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Biomedical subjects

J C Gaydos

Publications and source records attributed to J C Gaydos.

At least 37 records · Page 2Linked to original sources
PubMed1998

Prevention of adenoviral acute respiratory disease in Army recruits: cost-effectiveness of a military vaccination policy.

INTRODUCTION: Since 1971 widespread vaccination has limited the number of adenoviral acute respiratory disease (ARD) outbreaks in Army recruits. Increased vaccine costs have recently threatened the continuation of the vaccination program. METHODS: We conducted a cost-effectiveness analysis to assess the consequences of changing the year-round Army adenovirus vaccination program to (1) seasonally targeted vaccine administration (only during the high-risk period) or (2) complete discontinuation of the program from the perspective of total cost to the Army. Costs included vaccination costs and direct and indirect medical and military training costs. Health outcomes were estimated as the number of hospitalizations for ARD prevented. In the reference case, the incidence rate among unvaccinated and vaccinated individuals was 4.06 and 1.5 per 100 person weeks, respectively. Results are expressed for a cohort of 76,171 recruits. RESULTS: In the absence of adenoviral vaccination, a projected 12,370 cases of ARD hospitalization would occur, costing $26.4 million annually. A seasonally targeted program would prevent 7,800 cases of ARD and save $16.1 million over no vaccination. Year-round immunization would not prevent any additional cases but would save $15.5 million over no vaccination. Year-round vaccination would become the cost-effective strategy if ARD incidence during the low-risk months were to increase. CONCLUSION: Vaccination of Army recruits by any schedule was cost-saving due to the high level of prevented disease and averted hospitalizations. Even though a seasonally targeted program provided the greatest cost-savings, year-round vaccination must remain an option due to the potential for adenoviral ARD outbreaks in the low-risk period.

Acute Disease↗
PubMed1998

Prevalence of antibodies to adenovirus serotypes 4 and 7 among unimmunized US Army trainees: results of a retrospective nationwide seroprevalence survey.

The 1996 production halt of adenovirus types 4 and 7 vaccines prompted concerns about the resurgence of large respiratory disease outbreaks among US military basic trainees. This serosurvey was conducted to assess the current susceptibility of the trainee population to these viruses. A stratified, random sample (n=303) of trainees' sera was tested using a quantitative colorimetric microneutralization assay to demonstrate antibody titers considered to provide immunologic protection against each adenovirus type. Results were analyzed for relationships between susceptibility and 4 demographic factors-gender, race, prior military service, and age. Results showed that 66% and 73% of trainees were susceptible to serotypes 4 and 7, respectively. Nearly 90% were susceptible to at least one serotype. Susceptibility was significantly (P<.05) related to lack of prior military service and younger age. Consistent with a serosurvey conducted 20 years ago, these results demonstrated significant susceptibility to two vaccine-preventable causes of disease. These findings may have civilian implications.

Adenovirus Infections, Human↗
PubMed1998

Use of ligase chain reaction with urine versus cervical culture for detection of Chlamydia trachomatis in an asymptomatic military population of pregnant and nonpregnant females attending Papanicolaou smear clinics.

Ligase chain reaction (LCR) (Abbott Laboratories, Abbott Park, Ill.) with first-catch urine specimens was used to detect Chlamydia trachomatis infections in 465 asymptomatic military women attending clinics for routine Papanicolaou smear tests. Results were compared to results of cervical culture to determine the sensitivity of the urine LCR and the possible presence of inhibitors of amplification in pregnant and nonpregnant women. Discrepant results for LCR and culture were resolved by direct fluorescent antibody staining of culture sediments, two different PCR assays, and LCR for the outer membrane protein 1 gene. The prevalence of Chlamydia in specimens by urine LCR was 7.3% compared to 5% by culture. For 434 women with matching specimens, there were 11 more specimens positive by LCR than were positive by culture, of which all but one were determined to be true positives. There were four culture-positive, LCR-negative specimens, all from nonpregnant women. The sensitivity, specificity, and positive and negative predictive values of urine LCR after discrepant results were resolved were 88.6, 99.7, 96.9, and 99.0%, respectively. The sensitivity of culture was 71.4%. From the 148 pregnant women (prevalence by LCR, 6.8%), there were no patients who were cervical culture positive and urine LCR negative to indicate the presence in pregnant women of inhibitors of LCR. Additionally, a subset of 55 of the LCR-negative frozen urine specimens from pregnant women that had been previously processed in LCR buffer were inoculated with 5 cell culture inclusion forming units of C. trachomatis each and retested by LCR; all tested positive, indicating the absence of inhibitors of LCR in urine from these pregnant women. The use of LCR testing of urine specimens from asymptomatic women, whether pregnant or not, offers a sensitive and easy method to detect C. trachomatis infection in women.

Adult↗
PubMed1998

Control of workers' compensation claims and costs in the U.S. Army.

The Army Medical Department has been implementing initiatives to reduce workers' compensation claims and costs since 1983. After years of an upward trend, reductions in both costs and claims were reported for 1995 and 1996. To assess efforts at managing workers' medical care and compensation in the Army, we reviewed Department of Defense and Department of the Army documents and studied data on claims and costs. We found several programs that were launched to control claims and associated costs. None of these programs adequately addressed the absence of real-time financial incentives for reducing compensation costs, a lack of acceptable workers' compensation data collection and data management systems, and a lack of emphasis on medical case management. To sustain this trend of decreased costs and claims, the Army must focus on (1) incentives, (2) data management systems, and (3) a comprehensive plan for medically managing workers' compensation claims and costs.

Cost Control↗
PubMed1997

Identifying comparison groups for evaluating occupational hearing loss: a statistical assessment of 22 industrial populations.

Finding appropriate comparison groups to study occupational hearing loss has been difficult. Recently, however, the National Institute for Occupational Safety and Health sponsored the complication of potentially useful data from 22 diverse industrial companies in the U.S.A. and Canada. We conducted a statistical evaluation to determine which of the 22 populations might be suited as comparison groups in future studies of workers exposed to hazardous noise. In a Cox Proportional Hazards model that included age and sex, the relative risk of developing hearing loss in each company was estimated at two, five, and ten years of follow-up. We ranked the companies based on their relative risks, and rated them on a five-point scale from "excellent" to "poor" to indicate their suitability as comparison groups. The risk profiles developed and other variables described in this study will assist researchers in selecting appropriate comparison groups for evaluating occupational hearing loss.

Age Distribution↗
PubMed1997

Hepatitis B virus, human immunodeficiency virus type-1, and syphilis among women attending prenatal clinics in Belize, Central America.

Women and their infants may benefit from therapeutic interventions when hepatitis B, human immunodeficiency virus (HIV), or syphilis are detected during the prenatal period. We initiated hepatitis B and HIV screening of women attending prenatal clinics in Belize. Risk factor assessment information for hepatitis B infection and demographic data were determined by interview. Of 543 evaluable women, 81 (14.9%) were seropositive for hepatitis B core antibody (anti-HBc); one woman had asymptomatic hepatitis B surface antigenemia. Antibodies to HIV-1 were detected in one woman. Reactive syphilis serologies were detected in 15 (2.8%) women. Anti-HBc seroprevalence varied by district (range 3.1-43.5%) and by ethnicity (range 0.0-40.9%). Significant identified risks for anti-HBc seropositivity from univariate analyses included being of the Garifuna ethnic group, residence or birth in the Stann Creek or Toledo districts, a reactive syphilis serology, a household size of eight or greater, and five or more lifetime sexual partners. Multivariate analyses identified ethnicity and a reactive rapid plasma reagin as the best predictors of anti-HBc seropositivity. Highly variable differences in anti-HBc prevalence by district may permit the targeting of limited public health resources for education, screening, and prevention programs.

Adolescent↗
PubMed1996

Errors in derivations of the Coburn-Forster-Kane equation for predicting carboxyhemoglobin.

An error identified in a 1993 textbook of military medicine led to an investigation of derivations of the Coburn-Forster-Kane equation (CFKE) for predicting carboxyhemoglobin (COHb) levels. Reviews of the scientific literature, military documents, and personal interviews revealed that errors were made in earlier derivations of the CFKE. One flawed derivation was used by the U.S. Army until 1985, and another is still used by the National Institute for Occupational Safety and Health (NIOSH). The original and later CFKE derivations are reviewed and errors in the equations are identified. The effect of the errors is discussed.

Carboxyhemoglobin↗
PubMed1996

Tuberculosis and HIV infection in new inmates in Federal Bureau of Prisons facilities.

A significant change in the manner in which medical data were managed in the Federal Bureau of Prisons (BOP) occurred in calendar year 1992 (CY 92). Prior to CY 92, all BOP medical data were stored only as hard copy medical records. Beginning with CY 92, medical records data for all inmates have been transcribed to magnetic tape using the BOP SENTRY system. This study was an initial attempt to determine if this innovation would permit the development of meaningful infectious diseases data on BOP inmates. Our objective was to define the prevalence of tuberculosis (TB) skin test positivity, active TB, and HIV infection in new BOP inmates in CY 92 and to compare the new inmate population with the total BOP 1992 prisoner population. This initial study is important for two reasons: (1) the BOP SENTRY system for demographic and medical data was found to be a feasible tool for disease surveillance purposes; and (2) the 1992 new inmate population had much greater prevalences of purified protein derivative positivity, active TB, and HIV infection compared to the total BOP population. These findings may signal an increase in serious infectious diseases in BOP prisoners.

AIDS Serodiagnosis↗
PubMed1995

Adenovirus vaccines in the U.S. military.

Acute respiratory disease (ARD) due to adenoviruses caused significant morbidity in military training populations. Since 1971 ARD has been controlled by the use of live, enteric-coated, adenovirus (ADV) types 4 and 7 vaccines. This immunization program overcame significant problems in vaccine development. Due to a production delay, military training posts stopped ADV vaccine administration in spring 1994. The delivery of ADV vaccine resumed in late February 1995, but another production delay is anticipated. A generation of military medical people have not been exposed to the significant morbidity caused by adenoviruses and are unaware of the effectiveness of the ADV vaccine. ARD morbidity before ADV vaccines, the ADV vaccine development program, and current issues regarding the control of ARD due to adenoviruses in the military are discussed.

Adenoviridae↗
PubMed1994

Military participation in emergency humanitarian assistance.

Military forces of the United States and other countries possess training, equipment and capabilities that are suited for work in disaster preparedness and assistance. Information on the use of military units in domestic and foreign disaster-related efforts, particularly by United States forces in the medical area, was obtained by review of the literature and unpublished military reports, and from interviews with people who have been involved with disaster-related activities. The historical reasons for viewing United States forces as resources in disaster situations are identified. Additionally, issues and problems related to disaster preparedness and assistance in general, and more specifically, to the past and future use of military personnel for this mission are examined. The need for a defined military mission for emergency humanitarian assistance and the need for a military organizational structure to support this mission are identified. Once these two critical issues have been properly addressed, the United States military should participate in the establishment of a disaster institute for joint civilian-military disaster planning and training, in both domestic and foreign areas.

Disaster Planning↗
PubMed1993

Assessment of the proposed Draft American National Standard method for evaluating the effectiveness of hearing conservation programs.

Using audiometric data, this study assessed the Draft American National Standard ANSI S12.13-1991 (DANS) method for evaluating the effectiveness of hearing conservation programs by comparing it against a standard epidemiologic method. Although the hearing conservation program of the study population was rated as "acceptable" (scale: acceptable, marginal, unacceptable) using the DANS method, the epidemiologic method found a 130% increased risk of hearing loss (relative risk = 2.3, 95% confidence interval = 0.8 to 6.5). In addition, study workers who were excluded from analyses for failing to comply with the DANS criteria were found to be at significantly increased risk of hearing loss (relative risk = 9.1, 95% confidence interval = 3.4 to 24.2). These data indicate that the DANS method may overestimate the effectiveness of hearing conservation programs and systematically exclude workers at high risk of hearing loss from analyses.

Adult↗
PubMed1993

An epidemiologic method for assessing the effectiveness of hearing conservation programs using audiometric data.

A hearing conservation program (HCP) must include audiometric monitoring. In keeping with this requirement, enormous bodies of audiometric data have been accumulated. However, only a limited number of methods are available for using audiometric data to assess HCP effectiveness. This study illustrates an epidemiologic method. The risk of developing hearing loss (measured by the standard threshold shift) was compared between study and reference populations using the risk ratio. The study population had an increased risk of nearly 3-fold. Epidemiologic risk comparison methods, using reference populations, offer an alternative to current methods for HCP evaluation using audiometric data.

Adult↗
PubMed1993

The role of military medicine in military civic action.

We are moving into an era when U.S. military forces will be called upon frequently to perform military civic action (MCA) projects. Such projects, have been used successfully and unsuccessfully, primarily in the areas of medicine and engineering, to enhance the standing of military forces with indigenous populations. However, the available criteria for planning and assessing MCA projects are not widely known. These related and overlapping criteria are supported by facts, interpretative data, anecdotes, and common sense, but none can be considered absolute. Selected criteria are defined, reviewed, and illustrated with examples of past successes and failures.

Humans↗
PubMed1979

Seroimmunity to polioviruses in U.S. Army recruits.

Titers of neutralizing antibody to poliovirus types 1, 2, and 3 were determined for serum specimens obtained from 268 U.S. Army recruits. Among those tested, 20.9% lacked neutralizing antibody to one or more types of poliovirus, and 1.1% lacked antibody to all three types. An analysis of demographic data showed that age of less than 18 years, schooling for less than 10 years, and residence in the northeastern United States were associated with higher percentages of recruits lacking neutralizing antibodies to polioviruses in serum.

Adolescent↗