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PubMed1994

AIDS-associated Kaposi's sarcoma and non-Hodgkin's lymphomas reporting in Italy: a linkage study.

To evaluate the completeness and accuracy in the reporting of AIDS-associated Kaposi's sarcoma (KS) and non-Hodgkin's lymphomas (NHL) in Italy, a linkage study of the notifications to the Italian AIDS Registry (RAIDS--the national compulsory AIDS surveillance system) and the clinical and pathological records of the Italian Cooperative Group on AIDS-related tumors (GICAT--a nationwide voluntary reporting system for HIV-infected individuals who develop cancer) was carried out. A total of 288 cases of KS and 258 cases of NHL fulfilling the AIDS definition criteria, histologically diagnosed by the GICAT centers between January 1987 and March 1992, were matched with the 16,860 AIDS cases reported to the RAIDS up to March 1993. The linkage procedure, based on name, gender, and date of birth, identified 276 cases of KS (96%) and 241 cases of NHL (93%) present in both files ("linked" cases). The diagnosis of KS did not appear among the clinical manifestations of AIDS in the RAIDS file in 67 out of the 276 linked KS (24%), either with coincident dates of KS diagnosis and of case notification (19 cases) or when the KS diagnosis followed by > or = 2 months the case notification to RAIDS (48 cases). Of the 241 linked NHL, 84 (33%) had no such neoplastic complications of AIDS listed in the RAIDS file, 23 with coincident dates of NHL diagnosis and of case notification and 61 with the NHL diagnosis made > or = 2 months after the notification. A noteworthy discrepancy in the classification of the three histologic subtypes of NHL emerged between the GICAT and the RAIDS. The degree of underreporting of AIDS-associated cancers that emerged from the present study suggests that augmentation with other sources of oncological information is important to better estimate the burden of AIDS-related tumors and to study the interaction between HIV infection and cancer.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Estimating the incidence of rheumatoid arthritis: trying to hit a moving target?

OBJECTIVE: To examine the effect of delay between symptom onset and notification to an arthritis register and the effect of application of the American College of Rheumatology (ACR; formerly, the American Rheumatism Association) 1987 criteria in a cumulative manner on estimates of the incidence of rheumatoid arthritis (RA). METHODS: General practitioners and/or hospital consultants in the Norwich Health Authority, Norfolk, UK, notified the Norfolk Arthritis Register (NOAR) of all patients who had onset of inflammatory polyarthritis (swelling of > or =2 joints) during 1990. The patients were assessed within 2 weeks of notification and annually thereafter. The ACR 1987 criteria for RA were applied at each assessment. Age- and sex-specific incidence rates were calculated. RESULTS: If up to 12 months elapsed from symptom onset to notification to NOAR and the ACR criteria were applied at the baseline assessment, RA incidence estimates, age-adjusted to the population of England and Wales, were 30.8/100,000 for women and 12.7/100,000 for men. If up to 5 years elapsed from symptom onset to notification, these estimates rose by 45% for women and 36% for men. If up to 5 years elapsed between symptom onset and notification and the criteria were applied cumulatively, the estimates rose by 75% and 93% for women and men, respectively, compared with the 1-year data, reaching 54.0/100,000 for women and 24.5 per 100,000 for men. CONCLUSION: Accurate estimation of the incidence of RA requires long-term followup of patients who present with undifferentiated inflammatory polyarthritis. The highest age-adjusted estimates from this study are probably the best that are available.

Adolescent↗
PubMed2005

Notified cases of occupational asthma in Norway: exposure and consequences for health and income.

BACKGROUND: Estimates of occupational asthma (OA) may vary between countries and within countries. An overview of cases of occupational asthma in Norway has not been presented previously. Norwegian physicians are obliged to report occupational diseases to the Labor Inspection Authority. The registry of these notifications was used to study the cases of OA. METHODS: Data were collected from the notifications for respiratory disease for the period 1995-1999. A postal questionnaire inquiring into work, respiratory symptoms, smoking, and socioeconomic consequences of the disease was sent to 1,239 workers with a physician's diagnosis of obstructive respiratory disease. RESULTS: The response rate to the questionnaire was 81% (1,000 workers of whom 723 had OA). On an average, 223 annual cases of OA were reported in the study period (1995-1999). The highest incidence of notifications was found in the primary aluminum industry and in bakers, car painters, and welders. At the time of notification, more than half of the workers had left their original jobs. At the time of this study 2-6 years later, approximately the same proportion of workers had experienced a reduction in income and had received financial compensation; 60-78% were still on antiasthmatic medication. DISCUSSION: The notification of OA by Norwegian physicians may underestimate the true incidence considerably. A majority of the notified cases seemed to become chronic despite medical treatment. CONCLUSIONS: More emphasis should be put on early recognition of OA and on the reduction or cessation of exposure after the diagnosis of OA.

Adult↗
PubMed2005

Infovigilance: reporting errors in official drug information sources.

INTRODUCTION: The French drug database Thériaque (http://www.theriaque.org) developed by the (Centre National Hospitalier d'Information sur le Médicament) (CNHIM), is responsible for the dissemination of independent information about all drugs available in France. Each month the CNHIM pharmacists report problems due to inaccuracies in these sources to the French drug agency. In daily practice we devised the term "infovigilance": "Activity of error or inaccuracy notification in information sources which could be responsible for medication errors". The aim of this study was to evaluate the impact of CNHIM infovigilance on the contents of the Summary of Product Characteristics (SPCs). METHOD: The study was a prospective study from 09/11/2001 to 31/12/2002. The problems related to the quality of information were classified into four types (inaccuracy/confusion, error/lack of information, discordance between SPC sections and discordance between generic SPCs). MAIN OUTCOME MEASURES: (1) Number of notifications and number of SPCs integrated into the database during the study period. (2) Percentage of notifications for each type: with or without potential patient impact, with or without later correction of the SPC, per section. RESULTS: 2.7% (85/3151) of SPCs integrated into the database were concerned by a notification of a problem. Notifications according to type of problem were inaccuracy/confusion (32%), error/lack of information (13%), discordance between SPC sections (27%) and discordance between generic SPCs (28%). 55% of problems were evaluated as 'likely to have an impact on the patient' and 45% as 'unlikely to have an impact on the patient'. 22 of problems which have been reported to the French drug agency were corrected and new updated SPCs were published with the corrections. CONCLUSIONS: Our efforts to improve the quality of drug information sources through a continuous "infovigilance" process need to be continued and extended to other information sources.

Contraindications↗
PubMed1992

HIV-related tuberculosis in England and Wales.

Numbers of tuberculosis notifications in England and Wales increased by 8% from 1987 to 1989. An analysis of notifications by age and sex has been undertaken to determine whether this increase has been due to an increase in young male adults, as has occurred in the USA, implying that HIV is largely responsible for the increase in notifications. Though notifications increased by 9.5% in younger males between 1987 and 1989 they also increased by over 10% amongst most age groups of females, and elderly males. These findings would suggest that there are a number of factors causing a rise in tuberculosis notifications, and that HIV is not yet directly implicated in England and Wales.

Adolescent↗
PubMed2005

Are adolescent girls with Chlamydia infection notifying their partners?

OBJECTIVES: (1) To determine the proportion of inner-city adolescent girls diagnosed with chlamydial cervicitis who notify their sex partners; (2) to examine girls' attitudes and perceptions about partner notification and treatment; and (3) to assess whether or not girls knew if their partners were treated for chlamydia infection. DESIGN/METHODS: Adolescent girls who had a positive DNA hybridization test for chlamydial cervicitis from March 2000 to May 2002 completed a 37-item self-administered survey assessing sexual behavior and partner notification, as well as the Rosenberg self esteem scale. Subjects completed the survey 1-3 months after the diagnosis of chlamydia infection. RESULTS: Fifty-five adolescent girls (46% Hispanic, 36% African American) aged 13-21 years (mean 18.3 years) completed the survey. The median age at first intercourse was 14 (SD = 1.6); median number of lifetime sex partners was 4. Forty-one subjects (75%) notified their sex partners. The most common reasons for partner notification were"I did not want my sex partner to give the infection back to me"and"I wanted to let my sex partner know that he/she had given me the infection". There was a trend toward increased notification if the girls were 18 years of age or older (P = 0.07) or had only one lifetime sex partner (P = 0.08). Of the 41 subjects who notified their partners, 22 (54%) reported that the partners were treated; 16 did not know, and three knew that partners were not treated. CONCLUSIONS: The majority of inner-city girls in this study notified their partners about chlamydia infection. Self-protection from re-infection was an important reason given for notification and suggests that girls in committed ongoing relationships might be more likely to notify partners.

Adolescent↗
PubMed2002

Screening for depression in patients in long-term care facilities: a randomized controlled trial of physician response.

OBJECTIVES: To determine the effect of a screening protocol using the Geriatric Depression Scale (GDS) on the frequency of primary care physicians' decisions to prescribe drug therapy or refer long-term care patients with possible depression to mental health care. DESIGN: Case-finding phase, followed by a randomized controlled trial of the effect of a physician-targeted intervention on antidepressant prescribing or referral to mental health services. SETTING: Twenty-two nonacademic long-term care facilities. PARTICIPANTS: One hundred three of 1,602 patients aged 65 and older who met criteria for cognitive function and untreated symptoms of depression. INTERVENTION: The 77 physicians of these patients were randomized as clusters into an early notification (experimental) or a delayed notification (control) group. MEASUREMENTS: Frequency of physician response (mental health consult or antidepressant therapy) at 4 and 8 weeks from notification, physician follow-up, and factors associated with physician response. RESULTS: Frequency of physician response in the early group (25%) was greater than in the delayed group (2%) (P <.005) 4 weeks from baseline. Physician response rate when the groups were combined was 36% (95% confidence interval (CI) = 26%-46%) 8 weeks from notification. Overall, there was evidence of physician action after letters of notification in 69% (95% CI = 60%-78%) of cases. Univariate logistic regression suggested that physicians' decisions were primarily associated with physician-related characteristics. CONCLUSIONS: Screening of long-term care patients for depression can increase the frequency of treatment or referral by primary care physicians.

Adult↗
PubMed1998

Response rate to mailed epidemiologic questionnaires: a population-based randomized trial of variations in design and mailing routines.

Although self-administered questionnaires are major sources of information in epidemiology, comparatively little has been done to study practical aspects of design and mailing. The objective of this study was to evaluate various measures taken to increase the response rate. A questionnaire was mailed in July 1995 to a random sample (n = 2,000) of the Swedish population aged 20-79 years. Using a randomized factorial study design, the questionnaire and mailing procedures were changed in three ways: preliminary notification, length of the questionnaire, and mention of telephone contact. The overall questionnaire retrieval rate was 49%. Preliminary notification (adjusted odds ratio of receiving a completed questionnaire = 1.30, 95% confidence interval (CI) 1.08-1.56 relative to the absence of preliminary notification) and short length of the questionnaire (odds ratio = 1.24, 95% CI 1.04-1.48 relative to a long questionnaire) were both independently associated with a higher retrieval rate. Of eight possible combinations, the one comprising preliminary notification, a short questionnaire, and no mention of telephone contact gave the highest retrieval rate, 56%. The lowest retrieval rate, 40%, was observed for the combination of no preliminary notification, a long questionnaire, and mention of telephone contact. Young age, male sex, and urban residence significantly lowered the retrieval rate. Although there was a positive association between the questionnaire retrieval rate and partial nonresponse (missing answers in retrieved questionnaires), the marginal losses due to the latter did not cancel the gains by optimized mailing routines. Old age was the strongest determinant of partial nonresponse. The data provide evidence that design and mailing strategies, as well as demographic characteristics, may greatly influence the response rate of mailed epidemiologic questionnaires.

Adult↗
PubMed1990

Psychological responses to serological testing for HIV.

To determine the emotional impact of serological testing for HIV, 218 physically asymptomatic adults were evaluated in a confidential clinical setting 2 weeks before HIV test notification, immediately before and after notification, and 2 and 10 weeks later. All received extensive pre- and post-test counseling. The 179 seronegatives reported one or more HIV risk behaviors: homosexual intercourse (n = 111), heterosexual intercourse with possibly infected partners (n = 62), intravenous drug use (n = 20). Immediately after notification, seronegatives had significant decreases in visual analogue scale (VAS) measures of anxiety, depression, fear of getting AIDS, and fear of having infected others. Reductions were sustained at both follow-up assessments and were complemented by significant reductions on standardized self-reported measures of anxiety (Spielberger State Anxiety Inventory, SAI), depression (Beck Depression Inventory, BDI), and psychiatric symptoms (Brief Symptom Inventory, BSI) as well as by clinical ratings of depression (Hamilton Depression Rating Scale, HDRS). Of 39 seropositives, 35 had homosexual risk behaviors, seven had been intravenous drug users (IVDUs; four of whom were homosexual men), and one was a female partner of an IVDU. Immediately after notification, VAS measures of their anxiety were not significantly increased, and at 10 weeks after notification, their VAS measures of distress and mean scores on BDI, SAI and BSI were significantly lower than at entry. Their HDRS ratings were not significantly increased.

AIDS Serodiagnosis↗
PubMed2006

A cost-effectiveness evaluation of a jail-based chlamydia screening program for men and its impact on their partners in the community.

BACKGROUND: Few cost-effectiveness evaluations of screening men in jails for chlamydia have been published, and none have evaluated the cost-effectiveness of providing partner notification services to the partners of chlamydia-infected inmates. GOAL: The goal of this study was to evaluate the cost-effectiveness of the chlamydia screening and partner notification programs for men conducted by a Massachusetts jail compared with 3 hypothetical alternatives. STUDY DESIGN: Using jail cost and testing data, we used decision analyses to compare the cost and effectiveness of universal screening, age-based screening with 2 age cutoffs, and testing of symptomatic inmates at intake using treated cases of chlamydia and gonorrhea as the primary outcome. We also evaluated the cost-effectiveness of adding partner notification to these alternatives. RESULTS: Universal screening was the most effective and expensive alternative. Age-based screening would have identified slightly fewer cases at half the cost of universal screening. The net cost of partner notification was low. Assuming high sequelae costs in female partners made partner notification a cost-saving intervention. CONCLUSIONS: Age-based screening could lower costs without substantially sacrificing effectiveness. Notifying partners of infected inmates was a cost-effective adjunct to screening inmates.

Adult↗
PubMed2005

An evaluation of public health interventions during a pertussis outbreak in the ACT, 2003.

OBJECTIVE: To assess whether issuing information alerts increased the proportion of pertussis cases notified within the 21-day infectious period during a pertussis outbreak in the Australian Capital Territory (ACT) in 2003. METHOD: The study included all persons resident in the ACT for whom a notification of pertussis was received with onset of disease between 1 March and 31 December 2003. Cases notified within 21 days of onset were called 'early notifications'. The effectiveness of information alerts was assessed by comparing the proportion of early notifications before and after each alert and over the course of the outbreak. MAIN OUTCOME MEASURE: The proportion of early notifications. RESULTS: The proportion of early notifications ranged from 1/36 (2.7%) prior to the first intervention to 29/52 (55.7%) after the final intervention (p < 0.001). CONCLUSIONS: This study supports the hypothesis that information alerts by ACT Health increase the proportion of cases notified within the infectious period of 21 days. IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Early diagnosis of pertussis cases (within the infectious period) has the potential to limit transmission and protect susceptible infants.

Adolescent↗
PubMed2006

Improvement in screening performance and diagnosis of congenital hypothyroidism in Scotland 1979-2003.

AIM: To assess the Scottish newborn screening programme for congenital hypothyroidism from 1994 to 2003 (period 2) for performance and compare with an initial audit covering 1979 to 1993 (period 1). DESIGN: Performance data-age at blood spot sampling, notification by screening laboratory, start of treatment, and the prevalence of late testing, notification or treatment-were compared, together with the incidence of congenital hypothyroidism. RESULTS: Comparing data for period 2 with period 1, the mean annual incidence of true congenital hypothyroidism was 1:3655 live births v 1:4363. Median age for Guthrie sampling (all referrals) was 6 v 7 days (p<0.0001). Late sampling (>10 days) had fallen from 10.7% to 7%. For infants requiring repeat sampling before notification, the median (range) interval between initial and final repeat samples was 11 (1 to 52) compared with 14 (3 to 73) days. Median age at notification for true congenital hypothyroidism was 10 v 12 days (p <0.0001). Late notification (>15 days) was justifiable (mild TSH elevation) in 10 of 13 patients in period 2. Median age at start of treatment for true congenital hypothyroidism had improved to 11 days from 13.5 days. For true congenital hypothyroidism, late treatment (>16 days) occurred in 7% of patients compared with 19% (p<0.0001). CONCLUSIONS: There has been an improvement in performance measures for the congenital hypothyroidism screening programme in Scotland. However, late sampling, occurring primarily in inpatients and which is never justified, remains a problem, while the interval between initial and recall sampling is a further source of delay.

Age Factors↗
PubMed1999

Childhood tuberculosis in an urban population in South Africa: burden and risk factor.

AIM: To study the epidemiology of childhood tuberculosis (TB) in a developing country. SETTING: Two urban communities of Cape Town, South Africa with a TB case notification rate of 1149/100 000. DESIGN: Retrospective descriptive study using the national population census (1991), 10 year official TB notification records, and a geographical information system. RESULTS: The case notification rate of TB in children 0-5 years old was 3588 cases/100 000 children aged 0-5 years, 3.5 times the case notification rate in adults. Children (0-14 years) accounted for 39% of the total case load. Childhood TB case notification rate correlated with parental education (r = -0.64), annual household income (r = -0.6), and crowding (r = 0.32). CONCLUSION: Children, especially those living in poor socioeconomic conditions, form an important epidemiological group and account for a notable proportion of the morbidity caused by TB. Efforts to improve TB control must therefore not only target adults (case detection and cure of infectious cases) but also children (screening of child contacts of adult cases) and the socioeconomic living conditions.

Adolescent↗
PubMed2006

Improving pediatric prevention via the internet: a randomized, controlled trial.

BACKGROUND: Innovations to improve the delivery of pediatric preventive care are needed. METHODS: We enrolled children, 0 to 11 years of age, into a factorial, randomized, controlled trial of a tailored, evidence-based, Web site (MyHealthyChild) that provided information on prevention topics before a scheduled well-child visit. There were 2 components of the intervention, namely, parental Web content and provider notification. Parental Web content provided information to parents about prevention topics; provider notification communicated to physicians topics that were of interest to parents. We assigned 887 children randomly to 4 groups (usual care, content only, content and notification, or notification only). Outcomes were determined with telephone follow-up surveys conducted 2 to 4 weeks after the visit. Poisson regression analysis was used to determine the independent effects of each intervention on the number of topics discussed and the number of preventive practices implemented. RESULTS: Parents in the notification/content group and in the notification-only group reported discussing more MyHealthyChild topics with their provider. Parents in the notification/content group and in the content-only group reported implementing more MyHealthyChild topic suggestions (such as use of a safety device). CONCLUSIONS: A Web-based intervention can activate parents to discuss prevention topics with their child's provider. Delivery of tailored content can promote preventive practices.

Child↗
PubMedDate not supplied

[Adverse drug reaction reporting in emergency medicine].

METHODS: A regional survey was performed between June and September 2002, to evaluate knowledge and attitudes of emergency physicians regarding adverse drug reaction (ADR) reporting in a French district. 100 questionnaires completed by physicians working in emergency departments and/or mobile intensive care units were analysed. RESULTS: The frequency of ADRs encountered by emergency practitioners was estimated at > or = 0.73 per year and per physician. The ADR notification rate in emergency medicine was estimated at < or = 6%. A minority of physicians were responsible for the majority of ADR reporting. Sixty-four percent of emergency physicians underestimated the conditions required for ADR notification: 28% thought that certain causality was an absolute necessary condition for notification, while 37% considered that notification was required only for ADRs that were both severe and unexpected. CONCLUSION: Interventions focused on advertising ADR reporting procedures could help to improve the notification rate in emergency medicine.

Adverse Drug Reaction Reporting Systems↗
PubMed2002

Australia's notifiable diseases status, 2000. Annual report of the National Notifiable Diseases Surveillance System.

In 2000, there were 89,740 notifications of communicable diseases in Australia collected by the National Notifiable Diseases Surveillance System (NNDSS). The number of notifications in 2000 was an increase of 5.9 per cent over those reported in 1999 (84,743) and the largest reporting year since the NNDSS commenced in 1991. Notifications in 2000 consisted of 28,341 bloodborne infections (32% of total), 24,319 sexually transmitted infections (27%), 21,303 gastrointestinal infections (24%), 6,617 vaccine preventable infections (7%), 6,069 vectorborne infections (7%), 2,121 other bacterial infections (legionellosis, meningococcal infection, leprosy and tuberculosis) (2%), 969 zoonotic infections (1%) and only one case of a quarantinable infection. Steep declines in some childhood vaccine preventable diseases such as Haemophilus influenzae type b, measles, mumps and rubella, continued in 2000. In contrast, notifications of pertussis and legionellosis increased sharply in the year. Notifications of bloodborne viral diseases (particularly hepatitis B and hepatitis C) and some sexually transmitted infections such as chlamydia, continue to increase in Australia. This report also summarises data on communicable diseases from other surveillance systems including the Laboratory Virology and Serology Surveillance Scheme (LabVISE) and sentinel general practitioner schemes. In addition this report comments on other important developments in communicable disease control in Australia in 2000.

Australia↗
PubMedDate not supplied

Facsimile communication between emergency departments and GPs, and patient data confidentiality.

OBJECTIVE: To assess general practitioners' perceptions of the effectiveness of facsimile notification of their patients being admitted from the emergency department (ED), and its adequacy in terms of patient confidentiality. DESIGN: Questionnaire survey, before and after the initiation of facsimile notification. SETTING: A provincial community of approximately 120,000 residents in Victoria. MAIN OUTCOME MEASURES: Changes in GPs' ratings of communication with the ED; acceptability of facsimile notification; and concerns about patient confidentiality. RESULTS: 77 of 85 GPs participated; only 44 (57.1%) returned both questionnaires. ED-GP communication ratings of "adequate" or better increased from 48% to 100% (P < 0.05). The proportion of GPs who were notified of all admissions increased from 0 to 41% (P < 0.05). The proportion of GPs who preferred facsimile for notification increased from 39% to 68% (P < 0.05). Most GPs found the initiative acceptable and reservations about confidentiality decreased from 36% to 16% (P < 0.05). 38 of the 887 patients admitted from the ED (4.3%) refused facsimile notification. CONCLUSIONS: Facsimile improves ED-GP communications and may, in turn, improve the quality and continuity of patient care. Informed consent should be obtained from all patients.

Adult↗
PubMed2002

Giardia infection in Auckland and New Zealand: trends and international comparison.

AIMS: To describe the epidemiological pattern of Giardia infection in the Auckland region and compare it with national and international patterns of Giardia infection. METHODS: Anonymised giardiasis notification data from the Auckland District Health Board for the period July 1996 to June 2000 were analysed by person, place and time. Infection rates and relative risks were calculated and compared with national and international information. RESULTS: Auckland had a significantly higher rate of Giardia infection than New Zealand as a whole. Infection rates, which peaked during February-May, were significantly higher in Pakeha/Europeans and Asian/others, compared with Maori/Pacificans. Adjusted notification rates were higher for residents of North Shore and Auckland cities than for other areas of Auckland. The crude regional and national notification rates were almost six times the rate of laboratory identification of positive isolates in the UK and four times US reported rates. CONCLUSIONS: The higher rates of giardiasis observed in Auckland and New Zealand, in comparison with other developed countries, may be related to environmental or social factors. Missing ethnicity information precludes clear interpretation of variations in notification rate by ethnic group and suggests a need for improvement in data collection. There are opportunities to investigate the influence of risk factors on seasonal changes in notification rates both locally and nationally.

Adolescent↗