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US-bound immigrants and refugees undergo a mandatory overseas medical examination that includes tuberculosis screening; this exam is not routinely required for temporary visitors applying for non-immigrant visas (NIV) to visit, work, or study in the United States. US health departments and foreign ministries of health report tuberculosis cases in travelers to Centers for Disease Control and Prevention Quarantine Stations. We reviewed cases reported to this passive surveillance system from January 2011 to June 2016. Of 1252 cases of tuberculosis in travelers reported to CDC, 114 occurred in travelers with a long-term NIV. Of these, 83 (73%) were infectious; 18 (16%) with multidrug-resistant tuberculosis (MDR TB) and one with extensively drug-resistant tuberculosis (XDR TB). We found evidence that NIV holders are diagnosed with tuberculosis disease in the United States. Given that long-term NIV holders were over-represented in this data set, despite the small proportion (4%) of overall non-immigrant admissions they represent, expanding the US overseas migration health screening program to this population might be an efficient intervention to further reduce tuberculosis in the United States. [ABSTRACT FROM AUTHOR]

We describe the implementation of universal glucose-6-phosphate dehydrogenase (G6PD) screening during the first year of New York State mandated testing, as well as operational challenges and clinical knowledge gained. All infants born at or transferred to our center between June 21, 2022 and June 30, 2023, underwent testing for G6PD enzyme deficiency and were included in the study cohort. Infant blood samples were collected and sent to a reference laboratory for quantitative assay. After initiation of universal screening, a quality improvement initiative was launched to: 1. monitor and improve the suitability of blood sample collection to ensure timely return of results; 2. improve the reliability and validity of the reference laboratory enzyme assay; and 3. establish accurate reference ranges for G6PD deficiency in newborns. A total of 5601 newborns were included. Within the first year of implementation, the percentage of samples yielding any test result increased from 76% to 85%, and most patients had a G6PD result available within 1 day of discharge. We established a more accurate threshold for G6PD deficiency in newborns of <4.9 U/g Hb and G6PD intermediate of <10.0 U/g Hb. Using the updated reference ranges, 224 patients in our cohort were identified as G6PD deficient or intermediate (4.0%). Through a quality-sensitive process, we identified the importance of a standardized approach, improved sample collection processes, decreased sample turnaround time, and established more accurate reference ranges.We hope our experiences will help others seeking to improve processes and implement similar programs at other institutions. [ABSTRACT FROM AUTHOR]

Background: Apnea testing is mandatory to confirm brain death; however, it is unsafe for patients who have substantial hypoxemia without ventilator support. We used a new modified apnea test without the need to disconnect the patient from the ventilator in the present study and compared the outcomes and complications of the new method to the widely used old method. Materials and Methods: The current study was conducted on people suspected of having brain death. Both the old and new apnea tests were carried out on the same individual. In the new modified method, instead of hyperventilating and then separating the brain death from the ventilator, the induced hypercapnia method was used, and instead of performing repeated arterial blood gas (ABG), the target ETCO2 was obtained, and at the time of the target ETCO2, ABG was also checked followed by comparing ETCO2 with PaCO2. Results: Thirty patients, including 25 (83.3%) males and 5 (16.75%) females, were included in the study. The results showed significant improvement in terms of O2 saturation and heart rate (HR) using the new modified apnea test compared to the common test. Systolic blood pressure, diastolic blood pressure, and the frequency of complications were improved in the new modified test. Conclusion: The modified apnea test produced better results in terms of O2 saturation, HR, and other clinical factors, while it does not require disconnection from the ventilator and repeated ABG assessment. Therefore, it can be used to successfully diagnose brain death in high-risk individuals suffering from severe hypoxia. [ABSTRACT FROM AUTHOR]

• Familial hypercholesterolemia (FH) is underdiagnosed and undertreated in Slovakia. • FH and at-risk individuals must be detected before the first cardiovascular event. • Pediatric screening is effective in identifying parents at risk of FH. • Dutch lipid clinic network criteria are insufficient at present to catch FH early. • Most enrolled parents required lipid-lowering therapy, but were untreated. In Slovakia, a mandatory national universal pediatric total cholesterol (TC) screening program is in place to identify cases of familial hypercholesterolemia (FH). However, the program's effectiveness has not been systematically assessed. This study aimed to estimate the prevalence of FH among parents of children that had elevated TC levels identified during screening. This prospective, non-interventional, observational study enrolled parents of 11-year-old children who underwent TC screening in 23 selected pediatric outpatient clinics between 2017 and 2018. FH was diagnosed using the Dutch Lipid Clinic Network (DLCN) criteria and targeted next-generation sequencing. The primary objective was to estimate the proportion of children with a TC level of >188 mg/dL (>4.85 mmol/L) who had a parent with a confirmed diagnosis of FH. A total of 112 parents of 56 children with an elevated TC level were enrolled. Five children (8.9%) had a parent in whom FH was genetically confirmed. Without genetic analysis, all five parents would only be diagnosed with "possible FH" by DLCN criteria. Of parents, 83.9% (n = 94/112) had an low-density lipoprotein cholesterol (LDL-C) level of >116 mg/dL (>3 mmol/L), but only 5.3% (n = 5/94) received lipid-lowering therapy. Among the five parents with genetically confirmed FH, all had an LDL-C level >116 mg/dL (>3 mmol/L), with a mean (±SD) of 191 (±24) mg/dL (4.94 [±0.61] mmol/L). Only two of these parents received lipid-lowering therapy. The present study demonstrates the significance of mandatory universal pediatric TC screening in identifying families with FH and other at-risk families in need of lipid-lowering therapy. [Display omitted] [ABSTRACT FROM AUTHOR]

Glasgow, Scotland's largest city, has been experiencing an HIV outbreak among people who inject drugs (PWID) since 2015. A key focus of the public health response has been to increase HIV testing among those at risk of infection. Our aim was to assess the impact of COVID-19 on HIV testing among PWID in Glasgow. HIV test uptake in the last 12 months was quantified among: (1) PWID recruited in six Needle Exchange Surveillance Initiative (NESI) surveys (n = 6110); linked laboratory data for (2) people prescribed opioid agonist therapy (OAT) (n = 14,527) and (3) people hospitalised for an injecting-related hospital admission (IRHA) (n = 12,621) across four time periods: pre-outbreak (2010–2014); early-outbreak (2015–2016); ongoing-outbreak (2017–2019); and COVID-19 (2020–June 21). From the pre to ongoing period, HIV testing increased: the highest among people recruited in NESI (from 28% to 56%) and on OAT (from 17% to 54%) while the lowest was among people with an IRHA (from 15% to 42%). From the ongoing to the COVID-19 period, HIV testing decreased markedly among people prescribed OAT, from 54% to 37% (aOR 0.50, 95% CI 0.48–0.53), but increased marginally among people with an IRHA from 42% to 47% (aOR 1.19, 95% CI 1.08–1.31). In conclusion, progress in increasing testing in response to the HIV outbreak has been eroded by COVID-19. Adoption of a linked data approach could be warranted in other settings to inform efforts to eliminate HIV transmission. [ABSTRACT FROM AUTHOR]

Introduction: Early during the COVID-19 outbreak, various approaches were utilized to prevent COVID-19 introductions from incoming airport travellers. However, the costs and effectiveness of airport-specific interventions have not been evaluated. Methods: We evaluated policy options for COVID-19-specific interventions at Entebbe International Airport for costs and impact on COVID-19 case counts, we took the government payer perspective. Policy options included; (1)no screening, testing, or mandatory quarantine for any incoming traveller; (2)mandatory symptom screening for all incoming travellers with RT-PCR testing only for the symptomatic and isolation of positives; and (3)mandatory 14-day quarantine and one-time testing for all, with 10-day isolation of persons testing positive. We calculated incremental cost-effectiveness ratios (ICERs) in US$ per additional case averted. Results: Expected costs per incoming traveller were $0 (Option 1), $19 (Option 2), and $766 (Option 3). ICERs per case averted were $257 for Option 2 (which averted 4,948 cases), and $10,139 for Option 3 (which averted 5,097 cases) compared with Option I. Two-week costs were $0 for Option 1, $1,271,431 Option 2, and $51,684,999 Option 3. The per-case ICER decreased with increase in prevalence. The cost-effectiveness of our interventions was modestly sensitive to the prevalence of COVID-19, diagnostic test sensitivity, and testing costs. Conclusion: Screening all incoming travellers, testing symptomatic persons, and isolating positives (Option 2) was the most cost-effective option. A higher COVID-19 prevalence among incoming travellers increased cost-effectiveness of airport-specific interventions. This model could be used to evaluate prevention options at the airport for COVID-19 and other infectious diseases with similar requirements for control. [ABSTRACT FROM AUTHOR]

Objective: Assessment of predictive values of clinical symptoms for COVID-19 diagnosis in young adults. Participants: Nonresidential university students (ages 18–25) participating in surveillance testing and mandatory symptom survey between 9/9/2020 and 11/25/2020. Methods: Retrospective study of test results and symptom survey data. Results: Among 6,489 individuals, 288 (4.4%) tested positive for COVID-19, 90 (31.3%) of whom reported symptoms. COVID-19 prevalence among individuals reporting and not reporting symptoms was 17.2% and 3.3%, respectively. The four symptoms with highest positive predictive values (PPVs) were smell/taste loss (PPV = 38.5%), chills (PPV = 31.5%), muscle/joint pain (PPV = 26.0%), and fever (PPV = 25.9%). Conclusions: Institutions should emphasize COVID-19 risk for highly predictive symptoms in public health messaging to inform individuals on when to seek testing or self-isolation. However, low COVID-19 diagnostic accuracy of clinical symptoms and the high pre-symptomatic/asymptomatic rate (69%) highlight the limitations of voluntary testing strategies employed by higher education institutions during the original strain of SARS-CoV-2. [ABSTRACT FROM AUTHOR]

This study used a self-administered questionnaire to investigate the relationship between HIV/AIDS knowledge, social discrimination, HIV self-efficacy, sexual behavioral characteristics and HIV testing behavior among young students with a history of sexual activity in Chongqing. Propensity score matching was used to construct a control group with similar demographic characteristics to the HIV testing group, only without HIV testing behaviors. Structural equation modeling was used to conduct chain-mediated effect analysis. The HIV testing rate among young students with a history of sexual behavior was 17.16%. Young students with HIV testing behavior had higher levels of HIV/AIDS knowledge, lower social discrimination, better self-efficacy, and no difference in sexual behavior characteristic scores between the two groups (P = 0.062). The mediated effect values of social discrimination and self-efficacy were 0.022 and 0.063, respectively, while their chain mediated effect value was 0.007. There was no mediated effect of sexual behavior characteristics. The level of young students' HIV/AIDS knowledge does not directly influence their HIV testing behavior but plays a complete chain mediating effect on HIV testing behavior through social discrimination and self-efficacy. HIV testing behavior should be promoted through the perspectives of enhancing HIV/AIDS knowledge level, reducing social discrimination, and improving self-efficacy. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular events are known to be the leading cause of death among on-duty firefighters. Implementing fitness standards may help reduce the incidence of cardiovascular deaths; however, standards vary between firefighter type and states. We aimed to investigate the rate of cardiovascular events among firefighters across states. Methods: Using publicly available data from the United States Fire Administration, we explored the rates of cardiovascular deaths between firefighter type (e.g., career, volunteer, and wildland) and state. Specifically, we examined rates of cardiovascular deaths between California and Tennessee, which have fitness standards for all firefighters, and New York, which does not have fitness standards for volunteer firefighters. We used descriptive statistics and trend analysis to examine the data. Findings: Most cardiovascular events occur among volunteer firefighters (60.6%, n = 877). Volunteer firefighters had 7.5 (95% CI = [4.8, 11.7], p <.001) greater odds of cardiovascular events compared to wildland firefighters, who had the lowest incidence of cardiovascular events (1.7%, n = 24). New York reported the most cardiovascular events (n = 161), primarily among volunteer firefighters (73.9%, n = 119). After the passage of legislation mandating fitness standards in California, a downtrend in the number of volunteer firefighter fatalities is observed. However, a null effect was observed in Tennessee after the passage of similar fitness standards as in California. Conclusions/Applications to Practice: Volunteer firefighters are significantly more likely to die of a cardiovascular event than career and wildland firefighters, both of which have stricter fitness standards. However, the effect of legislation mandating stricter fitness standards among volunteers did not produce a clear benefit for preventing fatalities. Nurses need to promote cardiovascular health among volunteer firefighters. [ABSTRACT FROM AUTHOR]

Background Inappropriate Clostridioides difficile testing is common in the hospital setting, leading to potential overdiagnosis of infection when single-step nucleic acid amplification testing is used. The potential role of infectious diseases (ID) specialists in enforcing appropriate C. difficile testing is unclear. Methods At a single 697-bed academic hospital, we performed a retrospective study from 1 March 2012 to 31 December 2019 comparing hospital-onset C. difficile infection (HO-CDI) rates during 3 consecutive time periods: baseline 1 (37 months, no decision support), baseline 2 (32 months, computer decision support), and intervention period (25 months, mandatory ID specialist approval for all C. difficile testing on hospital day 4 or later). We used a discontinuous growth model to assess the impact of the intervention on HO-CDI rates. Results During the study period, we evaluated C. difficile infections across 331 180 admission and 1 172 015 patient-days. During the intervention period, a median of 1 HO-CDI test approval request per day (range, 0–6 alerts/day) was observed; adherence by providers with obtaining approval was 85%. The HO-CDI rate was 10.2, 10.4, and 4.3 events per 10 000 patient-days for each consecutive time period, respectively. In adjusted analysis, the HO-CDI rate did not differ significantly between the 2 baseline periods (P =.14) but did differ between the baseline 2 period and intervention period (P <.001). Conclusions An ID-led C. difficile testing approval process was feasible and was associated with a >50% decrease in HO-CDI rates, due to enforcement of appropriate testing. [ABSTRACT FROM AUTHOR]

Background: We examined whether the policy amendment from March 2017 for a cognitive screening test for older drivers at driver's license renewal was associated with the decreased risk of motor vehicle collisions for drivers and the increased risk of injuries for pedestrians and cyclists among older people. Methods: This was a controlled interrupted time‐series study. We used police‐reported data on the number of collisions as drivers and injuries as pedestrians and cyclists among people aged 70 years or older in Japan from July 2012 to December 2019. As the outcome measures, we used the ratio of the monthly number of collisions per population among drivers of three groups aged 75 years or older (75–79, 80–84, and ≥85 years), who were targeted or exposed by the policy, to that among drivers aged 70 to 74 years, who were unaffected or unexposed by the policy and would serve as controls. The ratio of pedestrian and cyclist injuries was also calculated, as previous studies have shown a concomitant increase in these injuries after the introduction of cognitive screening for driver's licenses. Results: During the study period, there were 602,885 collisions as drivers and 196,889 injuries as pedestrians and cyclists among people aged 70 years or older. After the policy amendment in March 2017, collisions decreased among male drivers, and injuries increased among some age subgroups in both sexes. Cumulative estimated changes in the numbers of collisions and injuries from March 2017 to December 2019 were −3670 (95% confidence interval: −5125, −2104) and 959 (95% confidence interval: 24, 1834), respectively. Conclusions: Following the policy amendment, there was a decrease in motor vehicle collisions as drivers and an increase in road injuries as pedestrians and cyclists among older people. [ABSTRACT FROM AUTHOR]

Asymptomatic COVID‐19 testing programmes are being introduced in higher education institutions, but stakeholder views regarding the acceptability of mandating or incentivizing participation remain little understood. A mixed‐method study (semi‐structured interviews and a survey including open and closed questions) was undertaken in a case study university with a student testing programme. Survey data were analysed descriptively; analysis for interviews was based on the framework method. Two hundred and thirty‐nine people participated in the study: 213 in the survey (189 students, 24 staff), and 26 in interviews (19 students, 7 staff). There was majority (62%) but not universal support for voluntary participation, with a range of concerns expressed about the potentially negative effects of mandating testing. Those who supported mandatory testing tended to do so on the grounds that it would protect others. There was also majority (64%) opposition to penalties for refusing to test. Views on restricting access to face‐to‐face teaching for non‐participants were polarized. Three‐quarters (75%) supported incentives, though there were some concerns about effectiveness and unintended consequences. Participants emphasized the importance of communication about the potential benefits of testing. Preserving the voluntariness of participation in student asymptomatic testing programmes is likely to be the most ethically sound policy unless circumstances change. [ABSTRACT FROM AUTHOR]

A blood transfusion is a way of adding blood to your body after an illness or injury. It's a kind of life saving procedure. But this procedure also has life threatening hazards. Transfusion transmitted infections are one of the major side effects of blood transfusion. We can prevent them by proper screening of blood products and public awareness. To know about trend of transfusion transmitted infections (TTI) for the blood donors of Dhiraj hospital blood bank, the study was done. Method: Study was done including blood donors of age 18-65 years from 2011 to 2016 retrospectively. TTIs testing for HIV, HBV and HCV was done with 3rd generation ELISA but from the year 2016 onwards 4th generation ELISA was used for HIV testing. Syphilis and malaria screening was done with rapid card test. Result: Over a six year period total blood donation was 20,392. The overall prevalence of HIV, HbsAg, HCV, syphilis and malaria were 0.16%, 1.43%, 0.10%, 0.61% and 0.009% respectively. Conclusion: Nucleic acid amplifcation testing (NAT) must be applied that identify positive blood donor during the immunological window period before seroconversion. Information to TTIs reactive donor is a best method to prevent the chance of repeated reactive donation. [ABSTRACT FROM AUTHOR]

Radon causes approximately 21,000 lung cancer deaths every year in the U.S. Facilities that are required to test for radon in Florida include public and private schools, state-regulated child care centers, and adult 24-hour care facilities. All these facilities are required to perform an initial test with a 5-year follow-up test. This study examined noncompliance among facilities with mandatory testing, the effectiveness of outreach to noncompliant facilities, and whether certain groups are more likely to be noncompliant. To determine noncompliance, a sample of 656 facilities was selected from the state-operated database on mandatory radon testing. Outreach to noncompliant facilities was attempted to alert them of their noncompliant status and what they needed to do to become compliant. The database was consulted to determine which facilities became compliant after outreach. The results showed a 50% success rate in outreach. There were no statistically significant relationships between noncompliance and any of the groupings examined. It is recommended that the methods of outreach employed only be used as a supplement to other forms of outreach when seeking to reduce noncompliance among mandatory testing facilities in Florida. [ABSTRACT FROM AUTHOR]

Background: Sickle cell trait (SCT) has been associated with an increased risk of sudden death in athletes during strenuous exercise. In August 2010, the National Collegiate Athletic Association (NCAA) began requiring athletes to be screened for SCT, provide proof of SCT status, or sign a waiver and launched an educational campaign for athletes, coaches, and medical staff. The impact of this program is unknown. The purpose of this study was to determine the incidence of death associated with sickle cell trait (daSCT) in NCAA athletes before and after legislation.Hypothesis: NCAA SCT legislation will decrease the incidence of daSCT.Study Design: Observational study.Level Of Evidence: Level 2.Methods: A database of NCAA athlete deaths from 2000 to 2019 was reviewed for daSCT. A total of 8,309,050 athlete-years (AY) were included. Incidence of death was calculated before and after legislation.Results: The incidence of daSCT in Division I (DI) football athletes before legislation (n = 9) was 1:28,145 AY and after legislation (n = 1) was 1:250,468 AY (relative risk [RR], 0.112; 95% CI, 0.003-0.811; P = 0.022), an 89% reduction in risk after legislation was enacted. The incidence of daSCT in African American DI football athletes before legislation (n = 9) was 1:12,519 AY and after legislation (n = 1) was 1:118,464 AY (RR, 0.106; 95% CI, 0.002-0.763; P = 0.017), also an 89% risk reduction after legislation was enacted. For all NCAA athletes, the incidence of daSCT was 1:489,749 AY before legislation (n = 10) and 1:1,705,780 AY after legislation (n = 2) (RR, 0.288; 95% CI, 0.031-1.347; P = 0.146).Conclusion: The incidence of daSCT in DI football athletes has decreased significantly since legislation was enacted. Cases of daSCT outside of football are rare. It is unclear whether the decrease is related to screening for SCT, education, or both.Clinical Relevance: This is the first evidence that NCAA SCT legislation may save lives. [ABSTRACT FROM AUTHOR]

Background The validated 4 As Test (4AT) cognitive screening tool was incorporated into the electronic patient record (EPR) to facilitate hospital wide delirium and dementia screening. Completion of the 4AT was mandated by its incorporation into a computer alert targeted at doctors. This alert was generated on all hospital inpatients aged 65 years and over at 24 hours into admission in keeping with the National Institute for Health and Care Excellence guidelines. An option to bypass the 4AT alert was available. Methods Multidisciplinary clinical stakeholder workshops informed the design of the electronic cognitive screening alert. An implementation strategy was undertaken using intensive clinical engagement. On June 27th 2018, the 4AT electronic alert was deployed. Data entries from the completed electronic 4AT assessments were extracted from the EPR facilitating descriptive statistical analysis and point prevalence analysis for delirium and dementia. Specialty-based comparisons were also made. Results During the first 24 hours post-implementation, 4AT screening assessments were completed in 61% of instances equating to 324 completed assessments. Forty eight percent (n=155) had a score of zero suggestive of normal cognitive status. Notably, 20% assessments yielded a score reflective of possible delirium (four or more). Dementia was a recognised clinical diagnosis in 23% (n=76) of patients. One in two of these dementia patients scored four or more indicative of coexistent delirium. Conclusion Electronic patient records can be harnessed to facilitate hospital-wide delirium and dementia screening and improve detection. This also represents a novel method to capture data for the purposes of audit and research as well as to inform and improve future directions in clinical care and resource allocation. Innovative computer-based strategies may offer future directions to augment detection of cognitive disorders in hospitalised populations. [ABSTRACT FROM AUTHOR]

Health care‐associated infection is a real and relative risk within the realm of organ donation. Despite detailed guidance from the Advisory Committee on the Safety of Blood, Tissues and Organs on the microbiological safety of human organs, tissues and cells used in transplantation, the topic has received limited exposure in the literature. This paper will give a context to the Safety of Blood, Tissues and Organs guidance, outline the key recommendations for mandatory/recommended screening and provide a summary of infections that may be present at the time of donation that require careful risk assessment. This does not detract from national guidelines and cannot replace expert advice but will raise awareness and complement safe and effective care delivery. [ABSTRACT FROM AUTHOR]

The American College of Obstetricians and Gynecologists and the Infectious Diseases Society of America offered guidelines for how physician offices, clinics, and other facilities can reopen to in-person, nonessential services in the next phase of the pandemic. [ABSTRACT FROM AUTHOR]

Although HIV screening is needed at a wider range of sites, dentists have shown reluctance to incorporate screening in their practices, but dental hygiene settings may be better suited for such screenings. The aim of this mixed-methods study was to determine the feasibility and acceptability of point-of-care (POC) HIV screening in dental hygiene education community settings from the patient, faculty, and student perspectives. After training, dental hygiene students and faculty at a Canadian dental school offered POC HIV screening to patients as part of routine dental hygiene care over 36 weeks at four sites in 2015-16. Of the 199 patients offered screening, 78 agreed; no positive results were found. Of the 199 patients, 97 completed an 11-item survey (49% response rate), with 80 (82%) agreeing HIV screening was within the scope of practice of a dental professional. Of the 57 patients who were screened, 48 (84%) agreed POC HIV screening should be part of regular dental check-ups, and 52 (91%) perceived dental settings were appropriate sites for screening. The main reasons for patients' agreeing to screening were that it was free and convenient and the results were delivered quickly. Those who refused screening had been tested recently or did not perceive themselves at risk for HIV. In two focus groups with 12 dental hygiene students, one focus group with five faculty members, and individual interviews with five other faculty members, participants agreed on the importance of offering POC HIV screening in the dental setting as a public health service. Faculty members thought students were well prepared and increased in confidence with testing. Students expressed a desire to offer screening throughout their careers and to educate patients about the importance of HIV testing. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Bacterial sexually transmitted infections (STIs) contribute to a significant burden of ill-health despite being easy to diagnose and treat. STI management guidelines provide clinicians with evidence-based guidance on best-practice case management. AIM: To determine the extent of adherence to STI management guidelines for partner notification, follow up and testing for reinfection following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae. METHODS: Retrospective review of electronic patient records for individuals diagnosed with chlamydia or gonorrhoea in eight primary care clinics in Wellington, New Zealand. At each clinic, 40 clinical records were reviewed (320 in total). Outcome measures were: overall numbers (%) of cases with documented evidence of reason for testing, sexual history, treatment, advice, partner notification and follow up. Partner notification outcomes were: n (%) with evidence of partner notification discussion and n (%) with partners advised, tested and treated. Proportions retested between 6 weeks and 6 months and n (%) positive on retesting were also determined. RESULTS: Presenting features and treatment were generally well documented. Recent sexual history including number of partners was documented for half of cases reviewed (159/320). Partner notification discussion was documented for 74% (237/320) of cases, but only 24.4% (78/320) had documentation on numbers of partners notified and 17% (54/320) on numbers of partners treated. Testing for reinfection between 6 weeks and 6 months occurred for 24.7% (79/320), of whom 19% (15/79) re-tested positive. CONCLUSIONS: This research suggests there are gaps in important aspects of patient care following bacterial STI diagnosis -- a factor that may be perpetuating our high rates of infection. A more systematic approach will be needed to ensure people diagnosed with an STI receive the full cycle of care in line with best practice guidelines. [ABSTRACT FROM AUTHOR]

Aim: Over a 10-year period from 2003, around 1.7 million arrests in England and Wales resulted in the suspect being exposed to mandatory drug testing and assessment processes. These provisions formed part of a wider drug interventions programme costing £1.3 billion. This study sought to assess the impact of compliance with these measures on treatment uptake and reoffending. Recidivism risk factors were also investigated.Methods: The use of linked administrative data relating to matched samples of recent heroin and/or cocaine (H/C) users identified in one English police force area over a 12-month period (N = 1630).Findings: There was no association between compliance with a compulsory model of drug diversion and subsequent engagement with structured treatment services, rates of treatment retention and successful discharge. Compliance was also not found to be associated with reductions in the rate and volume of reoffending after 12 months. The factor with the largest effect on risk of recidivism was poly use of H/C. Main offence, engagement with structured treatment, number of prior convictions and (younger) age were also identified as recidivism risk factors.Conclusions: These results are discussed in the context of subsequent legislation and policy which further expands the reach of mandatory testing and assessment measures as a form of constraints-based drug diversion. [ABSTRACT FROM PUBLISHER]

Background: HIV screening has existed in numerous methods as an important part of HIV prevention efforts over the years. Premarital HIV testing for couples who wish to marry has been implemented in a number of regions, which often operate in a mandatory rather than voluntary basis and is considered a contentious issue, with viewpoints held in favour and against. One such region is Malaysia which has a policy of mandatory premarital HIV testing of prospective Muslim married couples. The purpose of this study is to understand stakeholders' views on premarital HIV testing given the Malaysian Islamic context. Methods: 35 in-depth face to face semi-structured interviews were undertaken with key stakeholder groups involved in HIV prevention policy in Malaysia, namely, officials from the Ministry of Health, religious leaders and people living with HIV. Participants were recruited from the Klang Valley area, from July to December 2013, using purposive sampling techniques. Inclusion criteria necessitated that participants were over the age of 18 and provided full consent. Interviews were audiotaped, followed a standardised topic guide, transcribed verbatim and analysed using a framework analysis. Results: Participants identified pre-marital HIV testing as an effective HIV prevention policy implemented in Malaysia and was viewed, for the most part, as a positive initiative across all stakeholders. Religious leaders were supportive of testing as it provides a protective mechanism, in line with the teachings of the Shariah, while Ministry of Health officials considered it a normal part of their HIV prevention screening initiatives. However, there were concerns surrounding issues such as confidentiality, counselling and discrimination surrounding the test described by the PLHIV group. Conclusion: The findings of this study show that among the participants interviewed was strong support for mandatory premarital HIV testing, which could possibly expose the vulnerability to HIV, reluctance to test and other areas in the HIV response in Malaysia that need to be addressed. Furthermore, although international health organisations are vehemently against mandatory premarital HIV testing, the strong local support for such measures and the mismatch between these views is worth exploring in more detail, given the cultural, social and religious context. [ABSTRACT FROM AUTHOR]

The article discusses the U.S. Court of Appeals for the Fourth Circuit's ruling in the case Stuart v. Camnitz which deals with the standard of care for abortion providers and the court's determination that the Real Time View Requirement of North Carolina's 2011 Woman's Right to Know Act is unconstitutional under the U.S. Constitution's First Amendment. The legal aspects of ultrasound image viewing and fetal heart tone monitoring prior to an abortion are examined.

Objective: To retrospectively analyze multiple years of legal blood alcohol test (LBAT) results as part of a laboratory process improvement plan.Methods: We analyzed the LBAT requests received by the Brooke Army Medical Center during calendar years 2013 and 2014.Results: We received 365 samples from 11 installations; 351 were tested and 14 were rejected. Nearly one-third of the tested samples had negligible ethanol levels. One installation was responsible for submitting 10 rejected samples which prompted laboratory intervention.Conclusion: The ability to perform timely LBATs is invaluable to the Department of Defense as the results are more readily accepted in a court of law than routine clinical ethanol test results. [ABSTRACT FROM AUTHOR]

We use the 1997-2008 Medical Expenditure Panel Survey (MEPS) and variation in the timing of state mandates for coverage of colorectal, cervical, and prostate cancer screenings to investigate the behavioral and financial effects of mandates on privately insured adults. We find that state mandates did not result in increased rates of cancer screening. However, coverage of preventive care, whether mandated or not, moves the cost of care from the consumer's out-of-pocket expense to the premium, resulting in a cross-subsidy of users of the service by non-users. While some cross-subsidies are intentional, others may be unintentional. We find that users of cancer screening have higher levels of income and education, while non-users tend to be racial minorities, lack a usual source of care, and live in communities with fewer physicians per capita. These results suggest that coverage of preventive care may transfer resources from more advantaged individuals to less advantaged individuals. [ABSTRACT FROM AUTHOR]

Objective: This campaign sought to (a) increase awareness of sexual health and chlamydia testing; (b) motivate students, particularly sexually active men who do not pursue regular sexually transmitted infection (STI) testing, to get tested; and (c) improve the capacity of the student health center to provide free chlamydia testing and treatment for all students. Participants: Students enrolled at a 4-year public research university (N = 333). Methods: Collaborative partnerships formed the foundation of a campus marketing and testing campaign, with treatment for students testing positive for chlamydia. Results: A total of 333 students were tested over 5 consecutive Mondays, showing a chlamydia incidence of 9.6%. The incidence for females and males were 8.6% and 10.8%, respectively. Conclusions: The campaign was effective in reaching men, an at-risk population not traditionally emphasized in STI testing. [ABSTRACT FROM AUTHOR]

Background: Vaccination of health care workers (HCW) against seasonal influenza (SI) is recommended but vaccination rate rarely reach >30%. Vaccination coverage against 2009 pandemic influenza (PI) was 52% in our hospital, whilst a new policy requiring unvaccinated HCW to wear a mask during patient care duties was enforced. Aims: To investigate the determinants of this higher vaccination acceptance for PI and to look for an association with the new mask-wearing policy. Methods: A retrospective cohort study, involving HCW of three critical departments of a 1023-bed, tertiarycare university hospital in Switzerland. Self-reported 2009-10 SI and 2009 PI vaccination statuses, reasons and demographic data were collected through a literature-based questionnaire. Descriptive statistics, uni- and multivariate analyses were then performed. Results: There were 472 respondents with a response rate of 54%. Self-reported vaccination acceptance was 64% for PI and 53% for SI. PI vaccination acceptance was associated with being vaccinated against SI (OR 9.5; 95% CI 5.5-16.4), being a physician (OR 7.7; 95% CI 3.1-19.1) and feeling uncomfortable wearing a mask (OR 1.7; 95% CI 1.0-2.8). Main motives for refusing vaccination were: preference for wearing a surgical mask (80% for PI, not applicable for SI) and concerns about vaccine safety (64%, 50%) and efficacy (44%, 35%). Conclusions: The new mask-wearing policy was a motivation for vaccination but also offered an alternative to non-compliant HCW. Concerns about vaccine safety and efficiency and self-interest of health care workers are still main determinants for influenza vaccination acceptance. Better incentives are needed to encourage vaccination amongst non-physician HCW. [ABSTRACT FROM AUTHOR]

Résumé Figure traditionnelle de la dangerosité psychiatrique, la paranoïa souffre d’une charge morbide particulièrement péjorative : « résistante », « incurable », « meurtrière », « aliénante », « dangereuse »… Cet article explore de manière succincte les trois pôles de la prise en charge des paranoïaques : la psychopathologie, le soin et le consentement, l’évolution. Abstract Traditional figure of the psychiatric dangerousness, the paranoia suffers from a particularly pejorative morbid load: “resistant”, “incurable”, “murderous”, “alienating”, “dangerous”. This article briefly explores the three poles of paranoid care: psychopathology, care and consent, evolution. [ABSTRACT FROM AUTHOR]

Objective: HIV testing is mandatory in re-education-through-labour camps (laojiaosuo) in China yet no studies have reported on the process. Methods: The survey response rate was 100% although 29 detainees were excluded because they were under 18 years of age. A cross-sectional face-to-face survey was conducted in three labour camps in Guangxi, located in the south-western region of China. Results: Of the 755 detainees surveyed, 725 (96%) reported having a blood test in the labour camps of whom 493 (68%) thought this included an HIV test. 61 detainees self-reported they were HIV infected, their status confirmed by medical records, if available. Of these, 53 (87%) recalled receiving post-test HIV education, and 15 (25%) were currently receiving HIV antiretroviral therapy. Pretest education on HIV was provided to 233/725 (32%) detainees. The study further reports on detainees' reactions and feelings towards non-disclosure and disclosure of their HIV test results in the labour camps. Conclusions: Mandatory testing is almost universal in the labour camps although a proportion of detainees were unaware that this included an HIV test. HIV test results should be disclosed to all labour camp detainees to reduce their distress of not knowing and prevent misconceptions about their HIV status. Labour camps provide another opportunity to implement universal treatment ('Test and Treat') to prevent the spread of HIV. [ABSTRACT FROM AUTHOR]

Objectives. We identified correlates of racial/ethnic disparities in colorectal cancer screening and changes in disparities under state-mandated insurance coverage. Methods. Using Behavioral Risk Factor Surveillance System data, we estimated a Fairlie decomposition in the insured population aged 50 to 64 years and a regression-adjusted difference-in-difference-in-difference model of changes in screening attributable to mandates. Results. Under mandated coverage, blood stool test (BST) rates increased among Black, Asian, and Native American men, but rates among Whites also increased, so disparities did not change. Endoscopic screening rates increased by 10 percentage points for Hispanic men and 3 percentage points for non-Hispanic men. BST rates fell among Hispanic relative to non-Hispanic men. We found no changes for women. However, endoscopic screening rates improved among lower income individuals across all races and ethnicities. Conclusions. Mandates were associated with a reduction in endoscopic screening disparities only for Hispanic men but may indirectly reduce racial/ ethnic disparities by increasing rates among lower income individuals. Findings imply that systematic differences in insurance coverage, or health plan fragmentation, likely existed without mandates. These findings underscore the need to research disparities within insured populations. [ABSTRACT FROM AUTHOR]

Background: The goal of newborn screening is early identification of babies with a high risk for disorders that may not be clinically evident at birth, but have severe consequences if untreated. New insight into inherited diseases and the ability to test for numerous diseases using new technique such as tandem mass spectrometry have made it practical to greatly expand the number of conditions tested. The expanded neonatal screening is now available and relatively simple, but this represents only a part of the picture. Positive results require follow-up confirmation. Most disorders screened require confirmatory biochemical or genetic tests and specialist visits. An efficient system is needed for managing the care of affected newborns. Expanded newborn screening is not yet available in all Regions of Italy, but discussions aimed at organizing universal access are underway. If these are successful, the role of the pediatrician as the primary contact with the parents is expected to become even more important. Methods: We have conducted a survey of Italian pediatricians to assess their familiarity and opinions on newborn screening in general and on expanded newborn screening. All members of the Italian Association of Pediatricians (n = 9000) were invited to compile a 10-item questionnaire online. Results: The response rate was 10 %, corresponding to 605 of 6000 active members. Respondents were from all Regions of Italy, with the highest number of responses coming from Lombardy (138, 22.8 %), Campania and Puglia (n = 61; 10.1 %). Interestingly, expanded neonatal screening was not available in any of these Regions at the time of the survey. Regarding their understanding of neonatal screening in general, most respondents (n = 552; 91.1 %) considered that they had at least a sufficient level of knowledge; however, only 59.6 % thought they had sufficient knowledge of expanded newborn screening. Conclusions: Successful implementation of a universal expanded NBS program will require efficient procedures for follow-up, diagnosis and treatment to prevent morbidity and mortality of infants and to reduce the period of uncertainty for unaffected families. Pediatricians may need additional [ABSTRACT FROM AUTHOR]

Mandatory reporting of impaired doctors is compulsory in Australasia. Australian Health Practitioner Regulation Agency guidelines for notification claim high benchmark though the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians suggest they still obstruct doctors seeking help. Western Australia excludes mandatory reporting of practitioner-patients. This study examines reporting, consequences and international experiences with notification. Depressed doctors avoid diagnosis and treatment, fearing consequences, yet are more prone to marital problems, substance dependence and needing psychotherapy. South African research confirms isolation of impaired doctors and delayed seeking help with definable characteristics of those at risk. New Zealand data acknowledge: errors occur; questionable contribution from mandatory reporting; issues concerning competence assessment; favouring reporting to senior colleagues or self-intervention to compliance with mandatory reporting. UK found an anaesthetist guilty of professional misconduct for not reporting and sanctioned doctors regarding Harold Shipman. Australians are reluctant to report, fearing legalistic intrusion into care. Australian research confirmed definable characteristics for doctors with psychiatric illness or alcohol abuse. Exposure to legal medicine evokes personal disenchantment for doctors involved. Medicine poses barriers for impaired doctors. Spanish and UK doctors do not use general practitioners and may have suboptimal care. US and European doctors self-medicate using samples. US drug-dependent doctors also prescribe for spouses. Junior doctors are losing empathy with the profession. UK doctors favour private care, avoiding public scrutiny. NZ and Brazil created specific services for doctors, which appear effective. Mandatory reporting may be counterproductive requiring reappraisal. [ABSTRACT FROM AUTHOR]

The article discusses the research which shows the response of the Australian government to refugees and people seeking asylum. It states that 80 percent of research respondents use the term asylum seekers rather than boat person or illegal immigrant. It notes that 80 percent agreed that the detention of children constitutes child abuse and is not favor with offshore processing. It suggests the need for education about issues such as health screening and medicare eligibility.

Reactions to the first clinical recommendations for the return of incidental findings (IFs) from genomic sequencing published by the American College of Medical Genetics and Genomics (ACMG) were polarized and resolute. Exploring the three main points of controversy: mandatory testing, testing children for adult conditions, and selection of conditions to be reported on, illuminates concerns for and conservation of bioethical principles—specifically, autonomy and non-directiveness. With the historical context of genetic testing in mind, this article studies the potential application of the ACMG recommendations to embryonic testing in the form of preimplantation genetic diagnosis. Theoretical extension of the current recommendations assists in the identification of bioethical dilemmas and possible societal impacts. The recommendations make a statement on the importance of diagnosis and intervention for specific genetic conditions, setting a precedent for disease classification and patient autonomy. In the extreme, the clinical application of such recommendations prenatally may result in discarded embryos, and less societal tolerance of specific conditions. Skilled professionals, such as genetic counselors, researchers, and lawmakers must work together to maintain patient autonomy, providing care in the best interest of each patient. [ABSTRACT FROM PUBLISHER]

While HIV/AIDS continues to inflict a heavy toll on African militaries, the military commitment and leadership response has been inconsistent, as reflected by variable presence of a written HIV policy. The Department of Defense HIV/AIDS Prevention Program collaborates with most sub-Saharan military HIV/AIDS programs. In 2010, 28 invited countries (80%) completed a self-administered survey describing their program, including policy. Descriptive and nonparametric measures were calculated. The majority (57%) of respondents reported having a written military HIV policy. Of these, 86% included HIV testing, 88% required recruit testing, and 96% denied entry for those testing HIV-positive. Mandatory HIV testing was reported by 71%, occurring before deployments, peacekeeping missions, foreign training, and when clinically indicated. Southern African militaries were most likely to require HIV testing. The majority of militaries allowed deployment of HIV-positive personnel in-country, whereas few allowed foreign deployment. Most sub-Saharan militaries screen applicants for HIV and other diseases to determine duty fitness, resulting in near universal HIV negative recruit cohorts. No militaries discharge personnel from service if they acquire HIV. Legal challenges to military HIV policies may hinder finalization and dissemination of policies. Lack of HIV policies impedes routine testing and earlier care and treatment for HIV-infected personnel. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to prepare control blood for an external quality assessment scheme (EQAS) for international normalized ratio (INR) point-of-care testing (POCT) in the Netherlands and to assess the performance of the participants. Methods: Control blood was prepared from dialyzed pooled patient plasma and washed human erythrocytes. Samples of control blood were mailed to participants of the Netherlands EQAS from October 2006 through December 2012. Results: Most participants used CoaguChek XS (Roche Diagnostics, Mannheim, Germany) devices for POCT. The median between-center coefficient of variation (CV) of the reported INR decreased from 4.5% in 2006 to 2.6% in 2012. A few participants used the ProTime Microcoagulation System (ITC, Edison, NJ) for POCT. The median CV (per year) of the INR with the latter system was 7.0% to 10.6%. Conclusions: The control blood samples were useful for external quality assessment in the Netherlands. The participants' performance with the CoaguChek XS system improved with time, demonstrating the value of external quality assessment. [ABSTRACT FROM AUTHOR]

Objectives: Many nonpathologists and some pathologists consider utilization review essential to laboratory quality improvement, but (1) confusion surrounding the definition of "appropriate" laboratory utilization, (2) the reliance on manual chart review, and (3) a lack of leadership have contributed to its unstandardized implementation. How the solutions to these barriers have evolved since the 1950s is described. Methods: A systematic literature review is used. Results: Current literature largely defines inappropriate laboratory utilization as any test order in violation of a guideline produced by a government or professional society. Audits performed without manual chart review (ie, database query) have dramatically increased since the mid-1990s. Most utilization audits do not involve any author with a pathology or laboratory medicine affiliation. Conclusions: Literature consensus defining "inappropriate" utilization combined with the adoption of database technology has removed key obstacles to utilization reviews. Leadership is needed to unify and benchmark laboratory utilization. [ABSTRACT FROM AUTHOR]

Health care institutions have paid increasing attention to preventing nosocomial transmission of influenza through vaccination of health care personnel. While multifaceted voluntary interventions have increased vaccination rates, proponents of mandatory programs contend the rates remain unacceptably low. Conventional bioethical analyses of mandatory programs are inadequate; they fail to account for the obligations of nonprofessional personnel or to justify the weights assigned to different ethical principles. Using an ethics framework for public health permits a fuller analysis. The framework's focus on fairness accentuates the potential differences between the risk of transmitting infection and employment status, and the need to equitably evaluate exemptions. The framework's emphasis on balancing benefits and burdens highlights the need to justify a specific goal and questions the need to exclude all nonmedical exemptions. While mandatory vaccination programs are justifiable, greater attention should be paid to their implementation. [ABSTRACT FROM AUTHOR]

Copyright of Academic Emergency Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Academic Emergency Medicine is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article reports that the Centers for Disease Control and Prevention (CDC) in the U.S. has released a unified and aggressive HIV prevention strategy according to which it is mandatory to offer a HIV screening to every patient who seek medical care. It also mentions that HIV screening helps in detecting HIV at an early stage which is a benefit in reducing the infectivity and other ill effects.

Drug use in sport has a number of defining features with regard to type of drug, policy, behaviours and the collection of evidence. Since the mid-1960s, sports authorities with the support of other Government agencies have attempted to prevent high-level competitive athletes from enhancing their performance with stimulants or enhancing their training with steroids, growth hormones, blood boosters and other related practices known as 'doping'. This attempted control has been based on establishing a list of banned substances, testing athletes for these and subsequently punishing those found guilty. A number of critics have argued that 'anti-doping' policy and testing has consistently failed to stop this form of cheating. Over time, the testing methods have become more sophisticated and the amount of testing has increased, especially since the formation of the World Anti-Doping Agency in 1999 to co-ordinate and improve international activities. This article reviews the testing statistics since then, and contrasts those to the evidence provided by quantitative social science research into prevalence. The extent of doping suggested by the latter is significantly higher than that found in the official statistics. The implications of this will be discussed. [ABSTRACT FROM AUTHOR]