Fatherhood as a component of men's health.
Explore the source record for details and available documents.
Biomedical Research↗
Biomedical subjects
Matthew M Davis
Publications and source records attributed to Matthew M Davis.
Influenza vaccination as secondary prevention for cardiovascular disease: a science advisory from the American Heart Association/American College of Cardiology.
Evidence from cohort studies and a randomized clinical trial indicates that annual vaccination against seasonal influenza prevents cardiovascular morbidity and all-cause mortality in patients with cardiovascular conditions. The American Heart Association and American College of Cardiology recommend influenza immunization with inactivated vaccine (administered intramuscularly) as part of comprehensive secondary prevention in persons with coronary and other atherosclerotic vascular disease (Class I, Level B). Immunization with live, attenuated vaccine (administered intranasally) is not currently recommended [corrected] for persons with cardiovascular conditions. It is important to note that influenza vaccination coverage levels overall and in this population remain well below national goals and are marked by disparities across different age and ethnic groups. One of the barriers to vaccination for patients with cardiovascular disease is that cardiology practices frequently do not stock and administer influenza vaccine. Healthcare providers who treat individuals with cardiovascular disease can help improve influenza vaccination coverage rates by providing and strongly recommending vaccination to their patients before and throughout the influenza season.
American Heart Association↗
Influenza vaccination as secondary prevention for cardiovascular disease: a science advisory from the American Heart Association/American College of Cardiology.
Evidence from cohort studies and a randomized clinical trial indicates that annual vaccination against seasonal influenza prevents cardiovascular morbidity and all-cause mortality in patients with cardiovascular conditions. The American Heart Association and American College of Cardiology recommend influenza immunization with inactivated vaccine (administered intramuscularly) as part of comprehensive secondary prevention in persons with coronary and other atherosclerotic vascular disease (Class I, Level B). Immunization with live, attenuated vaccine (administered intranasally) is not currently recommended [corrected] for persons with cardiovascular conditions. It is important to note that influenza vaccination coverage levels overall and in this population remain well below national goals and are marked by disparities across different age and ethnic groups. One of the barriers to vaccination for patients with cardiovascular disease is that cardiology practices frequently do not stock and administer influenza vaccine. Healthcare providers who treat individuals with cardiovascular disease can help improve influenza vaccination coverage rates by providing and strongly recommending vaccination to their patients before and throughout the influenza season.
Adult↗
Falling into the doughnut hole: drug spending among beneficiaries with end-stage renal disease under Medicare Part D plans.
The Medicare Part D prescription drug benefit may facilitate provision of medications by subsidizing drug costs. However, beneficiaries with higher drug utilization may face higher out-of-pocket (OOP) costs under the benefit's "doughnut hole" provisions that substantially increase beneficiary cost-sharing. The Medicare Current Beneficiary Survey Cost and Use data for 1997 through 2001 were used to estimate the impact of the standard Part D benefit on drug expenditures. The sample consisted of adults who were not dually enrolled in Medicaid (41,617 without ESRD, 256 with ESRD). Outcomes were annual total and OOP drug spending projected to 2006, as well as estimates of individual spending changes under Part D. In 2006, ESRD beneficiaries will have mean annual total and OOP expenditures that are approximately twice that of their Medicare peers. The overall impact of Part D on OOP expenditures is similar among all beneficiaries; however, many individuals with employer-sponsored coverage and those with higher costs (especially those with ESRD) may face cost increases with significant monthly variability as a result of reaching the "doughnut hole," a no-coverage gap in the standard benefit. Therefore, ESRD beneficiaries face substantial total and OOP annual expenditures for medications, causing most to reach the Part D benefit gap. Higher OOP costs may lead to reductions in spending and medication use with subsequent treatment gaps that may lead to increased use of medical services. As the new legislation takes effect, policy makers who are considering modifications in the program may benefit from further research to monitor patterns and gaps in coverage, medication use and spending, and hospitalization and survival trends.
Aged↗
Could a federal program to promote influenza vaccination among elders be cost-effective?
BACKGROUND: Influenza-related mortality predominately and disproportionately impacts the elderly. Rates of annual influenza vaccination among the elderly are approximately 65%, far below the Healthy People 2010 target of 90%. We estimated the cost-effectiveness of a 10-year federal program to promote influenza vaccine, intended to increase vaccination rates among persons > or = 65 years old. METHODS: Published estimates regarding influenza-associated mortality rates and vaccine efficacy among the US elderly were used to calculate the number needed to vaccinate (NNV) to prevent one all-cause death due to influenza, as well as the mortality reduction expected from increased vaccination rates. The costs per life-year saved were estimated for a hypothetical federal promotional campaign, patterned after a direct-to-consumer (DTC) advertising program (2006-2015). The base case scenario presumed a 25-percentage-point increase in vaccination rates to 90%; in sensitivity analyses, we examined programs that increased rates by 10-20 points. RESULTS: The base case NNV was 1116 (95% CI: 993-1348). Over the 10-year DTC-style influenza vaccine promotion program, 6516 (5576-7435) elderly lives would be saved. The incremental cost-effectiveness (C/E) of the program was dollar 16,300 (dollar 11,347-dollar 25,174) per life-year saved in 2006 and increased to dollar 199,906 (dollar 138,613-dollar 307,423) per life-year saved by 2015. Overall, the C/E for the 10-year program was dollar 37,621 (dollar 32,644-dollar 43,939) per life-year saved. Programs that yielded a 15-percentage-point increase or less in vaccination rates would have C/E values exceeding dollar 50,000 per life-year saved and save fewer than 4000 total lives. CONCLUSIONS: DTC-style promotional campaigns for influenza vaccine among elders may represent a cost-effective strategy for the federal government to pursue as a means of increasing elders' vaccination rates and reducing influenza-related mortality.
Actuarial Analysis↗
States' emergency orders regarding the 2004-05 influenza vaccine shortage.
Influenza vaccine shortages during the 2004-05 season led some states to issue emergency orders that prioritized high-risk groups and in some cases threatened criminal penalties. Decision-making that led states to issue - or not issue - these orders has not been examined. Therefore, we conducted analyses of semi-structured, in-depth interviews with health officials in 23 states, in order to identify principal decision-making factors and patterns regarding emergency flu vaccine orders. Four of 14 issuing states and one of 9 non-issuing states had a formal structure for decisions of this nature; 3 states utilized a bioterrorism preparedness infrastructure. Eight issuing states cited inadequate or uncertain supply as most important in their decision-making. Four issuing states said that informing the public that high-risk prioritization was a state decision (and not a provider-specific decision) was most important. Among non-issuing states, 7/9 believed they could accomplish their objectives without issuing an order. No states had formal mechanisms to assess vaccine supply or monitor physicians' adherence to prioritization guidelines. We conclude that broad differences in states' approaches to influenza vaccine supply illustrate 3 salient themes: decentralization of vaccine supply control and management, lack of monitoring and enforcement capacity, and benefits of disaster preparedness efforts.
Centers for Disease Control and Prevention, U.S.↗
Inpatient health care use among adult survivors of chronic childhood illnesses in the United States.
OBJECTIVES: To describe the inpatient length of stay and related charges for adults in the United States with childhood-onset chronic disease and to examine patterns with respect to different hospital settings. DESIGN: We analyzed data from the 2002 Nationwide Inpatient Sample, a nationally representative data set of hospital discharges. We performed a case-mix-adjusted, sample-weighted regression analysis as well as descriptive statistics of hospital use among adults with childhood-onset chronic disease. SETTING: United States. PARTICIPANTS: We identified hospitalizations for persons aged 18 years or older with a diagnosis of complex congenital heart disease, cystic fibrosis, sickle cell disease, or spina bifida. Main Exposure Childhood chronic illness. MAIN OUTCOME MEASURES: Length of stay and total charges among pediatric, adult, and mixed hospitals. RESULTS: In multivariate adjusted analyses, patients with complex congenital heart disease and cystic fibrosis had a significantly longer length of stay in pediatric hospitals than in adult or mixed hospitals (P<.001); no similar difference was found for sickle cell disease and spina bifida. For all of the 4 conditions, hospital charges were significantly greater in pediatric hospitals than in adult or mixed hospitals (P<.001 for cystic fibrosis, complex congenital heart disease, and sickle cell disease, and P<.01 for spina bifida). CONCLUSIONS: The vast majority of persons who have survived to adulthood with complex congenital heart disease, cystic fibrosis, spina bifida, or sickle cell disease are hospitalized in hospitals that predominantly care for adults, where charges for care appear to be lower than in pediatric hospitals.
Adult↗
Interpreting negative results from an underpowered clinical trial: warts and all.
Explore the source record for details and available documents.
Adhesives↗
Estimated cost-effectiveness of growth hormone therapy for idiopathic short stature.
OBJECTIVE: To estimate the cost-effectiveness of growth hormone (GH) therapy for idiopathic short stature (ISS). DESIGN: Cost-effectiveness analysis. SETTING: Decision model. PATIENTS: A cohort of 10-year-old prepubertal boys with ISS treated with GH. INTERVENTIONS: Comparison of children treated for 5 years with GH therapy vs children receiving no intervention. MAIN OUTCOME MEASURES: Incremental cost per child, incremental growth per child, and incremental cost per inch of final height gain. RESULTS: The estimated incremental cost-effectiveness ratio of GH therapy for ISS in the base case analysis compared with no therapy was 52,634 dollars per inch (per 2.54 cm), or 99,959 dollars per child, reflecting an incremental growth of 1.9 in (4.8 cm). Alternate treatment strategies such as increased duration of GH treatment and high pubertal dosing of GH did not substantially improve the cost-effectiveness ratio. Probabilistic sensitivity analyses showed that growth variability in response to GH had the greatest impact on the cost-effectiveness of GH therapy. CONCLUSIONS: Targeted treatment of children with ISS with the greatest potential for growth appears critical for maximizing cost-effectiveness of GH treatment. However, the significance of the cost per inch is difficult to judge until the utility gains associated with height gain after GH therapy for ISS can be ascertained.
Body Height↗
Parental report of health conditions and health care use among children with and without autism: National Survey of Children's Health.
OBJECTIVE: To compare parent-reported prevalence of health conditions and health care use between children with and without autism. DESIGN: Cross-sectional analysis of the 2003 to 2004 National Survey of Children's Health. SETTING: Population-based sample across the United States. PARTICIPANTS: More than 100 000 parents. The main exposure was "autism" (not further defined), from response to the question: "Has a doctor or health professional ever told you that your child has autism?" MAIN OUTCOME MEASURES: Medical and mental health conditions and measures of health care use. RESULTS: Autism prevalence among children aged 3 to 17 years was 53 per 10 000 (95% confidence interval, 45-61 per 10,000), equating to a national estimate of 324 000 children (95% confidence interval, 274,000-375,000 children). Children with autism had a significantly (P<.001) higher prevalence of depression or anxiety problems (38.9% vs 4.2%) and behavioral or conduct problems (58.9% vs 5.2%) than children without autism. Respiratory, food, and skin allergies were reported by parents more often for children with autism, with food allergies having the strongest relative difference between the groups (odds ratio, 4.5; 95% confidence interval, 3.0-7.0). Children with autism had significantly (P<.001) higher mean physician visits over 12 months for preventive care, nonemergency care, and hospital emergency care, and were far more likely than children without autism to receive physical, occupational, or speech therapy (76.0% vs 6.3%), to need treatment or counseling for an emotional, developmental, or behavioral problem (75.4% vs 7.0%), and, among those taking a prescribed medication, to be using a medication long-term (51.4% vs 14.5%). CONCLUSION: We found markedly higher reports of concurrent conditions and health care use associated with childhood autism in this study.
Adolescent↗
Effect of missed opportunities on influenza vaccination rates among children with asthma.
OBJECTIVES: To assess rates of influenza vaccination among children with asthma; document the frequency, timing, and patterns of missed opportunities to vaccinate during successive influenza seasons; and project potential influenza vaccination rates that could be achieved by reducing or eliminating missed opportunities. SETTING: Michigan Medicaid program during the 2001-2002 and 2002-2003 influenza seasons. DESIGN: Retrospective cohort analysis of administrative claims. PARTICIPANTS: We evaluated the claims of 4358 children aged 5 to 18 years with persistent asthma who were continuously enrolled in Medicaid. MAIN OUTCOME MEASURES: Influenza vaccinations and missed opportunities assessed using procedure and diagnosis codes. RESULTS: During the 2001-2002 season, 16.7% of children with asthma received an influenza vaccination; during 2002-2003, 21.8% received the vaccine (9.5% vaccinated in both seasons). However, 76.5% of children had at least 1 office visit during the 2001-2002 influenza season (75.3% during 2002-2003). Among children without influenza vaccination, 72.9% had at least 1 missed opportunity for vaccination during the 2001-2002 season and 69.3% during 2002-2003. The most common outcome was having at least 1 missed opportunity (39.6%) in each of 2 successive influenza seasons. Eliminating missed opportunities prior to the historical peak of influenza season would have increased the influenza vaccination rate among this population of children to 76%. CONCLUSIONS: Missed opportunities for influenza vaccination among children with asthma are common and are often repeated from one influenza season to the next. Future studies should assess how interventions could be aimed at patients and health care professionals to improve awareness of the need for annual influenza vaccination.
Adolescent↗
National trends in bariatric surgery, 1996-2002.
BACKGROUND: Surgical therapy for the long-term treatment of obesity ("bariatric surgery") in individuals whose body mass index (calculated as weight in kilograms divided by the square of height in meters) is 40 or higher or in those who have significant obesity-related comorbidities and a body mass index of 35 or higher is one of few interventions shown to be effective. Many aspects of recent national bariatric surgery trends are unclear, including the ages of individuals undergoing such procedures and the economic burden borne by public vs private payers. HYPOTHESIS: Population-adjusted rates of bariatric surgery are rapidly increasing and have economic implications that differ for private vs public payers. DESIGN AND SETTING: We examined hospitalization and charge data from the Nationwide Inpatient Sample from 1996 through 2002, representative of national patterns for children and adults. We derived nationally weighted estimates of population-adjusted hospitalization rates and inflation-adjusted charges for bariatric surgery. We also examined the relative economic burden for public vs private payers for bariatric surgery discharges. RESULTS: Population-adjusted rates of bariatric surgery in the overall sample increased more than 7-fold in the study period, from 3.5 per 100 000 US population in 1996 to 24.0 per 100 000 in 2002. During this period, among youth (<20 years old), rates increased from 0.23 per 100 000 to 0.73 per 100 000; and among elderly persons (>65 years old), rates increased from 0.30 per 100 000 to 1.69 per 100 000. The rate increased most dramatically among those aged 20 to 65 years, who composed 97% or more of bariatric surgery discharges annually. Increases in bariatric surgical volume corresponded with increasing economic consequences overall, exceeding USD $2 billion in annual charges by 2002 (mean, USD $29,107 per discharge). Since 2000, private payers have been charged for more than 80% of the national total; annual charges to Medicare and Medicaid have been comparatively modest, but each exceeded USD $100 million by 2002. CONCLUSIONS: National rates of bariatric surgery have increased markedly among children and adults, with attendant economic consequences, principally for private insurers. This trend may reflect the dearth of effective primary care and preventive interventions to address the obesity epidemic.
Adult↗
Influenza vaccination status and influenza-related perspectives and practices among US physicians.
BACKGROUND AND OBJECTIVE: The influenza vaccination rate among US healthcare workers (HCWs) remains low. This survey was designed to assess influenza vaccination status and related knowledge, attitudes, and beliefs among a national sample of primary care physicians and subspecialists likely to see patients at high risk for complications from influenza. METHODS: We used a mail survey of a national random sample of 495 family physicians (FPs), 491 internists (IMs), 498 geriatricians (GERs), and 497 pulmonologists (PUDs). RESULTS: The overall response rate was 38%. Almost all respondents (87%) reported receiving an influenza vaccine during the 2003-2004 influenza season, with no significant difference across specialty groups (84% FPs, 87% IMs, 87% GERs, 91% PUDs). In a multivariate model, adjusted for physician specialty and age group, significant predictors of vaccination were: strong agreement that HCWs have professional responsibility to be vaccinated, access to vaccination on site and free of charge, strong worksite recommendation for HCWs to be vaccinated, and strong agreement that benefits of vaccination outweigh risk of side effects. CONCLUSIONS: Physicians reported a high influenza vaccination rate. To improve these rates further, with likely benefits for other HCWs, worksite policies that facilitate access to vaccination and documentation of reductions in nosocomial influenza associated with HCW vaccination should continue to be pursued.
Aged↗
Physician perspectives to inform a new recommendation for meningococcal conjugate vaccine (MCV4).
PURPOSE: In January 2005, the U.S. Food and Drug Administration licensed a new tetravalent meningococcal conjugate vaccine (MCV4). Before any policy decisions by the U.S. Advisory Committee on Immunization Practices (ACIP) related to MCV4, the Centers for Disease Control and Prevention requested a study to explore the perspective of primary care physicians regarding different recommendation scenarios for use of MCV4. METHODS: Cross-sectional mail survey of a national random sample of pediatricians (PDs) and family physicians (FPs), conducted January 2005. Respondents chose from four MCV4 recommendation scenarios in terms of ability to implement, perceived patient/parent preferences, scientific evidence, and overall best fit. RESULTS: Response rate to the single-mailing survey was 57%. In terms of ability to implement, respondents generally preferred an MCV4 recommendation targeted to middle-school entry (11-12 years old) or with the Td booster at any age, but on the basis of scientific evidence they favored MCV4 at high school completion. For "overall best fit," relatively equal proportions of respondents favored a recommendation at middle school entry and one linked to Td booster administration (whenever it occurred); there were no significant differences between PDs and FPs. Major influences on willingness to recommend MCV4 were vaccine safety/side effects and insurance coverage/reimbursement. CONCLUSIONS: Support for an MCV4 recommendation at middle school entry is common but not universal among primary care providers. Data suggest that respondents appreciate the potential discrepancy between practical aspects of vaccine delivery and the need to protect those adolescents at greatest risk of disease. Respondents' preferences for the overall best fit appear to prioritize ease of implementation over epidemiologic patterns.
Adolescent↗
Growth, development, and failure to thrive: factors that underlie the availability of pediatric critical care facilities in the United States.
OBJECTIVE: Pediatric intensive care units (PICUs) have grown in number and size over time in aggregate across the United States, but the factors promoting such changes have not been well characterized. This study was conducted to explore the establishment, expansion, and closure of PICUs. DESIGN: A cross-sectional in-depth telephone interview survey of executive hospital administrators. SETTING: Fourteen institutions representing four newly established PICUs, two PICU expansions, and eight PICU closures. MEASUREMENTS AND MAIN RESULTS: Officials' comments indicate that the establishment of PICUs is driven primarily by the need to care for patients requiring intensive cardiorespiratory monitoring and/or postoperative surgical care and to respond to the needs of outlying community hospitals. The main factors that drive PICU expansion are institutional growth in pediatric subspecialist medical and surgical support for critically ill patients and the need to match increases in demand and patient volume experienced by existing PICUs. With regard to PICU closures, competition from other institutions within the same market for patients and subspecialty care providers, lower-than-expected volumes of patients, and/or negative financial margins were cited as key factors. CONCLUSIONS: This study provides new insight into decision-making that influences the availability of critical care services for children. The establishment, expansion, and closure of PICUs are driven predominantly by local demand for pediatric critical care services, whereas availability of subspecialists as well as competition between PICUs within the same market affect the long-term sustainability of such services.
Child↗
Characteristics and outcomes of interhospital transfers from level II to level I pediatric intensive care units.
OBJECTIVE: To examine the characteristics, resource utilization, and outcomes for transfer admissions from level II to level I pediatric intensive care units (PICUs). DESIGN: Retrospective study. SETTING: A 16-bed level I PICU in a tertiary care children's hospital. PATIENTS: All transfer admissions from level II PICUs from January 1, 1997, through December 31, 2003; admissions for cardiac surgery were excluded. Patient characteristics, resource utilization, and outcomes were described and then compared across predefined strata (low <5%, moderate 5-30%, and high >30%) of predicted probability of death. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 168 transfer admissions, 45%, 30%, and 25% were in the low, moderate, and high mortality risk groups, respectively. Length of stay at the referring PICU was shortest for the high-risk admissions. The most frequent diagnoses among all risk groups were respiratory failure (49%) and sepsis (14%). High-risk admissions were more likely to receive advanced therapies such as extracorporeal membrane oxygenation (41.5% high risk vs. 39.2% moderate vs. 6.6% low risk, p < .01) and renal replacement therapy (34.2% vs. 17.7% vs. 2.6%, p < .01). The high-risk admissions had longer PICU length of stay and the highest death rates (34% vs. 10% vs. 4%, p < .01) when compared with the moderate- and low-risk admissions, respectively. CONCLUSIONS: This study highlights significant differences in patient characteristics, resource utilization, and outcomes across mortality risk-stratified groups of critically ill and injured children transferred from level II to level I PICU care. Further studies are warranted to investigate decision making that prompt inter-PICU transfers.
Female↗
Detection of maternal alcohol use problems in the pediatric emergency department.
BACKGROUND: Maternal alcohol use problems may impact the health and well-being of children, but often remain unrecognized. Mothers of young children seldom seek outpatient care for themselves; thus, pediatric settings may present an opportunity for the detection of maternal alcohol use problems. This study examines the feasibility of screening for and prevalence of alcohol use problems in mothers of young children in the context of seeking pediatric emergency care. We also examined the relationship of maternal alcohol use problems with use of pediatric emergency care. METHODS: A total of 361 English-speaking mothers of children aged 7 and younger completed screening measures during their child's emergency care visit. TWEAK was used to screen for alcohol use problems. The screening survey also included information on children's health status and health care use, demographics, and the Center for Epidemiological Studies Depression Scale. RESULTS: Of the women approached, 90% agreed to complete the screening measure. On the basis of cutoff score of 2 or more, 7% of women had elevated TWEAK scores. Those women with a TWEAK score > 2 reported greater use of the pediatric emergency department (PED) than women scoring below the cutoff. On the basis of multivariate analyses, significant predictors of recent PED use included the presence of child chronic illness, younger maternal age, and TWEAK score. CONCLUSIONS: Screening for alcohol use problems among mothers of young children using the TWEAK appears to be feasible in a busy PED setting. The PED setting is promising for identifying risk drinking among women who may be less likely to be otherwise detected and for whom alcohol use may be impacting child outcomes.
Adolescent↗
Physicians' attitudes and practices regarding adherence to medical regimens by patients with chronic illness.
Health professionals often do not detect nonadherence despite substantial adverse impacts on health-care delivery and costs. We sought to determine how physicians assess and manage adherence among patients with chronic illness, and whether approaches to nonadherence differ by level of clinical training or prior training regarding adherence. Two-hundred seventeen pediatricians and internists completed an Internet-based survey. Responses demonstrated that few had previous formal training regarding patient adherence. Physicians' assessment of nonadherence and knowledge and skills regarding strategies for improving adherence appeared significantly more advanced among physicians with more clinical experience and among those with formal training in adherence assessment and management. Formal educational interventions may improve adherence-related knowledge and skills.
Attitude of Health Personnel↗