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PubMed2003

Drug testing athletes to prevent substance abuse: background and pilot study results of the SATURN (Student Athlete Testing Using Random Notification) study.

PURPOSE: To assess the deterrent effect of mandatory, random drug testing among high school (HS) athletes in a controlled setting. METHODS: Two high schools, one with mandatory drug testing (DT) consent before sports participation, and a control school (C), without DT, were assessed during the 1999-2000 school year. Athletes (A) and nonathletes (NA) in each school completed confidential (A) or anonymous (NA) questionnaires developed for this study, respectively, at the beginning and end of the school year. Positive alcohol or drug tests required parent notification and mandatory counseling without team or school suspension. Thirty percent of the DT athletes were tested. Data were analyzed using the end of the school year measure, adjusted for the initial questionnaire results. Demographics of the athlete sample revealed that mean age was 15.5 years with 81.5% white, 9.6% Hispanic, 4.5% Asian, 2.6% American Indian/Native Alaskan, 1.3% African-American, and 1.3% Native Hawaiian/Pacific Islander. RESULTS: A (n = 276) and NA (n = 507) were assessed at the beginning (baseline) and at the end of the school year (A, n = 159; NA, n = 338). The past 30-day index of illicit drugs (4-fold difference) and athletic enhancing substances (3-fold difference) were lower (p < .05) among DT athletes at follow-up without difference in alcohol use. However, most drug use risk factors, including norms of use, belief in lower risk of drugs, and poorer attitudes toward the school, increased among DT athletes (p < .05). Although a reduction in the illicit drug use index was present among nonathletes at the DT school, at the end of the school year, it did not achieve statistical significance (p < .10). CONCLUSIONS: Random DT may have reduced substance use among athletes. However, worsening of risk factors and small sample size suggests caution to this drug prevention approach. A larger long-term study to confirm these findings is necessary.

Adolescent↗
PubMed2002

Impact of pager notification on report verification times.

RATIONALE AND OBJECTIVES: The purpose of this study was to assess the impact on times of verification (TOVs) by a pager notification system (PNS) that informs physicians when reports are available for signature. MATERIALS AND METHODS: An automated PNS was implemented in the authors' department in November 2000. Monthly report verification times of each physician were collected for 3 months in the years before and after initiation of the PNS. Radiologists enrolled in the PNS and those who were not were assigned into two groups for analysis. Mean TOVs for the two sets of 3 months and for the two groups were calculated and differences recorded. Two-tailed t tests were used to assess for statistical differences between the groups. RESULTS: Twenty-nine of 37 radiologists voluntarily enrolled in the PNS (group 1). Mean TOV was 26.75 hours (standard deviation [SD] = 17.76) for these physicians before and 14.48 hours (SD = 11.86) after the PNS was employed (P < .01). For those physicians who did not enroll in the PNS, mean TOV was 11.53 hours (SD = 5.55) before and 9.77 hours (SD = 9.86) after the PNS was employed (P = .33). Both the absolute and percentage reductions in TOVs were significantly greater for those physicians enrolled in the PNS than for those who were not (P = .035). Twenty-three of 29 (79%) physicians who used the PNS showed a reduction in their report turnaround times. CONCLUSION: Linking the PNS with the radiology information system to notify physicians of unsigned reports was effective in reducing report verification times.

Humans↗
PubMed1985

The estimation of age-related rates of infection from case notifications and serological data.

The paper describes a maximum-likelihood method for the estimation of age-related changes in the per capita rate of infection, from case notification records or serological data. The methods are applied to records of measles incidence in the UK and USA, for which the estimated rates of infection tend to rise to a maximum value at around 10 years of age and then to decline in the older age-classes. Longer-term and seasonal trends are analysed by reference to changes in the estimated average age at infection; a statistic derived from a knowledge of the age-specific rates of infection. Future data needs in the epidemiological study of directly transmitted viral and bacterial diseases are discussed with reference to the detection and interpretation of age-dependent rates of disease transmission.

Age Factors↗
PubMed1991

Cognitive-behavioral stress management intervention buffers distress responses and immunologic changes following notification of HIV-1 seropositivity.

Forty-seven asymptomatic, healthy gay men were randomly assigned to a cognitive-behavioral stress management (CBSM) condition or an assessment-only control group 5 weeks before being notified of their HIV-1 antibody status. Seventy-two hours before and 1 week after serostatus notification, blood samples and psychometric data were collected. Control subjects showed significant increases in depression, but only slight decrements in mitogen responsivity and lymphocyte cell counts pre- to postnotification of seropositivity. Seropositive CBSM Ss did not show significant pre-post changes in depression, but did reveal significant increases in helper-inducer (CD4) and natural killer (CD56) cell counts as well as a slight increment in proliferative responses to phytohemagglutinin (PHA). Individual difference analyses suggest that the psychological buffering and immunomodulating effects of the CBSM manipulation may be attributable, in part, to relaxation skills learned and practiced or to a general willingness to comply with the intervention guidelines.

AIDS Serodiagnosis↗
PubMed1996

Adverse drug reactions in a hospital general medical unit meriting notification to the Committee on Safety of Medicines.

1. We have retrospectively analysed data collected by a local adverse drug reactions reporting scheme in an acute hospital medical setting and have determined the numbers and types of reactions that would have merited notification as yellow card reports according to the guidelines of the Committee on Safety of Medicines. 2. The data related to 20,695 consecutive acute general medical admissions on seven general medical wards (140 beds) and were collected over 3 years, from April 1990 to March 1993. 3. Over 3 years there were 1420 reports of suspected adverse drug reactions, a rate of 68.7 per 1000 admissions. 4. If the guidelines for reporting issued by the Committee on Safety of Medicines had been strictly followed, 477 yellow cards would have been sent (23.1 per 1000 admissions). In 357 of these reports (74.8%), the reaction had caused admission to hospital. Only 31 of the 477 potential cards (6.5%) involved black triangle drugs and 10 of these were for minor reactions. 5. Only 30 of the 477 potential yellow cards (6.3%) were known to have been sent. The majority of those reactions not reported were for drug-related admissions, most of which were for well-known reactions to established drugs. 6. We have confirmed and quantified the extent of under-reporting of serious suspected adverse drug reactions to the Committee on Safety of Medicines from our hospital medical unit.

Adverse Drug Reaction Reporting Systems↗
PubMed2003

Retrospective targeted HCV lookback using centralized contracted notification service.

BACKGROUND: Mandated HCV 2.0 lookback significantly challenged the human and financial resources available to the six Los Angeles County Department of Health Services (DHS) hospital blood banks. To comply with FDA requirements, DHS developed a centralized process that utilized the services of a contract vendor for performing HCV lookback. STUDY DESIGN AND METHOD: A DHS public health nurse acted as HCV lookback coordinator and as liaison with the vendor. Cases were electronically forwarded to the vendor, who then reviewed the patient's chart to obtain information necessary for tracking the patient through commercial databases. The vendor was responsible for notifying the recipient for pretest counseling and for providing documentation of all efforts. RESULTS: In total, 411 recipients were identified, of which, 168 cases were completed by the hospitals, 243 were forwarded to the vendor, 50 percent were deceased, 21 percent were contacted, and 28 percent could not be contacted, and 1 percent could not be located on any databases. The vendor contacted 35 of 66 cases that the hospitals had unsuccessfully attempted to contact. Of the cases forwarded to the vendor, 82 percent were completed on time. Delays were attributable to the vendor in less than 2 percent of cases. The cost per case forwarded to the vendor was 322 US dollars. CONCLUSION: Utilizing a professional service to conduct HCV recipient notifications is an effective strategy for meeting FDA deadlines and for freeing transfusion service staff to perform critical functions. It remains to be seen whether such strategies offer a cost savings.

Blood Donors↗
PubMed2001

Aspects of clinical features, diagnosis, notification and tracing back referring to Trichinella outbreaks in north Rhine-Westphalia, Germany, 1998.

52 cases of human trichinellosis were notified from 11 towns in North Rhine-Westphalia from November 1998 to March 1999. After non-typical symptoms in the enteral phase, fever, muscular ache, headache, oedema, disorder of vision and rash occurred in the parenteral phase. Trichinellosis was serologically confirmed by ELISA, IFAT or western blot. Raw sausage and minced meat produced from raw pork could be determined as probable source of infection with 44 and eight notified cases, respectively. Whereas questionable raw sausage was not available for examination, frozen minced meat from the second outbreak could be secured in households of infected people. Larvae were isolated from minced meat and were identified by PCR as Trichinella spiralis. Tracing back to the source of infection was difficult because of the long time between clinical symptoms, laboratory diagnosis and notification as well as complex trade routes for pork and its products. Trichinella cases emphasize the necessity to meet the prescribed slaughter inspection and to guarantee a reliable prove of origin for meat products especially in view of specific consumer habits, i.e. the consumption of raw meat.

Animals↗
PubMed1999

Complicated bereavement and posttraumatic stress disorder following fatal car crashes: recommendations for death notification practice.

This article reviewed how four characteristics of car crash deaths--suddenness, untimeliness, preventability, and violent, mutilating injuries--may contribute to complicated bereavement syndromes or to the development of posttraumatic stress disorder (PTSD). The Fatality Analysis Reporting System was then used to assess the proportion of car crashes from 1990-1996 that involved one or more of these characteristics. At least 75% of all deaths involved suddenness, untimeliness, or were preventable, that is, due to alcohol or drug use. Twenty-eight percent of crash deaths involved 2 of these characteristics and 6% involved all 3. Recommendations for performing death notifications were provided with an emphasis on identifying and responding to circumstances that may lead to complicated bereavement or PTSD. Recommendations for further research also were provided.

Accidents, Traffic↗
PubMed1995

Experiences with the application of QSAR in the routine of the notification procedure.

On behalf of the Umweltbundesamt the Fraunhofer Gesellschaft has developed a software system (SAR-system) comprising more than 90 estimation models for endpoints relevant in environmental risk assessment. These estimation models are based on the approach of quantitative structure-activity relationships (QSAR). All models were checked for their validity and application range. In the last months the Umweltbundesamt started to test the applicability of some models concerning the endpoints fish acute toxicity, daphnia acute toxicity and ready (i.e., ultimate) biodegradability in the daily routine of the notification procedure. For testing these models the corresponding confidential data given in the dossiers of substances notified 1993 in Germany, were used. We were able to make calculations for 36% of the notified substances. For the remaining 64% of the chemicals it was impossible to accomplish SAR estimations due to several reasons, e.g., ionic structure of the compounds. Different results for the applicability of the mentioned endpoints are obtained. The predictions of the fish and Daphnia toxicity are in sufficient agreement with the experimental results, in case of the fish toxicity we receive 58% agreement, for the Daphnia toxicity 56%. The corresponding values which were obtained in the US EPA/E.C. Joint Project on the evaluation of (quantitative) structure activity relationships were 82.3% and 70.9%. About 300 different models were used for the calculations of these endpoints within the framework of the EPA/EC project. The SAR-system presented here contains 8 models for estimating the fish toxicity and 6 models for the Daphnia toxicity. For the prediction of the biodegradability the results obtained with the SAR-system are rather poor and have to be improved. Meanwhile the SAR-system is commercially available and can be ordered at the Fraunhofer Institute for Environmental Chemistry and Ecotoxicology, Schmallenberg (Germany).

Animals↗
PubMed2007

Automated documentation error detection and notification improves anesthesia billing performance.

BACKGROUND: Documentation of key times and events is required to obtain reimbursement for anesthesia services. The authors installed an information management system to improve record keeping and billing performance but found that a significant number of their records still could not be billed in a timely manner, and some records were never billed at all because they contained documentation errors. METHODS: Computer software was developed that automatically examines electronic anesthetic records and alerts clinicians to documentation errors by alphanumeric page and e-mail. The software's efficacy was determined retrospectively by comparing billing performance before and after its implementation. Staff satisfaction with the software was assessed by survey. RESULTS: After implementation of this software, the percentage of anesthetic records that could never be billed declined from 1.31% to 0.04%, and the median time to correct documentation errors decreased from 33 days to 3 days. The average time to release an anesthetic record to the billing service decreased from 3.0+/-0.1 days to 1.1+/-0.2 days. More than 90% of staff found the system to be helpful and easier to use than the previous manual process for error detection and notification. CONCLUSION: This system allowed the authors to reduce the median time to correct documentation errors and the number of anesthetic records that were never billed by at least an order of magnitude. The authors estimate that these improvements increased their department's revenue by approximately $400,000 per year.

Anesthesia↗
PubMedDate not supplied

Psychological and neuroendocrine measures related to functional immune changes in anticipation of HIV-1 serostatus notification.

Our previous work indicated that gay males ultimately found to be seronegative showed impaired lymphocyte proliferative responses to phytohemagglutinin (PHA) and pokeweed mitogen (PWM) upon entering a study in which they would be notified of their human immunodeficiency virus-Type 1 (HIV-1) antibody status. To examine the degree to which alterations in various neuroendocrine and psychological markers might be related to this phenomenon we measured plasma cortisol, beta-endorphin, denial coping strategies, intrusive thoughts related to AIDS risk, and several affective distress markers in 46 HIV-1 seronegative subjects at each of the timepoints previously studied. Results indicated that cortisol levels were elevated at study entry and decreased across the subsequent five-week period--mirroring the changes in mitogen responsivity across these timepoints. Analyses of individual differences showed that higher baseline cortisol and lower denial coping scores predicted lower PHA values at baseline. Persisting intrusive thoughts about risk of HIV-1 infectivity (after seronegativity notification) were consistently associated with higher plasma cortisol levels. Finally, beta-endorphin levels did not change significantly across the 10-week observation period, were not associated with psychological variables, and were inconsistently associated with immune functioning.

AIDS Serodiagnosis↗
PubMedDate not supplied

Voluntary human immunodeficiency virus testing, recidivism, partner notification, and sero-prevalence in a sexually transmitted disease clinic: a need for mandatory testing.

Universal, voluntary testing for antibodies to the human immunodeficiency virus (HIV) was offered to 17,092 eligible clients attending a public sexually transmitted disease clinic between March, 1988 and June, 1989. In an environment of legally mandated reporting and partner notification, 15,649 (91.6%) clients were tested, 160 of whom were HIV sero-positive. Client acceptance of testing is discussed, and the serologic data compared with results of a federally funded sero-prevalence survey conducted in-clinic. A recidivism rate of 20% was observed among sero-positive individuals. Of 159 contacts for whom HIV sero-status was determined, 66 (42%) were seropositive. It is proposed that, in the setting of sexually transmitted disease clinics, HIV testing be changed from a voluntary service to a mandatory test. Some benefits of this change are defined.

AIDS Serodiagnosis↗
PubMedDate not supplied

A comparison of the case-finding effectiveness and average costs of screening and partner notification.

BACKGROUND AND OBJECTIVES: Sexually transmitted disease control programs rely on case-finding through screening and partner notification to control syphilis. Difficulty in controlling recent syphilis epidemics have raised questions about the effectiveness of these strategies. GOALS OF THE STUDY: This study sought to evaluate the contributions of screening and field epidemiology to case-finding and compare average costs of these methods. STUDY DESIGN: The study was designed as a descriptive study of outcomes in a cohort tested for syphilis through a county health department. Cost-effectiveness analysis using average costs per outcome were used. RESULTS: Testing self-motivated individuals accounted for 85% of the case-finding. Testing was more cost-effective than Disease Intervention Specialist activity when measured as cost per new case. Testing and Disease Intervention Specialist activity were comparable in cost when measured in terms of a Weighted Disease Intervention Index. CONCLUSIONS: Sexually transmitted disease control programs must consider how to balance investments in screening and DIS field intervention. Programs also should reevaluate their approach to control of epidemic syphilis in light of the limited effectiveness of traditional control strategies.

Adolescent↗
PubMed2003

Partner notification for HIV and STD in the United States: low coverage for gonorrhea, chlamydial infection, and HIV.

BACKGROUND: Little is known about the scope of current public health partner-notification (PN) activities in the United States. GOAL: The goal of the study was to define what PN services U.S. health departments provide in areas with high STD/HIV-related morbidity. STUDY DESIGN: The study involved a survey of STD program staff members in U.S. areas with the highest reported rates of infectious syphilis, gonorrhea, chlamydia, and HIV in 1998. RESULTS: Staff members of 60 (77%) of 78 health departments provided data. PN interviews were conducted with 7583 (89%) of 8492 cases of syphilis, 23,097 (17%) of 139,287 cases of gonorrhea, and 26,487 (12%) of 228,210 cases of chlamydia. In areas with mandatory HIV reporting, 4375 (52%) of 8328 persons infected with HIV were interviewed for PN. CONCLUSIONS: Except for patients with syphilis, public health PN services affect only a minority of persons with STD or HIV infection in high-morbidity areas of the United States.

Chlamydia Infections↗
PubMedDate not supplied

Genotypic differences of MCAD deficiency in the Asian population: novel genotype and clinical symptoms preceding newborn screening notification.

PURPOSE: In contrast to its high prevalence in Caucasians, medium-chain acyl-CoA dehydrogenase (MCAD) deficiency is reported to be an extremely rare metabolic disorder in the Asian population. The common MCAD gene (ACADM) mutation 985A>G (p.K329E), accounting for the majority of cases in Caucasians, has not been detected in this ethnic group, and the spectrum of ACADM mutations has remained unknown. METHOD: Biochemical genetic testing including plasma acylcarnitine and urine acylglycine analyses, as well as sequencing of ACADM was performed in a Korean family with a newborn who had an elevated octanoyl (C8) carnitine concentration by newborn screening (NBS). Genotyping of 50 Korean newborns with normal NBS results was performed. RESULT: We report the identification of the first Korean patient with MCAD deficiency, caused by a novel missense mutation in ACADM, 843A>T (R281S), and a 4-bp deletion, c.449_452delCTGA. The patient became symptomatic before notification of the abnormal NBS result. Both the father and a brother who were identified as carriers for the 4-bp deletion had mildly elevated plasma C8 and C10:1 carnitine concentrations, whereas the acylcarnitine profile was normal in the mother who carries the missense mutation. CONCLUSION: The 4-bp deletion may represent a common Asian ACADM mutation, considering that it recently has also been found in two of the three Japanese patients in whom genotyping was performed. Greater availability of MCAD mutation analysis is likely to unravel the molecular basis of MCAD deficiency in the Asian population that might differ from Caucasians.

Acyl-CoA Dehydrogenase↗
PubMed2004

HIV partner notification in the United States: a national survey of program coverage and outcomes.

OBJECTIVE: The objective of this study was to define the scope and case-finding success of HIV partner notification (PN) in the United States. STUDY: The authors conducted an analysis of PN data from metropolitan areas >500,000 reporting > or =200AIDS cases in 2001. RESULTS: Data were collected from 28 (72%) of 39 eligible jurisdictions. In 22 jurisdictions with reportable HIV, health departments interviewed 32% of 20,353 persons with newly reported HIV. Among 6394 sex or needle-sharing partners, 19% had been previously HIV-diagnosed; 10% tested HIV-positive; 32% tested HIV-negative; and 39% were not notified, denied previous HIV diagnosis and refused HIV testing, or outcome was unknown. Health departments interviewed 13.8 persons to identify 1 new case of HIV (range, 1.0-196). Areas in which larger proportions of AIDS cases occurred among men who have sex with men reported less success identifying new cases of HIV through PN. CONCLUSIONS: HIV PN programs identify new cases of HIV but have variable success and affect a minority of persons reported with HIV.

Contact Tracing↗
PubMed2005

Case-finding effectiveness of partner notification and cluster investigation for sexually transmitted diseases/HIV.

OBJECTIVE: To assess the case-finding effectiveness of partner notification(PN) and cluster investigation for sexually transmitted disease (STD)/human immunodeficiency virus (HIV). STUDY: Literature review and quantitative summary. RESULTS: Since 1975, the median case-finding yield for syphilis, gonorrhea, and chlamydia PN reported in the literature is about 1 new case found for every 4 or 5 cases interviewed. The yield from HIV PN is approximately half as large, although there is substantial variability in yield across reports for each disease. Published reports underline the central role provider referral plays in effective PN and case-finding. Successful PN is more likely with index cases who are of majority ethnicity and detected through screening or spontaneous presentation for care with symptoms and with partners with whom index cases have had sexual contact that is recent, frequent, and of long duration. The case-finding yield for HIV PN also is much higher when cases are diagnosed through confidential, rather than anonymous, testing. Cluster investigation and related strategies tend to have lower case-finding yields than PN but can play a very useful case-finding role, especially in settings with high disease incidence. CONCLUSIONS: STD/HIV PN and cluster investigation can contribute meaningfully to case finding. More research is needed to strengthen the empiric foundation of PN and related strategies, including the impact they have on disease transmission.

Chlamydia Infections↗
PubMed2005

Divergent approaches to partner notification for sexually transmitted infections across the European union.

OBJECTIVE: The objective of this study was to characterize partner notification (PN) policy and practice for sexually transmitted infections (STIs) in the European Union (EU) and Norway. GOAL: The goal of this study was to promote European good practice in PN. STUDY: This study consisted of a cross-sectional survey using a structured questionnaire to national STI surveillance leads. RESULTS: Considerable heterogeneity exists in approaches to PN. In 2 countries, PN is compulsory for notifiable STIs; and in 13, it is voluntary. Most countries use patient referral but 5 of 15 also offer provider referral. Activity level varies by country and disease. Etiologic treatment of contacts is most common; 5 usually offer epidemiologic treatment and patient-expedited treatment is unusual. Similarities exist with provision mainly by specialized STI treatment services for bacterial STIs. CONCLUSIONS: This divergence in approach calls for the setting of minimum standards for PN delivery together with mechanisms for establishing and sharing best practice. Further research must identify monitoring systems for inclusion in routine surveillance.

Contact Tracing↗