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PubMed2004

Ethical principles for collective immunisation programmes.

Ethical issues arise in discussion of both the content and implementation of collective immunisation programmes. In this paper we propose and discuss seven principles that may guide reflection and debate in this controversial area. Whilst this paper is not intended to be a final and complete account of the relevant principles for collective immunisation programmes we hope that it can help stimulate more active discussion of these issues. Debate about these principles may help to make moral conflicts more explicit and open up the possibility of resolution. We argue that analysis and discussion of the ethical issues should be part of any justification of collective vaccination programmes.

Humans↗
PubMed1996

Physician attitudes toward human immunodeficiency virus testing in pregnancy.

OBJECTIVE: Our purpose was to determine physician attitudes regarding voluntary versus mandatory status of human immunodeficiency virus testing in pregnant women. STUDY DESIGN: A questionnaire was sent to a sampling of the membership in District IX of The American College of Obstetricians and Gynecologists. Members were queried about experience with pregnant patients who were human immunodeficiency virus positive. Practice characteristics were sampled, as were experiences with antiviral agents in pregnant women. RESULTS: Physician attitudes were influenced by their type of medical practice environment. Bioethical considerations were further influenced by data reflecting zidovudine use in pregnant women. Two thirds of respondents favored mandatory human immunodeficiency virus testing of all pregnant patients. More than 90% favored public health reporting of all human immunodeficiency virus-positive patients. One quarter of respondents were not current on California human immunodeficiency virus codes. A persistent percentage do not offer human immunodeficiency virus counseling or testing. CONCLUSION: Considerable physician support exists for mandating human immunodeficiency virus testing in all pregnant patients as the primary means of decreasing maternal-fetal human immunodeficiency virus transmission and the considerable resulting costs.

Attitude of Health Personnel↗
PubMed1995

Growth monitoring: the role of community health volunteers.

A community volunteer programme was initiated in rural Jamaica in May 1990. The main aim of the programme was to monitor the growth of children less than 36 months of age through community health volunteers (CHVs) and improve their nutritional status. At the end of the second year the programme was evaluated to determine its effectiveness. The results of the evaluation indicated that almost all (95.6%) of the children were covered by the CHVs. In addition the participation rate was high (78.5%). However, only 50% of the children were adequately covered. Nonetheless, 81% of them gained adequate weight. Indeed, malnutrition levels declined by 34.5%. The annual cost per child per year for the total programme was fairly moderate (US$14.5) with growth monitoring accounting for nearly half (42.7). The results suggest that CHVs can play an important role in primary health care programmes in developing countries.

Adult↗
PubMed1996

Reporting results of laparoscopic procedures. The state-wide registry approach.

The rapid development of technology facilitating minimally invasive surgery has challenged the surgical community to evaluate the safety and efficacy of these new techniques even as they were being widely utilized. The publication of retrospective series in a few institutions was followed by widespread adoption of laparoscopic cholecystectomy and subsequent reports of increased complications from the procedure. Other laparoscopic procedures such as antireflux operations and colectomy for cancer require greater technical skill and hold potential for significant morbidity. Because a prospective, randomized clinical trial is unlikely for these procedures, other measures of results need to be examined. A state registry is one such outcome study to be considered. In the state of Oregon we designed and implemented a voluntary registry program for these advanced procedures. Although the antireflux procedures are apparently being done safely, conclusions that can be drawn from such a registry are limited because of incomplete data collection. For a registry to be maximally effective, an automatic method of data accumulation is needed that will capture all cases that are done as well as follow-up information.

Cholecystectomy, Laparoscopic↗
PubMed1988

Trial of anonymous versus confidential human immunodeficiency virus testing.

Before December, 1986, all public human immunodeficiency virus (HIV) testing in Oregon was done confidentially (using names). In December, clients were offered the option of either anonymous or confidential services. As judged by questionnaire responses, the availability of anonymity increased overall demand for testing by 50%: 125% for homosexual/bisexual (gay) men, 56% for female prostitutes, 17% for intravenous drug users, and 32% for other clients. The number of gay clients who had tests increased from a mean of 42 per month during the 4 months before anonymity was available to 108 per month during the 4 months after, whereas, at public sites in Colorado or California and private sites in Oregon, the number of gay clients tested did not increase. Twice as many seropositive persons were identified during the 3 1/2 months after anonymity became available (n = 85) as in the 3 1/2 months before (n = 36). Thus, availability of anonymous HIV testing and counselling drew gay men who had not sought services under a confidential testing system.

California↗
PubMed1989

Antenatal testing for human immunodeficiency virus. Results from the Royal College of Obstetricians and Gynaecologists' National Study of HIV Infection in Pregnancy.

Current policies on antenatal testing for human immunodeficiency virus (HIV) in the main obstetric units of the United Kingdom and the Republic of Ireland were surveyed by postal questionnaire; 294 of 299 units responded. HIV testing was available at 192 (65%) of the 294 units that responded. 414 HIV-positive pregnancies in 386 women were reported from 74 (25%) units. Most were from Scotland, the four Thames Regions, and Ireland. In 46% of the HIV-positive women the infection was identified by antenatal testing; the remainder had been tested previously and knew that they were infected. The findings support the view that selective antenatal testing should be established in areas where no testing is offered at present and possibly that testing should be offered to all pregnant women in high-prevalence areas.

Counseling↗
PubMed1991

Screening for fetal and genetic abnormalities.

Screening for genetic abnormalities is an integral part of obstetrics. Prior to initiating screening, however, several prerequisites must be met: (i) capacity to alter clinical management, (ii) cost effectiveness, (iii) reliable means (usually assays) of assessment, and (iv) capacity to handle problems. In all pregnancies one should determine in systematic fashion whether family history places a pregnant woman at increased risk over the background risk of 2-3% congenital anomalies. All women over age 35 years at delivery should be offered prenatal cytogenetic testing, and women of all ages should be offered maternal serum alpha-fetoprotein screening for neural tube defects. Screening ostensibly normal populations is appropriate in certain ethnic groups to determine heterozygosity for selected disorders: Blacks for sickle-cell anaemia, Mediterranean people for beta-thalassaemia, Southeast Asians and Filipinos for alpha-thalassaemia, Ashkenazi Jews and perhaps French-Canadians for Tay-Sachs disease. Cystic fibrosis screening (delta F508 mutations) is not currently recommended for the general populations, but should be offered to relatives of an individual having delta F508 cystic fibrosis. Irrespective of the extent of screening programmes for Mendelian traits, the mutant allele will remain in the general population because by far the greatest genetic load lies in clinically normal heterozygotes, affected contributing far less to the load despite the obvious clinical effect.

Abortion, Legal↗
PubMed2006

Promoting female condoms in HIV voluntary counselling and testing centres in Kenya.

Promotion of male condoms and voluntary counselling and testing for HIV (VCT) have been cornerstones of Kenya's fight against the HIV epidemic. This paper argues that there is an urgent need to promote the female condom in Kenya through VCT centres, which are rapidly being scaled-up across the country and are reaching increasingly large numbers of people. Training of counsellors using a vaginal demonstration model is needed, as well an adequate supply of free female condoms. In a study in five VCT centres, however, counsellors reported that most people they counselled believed female condoms were "not as good" as male condoms. In fact, many clients had little or no knowledge or experience of female condoms. Counsellors' knowledge too was largely based on hearsay; most felt constrained by lack of experience and had many doubts about female condoms, which need addressing. Additional areas that require attention in training include how to re-use female condoms and the value of female condoms for contraception. VCT counsellors in Kenya already promote male condoms as a routine part of risk reduction counselling alongside HIV testing. This cadre, trained in client-centred approaches, has the potential to champion female condoms as well, to better support the right to a healthy and safe sex life.

Single-Use Internal Condom↗