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PubMed1999

Emergency department-based HIV screening and counseling: experience with rapid and standard serologic testing.

STUDY OBJECTIVE: We sought to (1) determine whether some emergency departments could play an important role in the national strategy of early HIV detection through the implementation of a voluntary HIV screening program and (2) describe the experience with standard and rapid HIV testing. METHODS: Consenting adults were enrolled during 3 distinct phases between 1993 and 1995 for the assessment of routine testing only, routine versus rapid testing, and rapid testing only. Patients administered the rapid test were given information at the time of the visit. We assessed the cost of the program. RESULTS: Of 3,048 patients approached, 1,448 (48%) consented, 981 to standard and 467 to rapid testing. Of these, 6.4% and 3.2%, respectively, were newly identified as being HIV seropositive. More than twice as many new infections were diagnosed among those discharged from the ED as among those admitted (55 versus 21). Even among those previously tested, 5% proved seropositive. The mean+/-SD time to obtain results for the rapid assay performed in the hospital's main laboratory was 107+/-52 minutes, with 55% leaving the ED before receiving the results. Rapid assays performed in the ED satellite laboratory required 48+/-37 minutes, and only 20% left before getting the results. Follow-up among HIV-seropositive patients was 64% for the standard protocol and 73% for the rapid protocol (P >. 20). The prearranged HIV clinic intake appointment was kept by 62%. Rapid test sensitivity and specificity were 100% and 98.9%, respectively, with 5 initial false-positives and no false-negatives. Cost per patient enrolled and counseled was $38. Cost per infection detected was $601 for the routine test and $1,124 with the rapid test; these prices are competitive with those incurred at other sites. CONCLUSION: Emergency department-based HIV testing was well accepted and detected a significant number of new HIV infections earlier than might have otherwise been, particularly among patients sent home. The rapid test is best performed on-site and is very sensitive. Confirmation of initial results is required because of the occurrence of occasional false-positive results. With relatively high HIV detection and return rates, it is evident that some EDs could play a major role in the national strategy of early HIV detection.

Adolescent↗
PubMed2002

Evaluation of the long-term immune response in cattle after vaccination against paratuberculosis in two Dutch dairy herds.

In the past decades, vaccination against paratuberculosis in cattle was performed in The Netherlands only on a limited scale. Because of its interference with the diagnosis of bovine tuberculosis, vaccination was restricted to herds with a high prevalence of clinical cases of paratuberculosis and was meant to aid in the economical survival of the farm. Recently, a voluntary paratuberculosis certification program has started, based in part on serological screening of cattle of at least 3 years of age. Herds that have been vaccinated against paratuberculosis are, therefore, likely to encounter problems when entering this program. The aim of this study was to evaluate the immune response resulting from vaccination with a heat-killed paratuberculosis vaccine. Over a period of 12-14 years, new-born calves were vaccinated in two herds. The B-cell response was evaluated using both the complement-fixation test (CFT) and an enzyme-linked immunosorbent assay (ELISA) and the cell-mediated immune response was evaluated using the gamma-interferon assay. Data obtained show a marked and prolonged effect of the vaccination on both cellular and humoral immune responses, in particular to the paratuberculosis antigen but also to the bovine tuberculosis antigen, using the respective tests. These responses were detected rapidly after vaccination. The individual responses were highly variable between animals with respect to both the level and to the duration of the evoked immune response. No relation between the results obtained with the ELISA and the CFT was observed. In conclusion, for a large number of vaccinated cattle, a long lasting interference is to be expected with the presently available immunodiagnostic methods for both bovine tuberculosis and paratuberculosis.

Animals↗
PubMed2006

[Changes in the perception of risk factors for stroke in the German population between 1995-1996 and 2000-2001. Results of two representative EMNID surveys].

BACKGROUND AND OBJECTIVE: Stroke is one of the leading causes for death and disability worldwide. A better understanding of the perception of modifiable stroke risk factors in the population is the first step to initiate effective prevention strategies on population level. Changes over 5 years in the risk perception in the general population were investigated by two representative surveys in Germany. METHODS: Nationwide programs to screen voluntary participants for stroke risk were undertaken in 1995-1996 and 2000-2001 by the German Stroke Foundation, in cooperation with the health insurance company BARMER and the Sanofi-Synthelabo Company. As part of these programmes two surveys were performed by TNS-EMNID to collect data on population knowledge. A representative sample of the German population was selected and asked to categorize their perception of stroke risk for common vascular risk factors. RESULTS: A total of 8193 participants were interviewed (4081 in 1995-1996 and 4112 in 2000-2001); 43.5% were (3) 50 years of age and 52.5% were female. Hypertension was rated by 68.3% to be in the highest risk category for stroke, followed by smoking (52.3%), hypercholesterolemia (48.0%), overweight (48.0%), excessive alcohol consumption (32.9%) and diabetes (26.6%). The proportion of participants who graded these factors to be important for stroke occurrence was persistently higher in 2000-2001 than in 1995-1996. CONCLUSION: Perception of modifiable risk factors for stroke increased over a 5-year time period in two representative surveys in Germany. The importance of diabetes mellitus as a risk factor for stroke is especially underestimated in the general population.

Adolescent↗
PubMed2003

Self-reported drinking-game participation of incoming college students.

Drinking games are associated with excess alcohol use and alcohol-related problems, yet it is unclear whether they are unique to the college environment or whether students come to college familiar with such games. The authors queried 1,252 students attending voluntary summer orientation programs about their experiences with drinking games. A majority (63%) indicated they had played drinking games and viewed them as a means to get drunk quickly and to socialize, control others, or get someone else drunk. Logistic regression analyses revealed that familiarity with drinking situations was associated with a greater likelihood of playing drinking games. Students who reported drinking more frequently and consuming greater quantities of alcohol than others, having lifetime marijuana use, and initiating alcohol consumption between the ages of 14 and 16 years were significantly more likely to have participated in drinking games. These findings demonstrate the importance of considering students' participation in drinking games when campus officials address alcohol use.

Adolescent↗
PubMed1975

Outpatient alcoholics give valid self-reports.

Thirty-nine male alcoholics in a voluntary outpatient treatment program were interviewed individually on two separate occasions about their social and drinking history. Critical test questions were identical for both interviews but embedded among different filler items. The validity of the subjects' self-reports about both alcohol and nonalcohol-related questions was assessed through official records and documents. Self-reports of life history data provided by this group of outpatient alcoholics under specified interview procedures were highly reliable and valid. Differential item reliability and validity were obtained. Further, the value of using the technique of double interviews to predict valid and invalid self-reports is discussed. Suggestions for future research are offered.

Accidents, Traffic↗
PubMedDate not supplied

Notification of the sex and needle-sharing partners of individuals with human immunodeficiency virus in rural South Carolina: 30-month experience.

The authors conducted a confidential and voluntary partner notification program to identify and educate the sex and needle-sharing partners of individuals with the human immunodeficiency virus (HIV) in a rural health district in South Carolina. During the first 30 months, of 485 named contacts, 290 (60%) were residents of the health district and were contacted and offered testing. Of the 290 contacted, 280 (97%)--53 women and 227 men; age range 14-74 years--accepted counseling and testing and 49 (18%) were HIV-antibody positive. Only 3 of the 49 (6%) had been previously tested. All HIV-infected individuals received appropriate physician, laboratory, and public health referrals. During the study, the mean number of sex partners per 6-month period decreased from 5.6 to 1.1 (80% reduction) for HIV-antibody positive persons and from 4.0 to 2.0 (50% reduction) for HIV-antibody negative persons. The authors conclude that in a rural setting, partner notification of HIV exposure can accurately target education and testing and can produce positive behavior change.

Adolescent↗
PubMed2000

Urine screening for gonococcal and chlamydial infections at community-based organizations in a high-morbidity area.

BACKGROUND: Increasing availability of urine testing for Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) offers expanded opportunities to collaborate with community-based organizations (CBOs) to screen high-risk populations for sexually transmitted diseases (STDs). GOAL: To determine the prevalence and correlates of genital tract gonococcal and chlamydial infection among CBO clients, and to assess the feasibility of implementing widespread community-based STD screening programs. DESIGN: Free, voluntary, confidential first-catch urine screening was conducted at 20 CBOs serving disadvantaged populations in St. Louis, MO. Brief demographic, behavioral, and sexual contact data were obtained from all participants. Urine samples were tested by ligase chain reaction (LCR). Persons testing positive were promptly notified and directed to seek treatment. RESULTS: A GC and/or CT infection was identified in 24 of 277 persons (8.7%) screened; 2 persons were infected with GC only, 17 with CT only, and 5 with GC and CT. Treatment was documented for 22 persons (91.7%) testing positive. The highest rates of infection were found at shelters (12.3%) and residence facilities (11.1%). Costs of screening were $38 per sample collected and $453 per case identified. CONCLUSION: Community-based urine testing successfully identified GC and CT infections, and was well accepted by community members and CBOs. Community-based screening can significantly impact STD epidemiology by facilitating early detection, treatment, and interruption of transmission.

Adolescent↗
PubMed1979

Screening for colorectal cancer.

A voluntary colorectal screening program was carried out in North Carolina to evaluate the public's willingness to perform a do-it-yourself bowel test, to educate the public on the importance of routine colorectal screening, and to assess the efficacy of a small-scale screening program in detecting colorectal cancer. A screening kit was requested by 1,204 individuals after hearing or reading about the program; 770 kits were returned. Of 29 (3.7%) positive test results, six were negative after retesting. Adequate follow-up was available for 18 of the remaining 23 positive results. Thirteen were due to anal bleeding, diverticulosis, or heavy ingestion of aspirin; five were considered false-positive results, since no evidence of disease could be found. No cases of polypoid tumors or carcinoma were detected. The main value of such a program in an area with a small population base is to increase the awareness of the public of the importance of routine screening for colorectal cancer.

Adult↗
PubMed1983

Comparison of respondents and nonrespondents to a worksite health screen.

As part of an evaluation of the voluntary health promotion program offered by Johnson & Johnson to its employees, comparisons were made between nonrespondents and respondents (75% of all employees) in the baseline health screen. A survey of randomly selected nonrespondents was conducted in 1979-1980 to collect health and life-style information. Comparisons between respondents and nonrespondents on a multitude of characteristics indicated that the nonrespondents reported life-styles as healthful as those of the respondents with the exception that significantly more nonrespondents reported ever having smoked cigarettes and significantly more female nonrespondents currently smoke. These results suggest that the systematic biases found among nonrespondents in general population health surveys do not exist among this more homogeneous employed population and imply that the participants in the program provide a good estimate of the health status and life-style of the entire workforce.

Adult↗
PubMed2004

A political history of medicare and prescription drug coverage.

This article examines the history of efforts to add prescription drug coverage to the Medicare program. It identifies several important patterns in policymaking over four decades. First, prescription drug coverage has usually been tied to the fate of broader proposals for Medicare reform. Second, action has been hampered by divided government, federal budget deficits, and ideological conflict between those seeking to expand the traditional Medicare program and those preferring a greater role for private health care companies. Third, the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 reflect earlier missed opportunities. Policymakers concluded from past episodes that participation in the new program should be voluntary, with Medicare beneficiaries and taxpayers sharing the costs. They ignored lessons from past episodes, however, about the need to match expanded benefits with adequate mechanisms for cost containment. Based on several new circumstances in 2003, the article demonstrates why there was a historic opportunity to add a Medicare prescription drug benefit and identify challenges to implementing an effective policy.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1991

Two-year trends in physical performance following supervised exercise among community-dwelling older veterans.

The extent to which exercise can delay the normal decline in physical performance associated with aging is unknown. We examined the impact of 2 years of supervised exercise on cardiovascular fitness, flexibility, and strength in a group of elderly (age 65-74) veterans. Seventy-five patients exercised 3 days/week for 90-minute sessions emphasizing aerobic, flexibility, and strength development. Thirty-six (47%) completed 2 years of a voluntary supervised exercise program (n = 25 with complete data). Over a 2-year follow-up period, cardiovascular outcome variables improved significantly: metabolic equivalents increased 20% (7.4 +/- 2.2 to 9.0 +/- 2.4, P less than 0.001) and submaximal heart rate decreased 7% (68.5 +/- 8.0 to 63.6 +/- 8.4 beats/minute, P = 0.02). Resting heart rate decreased 8% (131.4 +/- 14.8 to 121.0 +/- 18.5 beats/minute, P = 0.06), but this difference did not reach statistical significance. Flexibility, measured by hamstring length, improved 11% (57.5 +/- 15.1 to 64.0 +/- 11.1 degrees, P = 0.02). Strength variables did not improve. The study indicates that improvements in cardiovascular function and flexibility achieved by the elderly in the early stages of an exercise program can be maintained for at least 2 years.

Aged↗
PubMed1991

Two-year trends in physical performance following supervised exercise among community-dwelling older veterans.

The extent to which exercise can delay the normal decline in physical performance associated with aging is unknown. We examined the impact of 2 years of supervised exercise on cardiovascular fitness, flexibility, and strength in a group of elderly (age 65-74) veterans. Seventy-five patients exercised 3 days/week for 90-minute sessions emphasizing aerobic, flexibility, and strength development. Thirty-six (47%) completed 2 years of a voluntary supervised exercise program (n = 16-25 with complete data). Over a 2-year follow-up period, cardiovascular outcome variables improved significantly: metabolic equivalents increased 20% (7.4 +/- 2.2 to 9.0 +/- 2.4, P less than 0.001) and submaximal heart rate decreased 7% (131.4 +/- 14.8 to 121.0 +/- 18.5 beats/minute, P = 0.06). Resting heart rate decreased 8% (68.5 +/- 8.0 to 63.6 +/- 8.4 beats/minute, P = 0.02) but this difference did not reach statistical significance. Flexibility, measured by hamstring length, improved 11% (57.5 +/- 15.1 to 64.0 +/- 11.1 degrees, P = 0.02). Strength variables did not improve. The study indicates that improvements in cardiovascular function and flexibility achieved by the elderly in the early stages of an exercise program can be maintained for at least 2 years.

Aged↗
PubMed2002

The effects of long-term herbal treatment for pediatric AIDS.

This paper presents our long-term (1992-2000) treatment of pediatric Acquired Immune Deficiency Syndrome (AIDS) patients (maximum 100 children, last three years 65) using native herbal remedies in a voluntary medical assistance program in Constanta, Romania. We primarily report the progress of 10 children at a facility called the "House of Tomorrow" and three other facilities. The long-term (8 years and 8 months) treatment contributed to a drop of the amount of Human Immunodeficiency Virus Ribonucleic Acids (HIV-RNA) below the measurable level for 9 out of 10 patients at the "House of Tomorrow." Furthermore, the treatment led to preservation and increase of the cluster of differentiation (CD4) count, a remarkable decrease in mortality rate, as well as the maintenance of a good quality of life. It took one to three years for the beneficial effects of the treatment to emerge. No side-effects were recognized either clinically or biochemically, nor was there any emergence of drug-resistant strains of HIV as seen with anti-HIV chemical treatments. This paper also refers to which herbal remedies were used and their general mechanism of action.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Functional properties of human muscle fibers after short-term resistance exercise training.

The aim of this study was to assess the relationships between human muscle fiber hypertrophy, protein isoform content, and maximal Ca(2+)-activated contractile function following a short-term period of resistance exercise training. Six male subjects (age 27 +/- 2 yr) participated in a 12-wk progressive resistance exercise training program that increased voluntary lower limb extension strength by >60%. Single chemically skinned fibers were prepared from pre- and posttraining vastus lateralis muscle biopsies. Training increased the cross-sectional area (CSA) and peak Ca(2+)-activated force (P(o)) of fibers containing type I, IIa, or IIa/IIx myosin heavy chain by 30-40% without affecting fiber-specific force (P(o)/CSA) or unloaded shortening velocity (V(o)). Absolute fiber peak power rose as a result of the increase in P(o), whereas power normalized to fiber volume was unchanged. At the level of the cross bridge, the effects of short-term resistance training were quantitative (fiber hypertrophy and proportional increases in fiber P(o) and absolute power) rather than qualitative (no change in P(o)/CSA, V(o), or power/fiber volume).

Adaptation, Physiological↗
PubMedDate not supplied

The cost-effectiveness of HIV testing: accounting for differential participation rates.

OBJECTIVE: To understand the impact of differences in participation rates between infected and uninfected individuals on estimates of the cost-effectiveness of HIV screening. METHODS: Costs per infection detected are modeled as function of both prevalence and serostatus-dependent testing rates. Data from national surveillance surveys, seroprevalence studies, and other sources are employed to suggest the magnitude of results. RESULTS: Differential participation produces a near-doubling in the estimated cost per infection identified. This result is sensitive to assumptions regarding the benefits of screening for seronegatives. CONCLUSIONS: Voluntary HIV screening programs may incur prohibitive costs by over-recruiting people at little risk of infection. Failure to account for differential participation can result in over-optimistic cost-effectiveness estimates. However, the relevance of this result--and the significance of both prevalence and participation as cost drivers--is overwhelmed by what is assumed about the benefits conferred to uninfected people by HIV screening.

Cost-Benefit Analysis↗
PubMed2006

Injection drug use and HIV/AIDS in China: review of current situation, prevention and policy implications.

Illicit drug abuse and HIV/AIDS have increased rapidly in the past 10 to 20 years in China. This paper reviews drug abuse in China, the HIV/AIDS epidemic and its association with injection drug use (IDU), and Chinese policies on illicit drug abuse and prevention of HIV/AIDS based on published literature and unpublished official data. As a major drug trans-shipment country with source drugs from the "Golden Triangle" and "Gold Crescent" areas in Asia, China has also become an increasingly important drug consuming market. About half of China's 1.14 million documented drug users inject, and many share needles. IDU has contributed to 42% of cumulatively reported HIV/AIDS cases thus far. Drug trafficking is illegal in China and can lead to the death penalty. The public security departments adopt "zero tolerance" approach to drug use, which conflict with harm reduction policies of the public health departments. Past experience in China suggests that cracking down on drug smuggling and prohibiting drug use alone can not prevent or solve all illicit drug related problems in the era of globalization. In recent years, the central government has outlined a series of pragmatic policies to encourage harm reduction programs; meanwhile, some local governments have not fully mobilized to deal with drug abuse and HIV/AIDS problems seriously. Strengthening government leadership at both central and local levels; scaling up methadone substitution and needle exchange programs; making HIV voluntary counseling and testing available and affordable to both urban and rural drug users; and increasing utilization of outreach and nongovernmental organizations are offered as additional strategies to help cope with China's HIV and drug abuse problem.

Journal Article↗
PubMedDate not supplied

Clinical evaluation of Functional Electrical Therapy in acute hemiplegic subjects.

This paper describes a clinical randomized single-blinded study of the effects of Functional Electrical Therapy (FET) on the paretic arms of subjects with acute hemiplegia caused by strokes. FET is an exercise program that comprises voluntary arm movements and opening, closing, holding, and releasing of objects that are assisted by a neural prosthesis (electrical stimulation). FET consisted of a 30 min everyday exercise for 3 consecutive weeks in addition to conventional therapy. Twenty-eight acute hemiplegic subjects participated in a 6 mo study. The subjects were divided into lower functioning groups (LFGs) and higher functioning groups (HFGs) based on their capacity to voluntarily extend the wrist and fingers against the gravity, and were randomly assigned to controls or FET groups. The outcomes included the Upper Extremity Function Test, the coordination of elbow and shoulder movements, spasticity of key muscles of the paretic arm, and Reduced Upper Extremity Motor Activity Log. FET and control groups showed a recovery trend in all outcome measures. The gains in FET groups were much larger compared with the gains in control groups. The speed of recovery in FET groups was substantially faster compared with the recovery rate in control groups during the first 3 weeks (treatment). The LFG subjects showed less improvement than the HFG in both the FET and control groups.

Adult↗
PubMed1980

Nutrition and cognitive development among rural Guatemalan children.

Women and children from four Guatemalan villages participated in a voluntary food supplementation program for seven years. In two of the villages, they received a vitamin and mineral fortified, high-protein calorie supplement. In the other two villages, the vitamin-mineral fortified supplement contained no protein and a relatively small number of calories. Cognitive tests were administered regularly to children ages three to seven, and anthropometric measures obtained. In addition, measures of families' social milieu were collected at several points in time. Using multiple regression analysis, we find that both nutritional and social environmental measures are related to various dimensions of cognitive competence. The results suggest that nutritional intake, independent of social factors, affects cognitive development. There is also some evidence that the children who receive the high-protein calorie supplement (and whose mothers received it during pregnancy and lactation) are more likely to score high in cognitive performance. Our results, while not diminishing social environmental explanations of differences in cognitive function, suggest benefits from nutrition intervention programs in rural areas of lesser-developed countries.

Anthropometry↗