Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 10 de 10
Filtrar
1.
Prev Med ; 41(2): 540-4, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15917050

RESUMO

BACKGROUND: Missed childhood vaccination opportunities have been generally described, yet not since the immunization schedule's recent rapid expansion. Little is known about the relationship between the number of vaccine doses due and whether all scheduled doses are administered, and the effect of dose deferral on immunization coverage. METHODS: 32 private pediatrics centers reviewed medical records covering the first 2 years of life for 858 patients. For each visit during ages 2-8 months, we determined the numbers of vaccine doses due versus administered. Logistic regression was used to assess the effect of dose deferral on immunization coverage at ages 1 and 2 years. RESULTS: Of 2224 visits during ages 2-8 months at which > or =1 dose was administered, > or =1 due dose was deferred at 26%, 34%, and 48% of the visits at which < or =3, 4, and 5 doses were due, respectively. Absence of a deferred dose visit predicted increased coverage at age 1 (adjusted odds ratio: 2.4, 95% confidence interval: 1.8-3.2) and 2 years (2.1, 1.4-3.0). CONCLUSIONS: Administering some but not all vaccine doses at visits during ages 2-8 months impairs immunization coverage through age 2 years.


Assuntos
Esquemas de Imunização , Vacinação/estatística & dados numéricos , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , Masculino , Cooperação do Paciente , Padrões de Prática Médica , Estudos Retrospectivos , Estados Unidos
2.
Pediatr Infect Dis J ; 20(11 Suppl): S57-62, 2001 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11704725

RESUMO

BACKGROUND: One reason that recommended childhood immunizations due at child health visits are deferred is to avoid the pain and emotional distress associated with the increasing number of injections required. This deferral leads to additional visits and costs and reduced immunoprotection against vaccine-preventable illnesses. To assess the economic value of combination vaccines that address this problem, we surveyed parents to determine the amount they would be willing to pay to avoid the pain and emotional distress experienced by their infants from injections. METHODS: A self-administered questionnaire was completed within 24 h of the vaccinations by 294 parents of children ages 11/2 to 7 months receiving vaccine injections at 26 outpatient child health centers. The willingness-to-pay (WTP) method was used to estimate the intangible cost of the pain and emotional distress of the 1 to 4 injections their child had received. Parents were asked how much of their own money they would have paid to avoid these injections, without any compromise in the safety and efficacy of the vaccinations. RESULTS: Wide variations in WTP amounts were observed, ranging from median values of $10 to $25 and average values of $57.06 to $79.28 to avoid the pain and emotional distress associated with eliminating all injections at visits in which one to four injections were administered. Parents placed greater value on reductions that avoided all injections than on reductions that avoided only some injections. Overall the median cost per injection avoided was $8.14, and the mean was $30.28. CONCLUSIONS: Parents have strong preferences for limiting vaccine injections. The economic cost of the pain and distress associated with such injections, reflected in the amounts they report they would be willing to pay to avoid them, represents a substantial component of the cost of disease control through immunization.


Assuntos
Vacinação/economia , Vacinas Combinadas/economia , Adulto , Análise Custo-Benefício , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Esquemas de Imunização , Lactente , Injeções/efeitos adversos , Injeções/economia , Masculino , Dor/economia , Dor/etiologia , Pais , Estresse Psicológico/economia , Estresse Psicológico/etiologia , Inquéritos e Questionários , Vacinação/efeitos adversos , Vacinação/psicologia , Vacinas Combinadas/administração & dosagem
3.
J Viral Hepat ; 8(6): 454-8, 2001 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-11703577

RESUMO

In the USA, cost effectiveness assessments support childhood hepatitis A vaccination in geographical areas with elevated disease rates, but not nationally. However, these studies do not address the reduction in disease transmission which may result from routine childhood vaccination. Using decision analysis, we estimated the number and age distribution of secondary hepatitis A cases occurring within households with an index case. Based on the age of the index case, we determined household size and age composition, the proportion of household members susceptible to hepatitis A, the probability of disease transmission, and the likelihood secondarily infected household members would exhibit symptoms. Our model indicates that for every 100 index cases age 6-11 years, 47.2 secondary infections would occur within households, with 23.1 causing overt disease. Lower transmission rates for older index cases reflect smaller household sizes and a higher proportion of household contacts with hepatitis A immunity. When disease transmission rates are applied to a model simulating lifetime risks of hepatitis A, universal vaccination of an annual USA birth cohort is estimated to prevent 24 100 cases of overt disease among household contacts in addition to 71 000 cases among vaccinees. Sensitivity analysis provides a wide range of estimates, but even conservative assumptions suggest routine vaccination would yield an important reduction in secondary cases. Evaluations of hepatitis A prevention should consider the ability of immunization to protect household and other personal contacts.


Assuntos
Hepatite A/transmissão , Adolescente , Adulto , Criança , Saúde da Família , Hepatite A/prevenção & controle , Vacinas contra Hepatite A/administração & dosagem , Vírus da Hepatite A Humana/imunologia , Humanos , Estados Unidos , Vacinação
4.
Prev Med ; 33(6): 639-45, 2001 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11716661

RESUMO

BACKGROUND: Several state and local U.S. governments are considering making varicella, hepatitis A, and/or pneumococcal conjugate vaccination conditions of day care or school entry. These requirements will likely be issued sequentially, because simultaneous mandates exacerbate budget constraints and complicate communication with parents and providers. Cost-effectiveness assessments should aid the establishment of vaccination priorities, but comparing results of published studies is confounded by their dissimilar methods. METHODS: We reviewed U.S. cost-effectiveness studies of childhood varicella, hepatitis A, and pneumococcal conjugate vaccines and identified four providing data required to standardize methods. Vaccination, disease treatment, and work-loss costs were estimated from original study results and current prices. Estimated life-years saved were derived from original study results, epidemiological evidence, and alternative procedures for discounting to present values. RESULTS: Hepatitis A vaccine would have the lowest health system costs per life-year saved. Varicella vaccine would provide the greatest reduction in societal costs, mainly through reduced parent work loss. Pneumococcal conjugate vaccine would cost twice the amount of varicella and hepatitis A vaccines combined and be less cost effective than the other vaccines. CONCLUSIONS: Hepatitis A and varicella vaccines, but not pneumococcal conjugate vaccine, meet or exceed conventional standards of cost effectiveness.


Assuntos
Vacina contra Varicela/economia , Análise Custo-Benefício , Vacinas contra Hepatite A/economia , Vacinas Pneumocócicas/economia , Creches , Humanos , Lactente , Longevidade
6.
J Food Prot ; 63(6): 768-74, 2000 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10852572

RESUMO

Foodborne transmission is an important means of hepatitis A infection that may be reduced through vaccination of food service workers (FSWs). Several states are considering actions to encourage or mandate FSW vaccination, but the cost effectiveness of such policies has not been assessed. We estimated the clinical and economic consequences of vaccinating FSWs from the 10 states with the highest reported rates of hepatitis A. A decision analytic model was used to predict the effects of vaccinating FSWs at age 20 years. It was assumed all FSWs would receive one dose of inactivated hepatitis A vaccine, and 50% would receive the second recommended dose. Parameter estimates were obtained from published reports and Centers for Disease Control and Prevention databases. The primary endpoint was cost per year of life saved (YOLS). Secondary endpoints were symptomatic infections, days of illness, deaths, and costs of hepatitis A treatment, public health intervention, and work loss. Each endpoint was considered separately for FSWs and patrons. We estimate vaccination of 100,000 FSWs would cost $8.1 million but reduce the costs of hepatitis A treatment, public health intervention, and work loss by $3.0 million, $2.3 million, and $3.1 million, respectively. Vaccination would prevent approximately 2,500 symptomatic infections, 93,000 days of illness, and 8 deaths. A vaccination policy would reduce societal costs while costing the health system $13,969 per YOLS, a ratio that exceeds generally accepted standards of cost effectiveness.


Assuntos
Análise Custo-Benefício , Indústria de Processamento de Alimentos , Vacinas contra Hepatite Viral/economia , Adulto , Idoso , Hepatite A/prevenção & controle , Hepatite A/transmissão , Vacinas contra Hepatite A , Humanos , Pessoa de Meia-Idade , Exposição Ocupacional , Vacinação/economia
7.
Hepatology ; 31(2): 469-73, 2000 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-10655272

RESUMO

The incidence of hepatitis A has declined in the United States for several decades, leading to an increased number of susceptible adolescents and adults. Because clinical severity increases with age, hepatitis A infections in older individuals cause greater morbidity, mortality, and treatment costs. Because the economic burden of hepatitis A has not been well described, we estimated its costs, from the societal perspective, for patients infected at distinct ages. A case-series study described treatment patterns, work loss, and symptom duration. Disease outcomes were estimated by an expert panel. Economic losses were calculated by applying normative data reflecting treatment charges, employee compensation, and the value of housekeeping services. In the case-series study, mean treatment charges were $740 for nonhospitalized patients versus $6,914 for hospitalized patients (P <.001). Symptom duration (67.8 vs. 34.4 days, P <.001) and work loss (33.2 vs. 15.5 days, P <.01) were also greater for those hospitalized. Nationally, we estimate 63,363 symptomatic hepatitis A infections occurred among adolescents and adults during 1997, resulting in 8,403 hospital admissions and 255 deaths. Nearly 2.5 million days of symptomatic illness and 829,000 work-loss days resulted, and 7,466 years of life were lost. Under base-case assumptions, annual hepatitis A costs were estimated at $488.8 million. In sensitivity analyses, this estimate varied from $332.4 to $579.9 million. These costs may be reduced by regionally targeted vaccination of children, as recommended by the Advisory Committee on Immunization Practices, although the cost effectiveness of this policy has not yet been established.


Assuntos
Custos de Cuidados de Saúde , Hepatite A/terapia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Hepatite A/complicações , Hepatite A/diagnóstico , Hepatite A/epidemiologia , Hepatite A/mortalidade , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
8.
Am J Manag Care ; 3(8): 1187-96, 1997 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10170301

RESUMO

Although panic disorder has been associated with impaired quality of life (QOL) and financial dependence, no prior study has examined whether a clinical intervention will improve these outcomes. This study examines the effects of clinically titrated doses of clonazepam versus placebo on QOL and work productivity (WP) in patients with panic disorder. QOL and WP were measured in conjunction with a randomized, double-blind, placebo-controlled trial. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Work Productivity and Impairment questionnaire were used to assess QOL and WP, respectively. Baseline assessments were obtained before randomizing patients to receive clinically titrated doses of clonazepam or placebo. Follow-up assessments were obtained after 6 weeks of therapy with the test drug or at premature termination from the study. Improvement on the SF-36 Mental Health Component Summary scale was more than twice as great with clonazepam than with placebo (P = 0.03). Clonazepam patients improved (P < 0.05) on all five measures of mental health-related QOL, and both measures of physical health-related QOL, and both measures of WP. Placebo patients improved on three of five measures of mental health-related QOL, but on no other measures. Patients with marked improvements on clinical measures of panic disorder severity, especially avoidance and fear of the main phobia, showed the greatest gains on the SF-36 Mental Health Component Summary scale. Clinically titrated doses of clonazepam significantly improved mental health-related QOL and WP in panic disorder patients. Lesser improvements were obtained with placebo.


Assuntos
Clonazepam/uso terapêutico , Eficiência , Moduladores GABAérgicos/uso terapêutico , Avaliação de Resultados em Cuidados de Saúde , Transtorno de Pânico/tratamento farmacológico , Qualidade de Vida , Adulto , Clonazepam/administração & dosagem , Relação Dose-Resposta a Droga , Emprego , Feminino , Moduladores GABAérgicos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Carga de Trabalho
9.
J Nerv Ment Dis ; 185(6): 368-72, 1997 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-9205422

RESUMO

Our purpose was to measure quality of life (QOL) and work productivity (WP) in persons with panic disorder. Eighty-four panic disorder patients with limited psychiatric comorbidity for ten U.S. outpatient mental health centers were evaluated in a cross-sectional design. Patients self-administered the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Work Productivity and Impairment (WPAI) questionnaire. The independent effects of psychiatric comorbidity were addressed through entry criteria, stratification, and regression analyses. QOL scores are significantly below age and sex-adjusted population norms on all SF-36 measures (p < .01). We note far greater impairment on measures of mental and emotional versus physical well-being. The unemployment rate among these patients is 25%, and only 57% are employed full-time. Those who are employed rated their WP as low. This sample of outpatients suffer marked QOL and employment impairment, which is only partially explained by the presence of psychiatric comorbidity.


Assuntos
Emprego , Transtorno de Pânico/diagnóstico , Qualidade de Vida , Adulto , Comorbidade , Estudos Transversais , Eficiência , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtorno de Pânico/epidemiologia , Transtorno de Pânico/psicologia , Índice de Gravidade de Doença , Perfil de Impacto da Doença , Inquéritos e Questionários , Trabalho
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...