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At least 1,603 records · Page 89Linked to original sources
PubMed1996

Variation in patient charges for vaccines and well-child care.

BACKGROUND: Several state and federal programs have attempted to boost immunization rates by reducing or eliminating provider vaccine costs. The relation between patient vaccine and well-child visit charges and vaccine financing systems is unknown. OBJECTIVES: To determine patient charges for vaccines and well-child visits in three states with varying vaccine financing systems and to examine the effects of a short-term reduction in provider vaccine costs. DESIGN: Cross-sectional survey study of a random sample of physicians in three states. PARTICIPANTS: A total of 2797 pediatricians and family physicians in North Carolina, Texas, and Massachusetts were surveyed. MAIN OUTCOME MEASURES: Current charges to patients for diphtheria-tetanus-pertussis vaccine (DTP), measles-mumps-rubella vaccine, Haemophilus influenzae type b vaccine (Hib), and combined DPT-Hib vaccine for well-child visits; changes in charges over the previous 8 months. RESULTS: Response rate was 62%. Vaccine and well-child visit charges were comparable in North Carolina and Texas. Massachusetts' average charges for well-child visits were higher than in the other states, although vaccine charges were lower; with the use of combined DPT-Hib vaccine, total simulated charges for vaccines and well-child care during the first 6 months of life averaged only 10% less in Massachusetts vs Texas and North Carolina. Neither regional variation in cost of living nor Medicaid reimbursement rates explained this difference. CONCLUSIONS: The average cost and composition of charges for well-child care in Massachusetts, a state with universal purchase of vaccines, compared with the other states, warrant further study to explore whether physicians shift costs to other preventive services to compensate for lower allowable immunization charges. If such cost shifting occurs, current federal immunization initiatives that lower or eliminate provider cost may not provide increased access to preventive services.

Child↗
PubMed1996

Combining New Immune Therapies with Traditional Endometriosis Treatment

Surgical treatment of endometriosis removes endometrial implants, but leaves the systemic disease intact. The diagnosis of the disease includes (needle) microlaparoscopy with conscious pain mapping under local anesthesia. Treatment is operative laparoscopy to remove endometrial implants and immune therapy for the systemic disease. The immune treatment program consists of oral tolerization, immune supplement, and diet changes. According to case studies, this therapy looks promising. Multicenter, controlled, long-term studies are warranted.

Journal Article↗
PubMed1998

An assessment of the value of Haemophilus influenzae type b conjugate vaccine in Asia.

Haemophilus influenzae type b (Hib) is a leading cause of bacterial meningitis and pneumonia. Although invasive Hib disease has been reduced substantially wherever Hib conjugate vaccines have been introduced into routine childhood immunization schedules, these vaccines are more costly compared with the vaccines routinely used in the Expanded Program for Immunization. Consequently a model was constructed to compare the expected burden of Hib disease with and without a national vaccine program for various Asian countries. Cost of the vaccine program, expected benefits of reduced deaths and savings from prevented disease treatment were assessed for each country based on the model assumptions. Model outcomes were expressed as a net cost, cost per death prevented and cost per disability-adjusted life year for each country and economic stratum. With the assumption of a disease burden of meningitis and pneumonia comparable with that observed in other regions, the model predicts that 668000 cases of Hib pneumonia and 136000 cases of Hib meningitis would occur annually in this cohort resulting in 156000 deaths. Based on current vaccination coverage rates for the individual countries, the model predicted that approximately 136000 (87%) Hib deaths could be prevented annually with incorporation of Hib vaccine into the Expanded Program for Immunization. For each of the countries considered, routine vaccination with Hib would cost between 0.1 and 3.0% of per capita gross national product per child <5 years of age. Although Hib vaccine would be considered a cost-effective public health intervention, it may be cost-prohibitive to implement in the lowest income countries without initial donor assistance.

Asia↗
PubMed1999

A fundamental shift in the approach to international health by WHO, UNICEF, and the World Bank: instances of the practice of "intellectual fascism" and totalitarianism in some Asian countries.

Navarro has used the term "intellectual fascism" to depict the intellectual situation in the McCarthy era. Intellectual fascism is now more malignant in the poor countries of the world. The Indian Subcontinent, China, and some other Asian countries provide the context. The struggles of the working class culminated in the Alma-Ata Declaration of self-reliance in health by the peoples of the world. To protect their commercial and political interests, retribution from the rich countries was sharp and swift, they "invented" Selective Primary Health Care and used WHO, UNICEF, the World Bank, and other agencies to let loose on poor countries a barrage of "international initiatives" as global programs on immunization, AIDS, and tuberculosis. These programs were astonishingly defective in concept, design, and implementation. The agencies refused to take note of such criticisms when they were published by others. They have been fascistic, ahistorical, grossly unscientific, and Goebbelsian propagandists. The conscience keepers of public health have mostly kept quiet.

Asia↗
PubMedDate not supplied

Childhood immunizations: a parent education and incentive program.

This article describes some strategies to help reduce the immunization barriers of parental knowledge deficits and transportation costs through a parent education and incentive program. A record review of 471 children in 22 licensed Norfolk, Virginia, day-care centers revealed that 141 (29.9%) had inadequate age-appropriate immunizations. Educational programs included depictions of preventable communicable diseases and their consequences. Upon completion of appropriate immunizations, parents received transportation vouchers and gifts. By June 2000, 255 parents, day-care administrators, teachers, and staff had participated in educational programs and seven day-care centers earned certificate awards for improved immunization rates among enrollees. Four centers had 100% age-appropriate immunization rate, and three had a rate of 92% to 95%.

Child↗
PubMed2004

Reducing overall health care costs for a city municipality: a real life community based learning model.

City municipalities implementing health and wellness programs patterned after North Little Rock, Arkansas, can significantly reduce the cost of health care for employees, as well as reduce costs associated with workers' compensation claims and lost time caused by injury. In addition to primary care services, effective programs include health risk assessments through pre-placement physicals, employee physicals, drug screening, employee health and wellness promotion programs, and immunization and registry. In implementing the program, a team from the University of Arkansas for Medical Sciences College of Nursing worked with city officials to establish a steering committee, safety initiatives through first responders, systems for monitoring immunizations, criteria for pre-placement physicals, and an employee health and wellness program. While the benefits for the city are well documented, the contract also created opportunities for education, research, and services in a real life community based learning laboratory for students in the College of Nursing. In addition, it provided opportunities for faculty to participate in faculty practice and meet the College's service missions. The College's model program holds promise for use by other major health care centers across the region and nation.

Arkansas↗
PubMed2006

Pathogen escape from host immunity by a genome program for antigenic variation.

The vector-borne bacterium Borrelia hermsii, a relapsing fever agent, switches gene expression of a surface protein between different antigenic variants, thereby causing sequential waves of immune escape within hosts and increasing the likelihood of transmission. Analogous programmed systems of antigenic variation occur in African trypanosomes and Plasmodium falciparum. In these examples, switch rates to individual variants differ over a wide range. We studied how B. hermsii determines switch rates in two experimental infections: one where variants were identified by specific antisera and one based on identification by DNA sequence. Unexpressed loci of variant antigens copy into a single expression site at rates determined by extragenic features of silent loci rather than similarity between coding sequences of variants at silent sites and the single expression site. Two elements, in particular, determine switch rates. One set of elements overlaps the 5' ends of the expressed gene and the silent loci; greater sequence identity between elements was associated with a higher switch rate. The second set of elements flanks the expression site on the 3' side and occurs at variable distances downstream from silent loci; the nearer an element to a silent locus, the greater the switch rate of that locus into the expression site. In combination, these two features of the genome provide a simple mechanism to modulate switch rate whereby silent loci form a hierarchy of switch rates into the expression site. Although the switching hierarchy causes changes in individual cells that are stochastic, ordering of variants within hosts is semipredictable.

Animals↗
PubMed2006

Community-based strategies to reduce childhood immunization disparities.

This study demonstrates how community-based immunization promotion reduced immunization disparities. In 2002 to 2004, the coalition enrolled 3,748 children younger than 5, with 1,502 aged 19 to 35 months in April 2004. Disparity reduction was assessed by comparing coalition immunization coverage rates (4:3:1:3:3) to the National Immunization Survey 2003 rates. Logistic regression was used to assess factors contributing to up-to-date immunizations. Coverage increased from 46.0% at enrollment to 80.5%, matching nationwide rates for all (t = 0.87) or White (t = 1.99) children. The 78% for African Americans was higher than 73% for U.S. African American children (t = 2.90); 84% for Latinos was higher than 77% for U.S. Latinos (t = 2.32). Being current with age-appropriate immunizations at enrollment (OR = 9.8), being Latino (OR = 1.6), and participating through child health insurance enrollment (OR = 4.9), Women, Infants, and Children (OR = 3.1), or child care or parenting (OR = 1.9) programs increased immunization coverage. Embedding immunization promotion into existing community programs was successful in eliminating immunization disparities. Most effective programs were those with direct linkages to health care systems or that targeted young children.

Child, Preschool↗
PubMed2003

Seroprevalence of rubella in school girls and pregnant women.

Many studies have been assigned to investigate the surveillance of congenital rubella syndrome, acquired rubella and seroprevalence in different countries to determine the new vaccination program and national vaccination schedules. Seroprevalence of rubella in Turkey is still insufficient and national immunization schedules do not include routine rubella vaccination. In this study we aimed to investigate the seroprevalence of rubella at child bearing age in an unvaccinated population in Adana, southern Turkey, to help determine whether routine rubella vaccination is necessary, if so when it should be administered. Ninety-four school girls aged 12-18 years living in Adana were selected for the study and stratified according to the socioeconomic status of their parents and evaluated for rubella antibodies. One hundred pregnant women aged 18-25 years and 100 pregnant women aged 26-35 years were sampled rubella antibodies. Rubella specific IgG antibody was measured qualitatively and quantitatively by using microparticule enzyme immune assay technology. Rubella specific IgG antibody was positive in 87-94 school girls (92.5%). The geometric mean rubella specific IgG antibody value was found be 148.14 IU/ml. No correlation was found between socioeconomic status and rubella seropositivity (p = 0.6521). In all pregnant women rubella specific IgG antibody was found to be positive. In conclusion rubella vaccination should be considered carefully in developing countries. Because of the high seropositivity to rubella in our region we do not recommend rubella vaccination in early childhood. Yet this is a preliminary study and further studies with larger population size are needed to determine the national immunization policy for rubella.

Adolescent↗
PubMed2000

[Investigation of immunization status in children of floating population in Henan Province].

OBJECTIVE: To understand the immunization status in children of floating population in Henan Province. METHODS: Floating people was divided into four types based on their geographical distribution and characteristics of settlement and randomly sampled from each type in 17 cities and prefectures of Henan Province. Immunization status was investigated in 2,141 children from floating population by household visits. RESULTS: Immunization coverage in children of floating population was less than 60% and coverage of complete immunization with four kinds of vaccine was only 32%, far lower than that in local children. Coverage for children in large-size bazaars and construction sites and from peddlers' families was the lowest, 20.8% and 25.1%, respectively, which indicated that immunization for children in floating population had restricted the in-depth development of Expanded Program on Immunization (EPI) in Henan Province. The main reasons for that were floating population had no stable residence and job. The key problems in immunization for floating population at present were their unawareness of EPI, lack of initiative and certain defects in EPI service existed in some areas. CONCLUSION: It is necessary to strengthen publicity for immunization, to improve the mode of EPI service and to enhance the management in immunization for floating population.

Child, Preschool↗
PubMed2001

Disseminating effective health promotion programs from prevention research to community organizations.

Promising programs developed through health promotion and disease prevention research are not always disseminated to the agencies, organizations, and individuals that can benefit from them most. Systematic and practical approaches to dissemination are needed to ensure that effective programs more often reach end users in communities. This article describes six steps used in translation and dissemination of the ABC Immunization Calendar program to public health centers in St. Louis, Missouri. The authors discuss how one health center successfully adopted this program and provide recommendations for other researchers seeking to disseminate innovative, effective health promotion programs.

Community Health Services↗
PubMed2003

[Maternal and childhood immunization in developing countries: success, problems and new approaches].

A quarter century after implementation of the Expanded Program of Immunization by the WHO, partner organizations and member states, significant progress has been made towards eradication of poliomyelitis, elimination of neonatal tetanus, and control of measles. Problems remain due to difficulties involved in extending immunization coverage to some regions (Africa), integrating new vaccines into routine immunization schedules and securing sufficient funding for programs. Injection safety is also a major problem that should be resolved by utilization and proper disposal of single-use auto-disabling syringes. The forthcoming availability of new vaccines on the market and the action of the Global Alliance for Vaccines and Immunization hold reasonable hope for the future.

Adult↗
PubMed2006

Genetic disorders of programmed cell death in the immune system.

Human genetics offers new possibilities for understanding physiological regulatory mechanisms and disorders of the immune system. Genetic abnormalities of lymphocyte cell death programs have provided insights into mechanisms of receptor biology and principles of immune homeostasis and tolerance. Thus far, there are two major diseases of programmed cell death associated with inherited human mutations: the autoimmune lymphoproliferative syndrome and the caspase-eight deficiency state. We describe the details of their molecular pathogenesis and discuss how these diseases illustrate important concepts in immune regulation and genetics.

Apoptosis↗
PubMed2025

HLA-E and NKG2A Mediate Resistance to BCG Immunotherapy in Non-Muscle-Invasive Bladder Cancer.

Bacillus Calmette-Gu&#xe9;rin (BCG) is the first-line therapy for high-grade non-muscle-invasive bladder cancer (NMIBC), yet many patients experience recurrence due to immune evasion. We identify HLA-E and NKG2A as mediators of adaptive resistance involving chronic activation of NK and T cells in BCG-unresponsive tumors. Prolonged IFN-&#x3b3; exposure enhances HLA-E and PD-L1 expression on recurrent tumors, accompanied by the accumulation of NKG2A+ NK and CD8 T cells. HLA-Ehigh tumor cells preferentially cluster near CXCL12-rich stromal regions with dense effector cell presence, underscoring a spatially segregated tumor architecture. Although cytotoxic lymphocytes retain effector potential, their activity is restrained by HLA-E/NKG2A and PD-L1/PD-1 pathways located in their immediate neighborhood within the bladder tumor microenvironment. These data reveal a spatially organized immune escape program that limits anti-tumor immunity. Our findings support dually targeting NKG2A and PD-L1 checkpoint blockade as a rational, bladder-sparing strategy for patients with BCG-unresponsive NMIBC.

BCG-unresponsive↗
PubMed2001

Preimmunization anti-pneumococcal antibody levels are protective in a majority of patients with cystic fibrosis.

OBJECTIVE: Although invasive pneumococcal disease is infrequent in cystic fibrosis (CF), it is recommended that all patients with CF receive pneumococcal immunization. As part of a comprehensive program to immunize our clinic population, we obtained preimmunization anti-pneumococcal antibody levels. We hypothesized that the percentage of CF patients without protective levels of anti-pneumococcal antibody levels would be high, as they are exposed to frequent antibiotic therapy that may eradicate organisms before generation of an antibody response. METHODS: An observational study of 100 patients with CF, aged 1 to 39 years, was conducted in a regional CF center. Preimmunization anti-pneumococcal antibody levels against 6 serotypes were measured by enzyme-linked immunosorbent assay. Protective antibody levels were defined as >200 ng/mL. RESULTS: A majority of CF patients-61% to 100%, depending on age and serotype-had protective levels of pneumococcal antibody. There was a significant positive correlation between antibody level and age for 5 of the 6 serotypes tested. CONCLUSIONS: In contradistinction to our hypothesis, the majority of CF patients have protective preimmunization anti-pneumococcal antibody levels. However, a significant proportion-between 17% and 39%, depending on the serotype-did not exhibit adequate levels. Therefore, we concur with current recommendations for pneumococcal immunization in CF.

Adolescent↗