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PubMed1985

Public health nursing: in sickness or in health?

Public health nursing began in the United States as a small undertaking in which a few wealthy women hired one or two nurses to visit the sick poor in their homes. By 1910, the work of these nurses had expanded to include a variety of preventive programs. While most preventive programs originated with voluntary organizations, such as the visiting nurse societies, they were eventually taken over either by boards of education or health departments. As a consequence of the new division that resulted, sick nursing would increasingly become the sole domain of the voluntary organizations, while the teaching of prevention would become the responsibility of public agencies. By examining the history of public health nursing between 1900-30, this article considers why a movement that might have been significant in delivering comprehensive health care to the American public failed to reach its potential.

Community Health Nursing↗
PubMed1998

Surveillance for Ross River virus infection using blood donors.

The number of clinical Ross River virus (RRV) infections (epidemic polyarthritis) each year in Australia continues to grow despite extensive vector control programs. There is a need, therefore, for a surveillance program that can give sufficient warning of outbreaks of the disease so that highly focused preventative measures may be undertaken. The ability of a surveillance program, based on voluntary Red Cross blood donations, to predict outbreaks of epidemic polyarthritis was evaluated. Anti-RRV IgM antibody was detected in significant numbers of blood donors from throughout the state of Queensland 6-9 weeks prior to an increase in the number of notified cases of epidemic polyarthritis. At a local level, significant numbers of anti-RRV IgM blood donors were detected in Brisbane in 1996 four weeks prior to an increase in the number of notified cases of epidemic polyarthritis. This system of surveillance is technically simple, rapid (results are obtained in 2-3 days), it samples the human population from throughout the state, and it gives timely warning of outbreaks of epidemic polyarthritis.

Adolescent↗
PubMed1999

Necessity of clinical information in surgical pathology.

OBJECTIVES: To examine the frequency and nature of problems caused by inadequate clinical data provided on surgical pathology requisition forms. DESIGN: Participants in the 1996 Q-Probes voluntary quality improvement program of the College of American Pathologists were asked to document prospectively all surgical pathology cases with inadequate information. Inadequate clinical information was defined as the pathologist's need for additional clinical information before a diagnosis could be rendered, regardless of the amount of information already present on the requisition slip. Cases that had no clinical information on a requisition slip were not counted if the lack of history did not hinder diagnosis. The study concluded when 3 months had elapsed or 40 surgical pathology cases were documented. The following data were recorded for each case: anatomic site, type of procedure, nature of disease, method of obtaining additional information, importance of obtained information, and the length of delay in the final diagnosis. PARTICIPANTS: Three hundred forty-one laboratories, 322 of which were from the United States. RESULTS: A total of 5594 cases (0.73%) required additional clinical information for diagnosis (10th through 90th percentile range, 3.01% to 0.08%). Institutions with greater average occupied bedsize, a greater number of cases accessioned per year, and a greater number of pathologists had a lower percentage of cases with inadequate clinical data (P <.05). Sixty-eight percent of these cases had no delay in completion of a case, 16.2% had a delay of 1 day or less, and 15.1% of cases were delayed more than 1 day. In 59.4% of cases, the additional clinical information obtained confirmed the initial diagnostic impression. In 25.1%, the information was not relevant to the pathologic diagnosis. In 6.1% there was a substantial change in the diagnosis or a revised report was issued, and in 2.2% no additional information could be obtained. Specific anatomic sites that correlated with a higher rate of changed diagnoses or revised reports in cases with inadequate information included the small bowel, the bronchus/lung, and the ovary. Resection specimens were also significantly associated with a higher rate of changed diagnoses or revised reports when additional information was obtained, as were malignant neoplasms and therapy-induced changes. CONCLUSIONS: This study establishes an aggregate rate of cases with inadequate clinical information for diagnosis (0.73%) and documents the extent of problems caused by inadequate clinical information. The criticality of appropriate clinical information provided to the pathologist is identified for specific anatomic sites and disease processes and is reflected in changed diagnoses or revised reports.

Humans↗
PubMed2001

Surgical pathology-based outcomes assessment of breast cancer early diagnosis: a College of American Pathologists Q-Probes study in 199 institutions.

OBJECTIVE: To develop breast cancer outcomes data relating pathologic tumor variables at diagnosis with clinical method of detection. DESIGN: Anatomic pathologists assessed 30 consecutive breast cancers at each institution, resulting in an aggregate database of 4232 breast cancers. SETTING: Hospital-based laboratories from the United States (98%), Canada, Australia, and Belgium. PARTICIPANTS: One hundred ninety-nine laboratories in the 1999 College of American Pathologists Q-Probes voluntary quality improvement program. MAIN OUTCOME MEASURES: Pathologic variables indicative of favorable outcomes included percentage of carcinomas detected at the in situ stage, tumors < or = 1 cm in diameter, and invasive cancers with lymph nodes negative for metastases. RESULTS: All outcomes measures, including percent in situ carcinomas (26.9% vs 13.8%), tumor size < or = 1 cm (57.8% vs 36.5%), and lymph node-negative status (77.8% vs 64%), were more favorable when tumors were detected by screening mammography (P <.001) compared to all other detection methods. CONCLUSIONS: This study demonstrates an opportunity for pathologists to develop outcomes information of interest to health care organizations, providers, patients, and payers by integrating routine oncologic surgical pathology and clinical breast cancer detection data. Such readily obtained interim outcomes data trended and benchmarked over time can demonstrate the relative clinical efficacy of preventive breast care provided by health care systems long before mortality data are available.

Adult↗
PubMed1999

Voluntary HIV testing in prison: do women inmates at high risk for HIV accept HIV testing?

This study examined the proportion of women inmates who accepted HIV testing and the sociodemographic, criminal, and HIV-related risk characteristics associated with accepting such testing in a state prison offering voluntary HIV testing. A consecutive sample of 805 women felons admitted to the North Carolina Correctional Institution for Women between July 1991 and November 1992 was interviewed. Of these inmates, 680 (84%) granted permission to access their medical records and had complete information on relevant characteristics. Seventy-one percent of the women inmates accepted HIV testing. In multivariate analysis, the exchange of sex for money or drugs and the conviction for a drug crime were significantly associated with accepting HIV testing. Injection drug use, drug-injecting sex partners, and a history of a sexually transmitted disease were not significantly associated with accepting HIV testing. A prison-based voluntary HIV testing program appears to be reaching a substantial proportion of women inmates potentially at risk for HIV, especially women inmates who exchanged sex for money or drugs.

AIDS Serodiagnosis↗
PubMed1999

Anonymous or confidential HIV counseling and voluntary testing in federally funded testing sites--United States, 1995-1997.

Human immunodeficiency virus (HIV) counseling and voluntary testing (CT) programs have been an important part of national HIV prevention efforts since the first HIV antibody tests became available in 1985. In 1995, these programs accounted for approximately 15% of annual HIV antibody testing in the United States, excluding testing for blood donation. CT opportunities are offered to persons at risk for HIV infection at approximately 11,000 sites, including dedicated HIV CT sites, sexually transmitted disease (STD) clinics, drug-treatment centers, hospitals, and prisons. In 39 states, testing can be obtained anonymously, where persons do not have to give their name to get tested. All states provide confidential testing (by name) and have confidentiality laws and regulations to protect this information. This report compares patterns of anonymous and confidential testing in all federally funded CT programs from 1995 through 1997 and documents the importance of both types of testing opportunities.

AIDS Serodiagnosis↗
PubMed1999

Pediatric research: coming of age in the new millennium.

One of the many provisions of the recently enacted Food and Drug Administration Modernization Act (FDAMA) provides for an additional period of market exclusivity in exchange for completed pediatric studies requested by the FDA for certain drugs of potential benefit to the pediatric population. The impetus for this law centers around two facts: Drugs needed in the pediatric population lack labeling for pediatric use, and industry lacks incentive to perform studies to support this additional labeling. Congress has now provided the incentive. The success of the pediatric initiative will rest initially on industry's willingness and readiness to do the studies. This willingness, in turn, will depend on FDAMA's impact on the economics of drug development and the availability of pediatric research capacity, both of which could be affected by the FDA's final rule on the assessment of safety and effectiveness of drugs and biologicals for pediatric patients. This rule will compel firms to conduct pediatric studies similar to the ones encouraged under FDAMA's voluntary pediatric exclusivity program. Although the Act provides for the statutory harmonization of the rule with the Act, whether the effects of the rule on the Act have been fully contemplated is a premise considered in this article. Congress too has much to contemplate as they evaluate the FDA's report, due in less than 2 years, on the public health effectiveness and economic effects of the Act's incentive program in preparation for possible FDAMA II modifications.

Drug Industry↗
PubMed2002

A survey of physical dosimetry to date and in the near future: Part 1. Review of standards and regulatory issues.

This article summarizes the status of the relevant standards and current regulatory issues for use of physical dosimetry devices for the occupational worker in the United States. Included is a summary of relevant standards from the International Organization for Standardization (ISO), the International Electrotechnical Commission (IEC), the American National Standards Institute (ANSI), the United States Nuclear Regulatory Commission NUREG-Series, the National Voluntary Laboratory Accreditation Program (NVLAP), the Department of Energy Laboratory Accreditation Program (DOELAP), and the U.S. Military Specifications and Standards (MIL-STD). Proposed changes to ANSI N13.11-1993, "American National Standard for Dosimetry-Personnel Dosimetry Performance Criteria for Testing," are listed. The strategic changes that the United States Nuclear Regulatory Commission (NRC) is making in rulemaking activities related to dosimetry and standards are given. The status of Measurement Program Description (MPD) C.18, "Implementation of Electronic Dosimetry for Primary Dosimetry," from the Council on Ionizing Radiation Measurements and Standards (CIRMS) is given.

Humans↗
PubMed2002

Phosphorus reductions following riparian restoration in two agricultural watersheds in Vermont, USA.

Achievement of management goals for Lake Champlain (Vermont/New York, USA and Quebec, Canada) will require significant reductions of phosphorus (P) loads from agriculture, the dominant diffuse source in the basin. Cost-effective P reduction strategies must be based on reliable treatment techniques beyond basic erosion control and animal waste storage practices. The Lake Champlain Basin Agricultural Watersheds National Monitoring Program (NMP) Project evaluates the effectiveness of low-cost livestock exclusion, streambank protection, and riparian restoration practices in reducing concentrations and loads of diffuse-source pollutants from grazing land at the watershed level. Treatment and control watersheds in northwestern Vermont have been monitored since 1994 according to a paired-watershed design. Monitoring includes continuous stream discharge recording, flow-proportional sampling for total P and other pollutants, and documentation of land use and agricultural management activities. Strong statistical calibration between the control and treatment watersheds has been achieved. Landowner participation in the land treatment program was entirely voluntary and all treatments were 100% cost-shared by the project and cooperators. Installation of riparian fencing, alternative water supplies, protected stream crossings, and streambank bioengineering was completed in 1997 at a cost of less than US$40,000. The paired-watershed design was effective in controlling for the influence of extreme variations in precipitation and streamflow over six years of monitoring. Two years of post-treatment data have documented significant reductions in P concentrations and loads from both treated watersheds. Reductions of approximately 20% in mean total P concentration and approximately 20-50% in mean total P load have been observed, with greater reductions occurring in the watershed receiving more extensive treatment. The effectiveness of riparian zone restoration in P reduction tended to be lower during periods of very high runoff, especially outside the growing season.

Agriculture↗
PubMed1992

Nutrition labeling of raw fruit, vegetables, and fish.

In response to certain requirements of the Nutrition Labeling and Education Act of 1990 (the 1990 amendments), the Food and Drug Administration (FDA) developed a voluntary nutrition labeling program for the 20 most frequently consumed raw fruit, vegetables, and fish in the United States. FDA used data on retail sales and food consumption to identify which foods to include in the program and developed guidelines for retailers to use in setting up the labeling program in their stores. FDA provided interim nutrition labeling data for retail use. These data are to be revised and updated at least every 2 years. A representative sample of 2,000 grocery stores will be used to assess compliance of retailers with the nutrition labeling guidelines. Substantial compliance with the guidelines is defined as compliance by 60% of the 2,000 stores.

Animals↗
PubMed1992

Medical rehabilitation for the indigent in Louisiana: a primer for physicians.

The impact of a stroke, head injury, spinal cord injury, or other disabling condition can be especially devastating for individuals without health insurance. Fortunately, a comprehensive system has evolved to address the needs of the indigent for medical rehabilitation services in Louisiana. The purpose of this paper is to familiarize readers with this complex system, and thereby to assist practicing physicians and other health care providers in better serving this large and medically needy population. First, state and federal medical assistance programs which cover rehabilitation services are reviewed; next, services available through Louisiana Rehabilitation Services are discussed; and finally, services available through the Handicapped Children's Services Program and various voluntary organizations are described.

Persons with Disabilities↗
PubMed2004

VEBAs--ordinary and necessary expenses--deductions and constructive dividends. Neonatology Associates, P.A. v. Commissioner of Internal Revenue.

Contributions made by professional medical corporations into voluntary employee benefit program plans (VEBAs), which were well in excess of the cost of the term life insurance provided to the participants, were not ordinary and necessary business expenses, and the distributions of surplus cash to owner physicians upon conversion to individual policies constituted constructive dividends taxable to the individual taxpayers.

California↗
PubMed1992

Relation between cardiorespiratory fitness and selected risk factors for coronary heart disease in a population of Canadian men and women.

OBJECTIVE: To determine the relation between cardiorespiratory fitness, as determined with the Canadian Aerobic Fitness Test (CAFT), and selected risk factors for coronary heart disease (CHD) in a Canadian population. DESIGN: Cross-sectional study. On the basis of age-specific and sex-specific national percentile scores, subjects were classified as being in the low-fitness, moderate-fitness or high-fitness category according to maximum oxygen consumption (VO2 max) predicted from performance on the CAFT. PARTICIPANTS: A total of 4082 male and 1205 female Canadian federal public servants aged 30 to 59 years who participated in a voluntary fitness testing program between 1984 and 1991. OUTCOME MEASURES: Body composition (body mass index, triceps skinfold thickness, sum of four skinfold measurements, predicted percentage of body fat and waist-hip ratio), blood lipid levels (total cholesterol, triglycerides, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol and ratio of total cholesterol to HDL-C) and hemodynamic measurements (heart rate and blood pressure at rest and during exercise and predicted VO2 max). MAIN RESULTS: For both men and women the mean anthropometric measurements, blood lipid levels and blood pressure measurements at rest and after exercise were significantly associated with fitness category (p less than 0.05). CONCLUSIONS: In both men and women a higher level of aerobic fitness, as defined by VO2 max predicted from performance on the CAFT, is associated with a more favourable CHD risk profile. The results support the use of VO2 max predicted from performance on the CAFT as a valid procedure for classifying people according to fitness level.

Adult↗
PubMed1992

Performance of the Kodak DT-60 physician's office analyzer as measured by CLIA-88 proposed evaluation criteria. Assessment of demographic and quality assurance factors influencing performance.

The 1988 Clinical Laboratories Improvement Act (CLIA-88) proposes to mandate universal proficiency testing and internal quality assurance practices for all laboratories, including those in physician offices. For 3 years, we have provided an independent voluntary proficiency testing program to more than 400 physician office laboratories using Kodak DT-60 analyzers (Eastman Kodak, Rochester, NY). This unique data set enables us to evaluate, using the CLIA-88 proposed grading criteria, the ability of these laboratories to meet the proposed regulatory standards. Using the equivalent of a year's participation under the CLIA proficiency testing format (20 challenges per analyte), at least 88% would "pass," ie, achieve acceptable performance. We investigated the relationship between proficiency testing performance and several internal quality assurance practices as well as other factors commonly associated with quality performance, including analyst's professional background, monthly test volume, number of physicians served, and source of training on the instrument. The best indicator of successful performance in proficiency testing was on-site training provided by the manufacturer, as opposed to training provided by distributor personnel. We conclude that with proper on-site training and retraining, physician office laboratories will be able to meet the mandatory CLIA-88 proficiency testing requirements.

Calibration↗
PubMed2005

Botswana: Refugees not entitled to same services as citizens.

Botswana, among the countries with the highest HIV/AIDS prevalence rates in the world, has been recognized internationally for its ambitious program to offer voluntary counseling and testing, prevention of mother-to-child transmission (PMTCT) and antiretroviral (ARV) treatment to all residents. Unfortunately, these policies have not been extended to the large numbers of refugees in Botswana. Botswana's Refugee Recognition and Control Act does not recognize a refugee as an ordinary resident.

AIDS Serodiagnosis↗
PubMedDate not supplied

Algorithm for recall of HIV reactive Indian blood donors by sequential immunoassays enables selective donor referral for counseling.

BACKGROUND: HIV/AIDS pandemic brought into focus the importance of safe blood donor pool. AIMS: To analyze true seroprevalence of HIV infection in our blood donors and devise an algorithm for donor recall avoiding unnecessary referrals to voluntary counseling and testing centre (VCTC). MATERIALS AND METHODS: 39,784 blood units were screened for anti-HIV 1/2 using ELISA immunoassay (IA-1). Samples which were repeat reactive on IA-1 were further tested using two different immunoassays (IA-2 and IA-3) and Western blot (WB). Based on results of these sequential IAs and WB, an algorithm for recall of true HIV seroreactive blood donors is suggested for countries like India where nucleic acid testing or p24 antigen assays are not mandatory and given the limited resources may not be feasible. RESULTS: The anti-HIV seroreactivity by repeat IA-1, IA-2, IA-3 and WB were 0.16%, 0.11%, 0.098% and 0.07% respectively. Of the 44 IA-1 reactive samples, 95.2% (20/21) of the seroreactive samples by both IA-2 and IA-3 were also WB positive and 100% (6/6) of the non-reactive samples by these IAs were WB negative. IA signal/cutoff ratio was significantly low in biological false reactive donors. WB indeterminate results were largely due to non-specific reactivity to gag protein (p55). CONCLUSIONS: HIV seroreactivity by sequential immunoassays (IA-1, IA-2 and IA-3; comparable to WHO Strategy-III) prior to donor recall results in decreased referral to VCTC as compared to single IA (WHO Strategy-I) being followed currently in India. Moreover, this strategy will repose donor confidence in our blood transfusion services and strengthen voluntary blood donation program.

Adult↗
PubMed1991

Interinstitutional comparison of performance in breast fine-needle aspiration cytology. A Q-probe quality indicator study.

In 1989, the College of American Pathologists, Northfield, Ill, instituted a voluntary quality assurance program, called "Q-Probes," that utilized nationwide interinstitutional peer comparison. One of the anatomic pathology modules retrospectively assessed performance in fine-needle aspiration cytology (FNAC) of the breast from cytohistologic correlations that were made in 294 institutions by 988 pathologists on their own cases that were accessioned during a 6-month period. Of the 13,066 cases of FNAC, 10,751 (82%) were satisfactory for evaluation. Of these satisfactory aspirates, 3471 cases (33%) had histologic correlation, which formed the basis for determining diagnostic accuracy. Of breast aspirates, 2254 (17%) were unsatisfactory for evaluation, with the mean frequency of unsatisfactory aspirates obtained by nonpathologists (18%), ie, more than twice that of unsatisfactory aspirates obtained by pathologists (7.2%). In the diagnosis of breast cancer by FNAC, the following performance results were derived with the use of the aggregate data: 82% sensitivity of the FNAC procedure, 97% sensitivity of diagnosis, 97% specificity, 95% positive predictive value, 86% negative predictive value, and 90% efficiency. No significant difference in performance was detected when institutions were stratified by six peer group characteristics. We made the following conclusions: (1) the aggregate and median breast FNAC performance values obtained from this interinstitutional comparison of data from routine procedures performed in diverse settings in North America compared very favorably with performance from single institutions published in studies of similar design in the literature, and (2) these data may provide a reference point for participant institutions to measure future quality improvement in fine-needle aspiration of breast.

Biopsy, Needle↗
PubMed1990

Evaluation of adverse events after influenza vaccination in hospital personnel.

Reactogenicity of trivalent influenza vaccine prepared for the 1988-89 season was assessed as part of a first-time voluntary influenza prevention program among hospital staff. Of approximately 500 full-time workers in areas with the highest concentrations of patients at high risk for influenza complications offered the vaccine 288 accepted. Of these, 266 (92%) returned a questionnaire regarding any symptoms experienced within 48 hours after vaccination; 238 (90%) of the respondents reported adverse effects. Soreness at the injection site was described by 229 subjects, 58 (25%) of whom had constant aching and 123 (54%) soreness with arm movement. Symptoms resolved in 1 to 2 days, and only 21 (9%) of those who reported symptoms said they took analgesic medication. Systemic adverse effects were described by 130 subjects (49%). Intercurrent illness accounted for some of these complaints, but 65 people (24%) described at least two of the following symptoms: generalized aching, tiredness, nausea, chills or onset of fever within 12 hours after vaccination (a symptom complex previously attributed to influenza vaccine). Systemic symptoms resolved within 0.5 to 2 days. Thirteen subjects (5%) reported missing work because of arm soreness (1 subject) or systemic symptoms (12). Adverse effects were encountered more often than expected, probably because most of the workers were young and lacked immunity to influenza. Acceptability of the program could likely be improved by using a split-virus vaccine.

Absenteeism↗