Canadian news. Concerns raised about new immigration rules

A new immigration law has been passed and will come into force in the near future. Community organizations have been critical of the proposed Regulations that will accompany the new law. Meanwhile, the federal government has instituted mandatory HIV testing of potential immigrants. Concerns have been voiced about how this testing will be carried out.

Compulsory HIV testing after an occupational exposure

In December 2001, the Ontario legislature passed Bill 105, authorizing a Medical Officer of Health to order blood testing of a source person in the event that emergency service workers and "good Samaritans" (as well as other categories of people) may have been exposed to a communicable disease. Similar legislation (Bill C-217) is before a committee of the House of Commons. This article discusses the value of information about the health status of the source person, Bill C-217 and Bill 105, current public health guidelines, recent Canadian research, and the conclusions of Backgrounder prepared by the Canadian HIV/AIDS Legal Network.

Newborn screening program practices in the United States: notification, research, and consent

OBJECTIVE

To define current practice among US newborn screening programs for notification of results, research, and consenting procedures.

METHODS

A telephone survey of all US newborn screening program supervisors.

RESULTS

All 51 programs participated. All states reported abnormal results to the infant's physician, and some also reported to the hospital and parents. Cases with abnormal results were tracked to different endpoints but usually (92.1%) at least until a follow-up appointment was made. A total of 66.6% of programs can communicate with programs in other states; 9.8% enable families to suppress reporting of results to the infant's physician. No state has a mechanism for parents to prevent results from entering the medical record. Parents or physicians who request results are often authenticated by providing their name (52.9%). Many programs (45.1%) report only to physicians and require just their name (43.5%), an identification number (17.4%), a letter (26.1%), or a parent's signature (26.1%). A total of 70.6% retain residual blood samples; of these, only 8.3% store them completely devoid of patient identifiers. A total of 49.0% of programs aggregate data for research. In 16.0% of these, the data are publicly available. In 24.0%, researchers obtain approval at their own institution; in 24.0%, researchers obtain approval through the state laboratory Institutional Review Board. In 74.5% of programs, parents are notified but not asked for consent before collection of the sample; 19.6% neither notify parents nor obtain consent before screening.

CONCLUSIONS

There is wide variation in practice among the US newborn screening programs. Because the programs collectively manage a comprehensive nationwide genomic databank, careful consideration of how information technology and high-throughput genomic analysis are used will be essential to allow progress in clinical care, public health, and research while protecting individual privacy.

A model comprehensive psychiatric fitness-for-duty evaluation

A three-pronged model for a comprehensive psychiatric fitness-for-duty evaluation is presented as a resource tool for occupational physicians in the evaluation of substance abuse. Specialized psychiatric evaluators can play a role in (1) rendering diagnosis and fitness-for-duty determinations, (2) recommending treatment and monitoring plans, and (3) offering remedies for improving the employee/employer and medical systems. The comprehensive evaluation is especially helpful in difficult-to-diagnose and complex cases. The author provides guidance for deciding when to refer, discusses issues of confidentiality, and lists indicators of substance abuse based on employee behavior/performance and medical signs and symptoms.

Legal issues facing physicians: substance abuse in the workplace

This chapter addresses key Department of Transportation (DOT) rules for drug testing employees working in industries regulated by the DOT. It also discusses the issue of substance abuse and the Americans with Disabilities Act. Finally, it reviews the iss e of confidentiality. It is important for the reader to recognize that this chapter is but a review of critical and crucial material. The reader is encouraged to pursue additional information if greater clarity and understanding are required.