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AIDS and South Africa--towards a comprehensive strategy. Part II. Screening and control.

In this, the second of a three-part series of articles in which we propose steps towards a comprehensive strategy for the control of HIV infection, we consider controversies relating to screening for HIV, the indications for and desirability of mandatory testing of certain groups at risk, and the place of voluntary testing in the control of HIV transmission and infection. Key recommendations are that mandatory testing of donors of blood and other vital tissues, patients on haemodialysis and haemodialysis unit staff is justified, and that children put up for adoption may require testing. We make further recommendations regarding HIV testing as a prerequisite for life insurance and recommend that voluntary testing be offered, supported by adequate pre- and post-test counselling. We consider that all health care workers should accept as their moral obligation the care and management of HIV-infected individuals, and that they should be adequately educated and skilled in such work. These recommendations were reached largely by consensus, although there were occasions when individual authors condoned recommendations with which they did not personally agree.

Acquired Immunodeficiency Syndrome↗

Clinicians and HIV infections: social policies and professional issues.

The human immunodeficiency virus (HIV) is a deadly infectious virus. Relatively hard to contract, it is the causative agent of acquired immunodeficiency syndrome. Nurses and other clinicians have an important role to play in influencing national and local management of the HIV infection through review and comment on policy. Policies recommending quarantine, isolation, mandatory testing of certain populations, and vigorous public education are explored. Quarantine, isolation of seropositive individuals, and mandatory testing of certain groups are explicated in the article as unethical, unmanageable or both. Some recommendations for vigorous, specific public education are made. The importance of the participation of health professionals in public policy debates is emphasized.

Acquired Immunodeficiency Syndrome↗

Different diagnostic approaches to adult candidates for cadaveric kidney transplantation in Europe.

We investigated which diagnostic procedures are mandatory for all transplant candidates irrespective of their individual situation in European transplant centres, how homogeneously these are applied and what centre characteristics determine differences in the diagnostic approach. A questionnaire was sent to European renal transplant centres asking which of 45 listed diagnostic procedures are mandatory for every transplant candidate. The 154 participating centres require 15.6 +/- 5.6 (4-33) mandatory tests, with significantly less mandatory diagnostics in centres in the UK (8.5 +/- 3.9) and Scandinavia (9.8 +/- 2.3). Geographic location is the single significant factor in multifactorial analysis of possibly related factors. Detailed analysis revealed 16 tests that are required significantly less often in the north of Europe. There are significant differences in the evaluation of renal transplant candidates across Europe. In some parts of Europe transplant candidates are either investigated more discriminately or less comprehensively than in other regions.

Adult↗

The political history of syphilis and its application to the AIDS epidemic.

The history of syphilis control from the mid-19th century through the present time is a strong argument for the need to enhance the public health efforts to find cases of human immunodeficiency virus (HIV) infection and to notify the partners of infected individuals. To do this, public policy must be changed to allow better case-finding (mandatory testing) and partner notification (mandatory reporting). The history of syphilis is such that one person in 22 was infected in this country in 1918. If we are to use this history to control the current HIV epidemic, control measures used for syphilis (before penicillin) are needed; these are equal attention to education, available health care, case-finding, and partner notification.

AIDS Serodiagnosis↗

Mandatory toxicology testing and chemical dependence consultation follow-up in a level-one trauma center.

OBJECTIVE: There is a growing body of evidence indicating an association between intoxication and major trauma. This study assessed the prevalence of alcohol or drug intoxication in major trauma admissions to an urban trauma center. DESIGN: Sequential case series. METHODS: Toxicology testing and structural clinical interview assessment. MAIN RESULTS: Seventy-eight percent of patients tested had positive toxicology results. Chemical dependence assessments performed on patients who tested positive revealed that 94% met the criteria for a substance dependence or abuse disorder. CONCLUSIONS: The implications of this data for admission toxicology testing policies and chemical dependence consultation support services to trauma units are discussed.

Alcohol Drinking↗

Porphyria cutanea tarda and pregnancy.

Porphyria cutanea tarda is the most common disorder of porphyrin metabolism in Europe and North America. The disorder is characterized by specific cutaneous lesions, associated systemic findings, and excessive accumulation and excretion of uroporphyrin and coproporphyrins. Reports of this condition associated with pregnancy are scarce in the literature. In this review, we present the case of a patient with porphyria cutanea tarda to illustrate the natural progression and complications of the disorder during pregnancy. Based in this report and a review of the published cases, pregnancy may exacerbate the cutaneous lesions of porphyria cutanea tarda during the first trimester. The incidence of diabetes, antinuclear antibodies, and hepatitis B and C are increased among them, making glucose tolerance and antibody testing mandatory. Newborns should be tested for the disorder during the neonatal period. Genetic counseling is advisable as well as teaching avoidance of provocative factors in affected children.

Adult↗

Mandatory HIV testing.

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Acquired Immunodeficiency Syndrome↗