Results of a rubella screening program for hospital employees: a five-year review (1986-1990)

Frequency of policy recommendations in epidemiologic publications

OBJECTIVES

The purpose of this study was to determine the frequency and character of policy statements in epidemiologic reports.

METHODS

The first author followed a standardized protocol and reviewed a random sample of articles selected from the American Journal of Epidemiology, Annals of Epidemiology, and Epidemiology. The second author reviewed all articles with policy statements and a 10% sample without such statements.

RESULTS

Overall, 23.8% of the articles contained policy statements. Annals of Epidemiology and the American Journal of Epidemiology had similar frequencies of articles with policy statements (30% and 26.7%, respectively), while Epidemiology evidenced the lowest frequency (8.3%). The majority of policy statements (55%) pertained to public health practice; 27.5% involved clinical practice, and the remainder (17.5%) focused on corporate policies, regulatory actions, or undefined arenas. The frequency of policy statements differed according to first author's affiliation, type of publication, area of research, research design, and study population.

CONCLUSIONS

Although a minority of publications included policy statements, the inclusion of a statement seemed to be influenced by specific study characteristics.

Primary prevention and rubella immunity: overlooked issues in the outpatient obstetric setting

OBJECTIVE

To determine the knowledge of rubella immune status among practicing obstetrician-gynecologists in the United States and of rubella immunity policies covering healthcare workers in the obstetric-care office setting.

DESIGN

Mailed survey questionnaire, August through December 1994.

SETTING

Physicians from multiple-practice sites including private office, public institution, university or teaching hospital, and closed panel health maintenance organization settings.

PARTICIPANTS

3,302 practicing obstetrician-gynecologists, chosen by a systematic random sample from the AMA national physician database.

MAIN OUTCOME MEASURES

Participants were defined as rubella immune if they reported knowledge of prior rubella vaccination or positive antibody titer. Knowledge of a policy for documenting rubella immunity among employees in the office-based practice setting also was assessed.

RESULTS

Questionnaires were returned from 50% (1,666) of the 3,302 surveyed, and 96% (1,599) were evaluable. Approximately 20% (304/1,599) of the responding obstetrician-gynecologists did not have knowledge of documented rubella immunity, and the majority of office-based practices did not require documentation of rubella immunity in the following groups: physicians, 66% (723/1,094); office nurses, 62% (666/1,070); and other office staff, 69% (728/1,063). Sixty-two percent (993/1,599) of responding physicians had individual rubella serologies performed, with 916 known to be positive, 53 reported negative, and 24 reported unknown. Fifty-seven percent (918/1,599) reported receiving monovalent rubella vaccine or trivalent measles-mumps-rubella vaccine. Multiple logistic regression analysis revealed the following to be independent predictors of positive immune status among respondents: female gender (odds ratio [OR], 2.4; 95% confidence interval [CI95], 1.8-3.1), medical school graduation since 1980 (OR, 2.6; CI95, 2.0-3.3), providing obstetric or fertility services (OR, 1.5; CI95, 1.2-1.9), and group practice setting (> or = 5 physicians; OR, 1.2; CI95, 1.1-1.4).

CONCLUSIONS

Nationally, nearly one of every five practicing obstetricians may not have documented rubella immunity, and the majority of office-based practices have no system for assuring such immunity. Rubella immunity should extend beyond the hospital setting, with consideration for requiring rubella immunity as a condition for employment. Methods for effective implementation and documentation of current guidelines need to be addressed, particularly in the office setting.