Biomedical subjects

Matthew M Davis

Publications and source records attributed to Matthew M Davis.

58 records · Page 4Linked to original sources

PubMedDate not supplied

Coverage of vaccines in private health plans: what does the public prefer?

Underinsurance for recommended vaccines in private health plans may affect 15 percent of children and more than 30 percent of adults. We conducted a nationally representative, Web-based study using health plan vignettes to determine adults' willingness to bear marginally higher plan premiums, to assure plan coverage of new vaccines as they are recommended for children and adults. Our results indicate a broad willingness (more than 75 percent of respondents) to pay the higher premiums. Such willingness was associated strongly with perceptions of vaccines' effectiveness and safety. Policymakers, physicians, and public health officials should examine health plan enrollees' preferences as they consider remedies for vaccine underinsurance.

Adult↗

PubMedDate not supplied

One-year uptake of pneumococcal conjugate vaccine: a national survey of family physicians and pediatricians.

BACKGROUND: Pneumococcal conjugate vaccine (PCV7) was recommended by June 2000 for administration to all US children </=23 months old and to children at high risk for pneumococcal disease 24 to 59 months old. We sought to identify physician characteristics associated with adoption of the recommendation within 1 year. METHODS: We conducted a cross-sectional mail survey from April to July, 2001, of 788 family physicians (FP) and 833 pediatricians (PD) in 24 states. We measured whether physicians had adopted PCV7 recommendations, their expectations of the effectiveness of PCV7, the number of vaccine injections they would consider administering at 1 visit, and barriers to administering multiple injections. RESULTS: Response rate was 60%. Overall, 87% of physicians had adopted PCV7 recommendations (68% FP; 99% PD; P <.001). FP adopters are significantly more likely than nonadopters to believe PCV7 will be effective in preventing pneumococcal sepsis and meningitis, as well as >25% of cases of otitis media. In multivariable logistic regression analyses of adoption of PCV7, FP who have higher proportions of African American patients and patients on Medicaid, see greater numbers of newborns, work in practices of >/=4 physicians, and are willing to consider administering at least 4 vaccine injections at 1 visit are significantly more likely to have adopted PCV7. Concerns about vaccine cost and reimbursement were the most commonly cited factors in physicians' decisions not to adopt PCV7 recommendations. CONCLUSIONS: One year after PCV7 was recommended, nearly all pediatricians and a majority of family physicians had incorporated this vaccine into their practices. Barriers to higher rates of uptake-especially among family physicians-must be addressed to achieve immunization goals with this new vaccine.

Attitude of Health Personnel↗

PubMedDate not supplied

Adult fat intake associated with the presence of children in households: findings from NHANES III.

BACKGROUND: Increasing prevalence of obesity and lifestyle related chronic disease is fundamentally tied to Americans' poor eating habits. Family environment, including the presence of children, may affect adults' diet behavior. OBJECTIVE: To compare dietary fat intake between adults with and without minor children in the home. DESIGN: Secondary analysis of cross-sectional survey data from the National Health and Nutrition Examination Survey III (NHANES III) public use dataset. SUBJECTS: Adults aged 17 to 65 years with and without children younger than 17 years old in the home. OUTCOME VARIABLES: Intake of total fat, saturated fat, and kilocalories based on a 24-hour dietary recall and a selection of high-fat foods from a food frequency questionnaire. METHODS: Linear and logistic regression, accounting for the sample weights and complex survey design. RESULTS: The presence of children in the household was associated with significantly higher adjusted total fat consumption for adults (4.9 g/24 hours [95% CI: 0.8, 9.1]) and significantly higher adjusted saturated fat consumption (1.7 g/24 hours [0.3, 3.3]). Adults with children ate many high-fat foods more frequently than adults without children, including salty snacks, pizza, cheese, beef, ice cream, cakes/cookies, bacon/sausage/processed meats, and peanuts. CONCLUSIONS: The presence of children in the home may affect adults' diets. Providers should emphasize dietary discretion for the entire family.

Adolescent↗

PubMedDate not supplied

Expected adverse events in a mass smallpox vaccination campaign.

CONTEXT: Recent anthrax attacks in the United States have raised concern about the nation's vulnerability to a smallpox attack. Many strategies have been suggested to minimize the impact of such an attack, ranging from quarantine and vaccination of case contacts to resumption of routine vaccination. Before the latter strategy is adopted, an understanding of the likely consequences of mass vaccination is essential. COUNT: Number of adverse events resulting from two vaccination campaigns: vaccinating persons 1 to 29 years of age and vaccinating those 1 to 65 years of age. CALCULATION: Number of adverse events = incidence rate of adverse events x number vaccinated. We assumed 75% vaccine uptake in the target group (i.e., we estimated that about 25% of potential vaccine recipients would be excluded because they are, or have close contact with, individuals who have eczema or are immunocompromised). DATA SOURCE: Historical data on the incidence of adverse events from smallpox vaccination were identified by a literature search. Number vaccinated was drawn from the January 2000 U.S. Census estimate. RESULTS: Fever (<1 case per 5 vaccine recipients) and rash (<1 case per 100 vaccine recipients) would be the most common adverse events. Serious adverse events, including encephalitis (<3 cases per million) and death (<2 cases per million), although rare, would be more common than with other currently recommended vaccines. After excluding high-risk individuals and their contacts, we estimate that a vaccination strategy directed at people aged 1 to 29 years would result in approximately 1600 serious adverse events and 190 deaths. Vaccinating people aged 1 to 65 years would result in approximately 4600 serious adverse events and 285 deaths. LIMITATIONS: While advances in health care over the past three decades could mitigate vaccine complications, the increased number of unimmunized high-risk individuals (e.g., those with eczema or immune suppression) could increase complication rates. CONCLUSIONS: The decision to resume smallpox vaccination depends on weighing the likelihood of a smallpox attack and its anticipated mortality against expected harm from a mass immunization program. Smallpox vaccine has a higher complication rate than any other vaccine currently being used. Careful prevaccination exclusion of high-risk individuals and their close contacts would be essential to minimize complications of a mass vaccination campaign, although such exclusions necessarily mean that some proportion of the population will remain susceptible to smallpox.

Adolescent↗