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Biomedical subjects

M Pratt

Publications and source records attributed to M Pratt.

At least 19 recordsLinked to original sources
PubMed2001

Inactivity-Associated medical costs among US adults with arthritis.

OBJECTIVE: To analyze direct medical costs among US adults with arthritis and estimate the proportion associated with inactivity. METHODS: In the 1987 National Medical Expenditure Survey, arthritis was defined using questions on self-reported, doctor-diagnosed arthritis or rheumatism. Physical activity was defined using a self-report question on level of activity. Inactivity-associated medical costs were derived by subtracting costs for active adults from costs for inactive adults after controlling for functional limitation. RESULTS: Among 5,486 adults with arthritis, inactive persons had higher medical costs than did active persons in all demographic groups examined. In multivariate models adjusting for key covariates, the proportion of costs associated with inactivity averaged 12.4% ($1,250 in 2000 dollars) and ranged from 7.8% to 14.3% among various demographic groups. CONCLUSION: Inactivity-associated medical costs among persons with arthritis are considerable. Physical activity interventions may be a cost-effective strategy for reducing the burden of arthritis.

Activities of Daily Living↗
PubMed2001

A preliminary report of the occupation of patients evaluated in patch test clinics.

BACKGROUND: The interplay between the occupational environment and worker's skin can result in contact dermatitis of both irritant and allergic types. Other forms of dermatitis can also be influenced by occupational exposures. OBJECTIVE: The aim of this study is to compare the occupations and allergens of occupational contact dermatitis cases with nonoccupational contact dermatitis cases. METHODS: Diagnostic patch testing with allergens of the North American Contact Dermatitis Group and occupational coding by the National Institute for Occupational Safety and Health methods. RESULTS: Of 2,889 patients referred for evaluation of contact dermatitis, 839 patients (29%) were found to have occupational contact dermatitis. Of the 839 cases deemed occupational, 455 cases (54%) were primarily allergic in nature and 270 cases (32%) were primarily irritant in nature. The remaining 14% were diagnoses other than contact dermatitis, aggravated by work. The occupation most commonly found to have allergic contact dermatitis was nursing. Allergens strongly associated with occupational exposure were thiuram, carbamates, epoxy, and ethylenediamine. CONCLUSION: Some contact allergens are more commonly associated with occupational contact dermatitis. Nursing and nursing support are occupations most likely to be overrepresented in contact dermatitis clinics.

Allergens↗
PubMed2001

Gold allergy in North America.

OBJECTIVE: To determine the prevalence of allergic reactions to gold among patients tested by the North American Contact Dermatitis Group (NACDG) from 1996 to 1998. METHODS: This is a prospective analysis of patch test results from the 12 centers that comprise the NACDG. Gold was tested as gold sodium thiosulfate (0.5% in petrolatum [pet]), along with 49 other screening allergens, in patients presenting with possible contact dermatitis. RESULTS: Of 4,101 patients tested, 388 (9.5%) had a positive patch test result to gold. Women accounted for 62.8% of the subjects tested and 90.2% of patients positive to gold (P < .0001). The most common sites of dermatitis in gold-allergic patients were the hands (29.6%), face (19.3%), and eyelids (7.5%). Nickel and cobalt allergies, respectively, also were present in 33.5% and 18.3% of gold allergic individuals, as compared with 14.2% and 9.0% of the total population. Gold was the only positive reaction in 15.2% of the 388 patients. CONCLUSION: Gold is a more common allergen than previously reported and might cause facial and eyelid dermatitis. Hypersensitivity to gold is statistically linked to female gender and to allergic reactions to nickel and cobalt.

Allergens↗
PubMed2000

Vaccines for preventing hepatitis B in health-care workers.

BACKGROUND: Hepatitis B causes acute and chronic liver disease and may be prevented by vaccination. OBJECTIVES: To assess the effectiveness and safety of plasma-derived vaccines against acute and chronic hepatitis B in health-care workers in protecting them from hepatitis B infection and its consequences. SEARCH STRATEGY: MEDLINE and Excerpta Medica Database (EMBASE) search using standard Cochrane strategy, Cochrane Library, full text searching of the journal "Vaccine", bibliography of retrieved studies and correspondence with authors, researchers and manufacturers. SELECTION CRITERIA: All original prospective randomised comparisons of yeast-derived vaccines and plasma-derived vaccines against no intervention, placebo, or vaccines against other disease (control vaccines). Assessment of trial quality was made according to: 1. generation of allocation schedule 2. measure(s) taken to conceal treatment allocation 3. drop-out of allocated health-care worker participants from the analysis of trial results 4. measures taken to implement double blinding Trial reports were blinded by removal of authors and their affiliation, journal reference, introduction, results, and discussion. DATA COLLECTION AND ANALYSIS: To assess efficacy the incidence rates of acute hepatitis B were observed in the surveillance of the vaccinated and control groups of the trials included in the review. Safety was assessed from side-effect rates, classified as systemic (malaise, nausea, fever, arthralgias, rash, headache) or local (induration and soreness at the site of the inoculation). MAIN RESULTS: Four trials fulfilling the criteria were identified and the data synthesised. All trials compared plasma-derived vaccines versus placebo. Differences in the settings (and level of incidence) between three of the trial settings and Dienstag's led us to stratify our comparison grouping the three trials performed in dialysis units together. After our stratification, the Desmyter, Smuzness and Crosnier group appears to be homogeneous (Chi-square = 0.11, degrees of freedom = 2). Our estimates of effectiveness and safety in the high risk group favour treatment, the OR for cases of HB being 0.34; 95% CI (0.21, 0.55). The analysis also revealed a non-significant trend towards benefit in the lower risk health-care workers (Dienstag trial, OR 0.26 (0.05, 1.30). Overall the evidence strongly favours vaccination (OR=0.33; 95% CI (0.21, 0.53)). There was no difference in the incidence and severity of side-effects between the two arms of the trials. We calculated that it was necessary to vaccinate between 145 (assuming a baseline rate of 10 cases/1000/year) and 7 (for a baseline rate of 200/1000/year) health-care workers with plasma-derived vaccines to avoid one case of hepatitis B. Completeness of trial reporting was not good with all four trials failing to report titre results on antibodies against hepatitis B surface antigen and hepatitis B core antigen in the placebo arms (correspondence with two of the four authors failed to shed light on the reasons for such an omission). All four trials achieved low scores in the four quality dimensions assessed (generation of allocation schedule, measure(s) taken to conceal treatment allocation, exclusion of allocated participants from the analysis of the trial and measures taken to implement and protect double blinding). Mean length of follow-up was 14.5 months. REVIEWER'S CONCLUSIONS: Plasma-derived vaccines appear to be efficacious and safe for use in high risk health-care workers, such as staff of renal dialysis and transplant units. There is some uncertainty concerning the effectiveness of the vaccine in lower risk health-care workers, although the trend is towards benefit. We found no evidence of a long-term protective effect due to the short follow-up time of the four trials included in this review. We found relatively poor standard of trial reporting, possibly related to the age of the trials.

Health Personnel↗
PubMed2000

Vaccines for preventing cholera.

BACKGROUND: Oral cholera vaccines (either killed whole cell or live recombinant vaccines) are newer alternatives to the parenteral vaccines which have been thought to confer only moderate and short-term immunity. OBJECTIVES: The objective of this review was to assess the effect of cholera vaccines in preventing cases of cholera and preventing deaths. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, Medline, Embase and reference lists of articles. We handsearched the journal Vaccine, contacted researchers in the field and manufacturers. SELECTION CRITERIA: Randomised and quasi-randomised studies comparing cholera vaccines (killed or live) with placebo, control vaccines or no intervention, or comparing types, doses or schedules of cholera vaccine. We included adults and children irrespective of immune status or special risk category. DATA COLLECTION AND ANALYSIS: Data extraction and assessment of trial quality was done independently by two reviewers. MAIN RESULTS: Thirty-two trials were included. Seventeen efficacy trials of relatively good quality, testing parenteral and oral killed whole cell vaccines and involving over 2. 6 million adults, children and infants were included. Nineteen safety trials have been conducted for both types of killed whole cell vaccines and for live vaccines and have involved 11,459 people. For all types of vaccines compared to placebo, the relative risk of contracting cholera at 12 months was 0.49, 95% confidence interval 0. 41 to 0.59 (random effects model). This translates to an efficacy of 51%, 95% confidence interval 41% to 59%. Both parenteral and oral administration were relatively efficacious, but significant protection extended into the third year for oral killed whole cell vaccines. Children under 5 were only protected for up to a year, while older children or adults were protected for up to three years. Parenteral killed whole cell vaccines were associated with increased systemic and local adverse effects compared to placebo. Oral killed whole cell vaccines or oral live vaccines were not. REVIEWER'S CONCLUSIONS: Cholera killed whole cell vaccines appear to be relatively effective and safe. Live oral recombinant vaccines appear to be safe, but efficacy data are not available. Protection against cholera appears to persist for up to two years following a single dose of vaccine, and for three to four years with an annual booster.

Adult↗
PubMed2000

Vaccines for preventing anthrax.

BACKGROUND: Anthrax is an acute bacterial skin disease which may be fatal. Three anthrax vaccines are commercially available but their comparative effectiveness and safety is not clear. OBJECTIVES: The objective of this review was to assess the effects of human anthrax vaccines in healthy adults and children. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, Medline, Embase and the reference lists of articles. We handsearched the journal Vaccine and contacted researchers in the field. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing anthrax vaccines with placebo, vaccines for other diseases or no intervention. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction was conducted independently by the six authors. MAIN RESULTS: Two trials involving 16,052 people were included. Both trials had methodological limitations. Compared to placebo, vaccination was associated with a reduced risk of contracting anthrax (relative risk 0.16, 95% confidence interval 0.07 to 0.35). Compared to placebo, the killed vaccine was associated with a higher incidence and severity of adverse effects (odds ratio 5.15, 95% confidence interval 2.28 to 11.61). Just over 5% of participants in the vaccine group reported adverse effects. The effectiveness of the vaccine does not appear to be influenced by the route of inoculation. REVIEWER'S CONCLUSIONS: Killed anthrax vaccines appear to be effective in reducing the risk of contracting anthrax with a relatively low rate of adverse effects. Further research should be restricted to testing new vaccines only.

Adult↗
PubMed2000

Vaccines for preventing plague.

BACKGROUND: Plague is endemic in China, Mongolia, Burma, Vietnam, Indonesia, India, large parts of Southern Africa, the United States and South America. There are three types of vaccines (live attenuated, killed and F1 fraction) with varying means of administration. OBJECTIVES: The objective of this review was to assess the effects of vaccines to prevent plague. SEARCH STRATEGY: We searched Medline, Embase, the Cochrane Controlled Trials Register and reference lists of articles. We handsearched the journal 'Vaccine' and contacted experts in the field. SELECTION CRITERIA: Randomised trials comparing live and killed plague vaccines against no intervention, placebo, other plague vaccines or vaccines against other disease (control vaccines). DATA COLLECTION AND ANALYSIS: Three reviewers assessed the eligibility of trials. MAIN RESULTS: No trials were included. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate the effectiveness of any plague vaccine, or the relative effectiveness between vaccines and their tolerability. Circumstantial data from observational studies suggest that killed types may be more effective and have fewer adverse effects than attenuated types of vaccine. No evidence appears to exist on the long-term effects of any plague vaccine.

Humans↗
PubMed2000

Vaccines for preventing tick-borne encephalitis.

BACKGROUND: Tick-borne encephalitis is a disease of the central nervous system caused by a virus. Other than the vaccine, there is no treatment for the disease. OBJECTIVES: The objective of this review was to assess the effects of vaccines to prevent tick-borne encephalitis. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group trials register, the Cochrane Vaccine Fields Trials Register, the Cochrane Controlled Trials Register, Medline, Embase and reference lists of articles. We also handsearched the journal Vaccine. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing tick-borne encephalitis vaccines against placebo, control vaccines or comparisons of different doses or schedules of tick-borne encephalitis vaccines. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied inclusion criteria. A panel of six assessors examined trial quality. MAIN RESULTS: Five trials were included. They could not be combined for meta-analysis because of differences in comparisons and outcomes. Four types of tick-borne encephalitis vaccines were used. All the vaccines gave seroconversion rates of over 87%. There were frequent reports of systemic and local adverse effects. REVIEWER'S CONCLUSIONS: Tick-borne encephalitis vaccines appear to be highly immunogenic, but the relationship between seroconversion and clinical protection has not been established. Although adverse effects were commonly reported, none were severe or life threatening.

Child↗
PubMed2000

Effectiveness of physician-based assessment and counseling for exercise in a staff model HMO.

BACKGROUND: Few primary care physicians routinely counsel for exercise, despite the benefits of physical activity and the high prevalence of inactivity. The objective of this study is to assess the effectiveness of Physician-Based Assessment and Counseling for Exercise (PACE), a brief, behavior-based tool for primary care providers counseling healthy adults. METHODS: This study is a randomized controlled trial of 812 patients age 30 years or older registered for well visits at 32 primary care physician offices at a staff model health maintenance organization. Intervention physicians were trained to deliver PACE exercise counseling protocols at the index visit, and one reminder telephone call occurred at 1 month. An enhanced intervention group received additional activity reminders. RESULTS: At the 6-month follow-up, the control group did not differ significantly from the intervention group for energy expended (2,048 kcal/week versus 2,108 kcal/ week, P = 0.77), time spent in walking or other moderate to vigorous activities (202 min/week versus 187 min/ week, P = 0.99), mental health, physical function, or behaviors previously shown to predict activity change. Among the intervention patients, the stages-of-change score for Contemplators increased significantly compared with controls (P = 0.03), but without a significant change in energy expended. Baseline levels of physical activity counseling were high (50%), as were baseline patient physical activity levels (61% exercised at least three times a week). CONCLUSIONS: These results suggest that a one-time PACE counseling session with minimal reinforcement, in a setting with high baseline levels of activity, does not further increase activity. The finding that Contemplators advanced in stage of behavior change suggests that further studies are needed to examine long-term, repeated counseling interventions.

Adult↗
PubMed2000

Disperse blue dyes 106 and 124 are common causes of textile dermatitis and should serve as screening allergens for this condition.

BACKGROUND: Textile dye dermatitis is frequently undiagnosed because clinical awareness is low and because of the absence of good screening allergens in standard patch test series for this type of contact dermatitis. OBJECTIVES: To determine the incidence of textile dye allergy in patients with problematic eczemas evaluated at a contact dermatitis clinic, and to determine the incidence of allergic contact dermatitis to diperse blue dyes in these patients. METHODS: We conducted a retrospective study of 788 patients who were patch tested to either the North American Contact Dermatitis Group (NACDG) Standard Series or the European Standard Series, in addition to other relevant series. The Chemotechnique textile series was utilized in 271 patients (28%). RESULTS: Forty patients reacted positively to 1 or more textile dyes, the majority reacting positively to Disperse Blue 106 (33 of 40; 82.5%) and to Disperse Blue 124 (32 of 40; 80%). Ten of 11 tested patients reacted to their own clothing, 9 of whom reacted to the blue/black 100% acetate or 100% polyester liners in their garments. CONCLUSIONS: Textile dye allergy is more common than previously reported. It can cause marked dermatitis and widespread autoeczematization reactions. The most frequent allergens are Disperse Blue 106 and 124, which are frequently found in the 100% acetate and 100% polyester liners of women's clothing. We recommend that Disperse Blue 106 or 124 serve as the screening allergen for textile dye dermatitis.

Adult↗
PubMed2000

Becoming a parent: the relation between prenatal expectations and postnatal experience.

The relationship between individuals' prenatal expectations about parenthood and their postnatal experience of parenthood was examined. Seventy-three primiparous couples were interviewed during the 3rd trimester of pregnancy and asked open-ended questions regarding their expectations. A content analysis of these expectations identified several themes. A cluster analysis, using these themes as variables, identified 3 clusters of women labeled prepared, fearful, and complacent and 4 clusters of men labeled prepared, fearful, complacent, and mixed. Postnatal comparisons indicated that women and men in the prepared cluster generally demonstrated better adjustment than did individuals in the other clusters. Results are discussed in terms of the content of expectations about parenthood, gender differences in these expectations, and the association between prenatal expectations and postnatal experiences.

Adult↗
PubMed2000

Measuring physical activity with the behavioral risk factor surveillance system.

PURPOSE AND METHODS: Because regular physical activity reduces the risk of premature death and disability, accurate methods of population-based measurement are important for public health surveillance efforts such as those based on the Behavioral Risk Factor Surveillance System (BRFSS). The present study: 1) briefly reviews and compares currently available methods to measure physical activity using BRFSS data, 2) describes physical activity patterns in the United States using these state-aggregated measures, and 3) provides suggestions on future directions for practitioners and researchers. Using a random-digit dialing, telephone survey, we collected data for noninstitutionalized adults aged 18 yr and older. We analyzed BRFSS data for 1996 from 50 states and the District of Columbia and Puerto Rico (N = 124,085). Based on recent literature and public health priorities, we developed eight different physical activity indices (one vigorous and seven moderate). These varied in their threshold for duration, kcal expenditure, and in frequency and intensity of activity. RESULTS: Using different algorithms, the population prevalence of moderate physical activity ranged from about 20% to 38%. Only 20% of adults met the Healthy People 2000 definition for regular, sustained activity (> or =30 min of moderate activity per day for at least 5 d x wk(-1)). CONCLUSIONS: Considerable progress is needed if the United States is to reach the current public health goal for regular physical activity. Standardized approaches to analyzing and collecting physical activity data are essential for public health surveillance, policy making, and communication to the public.

Adolescent↗
PubMed2000

Thinking ahead: complexity of expectations and the transition to parenthood.

This study examined the integrative complexity of thinking in individuals making the transition to parenthood, and the relationship between complexity and adjustment during this period. Sixty-nine couples were interviewed 3 months before their babies were born, and 6 months after the birth. The prenatal interview focussed on individuals' expectations about what it would be like being a parent; the postnatal interview focussed on individuals' actual experiences as parents. In addition, participants completed measures of depression, self-esteem, and marital satisfaction after each interview, and a measure of stress after the 6-month postnatal interview. Both men and women demonstrated a significant increase in the complexity of their thinking from the prenatal to the postnatal interview, with women demonstrating higher levels of complexity at both times. In addition, women with more complex expectations demonstrated better adjustment after their babies were born than did women with simpler expectations; these results were not obtained for men. Results are discussed with regard to the way in which thinking about the self changes as one negotiates major life transitions, and the way in which complex thinking can help counter some of the stresses that individuals may experience at these times.

Adaptation, Psychological↗
PubMed2000

Public health surveillance of physical activity.

There is a clear public health need to measure and track physical activity behavior. Surveillance systems should be flexible enough to keep up with scientific advances in identifying dose-response relationships and in developing new assessment techniques, and new ways to assess community indicators associated with physical activity. Having a strong public health surveillance system that produces data that can be used to plan, guide, and evaluate programs is essential for increasing the prevalence of an important health-related behavior: physical activity.

Adolescent↗
PubMed1999

Levels of physical activity and inactivity in children and adults in the United States: current evidence and research issues.

PURPOSE: The purpose was to describe current levels of physical activity and inactivity among adults and young people in the United States. METHODS: Estimates of participation in regular physical activity were derived from three national surveys for adults (National Health Interview Survey, National Health and Nutrition Examination Survey, and the Behavioral Risk Factor Surveillance System) and from the Youth Risk Behavior Survey for high school students. RESULTS: Overall, 63.8% of high school students surveyed on the 1997 YRBS reported participating in vigorous physical activity for at least 20 min on 3 or more days per week. Participation in vigorous activity was higher for boys (72.3%) than girls (53.5%), whites (66.8%) compared with blacks (53.9%) and Hispanics (60.4%), and decreased with advancing grade. Among adults, 27.7% meet recommended levels of either moderate or vigorous physical activity, whereas 29.2% report no regular physical activity outside of their work. Gender differences in participation in physical activity are less pronounced than in youth, and age-related patterns were complex. Whites are more active than blacks and Hispanics, and persons with higher family incomes and more education report being more physically active. There have been only minor changes in reported participation in leisure time physical activity over the past 15 yr. CONCLUSION: National estimates of physical activity appear to be reliable and valid for adults but may be less so for adolescents and are poor measures for children. Research is needed to determine the role that objective monitoring with accelerometers may play in surveillance. Reliable and valid measures of occupational, household, and transportation-related physical activity and sedentary behaviors are needed to better characterize the range of activity that is associated with health.

Adult↗