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PubMed2004

Overcoming recruitment challenges in construction safety intervention research.

BACKGROUND: Recruiting workers in small construction companies and securing their participation in voluntary safety programs or safety research poses unique challenges. Worker turnover and worksite changes contribute to difficulties in locating and enrolling participants. Economic pressures and time demands potentially threaten ongoing participation. METHODS: Six simulation exercises designed to reduce back and fall injuries in small construction companies were developed based on data from focus groups of workers and company owners. Working with a workers' compensation insurer, we had access to owner-operators of general, heavy, and special trade construction companies reporting less than $10,000 in payroll expenses. Recruitment methods included a participation incentive, mailed invitations followed by phone contacts, and follow-up reminders. RESULTS: Despite using recruitment methods recommended in the literature, participation rates were low over a 2-year intervention period. Because of these difficulties, factors affecting participation or nonparticipation became an additional research focus. Owners' perceptions of already having a good safety record and of the time demands of participation were the most commonly cited reasons for not participating. CONCLUSIONS: Literature on recruitment emphasizes processes and procedures under investigator control rather than understanding potential participants' judgments about the adequacy of their existing practices and the potential benefits of intervention participation relative to potential time and productivity trade-offs. Greater attention to such judgments may enhance recruitment and participation in under-studied and difficult to access populations.

Accidental Falls↗
PubMed1989

Prevalence of silicosis at death in underground coal miners.

This study was initiated by the National Institute for Occupational Safety and Health (NIOSH) and the Bureau of Mines (BOM) to determine the prevalence and pathological features of silicosis in coal miners. The population base was 3,365 autopsied underground miners whose records were submitted to the U.S. National Coal Workers' Autopsy Study between 1971 and 1980. This program is voluntary and covers an estimated 10% of all coal workers who die. The mean age at death of the population was 62 years, of whom 75% were current or ex-smokers at the time of death. The average work tenure was 26 years. Lung sections from all cases were reviewed and the type and severity of pneumoconiosis documented. These findings were correlated with years of mining, job history, and geographic location of mine. Classical silicotic nodules were found in 12.5% of the population. There was a significant relationship between length of underground mining and prevalence and severity of silicosis consistent with a dose-response effect. The study also showed that job category and geographic location of the mine were important determinants of silicosis prevalence and that silicosis was strongly associated with higher categories of coal workers' pneumoconiosis.

Aged↗
PubMed1993

Prenatal cystic fibrosis carrier screening: factors in a woman's decision to decline testing.

Among 2207 women eligible to be screened for cystic fibrosis (CF) carrier status during pregnancy, 325 (15 per cent) declined to be tested. Of these, 260 (80 per cent) answered a questionnaire soliciting their reasons for not participating. The main factor was opposition to termination of pregnancy, with 43 per cent being against termination for any reason and another 11 per cent against termination of a CF fetus. Other reasons given were partner's disapproval or non-participation (10 per cent), perceived risk of a CF child being low (7 per cent), the error rate of the test (6 per cent), and the generation of unacceptable levels of anxiety (5 per cent). Eleven women (4 per cent) said that they did not wish to be tested during pregnancy, but only six of these would have accepted screening at another time.

Abortion, Therapeutic↗
PubMed1996

Marketing human organs: the autonomy paradox.

The severe shortage of organs for transplantation and the continual reluctance of the public to voluntarily donate has prompted consideration of alternative strategies for organ procurement. This paper explores the development of market approaches for procuring human organs for transplantation and considers the social and moral implications of organ donation as both a "gift of life" and a "commodity exchange." The problematic and paradoxical articulation of individual autonomy in relation to property rights and marketing human body parts is addressed. We argue that beliefs about proprietorship over human body parts and the capacity to provide consent for organ donation are culturally constructed. We contend that the political and economic framework of biomedicine, in western and non-western nations, influences access to transplantation technology and shapes the form and development of specific market approaches. Finally, we suggest that marketing approaches for organ procurement are and will be negotiated within cultural parameters constrained by several factors: beliefs about the physical body and personhood, religious traditions, economic conditions, and the availability of technological resources.

Altruism↗
PubMed1993

The ethics of HIV testing by physicians.

This essay argues that informed consent remains desirable for both moral and practical reasons in regard to HIV testing by physicians. At the very least, respect for consent preserves patient control over treatment and affords the opportunity for education about the nature of HIV-related disorders. Nevertheless, there do appear to be circumstances under which involuntary testing may occur especially when health care workers may have become occupationally exposed to risk of HIV infection. To eliminate conflicts between health workers and their patients, however, it is desirable to work to eliminate the stigmatizing and discriminatory effects of HIV infection that can induce persons to resist testing.

AIDS Serodiagnosis↗
PubMed1995

Protecting the weakest link: a proposal for universal, unblinded pediatric HIV testing, counselling and treatment.

This paper argues that a system of unblinded, universal testing, counseling and treatment for pediatric HIV should be implemented immediately in New York State. First, it argues that New York's health and social services bureaucracies, in conjunction with special interests that do not represent the interests of children, have resisted efforts to have infants tested and treated for HIV. Second, the paper suggests that the campaign against universal infant screening and treatment reflects our society's continuing, calculated decision to ignore the complexity of the HIV/AIDS epidemic. Third, the paper outlines a plan for a prompt and comprehensive system of HIV testing, counseling and treatment for infants and children, as well as for their parents and families, who are HIV-positive. In the process of articulating the above positions, the paper documents the failure of universal blinded infant HIV screening in New York since 1987. It further explores the inadequacies of the proposed efforts by state and city regulatory authorities to improve the testing and counseling available for pediatric HIV. Although encouraged by New York State's recent move aggressively to test and treat HIV-positive infants and children in foster care, the paper argues that this effort must be expanded to apply to the entire newborn population. Finally, the paper examines in detail the limitations of testing and counseling provided to children in the foster care system.

Child↗
PubMed1995

The case against mandatory newborn screening for HIV antibodies.

The paper examines the controversy surrounding legislative proposals in New York State that would require amending the public health law's stringent confidentiality provisions; the legislation calls for "unblinding" the results of a 7-year old statewide HIV seroprevalence study that tests newborns for HIV antibodies in order to track the incidence of HIV infection among parturient women. The pivotal point is made that mandatory disclosure of the test results is tantamount to mandatory testing of the mother, since presence (or absence) of HIV antibodies conclusively reveals the mother's HIV status. The author presents the history of the epidemiological study and documents the ongoing discussion of mandatory testing, within the medical, bioethical and public health community. Citing numerous papers, including the report of the Subcommittee on Newborn Screening of the New York State AIDS Advisory Council, the author--a member of both the council and its subcommittee--argues against the principle of mandatory testing in general and "unblinding" of the seroprevalence survey in particular. Besides making a strong argument from the ethical viewpoint, the paper provides ample medical data to support the argument that mandatory testing of newborns is poor public health policy that would be essentially ineffectual in the effort to stem the spread of HIV.

Advisory Committees↗
PubMed1994

The reproduction of America.

... This essay draws a connection between the medical procedures produced by new reproductive technologies, most specifically the use of pre-natal tests which result in abortion, and the dictates of American liberal theory. There is, I believe, a strong link between certain contemporary American abortion practices and American liberalism's formulation of and emphasis on rational individualism. The touchstone and criterion of reason as the sole measure of humanity has influenced the conditions under which we reproduce, and consequently, when we abort. Although America purports to offer certain kinds of freedom to all individuals, only those who exercise the capacity for rationality are in fact permitted to reap the benefits of liberal society.

Abortion, Eugenic↗
PubMed2005

Differences between participants and non-participants in an RCT on physical activity and psychological interventions for older persons.

BACKGROUND AND AIMS: Volunteer bias in intervention studies on successful aging has been poorly explored. This paper investigated differences between participants and non-participants of the Groningen Intervention Study on Successful Aging (GISSA) over a wide range of demographic, physical, psychological and social subject characteristics. METHODS: Subjects were recruited among a longitudinal cohort study (Groningen Longitudinal Aging Study) and included 558 men and 711 women, aged 65-96 years, who were invited to participate in the GISSA. Measures were obtained by questionnaires at the moment of invitation and eight years before invitation. Participants were compared with three groups of non-participants: persons who refused to participate, those who did not respond after a reminder, and those who intended to participate but withdrew before pre-test. RESULTS: At the moment of invitation, participants were younger, better educated, and functionally and physically more active than the three groups of non-participants. They also had better scores on the physical functioning subscale of the medical outcome scale, better ADL, iADL and vigorous ADL functions and fewer depressive symptoms, and perceived less social support in everyday and problem situations. Participants reported a less strong rate of decline in physical and psychological functioning in the eight years prior to the invitation than did the other groups. CONCLUSION: Due to volunteer bias, results of intervention studies on successful aging may have limited generalizability.

Activities of Daily Living↗
PubMed2006

Educational attainment and HIV status among Ethiopian voluntary counseling and testing clients.

We examined the association between HIV infection and educational attainment level among a population of 34,512 voluntary counseling and testing (VCT) clients in Ethiopia, using client data from the Family Guidance Association of Ethiopia (FGAE). Overall, more than 50 percent of the VCT clients report at least secondary level educational attainment, and HIV prevalence is 8.5 percent for men and 14.3 percent for women. HIV prevalence decreases significantly with each increase in education level for both men and women, and this association persists at secondary and higher education levels in the multivariate model. Male and female VCT clients with more than secondary level education are 58 percent and 66 percent (respectively) less likely to be HIV-positive than those with no education. HIV prevention and treatment interventions in Ethiopia should target less educated segments of the population including women, who have higher HIV prevalence and lower educational attainment than men.

Achievement↗
PubMed2005

Trends in voluntary HIV testing in general practices in France between 1987 and 2002.

OBJECTIVES: To measure the level of voluntary HIV testing and to assess its changes in the French general population according to the evolution of HIV testing policies. METHODS: When general practitioners belonging to the Sentinelles network (SGP) offer HIV testing to their patients, they send the network an anonymous description of the patient and a report of the test results. RESULTS: The number of HIV tests peaked in 1993 at 1760 per 100,000 inhabitants. Since 1995 the rate has fallen slightly, from 1474 to 810 per 100,000 in 2002. Between 1987 and 2002 there was a significant fall in the proportion of persons with a history of STD (31.4-5.1%, p = 0.0001), clinical signs of HIV infection (9.1-4.5%, p = 0.0002) and a history of prior testing (19.3-13.6%, p = 0.0005). CONCLUSIONS: Our results show that demand for HIV testing among the French general practice patient population has fallen since 1995, along with the frequency with which GPs offer HIV testing.

AIDS Serodiagnosis↗