Overdose Epidemic, Prescription Monitoring Programs, and Public Health: A Review of State Laws.

Prescription monitoring programs (PMPs), state-level databases that collect patient-specific prescription information at the time medications are dispensed, have been suggested as tools to address the overdose epidemic. We reviewed all laws in the United States (n = 25) that articulated the purposes PMPs are intended to serve. Attributes related to reducing abuse, misuse, and diversion of prescription medications appeared most commonly. Only 5 purpose statements mentioned the promotion of public health as goals of the PMP, and only 3 listed improving health care. None listed overdose prevention as a goal of the PMP.

Can student-perpetrated college crime be predicted based on precollege misconduct?

OBJECTIVES: Many colleges assess criminal histories during the admissions process, in part, to address violence on campus. This study sought to examine the utility of screening as a means of reducing violence. METHODS: Using cohort and case-control analyses, we identified college misconduct through college records and self-reports on a confidential survey of graduating seniors, and examined precollege behaviour as indicated on admissions records, a survey and criminal background checks. RESULTS: One hundred and twenty students met our case definition of college misconduct, with an estimated OR of 5.28 (95% CI 1.92 to 14.48) associated with precollege misconduct revealed on the college application. However, only 3.3% (95% CI 1.0% to 8.0%) of college seniors engaging in college misconduct had reported precollege criminal behaviours on their applications and 8.5% (95% CI 2.4% to 20.4%) of applicants with a criminal history engaged in misconduct during college. DISCUSSION: Though precollege behaviour is a risk factor for college misconduct, screening questions on the application are not adequate to detect which students will engage in college misconduct. This pilot work would benefit from replication to determine the utility of criminal background investigations as part of admissions.

HIV testing for pregnant women: a rights-based analysis of national policies.

Ethical and human rights concerns have been expressed regarding the global shift in policies on HIV testing of pregnant women. The main purpose of this research was to conduct a policy analysis using a human rights-based approach of national policies for HIV testing of pregnant women. We collected HIV testing policies from 19 countries including: Cambodia, China, Guyana, Haiti, India, Jamaica, Kenya, Moldova, Papua New Guinea, Russian Federation, South Africa, Sudan, Swaziland, Tanzania, Ukraine, United States, Uzbekistan, Zambia and Zimbabwe. We analysed the HIV testing policies using a standardised framework that focused on government obligations to respect, protect and fulfil. Our results highlight the need for more attention to issues of pregnant women's autonomy in consenting to HIV testing, confidentiality in antenatal care settings and provision of counselling and care services. We conclude with a discussion about potential implications of the current testing policies and provide recommendations for ways that HIV testing policies can more effectively uphold the human rights of pregnant women.

Multiple Forensic Interviews During Investigations of Child Sexual Abuse: A Cost-Effectiveness Analysis.

In cases of suspected child sexual abuse (CSA) some professionals routinely recommend multiple interviews by the same interviewer because any additional details provided might improve decision-making and increase perpetrator convictions. We analyzed alternative policies about child interviewing to estimate the probability that a policy of all children receiving multiple interviews will increase criminal convictions and better protect children. Using decision analysis, we prepared a decision tree reflecting the structure through which a case of possible CSA passes through the health care, welfare, and legal systems with an estimated probability of conviction of the offender. We reviewed the CSA disclosure, criminal justice, and child welfare literature to obtain estimates for the median and range of rates for the steps of disclosure, substantiation, criminal charges, and conviction. Using the R statistical package, our decision analysis model was populated using literature-based estimates. Once the model was populated, we simulated the experiences of 1,000 cases at 250 sets of plausible parameter values representing different hypothetical communities. Multiple interviews increase the likelihood that an offender will be convicted by 6.1% in the average community. Simulations indicate that a policy in which all children seen for a CSA medical evaluation receive multiple interviews would cost an additional $100,000 for each additional conviction. We estimate that approximately 17 additional children would need to be interviewed on more than one occasion to yield one additional conviction. A policy of multiple interviews has implications for the children, for the costs of care, for protecting other children, and for the risk of false prosecution.

Testing public health ethics: why the CDC's HIV screening recommendations may violate the least infringement principle.

The CDC's HIV screening recommendations for health care settings advocate abandoning two important autonomy protections: (1) pretest counseling and (2) the requirement that providers obtain affirmative agreement from patients prior to testing. The recommendations may violate the least infringement principle because there is insufficient evidence to conclude that abandoning pretest counseling or affirmative agreement requirements will further the CDC's stated public health goals.