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PubMed2001

Educating the community about violence through a gun turn-in program.

The Ceasefire Oregon gun turn in program was initiated to educate the community regarding violence through a gun turn-in program with voluntary surrender of firearms, educational efforts about violence, and institution of public safety policies. The community board of directors was composed of multiple community leadership organizations. A multi-intervention education, outreach and media program consisting of distribution of brochures, presentations, school education programs, and workshops was implemented throughout the year in addition to the gun turn-in program held in May for two days. A survey was administered to participants in the program at the turn-in sites. The cumulative total for guns turned in years 1994 to 1999 was 4,345. Half of the respondents reported possession of a gun at home. The most common reasons for participating in the gun turn in were obtaining gift certificates and not wanting the gun any more. A successful community grassroots program, Ceasefire Oregon has shown sustainability over six years with increased participation secondary to education, advertising and incentives. Community and statewide efforts can assist with building the infrastructure for programs, however more tools for quantitative performance program evaluation would facilitate measuring the impact on the community.

Community Health Planning↗
PubMed1986

Medical surveillance of employees under the Occupational Safety and Health Administration.

This paper will consider medical surveillance in the context of the Occupational Safety and Health Act of 1970. The Occupational Safety and Health Administration (OSHA) has issued (after rule making) health standards covering approximately 24 toxic substances, and all these standards have included medical surveillance programs. OSHA is not only empowered but compelled by law to require medical surveillance programs for exposed employees. At the same time, a number of major legal/policy issues relating to medical surveillance have been raised at the standards rule-making stage and litigated in court. Among the more significant of these are access to medical records, selection of physician, and medical removals. Many of these issues were involved in OSHA's Lead Standard, issued in 1978 and affirmed in relevant part by the Court of Appeals for the District of Columbia in 1980, and in the "medical access" rule, issued in 1980 and upheld by the Court of Appeals for the Fifth Circuit. These two proceedings will be used as a focus for the discussions of medical surveillance programs under the OSHA act.

Federal Government↗
PubMed2005

Preparing for an influenza pandemic: ethical issues.

In the near future, experts predict, an influenza pandemic will likely spread throughout the world. Many countries have been creating a contingency plan in order to mitigate the severe health and social consequences of such an event. Examination of the pandemic plans of Canada, the United Kingdom and the United States, from an ethical perspective, raises several concerns. One: scarcity of human and material resources is assumed to be severe. Plans focus on prioritization but do not identify resources that would be optimally required to reduce deaths and other serious consequences. Hence, these plans do not facilitate a truly informed choice at the political level where decisions have to be made on how much to invest now in order to reduce scarcity when a pandemic occurs. Two: mass vaccination is considered to be the most important instrument for reducing the impact of infection, yet pandemic plans do not provide concrete estimates of the benefits and burdens of vaccination to assure everyone that the balance is highly favorable. Three: pandemic plans make extraordinary demands on health care workers, yet professional organizations and unions may not have been involved in the plans' formulation and they have not been assured that authorities will aim to protect and support health care workers in a way that corresponds to the demands made on them. Four: all sectors of society and all individuals will be affected by a pandemic and everyone's collaboration will be required. Yet, it appears that the various populations have been inadequately informed by occasional media reports. Hence, it is essential that plans are developed and communication programs implemented that will not only inform but also create an atmosphere of mutual trust and solidarity; qualities that at the time of a pandemic will be much needed.

Canada↗
PubMed1999

Should childhood immunisation be compulsory?

Immunisation is offered to all age groups in the UK, but is mainly given to infants and school-age children. Such immunisation is not compulsory, in contrast to other countries, such as the United States. Levels of immunisation are generally very high in the UK, but the rates of immunisation vary with the public perception of the risk of side effects. This article discusses whether compulsory vaccination is acceptable by considering individual cases where parents have failed to give consent or have explicitly refused consent for their children to be immunised. In particular, the rights of: a parent to rear his/her child according to his/her own standards; the child to receive health care, and the community to be protected from vaccine-preventable infectious disease are considered. The conclusion of the article is that compulsory vaccination cannot, with very few exceptions, be justified in the UK, in view of the high levels of population immunity which currently exist.

Child↗
PubMed1999

An international survey of medical ethics curricula in Asia.

SETTING: Medical ethics education has become common, and the integrated ethics curriculum has been recommended in Western countries. It should be questioned whether there is one, universal method of teaching ethics applicable worldwide to medical schools, especially those in non-Western developing countries. OBJECTIVE: To characterise the medical ethics curricula at Asian medical schools. DESIGN: Mailed survey of 206 medical schools in China, Hong Kong, Taiwan, Korea, Mongolia, Philippines, Thailand, Malaysia, Singapore, Indonesia, Sri Lanka, Australia and New Zealand. PARTICIPANTS: A total of 100 medical schools responded, a response rate of 49%, ranging from 23%-100% by country. MAIN OUTCOME MEASURES: The degree of integration of the ethics programme into the formal medical curriculum was measured by lecture time; whether compulsory or elective; whether separate courses or unit of other courses; number of courses; schedule; total length, and diversity of teachers' specialties. RESULTS: A total of 89 medical schools (89%) reported offering some courses in which ethical topics were taught. Separate medical ethics courses were mostly offered in all countries, and the structure of vertical integration was divided into four patterns. Most deans reported that physicians' obligations and patients' rights were the most important topics for their students. However, the evaluation was diverse for more concrete topics. CONCLUSION: Offering formal medical ethics education is a widespread feature of medical curricula throughout the study area. However, the kinds of programmes, especially with regard to integration into clinical teaching, were greatly diverse.

Animal Experimentation↗
PubMed2006

Predicting sex offender treatment entry among individuals convicted of sexual offense crimes.

This study examined what factors were predictive of who volunteers for sex offender treatment (self-selection) as well as who enters treatment after volunteering (administration selection). Research participants included 404 treatment volunteers and 387 nonvolunteers to treatment who were convicted of a sexual offense involving minors within the federal prison system. Maximum likelihood probit estimation procedures indicated that when compared with nonvolunteers, treatment volunteers were more likely to be recommended by a judge to receive treatment at the time of sentencing, had received prior treatment for sexually deviant behavior, reported higher levels of motivation to change their sexually deviant behavior, and had lower rates of a substance use disorder in the year prior to incarceration. Of those persons who initially volunteered, 62% were accepted and entered treatment, 16% were denied entry to treatment by program staff, and 22% refused treatment after being accepted to the waiting list. When compared with those who were accepted and entered treatment, motivation was the only predictor of being denied admission into treatment by program staff and for refusal of treatment once accepted. The findings emphasize the need to control for selection bias in treatment outcome studies and the importance of examining the role of motivation in treatment volunteerism and treatment entry for sexual offenders.

Child↗
PubMed1996

Editorial.

Explore the source record for details and available documents.

Adolescent↗
PubMed1991

Who seeks HIV testing? The impact of risk, knowledge, and state regulatory policy on the testing decision.

This study examines the determinants of an individual's decision to be tested for HIV infection. Using data from the 1988 AIDS Knowledge and Attitudes Survey we develop and test a conceptual model of the factors that impact the testing decision. We estimate the impact that individuals' risk characteristics, sociodemographic characteristics, knowledge about HIV infection, and access to testing have on their decision to be tested. We also examine the impact of state confidentiality policies on the testing decision. Our results indicate that risk group membership, knowledge about HIV infection, and the sociodemographic characteristics of the individual exert a significant impact on the decision to receive an HIV test. In addition, state policies that preserve confidentiality also have a significant effect on an individual's decision to be tested.

AIDS Serodiagnosis↗
PubMed1996

Effect of primary care referral on emergency department use: evaluation of a statewide Medicaid program.

BACKGROUND AND OBJECTIVES: Medicaid recipients without a regular source of care frequently use hospital emergency departments (EDs) for minor problems. This study examined whether referring Medicaid patients to primary care physicians and obstetricians results in a decrease in ED use and an increase in physician office visits. METHODS: The statewide Voluntary Initiative Program (VIP), which referred Medicaid patients to primary care physicians and obstetricians without any managed care component, was examined. Claims data were reviewed for Medicaid clients 0-64 years old who obtained VIP referrals during the first five months of the program. The change in rate of visits to hospital EDs and physician offices was compared for the study group (n = 444) and for the state's overall Medicaid population (n = 40,860). RESULTS: After referral, ED use decreased 24 percent for the VIP group and 4 percent for the Medicaid population. During the same period, physician office visits increased 50 percent for the VIP group but decreased 13 percent for the Medicaid population. CONCLUSIONS: Even in the absence of managed care, referral to primary care physicians and obstetricians resulted in fewer ED visits and more physician office visits. These findings confirm the importance of primary care in improving the efficiency of health care delivery for the Medicaid population.

Adolescent↗
PubMed1996

Effect of primary care referral on emergency department use: evaluation of a statewide Medicaid program.

BACKGROUND AND OBJECTIVES: Medicaid recipients without a regular source of care frequently use hospital emergency departments (EDs) for minor problems. This study examined whether referring Medicaid patients to primary care physicians and obstetricians results in a decrease in ED use and an increase in physician office visits. METHODS: The statewide Voluntary Initiative Program (VIP), which referred Medicaid patients to primary care physicians and obstetricians without any managed care component, was examined. Claims data were reviewed for Medicaid clients 0-64 years old who obtained VIP referrals during the first 5 months of the program. The change in rate of visits to hospital EDs and physician offices was compared for the study group (n = 444) and for the state's overall Medicaid population (n = 40,860). RESULTS: After referral, ED use decreased 24% for the VIP group and 4% for the Medicaid population. During the same period, physician office visits increased 50% for the VIP group but decreased 13% for the Medicaid population. CONCLUSIONS: Even in the absence of managed care, referral to primary care physicians and obstetricians resulted in fewer ED visits and more physician office visits. These findings confirm the importance of primary care in improving the efficiency of health care delivery for the Medicaid population.

Adolescent↗
PubMed2004

Rethinking smallpox.

The potential consequences of a competently executed smallpox attack have not been adequately considered by policy makers. The possibility of release of an aerosolized and/or bioengineered virus must be anticipated and planned for. The transmission and infectivity of variola virus are examined. Arguments for and against pre-event vaccination are offered. The likely morbidity and mortality that would ensue from implementation of a mass pre-event vaccination program, within reasonable boundaries, are known. The extent of contagion that could result from an aerosolized release of virus is unknown and may have been underestimated. Pre-event vaccination of first responders is urged, and voluntary vaccination programs should be offered to the public. Two defenses against a vaccine-resistant, engineered variola virus are proposed for consideration. Methisazone, an overlooked drug, is reported to be effective for prophylaxis only. The extent of reduction in the incidence of smallpox with use of this agent is uncertain. It is useless for treatment of clinical smallpox. N-100 respirators (face masks) worn by uninfected members of the public may prevent transmission of the virus.

Biological Warfare↗