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PubMed1993

Dioxin: a case study.

The need to notify individuals of a possible health risk from their past exposure to potentially hazardous agents frequently extends beyond workers to include community groups. The issues to consider in community notification are frequently similar to those that are important for worker notification but may include some that are unique. This case study traces the evolution of one company's strategy for communicating with the public about possible dioxin contamination associated with its operations. Early communications tended to emphasize the technical aspects of the issues in the fashion of scientists talking to other scientists. This was interpreted by some to be symptomatic of an arrogant and uncaring attitude. Beginning in the early 1980s, the company's management recognized the need to reach out to a variety of audiences on multiple levels, and shifted to a more comprehensive communications strategy. A similar shift is now occurring throughout the chemical manufacturing industry as top managers realize that, if they expect to continue to operate, they must become more accountable and responsive to the public.

Chemical Industry↗
PubMed1991

Birth prevalence of Down's syndrome in England and Wales.

The natural birth prevalence of Down's syndrome for England and Wales in 1974-1987 (i.e., the birth prevalence in the absence of prenatal diagnosis and the induced abortion of affected pregnancies) was estimated by applying the maternal age-specific birth prevalence derived from epidemiological studies to the number of births in single-year age groups tabulated by the Office of Population Censuses and Surveys (OPCS). On average, the natural birth prevalence was 12.6 per 10,000 births and increased slightly from 12.2 to 13.2 per 10,000 births over the 14-year period. Using data on induced abortions carried out on account of Down's syndrome reported to OPCS under the statutory abortion notification scheme, 14 per cent of affected births were avoided by the induced abortion of affected pregnancies, so that the actual birth prevalence of Down's syndrome was estimated at 10.8 per 10,000 births. Using data on Down's syndrome births reported to OPCS under the voluntary congenital malformation notification scheme, the prevalence was 7.2 per 10,000 births, so only 67 per cent of the estimated number of affected births were, in fact, notified to the scheme.

Abortion, Spontaneous↗
PubMed2001

Using the Colorado birth defects monitoring program to connect families with services for children with special needs.

BACKGROUND AND METHODS: The Community Notification and Referral Program (CNRP), which operates from within the state's birth defects monitoring and prevention program, links children and their families with local public health and early childhood agencies, which then inform families of services and resources in their home communities. In Colorado, many communities have developed systems for identifying, screening, evaluating, and providing services to children with developmental delays or other special needs. CNRP uses the existing infrastructure of services for children with special needs by notifying local community programs of children reported to the birth defects program with birth defects, developmental disabilities, or risks for developmental delay. Children to be referred to local agencies are identified from the birth defects registry on the basis of diagnosis and residence. Minor or lethal conditions are excluded from referral. CNRP provides the child's name, date of birth, address, phone, guardian, diagnoses, date and source of diagnosis, and length of stay to the local agency. A parental consent process is used under some circumstances. RESULTS: CRCSN analyzed data from 1621 children referred to local agencies in 1998. The local agencies contacted 34.1% of the families and referred 46.9%. of those contacted to early intervention, developmental, evaluation, or other services. They determined that 29.5% could definitely or moderately benefit from developmental services. In a telephone survey of families, 65.4% said they had learned about services, resources, or developmental screening about which they had not been aware. CONCLUSION: CRCSN has developed a notification and referral program to link families with services for children with special needs that could serve as a model for other birth defects registries.

Adolescent↗
PubMed1996

Creutzfeldt-Jakob disease: current U.S. policy to further reduce the possible risk of transmission by transfusion.

Because the results of epidemiological and subhuman primate studies conducted over the last quarter of a century have failed to show a statistically significant risk of transmission of CJD by transfusion of blood components or plasma derivatives, the FDA's position is that only a theoretical low risk of CJD transmission cannot be excluded at this time. Consequently, FDA issued two memoranda on 8 August 1995 as updated interim policy documents recommending: (1) permanent deferral from donating blood or plasma for all persons who state at the time of donation, or for whom post donation information becomes available, that they have ever received pit-hGh, a dura mater transplant graft, or have a blood relative history of CJD, unless this increased risk for CJD is excluded on the basis of genetic analysis testing; (2) the quarantining of all undistributed in-date units of blood or blood components collected from either of these three groups of donors together with notification of all consignees of such in-date units so that distributed units also can be quarantined and recipient tracing and notification may be effected, and (3) the withdrawal from distribution and quarantining of in-date plasma derivative products derived from plasma pools containing a unit from either of these three groups of donors at known high risk for CJD, or donors subsequently diagnosed as having CJD. Consignees of these products are to be notified in order that they, in turn, may inform physicians or other qualified personnel responsible for the care of product recipients to provide counseling as deemed medically appropriate. The 'family history of CJD' criterion was further clarified to mean a 'history of CJD in 2 or more family members' during the BPAC meeting of 14 December 1995. In a workshop meeting on 29 January 1996 the FDA urged that additional laboratory animal data be generated by plasma derivative manufacturers in order to ascertain if the sterilization steps used in their production of plasma derivatives further reduce the risk of transmission of CJD.

Blood Transfusion↗
PubMedDate not supplied

Educational and informational strategies to reduce pesticide risks. Council on Scientific Affairs.

BACKGROUND: In 1993, the American Medical Association (AMA) requested its Council on Scientific Affairs to investigate issues and concerns related to (1) improving public notification of pesticide applications and (2) improving educational programs for commercial and farm pesticide applicators and increasing enforcement of licensing examination requirements. This report was presented at the 1994 Interim Meeting of the AMA House of Delegates as Report 4 of the Council on Scientific Affairs. METHODS: Information for the report was derived from published literature and from personal communications with state and federal regulatory officials, physicians, and representatives of pest control, lawn care, and farm organizations. Some information about state certification and training programs was obtained from telephone conversations with pesticide applicator training program coordinators from California, Florida, Illinois, Iowa, Michigan, Missouri, Nebraska, New Jersey, New York, Texas, Washington, and Wisconsin. These states were selected because they contain large agricultural or urban populations that are likely to require the services of trained professional pesticide applicators. RESULTS: Current surveillance systems are inadequate to characterize potential exposure problems related either to pesticide usage or to pesticide related illnesses. The effectiveness of applicator certification and training programs and public notification programs could not be determined because of a lack of federal and state survey data for making useful assessments. CONCLUSIONS: Considering current data gaps, it is prudent for homeowners, farmers, and workers to limit pesticide exposures to themselves and others.

Certification↗
PubMed1987

Year of birth, sex and residence, as "determinants" of tetanus incidence and immunity in Italy.

Regional results of a seroepidemiological study and official notification data are evaluated to describe the situation of tetanus in Italy. Tetanus incidence has been decreasing during the past years. Vaccination has been the principal means of tetanus prevention. Trend analyses for sex- and age-specific rates suggest a change of exposure, presumably linked to the transformation of the Italian society after the World War II, a higher incidence among the elderly as a function of poor coverage and vanishing immunity. Regional data show remarkable variability in prevalence of susceptible population. Reported rates by region are different. Different degrees of regional underreporting in case notification is suggested.

Adolescent↗
PubMed1989

Managing local government opposition to community-based residential facilities for the mentally disabled.

"Prior Notification" policies have elicited fears of community opposition from agencies who have adopted a "low profile" approach in locating community-based residential facilities. Nevertheless, data from a survey of New Jersey community care providers indicate that local government officials express less opposition when informed of the proposed location and invited to meet with the provider. Arranging to meet with local officials is most important when neighbors have leadership, since officials express more intense opposition when neighbors invite them to a meeting. The literature has already established the fact that meeting with neighbors can facilitate mobilization and thereby engender more intense opposition, both from neighbors and from local officials. Hence, the available evidence suggests that providers should meet with local officials to discuss the community care program but should attempt to deal with neighbors individually. This strategy is compatible with the policy of "prior notification" adopted in New Jersey.

Attitude↗
PubMed1994

Hepatitis B in children in Italy: incidence and risk factors: SEIEVA Collaborating Group. Sistema Epidemiologico Integrato dell'Epatite virale Acuta.

The objectives of the present report were to give a baseline picture of hepatitis B notification incidence rates in children before the campaign of mass vaccination for newborns and adolescents (12-13 years old), and to study the role of different risk factors. Data from a specific national surveillance system of acute viral hepatitis (SEIEVA, Sistema Epidemiologico Integrato dell'Epatite Virale Acuta) were used and acute hepatitis B cases were compared to acute hepatitis A patients with the case-control study method to estimate the associations with the considered risk factors. Since the system began, one hundred and sixty-three local health departments have joined SEIEVA covering 30% of the Italian population. The incidence of acute hepatitis B notifications among 0-14 aged children was 9 per 100,000 in 1985 and 1 per 100,000 in 1990. Such decline in incidence was observed in both the North and the South of Italy. Surgical interventions, dental therapy and household contacts with a HBsAg chronic carrier were found to be associated with acute hepatitis B. The point estimate of the odds ratio was 10 for the latter risk factor. Other preventive measures in addition to vaccination are needed to control the risk of hepatitis B infection and other parenteral diseases due to surgical intervention and dental therapy.

Acute Disease↗
PubMed1992

Time trends of HBsAg prevalence among blood donors in Fukuoka, Japan.

We examined time trends of the prevalence of hepatitis B surface antigen (HBsAg) among blood donors at the Fukuoka Red Cross Blood Center, Japan, during 1977-88. As was expected, a marked but artificial decrease in the HBsAg prevalence attributable to a notification program was detected. The seropositivities among males were uniformly higher than those among females. About 1% absolute rate decrease (approximately 50% relative rate reduction) was found among young donors aged 16-19 in seven years before the notification schedule. An age effect closely related to self-selection due to chronic hepatitis B virus (HBV) infection was demonstrated in the declining trends according to the advance of age. A remarkable birth cohort effect was also observed for both sexes. These data undoubtedly indicate that there were medical/iatrogenic factors as well as natural (sanitary/socioeconomic/nutritional) factors causing the reduction of chronic HBV infection.

Adolescent↗
PubMed2006

Feasibility of mental health screening and intervention in the HUNT population study.

BACKGROUND: The aim of the current study was to investigate feasibility, response, and consequences of mental health screening and intervention in a population study setting. METHODS: In the Intervention study against Depression and Anxiety in Nord-Trøndelag (IDANT), all GPs and psychiatric nurses were invited to a psychiatric educational programme prior to the Health Study of Nord-Trøndelag County, Norway (HUNT 2, 1995-1997). Included in the HUNT 2 was the Hospital Anxiety and Depression rating Scale (HADS). All participants scoring 25 points or above (99th percentile, n = 654) were defined as the Psychiatric High Risk Group, (PHRG) and received a written notification regarding their high scores with a request to see their GP and to participate in the IDANT. RESULTS: In total 422 (64%) baseline forms could be retrieved in the IDANT. However, only 177 (27%) were returned by the GPs. Three out of four participants in the PHRG were already recognised by their GPs as patients with mental disorders prior to the IDANT. Negative reactions to the notification letter or to the invitation to the IDANT were uncommon, still only half of the subjects in the PHRG participated in the study. However, as a consequence of the IDANT in 64% of the cases the GPs started new treatment, revised ongoing treatment, or referred the respondents. CONCLUSIONS: Though attitude towards psychiatry among GPs and participants was generally positive, response to the IDANT study was inadequate. Relatively few new cases were detected, yet the results indicate that the GPs altered their psychiatric care and practice markedly within the PHRG. Whether the educational programme had an impact on psychiatric services in the county in general cannot be answered in this study.

Adult↗
PubMed2007

'Wet Reads' in the age of PACS: technical and workflow considerations for a preliminary report system.

Communication between clinicians, technologists, and radiologists has become more complex, with Picture Archiving and Communication Systems (PACS) now allowing the radiologist to be removed from the physical location of the patients and the site of imaging. With these changes, effective communication becomes an ongoing challenge. Efficient communication of study interpretations has also become a priority for radiologists as they struggle to maintain relevance and provide added value to patient care when clinicians have ready access to radiology images. The purpose of this paper is to share our experience in developing and implementing the Collaborative Notification System (CNS), a communication tool used to inform referring clinicians of urgent findings-a.k.a. "wet reads." The system utilizes a system of web pages integrated into PACS for the sending and receiving of succinct messages to provide clinical information at the point of need. A second system of pager alerts provides notification of the need for such communication through a relatively unintrusive, one-way, acknowledged alert system. The CNS provides asynchronous, integrated communication for the reporting of urgent and emergent radiology findings in a complex, geographically distributed medical environment.

Efficiency, Organizational↗
PubMed1991

A seven-year experience with methicillin-resistant Staphylococcus aureus.

From July 1983 through June 1990, 319 patients with methicillin-resistant Staphylococcus aureus (MRSA) were identified at the University of California, Davis Medical Center. Initially, our goal was eradication of MRSA from the hospital flora. Our approach was: (a) immediate notification of all MRSA isolates by the microbiology laboratory; (b) strict isolation; (c) cohorting; (d) bathing patients with an iodophor; (e) surveillance cultures of patients and staff; (f) treatment of all colonized persons; and (g) strict isolation on readmission. Control of spread was achieved but eradication was not. In 1987 our strategy was modified in order to establish the least restrictive methods to maintain control of the spread of MRSA. After notification by the microbiology laboratory, we now require: (a) contact isolation; (b) surveillance cultures of patients associated with each new case; and (c) contact isolation for all MRSA patients on readmission. Strict isolation and employee culturing are used only during major outbreaks. We have averaged four new cases of MRSA per month over the 7-year period, including four major outbreaks. Since 1987, we have averaged only three new cases per month with one major MRSA outbreak. Annual cost savings of greater than $50,000 have been realized through the policy modifications. We conclude that the use of contact isolation with some modifications has saved time and money and has successfully controlled the spread of MRSA in our university hospital.

Adult↗
PubMed1991

Disparities in psychological, neuroendocrine, and immunologic patterns in asymptomatic HIV-1 seropositive and seronegative gay men.

The present study concurrently measured psychological distress (state anxiety, depression, confusion, and intrusive thoughts), neuroendocrine (plasma cortisol concentrations), and immunologic [lymphocyte proliferative responses to phytohemagglutinin (PHA) and pokeweed mitogen (PWM)] changes in the 5-week periods preceding and following serostatus notification among asymptomatic Human Immunodeficiency Virus-type 1 (HIV-1) seropositive and seronegative gay men. Seropositives, as opposed to seronegatives, showed a disparity in predicted relationships among distress, cortisol, and immunologic measures across the prenotification to postnotification period. Individual difference analyses suggested that among seropositives, in contrast to seronegatives, plasma cortisol concentrations were negatively correlated with psychological distress and positively correlated with responses to PHA (assessed at study entry and after serostatus notification). This pattern in seropositives could not be explained by differences in prenotification perceived risk of infectivity, extraneous environmental stressors, or CD4 cell counts within the seropositive group.

AIDS Serodiagnosis↗
PubMed1996

Factors associated with depression in a heterogeneous HIV-infected sample.

The present study examined factors contributing to depressive symptomatology in a low SES, heterogeneous HIV seropositive sample. The sample was comprised of 120 HIV-infected patients who completed psychosocial measures upon their initial visit to an outpatient HIV clinic. Length of time since HIV seropositive notification and HIV-related symptomatology were also assessed. Social support, major life stress, and HIV-related symptomatology were significantly associated with depression. Perceived availability of social support accounted for the greatest variance in depression scores. Length of time since seropositive notification was not significantly associated with depression. These findings extend previous research with middle-class, homosexual, white males to the rapidly growing minority, heterosexual, and low SES populations and point to the need for the inclusion of social support interventions in the provision of services of these individuals.

Adult↗
PubMed1996

Adolescent contraceptive behavior: the impact of the provider and the structure of clinic-based programs.

OBJECTIVE: To characterize general trends in research on the impact of provider variables on adolescent contraceptive behavior and to identify useful frameworks for designing clinic-based programs aimed at reducing unintended adolescent pregnancy. DATA SOURCES: A computerized search of Psychological Abstracts, Sociological Abstracts, and MEDLINE identified English-language articles from 1990 to 1995 on adolescent contraceptive behavior in the United States. All relevant citations within these articles also were examined. METHODS OF STUDY SELECTION: Studies were selected that focused on any aspect of provider characteristics as they relate to adolescent contraceptive behavior. TABULATION, INTEGRATION, AND RESULTS: Based on a conceptual integration of the articles, three general research issues on provider characteristics were identified; 1) the effectiveness of adolescent-based clinic programs and provider variables that discriminate successful versus unsuccessful programs, 2) the effects of parental notification policies on adolescent clinic use, and 3) whether the presence of clinics promotes sexual activity on the part of adolescents. Issues that must be considered in the structuring of provider-based programs include the strategic focus of the program, the target behaviors, the target population, and the structuring of educational materials. CONCLUSION: The effectiveness of adolescent-based clinic programs is mixed. Parental notification of adolescent use of a clinic can, in some cases, decrease the likelihood of clinic use. There is little convincing evidence that the presence of adolescent clinics promotes sexual activity.

Adolescent↗
PubMed1985

Tuberculosis in an Indochinese refugee camp: epidemiology, management and therapeutic results.

In a 3-year period tuberculosis was diagnosed in 629 patients in Thailand's largest camp for Kampuchean refugees: 62% had pulmonary disease and 38% extrapulmonary forms. Tuberculosis of lymph nodes was the most important extrapulmonary manifestation (50%). The mean annual notification rates were 0.5% and 0.24% for all forms and smear-positive pulmonary tuberculosis respectively. There was a steep rise in the annual notification rate with increasing age. A 6-month course of fully supervised chemotherapy efficiently counteracted defaulting, early absconding and initial drug resistance. Seventy-three per cent of all patients remained on chemotherapy for the planned period; only 2% of the smear-positive patients failed bacteriologically on chemotherapy. Of the patients with the most common forms of extrapulmonary disease, 90% showed a favourable response to chemotherapy.

Adolescent↗
PubMed1993

Variations in national infectious diseases surveillance in Europe.

Because the Maastricht treaty includes a chapter on public health in the European Community (EC) public health surveillance needs to be developed at EC level. To assess the feasibility of EC surveillance we did a survey of national systems in Europe in 1991-92. In seventeen countries (twelve EC plus Austria, Finland, Norway, Sweden, and Switzerland) the public health institution(s) responsible for surveillance were visited to collect standardised data on surveillance systems for sexually transmitted diseases (STD), hepatitis, and tuberculosis (TB). Surveillance systems varied widely by type, design, and quality. Although mandatory notification has a place in nearly all countries there is a trend towards voluntary systems based on samples of physicians, clinics, or laboratories. The time unit for reporting ranged from daily to once a year. For mandatory notification systems of STD completeness of reporting varied from over 90% to less than 10% and most countries did not use case definitions. Surveillance data were disseminated through national epidemiological bulletins in twelve countries, and the bulletin was a weekly one in six. The heterogeneity of national public health surveillance systems that this survey has revealed points to the need for a coordinated approach if surveillance at an EC level is to be developed.

Communicable Disease Control↗
PubMed1995

BCG--mass or selective vaccination?

After years of decline, notifications of tuberculosis in England and Wales have recently increased. BCG immunization forms part of the programme of measures to control tuberculosis in this country. All tuberculin negative 10-13-year-old schoolchildren are offered vaccination. In addition BCG is offered selectively at any age to those considered to belong to groups at increased risk of tuberculosis. While the protective effect of BCG immunization in the population of this country is well established, the cost-effectiveness of the School's BCG programme has been the subject of considerable debate. If the rate of tuberculosis notifications in the 15-29-year-old age group within the white majority population, the major group to whom any potential benefit of the Schools' programme applies, continues to decline, serious consideration should be given to discontinuing this programme while strengthening the programme of selective immunization.

Adolescent↗