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PubMedDate not supplied

The constitutionality of random drug and alcohol testing of students in secondary schools.

Adolescent drug and alcohol use is a major public health problem. Multiple studies indicate that substance use is a risk factor for physical and mental disorders in adolescents. Secondary schools and the communities they serve have been facing a long-standing problem of substance abuse. American adolescents have become quite accustomed to drug prevention being a part of their curriculum. However, some policy decisions made by school administrators have been legally challenged. In 1989, Vernonia School District serving a small community in Oregon, instituted a random drug testing policy of its athletes. In 1991, the parents of a seventh grader refused to give their consent for random drug testing. The seventh grader was denied participation in the sport and sued the School District arguing that the school policy violated the Fourth and Fourteenth Amendments to the United States Constitution, and Article I, Section 9 of the Oregon Constitution. In 1995, on appeal to the Supreme Court of the United States, the School District won the case. The Vernonia School District versus Acton case became a landmark case, but random drug and alcohol testing in secondary schools has been a subject of multiple court cases. The authors discuss three of them. Both Federal and State Courts have recognized that a secondary school environment in itself represents "a special need," for which suspicionless searches are sometimes necessary to maintain order, safety, and discipline. Drug and alcohol testing programs in secondary schools may still be challenged on its legality. Therefore, examining court sanctioned programs and their long-term efficacy statistics is recommended.

Adolescent↗
PubMed2006

HIV/AIDS and other infectious diseases among correctional inmates: transmission, burden, and an appropriate response.

Correctional inmates engage in drug-related and sexual risk behaviors, and the transmission of HIV, hepatitis, and sexually transmitted diseases occurs in correctional facilities. However, there is uncertainty about the extent of transmission, and hyperbolic descriptions of its extent may further stigmatize inmates and elicit punitive responses. Whether infection was acquired within or outside correctional facilities, the prevalence of HIV and other infectious diseases is much higher among inmates than among those in the general community, and the burden of disease among inmates and releasees is disproportionately heavy. A comprehensive response is needed, including voluntary counseling and testing on request that is linked to high-quality treatment, disease prevention education, substance abuse treatment, and discharge planning and transitional programs for releasees.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Glucose monitoring as a guide to diabetes management. Critical subject review.

PURPOSE: To encourage a balanced approach to blood glucose monitoring in diabetes by a critical review of the history, power and cost of glucose testing. DATA SOURCES: The Cambridge Data Base was searched and was supplemented by a random review of other relevant sources, including textbooks, company pamphlets, and laboratory manuals. STUDY SELECTION: Keywords used were "glucosuria diagnosis," "blood glucose self-monitoring," "glycosylated hemoglobin," and "fructosamine" for the 10-year period ending 1992, restricted to English language and human. DATA EXTRACTION: About 200 titles were retrieved and reviewed according to the author's judgment of relevance. FINDINGS: "Snapshot tests" (venous and capillary blood glucose) and "memory tests" (urine glucose, glycated hemoglobin fractions and fructosamine) must be employed according to individual patients treatment goals. Day-to-day metabolic guidance is facilitated by capillary blood glucose testing for patients receiving insulin and by urine glucose testing for others. Capillary blood glucose testing is mandatory in cases of hypoglycemia unawareness (inability to sense hypoglycemia because of neuropathy) but is not a substitute for a knowledge of clinical hypoglycemia self-care. Criteria by reason (clinical judgement and cost effectiveness) must be separated from criteria by emotion (preoccupation with technology and marketing). No randomized studies show that any of these tests consistently improve clinical outcome. Optimal metabolic control and cost savings can be expected from a rational selection of tests.

Blood Glucose↗
PubMed2001

Gaps between HIV/AIDS policies and treatment in correctional facilities.

In this article the authors examined correctional policy and its impact on the incidence of HIV/AIDS in prison population. Using data from the Florida Correctional System, they find that HIV/AIDS is still the leading cause of death. Improved treatment and care may have led to declines in AIDS-related mortality but the prison population continues to experience a much higher risk of mortality than he general population in spite of changes in the treatment and provision of care to infected patients. The dominance of HIV-related deaths indicates that treatment and voluntary testing policy have been ineffective. The authors argue that the persistence of HIV infections and AIDS-related deaths is largely attributable to continuing unequal distribution of health care resources between identified and unidentified HIV-infected inmates. Their analysis suggests that future changes in HIV/AIDS policy ib testing and treatment can contribute to improvement in health conditions of infected inmates.

AIDS Serodiagnosis↗
PubMed1996

Neisseria gonorrhoeae RNA/DNA hybridization and culture for screening of gonococcal infections in a low-prevalence population.

Gonorrhea is still a major sexually transmitted disease (STD) worldwide. Its etiologic diagnosis is based on identification of the causative agent, Neisseria gonorrhoeae, by culture of genital secretions, which is often hampered by difficulties of sample collection and transport. Alternatively, nucleic acid hybridization techniques for routine diagnosis of N. gonorrhoeae appear to be useful by eliminating problems associated with bacterial viability, particularly for surveillance of low-prevalence populations. Our study among 1,508 outpatients undergoing routine examination for common STDs used RNA/DNA hybridization with a DNA probe specific for N. gonorrhoeae (Gen Probe Pace 2) and classical culture. Of the 1,750 specimens tested, 12 were positive by DNA probe and culture. In 8 cases, only DNA probe was positive while culture was negative. In 3 of these discrepant cases clinical and epidemiological data suggested true N. gonorrhoeae infection. Thus, DNA probe assay for N. gonorrhoeae may greatly improve screening of N. gonorrhoeae among low-prevalence populations. However, culture remains mandatory for testing antimicrobial resistance of these highly communicable infectious agents.

Acridines↗
PubMed2001

[Intracranial hemorrhages in infants: child abuse or a congenital coagulation disorder?].

In children with head injuries the severity of the neurological symptoms should concord with the patient's history and signs of neurotrauma on examination. Discrepancies between the (hetero)anamnesis and physical examination on the one hand and neurological findings on the other may indicate child abuse. The presence of both old and new intracranial haemorrhages in the absence of proportional trauma is generally considered as evidence for child abuse. However, these symptoms may also be the first manifestation of a congenital coagulation disorder. Three children, two girls aged 8 and 5 months and a boy aged 6 months were presented with alarming neurological symptoms due to intracranial haemorrhages without external signs of head trauma. The first girl had 'shaken baby' syndrome while the other 2 had congenital coagulation disorders (haemophilia B and factor V deficiency, respectively). All three recovered, the last two with remaining one-sided neurological deficits. Child abuse and congenital coagulation disorders may present with similar neurological symptoms and radiological findings. In these patients coagulation tests are mandatory and--if abnormal--enable early substitution of deficits and prevent inappropriate suspicion or accusation of caretakers.

Blood Coagulation Disorders↗
PubMedDate not supplied

Current status of stress echocardiography in the diagnosis of coronary artery disease.

Stress echocardiography is a cost-effective and reliable diagnostic test for patients with suspected coronary artery disease. Stress echocardiography should be used in preference to exercise electrocardiography as the primary test in patients with uninterpretable ST segments. It is attractive for use as the primary test in patients with coexisting valvular disease. It probably is the optimal test for women. Stress echocardiography should be used as a secondary test when the result of exercise electrocardiography is inconsistent with the clinical status. In patients requiring nonexercise stress testing, an imaging test is mandatory. The ability of stress echocardiography to identify the location and extent of myocardial ischemia makes it appropriate in situations where decisions regarding revascularization will be made on these grounds. The overall accuracy of stress echocardiography and perfusion scintigraphy is comparable in expert hands. but one must always consider the expertise of the operator and the quality of each test in the environment in which it is performed.

Coronary Disease↗
PubMed2004

Accuracy of automated auscultatory blood pressure measurement during supine exercise and treadmill stress electrocardiogram-testing.

OBJECTIVES: Monitoring of brachial blood pressure during exercise-electrocardiogram (ECG) testing is mandatory and changes in blood pressure (BP) can provide critical management evidence. Patient movement, mechanical vibration, artifactual sounds and observer variability make standard manual techniques problematic. This was an investigator-initiated study to assess an automated auscultatory technique of BP assessment [Tango exercise blood pressure monitor (SunTech Medical Instruments, NC, USA)] to adequately measure BP during stress-ECG testing. METHODS: Initially five fit young male volunteers underwent invasive right brachial artery BP recording using a low-compliance fluid-filled catheter with simultaneous manual and automated assessment. Secondarily, during exercise-ECG testing, the system was assessed against beat-to-beat brachial blood pressures obtained from a catheter-tip solid-state pressure manometer positioned in the ipsilateral brachial artery. RESULTS: In the supine study overall mean difference (+/-SEM) between invasive and manual blood pressures was 3.26 (1.53) and 3.89 (1.90) mmHg for diastolic BP (DBP) and systolic BP (SBP) respectively. Corresponding differences between invasive and automated results, and manual and automated were 3.68 (0.84) and -7.31 (1.83) mmHg, and -0.64 (+/-1.43) and -11.42 (+/-1.59) mmHg. During treadmill exercise-ECG testing the combined mean difference (+/-SEM) between invasive and automated SBP and DBP was 4.79 (+/-0.14) and 6.33 (+/-0.10) mmHg, respectively. CONCLUSION: Automated BP assessment during exercise-ECG testing is feasible with the use of appropriate automatic devices likely to be at least as accurate as manual BP registration. The Tango device is tolerant to exercise and provides reliable automatic BP assessment with absolute differences within an acceptable clinical range.

Adult↗
PubMed1999

Studies of host response to orthopedic implants and biomaterials.

The use of implanted biomaterials in orthopedic surgery has increased rapidly during the past two decades. Total joint replacement of the hip or knee joint has become common treatment; at the same time, an increasing number of fractures are treated with osteosynthesis. The original Charnley low-friction arthroplasty of the hip is still widely used and gives in large series excellent results. Aseptic loosening of this arthroplasty has been thought to be due to wear debris of the methylmethacrylate used for fixation of the implants, or to debris generated from wear of the polyethylene socket. To date, many different materials have been tried in order to reduce wear and generation of macrophage irritating submicron sized particles, or to provide more biocompatible components. However, trials to improve the methylmethacrylate cement or to invent better polyethylenes have often failed. Diamond coating of the metallic components seems promising: there is less wear and diamond is very biocompatible in bulk and small particulate form. Biodegradable implants have also been found useful in treating fractures. Bioactive bioabsorbable materials may also make possible a tissue engineering approach and can be used as carriers for selected drugs and cytokines. Because many promising materials and designs have failed in clinical use, extensive theoretical and experimental testing is mandatory before introducing new materials and implants in a clinical setting.

Biocompatible Materials↗
PubMed2005

Two-tiered immunoreactive trypsinogen-based newborn screening for cystic fibrosis in Colorado: screening efficacy and diagnostic outcomes.

OBJECTIVE: To examine immunoreactive trypsinogen (IRT)-based screening for cystic fibrosis (CF) for recall rate, genotype distribution, and "borderline" sweat test results. STUDY DESIGN: CF newborn screening in Colorado began in 1982, and >1,153,000 infants were screened through 2002 with an IRT-based screen (IRT/IRT). RESULTS: We have identified 313 infants with CF, giving an overall incidence of 1 in 3684 and a Hispanic incidence of 1 in 6495. Fifty-five infants with meconium ileus (17.6%) were excluded from analysis. Fourteen infants with false-negative results were identified (5.4%). The average recall rate was 0.6%, with a positive predictive value of 4.7%. Ninety-three percent of the infants had at least 1 DeltaF508 mutation, and 98% of the infants had at least 1 mutation from the American College of Medical Genetics recommended panel. Six infants had hypertrypsinogenemia and borderline results on sweat tests (30-60 mmol/L). Increased variability in sweat chloride levels were seen in these infants compared with infants with homozygous DeltaF508. Three children with initial borderline results on sweat tests had CF diagnosed. CONCLUSIONS: The recall and false-negative rates of our IRT/IRT CF screening program are reported. Additionally, genotypes of the patients identified mirror the CF population genotypes, reflecting similar disease severity in the screened population. Finally, infants with persistent hypertrypsinogenemia and borderline sweat test results need long-term follow-up.

Chlorides↗
PubMed1999

Mandated tuberculosis screening in a community of homeless people.

BACKGROUND: To examine the effects of a community program on tuberculosis incidence, prevalence, and transmission requiring users of public facilities to carry cards certifying their compliance with a tuberculosis screening, prophylaxis, and treatment program. Community knowledge of tuberculosis and costs and benefits of the program are described. SETTING: A West Coast "skid row" community with historically high rates of tuberculosis, homelessness, poverty, and use of drugs and alcohol. DESIGN: Analysis of tuberculosis activity in communities in Oregon using Oregon Health Division Tuberculosis Data Bank data. Description of community response and cost considerations. MAIN OUTCOME MEASURES: Rates of active disease, mortality, and skin-test response. Compliance with card use and understanding of tuberculosis control measures. Program expenditures. RESULTS: An 89% drop in active disease in the highest-risk community in Oregon occurred over the first 10 years of the program. Compliance with the program permitting the use of public facilities, based on cooperation with skin testing, radiology, sputum collection, and therapy has been between 33% of converters completing prophylaxis in the worst year to 100% of active cases completing 4-drug therapy in the best. Facilities that provide services have been almost universal in requiring cooperation for participants. Costs have been reduced. CONCLUSION: A program of mandated compliance with tuberculosis skin testing, radiologic and sputum examination and treatment, coupled with education and outreach, succeeded in drastically reducing active tuberculosis, transmission, deaths, and cost in a homeless community.

Adult↗
PubMed1998

New Federal guidelines for hepatitis C virus lookback.

Given the recent approval of treatments for the hepatitis C virus, the FDA has issued guidelines on testing, tracing, and notification procedures regarding blood donor testing for hepatitis C. The deadline to begin this lookback policy is September 20, 1998, so understanding these regulations, as well as the legal and ethical risks of noncompliance, is imperative.

Blood↗
PubMed2005

Imposition of virginity testing: a life-saver or a license to kill?

Little is known about medical and juridical (medicolegal) responses to sexual abuse in Palestinian society. Conventional wisdom posits that the actions of the medicolegal community help victims of sexual abuse and deter offenders. This study focuses on the prevailing practice of imposing a virginity test (IVT) on women in Palestinian society when questions of sexual abuse or perceived misconduct arise. We found that the continuing practice of uncritically collecting forensic reports and the refusal to closely examine the specific dynamics of oppression (medical, cultural, legal, political) in which the victims of sexual abuse are necessarily implicated actually increases the power of medicine and law to adversely function as tools of oppression. However, as I elaborate below, despite the localized factors in play, it is critically important not to view the process of virginity testing merely through the rubrics of "culture"-an approach that more often than not impedes understanding and fails to contextualize what we observe.

Adolescent↗
PubMed2005

A missed opportunity: hepatitis C screening of prisoners.

In 2003, the Centers for Disease Control and Prevention issued recommendations to screen all inmates with a history of injection drug use or other risk factors for hepatitis C. We compared self-reported risk factors for hepatitis C with serostatus from inmates in the Rhode Island Department of Corrections. Of the male inmates who were hepatitis C positive, 66% did not report injection drug use. Risk-based testing underestimates the hepatitis C virus (HCV) prevalence in correctional settings and limits the opportunity to diagnose and prevent hepatitis C infection.

Adult↗
PubMed1996

Compulsory testing for HIV in Hungary.

Compulsory testing for the human immunodeficiency virus (HIV) has been a cornerstone of Hungary's AIDS prevention and care programme since 1988. This strategy is based on a two-fold public health rationale. Firstly, informing as many HIV positive people as possible of their serostatus is important for HIV prevention because infected people have a crucial role to play in preventing the further spread of the virus. Secondly, the earlier an HIV diagnosis can be provided the greater the opportunity for delaying the onset of symptoms and for maintaining as high a quality of life as possible for the affected individual. For these reasons, and because compulsory testing appears to be widely accepted within Hungary as part of a comprehensive social welfare system which places equal emphasis on citizens' rights and responsibilities, the country's public health establishment has continued to resist pressure from international agencies and other external bodies which have urged Hungary to abandon compulsory testing in favour of voluntary testing based on individual informed consent. Any changes to Hungary's HIV testing programme which occur in the coming years are more likely to be a response to the country's changing epidemiological, social and economic conditions rather than to pressure from outside.

Community Health Services↗