by statute. They felt that it would be helpful to have a poster in the A&E department listing the notifiable diseases of that region. To encourage accurate reporting, interregional variation between the statutory lists should be abolished and replaced by one nationally agreed list.

Communicable Diseases↗
PubMed2005

Discordance between trends in chlamydia notifications and hospital admission rates for chlamydia related diseases in New South Wales, Australia.

BACKGROUND: In Australia, notification rates for chlamydia have increased fourfold since the early 1990s. An increasing incidence of genital Chlamydia trachomatis infection would be expected to lead to a rise in the incidence of chlamydia related diseases. OBJECTIVES: To determine trends in hospital admission rates for pelvic inflammatory disease (PID), ectopic pregnancy, and epididymo-orchitis in New South Wales. METHODS: Age specific admission rates from 1992 to 2001 were ascertained using inpatient data from all hospitals within the state. RESULTS: Among women aged 15-34 years, hospital admission rates for PID fell from 165 per 100,000 population in 1992 to 64 per 100,000 population in 2001 (p for trend<0.0001). 15% of PID cases in women aged 15-24 years were chronic, compared with 32% in those aged 25-34 years, and 46% in the 35-44 year age group. The incidence of ectopic pregnancy and admission rates for epididymo-orchitis remained constant. CONCLUSIONS: On a population level, trends in the incidence of chlamydia related diseases do not necessarily parallel those of reported chlamydia rates and ecological associations between the two need to be interpreted with caution.

Acute Disease↗
PubMed1998

[Neurocysticercosis: contribution of autopsies in the consolidation of mandatory notification in Ribeiräo Preto-SP,Brazil].

Neurocysticercosis is a serious public health problem in several countries of Asia, Africa and Latin America. The objective of the present study is to present autopsy findings of neurocysticercosis in the Pathology Division of the University Hospital, Medical School of Ribeirão Preto, University of São Paulo, from 1992 to 1997. Neurocysticercosis was detected in 38 (1.5%) of 2522 autopsies. In twenty two (57.9%) of these, the diagnosis was made post-mortem, while 16 (42.1%) had a previous diagnosis of cysticercosis based on laboratory and imaging studies. Reviewing the medical records, we found that 21 patients (55.2%) were neurologically asymptomatic, while the various clinical manifestations in the others were in accordance with the literature. The high frequency of asymptomatic individuals detected only post-mortem indicates the importance of autopsies as an additional source of data to consolidate the compulsory notification of cysticercosis. Considering the results of this study, the new coefficient of prevalence of cysticercosis in Ribeirão Preto is 67 cases/100,000 inhabitants.

Aged↗
PubMed1997

Tuberculosis notifications in Australia, 1995.

This is the fifth annual report of the National Mycobacterial Surveillance System (NMSS), for new and relapsed cases of tuberculosis notified to State and Territory health authorities in 1995. Cases of atypical mycobacterial infection notified to the scheme are also briefly summarised. The notification rate for new cases of tuberculosis was 5.47 per 100,000 population, and for relapsed cases 0.28 per 100,000. These rates have remained stable for a number of years in Australia, and are low compared with rates in other countries. Some identifiable groups in the Australian community continue to experience higher rates of tuberculosis, including members of indigenous communities and some groups born overseas. Surveillance through the NMSS has a major role to play in the control of tuberculosis.

Adolescent↗
PubMed2005

Health effects in Army Gulf War veterans possibly exposed to chemical munitions destruction at Khamisiyah, Iraq: Part II. Morbidity associated with notification of potential exposure.

The purpose of this study was to examine the association of notification of potential exposure to chemical warfare agents in the 1991 Gulf War with subsequent self-reported morbidity. The study sample included 1,056 deployed Army Gulf War veterans who responded to the 1995 National Health Survey of Gulf War Era Veterans and who were resurveyed in 2000. One-half of the subjects had been notified of potential exposure to chemical warfare agents and one-half had not. Comparing notified and non-notified subjects, there were no statistically significant differences with respect to bed days, activity limitations, clinic visits, or hospital visits. Among 71 self-reported medical conditions and symptoms, there were 5 statistically significant differences, 4 of which were for lower rates of illness among notified subjects. Our findings contradict the prevailing notion that perceived exposure to chemical warfare agents should be considered an important cause of morbidity among Gulf War veterans.

Adult↗
PubMed1999

Lessons from patient notification exercises following the identification of hepatitis B e antigen positive surgeons in an English health region.

The results of hepatitis B virus (HBV) serology from notification exercises conducted in cohorts of patients exposed to three surgeons positive for hepatitis B e antigen (HBeAg) identified in one English health region in 1994 and 1995 were reviewed. Of 777 patients notified, serology results at six months or more after exposure were available for 514 individuals who had not received post exposure prophylaxis. In one case DNA analysis confirmed transmission of HBV from surgeon to patient. Pre-existing natural immunity to HBV was found in a further 19 patients, none of whom had evidence of recent infection, and in 13 patients (classified as cases of undetermined origin) transmission during surgery could not be excluded. The overall estimated transmission rate was 0.2% for confirmed cases (95% confidence interval (CI) 0.004-1.1) and 2.7% (95% CI 1.5-4.5) if cases of undetermined origin were included. The management of recall exercises should consider the risks of the operative procedures performed and the time that has elapsed since exposure.

Adolescent↗
PubMed2002

PCR and the notification of meningococcal disease.

The polymerase chain reaction (PCR) can be used to investigate suspected meningococcal infection, with rapid results. We became aware that Birmingham Health Authority was not being informed about certain patients on whom meningococcal PCR had been performed. To establish whether notification was overlooked in some patients with suspected meningococcal disease, or whether PCR was performed on patients in whom it was thought meningococcal disease was unlikely, we compared numbers of patients notified to us over six months who had PCR with numbers of patients not notified who had PCR. Between 1st August 1999 and 31st January 2000, 54 PCR requests were made on seventy-seven notified patients; 51 PCR requests were made on non-notified patients and none were positive. Median age and length of stay were shorter in the non-notified patients. We conclude: (i) PCR may be being used inappropriately on younger patients who have shorter admissions and are unlikely to have meningococcal disease; (ii) in a number of patients initially admitted and notified with meningococcal disease the diagnosis is subsequently reconsidered. A 'denotification' procedure for such patients could make information on meningococcal disease more reliable.

Adolescent↗
PubMed2005

Increased risk of tuberculosis among health care workers in Samara Oblast, Russia: analysis of notification data.

SETTING: Samara Oblast, Russia. OBJECTIVE: To compare the rates of tuberculosis (TB) in health care workers (HCWs) working in TB services, general health services (GHS) and the general population in a region of the Russian Federation. DESIGN: Analysis of notification rates of TB among HCWs, GHS workers and the general population during the 9-year period from 1994 to 2002. RESULTS: During 1994-2002, TB incidence among staff employed at the TB services in Samara Oblast was ten times higher than among the general population, reaching 741.6/100 000 person years at risk. Staff working at in-patient TB facilities were found to be at highest risk, with an incidence rate ratio of 17.7 (95% CI 11.6-27.0) compared to HCWs at the GHS. CONCLUSIONS: HCWs at TB services in the Russian Federation are at substantially increased risk for TB, suggesting significant risks from nosocomial transmission. Control of institutional spread of TB in the Russian Federation is an area that requires urgent attention, especially given the epidemic of human immunodeficiency virus that Russia is currently witnessing.

Adult↗
PubMed1996

Attitudes to prenatal testing and notification for HIV infection in Nairobi, Kenya.

Four hundred antenatal clinic attendants were surveyed for their attitude to testing and notification for HIV infection test results. The participants were systematically sampled from the antenatal clinic at the Kenyatta National Hospital, Nairobi, and interviewed using a closed-ended structured questionnaire. All the attendants had heard of HIV, and only 5(1.3%) did not know how Acquired Immunodeficiency Syndrome (AIDS) presents. Fifty one percent of them had no objection to their blood being tested for HIV. In fact, 52.5% thought, wrongly, that blood was routinely tested for HIV at the hospital's antenatal clinic. More than one third (35.8%) of respondents wished their permission to be obtained before the testing and 95% wished to be informed of the test result. Acceptability of testing was 33.8%, for Named Voluntary Testing, 62.0% for Universal Testing and 1.0% for Anonymous Testing. All the women said they would want to use a method of contraception, principally tubal ligation, if found HIV seropositive and 63.7% would seek a termination of pregnancy. In this study population, acceptability and expressed willingness to know HIV test results and willingness to let a spouse/sexual partner know the result was high. This paper makes recommendations that HIV testing be made available at the ANC, together with competent pre and post-test counselling.

Adolescent↗
PubMed1997

Epilepsy and driving in South Australia--an assessment of compulsory notification.

We examined the licensing of drivers with conditions likely to endanger the public in a State in which doctors are obliged to notify the licensing authority. During 1991, 1460 medically endorsed licenses were cancelled. A sample of 245, including all 49 with epilepsy were mostly voluntary, the twenty exceptions with retained files being drivers with epilepsy. In the same period, 115 traffic accidents were attributed to illness, with the only four (4) investigated by the licensing authority being those with licenses endorsed "epilepsy" where a seizure was responsible. Compulsory notification appeared to result in the identification of epilepsy as the important medical reason for controlling licenses, but failed to recognise sleep disorders or alcoholism, both more significant causes of traffic accidents. In those accidents attributed to illness, almost no action was taken to review the medical fitness of drivers, suggesting a reliance on doctors rather than police or road safety authorities.

Accidents, Traffic↗
PubMed1997

[A handling program for resistant pneumococci. Physicians sometimes neglect mandatory notification].

Streptococcus pneumoniae infections belong to the leading worldwide causes of illness and death among young children, people with underlying debilitating medical conditions, and the elderly. Following early documentation of infections due to pneumococcal strains with reduced penicillin susceptibility in Australia in 1967, and of infections due to penicillin-resistant strains in South Africa in 1978, pneumococcal resistance to penicillin and other antibiotics has progressed rapidly and is now a global problem. In Sweden, notification of the occurrence of pneumococci with a minimum inhibitory concentration (MIC) > or = 0.5 mg/L for penicillin G (PcG) has been mandatory for general practitioners (GPs) and clinical microbiological laboratories since 1 January 1996. In 1996, 1,057 cases of infection by such pneumococci were reported by microbiological laboratories, but only 262 cases by GPs. With a view to minimising the impact of pneumococci with reduced penicillin susceptibility in Sweden, the National Board of Health and Welfare set up a working group of experts in November 1994. To reduce the transmission of such bacteria in the community, the working group introduced a control programme which includes the isolation of day-care children under six years of age carrying pneumococci with PcG-MICs > or = 0.5 mg/L. An enquiry among the 25 regional centres for infectious disease control in the country to ascertain compliance in the different counties of Sweden showed the programme to have been adhered to in a majority of counties, although many had chosen alternative measures to deal with the problem.

Disease Notification↗
PubMed1998

Tuberculosis notifications in England: the relative effects of deprivation and immigration.

SETTING: Metropolitan areas of England, including London boroughs, in 1991. OBJECTIVE: To investigate the relative importance of deprivation, immigration and the elderly in explaining variations in tuberculosis rate. DESIGN: A retrospective study using multiple Poisson regression models to assess the interrelationship between various population parameters. RESULT: Significant differences ere observed between London and other metropolitan districts in the measures of tuberculosis, immigration and the elderly. In addition, all population parameters were significantly intercorrelated in London: areas with a high proportion of immigrants had high levels of deprivation and low proportions of elderly. In other metropolitan districts, only immigration and the Jarman index were significantly associated, and removing the immigration component from the index removed this statistical significance. Multiple Poisson regression models revealed that the immigrant index had the strongest explanatory power in explaining tuberculosis rates, but there were significant interactions between this and measures of urban deprivation indices. That is, there was a greater effect of increasing deprivation at lower levels of immigration than at higher levels. This phenomenon was more pronounced in London boroughs than other metropolitan districts. The elderly index had no significant influence on tuberculosis rates. CONCLUSION: Although the association between tuberculosis and deprivation previously reported for the city of Liverpool is confirmed across all urban areas of England, the immigrant proportion of the population has a greater statistical power in explaining variations in rates of urban tuberculosis. However, tuberculosis notifications can be most accurately predicted by combining both measures than by either one alone.

Aged↗
PubMed1986

Decreasing the incidence of surgical wound infections. Validation of a surveillance-notification program.

In an attempt to validate the observations of a previously published ten-year study of surgical wounds, we studied 8,474 wounds over an 18-month period using a protocol nearly identical to that of the previous study. Our study corroborated the following predictors of clean-wound infection: increasing duration of surgery, age less than 1 or greater than 50 years, increasing duration of preoperative hospitalization, use of drains, and shaving and emergency surgery. We failed to corroborate use of wound irrigation as a protective measure or time of preoperative shaving as a significant variable. Most importantly, we found a 42% reduction in the clean-wound infection rate during the study period (1.9% to 1.1%), adding support to the concept that a wound surveillance program with surgeon notification is both efficacious and cost-effective.

Adolescent↗