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PubMed2005

Sexually transmitted infections in Switzerland: return of the classics.

Recent trends in western Europe show an increase in sexually transmitted infections (STIs). Available surveillance data in Switzerland confirm this rising trend. Gonorrhoea rates more than doubled between 1996 and 2003, and for Chlamydia there was a 64% increase from 1999 to 2003. Notifications of syphilis cases almost doubled in the year 2002 and rose to 174% compared to the period of 1998-2001. The resurgence of syphilis in 2002 and 2003 was most important in Zurich and Geneva with 54 and 24% of all cases, respectively. Eighty-four percent occurred in males, 40% affecting males who had sex with males, and at least 17% were HIV co-infected. For 2004, further increases in these bacterial STIs are expected. Increased awareness of the symptoms and signs of acute infections is needed as well as considering the diagnosis of STIs in patients with vague symptoms. In addition, laboratory reporting or mandatory disease notifications are needed to monitor syphilis trends in Switzerland.

Adolescent↗
PubMed2004

Smoking and tuberculosis among the elderly in Hong Kong.

A cohort of 42,655 clients that were first registered with the Elderly Health Service in 2000 were followed prospectively through the tuberculosis (TB) notification registry until the end of 2002. A total of 286 active TB cases (186 culture confirmed) were identified. The annual TB notification rates were 735, 427, and 174 per 100,000 among current smokers, ex-smokers, and never-smokers, respectively (p < 0.001). The trend in TB risk persisted after the control of background characteristics using Cox proportional hazards analysis (adjusted hazard ratios [HRs]: 2.63, 1.41, and 1, p < 0.001). In comparison with never-smokers, current smokers had an excess risk of pulmonary TB (adjusted HR, 2.87; 95% confidence interval [CI], 2.00-4.11; p < 0.001), but not extrapulmonary TB (adjusted HR, 1.04; 95% CI, 0.33-3.30; p = 0.95). Among the current smokers, those who developed TB smoked more cigarettes per day than those who did not (13.43, SD 8.76 vs. 10.96, SD 7.87, p = 0.01). A statistically significant dose-response relationship was observed with respect to active TB and culture-confirmed TB (both p < 0.05). Smoking accounted for 32.8% (95% CI, 14.9-48.0%), 8.6% (95% CI, 3.3-15.1%), and 18.7% (95% CI, 7.7-30.4%) of the TB risk among males, females, and the entire cohort, respectively. Approximately 44.9% (95% CI, 20.7-64.6%) of the sex difference was attributable to smoking.

Aged↗
PubMed2006

Undiagnosed tuberculosis in a community with high HIV prevalence: implications for tuberculosis control.

BACKGROUND: Although failure of tuberculosis (TB) control in sub-Saharan Africa is attributed to the HIV epidemic, it is unclear why the directly observed therapy short-course (DOTS) strategy is insufficient in this setting. We conducted a cross-sectional survey of pulmonary TB (PTB) and HIV infection in a community of 13,000 with high HIV prevalence and high TB notification rate and a well-functioning DOTS TB control program. METHODS: Active case finding for PTB was performed in 762 adults using sputum microscopy and Mycobacterium tuberculosis culture, testing for HIV, and a symptom and risk factor questionnaire. Survey findings were correlated with notification data extracted from the TB treatment register. RESULTS: Of those surveyed, 174 (23%) tested HIV positive, 11 (7 HIV positive) were receiving TB therapy, 6 (5 HIV positive) had previously undiagnosed smear-positive PTB, and 6 (4 HIV positive) had smear-negative/culture-positive PTB. Symptoms were not a useful screen for PTB. Among HIV-positive and -negative individuals, prevalence of notified smear-positive PTB was 1,563/100,000 and 352/100,000, undiagnosed smear-positive PTB prevalence was 2,837/100,000 and 175/100,000, and case-finding proportions were 37 and 67%, respectively. Estimated duration of infectiousness was similar for HIV-positive and HIV-negative individuals. However, 87% of total person-years of undiagnosed smear-positive TB in the community were among HIV-infected individuals. CONCLUSIONS: PTB was identified in 9% of HIV-infected individuals, with 5% being previously undiagnosed. Lack of symptoms suggestive of PTB may contribute to low case-finding rates. DOTS strategy based on passive case finding should be supplemented by active case finding targeting HIV-infected individuals.

Adolescent↗
PubMed1995

Fluoxetine and extrapyramidal side effects.

OBJECTIVE: The authors' goal was to determine whether fluoxetine is associated with extrapyramidal side effects. METHOD: They assessed the notifications of extrapyramidal manifestations in patients given fluoxetine in the New Zealand Intensive Medicines Monitoring Programme, a national system that monitored adverse reactions associated with fluoxetine over a 4-year period, and determined whether these adverse reactions were causally related to fluoxetine. RESULTS: In reports of adverse reactions in 5,555 patients given fluoxetine throughout New Zealand, there were 15 notifications of extrapyramidal events probably or possibly caused by fluoxetine. Fluoxetine was the only psychotropic agent used for seven of the 15 patients; two patients were also taking lithium, four were taking neuroleptics, two were taking tricyclic antidepressants, and one was taking metoclopramide. CONCLUSIONS: The authors conclude that fluoxetine may be associated with extrapyramidal reactions. These may occur with fluoxetine alone or fluoxetine may facilitate the reaction in patients receiving psychotropic medication or dopamine receptor blocking drugs.

Adult↗
PubMed1989

Warning third parties at risk of AIDS: APA's policy is a reasonable approach.

The author argues that the American Psychiatric Association's AIDS policy on confidentiality and disclosure provides reasonable guidelines for psychiatrists struggling to balance their obligation to maintain the confidentiality of individual patients infected with human immunodeficiency virus (HIV) with their obligation to protect the community's health. The policy states that notification of third parties who may be exposed to infection through the behavior of an HIV-positive patient is ethically permissible if the psychiatrist has exhausted efforts to work with the patient to terminate behavior that places others at risk and if the patient understands the limits of confidentiality. The author points out that judicious notification is within the medical tradition that includes disclosure of a patient's dangerousness in situations involving infectious diseases such as tuberculosis and is supported by the duty-to-warn precedent set by the Tarasoff decision.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Transboundary hazardous waste management. Part I: Waste management policy of importing countries.

Mixed metal-containing waste, polychlorinated biphenyls (PCB) containing capacitors, printed circuit boards, steel mill dust and metal sludge were among the most common wastes exported from Taiwan. Before the implementation of the self-monitoring model programme of the Basel Convention (secretariat of the Basel Convention 2001) in the Asia region, Taiwan conducted a comprehensive 4-year follow-up project involving government authorities and the waste disposal facilities of the importing countries. A total of five countries and nine plants were visited in 2001-2002. The following outcomes can be drawn from these investigations. The Chinese government adopts the strategies of 'on-site processing' and 'relative centralization' on the waste management by tightening permitting and increasing site inspection. A three-level reviewing system is adopted for the import application. The United States have not signed the Basel Convention yet; the procedures of hazardous waste import rely on bilateral agreements. Importers are not required to provide official notification from the waste exporting countries. The operation, administration, monitoring and licensing of waste treatment plants are governed by the state environmental bureau. Finland, France and Belgium are members of the European Union. The procedures and policies of waste import are similar. All of the documents associated with transboundary movement require the approval of each government involved. Practically, the notification forms and tracking forms effectively manage the waste movement.

Asia↗
PubMedDate not supplied

Long-term impact of HIV diagnosis on mood and substance use--St Stephen's cohort study.

Twenty HIV positive and 68 HIV negative subjects were assessed by the Hospital Anxiety and Depression Scale and by the Alcohol and Drugs Frequency Schedule immediately prior to notification of their HIV serostatus and 6 months after serodiagnosis. The 2 groups did not differ significantly in levels of anxiety or depression at baseline or follow-up. There were borderline levels of pathological anxiety prior to notification of HIV serostatus in both groups. The drop to normal levels of anxiety which had occurred by follow-up was significant in the HIV positive group. About a third of subjects in both groups were regularly making use of alcohol and/or drugs, both at baseline and follow-up. Mean levels of weekly alcohol intake for both groups ranged from about 20 to 30 units per week. The drugs most commonly used (in any frequency) were nitrates ('poppers') and cannabis.

AIDS Serodiagnosis↗
PubMed1998

Follow-up of sporadic cases of food-borne infection: comparison of a postal questionnaire with a personal visit.

The aim of the study was to evaluate the follow-up of sporadic cases of suspected food-borne illness by either a postal questionnaire or a personal visit by environmental health staff. This was achieved by comparing the practice in two authority areas within the West Pennine Health Authority in the north west of England. We included all identified cases of suspected food poisoning, campylobacteriosis, cryptosporidiosis, salmonellosis and dysentery occurring in the district between 1 July and 30 September 1996. The main outcome measures were: (1) the proportion of all cases which were successfully followed-up by each method; (2) the timeliness of follow-ups; (3) qualitative estimation by environmental health staff of the data obtained. Visiting by environmental health staff was successful in obtaining information from 76.3% (106/139) of cases, while the postal questionnaires elicited a 52% (50/96) response rate. We found that 70.5% of visits occurred within one week of notification. Although 69.8% (67/96) of questionnaires were issued within one week of notification, only 16% of replies to the questionnaire were received within this period. The information provided on the returned questionnaires was found by environmental health staff to be generally as useful as that obtained by visiting.

Adolescent↗
PubMed2006

Family responses to donor designation in donation cases: a longitudinal study.

CONTEXT: A 2001 state law reinforced donors' rights by mandating that donor consent be strictly honored. One concern was the potentially negative impact of donor designation notification on donor families. OBJECTIVES: To examine donor families' responses to donor designation. DESIGN: Descriptive nonexperimental design spanning July 1999 to September 2004. SETTING: State served by organ procurement organization. DATA: Results from surveys completed by 569 donor families, including 162 surveys from designated donor families. MAIN OUTCOME MEASURES: Previous discussions, designation awareness, information helpful, information stress, awareness of meaning of donation, and comfort with designation decision. RESULTS: The majority (79%) of designated donor families reported their loved ones had discussed donation with them; of these families, 86% were aware of donor designation, and 83% understood what donation entailed. The majority (75%) thought information about loved ones' donor designation was helpful, and only 8% found it stressful. In contrast, 18% of families of nondesignated donors said being approached about donation was stressful after the law was strengthened. However, over 80% of all donor families were comfortable with the donation decision. CONCLUSIONS: The results fail to support the assumption that donor families perceive donor designation notification as negative and stressful. The majority of designated donor families report relief and reduced stress, compared to families approached for donation. The findings suggest that strengthening donor designation legislation can lead to positive results for donor families and donation recipients.

Adaptation, Psychological↗
PubMed2006

Design and evaluation of a workplace intervention to promote organ donation.

BACKGROUND: A number of efforts have been made to improve rates of deceased organ donation. However, few have been specifically designed for implementation in the workplace. OBJECTIVES: To design and evaluate a workplace intervention to increase documentation of intention to be posthumous organ donors, communication of donation intention to families, and family members' documentation of their donation intentions. METHODS: The study was a randomized controlled trial of corporate employees. Within each corporation, worksites were randomized to a control condition or 1 of 2 educational interventions. Measures included baseline and 1-month postintervention measures of stage of organ donation intention, stage of family notification, and family members' organ donation intention. RESULTS: Across 12 corporations, 40 worksites with a total of 754 participants were randomized. At 1-month follow-up, 495 participants (66%) completed a posttreatment questionnaire. The percentage of participants who signed organ donor cards increased in the 2 intervention groups (29%, P < .001, and 31%, P < .002) but not in the control group (17%, P = .454). The percentage who discussed their donation intentions with family members increased significantly across all 3 arms (39%-47%, P < .001). The mean percentage of participants' family members who signed organ donor cards increased by 14% in the control group (P = .016) and by 17% in the 2 intervention groups (P < .001). CONCLUSIONS: Educational interventions in the corporate workplace setting can be effective in increasing organ donation intention, family notification, and recruitment of family members as potential organ donors.

Adult↗
PubMed2005

Value of electrical impedance scanning (EIS) in the evaluation of BI-RADS III/IV/V-lesions.

Two hundred and fifty-six (256) patients (72% preoperative, 28% pre-Mammotome) were prospectively examined with EIS using the TS 2000 (TransScan Research and Development Center, Israel; temporarily distributed by Siemens, Erlangen) with the "LOS"-software (level of suspicion). All exams were performed with the targeted scan probe, the observer knowing all clinical and imaging facts. The area of the lesions was examined with EIS at least with 5 single scans. The evaluation included a scaling of lesions from 1 (surely benign) up to 5 (highly suggestive for malignancy) as well as the additional notification of spots. Results of EIS were based upon the automatic scaling which is provided by the software and were compared with mammography and histology. Furthermore the influence of the histology, size of lesions, and presence/absence of spots on the EIS results were analyzed. Histology revealed benign results in 138 lesions and malignant results in 118 lesions (DCIS=61, ID-Ca=51, IL-Ca=5, mucinous Ca=1). Mammography as expected yielded high values with 91% sensitivity and 62% specificity. Overall sensitivity of EIS was 75.4%, specificity 42.03%, negative predictive value 66.7% and positive predictive value 52.7% (89 TP, 58 TN, 80 FP, 29 FN). EIS was false negative in 20 ID-Ca, 3 IL-Ca, 1 IDL-Ca, 4 DCIS, and 1 mucinous carcinoma. Sensitivity and specificity of EIS did not differ for the different histological differentiations neither for the degree of invasion. Also the additional notification of "spots" didn't show a correlation to malignancy. There were significant differences of the sensitivity of EIS regarding the tumor size. While EIS correctly diagnosed 85% of lesions <10 mm in size, only 64% of lesions >10 mm were detected. Most frequent lesion types for false positives were mastopathy (55/80 FP) and fibroadenoma (21/80 FP). Patient acceptance of EIS was perfect and there were no drop outs because of movement artifacts. In conclusion the "LOS"-software clearly improved the clinical performance of the TS 2000 as compared to the initial software. The high sensitivity of EIS in small cancers which was found in our study may indicate an advantage of this method. However, the overall sensitivity and specificity with this setup of EIS is still far too low. Further improvements especially including the measurement of higher frequencies should be realized.

Breast Neoplasms↗
PubMed2005

The pre-vaccination regional epidemiological landscape of measles in Italy: contact patterns, effort needed for eradication, and comparison with other regions of Europe.

BACKGROUND: Strong regional heterogeneity and generally sub-optimal rates of measles vaccination in Italy have, to date, hampered attainment of WHO targets for measles elimination, and have generated the need for the new Italian National Measles Elimination Plan. Crucial to success of the plan is the identification of intervention priorities based upon a clear picture of the regional epidemiology of measles derived from the use of data to estimate basic parameters. Previous estimates of measles force of infection for Italy have appeared anomalously low. It has been argued elsewhere that this results from Italian selective under-reporting by age of cases and that the true measles force of infection in Italy is probably similar to that of other European countries. A deeper examination of the evidence for this conjecture is undertaken in the present paper. METHODS: Using monthly regional case notifications data from 1949 to the start of vaccination in 1976 and notifications by age from 1971-76, summary equilibrium parameters (force of infection (FOI), basic reproductive ratio (R0) and critical vaccination coverage (pc)) are calculated for each region and for each of 5 plausible contact patterns. An analysis of the spectra of incidence profiles is also carried out. Finally a transmission dynamics model is employed to explore the correspondence between projections using different estimates of force of infection and data on seroprevalence in Italy. RESULTS: FOI estimates are lower than comparable European FOIs and there is substantial regional heterogeneity in basic reproductive ratios; certain patterns of contact matrices are demonstrated to be unfeasible. Most regions show evidence of 3-year epidemic cycles or longer, and compared with England & Wales there appears to be little synchronisation between regions. Modelling results suggest that the lower FOI estimated from corrected aggregate national data matches serological data more closely than that estimated from typical European data. CONCLUSION: Results suggest forces of infection in Italy, though everywhere remaining below the typical European level, are historically higher in the South where currently vaccination coverage is lowest. There appears to be little evidence to support the suggestion that a higher true force of infection is masked by age bias in reporting.

Journal Article↗
PubMed2006

The local lymph node assay in practice: a current regulatory perspective.

Following the formal acceptance of the local lymph node assay (LLNA) as an Organization for Economic Cooperation and Development (OECD) guideline in April 2002, the UK Health and Safety Executive (HSE) informed notifiers that this was now the method of choice for the assessment of skin sensitization potential under the EU notification scheme for new industrial chemicals (NONS). This paper summarizes the experience of the HSE for the 2-year period immediately following the issuing of this statement, during which 48 LLNA study reports were assessed for notification purposes. The issues discussed here include adherence to the OECD guideline, interpretation of results, and classification outcomes. Generally, notifying laboratories followed the OECD guideline successfully, with regard to the sex/ strain/numbers of mice used, the precise process used for measurement of cell proliferation, and the use of recommended vehicles and positive controls. Initially, use of the individual animal approach (measuring the cell proliferation in each animal rather than for a pooled dose group) highlighted problems caused by technical inexperience, but these were overcome by practice. Toxicity or irritation were found to be minor factors in dose selection; more important was the choice of vehicle to correctly maximize the test substance concentration, while maintaining appropriate application properties. Contrary to concerns that the LLNA would prove to be less sensitive or more sensitive than the traditionally used Guinea Pig Maximization Test (GPMT), the proportion of new substances classified as skin sensitizers was within the range observed in previous years. Although the sample size is relatively small, the experience of the HSE indicates that the LLNA is satisfactory for routine regulatory use.

Animals↗
PubMed2005

Does the emergency exception from informed consent process protect research subjects?

Although subject protection is the cornerstone of medical ethics, when considered in the context of research using emergency exception from informed consent, its success is debatable. The participants of a breakout session at the 2005 Academic Emergency Medicine Consensus Conference discussed the issues surrounding subject protection and advanced the following recommendations. 1) There are no outcome measures that define "protection"; therefore, it is not currently known whether or not subjects are protected under the current rules. 2) Care must be taken to protect not only the individual from harm during research but also to protect society from unregulated research in other countries and an inability to appropriately advance medical knowledge. 3) Some surrogate markers/methods of protection whose efficacies are debatable include data safety monitoring board activity, the community consultation and public notification (CC/PN) process, and institutional review board approval. 4) Minimal-risk studies should be held to different standards of protection than those that involve more significant risk to the subject. 5) A handful of studies have been published regarding community consultation and notification, and the majority are case studies. Those that are specifically designed to discover the most successful methods are hindered by a lack of formal outcomes measures and tend to have negative results. 6) Follow-up data from the CC/PN process should be disclosed to the Food and Drug Administration and incorporated into study designs. 7) Focus groups and/or random-digit dialing have been suggested as promising methods for fulfilling the CC/PN requirements. 8) Studies need to be funded and performed that formally investigate the best means of CC/PN. 9) More funding for this research should be a priority in the emergency medicine and critical care communities. More data regarding terminated studies should be made available to the research community. 10) Quantifiable markers of success for CC/PN must be validated so that research may determine the most successful methods. 11) Data regarding subjects' and family members' experiences with exception from informed consent studies need to be obtained.

Community-Institutional Relations↗
PubMed2006

Use and perceived benefits of handheld computer-based clinical references.

OBJECTIVE: Clinicians are increasingly using handheld computers (HC) during patient care. We sought to assess the role of HC-based clinical reference software in medical practice by conducting a survey and assessing actual usage behavior. DESIGN: During a 2-week period in February 2005, 3600 users of a HC-based clinical reference application were asked by e-mail to complete a survey and permit analysis of their usage patterns. The software includes a pharmacopeia, an infectious disease reference, a medical diagnostic and therapeutic reference and transmits medical alerts and other notifications during HC synchronizations. Software usage data were captured during HC synchronization for the 4 weeks prior to survey completion. MEASUREMENTS: Survey responses and software usage data. RESULTS: The survey response rate was 42% (n = 1501). Physicians reported using the clinical reference software for a mean of 4 years and 39% reported using the software during more than half of patient encounters. Physicians who synchronized their HC during the data collection period (n = 1249; 83%) used the pharmacopeia for unique drug lookups a mean of 6.3 times per day (SD 12.4). The majority of users (61%) believed that in the prior 4 weeks, use of the clinical reference prevented adverse drug events or medication errors 3 or more times. Physicians also believed that alerts and other notifications improved patient care if they were public health warnings (e.g. about influenza), new immunization guidelines or drug alert warnings (e.g. rofecoxib withdrawal). CONCLUSION: Current adopters of HC-based medical references use these tools frequently, and found them to improve patient care and be valuable in learning of recent alerts and warnings.

Adult↗
PubMed2002

Sexually transmitted diseases in Germany.

In the former West Germany, in specific venereal diseases legislation passed in 1953, only syphilis, gonorrhoea, ulcus molle, and lymphogranuloma venereum were defined as venereal diseases and subject to mandatory notification. The proportion of unreported cases was as high as 75% for syphilis and up to 90% for gonorrhoea. Epidemiological data for the past 10 years exist only on selected populations from research studies and are summarized in this article. In the former East Germany reporting of sexually transmitted infections (STIs) was mandatory and, due to the centralized organization, underreporting was considered to be low, although no specific studies have examined this. After the unification in 1990 of the two German states the West German laws were adopted in East Germany. Since 1982 - when the first AIDS case was reported in Germany - information on AIDS cases has voluntarily been collected at the national register at the AIDS Centre of the Robert Koch Institute in Berlin. The law governing the reporting of infectious diseases has recently been revised. Under the new Protection against Infection Act, which became effective on 1 January 2001, clinical diagnoses of STIs (with the exception of hepatitis B) are no longer notifiable diseases. Laboratory reporting of positive test results for Treponema pallidum has been introduced. With T. pallidum and HIV notifications, additional disaggregated data are collected. Since T. pallidum and HIV remain the only notifiable STIs, all other STIs have to be monitored through sentinel surveillance systems. These surveillance systems are currently being established. Under the new legislation, local health authorities have to provide adequate counselling and testing services for STIs, which may be provided free of charge if necessary.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Chlamydia trachomatis infection in a colposcopy unit: an audit of a fast track referral system for infected patients to a genitourinary medicine department and a survey of patients' demography, clinical findings and partner details.

We had previously shown that screening and treating patients for Chlamydia trachomatis prior to termination of pregnancy significantly reduces postoperative morbidity. Our success led us to consider screening women attending our colposcopy unit and this was introduced in 1998. However, it became apparent that a formal protocol was needed for managing women who had positive results to ensure that all patients and their partners were adequately treated. An interdepartmental protocol was devised for fast track referral of infected patients to the Genitourinary Medicine (GUM) clinic Health Advisor who arranged immediate treatment and partner notification. A re-audit, presented here, has shown that the introduction of the protocol has resulted in all infected patients receiving adequate treatment and partner notification with minimal use of doctor time or disruption of routine GUM services. We suggest that our system is effective and could be extended to other clinics where chlamydia screening is carried out.

Adolescent↗
PubMed2004

General practitioners and the National Strategy on Sexual Health and HIV.

To determine general practitioners' knowledge of, and opinions on, the National Strategy for Sexual Health and HIV and whether they intend to provide Level 1 and 2 HIV/STI services, a self-administered questionnaire was sent to one partner from 155 general practices in Sheffield and North Derbyshire in November 2001. Response rate was 57% (88). Forty-eight (55%) GPs aware of strategy but 53 (60%) had no knowledge of what it involved. LEVEL 1. Sixty-two (71%) felt confident in providing advice on STI prevention and 46 (52%) on HIV. Nine (10%) GPs provide HIV testing and 29 (33%) anticipate doing so but 24 (83%) require staff training and 20 (70%) increased funding. All Level 1 STI services are provided by 60 (68%) practices and 72 (82%) anticipate providing. LEVEL 2. Thirty-nine (45%) anticipate testing and treating STIs but only nine (10%) will undertake partner notification. Resources required are training, nine (60%) and funding, nine (60%). The main reasons for not offering in the future were too busy 58 (72%) and lack of demand 25 (31%). Many GPs are unaware of the strategy but most anticipate providing Level 1 STI services. Less than half anticipate offering HIV testing. Although 45% of GPs may provide Level 2 care, it is unlikely to include partner notification. Many GPs are too busy and require extra training and funding. These needs must be addressed if the Strategy is to be implemented.

Attitude of Health Personnel↗