Voluntary sterilization: an analysis based on service statistics of the national program.
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Asia↗
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Intradermal hepatitis B vaccination in a 300-bed primary care hospital: experience with a recombinant vaccine in a four-dose schedule.
BACKGROUND: All hepatitis B vaccination programs, regardless of route, must address such factors as primary response rate, additional booster injections for primary nonresponders, antibody persistence, the need for and timing of additional booster injections for primary responders, overall costs, and medical efficacy. A voluntary intradermal hepatitis B vaccination program with postvaccination testing was implemented in a 300-bed primary care hospital with a recombinant vaccine packaged in a concentration of 20 micrograms/ml (Engerix B; SmithKline and French Laboratories, Philadelphia, Pa.). METHODS: After informed consent was obtained, 460 employees were vaccinated intradermally over the deltoid muscle by a single employee health nurse at months 0 (initial), 1, 2, and 6, followed by testing for serologic response 1 to 2 months after the final dose. RESULTS: Of 411 employees who completed the entire protocol, 90.5% had seroconversion, as determined by enzyme immunoassay. Twelve of 29 primary nonresponders (41%) had seroconversion after an additional (fifth) intradermal booster injection. Of the primary responders, 84.5% remained seropositive when tested 18 months after the initial vaccination injection. These results are comparable to those of intramuscular vaccination and to the original studies of intradermal vaccination with plasma-derived vaccines that had shown excellent immunogenicity. CONCLUSIONS: Intradermal and intramuscular hepatitis B vaccination programs must be implemented in somewhat different ways, but both can provide excellent protection against hepatitis B viral infection. Even allowing for the additional expense of postvaccination testing and more frequent booster injections, intradermal vaccination greatly reduces the overall costs of hepatitis B vaccination and may therefore increase compliance in many different settings.
Adult↗
Smaller families through China's integrated project.
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Asia↗
Legal trends and issues in voluntary sterilization.
Legal barriers to voluntary sterilization are falling. In both developing and developed countries, new legislation, court decisions, government policy statements, and ministerial regulations increasingly leave the decision whether to be sterilized to the individuals involved rather than to medical experts or government officials. These legal changes confirm that voluntary sterilization is an acceptable means of fertility regulation and a legitimate medical procedure; it is no longer seen as physical mutilation to be condemned in the criminal codes. Nevertheless, barriers still exist in some countries that make it difficult for poor and rural populations to obtain voluntary sterilization. These obstacles arise when voluntary sterilization is excluded from national health and family planning programs and from private insurance plans. Changes in voluntary sterilization law reflect increasing choice of this method of fertility control. Over the last decade voluntary sterilization has become the most widely used means of family planning in the world. Approximately 100 million couples now are protected from unwanted pregnancy by voluntary sterilization. This amounts to one-eighth of the world's couples and one-third of all those practicing contraception. Almost half of these couples are in China. Voluntary sterilization is most prevalent in countries where the procedure has been clearly legal for a number of years. But now it is also becoming more common in countries like Brazil, where the legal status has been less clear.
Adolescent↗
Interdisciplinary education as a facet of health care policy: the impact of attitudinal research.
The past decade has seen a move toward a conscious interdisciplinary practice in health care delivery. Spurred on by intractable issues of fragmentation of services and lack of comprehensiveness, the proliferation of team and other kinds of integrated models have been reported in the literature but seldom conceptualized for their potential impact on service. Moreover, the literature generally lacks an empirical base and can be characterized as ideological. Educational institutions have remained largely untouched structurally in regard to providing interdisciplinary models of education, and issues such as the professional "hierarchies" in health and "turf" are seen as barriers to institutional response. This article describes a program of interdisciplinary education at one university, specifically in the context of potential impact on educational policies. The interdisciplinary health education program began as an informal, voluntary arrangement among four health-related professional schools and ultimately involved six schools. Research on cognitive and attitudinal learning of participating students was undertaken, supporting the educational rationale for conjoint, problem-focused learning. The article traces the history of the program's impact on education policies and points to the need for a stronger empirical base. Innovative education experiences, constructed from the earlier research undertaken, are described.
Attitude of Health Personnel↗
Employee rubella screening programs in Arizona hospitals.
One year after voluntary guidelines on rubella screening of hospital employees were issued by the Arizona Department of Health, a survey of 68 members of the Arizona Hospital Association was conducted, with an 81% response. Some form of employee rubella screening was present in only 49% of responding hospitals. Of the screening hospitals, 70% of programs had a mandatory aspect for selected employees. Administrative logistics, cost, problems encountered, and the quality and coverage of the program varied substantially among the different hospitals. Fewer than half of the screening hospitals had programs for physicians, students, or volunteers. Verbal histories of immunization or serological tests, although notoriously unreliable, were accepted by 14% of the screening hospitals. Half of the nonscreening hospitals plan to implement programs in the future. Reasons given for not establishing rubella screening programs include cost, no pediatric or obstetric service, liability issues, high turnover, and no previous case of rubella in an employee. Three hospitals (all screening) reported they had had a case of rubella in an employee. The data suggest slow partial compliance with recommendations for rubella screening in hospitals.
Adolescent↗
The Côte d'Ivoire national HIV counseling and testing program for tuberculosis patients: implementation and analysis of epidemiologic data.
OBJECTIVES: To describe the implementation of a free, voluntary and confidential HIV counseling and testing program for patients with newly diagnosed tuberculosis at the eight large outpatient tuberculosis centers in Côte d'Ivoire, and to present epidemiologic findings on participating patients. DESIGN: HIV counseling and testing program with ongoing HIV serosurveillance. METHODS: HIV counseling and testing services were established at the two tuberculosis centers in Abidjan in 1989 and were extended to six centers in the Côte d'Ivoire interior in the first half of 1994. Characteristics of counseled patients, acceptance rates of HIV testing, and HIV serologic results were analyzed for all eight centers from 1994 to 1996. Temporal trends in HIV seropositivity rates were examined for the two centers of Abidjan from 1989 to 1996. RESULTS: From July 1994 through December 1996, 17 946 (91.8%) out of 19 594 patients who were counseled at the eight centers in Côte d'Ivoire consented to HIV testing, of whom 7749 (43.2%) were HIV-seropositive. The highest rates of 47.0 and 45.6% were found in the two centers in Abidjan, with rates ranging from 32.9 to 42.4% in the six centers in the interior. HIV-seropositive tuberculosis patients from each of the 50 districts in Côte d'Ivoire were identified. In Abidjan, the HIV seropositivity rate remained relatively stable among men (46.7% in 1989, 48.5% in 1991, 43.6% in 1996), but rose sharply among women from 32.7% in 1989 to 50.1% in 1996. CONCLUSIONS: The high HIV seropositivity rates among tuberculosis patients in all geographic regions of Côte d'Ivoire indicate that the HIV epidemic has now spread throughout the country. However, the successful implementation of an extensive HIV counseling and testing program for more than 37000 tuberculosis patients to date demonstrates the commitment of the Côte d'Ivoire Ministry of Health to integrating HIV/AIDS prevention activities with tuberculosis control efforts. When logistically and economically feasible, the extension of HIV-related social and clinical services to HIV-seropositive tuberculosis patients should be considered by other national tuberculosis control programs in Africa.
AIDS Serodiagnosis↗
Past and future priorities in health promotion in the United States: a survey of experts.
BACKGROUND: The purpose of this study was to determine past and future priorities of the health promotion industry. Parameters included target markets, program staff, ethical issues, corporate programs, and program sites. METHODS: This study focused on the predictive perceptions of 76 prominent health and fitness professionals. Participants completed an inventory designed to compare past and future practices in health promotion. The Wilcoxon rank-sign test was used to determine changes in perceived importance from past to future periods. RESULTS: The most important markets in the future were women and the elderly. Predictions regarding staffing included an expected increase in staff size in many program settings, a high importance rating for marketers and health educators, and standardized training and certification for health promotion personnel. Many employers in the future were predicted to link medical care costs and reimbursements with lifestyle behaviors, support confidentiality of health status information, and offer voluntary participation in health promotion programs to all employees. Employers were also predicted to provide more healthful work environments. DISCUSSION: Future success of these projected programs will depend upon administrative flexibility, creativity, and strategic planning.
Adult↗
Haiti seminar discusses voluntary sterilization.
Devising strategies to meet the growing demand for voluntary sterilization in Haiti was a major topic of discussion during a week-long seminar November 28-December 2 organized by the Division of Family Hygiene (DHF) of the Haitian Department of Public Health and Population. More than 30 physicians trained in laparoscopy and minilap who provide services through the DHF program met to summarize progress and discuss problems of the program to date, review technical aspects of female sterilization, introduce technical aspects of vasectomy, and set goals for 1984. FHI provided 2 consultant-speakers for the seminar, Dr. Lise Fortier, medical director of Planned Parenthood of Los Angeles, and Dr. Liliane Toumi, consultant for training in male and female sterilization. The DHF has given high priority to its voluntary sterilization program, which has recorded a slow but steady increase in the number of individuals sterilized since its beginning in 1979. Postpartum minilaps account for the highest percentage of procedures (69%) of cases reported to the DHF in the 1st 1/2 of 1983), with most of the remainder consisting of laparoscopy. In 1983, there was also an increasing emphasis on vasectomy, accounting for 5% of all cases reported in the 1st 6 months. 3 physicians attending the seminar had just returned from Sao Paulo, Brazil, where they were trained in vasectomy by Dr. Marcos de Castro. An additional 3 are scheduled for training in Sao Paulo early this year. These 6 physicians will form the basis of an in-country vasectomy training program for their colleagues. Data from an ongoing FHI Maternity Care Monitoring pilot project at Hopital Universitaire de l'Etat d'Haiti support the observation of physicians at that center that 65%-70% of potential candidates for sterilization there are not sterilized. Discussion at the seminar identified the following possible reasons for the unmet need for sterilization: requirements for laboratory tests, lack of space for procedures and recovery, irregular supplies, and need for better patient education and motivation during the prenatal period. 1 suggestion to increase the access of rural populations outside of Port-au-Prince was to offer sterilization services through mobile clinics operating out of health centers around the country. FHI is continuing its assistance to the DHF program by helping to establish reporting and to maintain data on sterilizations performed throughout Haiti. Initially, the Division will use FHI female sterilization and male sterilization patient summary forms for monitoring cases in the 6 centers doing a large proportion of the procedures. The consensus of those attending the seminar was that a strong voluntary sterilization program is of the utmost importance in meeting Haiti's family planning needs.
Americas↗
An evaluation of program implementation strategies for a rural first-responder system.
An experimental emergency first-responder system was introduced in 36 small rural Georgia communities as a means for addressing inadequate access to emergency medical services for these communities. A prospective evaluation was designed to address the most efficient and effective means to organize, implement, and administrate such a program on a regional basis. Key to the program were community-selected residents who served as Emergency Medical Coordinators (EMCs) and performed as first responders, information sources on emergency care, and system organizers. The evaluation examined the process of organizing the program through local government versus voluntary group sponsors in terms of response and participation by communities and their ability to select effective EMCs. It assessed the effectiveness of a set of criteria for selecting residents as EMCs against three sets of performance measures encompassing first-responder skills and activities which maintained public awareness and program visibility. Critical to program success was the degree of sponsor involvement in selecting EMCs.
Community Health Services↗
Injecting risk behavior among drug users in Amsterdam, 1986 to 1992, and its relationship to AIDS prevention programs.
OBJECTIVES: Serial, cross-sectional trends in injecting risk behavior were studied among drug users from 1986 to 1992. METHODS: From a cohort study in Amsterdam, 616 intake visits of drug users who had injected in the 6 months preceding intake were selected. RESULTS: The proportion of drug users who reported borrowing and lending used injection equipment and reusing needles/syringes (in the previous 6 months), continuously declined from 51% to 20%, from 46% to 10% and from 63% to 39%, respectively. In multivariate analysis, it appeared unlikely that a selective recruitment of participants over time was responsible for these trends. Participants, recruited later in time, had been previously tested for human immunodeficiency virus (HIV) more often, had received daily methadone less often, and had obtained a higher proportion of new needles via exchange programs. Indications were found that (1) voluntary HIV testing and counseling leads to less borrowing, lending, and reusing equipment; and (2) obtaining needles via exchange programs leads to less reusing needles/syringes. It appeared that nonattenders of methadone and exchange programs have reduced borrowing and lending to the same extent as attenders. CONCLUSIONS: Methodologically, evaluating specific measures is difficult. However, the combination of various preventive measures in Amsterdam is likely to be responsible for the observed decrease in injecting risk behavior.
Acquired Immunodeficiency Syndrome↗
Legal and ethical issues in HIV testing, Part 2.
In part 1 of this two-part series, legal and ethical issues in HIV testing were examined, such as the ELISA test, informed consent, confidentiality, and mandatory vs. voluntary testing. In this article, the author presents the most important legal and ethical concerns related to legislation for testing, testing in the workplace, Centers for Disease Control guidelines and recommendations, ethical analysis, and implications for nurse executives.
AIDS Serodiagnosis↗
The voluntary acceptance of HIV-antibody screening by intravenous drug users.
Intravenous drug abusers in a methadone program in Minnesota were offered HIV-antibody screening to determine the degree of interest in screening and extent of infection. Thirty-nine (85 percent) were willing to be tested. Only seven refused. All patients were aware of acquired immunodeficiency syndrome (AIDS) and their high risk of exposure to the AIDS virus through sharing of injection paraphernalia. None reported exposure to additional risk factors, such as homosexual or bisexual activity or having received a blood transfusion. Of the patients tested, none was positive for HIV antibodies. The high degree of patient interest in screening was unanticipated as was the lack of positive laboratory findings for HIV antibodies. Factors associated with acceptance of testing included patient awareness of high seroprevalence rates, indifference to potential negative social consequences of positive HIV-antibody status, and the voluntary nature of the testing. These findings raise a cautious sense of optimism about HIV-antibody screening for similar risk groups.
Adult↗
Feasibility and effectiveness of offering a solution-focused follow-up to employees with psychological problems or muscle skeletal pain: a randomised controlled trial.
BACKGROUND: Long-term sick leave has been of concern to politicians and decision-makers in Norway for several years. In the current study we assess the feasibility and effectiveness of offering a voluntary, solution-focused follow-up to sick-listed employees. METHODS: Employees on long-term sick leave due to psychological problems or muscle skeletal pain were randomly allocated to be offered a solution-focused follow-up (n = 122) or "treatment as usual" (n = 106). The intervention was integrated within 2 social security offices' regular follow-up. The intervention group was informed about the offer with letters, telephone calls and information meetings. Feasibility was measured by rate of uptake to the intervention, and effectiveness by number of days on sick leave. RESULTS: In general, few were reached with the different information elements. While the letter was sent to all, only 31% were reached by telephone and 15% attended the information meetings. Thirteen employees (11.5%) in the intervention group participated in the solution-focused follow-up. Intention to treat analysis showed no difference in mean length of sick leave between the intervention group (217 days) and the control group (189 days) (p = 0,101). CONCLUSION: Even if the information strategy might be improved, it is not likely that a voluntary solution-focused follow-up offered by the social security offices would result in measurable reduction in length of sick leave on a population level. However, the efficacy of a solution-focused follow-up for the persons reporting a need for this approach should be further investigated.
Adult↗
Medicaid program; State share of financial participation--HCFA. Interim final rule with comment.
Under certain circumstances, States are currently permitted to use voluntary contributions (donated funds) from providers and all revenues from State-imposed taxes, as the State share of the costs of the Medicaid program. There is now widespread use of State donations or other voluntary provider payment programs that unfairly affect the Federal share of Federal Financial Participation (FFP). This practice circumvents the States' statutory obligation to expend funds for medical assistance. Therefore, effective January 1, 1992, this interim final rule requires that the amount of funds donated from Medicaid providers be offset from Medicaid expenditures incurred on or after this date before calculating the amount of FFP in Medicaid expenditures. It also interprets section 4701(b)(2) of the Omnibus Budget Reconciliation Act of 1990, which added section 1903(i)(10) to the Social Security Act. Section 1903(i)(10), precludes Federal Financial Participation (FFP) in State payments to hospitals, nursing facilities, and intermediate care facilities for the mentally retarded for facility expenditures that are attributable to provider-specific State taxes.
Centers for Medicare and Medicaid Services, U.S.↗
An overview of intravenous-related medication administration errors as reported to MEDMARX, a national medication error-reporting program.
Medication errors can be harmful, especially if they involve the intravenous (IV) route of administration. A mixed-methodology study using a 5-year review of 73,769 IV-related medication errors from a national medication error reporting program indicates that between 3% and 5% of these errors were harmful. The leading type of error was omission, and the leading cause of error involved clinician performance deficit. Using content analysis, three themes-product shortage, calculation errors, and tubing interconnectivity-emerge and appear to predispose patients to harm. Nurses often participate in IV therapy, and these findings have implications for practice and patient safety. Voluntary medication error-reporting programs afford an opportunity to improve patient care and to further understanding about the nature of IV-related medication errors.
Adverse Drug Reaction Reporting Systems↗
Medical screening and monitoring as noted by the insurance industry.
Medical screening and monitoring have a long and varied history as part of the insurance industry's safety and health relations with its policyholders. Many workers' compensation insurance carriers have assisted policyholder management in understanding the requirements of cost-effective health programs, in planning and undertaking steps necessary to comply with state-of-the-art medical practices, and in locating knowledgeable physicians to supervise employee health systems. Managing employees' health and associated records has become, for many employers, a complex operational and regulatory problem because of the amount and type of health information being collected. Administration of group health and accident insurance plans, workers' compensation, treatment for the ill and injured employees, voluntary health screening and counseling programs, preplacement and periodic physical examinations, and control mechanisms for health hazard exposures all contribute to this huge pool of acquired and stored health information.
Humans↗
Effects of high resistance training in coronary artery disease.
Resistive activities for cardiac patients have traditionally been discouraged. The purpose of this study was to assess the safety and efficacy of a 30 min/day, 3 day/week, 10-week strength training program in 9 stable, aerobically trained, male cardiac patients. The strength training program comprised lifting 80% of maximum voluntary contraction at 5 stations: quadriceps extension, bench press, standing biceps curl, hamstring curl and military press and performing 80% of the maximum number of sit-ups in 1 minute. Maximum voluntary contraction for each lift and body composition via body weight, hydrostatic weighing, skinfolds and girths were determined before and after training. The electrocardiogram was monitored during all maximum voluntary contraction lifts and heart rate and systolic and diastolic blood pressures were monitored during all activities. The only change in measures of body composition was an 11% increase in quadriceps girth (p less than 0.05). Maximum voluntary contraction increased 17, 12, 19, 53 and 46% for bench press, military press, standing biceps curl, quadriceps extension and hamstring curl, respectively (p less than 0.01), while the number of sit-ups performed in 1 minute increased 33% (p less than 0.05). No signs or symptoms of ischemia or abnormal heart rate or blood pressure responses were observed during the strength training program. Thus, resistive training at 80% of maximum voluntary contraction appears to be both safe and efficacious in stable, aerobically trained cardiac patients.
Aged↗