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PubMed1996

Mandatory drug testing in the workplace.

Although employees may object to mandatory drug testing due to concerns for an invasion of their privacy, employers are responsible for maintaining the public's safety. Education about substance abuse, testing, and treatment should be a part of every employer's anti-drug program. Costs for testing can range from $20 to $200; however, an employer, such as a hospital, that fails to test for substance abuse could face increased liability for an injury to a patient if a drug impaired employee caused it.

Employment↗
PubMed1991

An economic evaluation of mandatory premarital testing for HIV.

This study provides a comprehensive assessment of mandatory premarital testing for HIV. We incorporate new evidence about the assumptions underlying an economic evaluation of premarital testing, use standard methods of program evaluation (cost-effectiveness analysis and cost-benefit analysis), and carefully evaluate how changes in the various assumptions affect the results. The cost-effectiveness results show that, under the most likely conditions, the cost per case of HIV infection prevented by mandatory premarital testing would be between $70,000 and $127,000. In the cost-benefit analysis, the benefit-cost ratio in the most likely scenarios ranges between 3.1 and 28.2.

AIDS Serodiagnosis↗
PubMed1990

Testing for AIDS: uses and abuses.

In response to the public outcry for mandatory testing for AIDS, this Article explores the major issues concerning the identification of persons with AIDS in society. The Article first studies testing procedures and the purposes behind them to determine if a call for mandatory testing of the general populace would better achieve society's objectives for identifying individuals with AIDS. Concluding that testing should not be required of the population as a whole, the Article then explores whether testing should be required of certain subpopulations which society perceives as likely to have or to spread the disease. In this context, too, the Article concludes that mandatory testing would be unwarranted, and that funds proposed for mandatory testing would be put to better use in education and universal precautions to prevent the further spread of AIDS.

AIDS Serodiagnosis↗
PubMed1997

Cost-effectiveness of mandatory stress testing in chest pain center patients.

STUDY OBJECTIVE: To determine whether emergency patients with acute chest pain and low suspicion of acute myocardial infarction (AMI) can be managed cost-effectively and safely in a dedicated chest pain center (CPC) that incorporates mandatory stress testing. METHODS: We assembled a prospective observational case series of consecutive adult patients transferred from the emergency department to a nine-bed, 23-hour CPC in a 564-bed community hospital from January 13 through May 31, 1994. In our institution, all emergency patients with acute nontraumatic chest pain of unclear origin, suggestive of myocardial ischemia but with a low probability of AMI, are transferred to the CPC for further evaluation. All patients in whom AMI is ruled out undergo individually appropriate cardiac diagnostic testing in accordance with CPC clinical guidelines. Patients with end-stage coronary artery disease transferred to the CPC for a "rule-out" protocol only did not undergo further diagnostic testing. Admitted and discharged patients were followed through chart review and telephone survey, respectively. RESULTS: Of the 502 patients transferred to the CPC, 477 (95%) completed follow-up at 14 days. Four hundred ten (86%) were discharged home. Those discharged after diagnostic evaluation yielded negative findings had 100% survival and zero diagnosis of AMI at 5-month follow-up. Overall mortality and incidence of AMI on long-term follow-up for all patients transferred to the CPC were .4% and .2%, respectively. Sixty-seven patients (13%) were admitted from the CPC, of whom 44 (66%) had a final diagnosis of ischemic heart disease (IHD) or AMI. Twenty-four patients with IHD (55%; 6% of stress-tested group) were identified only on further stress testing. Of these patients, seven underwent percutaneous transluminal coronary angioplasty or coronary artery bypass grafting during hospitalization. All were discharged home without major morbidity. Four hundred twenty-four patients (84%) underwent stress testing. The cost of mandatory stress testing to identify one patient with IHD after AMI was ruled out was $3,125. An average cost-per-case savings of 62% was achieved for each patient transferred to the CPC who would have been hospitalized before the inception of the CPC. CONCLUSION: Mandatory stress testing is a safe, cost-effective, and valuable diagnostic and prognostic tool in CPC patients.

Acute Disease↗
PubMed1997

Harm reduction measures and injecting inside prison versus mandatory drugs testing: results of a cross sectional anonymous questionnaire survey. The European Commission Network on HIV Infection and Hepatitis in Prison.

OBJECTIVES: (a) To determine both the frequency of injecting inside prison and use of sterilising tablets to clean needles in the previous four weeks; (b) to assess the efficiency of random mandatory drugs testing at detecting prisoners who inject heroin inside prison; (c) to determine the percentage of prisoners who had been offered vaccination against hepatitis B. DESIGN: Cross sectional willing anonymous salivary HIV surveillance linked to a self completion risk factor questionnaire. SETTING: Lowmoss prison, Glasgow, and Aberdeen prison on 11 and 30 October 1996. SUBJECTS: 293 (94%) of all 312 inmates at Lowmoss and 146 (93%) of all 157 at Aberdeen, resulting in 286 and 143 valid questionnaires. MAIN OUTCOME MEASURES: Frequency of injecting inside prison in the previous four weeks by injector inmates who had been in prison for at least four weeks. RESULTS: 116 (41%) Lowmoss and 53 (37%) Aberdeen prisoners had a history of injecting drug use but only 4% of inmates (17/395; 95% confidence interval 2% to 6%) had ever been offered vaccination against hepatitis B. 42 Lowmoss prisoners (estimated 207 injections and 258 uses of sterilising tablets) and 31 Aberdeen prisoners (229 injections, 221 uses) had injected inside prison in the previous four weeks. The prisons together held 112 injector inmates who had been in prison for more than four weeks, of whom 57 (51%; 42% to 60%) had injected in prison in the past four weeks; their estimated mean number of injections was 6.0 (SD 5.7). Prisoners injecting heroin six times in four weeks will test positive in random mandatory drugs testing on at most 18 days out of 28. CONCLUSIONS: Sterilising tablets and hepatitis B vaccination should be offered to all prisoners. Random mandatory drugs testing seriously underestimates injector inmates' harm reduction needs.

Cross-Sectional Studies↗
PubMed1994

Mandatory HIV testing and the character of medicine.

Proponents of mandatory HIV testing for patients and providers may not be giving adequate attention to the problems associated with such tests: violations of confidentiality, false negatives, reduced compliance with universal precautions, and misuse of resources.

AIDS Serodiagnosis↗
PubMed1993

Responses of health care professionals to proposed mandatory HIV testing.

OBJECTIVE: to survey active health professionals to assess the response to and impact of a mandatory human immunodeficiency virus (HIV) testing policy on health care providers and the communities in which they practice. DESIGN AND SETTING: Anonymous four-page survey of active health professionals at 13 hospitals in northern and central New Jersey. PARTICIPANTS: 1557 physicians and nurses responded to the survey. Response rate was approximately 41%. INTERVENTION: Hypothetical intervention. MAIN OUTCOME MEASURES: Responses to a series of questions relating to a hypothetical mandatory HIV testing policy for health professionals. RESULTS: Approximately three fourths of all surveyed health professionals stated that a mandatory testing policy would persuade individuals in their profession not to work in high-prevalence areas. Among those who currently work in high-prevalence HIV/acquired immunodeficiency syndrome (AIDS) areas, only 51% said that they would definitely or probably remain in that area should such a policy be instituted. Among those practicing surgery or performing invasive procedures, 7% currently avoid HIV-positive patients, and an additional 34% said that they would do so under the proposed testing policy. Finally, 4% of these professionals currently advice others to stop working in high-prevalence areas, and an additional 22% state that they would definitely do so if the proposed policy were instituted. CONCLUSIONS: If physicians and nurses behaved in accordance with their survey responses, institution of a mandatory HIV testing policy would create a shortage of physicians and nurses in high-prevalence HIV/AIDS areas.

Adult↗
PubMed1988

Substance abuse and mandatory drug testing in health care institutions.

Substance abuse in the workplace is a problem of enormous proportions. Hospitals, like other organizations, must recognize the potential risks posed by substance abuse and effectively deal with the problem. A nationwide study was conducted of hospital personnel managers' attitudes toward drug abuse and mandatory drug testing. The study focuses on the policies hospitals have formulated and reveals hospital administrators' concerns over the legality of mandatory testing.

Attitude of Health Personnel↗
PubMedDate not supplied

AIDS and HIV: the dilemma of the health care worker.

1. An estimated 5,800 health care workers have AIDS. Many times that number have HIV but have not yet developed AIDS. As of this date, 29 health care workers in the United States have seroconverted to HIV positive due to occupational exposure to the virus. Eleven are nurses. 2. Although much has been done to study the characteristics and etiology of the disease, there is still much debate over the methods of transmission, the best techniques of prevention, and the employability of those infected. 3. Over half the people surveyed would no longer seek medical attention from a health care provider if they knew that the provider had AIDS or HIV infection. This statistic demonstrates an almost irrational fear on the part of the public, since the chance of actual transmission from health care worker to patient is minimal. 4. Over 10 years of epidemiologic studies of HIV infected health care workers who performed highly invasive procedures have indicated that no transmissions have occurred. Therefore, the ANA is opposed to mandatory testing and mandatory disclosure of HIV status of patients and/or nurses. Voluntary anonymous or confidential testing--in conformance with informed consent laws--and counselling are encouraged. 5. Despite the laws and recommendations for employability of infected workers, there still exists widespread discrimination against individuals infected with HIV or individuals with AIDS, largely due to the confusion generated by the various guidelines and recommendations.

Acquired Immunodeficiency Syndrome↗
PubMed1990

1989 Sir Henry Wellcome medal and prize winner. Mandatory HIV testing and the duty to screen.

The decision to engage in mandatory HIV testing of active duty military personnel and all applicants was done with the idea that the test was good and that medical technology should be used whenever available and feasible. This addresses but half of the aspects of a good test program and runs contrary to standards practiced within the civilian sector. The other half is the area in greatest need of study: the effect of HIV labeling on the individual and on the social network within which the individual exists. Attributes and implications of the military test program are discussed.

AIDS Serodiagnosis↗
PubMedDate not supplied

Radon in a self-selected sample of Israeli homes, schools, and workplaces.

Some 1,100 residences and places of work and 400 schoolrooms in Israel were tested for ambient air radon activity concentration in response to requests by the owners, tenants, or local authorities. A polyethylene vial containing activated charcoal was exposed to room air in each of these structures for 7 days, sealed, and transported to the laboratory. Adsorbed radon was extracted with a toluene-based cocktail which was then subjected to liquid scintillation counting. Mean radon activity concentrations were found to vary from city to city by more than an order of magnitude, indicating strong regional differences. The countrywide geometric mean was found to be 38 Bq/m3; the median, 37. The range for these means was 6-77 Bq/m3; for the medians, 11-100 Bq/m3. The highest reading was 9,100 Bq/m3. Our results are basically in line with those from the United States and much of Europe, but apparently higher than those found in the United Kingdom and Japan. It may be fairly said that mass testing for radon (222Rn) inside buildings in the United States began in the wake of the finding of a radon activity concentration in excess of 100,000 Bq/m3 in the home of the Watras family in Boyertown, PA in December 1984. To date, literally millions of American buildings have been tested, and mandatory testing of schoolrooms has begun in some states. In Israel, by contrast, where such a dramatically high measurement has not (yet) occurred, only 5 structures had been checked for radon by 1989.(ABSTRACT TRUNCATED AT 250 WORDS)

Housing↗
PubMed1995

Mandatory HIV testing of patients and professionals: bringing ethics into practice.

A contemporary health dilemma, that of mandatory HIV testing of patients and professionals, is used as a focus for an ethics class. Background material which is given to students is described and referenced. The interjection of ethical theory is described. The exercise has provided an effective focus for medical and health professional undergraduate and postgraduates. It combines contemporary material with ethical theory, and so brings ethics into practice for students.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

HIV serosurveillance of newborns. A clinician's perspective on legislative, political, and ethical issues.

This article reviews the complex issues surrounding the anonymous HIV testing of newborns to monitor the prevalence of HIV infection in women of childbearing age. This serosurveillance of newborns has become a topic of legislative debate focusing on disclosure of currently anonymous results of HIV antibody tests of newborns, thus revealing the serostatus of the mother. This, in effect, would mandatorily test women without their consent. The discussion includes the following topics: (a) the historical demographics of incidence rates of AIDS, (b) current political and legislative issues raised by serosurveillance, (c) professional and ethical issues confronting health care providers, and (d) why HIV testing of newborns is a mandatory testing of all women of childbearing age. It is recommended that principles of patients right of self-determination be respected, that mandatory testing would be counterproductive and would disproportionately impact on minorities. The integration of education, counseling, and voluntary testing will result in the most effective way to get both women and children into the health care system.

AIDS Serodiagnosis↗
PubMedDate not supplied

Mandatory HIV testing: a timely controversy.

Incidence of infection with the human immunodeficiency virus (HIV) has increased to epidemic proportions. Strategies are needed to prevent transmission of the virus. One strategy, mandatory HIV testing of nurses, is controversial. Both sides of this issue are debated in this article.

AIDS Serodiagnosis↗