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PubMed2000

An evaluation of the LPG vehicles program in the metropolitan area of Mexico City.

The environmental agency in the metropolitan area of Mexico City has launched a program to introduce more energy-efficient modes of transport, one of which is the use of alternative and less polluting fuels. With the perspective in mind, a liquefied petroleum gas (LPG) fleet of vehicles is exempt of the mandatory "one day without a car" program if the emission of pollutants is below the standard authorized for that specific purpose. Today, about 28,000 light-duty vehicles and heavy-duty trucks circulate in the area, most of them as aftermarket converted vehicles. In this work, we evaluated regulated exhaust emission and other parameters on 134 representative vehicles of that fleet. From the data obtained, an estimate of emission factors and their contribution to the global emission in the metropolitan area is provided. It is concluded that more than 95% of the in-use vehicles using LPG presented regulated emissions which exceeded in one or more the environmental regulations values required for certification. The poor maintenance of the vehicles and the type of conversion kit installed could be the culprits of the results obtained.

Air Pollution↗
PubMed1993

[Resources for the campaign against nosocomial infection in hospitals].

Since 1973, the Ministry of Health has recommended to set up Infection Control Committees which became statutory in 1988. They have many responsibilities including the survey of nosocomial infection rate, the implementation of appropriate control strategies, the control of "antibiotic resistance", the training of staff, the production and the evaluation of written procedures for patients care, isolation, sterilization..., as well as they are in charge of the protection of health care workers against occupational risk of infection. Although, such committees have been appointed in more than 85% of hospitals, their true activity and the rate of nosocomial infection remain much less well known. The very low proportion of beds actually involved in a "surveillance" program, the scarcity of specific personnel, the insufficiency of institutional program of training, and the height prevalence of bacterial resistance to antibiotics are all of concern. Recently, the Ministry of Health has intensified its requirements and recommendations. However, resources allocated to nosocomial infection control remain unsatisfactory and it makes mandatory that each hospital generate a program which should be recognized as a priority. It is obvious that willingness is not sufficient and that the appointment of nosocomial infection control teams is warranted with appropriately trained personnel. However it is fair te recognize that the cost-effectiveness evaluation of various strategies remains to be done.

Cross Infection↗
PubMed1992

Physicians' attitudes toward mandatory workplace urine drug testing.

BACKGROUND: Workplace drug testing programs are being increasingly implemented in both the public and private sectors, and health care workers are unlikely to be excluded from such testing. METHODS: A survey of attending physicians' attitudes toward mandatory hospital-based urine drug testing was undertaken in a medium-sized, midwestern county. RESULTS: Seventy-four percent (272/368) of the sample responded. Seventy-two percent of the subjects believed physician drug use to be a minor or nonexistent problem, 38% lacked confidence in the testing procedure, and 60% believed that testing infringed on the physician's right to privacy; yet 87% would submit to testing if required by a hospital. Forty-five percent of respondents agreed with the policy of mandatory testing for physicians with hospital privileges, 34% disagreed, and 21% were uncertain. Respondents were more supportive of mandatory testing of other health care and non-health care occupations than for themselves. Support for testing was greatest for illicit drugs. If implemented, physicians preferred mandatory testing to be performed by hospital medical staff independent of hospital administration. CONCLUSIONS: Further education and discussion within the physician community appears to be necessary before widespread mandatory workplace urine drug testing of physicians is implemented.

Attitude of Health Personnel↗
PubMed1989

A national health program for the United States. A physicians' proposal.

Our health care system is failing. Tens of millions of people are uninsured, costs are skyrocketing, and the bureaucracy is expanding. Patchwork reforms succeed only in exchanging old problems for new ones. It is time for basic change in American medicine. We propose a national health program that would (1) fully cover everyone under a single, comprehensive public insurance program; (2) pay hospitals and nursing homes a total (global) annual amount to cover all operating expenses; (3) fund capital costs through separate appropriations; (4) pay for physicians' services and ambulatory services in any of three ways: through fee-for-service payments with a simplified fee schedule and mandatory acceptance of the national health program payment as the total payment for a service or procedure (assignment), through global budgets for hospitals and clinics employing salaried physicians, or on a per capita basis (capitation); (5) be funded, at least initially, from the same sources as at present, but with all payments disbursed from a single pool; and (6) contain costs through savings on billing and bureaucracy, improved health planning, and the ability of the national health program, as the single payer for services, to establish overall spending limits. Through this proposal, we hope to provide a pragmatic framework for public debate of fundamental health-policy reform.

Budgets↗
PubMed2006

Pre-marital examination as a method of prevention from blood genetic disorders. Community views.

The Saudi Royal Cabinet issued the Saudi Royal Decree No. 3 dated 11-7-1424, establishing the pre-marital examination as a health preventive measure for all Saudis, and requesting the 2 prospective partners (male and female) to carry out a pre-marital examination and present a certificate of pre-marital examination before the wedding. However, the prospective husband and wife are not obliged to abide by the laboratory results if they so wish. This program started officially on the 1st of Muharram, 1425. As a consequence, the community perception and views on the pre-marital examination program as a preventive measure become crucial. Therefore, this study was organized and conducted to reveal the perception of the community regarding the program, through a purpose-made questionnaire that was distributed during symposia and awareness lectures held throughout the Kingdom (Riyadh, Jeddah, Dammam, Al-Khobar, Al-Ahsa, Al-Qassim, and Madinah). The questionnaire covers the opinions of the participants in various aspects related to genetic diseases including nature of diseases, mode of transmission, affecting factors, complications, management, and prevention. In addition, the questionnaire also covers opinions regarding the pre-marital examination as a preventive measure of blood genetic diseases, and its contribution to the control of these diseases. The questionnaire also covers methods in obtaining information, whether from studies, lectures, information media, and awareness lectures. The results revealed that the majority of the participants (94.3%) were convinced that the pre-marital examination is an effective mean of prevention of blood genetic diseases. The majority (86.9%) of the participants were also convinced that the pre-marital examination should be mandatory. These are indications that the community is aware of the pre-marital examination, and the effectiveness of the awareness program is enriching the knowledge of the citizens.

Female↗
PubMed2001

Home care training in internal medicine residencies: a national survey.

PURPOSE: To determine the amount and type of training U.S. internal medicine residents receive in providing home care to patients. METHOD: A four-item questionnaire was developed and sent to the program directors of all accredited internal medicine residencies in the United States (n = 397) to assess the amounts and types of training (didactic sessions or lectures, house calls, or both) internal medicine residents receive in providing home care. Demographic information about the residency programs was also collected and analyzed. RESULTS: A total of 312 (78.6%) of the program directors responded. Sixty-eight percent of their programs included instruction in home care consisting of house calls, lectures, or both. Fewer than half of the responding programs offered any lecture in home care in their curricula, and only 25% of them included a mandatory house-call experience for trainees. Residency programs that had primary care tracks were more likely than were other programs to include either of these experiences in their curricula. CONCLUSIONS: Most internal medicine residents receive limited training in home care. As a consequence, future internists may be inadequately prepared to meet the needs of their patients, particularly as the population ages.

Curriculum↗
PubMedDate not supplied

Teaching electrocardiography: computer assisted learning vs lecture method.

This study investigated nursing students' responses to a basic electrocardiography computer assisted learning (CAL) program and a lecture on the same topic. There were no significant differences between the CAL and lecture groups on cognitive outcomes (measured by a 20 item test on electrocardiogram knowledge) or transfer of learning outcomes (measured in the clinical setting by the students' ability to identify and interpret six electrocardiogram tracings). However, CAL students displayed more positive affective responses. They also took between 10 and 32 minutes to complete the program while all lecture students took a mandatory 50 minutes or more.

Adult↗
PubMed1995

Attitudes toward urinalysis drug testing within a civilian pilot training program.

BACKGROUND: This descriptive-correlational study examined civilian student pilots' attitudes toward urinalysis (UA) drug testing and the pilots' opinions regarding effectiveness, adequacy, and fairness of the method as a deterrent for substance abuse among pilots. HYPOTHESIS: There will be significant differences among attitudes of professional aviation student pilots in mandatory and nonmandatory UA drug tested sections of a flight program when considering the pilots' flight hours, ages, gender, anxiety produced by UA drug testing, opinions on drug and alcohol abuse by pilots on the flight schedule, and their attitudes toward the testing process. METHODS: A Likert-scaled questionnaire was completed by the student pilots who were enrolled in mandatory and nonmandatory UA drug tested class sections within a large civilian aviation flight program. RESULTS: Pilots felt mandatory UA testing was less anxiety-producing (t = 2.25, p < 0.05) than the students in nonmandatory tested flight classes. The pilots in nonmandatory tested sections felt more strongly (t = 2.55, p < 0.01) that drug use existed among pilots on the flight schedule than mandatorily tested pilots. Significant intercorrelations (p < 0.05) emerged among the variables age, gender, flying hours, randomization of UA testing, and attitudes toward the UA testing process and its' effectiveness. CONCLUSIONS: Based on the results, mandatory UA drug testing appeared to decrease substance abuse among pilots on the flight schedule.

Adult↗
PubMed2003

Mandatory reporting of HIV infection and opt-out prenatal screening for HIV infection: effect on testing rates.

BACKGROUND: Mandatory reporting of HIV infection to public health authorities, although now common, may deter people from undergoing testing. We examined HIV testing frequency in Alberta before and after mandatory reporting was implemented. We also examined the effect on testing rates among pregnant women when Alberta adopted an opt-out approach to prenatal HIV screening. METHODS: Using data from the Provincial Laboratory for Public Health, we determined the number of HIV tests done between Jan. 1, 1993, and Dec. 31, 2000, for males and females in Alberta. We used data from the Canadian Blood Services laboratories to obtain the number of tests conducted as part of the opt-out prenatal HIV testing program. Reporting of HIV infection became mandatory on May 1, 1998, and opt-out prenatal HIV testing was introduced on Sept. 1, 1998. RESULTS: Among males, the average annual percent increase in the number of HIV tests was 4.0% for the period before mandatory testing, as compared with 4.3% for the period after mandatory reporting was implemented; the difference in yearly trend was significant (p < 0.001). Among females, the average annual percent increase in the number of HIV tests was 9.2% for the period before mandatory reporting. In the month immediately following the adoption of opt-out prenatal HIV testing, the rate increased by 28%. Between 1999 and 2000, the average annual percent increase in the number of HIV tests among females was 1.4%. INTERPRETATION: The introduction of mandatory reporting of HIV infection did not appear to have a deterrent effect on rates of HIV testing. The implementation of an opt-out prenatal HIV testing policy resulted in a dramatic increase in the number of females being tested for HIV infection.

AIDS Serodiagnosis↗
PubMed2004

Some consequences of different older driver licensing procedures in Australia.

Given both the expected growth in the number of older drivers and their over-involvement in fatal and serious injury crashes, there has been a world-wide call for improved licensing procedures to manage older driver safety. In particular, licensing authorities have been urged to move from mandatory assessment of all older drivers to assessment practices targeting only those at higher crash risk. The current study examined older driver fatal and serious injury crash involvement rates across all Australian States to determine a possible association with the different licensing procedures. In particular, older driver crash involvement rates in Victoria (where there is no age-based assessment program) have been compared with rates in other jurisdictions with assessment programs. Crash involvement rates have been calculated using two denominators: per population and per number of licensed drivers. Some data limitations notwithstanding, older drivers in jurisdictions with age-based mandatory assessment programs could not be shown to be safer than drivers in Victoria. Further, there is some indicative evidence that older drivers in Victoria may have a significantly safer record regarding overall involvement in serious casualty crashes.

Accidents, Traffic↗
PubMed2002

Impact of work therapy on health status among homeless, substance-dependent veterans: a randomized controlled trial.

BACKGROUND: Little is known about the health outcomes of clinician-supervised, performance-based, abstinence-contingent therapeutic work programs on homeless persons with addiction disorders. This study examined the effect of the Department of Veterans Affairs compensated work therapy program (CWT) on nonvocational outcomes. With mandatory urine screenings and adherence to addiction treatment schedules, CWT provided work opportunities (wages, hours, and responsibilities) with jobs created from Veterans Affairs contracts competitively obtained from private industry. METHODS: Homeless, substance-dependent veterans (N = 142) from 4 Department of Veterans Affairs medical centers were randomized, assessed at baseline, and reassessed at 3-month intervals for 1 year. Both CWT and control groups had access to comprehensive rehabilitation, addictions, psychiatric, and medical services. Data were analyzed to determine an immediate CWT effect after treatment and rates of change during 1 year. RESULTS: Compared with control subjects, patients in the CWT program were more likely to (1) initiate outpatient addictions treatment, (2) experience fewer drug and alcohol problems, (3) report fewer physical symptoms related to substance use, (4) avoid further loss of physical functioning, and (5) have fewer episodes of homelessness and incarceration. No effect on psychiatric outcomes was found. CONCLUSION: Work therapy can enhance nonvocational outcomes of addiction treatment for homeless persons, although long-term gains remain unknown.

Adult↗
PubMed1990

How voluntary prenatal diagnosis and selective abortion increase the abnormal human gene pool.

It is often assumed that prenatal diagnosis followed by the selective abortion of "defective" fetuses has a positive eugenic effect. Although mandatory selective abortion of "defective" fetuses and, more important, carriers would tend to reduce the number of deleterious genes in the gene pool, the present program of voluntary prenatal diagnosis and selective abortion actually increases the number of deleterious genes. This raises the issue of freedom of choice regarding selective abortion and societal pressure on parents to undergo prenatal testing and to abort their fetus should it have a genetic disorder or be a carrier of one.

Abortion, Therapeutic↗
PubMed2004

[Experiences and difficulties in implementing immunization registries in Saxony-Anhalt].

In the German Federal State of Saxony-Anhalt, the Health Department must be notified of vaccines administered to children <7 years of age including their names. The goal of this mandatory notification is to improve and stabilize the age-appropriate vaccination coverage. However, difficulties have been encountered in implementing mandatory notification. Therefore, the Health Departments of Magdeburg and Halle have launched a model project focusing on analysing and eliminating these problems. Mandatory notification requires parents' approval, endorsement of vaccantors, and availability of human and technicely resources in the Health Department. An enquiry among paediatricians and family doctors in private practice revealed widespread reservations about mandatory notification because of privacy issues related to data and legal protection. Furthermore, family doctors believed that parents disapproved of notification by name. However, a survey among young mothers revealed this not to be the case. Winning young mothers' approval depends largely on the positive attitude of the vaccinators. To implement the mandatory notification of vaccinations to the Health Department, it is necessary to dispel physicians' concerns and to inform young parents about the practical benefits. However, this places high demands on the Health Departments for maintaining immunization registries, communicating with physicians and notifying parents when immunisations are due or late.

Adult↗
PubMed1997

HIV counseling and testing: its evolving role in HIV prevention.

The development of an enzyme-linked immunosorbent assay (ELISA) for screening blood for antibodies to HIV was a major milestone in the history of AIDS prevention and treatment. Since early 1985, the Centers for Disease Control and Prevention (CDC) has provided public funds to state and local health departments to support a national HIV counseling-and-testing (HIV CT) program directed toward persons at risk of transmitting or becoming infected with HIV. The implementation and ongoing development of this national program has often been marked by intense policy debate, especially in the area of mandatory testing. Furthermore, the lessons learned during its 11-year program history are highly relevant to understanding the challenges that might arise when implementing other new biomedical or behavioral HIV prevention technologies. Using the construct of public health infrastructure, this article describes key features, events, lessons learned, and future challenges of this evolving national prevention program.

AIDS Serodiagnosis↗
PubMed2001

Planning and execution of a successful hepatitis B immunization program.

Today's college students occupy a "window" between older adults, whose need for hepatitis B vaccination is minimal, and younger people who receive the vaccine as part of their childhood immunization series. However, because of the high-risk activities that are often part of student behavior, college students are among the individuals who are at the highest risk for this disease; 75% of all reported hepatitis B cases occur in persons between the ages of 15 and 39 years. It is therefore imperative that college health professionals take seriously their responsibility to educate students about issues related to hepatitis B and make available programs that enable the students to receive immunizations. This article briefly describes a successful hepatitis B education and immunization program at an institution that has no mandatory prematriculation immunization requirements.

Adolescent↗
PubMed2003

Views of practicing dentists regarding a mandatory fifth year of training.

As part of a U.S. Health Resources and Services Administration-funded evaluation of the impact of federal funding on postgraduate general dentistry programs, a random sample of 6,725 dentists graduating in 1989, 1993, and 1997 were surveyed regarding practice patterns, advanced training, populations served, services provided, and their position on a mandatory fifth year of training. Responses (1,965) showed 48 percent supporting a mandatory year and 52 percent not supportive. Open-ended comments were provided by 1,626 respondents. The main reasons for supporting a mandatory fifth year were the need for more instructional time and need for a transition year. Individual choice, no value in a fifth year of dental school, mentoring available elsewhere, and cost were cited in opposition. The following respondents were significantly more likely than other respondents to support a mandatory fifth year: individuals who had completed an AEGD, GPR, or specialty program; were Asian; held salaried positions in a community clinic, nursing home, or hospital; or described themselves as a consultant. Graduates in 1993 and 1997 were less supportive of a mandatory fifth year than were 1989 graduates. Significant differences in the reasons offered in support of respondents' positions on the issue were observed among AEGD, GPR, specialists, and nonspecialists and the three cohort years.

Attitude of Health Personnel↗
PubMed1992

On the assessment of bioequivalence in a two-period cross-over design.

The results obtained with Meineke and De Mey's algorithm for posterior probability distributions in the nonparametric evaluation of two-period cross-over bioequivalence studies are critically discussed. Suggestions for improvement of their program NEWPARM are given. It is shown that this program in its present form cannot handle the results from bioequivalence studies in which more than 15 subjects participated. For larger study sizes, conversion to a more powerful programming language capable of handling large three-dimensional arrays, is mandatory. An alternative algorithm, allowing large sample sizes to be analysed nonparametrically without program conversion, is offered. A general bioequivalence program written by the author, into which this alternative algorithm is implemented, has been in use by a number of pharmaceutical companies and drug regulatory agencies since February 1990; its most recent update is Version 3.7 (BIOEQV37.EXE) of October 1990.

Algorithms↗
PubMed1996

Quality improvement of diagnostic microbiology through a peer-group proficiency assessment program. A 20-year experience in Ontario. The Microbiology Committee.

OBJECTIVE: To evaluate the microbiology laboratory performance in Ontario over a 20-year period of participation in a quality assessment program and to assess the impact of quality improvement strategies. DESIGN: Longitudinal review of isolation, identification, and antimicrobial susceptibility testing of bacteria from lyophilized, simulated patient samples. SETTING: Ontario medical laboratories, licensed by the Ministry of Health, have been subjected to mandatory testing by the Laboratory Proficiency Testing Program of the Ontario Medical Association since 1974. Survey reports, information bulletins, correspondence, on-site consultations, educational assistance tutorials, and teleconference education are used as quality improvement strategies. PARTICIPANTS AND INTERVENTIONS: Laboratories were subjected annually to 20 external quality assessment challenges. Performance was assessed against consensus reference values. Single survey and cumulative profiles were reviewed by a peer-group panel for acceptable or unacceptable performance. Specific interventions are used to improve collective and individual laboratory performance. RESULTS: The number of microbiology laboratories declined from 335 in 1974 to 190 in 1994. Twenty-one percent failed expected performance standards on initial review. One hundred forty-two on-site consultations and 61 educational assistance tutorials have been provided. Twenty-five laboratories were declared nonproficient. Since 1989, 50% of the laboratories have scored at or above 80% for isolation and identification, but 25% have scored at or below 50% on susceptibility testing, and 10% or fewer have scored at or above 80%. Poor susceptibility testing performance is due to inappropriate agent selection, not testing errors. CONCLUSIONS: The emphasis of the Laboratory Proficiency Testing Program is on quality improvement, not punishment. Performance has improved, but poor performers have the same characteristics as in 1974. Identification to species is common owing to the use of commercial systems. Automated susceptibility testing has increased to 45% of participants.

Bacterial Infections↗