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PubMed2005

What are the odds? Random drug testing of students: a practice perspective.

Companion articles explore random drug testing programs in schools. The first article addresses random drug testing of students from a legal perspective. It describes legal issues and current case law regarding drug testing programs in schools and commonly asked questions regarding these programs. The second article addresses random drug testing of students from a practice perspective. It explores arguments for and against random drug testing programs and the role of the school nurse in policy and procedure development.

Adolescent↗
PubMed1999

[Meningitis in subjects with human immunodeficiency virus infection].

BACKGROUND: Neurological complications are frequently observed in HIV-1 patients. Lumbar puncture (LP) and LSF analysis are two key diagnostic procedures. AIM: To describe the etiology meningeal syndromes in a hospital series of HIV patients. RESULTS: In this study, we present the different meningeal complications from 198 HIV-1 patients referred, for the last five years, to the HIV Center of the Hospital of University of Chile. The diagnosis of HIV-1 was done clinically plus a positive ELISA test, and confirmed by Western blot and/or PCR. In all cases with a possible neurological complication (52/198), a LP was performed. Cytochemical and microbiological studies, were done in each CSF sample. Serum CD4/CD8 lymphocytes number were determined by flow cytometry, and brain CT scan and/or MRI were obtained. From the 52 patients in whom a LP was done, 24 showed an abnormal CSF, compatible with the diagnosis of meningitis. The most frequent etiology (11/24) was infection by Cryptococcus neoformans, followed by Treponema pallidum (7/24). There were 3 cases of HIV-1 meningitis, and 3 other cases with lymphoma, varicella zoster and cytomegalovirus meningitis. The frequency of cryptococcal infection was similar to that reported in the literature, but two interesting observations were the high frequency of neurosyphilis and the absence of TBC meningitis. In our country, the VDRL/FTA-ABS serum tests are mandatory in HIV patients. If these tests were positive a LP was performed, and this could partially explain the high number of cases coinfected with neurosyphilis. There is an important prevalence of lung TBC in our country, and as a consequence there is a policy of immunization to all newborn. It is possible that the high prevalence of TBC "promotes" a more actively search for TBC infection, with an early diagnosis and treatment of pulmonary TBC, and so a more frequent prophylaxis therapy in HIV patients, without the development of TBC meningitis.

Adult↗
PubMedDate not supplied

Seroprevalence of HIV, HTLV-I/II and other perinatally-transmitted pathogens in Salvador, Bahia.

Generation of epidemiological data on perinatally-transmitted infections is a fundamental tool for the formulation of health policies. In Brazil, this information is scarce, particularly in Northeast, the poorest region of the country. In order to gain some insights of the problem we studied the seroprevalence of some perinatally-transmitted infections in 1,024 low income pregnant women in Salvador, Bahia. The prevalences were as follow: HIV-1 (0.10%), HTLV-I/II (0.88%), T.cruzi (2.34%). T.pallidum (3.91%), rubella virus (77.44%). T.gondii IgM (2.87%) and IgG (69.34%), HBs Ag (0.6%) and anti-HBs (7.62%). Rubella virus and T.gondii IgG antibodies were present in more than two thirds of pregnant women but antibodies against other pathogens were present at much lower rates. We found that the prevalence of HTLV-I/II was nine times higher than that found for HIV-1. In some cases such as T.cruzi and hepatitis B infection there was a decrease in the prevalence over the years. On the other hand, there was an increase in the seroprevalence of T.gondii infection. Our data strongly recommend mandatory screening tests for HTLV-I/II, T.gondii (IgM), T.pallidum and rubella virus in prenatal routine for pregnant women in Salvador. Screening test for T.cruzi, hepatitis and HIV-1 is recommended whenever risk factors associated with these infections are suspected. However in areas with high prevalence for these infections, the mandatory screening test in prenatal care should be considered.

Adult↗
PubMed1987

Substance-abuse policies and guidelines in amateur and professional athletics.

Substance-abuse policies and guidelines in amateur and professional athletic organizations are described. Amateur athletic organizations, which are governed by the U.S. Olympic Committee or the National Collegiate Athletic Association (NCAA), have developed programs that include mandatory drug testing. Drugs banned by the two organizations include psychomotor stimulants, sympathomimetic amines, narcotic analgesics, anabolic steroids, miscellaneous central nervous system stimulants, and, in the case of the NCAA, certain street drugs. Professional organizations have been somewhat slower to follow and, with the exception of tennis, do not allow mandatory drug testing. Each formal drug-screening program includes penalties for violators. The enforcement practices of the organizations representing tennis, baseball, basketball, and football are described. One aspect unique to professional sports is the employee-assistance program, which allows the impaired athlete to receive treatment while continuing to play and receive a salary. As drug-control programs become more common in athletics, opportunities may arise for pharmacists to participate in the areas of drug information and educational services.

Doping in Sports↗
PubMed1992

Prevalence of tuberculin positivity and skin test anergy in HIV-1-seropositive and -seronegative intravenous drug users.

OBJECTIVES: --To identify differences in purified protein derivative (PPD) tuberculin positivity and skin test anergy rates by human immunodeficiency virus (HIV) serostatus, CD4+ lymphocyte count, and other risk factors in intravenous drug users (IVDUs); and to evaluate the appropriateness of the Centers for Disease Control (CDC)--recommended definition for a positive PPD tuberculin skin test result in HIV-1-seropositive patients. DESIGN: --Nested case-control and cross-sectional analyses. SETTING: --Community-based cohort of IVDUs. PATIENTS: --Two hundred sixty HIV-1-seropositive and -seronegative IVDUs, drawn from an unselected cohort, were skin-tested for sensitivity to PPD tuberculin, mumps, and Candida antigens using the Mantoux method. OUTCOME MEASURES: --Positivity to PPD tuberculin, skin test anergy. RESULTS: --Even using the CDC definition of an induration 5 mm or greater in diameter in HIV-1 seropositives, this group was substantially less likely to be PPD tuberculin positive than HIV-1 seronegatives (13.8% vs 25.2%; P = .02). In the HIV-1 seropositives the relative odds of being PPD positive varied depending on whether 10 mm or greater (odds ratio [OR], 0.3; 95% confidence interval [CI], 0.2 to 0.7), 5 mm or greater (OR, 0.5; 95% CI, 0.2 to 0.9), or 2 mm or greater (OR, 0.7; 95% CI, 0.4 to 1.3) was used to define a positive test result. The mean diameter induration in the HIV-1-seropositive group was 2.6 mm vs 5.4 mm in the seronegative group (P = .005). Skin test anergy (to mumps and Candida) appeared to explain the differential. Anergy was substantially higher in the HIV-1 seropositive group and increased as the CD4+ lymphocyte count fell (chi 2 for linear trend, 24.5; P less than .0001). An inverse linear trend for PPD positivity and CD4+ lymphocyte count was also observed (chi 2 for trend, 6.1; P = .01). In multivariate analyses, being 35 years of age or older and being HIV-1 seronegative were significantly associated with PPD positivity, while history of previous police arrest was of borderline significance. Only HIV-1 seropositivity was significantly associated with anergy. CONCLUSIONS: --These findings show that CDC-recommended definition of an induration 5 mm or greater in diameter for PPD tuberculin positivity in HIV-1 seropositives significantly underestimates the "true" infection rate (using the PPD positivity rate in HIV-1 seronegatives as the criterion standard). A definition of 2 mm or greater would appear to be a better cutoff for reducing misclassification in HIV-1 seropositives. This study also confirms that delayed-type hypersensitivity is seriously depressed in HIV-1 seropositive IVDUs and that anergy testing is mandatory to properly assess a negative PPD test result.

Adolescent↗
PubMed1997

A knowledge, attitudes, beliefs and practices (KABP) survey on HIV infection and AIDS among doctors and dental surgeons in Singapore.

An anonymous postal questionnaire survey studying the knowledge, attitudes, beliefs and practices on human immunodeficiency virus (HIV) infection was conducted among all registered medical and dental practitioners in Singapore in 1996. In all, 1523 replies were received, yielding a response rate of 29.3%. The level of knowledge regarding transmission and prevention was generally good, although there were a number who believed that HIV could be transmitted by the respiratory and oral routes. However, knowledge regarding diagnosis and medical management was unsatisfactory. Although a large majority felt they had the ethical obligation to treat HIV patients, only half of them indicated their willingness to do so if they were given the choice. The majority (62.3%) supported the idea of routine preoperative HIV testing for patients, but fewer (40%) supported mandatory HIV testing for health care workers. Dentists seemed more sensitive to issues involving transmission in the workplace, and 95% of them practised universal precautions. Continuing medical education on HIV infection is required to improve and maintain the level of knowledge and competency of doctors and dentists in Singapore.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[AIDS and life insurance in Germany. 10 years successful risk management].

The introduction of AIDS specific measures by the German life assurance industry in 1988 was an important step towards prevention of adverse selection by the well known risk groups. In retrospect one can state that in the eighties there was a tendency of risk groups for inappropriately high insurance coverage. This could be curtailed with the introduction of a question as to a positive HIV test in each proposal form and a mandatory HIV test for every policy exceeding DM 250,000. These tendencies could very nicely be demonstrated by studies of own AIDS cases. The claims for death and disability benefits because of AIDS are as of now compared to the total claims of minor importance.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Potential human and economic cost-savings attributable to vision testing policies for driver license renewal, 1989-1991.

PURPOSE: This study assessed the impact of vision-related relicensing policies on traffic fatalities in the United States. There is a limited empirical basis for state vision testing policies for relicensing. Furthermore, it is uncertain whether contemporary vision standards for driver licensing achieve their implicit goal of protecting the public's health, or inappropriately restrict the mobility of competent drivers. METHODS: The 48 contiguous states and the District of Columbia were the "subjects" in this investigation. During the study period (1989 to 1991), 10 states did not require vision testing for driver license renewal. Multiple regression modeling was used to assess the impact of vision-related relicensing policies on traffic safety and to estimate the number of avoidable vehicle occupant fatalities and corresponding economic costs associated with traffic crashes involving older drivers (> or = 60 years). The primary data source for this investigation was the Fatal Accident Reporting System (FARS) database. RESULTS: Vision-related relicensing policies were significantly associated (p < 0.05) with lower vehicle occupant fatality rates of older drivers. According to the final regression model, approximately 222 fewer vehicle occupant fatalities (-12.2%) associated with older drivers would be expected for the 3-year period if mandatory vision testing policies had been in effect in 8 of the 10 states without such policies. Conservatively, those avoidable deaths represent an estimated $31 million in avoidable economic costs. CONCLUSIONS: State-level mandatory vision testing for relicensure may enhance traffic safety and reduce the economic burden of fatal crashes. Vision testing requirements should be maintained by jurisdictions with such requirements, and jurisdictions without such requirements should consider the potential traffic safety benefits of vision testing for driver license renewal.

Accidents, Traffic↗
PubMed1992

[HIV infection: survey among practicing physicians in Bern].

With increasing numbers of HIV-infected patients, practitioners will play a crucial role in the prevention of HIV infection and in the care of infected persons. To assess the need for accurate education programs we investigated by questionnaire the current practice, attitudes and knowledge of 1057 practitioners (general, internists, surgeons, dermatologists, gynecologists), on care, prevention and treatment of HIV infection and HIV-related problems in the Canton of Berne (population 1 million), Switzerland. 65% of the practitioners provided completely evaluable responses. More than 90% had already prescribed HIV tests by the end of 1989. A majority rejected routinely performed tests (e.g. for all pregnant women, for all patients before surgery). Only about 50% considered a patient's informed consent mandatory before each test. Primary prevention by sexual history-taking was only rarely done in current practice. All recommendations from the Swiss "Stop Aids" campaign were supported, and even experimental measures such as allowing i.v. drug use in street corner agencies or controlled distribution of heroin were supported by the majority. Mandatory testing of risk groups was favored by about 50% but almost nobody wanted to establish name records of persons with risk behaviour. By the end of 1989 about one third of practitioners regularly cared for HIV-infected persons. Most practitioners would prefer to care independently for asymptomatic HIV-infected persons, but would favor a specialist support when caring for symptomatic patients. Lack of medical skills and knowledge was the main reason for their reluctance in caring for patients. Skilled and experienced practitioners were more prone to care for additional patients and were more active in prevention. Knowledge about HIV transmission, HIV-related complications and treatment was good among general practitioners and internists. However, there was some confusion about the indications for active vaccination in Aids patients. The readiness of Bern practitioners to care for HIV-infected persons is already large and could be increased by improving their medical knowledge. However, it is unlikely that more medical information alone will improve their prevention activities. It appears that education programs aimed at improving the prevention activities of practitioners are best designed and performed by their skilled and experienced colleagues.

AIDS Serodiagnosis↗
PubMed2005

HIV care in the U.S. Navy: a multidisciplinary approach.

We provide a review of the medical care provided to human immunodeficiency virus (HIV)-positive service members in the U.S. Navy and Marine Corps. An overview of the history of HIV and its impact on the U.S. Navy is presented. We also explain the policies of mandatory HIV testing within the U.S. Navy and the evaluation process for those found to have HIV infection. We specifically describe the multidisciplinary HIV medical care provided at Naval Medical Center San Diego, which is one of three HIV specialty clinics within the U.S. Navy.

California↗
PubMed1998

Low risk for tuberculosis in a regional pediatric hospital: nine-year study of community rates and the mandatory employee tuberculin skin-test program.

OBJECTIVE: To assess the risk of Mycobacterium tuberculosis infection and disease among patients and workers in a regional pediatric hospital. DESIGN: Descriptive epidemiological study of the mandatory tuberculin skin testing program of hospital employees at hire and during annual reevaluation, pediatric patients with tuberculosis (TB), efficacy of hospital infection control measures, and community rates of TB. SETTING: 361-bed, university, pediatric hospital serving Cincinnati (1.7 million population). RESULTS: During 1986 through 1994, 2,275 to 4,356 employees were compliant with Mantoux skin testing and screening each year. This represented >97% of the population who were eligible for screening. The cumulative rate of M tuberculosis infection from a previous positive tuberculin skin test was 10% to 12% per year during 1986 through 1994. Among new Mantoux skin-test converters in employees at annual reevaluation, the risk of TB infection was 0.3% in 1993 and 1994. There were no active cases of TB identified during new employee screening or annual reevaluation. Of 62 new Mantoux skin-test converters in 9 years, 23% were foreign-born, 13% were Asian, 23% were African American, 11% received the bacillus of Calmette-Guérin vaccine, and 60% had direct patient care or indirect patient contact. A cluster of five converters occurred in a department with no patient care or contact. Mantoux conversion rates were 1.9 per 1,000 employee patient-care or contact-years and 2.2 per 1,000 employee non-patient-contact years. Twenty pediatric patients with active TB were identified during 1991 to 1994, with < or =6 cases per year, placing this hospital in the low-risk category for M tuberculosis disease. Three children with pulmonary TB were admitted without immediate respiratory isolation, possibly exposing 9 patients and 42 employees; none converted their Mantoux skin tests on retesting. Rates of active TB in Cincinnati were stable during the period (eg, 8/100,000 population in 1994). CONCLUSIONS: Despite intense active surveillance among thousands of hospital employees with >97% annual compliance, tuberculin conversion rates were low, and no cases of active TB were identified during 9 years of follow-up. There was no evidence of transmission of M tuberculosis from infected patients to employees during uncontrolled exposures. Rates of TB in the community were low. These data suggest that rigorous application of the Centers for Disease Control and Prevention guidelines and Occupation Safety and Health Administration regulations for preventing nosocomial TB in pediatric hospitals may be excessive and costly. Special provisions should be made for pediatric hospitals with a proven low risk of transmission of M tuberculosis.

Adult↗