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At least 775 records · Page 43Linked to original sources
PubMed1995

The impact of initiating a human immunodeficiency virus screening program in an urban obstetric population.

OBJECTIVE: Our purpose was to describe the incidence of human immunodeficiency virus infection and to assess the cost/benefit ratio of universal antenatal human immunodeficiency virus screening. STUDY DESIGN: Medical records of women in this urban obstetrics population, from the years 1988 to 1993, were examined. The incidence of known human immunodeficiency virus seropositivity at delivery was determined. The costs of performing human immunodeficiency virus screening, evaluating the disease status, and administering therapy were calculated. These costs were compared with an averaged cost for care and follow-up of infants infected through vertical transmission. RESULTS: The incidence of known human immunodeficiency virus seropositivity at delivery approximately doubled since the initiation of a human immunodeficiency virus screening program (0.26% to 0.48%). Obstetric screening added an approximate $100,000 to medical costs. The calculated cost of pediatric follow-up of human immunodeficiency virus-seropositive infants for the first 18 months was estimated at $344,355. In our population, with universal screening and zidovudine therapy, the medical costs could be reduced by $175,500 per year. CONCLUSION: A program of voluntary human immunodeficiency virus screening increases the incidence of known human immunodeficiency virus infection. Offering screening and follow-up to all pregnant patients in an urban setting is both cost-effective and medically beneficial.

Adult↗
PubMed1990

Reduction in pneumonia mortality and total childhood mortality by means of community-based intervention trial in Gadchiroli, India.

In a community-based intervention trial to reduce childhood mortality from pneumonia the intervention area included 58 villages (6176 children aged 0-4 years) and the control area 44 villages (3947 children) in Gadchiroli, India. The interventions included mass education about childhood pneumonia and case-management of pneumonia by paramedics, village health workers, and traditional birth attendants (TBAs) who were trained to recognise childhood pneumonia and treat it with co-trimoxazole. Parents sought treatment, and coverage was 76% without active case-detection efforts. The case-fatality rate among the 612 cases treated by health workers was 0.8%, compared with 13.5% in the control area. After a year of intervention pneumonia-specific childhood mortality was significantly lower in the intervention than in the control area (8.1 vs 17.5 deaths per 1000 children under 5 years); the difference between the areas was greatest in children under 1 year. The differences in infant mortality (89 vs 121 per 1000) and total under-5 mortality (28.5 vs 40.7 per 1000) were highly significant. Mortality from other causes remained similar in the two areas but neonatal mortality due to birth injury and prematurity was significantly lower in the intervention area, presumably owing to the combination of better maternal and neonatal care by the TBAs trained in the project and the availability of treatment for pneumonia. The cost of co-trimoxazole was US $0.025 per child per year ($2.64 per child saved).

Administration, Oral↗
PubMed1991

Routine prenatal screening for HIV infection.

Guidelines in most developed countries for testing pregnant women for HIV infection recommend that screening should be directed to groups with acknowledged risk factors for infection. Our prospective study of HIV seroprevalence among 2724 pregnant women in an inner-city area of Baltimore, USA, showed that if these guidelines had been applied only 57% of HIV-seropositive women would have been detected. By offering counselling and HIV testing to all pregnant women, the detection rate was raised to 87%. We conclude that screening directed at women who admit risk factors is not effective in identifying HIV-infected women and that routine HIV screening should be offered to all pregnant women.

Adult↗
PubMed1991

Should surgical patients be screened for human immunodeficiency virus infection?

There are increasingly strong arguments for the introduction of wider screening of all kinds of patients, including surgical patients, to diagnose otherwise undetected human immunodeficiency virus (HIV) infection in order to facilitate earlier treatment of HIV infection with zidovudine. Wider screening may also help to limit the spread of HIV in the community as infected patients may be counselled and more effective public health measures planned. In areas of high prevalence voluntary universal screening test programmes should be encouraged whereas in areas of low to medium prevalence more selective screening tests would be appropriate on people belonging to risk groups. Screening of patients undergoing elective surgery for infection control purposes is most appropriate in areas of low to medium prevalence so that extra precautions in the operating theatre can be selected for those patients who are screened and deemed to be at high risk. Screening methods include taking a comprehensive clinical history to include specific questions about risk group behaviour, questionnaire methods, serological screening tests and a combination of these three types of approach. Screening HIV antibody tests are recommended, with informed consent, of those patients who belong to risk groups. A further benefit of screening for infection control purposes occurs in the event of a sharps injury when prior testing of the source patient helps to facilitate decision making about the giving of immediate zidovudine prophylaxis.

AIDS Serodiagnosis↗
PubMed1989

Community and individual considerations in legislation and test policy regarding HIV-infection in the Nordic countries--a cross national comparative study.

The purpose of the study is to facilitate international co-operation and national development on AIDS-policy by describing and comparing the programmes on the control of AIDS in the five Nordic countries. This article is focusing especially on community and individual considerations in legislation and test policy regarding HIV-infection in relation to general testing, testing of special groups, registration, voluntariness and confidentiality. The data were collected in the period of April-December 1987 by a review of existing documental material, mailed questionnaires to key persons in the health agencies in each country and personal interviews with 60 representatives of relevant organisations and institutions. The analysis of the data demonstrate that all the Nordic countries are seeking compromises which try to satisfy individual as well as community needs, although with different weight attached to the elements involved. Compared with international recommendations, national AIDS-policies in the Nordic countries in some instances do not fully respect voluntariness and confidentiality. It is concluded that AIDS-policy should be studied in the context of national traditions concerning general health policy, individual rights and community protection.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Donated blood--gift or commodity? Some economic and ethical considerations on voluntary vs commercial donation of blood.

The author applies the theory of public goods on donated blood. Donated blood may be taken as a 'public good' like water and air, police and fire brigades. This theory trends to imply a preference for voluntary donation and bloodbanking by public and nonprofit organisations as well as for low cost supply. An additional commercial supply of blood nevertheless is welcome. Quality as well as quantity of blood depend first of all on the willingness to donate and the honesty of the donors about their health. An altruistic motivation alone, which is not triggered by some material incentive, does not in all systems guarantee a sufficient quantity of safe blood. Both the altruistic as well as the reimbursement-oriented donor's willingness and honesty have to be guarded by sound practice in bloodbanking and adequate public control within a legal framework which reflects the vital role of blood supply. A legal implementation of product liability will certainly be an important instrument in this field.

Altruism↗
PubMed1995

Presynaptic inhibition in humans.

Presynaptic inhibition plays an important role in controlling sensory processing of information in humans, as in other animals. However, because of experimental constraints the methods for measuring presynaptic inhibition are necessarily more indirect in humans. The most common method uses the modulation of the H-reflex by vibratory or electrical inputs. However, these stimuli can produce postsynaptic as well as presynaptic changes so it is important to use very short periods of stimulation and measure changes at a latency where presynaptic changes predominate. In addition, the stimuli should be superimposed upon a steady background of EMG activity, preferably in a single motor unit, to maintain the postsynaptic state at a constant level. Recent studies indicate that presynaptic inhibition is used as part of the program for voluntary movement and that it can be rapidly and dramatically adapted to the task being carried out. This task-dependent modulation is produced by pattern generators within the central nervous system as well as sensory feedback from the periphery, but the relative importance of the two remains uncertain. Clinical disorders, such as spasticity, affect the ability of humans to modulate presynaptic inhibition, and contribute to the deficits observed. Improved methods for treating the symptoms pharmacologically and electrically can improve function in these patients.

Electromyography↗
PubMedDate not supplied

The HIV-infected health care worker: legal, ethical, and scientific perspectives.

Emergency medical health care workers may face restrictions on their practices as state responses to federal mandates concerning human immunodeficiency virus (HIV) and hepatitis B virus (HBV) evolve. This article presents an analysis of legal, ethical, and scientific considerations for making decisions about the practices of HIV-infected health care workers (HCWs). A four-factor product analysis is proposed for risk assessment, and recommendations are developed related to decreasing the risk of HIV transmission in the health care setting while maintaining HCW rights.

Beneficence↗
PubMed1996

A rational approach to regulation of gene therapy in Canada.

Gene therapy offers prospects of dramatically improved treatments for and possibly true cures of previously intractable diseases, and has therefore attracted much public interest and hopeful expectation. At the same time, it involves new and exploratory techniques and potential risks to patients. The definition of a drug in the Canadian Food and Drugs Act clearly includes materials used to effect gene therapy and also the products of genetic manipulations. The regulatory framework in Canada is based on risk management. The potential hazards and benefits of gene therapy and similar interventions will be assessed for categorization according to risk and an appropriate level of control, with the additional principle of deriving positions that are harmonized with those of counterpart regulatory agencies.

Advisory Committees↗
PubMed2004

[Comparison of two electrical stimulation protocols on quadriceps muscle after anterior cruciate ligament surgery. Feasability study].

OBJECTIVES: To evaluate the feasibility of a study comparing the effects of two protocols of electrical stimulation of the quadriceps femoris after anterior cruciate ligament surgery. MATERIAL: Seven sportsmen with a mean age of 26 yrs were randomly grouped in two: a 20 Hz stimulated group (4 patients) and a 80 Hz stimulated group (3 patients). After surgery all patients received electrical stimulation of the quadriceps femoris, five days a week, for 12 weeks, and had a standard program of voluntary contractions. The main outcome assessed before and three months after surgery were: quadriceps and hamstring peak torque at 90, 180 and 240 degrees /second, maximal isometric quadriceps at 75 degrees of flexion and muscle and subcutaneous fat volumes of the thigh using MRI. RESULTS: After 12 weeks of rehabilitation, the thigh muscle volume deficit of the operated limb was between 3 and 9% in the 20 Hz stimulated group and between 1 and 2% in the 80 Hz stimulated group. Quadriceps peak torque deficit was less than 30% except for two patients in the 20 Hz stimulated group. Maximal isometric quadriceps deficit of the operated limb was higher than 30% except for two patients in the 20 Hz stimulated group. CONCLUSION: The study showed that comparison of two protocols of electrical stimulation of the quadriceps femoris after anterior cruciate ligament surgery is possible if stimulation period is not more than four weeks.

Adult↗
PubMed2005

How can the community contribute in the fight against HIV/AIDS and tuberculosis? An example from a rural district in Malawi.

This paper describes (a) the experience of initiating community involvement in HIV/AIDS and tuberculosis (TB) activities in a rural district in Malawi and (b) some of the different ways in which the community is contributing in the fight against these two diseases and the outcomes of their involvement. During a 2-year period, a total of 21,358 (41%) of 52,510 HIV tests performed at voluntary counselling and HIV testing (VCT) sites in the district were conducted by lay community counsellors. A team of 465 community volunteers, 1,362 trained family caregivers and 9 community nurses provided care and support to 5,106 HIV-positive individuals, of whom 2,006 (39%) were in WHO stage III or IV. All those in WHO stage III or IV were on co-trimoxazole prophylaxis and 895 (45%) of these were also on antiretroviral treatment. A total of 2,714 TB patients, of whom 1627 (60%) were HIV-positive, also received care and support. A total of 1,694 orphans were trained in vocational skills. Twelve vegetable gardens and three maize farms were set up, and pre-school activities were organised for 900 orphans. Communities can play an important contributory role in reducing the burden of HIV/AIDS and TB and in mitigating its impact. Despite this, community resources in most settings are often under-exploited and their role remains undefined.

Attitude to Health↗
PubMed2005

Dynamics of virus infections involved in the bovine respiratory disease complex in Swedish dairy herds.

The dynamics of bovine respiratory syncytial virus (BRSV), bovine parainfluenza virus 3 (PIV-3), bovine corona virus (BCoV) and bovine viral diarrhoea virus (BVDV) infections were studied in 118 dairy herds in south western Sweden. By using serology on paired samples from three approximately 7 vs. approximately 15-month-old calves per herd, the propagation of infections was investigated over about a 1-year period. The results implied that at least 74% of calves had experienced one or more of the monitored infections at the age of approximately 7 months (Sample 1, Spring); 30%, 48%, 34% and 8% were seropositive to BRSV, PIV-3, BCoV and BVDV, respectively. Seroconversions to BRSV, PIV-3, BCoV and BVDV occurred in 26%, 38%, 50% and 3% of seronegative animals and 63% had antibodies against two or more infections at approximately 15 months (Sample 2). In total, 90-97% of animals that were seropositive in Sample 1 remained positive in Sample 2. A significant association was found between BVDV and BCoV (P = 0.01). Moreover, a significantly higher proportion of herds in which no calves had a recorded history of respiratory disease (n = 15) were classified as negative to all four infections monitored when compared to herds in which disease was observed (P = 0.0002). This study showed a high infection burden in young animals and effective spread of BRSV, PIV-3 and BCoV in one area of Sweden. BVDV infections were restricted to a few herds, reflecting the effect of a voluntary control program against BVDV in Sweden.

Animal Husbandry↗