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R J Jacobs

Publications and source records attributed to R J Jacobs.

At least 19 recordsLinked to original sources
PubMed2005

Do too many shots due lead to missed vaccination opportunities? Does it matter?

BACKGROUND: Missed childhood vaccination opportunities have been generally described, yet not since the immunization schedule's recent rapid expansion. Little is known about the relationship between the number of vaccine doses due and whether all scheduled doses are administered, and the effect of dose deferral on immunization coverage. METHODS: 32 private pediatrics centers reviewed medical records covering the first 2 years of life for 858 patients. For each visit during ages 2-8 months, we determined the numbers of vaccine doses due versus administered. Logistic regression was used to assess the effect of dose deferral on immunization coverage at ages 1 and 2 years. RESULTS: Of 2224 visits during ages 2-8 months at which > or =1 dose was administered, > or =1 due dose was deferred at 26%, 34%, and 48% of the visits at which < or =3, 4, and 5 doses were due, respectively. Absence of a deferred dose visit predicted increased coverage at age 1 (adjusted odds ratio: 2.4, 95% confidence interval: 1.8-3.2) and 2 years (2.1, 1.4-3.0). CONCLUSIONS: Administering some but not all vaccine doses at visits during ages 2-8 months impairs immunization coverage through age 2 years.

Female↗
PubMed2001

Comparative cost effectiveness of varicella, hepatitis A, and pneumococcal conjugate vaccines.

BACKGROUND: Several state and local U.S. governments are considering making varicella, hepatitis A, and/or pneumococcal conjugate vaccination conditions of day care or school entry. These requirements will likely be issued sequentially, because simultaneous mandates exacerbate budget constraints and complicate communication with parents and providers. Cost-effectiveness assessments should aid the establishment of vaccination priorities, but comparing results of published studies is confounded by their dissimilar methods. METHODS: We reviewed U.S. cost-effectiveness studies of childhood varicella, hepatitis A, and pneumococcal conjugate vaccines and identified four providing data required to standardize methods. Vaccination, disease treatment, and work-loss costs were estimated from original study results and current prices. Estimated life-years saved were derived from original study results, epidemiological evidence, and alternative procedures for discounting to present values. RESULTS: Hepatitis A vaccine would have the lowest health system costs per life-year saved. Varicella vaccine would provide the greatest reduction in societal costs, mainly through reduced parent work loss. Pneumococcal conjugate vaccine would cost twice the amount of varicella and hepatitis A vaccines combined and be less cost effective than the other vaccines. CONCLUSIONS: Hepatitis A and varicella vaccines, but not pneumococcal conjugate vaccine, meet or exceed conventional standards of cost effectiveness.

Chickenpox Vaccine↗
PubMed2001

Transmission of hepatitis A through household contact.

In the USA, cost effectiveness assessments support childhood hepatitis A vaccination in geographical areas with elevated disease rates, but not nationally. However, these studies do not address the reduction in disease transmission which may result from routine childhood vaccination. Using decision analysis, we estimated the number and age distribution of secondary hepatitis A cases occurring within households with an index case. Based on the age of the index case, we determined household size and age composition, the proportion of household members susceptible to hepatitis A, the probability of disease transmission, and the likelihood secondarily infected household members would exhibit symptoms. Our model indicates that for every 100 index cases age 6-11 years, 47.2 secondary infections would occur within households, with 23.1 causing overt disease. Lower transmission rates for older index cases reflect smaller household sizes and a higher proportion of household contacts with hepatitis A immunity. When disease transmission rates are applied to a model simulating lifetime risks of hepatitis A, universal vaccination of an annual USA birth cohort is estimated to prevent 24 100 cases of overt disease among household contacts in addition to 71 000 cases among vaccinees. Sensitivity analysis provides a wide range of estimates, but even conservative assumptions suggest routine vaccination would yield an important reduction in secondary cases. Evaluations of hepatitis A prevention should consider the ability of immunization to protect household and other personal contacts.

Adolescent↗
PubMed2001

Economic value to parents of reducing the pain and emotional distress of childhood vaccine injections.

BACKGROUND: One reason that recommended childhood immunizations due at child health visits are deferred is to avoid the pain and emotional distress associated with the increasing number of injections required. This deferral leads to additional visits and costs and reduced immunoprotection against vaccine-preventable illnesses. To assess the economic value of combination vaccines that address this problem, we surveyed parents to determine the amount they would be willing to pay to avoid the pain and emotional distress experienced by their infants from injections. METHODS: A self-administered questionnaire was completed within 24 h of the vaccinations by 294 parents of children ages 11/2 to 7 months receiving vaccine injections at 26 outpatient child health centers. The willingness-to-pay (WTP) method was used to estimate the intangible cost of the pain and emotional distress of the 1 to 4 injections their child had received. Parents were asked how much of their own money they would have paid to avoid these injections, without any compromise in the safety and efficacy of the vaccinations. RESULTS: Wide variations in WTP amounts were observed, ranging from median values of $10 to $25 and average values of $57.06 to $79.28 to avoid the pain and emotional distress associated with eliminating all injections at visits in which one to four injections were administered. Parents placed greater value on reductions that avoided all injections than on reductions that avoided only some injections. Overall the median cost per injection avoided was $8.14, and the mean was $30.28. CONCLUSIONS: Parents have strong preferences for limiting vaccine injections. The economic cost of the pain and distress associated with such injections, reflected in the amounts they report they would be willing to pay to avoid them, represents a substantial component of the cost of disease control through immunization.

Adult↗
PubMed2000

The cost-effectiveness of adolescent hepatitis A vaccination in states with the highest disease rates.

BACKGROUND: The Advisory Committee on Immunization Practices has recommended routine childhood hepatitis A vaccination in states and communities where the incidence of disease exceeds the national average, but most adolescents are currently unprotected from infection. OBJECTIVE: To estimate clinical and economic consequences of vaccinating adolescents against hepatitis A in the 10 states with the highest disease rates. DESIGN: Decision analysis was used to assess cost-effectiveness from societal and health system perspectives. Parameter estimates were obtained from national surveillance data, a study of hepatitis A cases, and an expert panel. MAIN OUTCOME MEASURES: Reduction in disease incidence; costs of vaccination, treatment, and work loss; years of life saved (YOLS); and costs per YOLS. RESULTS: In states with the highest disease rates, vaccination of adolescents against hepatitis A would reduce the lifetime risk of symptomatic infection from 3.3% to 0.7% and prevent loss of 2117 years of life. Vaccination of a single birth cohort would cost $30.9 million, yet treatment and work loss costs would decline $14.2 million and $23.8 million, respectively. Hepatitis A vaccination would cost the health system $7902 per YOLS or $13,722 per discounted YOLS. Results are most sensitive to variation in the discount rate and assumptions regarding long-term vaccine protective efficacy. CONCLUSIONS: Hepatitis A vaccination of adolescents in states with high disease rates would reduce costs to society. Although health system costs would increase, cost-effectiveness is comparable to other recommended vaccines and superior to many commonly used medical interventions. Arch Pediatr Adolesc Med. 2000;154:763-770

Adolescent↗
PubMed2000

The cost of hepatitis A infections in American adolescents and adults in 1997.

The incidence of hepatitis A has declined in the United States for several decades, leading to an increased number of susceptible adolescents and adults. Because clinical severity increases with age, hepatitis A infections in older individuals cause greater morbidity, mortality, and treatment costs. Because the economic burden of hepatitis A has not been well described, we estimated its costs, from the societal perspective, for patients infected at distinct ages. A case-series study described treatment patterns, work loss, and symptom duration. Disease outcomes were estimated by an expert panel. Economic losses were calculated by applying normative data reflecting treatment charges, employee compensation, and the value of housekeeping services. In the case-series study, mean treatment charges were $740 for nonhospitalized patients versus $6,914 for hospitalized patients (P <.001). Symptom duration (67.8 vs. 34.4 days, P <.001) and work loss (33.2 vs. 15.5 days, P <.01) were also greater for those hospitalized. Nationally, we estimate 63,363 symptomatic hepatitis A infections occurred among adolescents and adults during 1997, resulting in 8,403 hospital admissions and 255 deaths. Nearly 2.5 million days of symptomatic illness and 829,000 work-loss days resulted, and 7,466 years of life were lost. Under base-case assumptions, annual hepatitis A costs were estimated at $488.8 million. In sensitivity analyses, this estimate varied from $332.4 to $579.9 million. These costs may be reduced by regionally targeted vaccination of children, as recommended by the Advisory Committee on Immunization Practices, although the cost effectiveness of this policy has not yet been established.

Adolescent↗
PubMed2000

Evaluation of office-based intervention to improve prevention counseling for patients at risk for sexually acquired hepatitis B virus infection. Hepatitis B-WARE Study Group.

The aim of this study was to determine the effectiveness of tools to identify and counsel patients at risk for sexually transmitted hepatitis B virus infection. Physicians were randomly assigned to either an intervention group or a control group. The intervention group was provided with materials intended to encourage patients to return for counseling and to guide counseling concerning prevention of hepatitis B virus infection. Baseline data on 457 patients at risk for hepatitis B virus infection showed that 7% had received prevention counseling and 2% had begun hepatitis B vaccination. Counseling was least likely to occur in obstetric-gynecologic practices, among uninsured patients, and among patients whose only risk factor was a diagnosis of a sexually transmitted disease. After a 6-month intervention period 26% of the intervention group patients and 7% of the control group patients had been counseled (P <.01). Vaccination was more likely among intervention group patients (8% vs <1%; P <.001). The use of tools to identify and counsel patients at risk for sexually transmitted hepatitis B virus infection resulted in increased office-based prevention activities.

Adolescent↗
PubMed2000

Comparative safety of filgrastim versus sargramostim in patients receiving myelosuppressive chemotherapy.

STUDY OBJECTIVE: To compare rates of adverse events with filgrastim versus sargramostim when given prophylactically to patients receiving myelosuppressive chemotherapy. DESIGN: Retrospective review with center crossover. SETTING: Ten United States outpatient chemotherapy centers. PATIENTS: Four hundred ninety patients treated for lung, breast, lymphatic system, or ovarian tumors. INTERVENTION: Prophylactic use of filgrastim or sargramostim, with dosages at investigator discretion. MEASUREMENTS AND MAIN RESULTS: The frequency and severity of adverse events and the frequency of switching to the alternative CSF were assessed. There was no difference in infectious fever. Fever unexplained by infection was more common with sargramostim (7% vs 1%, p<0.001), as were fatigue, diarrhea, injection site reactions, other dermatologic disorders, and edema (all p<0.05). Skeletal pain was more frequent with filgrastim (p=0.06). Patients treated with sargramostim switched to the alternative agent more often (p<0.001). CONCLUSION: Adverse events were less frequent with filgrastim than with sargramostim, suggesting that quality of life and treatment costs also may differ.

Antineoplastic Agents↗
PubMed2000

Cost effectiveness of vaccinating food service workers against hepatitis A infection.

Foodborne transmission is an important means of hepatitis A infection that may be reduced through vaccination of food service workers (FSWs). Several states are considering actions to encourage or mandate FSW vaccination, but the cost effectiveness of such policies has not been assessed. We estimated the clinical and economic consequences of vaccinating FSWs from the 10 states with the highest reported rates of hepatitis A. A decision analytic model was used to predict the effects of vaccinating FSWs at age 20 years. It was assumed all FSWs would receive one dose of inactivated hepatitis A vaccine, and 50% would receive the second recommended dose. Parameter estimates were obtained from published reports and Centers for Disease Control and Prevention databases. The primary endpoint was cost per year of life saved (YOLS). Secondary endpoints were symptomatic infections, days of illness, deaths, and costs of hepatitis A treatment, public health intervention, and work loss. Each endpoint was considered separately for FSWs and patrons. We estimate vaccination of 100,000 FSWs would cost $8.1 million but reduce the costs of hepatitis A treatment, public health intervention, and work loss by $3.0 million, $2.3 million, and $3.1 million, respectively. Vaccination would prevent approximately 2,500 symptomatic infections, 93,000 days of illness, and 8 deaths. A vaccination policy would reduce societal costs while costing the health system $13,969 per YOLS, a ratio that exceeds generally accepted standards of cost effectiveness.

Adult↗
PubMed1999

Influence of age on the multifocal electroretinography.

The influence of age on the amplitude density (nV/sq deg) of the multifocal electroretinogram (ERG) was studied in 90 healthy subjects aged 18-52 years. Subjects were divided into three separate age groups; (i) 18-22 years (ii) 33-37 years and (iii) 48-52 years. Amplitude density of first order kernel of the multifocal ERG was measured for the three different age groups. When the whole response of the retina is considered, analysis of variance showed no significant differences in amplitude density between the three age groups. (ANOVA, df. 2, 87 F = 2.29, p = 0.11. However if the responses were segregated into a central area and concentric rings around the central area, analysis of variance showed that there were significant differences in responses between rings at different eccentricities and between different age groups (Anova F = 76.19, df. 17, 522, p = 0.00001). Post hoc analysis showed that the responses from the centre and the second ring around the centre of fixation for 48-52 year olds were significantly lower than those responses from the 33-37 year old and the 18-22 year old age groups. The decline in the multifocal ERG in the central retina of the 48-52 year olds could be associated with the decline of the number of photoreceptors as the eye ages. Student t test revealed no significant differences in amplitude density between males and females.

Adolescent↗
PubMed1999

Study of luminance effects on pinhole test results for visually impaired patients.

PURPOSE: The visual acuity of visually impaired patients has been reported to improve after a refraction, despite pinhole test results that show a decline or no change in acuity. Our aim was to investigate whether the pinhole-induced reduction in retinal illuminance accounted for these unreliable predictions of best-corrected acuity. METHODS: Participants were 64 adult patients referred for low-vision rehabilitation. Neutral density filters reproduced the pinhole-induced luminance loss, allowing pinhole test and postrefraction acuities to be measured at essentially equivalent levels of retinal illuminance. The following data were collected in random order from each subject's better eye: (1) habitual visual acuity, (2) habitual visual acuity with filter, (3) habitual visual acuity with pinhole, (4) best-corrected/postrefraction visual acuity, (5) postrefraction visual acuity with filter. RESULTS: On average, the pinhole test under-estimated postrefraction visual acuity by six letters (95% confidence limits = +/- 20). The pinhole test underestimated postrefraction visual acuity with the filter by two letters (95% confidence limits = +/- 16). Among subjects whose acuity improved with the pinhole test (N = 24), 83% experienced better postrefraction visual acuity. Among subjects whose acuity declined or remained unchanged with the pinhole test (N = 40), 50% achieved better postrefraction visual acuity. CONCLUSIONS: The pinhole-induced luminance loss contributed to inadequate predictions of postrefraction visual acuity. Pinhole test results were enormously variable, underestimating and overestimating postrefraction visual acuity. The pinhole test was less reliable when improvements in postrefraction visual acuity were small. Visually impaired patients deserve periodic refractions, and the pinhole test result should not be used as a dichotomizer for clinical decisions regarding the need for a refraction.

Adult↗
PubMed1997

The quality of life and employment in panic disorder.

Our purpose was to measure quality of life (QOL) and work productivity (WP) in persons with panic disorder. Eighty-four panic disorder patients with limited psychiatric comorbidity for ten U.S. outpatient mental health centers were evaluated in a cross-sectional design. Patients self-administered the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Work Productivity and Impairment (WPAI) questionnaire. The independent effects of psychiatric comorbidity were addressed through entry criteria, stratification, and regression analyses. QOL scores are significantly below age and sex-adjusted population norms on all SF-36 measures (p < .01). We note far greater impairment on measures of mental and emotional versus physical well-being. The unemployment rate among these patients is 25%, and only 57% are employed full-time. Those who are employed rated their WP as low. This sample of outpatients suffer marked QOL and employment impairment, which is only partially explained by the presence of psychiatric comorbidity.

Adult↗
PubMed1997

The effects of clonazepam on quality of life and work productivity in panic disorder.

Although panic disorder has been associated with impaired quality of life (QOL) and financial dependence, no prior study has examined whether a clinical intervention will improve these outcomes. This study examines the effects of clinically titrated doses of clonazepam versus placebo on QOL and work productivity (WP) in patients with panic disorder. QOL and WP were measured in conjunction with a randomized, double-blind, placebo-controlled trial. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Work Productivity and Impairment questionnaire were used to assess QOL and WP, respectively. Baseline assessments were obtained before randomizing patients to receive clinically titrated doses of clonazepam or placebo. Follow-up assessments were obtained after 6 weeks of therapy with the test drug or at premature termination from the study. Improvement on the SF-36 Mental Health Component Summary scale was more than twice as great with clonazepam than with placebo (P = 0.03). Clonazepam patients improved (P < 0.05) on all five measures of mental health-related QOL, and both measures of physical health-related QOL, and both measures of WP. Placebo patients improved on three of five measures of mental health-related QOL, but on no other measures. Patients with marked improvements on clinical measures of panic disorder severity, especially avoidance and fear of the main phobia, showed the greatest gains on the SF-36 Mental Health Component Summary scale. Clinically titrated doses of clonazepam significantly improved mental health-related QOL and WP in panic disorder patients. Lesser improvements were obtained with placebo.

Adult↗
PubMed1997

The repeatability and variability of the multifocal electroretinogram for four different electrodes.

Multifocal electroretinograms were recorded from twelve subjects on three separate days using the Visual Evoked Response Imaging System (VERIS). The subjects were 18-40 years-of-age. Each recording session was separated by an interval of between one and 16 weeks. Four electrode types were compared: the JET contact lens electrode, the gold foil electrode, the DTL thread electrode and the carbon fibre (c-glide) electrode. The b-wave amplitude density (nV/sq.deg) recorded with each electrode was measured. The mean amplitude density recorded at each session for each subject and each electrode was calculated and compared. There were no significant differences in amplitude density for the ERGs recorded with each type of electrode over the three days. The coefficient of variation for each electrode and each subject was then calculated using the results for the three days. The coefficients of variation for each electrode showed significant differences (One-way ANOVA: F = 4.51, d.f. = 3.44, P < 0.008). The c-glide electrode results had the highest variability and post hoc tests showed that its coefficient of variation was significantly different from those of the JET and gold foil electrodes but not from that of the DTL thread electrode.

Adolescent↗