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PubMed2001

Dental device-associated problems: an analysis of FDA postmarket surveillance data.

BACKGROUND: The authors provide an analysis of dental device adverse event reports collected through the U.S. Food and Drug Administration's, or FDA's, mandatory and voluntary reporting programs between Aug. 1, 1996, and June 30, 1999. METHODS: This study includes an analysis of the total number of dental device adverse events reported during the study period and uses descriptive statistics to depict reporters' occupations, types of adverse events (deaths, injuries, malfunctions), device categories, device problems and patient problems. RESULTS: A total of 272,241 device reports were received during the 35-month study period, 28,555 (10.5 percent) of which involved dental devices. Within these reports, two deaths (0.007 percent), 18,406 injuries (64.4 percent) and 9,942 device malfunctions (34.8 percent) were reported. The most commonly reported dental devices were endosseous implants, which represented more than 90 percent of all dental device reports. Most reports (84.1 percent) provided the reporter's occupation, and the most frequently cited occupation was dentist (76.3 percent), followed by dental assistant (4.2 percent). CONCLUSIONS: Dentists and dental staff members are a vital link in the FDA's adverse event reporting system and are encouraged to report device problems to the FDA MedWatch program.

Data Collection↗
PubMed2003

Voluntary HIV counseling and testing during prenatal care in Brazil.

OBJECTIVE: Voluntary HIV counseling and testing are provided to all Brazilian pregnant women with the purpose of reducing mother-to-child HIV transmission. The purpose of the study was to assess characteristics of HIV testing and identify factors associated with HIV counseling and testing. METHODS: A cross-sectional study was carried out comprising 1,658 mothers living in Porto Alegre, Brazil. Biological, reproductive and social variables were obtained from mothers by means of a standardized questionnaire. Being counseling about HIV testing was the dependent variable. Confidence intervals, chi-square test and hierarchical logistic model were used to determine the association between counseling and maternal variables. RESULTS: Of 1,658 mothers interviewed, 1,603 or 96.7% (95% CI: 95.7-97.5) underwent HIV testing, and 51 or 3.1% (95% CI: 2.3-4.0) were not tested. Four (0.2%) refused to undergo testing after counseling. Of 51 women not tested in this study, 30 had undergone the testing previously. Of 1,603 women tested, 630 or 39.3% (95% CI: 36.9-41.7) received counseling, 947 or 59.2% (95% CI: 56.6-61.5) did not, and 26 (1.6%) did not inform. Low income, lack of prenatal care, late beginning of prenatal care, use of rapid testing, and receiving prenatal in the public sector were variables independently associated with a lower probability of getting counseling about HIV testing. CONCLUSIONS: The study findings confirmed the high rate of prenatal HIV testing in Porto Alegre. However, women coming from less privileged social groups were less likely to receive information and benefit from counseling.

Adolescent↗
PubMed2006

[Profile of prostate cancer at the general hospital of Porto Alegre].

OBJECTIVES: To describe prevalence and features of prostate cancer in the sample. METHODS: A five year long voluntary screening program was carried out in the "Hospital das Clínicas de Porto Alegre" with the participation of 3,056 patients in a cross sectional study. For statistical analysis the chi square test was used, considering a significance level of p < 0.05 RESULTS: Mean age of the sample was of 60.4 years and prevalence of prostate cancer was of 2.61%, increasing with age. Sensitivity and specificity of PSA were respectively 93.8% (CI = 85.4% to 97.7%) and 82.5% (CI = 81.1% to 83.8%), considering 4 ng/ml as the cut-off point for PSA. Rectal examination had a sensitivity of 60% (CI = 48.4% to 70.6%) and a specificity of 83.3% (CI = 81.9% to 84.6%) The number of biopsies performed for the diagnosis of a patient with prostate cancer was 11.9 and varied according to age. As for clinical staging, 51.3% of patients were T1C and 83.75% of the tumors were clinically confined to the organ. CONCLUSION: Screening programs can be performed in our environment and direct to a frequent diagnosis of patients with prostate cancer confined to the organ.

Adenocarcinoma↗
PubMed1988

Effects of HIV antibody test knowledge on subsequent sexual behaviors in a cohort of homosexually active men.

This study assesses the effects of HIV (human immunodeficiency virus) antibody testing on subsequent (one year) sexual behavior among 270 homosexual men at a Boston community health center, 21 per cent of whom were unaware of their test result. Except for the number of steady partners, the levels of all sexual activities of all groups of study participants declined over time. No effects of test awareness of antibody status were found on protective behavior for receptive anogenital contact. Elimination of unprotected insertive anogenital contact (by elimination of the practice or by condom use) was reported somewhat more often among seropositive men who became aware of their test result. Increased negative emotional reactions were reported by HIV seropositive men who were aware of their test result. These results suggest some behavioral impact of HIV antibody test knowledge in this cohort, but may not be generalizable to other populations.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Carrier screening for cystic fibrosis: a pilot study of the attitudes of pregnant women.

We surveyed the attitudes of a consecutive sample of 306 pregnant Caucasian women toward carrier screening for cystic fibrosis. Of the 214 respondents, 98% said that screening should be offered before pregnancy, and 69% said they would accept carrier screening during pregnancy. Twenty-nine percent of the respondents indicated a willingness to terminate a pregnancy if the fetus were found to have cystic fibrosis. We conclude that carrier screening is of interest to pregnant women, although interest in terminating a pregnancy because of screening results may be limited.

Adolescent↗
PubMed1993

The dual epidemics of tuberculosis and AIDS: ethical and policy issues in screening and treatment.

As the recent increase in cases of tuberculosis is addressed, there is a danger that the need for increased protection of the public health will create a climate in which the rights of individuals with tuberculosis and human immunodeficiency virus (HIV) infection may be disregarded. This paper considers ethical and policy issues in the control of tuberculosis. The authors conclude that mandatory HIV testing is not critical to effective tuberculosis control, and that although individuals infected with HIV are at increased risk for developing tuberculosis, exclusionary employment practices are not justified. Because failure to complete the course of tuberculosis treatment increases the prospect that drug-resistant strains will develop, it is crucial to require all those who commence treatment to complete their therapy. To ensure the completion of treatment, special attention must be paid to the needs of the homeless, drug users, and those with psychiatric impairments. In addition, all tuberculosis patients should begin their posthospital care under direct observation. Patients who fail to complete treatment despite efforts to encourage and facilitate their cooperation should be subject to confinement after a hearing with full due process protections.

AIDS Serodiagnosis↗
PubMed1998

Informed consent for HIV testing in a South African hospital: is it truly informed and truly voluntary?

OBJECTIVE: The purpose of this study was to assess informed consent to human immunodeficiency virus (HIV) testing in a perinatal HIV transmission study in a major referral hospital serving a largely Black population in South Africa. METHODS: First-time antenatal clinic attenders who were randomly selected from those enrolled in the perinatal HIV study (n = 56) answered questionnaires before and after counseling. RESULTS: Knowledge of HIV transmission and prevention, high at the outset, was little improved after counseling. The acceptance rate for HIV testing was high. Despite assurances that participation was voluntary, 88% of the women said they felt compelled to participate in the study. CONCLUSIONS: Informed consent in this setting was truly informed but not truly voluntary.

AIDS Serodiagnosis↗
PubMed1994

The evolution of a public health policy: health care providers and the transmission of HIV.

The single known instance of transmission of HIV from a health care provider to a patient raised issues concerning the responsibility of clinicians to their patients, and sparked debate over policies to prevent the spread of HIV in health care facilities. The intensity and politicization of the debate were reflected in revision of the Centers for Disease Control guidelines to control the spread of infection at health care facilities, and in legislation proposed in Congress. The guidelines and proposed legislation provoked responses by public health and medical organizations, several of which considered the measures to be unnecessarily restrictive and too costly in terms of potential benefits. This article describes the events and responses that took place during 1991-1992 after the public was made aware of the case involving transmission from provider to patient. The author examines the situation in the context of public health efforts to control the spread of HIV.

AIDS Serodiagnosis↗
PubMed1985

Health personnel training in the Nicaraguan health system.

The "Unified National Health System" of Nicaragua was established in 1979, in an attempt to transform some of Latin America's worst health indices. This system, based on the stated principles of planning, regionalization, public participation, and primary care, has prioritized the development of health professions training programs appropriate to its special needs and principles. Public Health and Epidemiology training was inaugurated in 1982. A new campus of the School of Medicine was opened in 1981, increasing the number of medical students by a factor of five. Formal residency training (never before available within the country) in primary care specialties has been established. Training for allied health personnel has been formalized in several fields, with the establishment of the Polytechnical Institute of Health. The rapid increase in number and size of training programs has created a tremendous need for educational resources both human and material. This article reviews the status of health personnel training in Nicaragua today, the integration of these programs into planning for the health system, and problems arising from their rapid appearance.

Allied Health Personnel↗