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PubMed1987

The ethical dimensions of policy for prenatal diagnostic technologies: the case of maternal serum alpha-fetoprotein screening.

New technologies have dramatically increased the number of fetal abnormalities that can be detected and, in some cases, effectively treated during the prenatal period. Considering the potential health benefits to children and parents from early detection of fetal abnormalities, various forms of mandatory prenatal screening programs have been suggested. In order to explicate the ethical dimensions of mandatory screening in general and to demonstrate the role of nurses in prenatal screening programs, maternal serum alpha-fetoprotein screening is analyzed. The benefits, risks, and potential consequences from the broad use of this technology are discussed in conjunction with the rights of fetuses and pregnant women. An active role in the formation of health policy that might regulate new technologies affecting maternal-fetal-newborn health is suggested as a fundamental responsibility of the nursing profession.

Amniotic Fluid↗
PubMed1989

Mandatory testing for the AIDS antibody.

The appearance of Acquired Immune Deficiency Syndrome (AIDS) has brought suffering and death to those who are afflicted. At the same time, this disease has posed enormous challenges to those who care for the sufferers, to biomedical scientists, and to those responsible for public health and social policy. The issue addressed in this article is whether the implementation of mandatory testing for the AIDS antibody is an appropriate and effective strategy to use in coping with the AIDS epidemic. The goal of an AIDS prevention program is to prevent transmission of Human Immunodeficiency Virus (HIV) infections. The pro and con aspects of using mandatory AIDS antibody testing to achieve this goal are given in issue statements. The opinions of leading authorities are presented, followed by a general review of the literature. The literature is then reviewed concerning the issue as it effects the nurse as an individual, the nursing profession, and the health-care delivery system. A position is taken and specific recommendations are proposed for the profession in the areas of practice, legislation, and research.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Health benefits and risks of reporting HIV-infected individuals by name.

With more treatment options emerging for human immunodeficiency virus (HIV) infection, the policy of reporting HIV-infected individuals by name merits reevaluation. This paper reviews the benefits and risks of name reporting of persons infected with HIV. Public health departments have linked name reporting with medical referrals, risk reduction counseling, and partner notification programs. Yet some studies indicate that people are less likely to be tested for HIV infection when name reporting is implemented. Whether name reporting actually improves individual or public health, therefore justifying the increased risk of loss of confidentiality and possibly reduced testing rates, remains unknown. The lack of health outcome data on name reporting allows beliefs rather than facts to dominate debate about this policy. Before this practice is more widely adopted, a determination should be made as to whether the potential benefits of name reporting outweigh the risks.

AIDS Serodiagnosis↗
PubMed2006

Evolving public perceptions and stability in vaccine uptake.

Recent vaccine scares and sudden spikes in vaccine demand remind us that the effectiveness of mass vaccination programs is governed by the public perception of vaccination. Previous work has shown that the tendency of individuals to optimize self-interest can lead to vaccination levels that are suboptimal for a community. We use game theory to relate population-level demand for vaccines to decision-making by individuals with varied beliefs about the costs of infection and vaccination. In contrast to previous work proposing that universal vaccination is impossible in a game theoretic context, we show that optimal individual behavior can vary between universal vaccination and no vaccination, depending on the relative costs and benefits to individuals. By coupling game models and epidemic models, we demonstrate that the pursuit of self-interest often leads to stable dynamics but can lead to oscillations in vaccine uptake over time. The instability is exacerbated in populations that are more homogeneous with respect to their perceptions of vaccine and infection risks. This research illustrates the importance of applying temporal models to an inherently temporal situation, namely, the time evolution of vaccine coverage in an informed population with a voluntary vaccination policy.

Algorithms↗
PubMed2001

Rising to the Kyoto challenge: is the response of Canadian industry adequate?

A major weapon in Canada's CO2-emissions reduction arsenal is reliance on moral suasion and voluntary action. In this regard, the Voluntary Challenge and Registry (VCR) program constitutes a major effort to encourage industrial firms to reduce their greenhouse gas emissions. In this paper, we begin by providing a critical review of Canadian climate change policy and Canada's international commitments. We then investigate the effectiveness of Canadian policies by analyzing a survey of industrial firms, examining factors that determine firms' familiarity with, participation in and commitment to the VCR program, and their stated potential to reduce emissions by 2008-2012 (Kyoto's commitment period). Results indicate that voluntary programs are unlikely to make a significant contribution to emissions reduction, with industrial firms indicating that, on average, they plan to reduce emissions by some 1-2% below their 1990 level under the current policy approach, much lower than Canada's 6% reduction target.

Air Pollution↗
PubMed1987

Experience of the Manitoba Perinatal Screening Program, 1965-85.

The Manitoba Perinatal Screening Program is guided by a committee of medical specialists with skills in the diagnosis and management of disorders of metabolism in the newborn. The program is voluntary and is centralized at Cadham Provincial Laboratory, in Winnipeg. A filter card blood specimen is collected from newborns on discharge from hospital, and a filter card urine sample is collected and mailed to the laboratory by the mother when the infant is about 2 weeks of age. The overall compliance rates for the blood and urine specimens are approximately 100% and 84% respectively. The blood specimen is screened for phenylalanine and other amino acids, thyroxine, galactose, galactose-1-phosphate and biotinidase. The urine specimen is screened for amino acids, including cystine, as well as methylmalonic acid and homocystine. Between 1965 and 1985, 83 cases of metabolic disorders were detected, including 23 cases of primary hypothyroidism, 14 of classic phenylketonuria, 5 of galactosemia variants, 3 of galactosemia, 2 of maple syrup urine disease and 1 of hereditary tyrosinemia. The direct cost per infant screened is $5.50, and the cost:benefit ratio is approximately 7.5:1. Maternal serum alpha-fetoprotein screening is being made available as the necessary supporting clinical facilities become available. On the basis of this experience, the author outlines the components that are important for an effective screening program.

Costs and Cost Analysis↗
PubMed1993

Psychological and ethical considerations in screening for disease.

Coronary artery disease is the leading cause of death in the United States. Serum cholesterol is a widely used screening test to detect persons at high risk for coronary artery disease, including those with familial hypercholesterolemia. However, universal screening of currently healthy persons is not without risk. Previous experience in screening for sickle cell anemia and hypertension has shown that these risks include misunderstanding of test results, misdiagnosis, labeling, stigmatization, and decreased psychological well-being. Results of screening programs may be misused by industry or insurance companies to exclude individuals from positions or benefits. Consideration of these harms suggests that screening should not be implemented until certain safeguards are in place. Physicians and the public should be educated about the potential risks and benefits of screening. Screening tests should be accurate, reliable, valid, and of demonstrated sensitivity. Informed consent for screening should be obtained. Follow-up surveillance and recommended treatments, including dietary counseling and drug therapy, should be available to all individuals identified as being at high risk regardless of their socioeconomic status. Finally, procedures to protect the right to privacy of individuals and their families should be implemented well in advance of the actual screening.

Ethics, Medical↗
PubMed1987

Compulsory premarital screening for the human immunodeficiency virus. Technical and public health considerations.

The effectiveness of a mandatory premarital screening program was examined as a means of curtailing the spread of the human immunodeficiency virus (HIV) infection in the United States. The epidemiology of the HIV, the technical characteristics of tests for antibodies to HIV, and the logistic, economic, and legal implications of such a program were considered. In one year, universal premarital screening in the United States currently would detect fewer than one tenth of 1% of HIV-infected individuals at a cost of substantially more than +100 million. More than 100 infected individuals would be told that they were probably not infected, and there would likely be more than 350 false-positive results. Public education, counseling of individuals, and discretionary testing can be important tools in reducing the spread of HIV infection, but mandatory premarital screening in a population with a low prevalence of infection is a relatively ineffective and inefficient use of resources.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Outcomes of intensive AIDS education for male adolescent drug users in jail.

OBJECTIVES: The purpose of the study was to conduct and evaluate an intensive AIDS education program for incarcerated male adolescent drug users. METHODS: The study was conducted in New York City's main jail facility for detained and sentenced male youths aged 16-19 years. A four-session, group-oriented AIDS education program based on Problem-Solving Therapy was conducted. The program was voluntary and all youths on designated dormitories were invited to participate. The evaluation compared youths participating in the AIDS education with waiting list controls who were discharged or transferred before they could be offered the education. Behavioral outcomes for AIDS education participants and controls were determined at a five month follow-up after release from jail. Behaviors were measured through personal interviews at baseline and follow-up. RESULTS: High rates of HIV risk behaviors were documented, including alcohol, marijuana and cocaine/crack use that may predispose youths to sexual risk-taking: practice of heterosexual anal sex; multiple and high-risk sexual partnerships; and no, or inconsistent, use of condoms. Education participants as compared with controls were significantly more likely to increase their condom use, to increase positive attitudes towards condoms, and possibly to decrease high-risk sexual partnerships. However, other sexual risk variables and substance use were unchanged. CONCLUSION: Intensive AIDS education provided in jail can be useful in reducing certain HIV risk behaviors of criminally-involved male adolescents.

Acquired Immunodeficiency Syndrome↗
PubMed2006

HIV in correctional facilities: role of self-report in case identification.

For treatment of HIV/AIDS in jails and prisons to be effective, these institutions must identify as many HIV-positive inmates as they can. We compare HIV status among a drug-addicted jail population determined through a physical examination and a voluntary HIV testing program, with self-reported status in an interview. Of 360 subjects interviewed and given physical examinations, approximately one third (110) took the voluntary HIV test and all were negative, and only 1 was identified as HIV-positive in the physical. However, 7 (2%) stated in the interview that they were HIV positive, none of whom took the HIV test. Five of the 7 also self-reported injection drug use and having shared needles. We conclude that inmate self-report is an important pathway for HIV case finding in correctional institutions.

AIDS Serodiagnosis↗
PubMed1999

Clinical progress and the future of HIV exceptionalism.

In the 18 years since the first cases of the acquired immunodeficiency syndrome (AIDS) were reported by the Centers for Disease Control and Prevention (CDC), the epidemic has undergone profound transformations, and so, too, has the sociomedical context within which public health policy is fashioned and implemented. The early years of neglect and panic were also characterized by relative therapeutic impotence and deep uncertainty about the epidemiological course the new threat would take. In the United States and in other economically advanced nations, the threat of contracting the human immunodeficiency virus (HIV) has abated. The incidence of infection has declined, and the prevalence of infection has stabilized and, in some instances, begun to fall. The pattern of HIV spread, where it has continued, has been dramatically circumscribed to marginalized populations. The panic of the mid-1980s has passed, and in many nations, AIDS has lost its salience as a public issue. A sense of therapeutic impotence no longer prevails, and a new mood of triumphalism has taken hold. How have these crucial changes affected AIDS policies in America?

Anonymous Testing↗