RESUMEN
OBJECTIVE: Although clinical microbiology testing facilitates both public health surveillance of infectious diseases and patient care, research on testing patterns is scant. We surveyed hospital laboratories in Georgia to assess their diagnostic testing practices. METHODS: Using e-mail, all directors of hospital laboratories in Georgia were invited to participate. The survey focused on timing and location of diagnostic testing in 2006 for 6 reportable diseases: giardiasis, legionellosis, meningococcal disease, pertussis, Rocky Mountain spotted fever, and West Nile virus disease. RESULTS: Of 141 laboratories, 62 (44%) responded to the survey. Hospitals varied widely in their use of diagnostic testing in 2006, with 95.1% testing for meningococcal disease, but only 66.1% and 63.3% testing for legionellosis and West Nile virus disease, respectively. Most laboratories (91%) performed gram stain/culture to diagnose meningococcal disease in-house and 23% performed ova and parasite panels for giardiasis were conducted in-house. Fewer than 11% of laboratories performed in-house testing for the remaining diseases. Laboratories affiliated with small hospitals (≤100 beds) were more likely to send specimens for outside testing compared with laboratories associated with large hospitals (>250 beds). Median turnaround time for ova and parasite panel testing for giardiasis was significantly shorter for in-house testing (1.0 days) than within-system (2.25 days) or outside laboratory (3.0 days) testing (P = .0003). No laboratories reported in-house testing for meningococcal disease, pertussis, or Rocky Mountain spotted fever using polymerase chain reaction. CONCLUSION: Many hospitals did not order diagnostic tests for important infectious diseases during 2006, even for relatively common diseases. In addition, hospital laboratories were unlikely to perform diagnostic testing in-house; sending specimens to an outside laboratory may result in substantial delays in receiving results. These unsettling findings have adverse implications for both patient care and public health surveillance; they indicate an immediate need to study nationally the use and timeliness of clinical microbiologic testing.
Asunto(s)
Enfermedades Transmisibles/microbiología , Laboratorios de Hospital/estadística & datos numéricos , Técnicas Microbiológicas/estadística & datos numéricos , Técnicas de Diagnóstico Molecular/estadística & datos numéricos , Ubicación de la Práctica Profesional , Personal Administrativo/psicología , Personal Administrativo/estadística & datos numéricos , Análisis de Varianza , Enfermedades Transmisibles/diagnóstico , Técnicas de Cultivo , Eficiencia Organizacional , Georgia , Capacidad de Camas en Hospitales , Humanos , Laboratorios de Hospital/clasificación , Laboratorios de Hospital/tendencias , Sensibilidad y Especificidad , Manejo de Especímenes , Coloración y Etiquetado , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
The life expectancy of persons cycling through the prison system is unknown. The authors sought to determine the 15.5-year survival of 23,510 persons imprisoned in the state of Georgia on June 30, 1991. After linking prison and mortality records, they calculated standardized mortality ratios (SMRs). The cohort experienced 2,650 deaths during follow-up, which were 799 more than expected (SMR = 1.43, 95% confidence interval (CI): 1.38, 1.49). Mortality during incarceration was low (SMR = 0.85, 95% CI: 0.77, 0.94), while postrelease mortality was high (SMR = 1.54, 95% CI: 1.48, 1.61). SMRs varied by race, with black men exhibiting lower relative mortality than white men. Black men were the only demographic subgroup to experience significantly lower mortality while incarcerated (SMR = 0.66, 95% CI: 0.58, 0.76), while white men experienced elevated mortality while incarcerated (SMR = 1.28, 95% CI: 1.10, 1.48). Four causes of death (homicide, transportation, accidental poisoning, and suicide) accounted for 74% of the decreased mortality during incarceration, while 6 causes (human immunodeficiency virus infection, cancer, cirrhosis, homicide, transportation, and accidental poisoning) accounted for 62% of the excess mortality following release. Adjustment for compassionate releases eliminated the protective effect of incarceration on mortality. These results suggest that the low mortality inside prisons can be explained by the rarity of deaths unlikely to occur in the context of incarceration and compassionate releases of moribund patients.
Asunto(s)
Atención a la Salud , Prisioneros/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Anciano , Estudios de Cohortes , Intervalos de Confianza , Atención a la Salud/organización & administración , Femenino , Fibrosis/epidemiología , Estudios de Seguimiento , Georgia/epidemiología , Infecciones por VIH/epidemiología , Cardiopatías/epidemiología , Hepatitis C/epidemiología , Homicidio/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Intoxicación/epidemiología , Prevalencia , Factores de Riesgo , Distribución por Sexo , Suicidio/estadística & datos numéricos , Tasa de SupervivenciaRESUMEN
Drawing on individuals who volunteer in US prisons to mentor HIV-infected inmates returning to the community may promote successful transitions. Evaluations published in the scientific literature of such community linkage programs are scant. Our quantitative and qualitative methods needs analysis and pilot study entailed interviewing convenience samples of 24 HIV-positive persons recently released from Georgia correctional facilities and 12 potential volunteer mentors. Both releasees and potential mentors were open to the establishment of a mentoring program. Releasees wanted nonjudgmental mentors. Releasees and volunteers had statistically significant differences in marital status, education, current employment, and possession of a driver's license but not in degree of religious involvement and attitudes toward condom use. A volunteer-staffed program, perhaps more aptly named "life coaching" than mentoring, to help HIV-infected persons to transition from prison to the community may be feasible. Success will require adequately trained volunteers and a straightforward program.
Asunto(s)
Infecciones por VIH/rehabilitación , Mentores , Evaluación de Necesidades/estadística & datos numéricos , Prisioneros/estadística & datos numéricos , Voluntarios/organización & administración , Adulto , Femenino , Grupos Focales , Georgia , Infecciones por VIH/psicología , Promoción de la Salud , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Prisioneros/psicología , Prisiones , Evaluación de Programas y Proyectos de Salud , Población Urbana , Voluntarios/psicologíaRESUMEN
Because certain groups at high risk for HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) come together in correctional facilities, seroprevalence was high early in the epidemic. The share of the HIV/AIDS epidemic borne by inmates of and persons released from jails and prisons in the United States (US) in 1997 was estimated in a previous paper. While the number of inmates and releasees has risen, their HIV seroprevalence rates have fallen. We sought to determine if the share of HIV/AIDS borne by inmates and releasees in the US decreased between 1997 and 2006. We created a new model of population flow in and out of correctional facilities to estimate the number of persons released in 1997 and 2006. In 1997, approximately one in five of all HIV-infected Americans was among the 7.3 million who left a correctional facility that year. Nine years later, only one in seven (14%) of infected Americans was among the 9.1 million leaving, a 29.3% decline in the share. For black and Hispanic males, two demographic groups with heightened incarceration rates, recently released inmates comprise roughly one in five of those groups' total HIV-infected persons, a figure similar to the proportion borne by the correctional population as a whole in 1997. Decreasing HIV seroprevalence among those admitted to jails and prisons, prolonged survival and aging of the US population with HIV/AIDS beyond the crime-prone years, and success with discharge planning programs targeting HIV-infected prisoners could explain the declining concentration of the epidemic among correctional populations. Meanwhile, the number of persons with HIV/AIDS leaving correctional facilities remains virtually identical. Jails and prisons continue to be potent targets for public health interventions. The fluid nature of incarcerated populations ensures that effective interventions will be felt not only in correctional facilities but also in communities to which releasees return.