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PubMed1997

Screening for human immunodeficiency virus infection during pregnancy.

Due to the increased risk of human immunodeficiency virus (HIV) infection during the childbearing years, voluntary screening during the prenatal period has been suggested. To study the impact of such a program in our population of pregnant women, we offered HIV testing to all prenatal patients with informed consent, beginning January 1, 1992. After 18 months (July 1993), HIV testing was offered as a component of our prenatal laboratory panel, using informed refusal. During the first screening period, there were 20 seropositive women among the 14,143 patients (1.4/1000), with 74 refusing testing. During the next 36 months (July 1993 to June 1996), 91 seropositive gravidas were identified among 31,496 parturients (2.9/1000), with only 17 refusing assessment. Free treatment with zidovudine (AZT) for both mother and baby, sponsored by the Mississippi state health department, began in January 1994. The perinatal transmission rate was 33% before AZT treatment, during our period of assessment, and was reduced to 10% during the next 30 months. Based on our data, it appears that a program of universal voluntary screening for HIV infection using informed refusal and free AZT for patients at risk for perinatal transmission results in almost 100% testing and a reduction in vertical transmission.

Female↗
PubMed1983

Voluntary regionalization and associated trends in perinatal care: the Nova Scotia Reproductive Care Program.

The Nova Scotia Reproductive Care Program is a system of voluntary regionalization that involves the 37 hospitals in the province that provide obstetric care to a population of 850,000. Between 1971 and 1980, the perinatal mortality rate in the central tertiary care unit for nonreferred patients fell progressively from 12.5 per 1,000 total births to 5.16. For all cases, including high-risk referrals, this rate has fallen from 12.7 to 7.2. During the same interval, the perinatal mortality rate for the province's seven regional hospitals fell from 18.7 to 12.2, and that for the 28 community hospitals fell from 18.4 to 7.0. Analysis of these reductions by fitted trend lines demonstrates statistical significance. Further analysis demonstrates that, with regionalization of perinatal services, it is possible to reduce the perinatal mortality rate in small community hospitals to levels that approximate those of a sophisticated tertiary care hospital.

Female↗
PubMed1989

Evolving concepts of quality in laboratory practice. A historical overview of quality assurance in clinical laboratories.

Early concepts of quality in clinical laboratory services stressed accuracy and precision. In the 1960s voluntary and mandated programs for laboratory accreditation followed. The increasing complexity of laboratory standard setting led to the promulgation of voluntary consensus standards in the 1970s. This was followed by a national reference system to minimize bias among clinical laboratories. The concept of total quality control emphasized that quality assurance must be a way of life for laboratorians, and concerns about growing laboratory volume led to the idea that managing laboratory utilization is also a component of quality assurance. Recent conferences have expanded the concept of laboratory quality to encompass everyone who participates, even remotely, in the provision of services. Now quality is evaluated by how well the patient is served.

Certification↗
PubMed1996

Utility Participation in a Multispecies Plan

/ Single-species listings under provisions of the federal Endangered Species Act (ESA) have caused, or have been accused of causing, significant regional economic impact. In an attempt to avoid such adverse effects on regional economic development, the state of California passed the Natural Communities Conservation Planning Act (NCCP) in 1991. It is a voluntary, consensus-based approach to balancing protection of sensitive biota and biodiversity with regional economic development. The pilot NCCP program for the conservation of several threatened, endangered, and category 1 species, plus an additional 35 coastal sage scrub-related species in southern California, was completed and submitted to the public for review and comment in December 1995. This program proposes the voluntary establishment of a 86,600-ha multispecies reserve system. Once completed, participating landowners will receive ESA Section 10(a) "incidental take" permits for present and identified future projects. Utility rights-of-way are incorporated into the program as important connective linkages between reserve units and other adjacent important habitat areas. All data and information regarding the proposed results of the NCCP are subject to change pending agency response to public comments on the draft Habitat Conservation Plan and joint EIR/EIS. KEY WORDS: Endangered species; Threatened species; Plant communities; Habitat types; Utility rights-of-way

Journal Article↗
PubMed1990

Enhancing the treatment attendance of mentally ill chemical abusers.

Patients dually-diagnosed with mental illness and chemical abuse often comply poorly with treatment. The present study tested the hypothesis that attendance at a day treatment program could be increased by offering modest incentives for regular participation. Fifty-three patients, enrolled in a voluntary day treatment program for the mentally ill chemical abuser, were studied for twelve weeks. Attendance was monitored for (a) 4 weeks prior to the incentive intervention; (b) 4 weeks during which an incentive was provided for regular attendance; and (c) 4 weeks following the incentive. The incentive consisted of modest rewards (e.g., coupons from a local restaurant) offered at the end of the week to all patients who attended the program for at least 5 hours a day on at least 3 days in a given week. The results demonstrated that modest incentives can enhance the attendance patterns of the dually-diagnosed.

Adult↗
PubMed1991

Outcomes of an AIDS prevention program for methadone patients.

Methadone maintenance patients are at risk of contracting or transmitting HIV through intravenous drug use and/or unsafe sexual practices. An outcome evaluation of a voluntary AIDS prevention program for methadone patients in three clinics (two experimental, one control) is reported. The prevention program included three components: didactic AIDS education, HIV antibody counseling/testing, and facilitated peer support groups. Participation in AIDS education was associated with increased knowledge of AIDS risks and with improved attitudes toward condoms. Peer group participation was associated with improved attitudes toward the use of condoms and with increased use of condoms. Learning of HIV seronegativity was related to increased self-efficacy and decreased intravenous drug use risk behaviors. Rates of participation in the prevention program were disappointing, but the program seemed beneficial for those patients who did become involved.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Village-based diagnosis and treatment of malaria.

Village-based volunteer workers have played an important role in malaria diagnosis and treatment in many different settings for more than 35 years. Two of these programs stand out in terms of their size and longevity: the Volunteer Collaborator Network of Latin America and the Village Voluntary Malaria Collaborator Program of Thailand. The success of these programs is based on a tradition of active community participation and sustained commitment and support from the national malaria control programs. As epidemiological conditions and program priorities change, these programs will have to be sufficiently flexible to keep pace. Perhaps the greatest challenge facing these single disease, vertical programs in the future is their integration into the general health services in a manner that will preserve their best features.

Community Health Workers↗
PubMedDate not supplied

Treatment of alcoholic violent offenders: ethics and efficacy.

The published literature tends to find that the outcome of mandatory treatment for alcohol dependence is no worse than that for 'voluntary' treatment. Supervised disulfiram has been shown to improve outcome in Court-referred patients. When offenders take treatment offered as part of probation or a deferred sentence, they choose to do so, rather than face a penalty. It is not a 'free' choice in the usual sense, but the outcome can be beneficial to the offender as well as to society and this helps to justify its use. Coping and social skills therapy have value, as probably have antipsychotic and antidepressant drugs in some cases. Supervised disulfiram has a role supported by controlled studies.

Alcoholism↗
PubMed1988

Sensitivity and specificity of three methods of detecting adverse drug reactions.

The sensitivity and specificity of three methods of detecting adverse drug reactions (ADRs) were determined. Minimal use of a voluntary ADR reporting program prompted this investigation of three ADR detection methods, as follows: screening of laboratory reports, pharmacist screening of medication orders, and voluntary reporting. A total of 98 patients who were receiving oral or i.v. digoxin therapy, oral or i.v. theophylline therapy, or i.v. gentamicin therapy were randomly selected and monitored for possible ADRs. A physician reviewed the charts of patients with suspected ADRs using the Naranjo algorithm to assess causality. The chart review served as the reference method to which the other three methods were compared. Thirteen "true" (i.e., confirmed by the Naranjo algorithm) ADRs were identified in 11 different patient charts, resulting in a 13.3% ADR incidence rate for the 98 sampled patients. For the three ADR detection methods, the decreasing order for level of sensitivity was screening of laboratory reports, pharmacist screening of medication orders, and voluntary reports; however, only the difference between laboratory reports and voluntary reports was significant. For level of specificity, the decreasing order for the three methods was voluntary reports, pharmacist screening of medication orders, and pharmacist screening of laboratory reports; the differences among all three methods were significant. Screening of laboratory reports and pharmacist screening of medication orders are two detection methods that appear to exhibit an appropriate combination of sensitivity and specificity for identifying ADRs; trials with larger sample sizes are needed to confirm the results of this study.

Algorithms↗
PubMed1995

Recent advances in pediatric HIV.

Pediatric human immunodeficiency virus (HIV) infection is a disease of mother-to-infant transmission. The World Health Organization estimates there will be ten million HIV-infected children by the end of this century. It is now thought that both intrauterine and intrapartum transmission of HIV occurs. Infants infected in utero develop clinical signs and symptoms at an earlier age than those who are infected at the time of delivery. We describe two cases that demonstrate early-onset and late-onset pediatric HIV disease, respectively. Recently, it was determined that perinatal transmission of HIV can be significantly reduced by the administration of the antiretroviral drug, zidovudine (ZDV), to HIV-positive pregnant women and their newborns, making HIV screening of pregnant women more desirable than ever. A program of universal voluntary HIV testing for pregnant women has been successfully implemented at the University of Arkansas for Medical Sciences. Details of this program are described herein.

Fatal Outcome↗
PubMed2002

Identifying undiagnosed human immunodeficiency virus: the yield of routine, voluntary inpatient testing.

BACKGROUND: Despite current recommendations for human immunodeficiency virus (HIV) counseling and testing among patients admitted to hospitals with at least a 1% prevalence of HIV infection, an estimated 300 000 people in the United States remain unaware of their HIV infection. METHODS: We implemented the Think HIV program, which offered voluntary HIV counseling and testing to patients admitted to the medical service of a Boston, Mass, teaching hospital. We compared the results of this effort with testing results from a 15-month historical control period. RESULTS: Patients admitted during the program period were 3.4 times more likely to undergo testing for HIV than those admitted during the control period (95% confidence interval [CI], 2.8-4.1). The testing program detected approximately 2 new diagnoses of HIV infection per month, compared with 1 per month during the control period. Patients who underwent testing during the program, and who likely would not have done so without this initiative, had an estimated prevalence of HIV infection of 3.8% (95% CI, 1.8%-5.8%). CONCLUSIONS: Testing efforts for HIV targeted to only symptomatic patients are inadequate to identify the one third of HIV-seropositive people in the United States who are unaware of their infection. We have shown that in a single urban hospital, offering voluntary, routine inpatient HIV counseling and testing can be successful as a screening program by identifying a substantial number of patients with undiagnosed HIV. These patients then can be informed, counseled, and linked to care and treatment. Seventy-two hospitals nationwide have demographics similar to those of the study hospital, suggesting that these results are generalizable to many urban hospitals.

Adult↗
PubMed2005

[Diversity of the local voluntary associations' involvement in cardiovascular disease prevention and health promotion programmes with respect to their mission].

The participation of institutions and organizations from outside the health sector such as self-governments, schools and non-governmental organizations in cardiovascular disease (CVD) prevention and health promotion programmes has been growing. In the context of the significant contributing of the socioeconomic status into health the involvement of social service institutions and organizations in these programmes should be regarded as vital for their efficiency and effectiveness. The article attempts to identify the factors which explain the differences in the level of involvement in the CVD prevention and health promotion programmes between organizations which have the mission to improve the health of community and these ones which are orientated towards the delivery of social services. Data for the analysis are taken from the study which covered 1333 local voluntary associations with various missions. They were collected by means of mail questionnaire. The findings of the study show that organizations with the mission--"helping needy people" are involved in unformalized preventive activities towards CVD risk factors, like cigarette smoking, alcohol abuse, the lack of skills to cope with stress, unhealthy diet and low physical activity, to the similar extent as organizations with "health improvement" as a leading aim. However the participation of both types of associations in comprehensive CVD prevention and health promotion programmes is significantly different. The analysis of the factors which determine the participation in such programmes did not allow to indicate "objective" conditions explaining this difference. However there are some premises which direct the attention towards the factors "subjective" by their nature. The results show that the barriers of social service organizations' involvement in CVD prevention and health promotion programmes lie probably in the specific mentality of their active members.

Cardiovascular Diseases↗
PubMed2003

A nephrological program in Benin and Togo (West Africa).

BACKGROUND: Nephrological programs are scarce in Benin and Togo, which are two small developing countries located in West Africa. This article describes a voluntary-based nephrological program that has recently been established in one hospital in north Benin and in another in south Togo. METHODS: The program included: (1) care of patients with a renal disease; (2) improvement of urinalysis; (3) introduction of serum Na+ and K+ measurements; and (4) screening of renal diseases. This was carried from the records of patients with serum creatinine >/=2.0 mg/dL and of patients with a >/=+++ albuminuria, and the distribution to doctors of a questionnaire. RESULTS: (1) Renal patients were seen on each visit at both hospitals; most had advanced renal failure or nephrotic syndrome. However, due to the lack of major diagnostic and therapeutic facilities, the management of such patients was often difficult. (2) Urinalysis was improved through the introduction of dipsticks for the evaluation of the 10 parameters, the introduction of phase contrast microscopy, and the permanent education of two laboratory technicians. (3) The introduction of flame photometry for the measurement of serum Na+ and K+ was unsuccessful probably due to the poor quality of water and/or gas. (4) In a year, patients in the Benin hospital who had serum creatinine values >/=2.0 mg/dL represented about 3.3% and patients with >/=+++ albuminuria represented 1.0% of all admissions. The questionnaire was answered by seven physicians working in three different institutions in Benin and in one in Togo. It revealed that basic diagnostic and therapeutic facilities, such as electrolyte measurement, urine culture, renal biopsy, and dialysis are either lacking or are available only for the few patients who can afford to pay. CONCLUSIONS: Severe renal diseases are found frequently in patients of Benin and Togo. However, due to the lack of money and basic diagnostic and therapeutic facilities, these patients cannot be properly managed.

Benin↗
PubMedDate not supplied

Themes in student attrition.

OBJECTIVE: To characterize similarities and differences in attrition in clinical laboratory science and clinical laboratory technician education programs by identifying general themes, specific academic and nonacademic reasons, and other relevant data. DESIGN: Mailed, written survey. PARTICIPANTS: Program directors of 208 clinical laboratory science and clinical laboratory technician educational programs. MAIN OUTCOME MEASURE: Responses to a 36-item forced-choice survey eliciting information about program attrition and the importance of reasons for student attrition. DATA SOURCES: Clinical laboratory science and clinical laboratory technician program directors across the United States. RESULTS: Students were found to withdraw from educational programs for both voluntary and nonvoluntary reasons in approximately equal numbers. Academic underpreparedness was a predominant general theme underlying student attrition in both levels of programs. The importance of certain specific reasons cited for student attrition differed significantly by program level. CONCLUSION: To be effective, it may be necessary to design retention programs that address academic concerns, as well as nonacademic concerns, of students. The level of educational program (clinical laboratory technician or clinical laboratory scientist) should be considered, because reasons for attrition vary in degree of importance. ABBREVIATIONS: CLT = clinical laboratory technician; CLS = clinical laboratory scientist; CAHEA = Committee on Allied Health Education and Accreditation. INDEX TERMS: Clinical laboratory technician students; clinical laboratory science students; education; attrition; retention.

Clinical Laboratory Techniques↗
PubMed1997

Quality assurance of stem cell enumeration by flow cytometry. Canadian QASE Study Group.

The enumeration of CD34+ cells by flow cytometry is commonly employed to assess progenitor/stem cell numbers in peripheral blood, cord blood, and apheresis products used for peripheral blood stem cell transplantation (PBSCT). Until recently, the enumeration of CD34+ cells has evolved in the absence of any procedural guidelines or quality assurance programs. We established a voluntary quality assurance for stem cell enumeration (QASE) program for Canadian laboratories involved in PBSCT. The goals of this study were 1) to survey current flow cytometric procedures for CD34 enumeration; 2) to evaluate inter-institutional reproducibility of currently employed assays; and 3) to evaluate the impact of adoption of a common method on inter-laboratory variability. Fourteen to nineteen laboratories participated in this program by enumerating CD34+ cells in shared cord blood samples. The survey showed a wide variation in flow cytometric methodology which in part contributed to the wide range in results obtained between different centres. Major differences in methodology included the number of events counted, use of isotype control and gating strategy. Participation in this program and adoption of a common methodology increased level of agreement for any given result although this trend did not reach statistical significance (P = 0.13). The results of this survey emphasize the need for a quality assurance program for stem cell enumeration by flow cytometry.

Antigens, CD34↗
PubMed1975

La operacion.

At long last we have some official information regarding that troublesome statistic often used by persons implying a genocidal plot in Puerto Rico: "35% fo all Puerto Rican women have been sterilized." According to a letter received by Mrs. Mary Morain, AVS board member, from Dr. Maria Teresa Berio, president of Puerto Rico's Commission for the Improvement of Women's Rights: Sterilization is a favorite method of the Puerto Rican women for family planning. It began in 1943 and its rate among women of reproductive age increased until 1968 when, according to a study done by Dr. Jose Velasquez Calzada, professor of demography of the University of Puerto Rico, School of Public Health, it reached 35%. The government had never officially offered these services through its family planning progra. In february 1974, when the leadership of the program was reorganized and the socioeconomic composition of that 35% was analyzed, it was found that the majority, almost 66% of the women, were of the upper class and the upper middle class, denying the concept that only the poor are sterilized and at the same time indicating an injustice in regard to the accessibility of these services. Only women of means or those who could pay were being sterilized, and those with lower incomes had no access to these services although they wanted and needed them as much as those who could pay. It was in order to correct an injustice in the offering of sterilization services that we decided to offer this operation free of charge to all strata of society. The poor did not have the same access as the rich to these serviecs. The Puerto Rican Family Planning Program is strictly voluntary. In no way are people convinced or coerced to use these services. The people of Puerto Rico have enthusiastically endorsed the family planning program. In a study carried out in 1974 by the Department of Health, 83% of the population believes that sterilization should be offered by the program and should be free of charge.

Americas↗
PubMed1992

World blindness and the medical profession: conflicting medical cultures and the ethical dilemmas of helping.

This is an account of a thwarted humanitarian effort and the strategic and ethical issues that is raised. Between 14 and 17 million people in the world are blind with cataract, a condition readily corrected by surgery. In 1989 a proposal was developed to attack this problem by supplying volunteer ophthalmologists to the world's leading private voluntary organizations that carry out programs in less developed countries. The proposal was rejected. This article describes the proposal and the issues on which it foundered: cost effectiveness, appropriate technology, changing ideologies of assistance, and conflict between the cultures of medicine and public health. The account illustrates the far-flung consequences of technological change in medicine, as well as the practical and ethical questions facing organizations that carry out overseas assistance programs.

Altruism↗
PubMed1977

Cost effectiveness of laboratory improvement programs: the viewpoint from the private sector.

The costs of participating in laboratory improvement programs are categorized and presented from the viewpoint of the laboratory. These include: prevention costs, appraisal costs, and compliance costs. Costs of participating in voluntary vs. mandatory programs are compared. Reduction of costs could be achieved by reducing duplication and overlapping of programs. In conclusion, it is difficult to identify the exact costs in any program, but it is estimated that for the individual laboratory it may represent 10-15% of the operating costs.

Cost-Benefit Analysis↗