The ethics of anonymized HIV testing of pregnant women: a reappraisal.
Seroprevalence monitoring of HIV in pregnant women by anonymized unlinked testing has been widely adopted in the UK and other countries. The scientific rationale is to eliminate participation and selection bias. The ethical justification is that the public good outweighs any harm to individuals. The assumption has been that individuals have had their autonomy respected by the offer of informed consent. In the light of new scientific evidence, it is doubtful that the public good is best served by the continuation of anonymously testing women receiving antenatal care. It is submitted that it is no longer ethical for health professionals to refrain from informing pregnant women of the benefits of voluntary named testing, or to request their consent to anonymized testing. The legal and moral concept of duty of care is examined, and the abrogation of this duty through anonymization is explained. (+info)
Value of mandatory testing for human immunodeficiency virus in a sub-Saharan hospital population.
Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) are currently hyperendemic in sub-Saharan Africa. HIV and AIDS have a special impact on working-age populations, economic resources, certain illnesses, and health care facilities. Assessment of HIV serostatus of hospitalized patients is rarely performed, however, because of a reluctance to intrude on patient confidentiality, a perceived lack of benefit (no antiretroviral therapy is available), and societal denial. We evaluated the effect on health care of HIV testing of patients routinely admitted to medical wards in the 2 major city hospitals in Harare, Zimbabwe. Of 196 patients tested, 58% were HIV positive with strong associations with infectious diseases, and with youth and weight loss, but not with cardiac, pulmonary, endocrinologic, or renal diagnoses, and not with rural versus urban location, occupation, sex, mortality, or cost of hospitalization. The clinical estimate of patients' HIV serostatus was largely inaccurate. Mandatory HIV testing of all hospitalized patients would improve diagnosis of infectious diseases, clarify patient prognosis, allow for individual counseling with regard to HIV prevention, and focus national health efforts by providing alarming, realistic statistics. (+info)
Screening method for seventy psychoactive drugs or drug metabolites in serum based on high-performance liquid chromatography--electrospray ionization mass spectrometry.
A screening method for 70 psychoactive drugs or drug metabolites in human serum by solid-phase extraction with subsequent high-performance liquid chromatography and electrospray ionization mass spectrometry was developed. Enhanced selectivity of detection was obtained by collision-induced dissociation using two different skimmer voltages for the individual scan. The mass spectra and the retention times of the compounds were incorporated into a self-generated spectra library for identification in screening experiments. The detection limits were found to be between 0.1 and 5 ng/mL serum for the majority of the compounds when measured in the selected ion mode. Because of the very small serum concentrations and the rather low extraction yield, lysergide could not be detected in this way. It was demonstrated with 140 serum samples from alcohol-related traffic cases that this method is suitable for a routine screening in a forensic laboratory. (+info)
Influence of Helix pomatia enzyme preparations on the oxidative conversion of some clostebol acetate metabolites in urine.
Clostebol acetate (4-chloro-testosterone acetate) is an anabolic steroid used for fattening purposes in cattle breeding. To safeguard public health, its use has been prohibited by the European Commission since 1986. Screening for its urinary metabolites is therefore an important tool for the control of possible violations. Because those metabolites appear conjugated to glucuronic acid or sulfate, deconjugation prior to analysis is necessary. This work describes the variability in results seen with the use of various commercial preparations of Helix pomatia (SHP) for enzymatic hydrolysis of the conjugates. A simultaneous oxidative side reaction was observed, converting metabolites with a 3-OH-4-ene structure into a 3-oxo-4-ene structure. This was not observed when samples were incubated without enzyme or in the presence of heat-inactivated SHP. GC-MS analysis revealed oxidation of some metabolites of clostebol acetate, 4-chloro-4-androsten-3alpha-ol-17-one and 4-chloro-4-androsten-3alpha,17beta-diol, changing them into other metabolites, 4-chloro-4-androsten-3,1 7-dione and clostebol (4-chloro-testosterone), respectively. Based on the difference in cross-reactivities of the antibodies for these metabolites, comparative analysis in enzyme immunoassay, following enzymatic hydrolysis, confirmed this transformation. This oxidative conversion phenomenon could be of great importance when considering the choice or target analytes for screening bovine urine. (+info)
HIV testing policy and serious mental illness.
OBJECTIVES: Using opinion data from experts, we examined the context of the argument for mandatory testing of psychiatric patients. METHODS: Vignettes were distributed to experts on HIV and mental illness. Respondents were asked to provide appropriateness ratings for different hypothetical clinical decisions regarding HIV management. RESULTS: Respondents were reluctant to impose testing without informed consent in most circumstances. The presence of risk factors or danger to another increased appropriateness ratings modestly. CONCLUSIONS: Despite experts' tendency to emphasize individual rights, public reluctance to mandate testing is unlikely to extend to people with serious mental illness. No argument for mandatory testing can be persuasive if improved voluntary testing can achieve adequate detection rates. Voluntary testing protocols should be studied to determine which successfully identify infected individuals. (+info)
HIV testing among pregnant women--United States and Canada, 1998-2001.
Since 1994, the availability of increasingly effective antiretroviral drugs for both the prevention of perinatal human immunodeficiency virus (HIV) transmission and maternal treatment has resulted in a greater emphasis on prenatal HIV testing and substantial increases in prenatal testing rates. In 2000, preliminary data indicated that 766 (93%) of 824 HIV-infected women in 25 states knew their HIV status before delivery (CDC, unpublished data, 2002). However, an estimated 280-370 perinatal HIV transmissions continue to occur in the United States each year. The primary strategy to prevent perinatal HIV transmission is to maximize prenatal HIV testing of pregnant women. States and Canadian provinces have implemented three different prenatal HIV-testing approaches. To assess their effectiveness, CDC reviewed prenatal HIV-antibody testing rates associated with these approaches. Medical record data suggest that the "opt-in" voluntary testing approach is associated with lower testing rates than either the "opt-out" voluntary testing approach or the mandatory newborn HIV testing approach. (+info)
Male prisoners and HIV prevention: a call for action ignored.
US prison inmates are disproportionately indigent young men of color. These individuals are severely affected by HIV/AIDS, largely owing to the high-risk behavior that they engage in prior to incarceration. Researchers and practitioners have issued a call for the importance of offering HIV prevention services in prison settings. However, this call has largely been ignored. In this article, we outline reasons why these recommendations have been largely ignored, discuss innovative HIV prevention programs that are currently being implemented in prison settings, and offer recommendations for securing support for HIV prevention services in correctional settings. (+info)
A survey of compliance: Medicaid's mandated blood lead screenings for children age 12-18 months in Nebraska.
BACKGROUND: To determine the frequency of Medicaid mandated blood lead level (BLL) screening compliance rates by clinical site. METHODS: Retrospective chart review for evidence of BLLs. Data analyses were conducted using frequencies, percentages & chi-square. RESULTS: The overall incidence of documented BLLs was 78.9% with one clinic demonstrating 100% BLLs while the others had 72%. Screening rates differed significantly by clinical site (X2 = 18.460, df = 3, p < 0.001). CONCLUSION: Although universal blood lead screening is mandated, there were missed opportunities to obtain BLLs in 21.1% of the records reviewed. Only one clinic had 100% documentation of BLLs when children on Medicaid were seen between the ages of 12-18 months. (+info)