PubMed Health⌕ Search

Biomedical subjects

B Fireman

Publications and source records attributed to B Fireman.

29 records · Page 2Linked to original sources
PubMed1992

Safety, immunogenicity, and efficacy in infancy of oligosaccharide conjugate Haemophilus influenzae type b vaccine in a United States population: possible implications for optimal use.

Between February 1988 and June 1990, the safety, immunogenicity, and efficacy of Haemophilus influenzae type b (Hib) oligosaccharide conjugate (HbOC) vaccine was evaluated in a prelicensure trial of 61,080 children. HbOC was found to be safe and immunogenic in infancy. Extended follow-up revealed that as of 31 December 1990, 30 cases of invasive Hib disease had occurred in 74,699 children; 26 were in unvaccinated children and 4 in children who had received only one dose. No disease occurred in children who had received two or three doses. By 30 September 1991, another case had occurred in an unvaccinated child. Comparison of these efficacy data with those of Hib capsular polysaccharide-outer membrane protein conjugate vaccine (PRP-OMP) reveals that both were effective in preventing disease in the first year of life. However, the small cohort in the PRP-OMP study did not allow demonstration of duration of protection beyond 1 year. Ongoing surveillance in larger populations is necessary to allow comparison of the duration of immunity provided by these vaccines.

Antibodies, Bacterial↗
PubMed1991

Safety and immunogenicity of oligosaccharide conjugate Haemophilus influenzae type b (HbOC) vaccine in infancy. The Northern California Kaiser Permanente Vaccine Study Center Pediatrics Group.

The safety and immunogenicity of the HbOC conjugate vaccine have been evaluated in a study population of 61,080 children in the Kaiser Permanente Medical Care Program of Northern California. Half of the population served as controls. The vaccine was given as part of a three-dose regimen in the first year of life with the first dose given between 6 weeks and 6 months of age, a minimum interval of 1 month between doses and with the third dose given by 1 year of age. The vaccine was highly immunogenic with 97% of infants developing 1 microgram/ml or more of anti-polyribosyl phosphate antibody as measured by Farr assay 1 month after completion of the three-dose series and with 71% maintaining this concentration until a booster dose was given at approximately 18 months of age. There were three cases of Haemophilus influenzae type b disease after the first dose of vaccine and two of these children died. However, there was no statistically significant difference between either the incidence of H. influenzae type b disease or the mortality rate in infants after one dose of HbOC vaccine when compared with H. influenzae type b disease incidence and mortality in unvaccinated children of the same age. The rate of sudden infant death syndrome following HbOC vaccine was lower than that observed within the Kaiser Permanente Medical Care Program as a whole or in the three counties in which sudden infant death syndrome surveillance was tabulated. Immediate local and systemic reactions were evaluated by telephone interviews of 6887 infants within 72 hours of vaccine.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibodies, Bacterial↗
PubMed1991

Efficacy in infancy of oligosaccharide conjugate Haemophilus influenzae type b (HbOC) vaccine in a United States population of 61,080 children. The Northern California Kaiser Permanente Vaccine Study Center Pediatrics Group.

The efficacy of the HbOC conjugate Haemophilus influenzae type b vaccine was evaluated in a study population of 61,080 infants in the Northern California Kaiser Permanente Medical Care Program. Between February, 1988, and June, 1990, the HbOC vaccine was given as part of a three-dose series at 2, 4, and 6 months of age to 20,800 infants. The study population included children with a well-care visit at a study center during the first 6 months of life. There were 25 cases of Haemophilus influenzae type b disease in the study population: 22 in unvaccinated children and 3 in children who received only one dose of HbOC vaccine. The efficacy of the full three-dose series was evaluated by several methods: a primary analysis comparing fully vaccinated children with unvaccinated children from 7 to 18 months of age; a stratified exact analysis adjusted for age and seasonality; and a case-control analysis which further adjusted for known risk factors. The efficacy of three doses of vaccine was 100% with the lower bound of the 95% confidence interval for the three analyses at 68, 71, and 64%, respectively. There were no cases of disease resulting from two doses of HbOC vaccine yielding an estimate of 100% efficacy (95% confidence interval, 47 to 100) for two doses of HbOC vaccine. However, for children who had received only one dose of HbOC vaccine, vaccine efficacy was estimated to be 26% and the possibility that one dose of HbOC vaccine had no efficacy could not be excluded.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Proteins↗
PubMed1991

Intense immunosuppression in chronic progressive multiple sclerosis: the Kaiser study.

The value of a short course of intensive immunosuppression with cyclophosphamide in stabilising chronic progressive multiple sclerosis (MS) was examined in a randomised single-blinded, placebo-controlled clinical trial. Forty two patients, from the Kaiser Permanente Medical Care Program, Northern California, were studied. Twenty two patients received a short course of cyclophosphamide in an outpatient neurology clinic until their leucocyte counts fell below 4000/mm3, and 20 patients received folic acid. Level of disability, impairment of functional systems, and performance of social roles were assessed before randomisation and reassessed 12, 18, and 24 months after therapy. In both the cyclophosphamide and folic acid groups, the mean level of disability increased from the baseline examination to the 12 month follow up examination (the primary endpoint) by 0.5 on Kurtzke's Expanded Disability Status Scale, indicating similar disease progression in the two groups. Although immunosuppression therapy can be safely administered to MS patients in an outpatient clinic, evidence of substantial benefits was not found.

Adult↗
PubMed1991

Apparent decreased risk of invasive bacterial disease after heterologous childhood immunization.

To investigate the possibility that there might be an increased risk of heterologous invasive bacterial disease after routine childhood immunization with measles, mumps, and rubella vaccine live; diphtheria and tetanus toxoids and pertussis vaccine; and oral poliovirus vaccine live, a case-control study was conducted within the Kaiser Permanente Northern California pediatric population. Contrary to the premise, an apparent protective effect against invasive bacterial disease was detected after all childhood vaccinations. However, when adjustment was made for frequency of well-care visits and day-care attendance, no significant relationship was seen between receipt of routine childhood immunizations and risk of invasive heterologous bacterial disease for any individual vaccine, although a statistically significant protective effect was detected within 1 or 3 months after the receipt of any vaccine. Since a decreased risk of invasive bacterial disease was also noted to be related to the receipt of routine well-child pediatric care, other preventive health care measures may be responsible for the apparent immunization protective effect.

Bacterial Infections↗
PubMed1989

Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization.

Two-hundred ninety-eight patients with gallstones accompanied by mild or nonspecific symptoms, 123 with asymptomatic gallstones, and 46 with nonfunction on cholecystogram and mild or nonspecific symptoms were followed in the setting of a health maintenance organization for up to 25 years after diagnosis. In a life-table analysis, complications (severe events) developed in about 1% per year of patients with visualized gallstones and in about 2% per year of patients with nonfunction. During each of the first 5 years after diagnosis, all events, both severe and non-severe (including surgery for continuing mild symptoms) occurred in about 6% of the patients with mild symptoms accompanying either gallstones or nonfunction, and in about 4% of patients with asymptomatic gallstones. The annual probabilities for all events tended to decrease as length of follow-up increased. Among patients with stones and mild symptoms, women were more apt to develop any event than men (p = 0.02) and more obese patients were more likely to develop severe events than those who were thinner (p = 0.05). The patients in this study are probably more representative of outpatients with gallstones seen by most primary care physicians than are most groups investigated previously for prognosis. Their event rates are sufficiently similar to those used in published decision analyses, that they should not alter previous conclusions that early elective cholecystectomy will have little positive or negative effect on average life expectancy of patients with gallstones.

Adult↗
PubMed1989

A survival analysis of hospitalization among patients with acquired immunodeficiency syndrome.

Survival analysis techniques were used in estimating lifetime inpatient utilization among patients diagnosed with acquired immunodeficiency syndrome (AIDS) using data on 863 members of the Kaiser Permanente Medical Care Program in the Northern California Region diagnosed with AIDS between January 1, 1981 and June 30, 1987. Using information on both deceased and living patients, we estimated means of 40.3 lifetime inpatient days and 3.3 hospitalizations among all AIDS patients. Those presenting with Kaposi's sarcoma experienced a mean of 7.6 fewer lifetime inpatient days than those presenting with Pneumocystis carinii pneumonia (95% confidence interval = .61, 14.6) and a mean of 11.0 (3.9, 18.6) fewer inpatient days than all other AIDS patients. Older patients had fewer hospital admissions than younger ones. Year of diagnosis does not appear to be related to lifetime utilization, and there is an indication that increased survival has been accompanied by decreased inpatient utilization intensity as measured on a per person-year basis. We recommend the use of survival analysis methods in the study of utilization among groups of patients with incomplete follow-up.

Acquired Immunodeficiency Syndrome↗
PubMed1986

The possible effect of increased surveillance on the incidence of malignant melanoma.

We investigated the hypothesis that the increased incidence of malignant melanoma at the Lawrence Livermore National Laboratory (LLNL) in California was associated with a difference in medical care received by its employees compared with that received by other residents of the same geographic area. From records of the Kaiser Permanente Medical Care Program, to which about half of the LLNL employees belonged, we confirmed that the incidence of melanoma at the laboratory was 3.2 times that among members served by the Kaiser Permanente medical center in Walnut Creek, a nearby community (95% CI, 1.7-6.0). Rates of biopsy showing junctional, compound, and dermal nevi in men were also higher in the LLNL employees than in the other health-plan members (relative risks, 3.2, 2.4, and 1.3, respectively). When LLNL employees without melanoma were compared with community controls, we found that the employees had substantially more skin biopsies. Although the excess number of skin biopsies existed among LLNL employees before publicity about the problem, this excess increased after the publicity. Exposure to some environmental agent(s) or personal risk factors may have caused clinically suspicious pigmented lesions that required LLNL employees to have more skin biopsies. On the other hand, awareness of the laboratory's excess melanoma incidence may have increased physicians' propensity to obtain biopsy specimens of pigmented lesions.

Adult↗
PubMedDate not supplied

Evaluating hypertension control in a managed care setting.

BACKGROUND: We conducted a retrospective cohort study on a random sample of adult patients with hypertension in a large health maintenance organization to assess the feasibility of documenting blood pressure (BP) control and to compare different measures for defining BP control. METHODS: Three criteria for BP control were assessed: systolic BP less than 140 mm Hg; diastolic BP less than 90 mm Hg; and combined BP control, with systolic BP less than 140 mm Hg and diastolic BP less than 90 mm Hg. Four methods of assessing hypertension control by the above criteria were examined: proportion of patients with BP under control at 75% and 50% or more of their office visits; the mean of all pressures during the study period; and the BP from the last visit during the study period. RESULTS: The proportion of patients meeting each criterion for control was similar whether we used the mean BP for all visits, the last recorded BP, or control at 50% or more of visits. Control rates were substantially lower when the more stringent assessment, 75% of visits, was used. The proportion of patients with combined BP control at 75% or more of their visits was half that of the other methods. CONCLUSIONS: In this health maintenance organization population, results with the use of the simplest approach, the last BP measurement recorded, were similar to results with the mean BP. Our findings indicate that evaluation of BP control in a large health maintenance organization will find substantial room for improvement, and clinicians should be encouraged to be more aggressive in their management of hypertension, especially with regard to the systolic BP, which until recent years has been underemphasized.

Aged↗
PubMedDate not supplied

Senior Team Assessment and Referral Program--STAR.

BACKGROUND: Although comprehensive geriatric assessment has been found to improve health and function and decrease hospital admissions, most such programs are staff-intensive and take many hours or even days. The Senior Team Assessment and Referral Program (STAR) was developed to address these two issues by using a short but comprehensive outpatient health appraisal that required only a few health professionals to complete. METHODS: Six hundred forty-nine Kaiser Permanente health plan members aged 65 years or older who received their health care at the Kaiser Permanente Medical Center, San Jose, Calif, were randomly selected during the first 12 months of the study and invited by mail to participate in STAR. Of those members contacted, 326 agreed to join the study. A nurse practitioner evaluated the health, functional, and social status of each STAR participant at an office visit once each year for the next 3 years and provided case management for those participants found to be frail or in danger of becoming frail. A control group of 764 elderly (aged 65 years and older) Kaiser members with characteristics similar to those of the STAR participants was drawn from Kaiser Permanente health plan members in San Jose. They continued to receive usual medical care throughout the study. A medical-functional profile was developed to stratify each STAR participant's overall health and functional status at each visit and case management contact. The results were entered on a grid that was used as a tracking tool throughout the study. Utilization of medical services, changes in health and function, and effects of STAR interventions on participant health behaviors were measured, and primary care physician and participant satisfaction was assessed. RESULTS: Although short-term utilization of medical services increased in the STAR group, health, function, and health behaviors improved as a result of STAR interventions. Ninety-three percent of the STAR participants described a satisfactory experience, and 71 percent were very satisfied. Sixty-five percent of primary care physicians who responded to a satisfaction questionnaire found something useful for their patients in the STAR assessment. CONCLUSIONS: STAR offers an efficient, minimally staff-intensive model for evaluating the health, functional, and social status of the 65-year-old and older age-group and intervening when they are frail or at risk of becoming frail. The improved health, function, and healthy behaviors in STAR participants and the high satisfaction rates among participants and physicians suggest that STAR would be a useful addition to the health care environment.

Aged↗