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Biomedical subjects

T O Jefferson

Publications and source records attributed to T O Jefferson.

At least 19 recordsLinked to original sources
PubMed2001

Antivirals for the common cold.

BACKGROUND: The common cold is a ubiquitous short and usually mild illness for which preventive and treatment interventions have been under development since the mid-40s. As our understanding of the disease has increased, more experimental antivirals have been developed. This review attempts to draw together experimental evidence of the effects of these compounds. OBJECTIVES: To identify, assemble, evaluate and (if possible) synthesise the results of published and unpublished randomised controlled trials of the effects of antivirals to prevent or minimise the impact of the common cold. SEARCH STRATEGY: We searched electronic databases, corresponded with researchers and handsearched the archives of the MRC's Common Cold Unit (CCU). SELECTION CRITERIA: We included original reports of randomised and quasi-randomised trials assessing the effects of antivirals on volunteers artificially infected and in individuals exposed to colds in the community. DATA COLLECTION AND ANALYSIS: We included 241 studies assessing the effects of Interferons, interferon-inducers and other antivirals on experimental and naturally occurring common colds, contained in 230 reports. We structured our comparisons by experimental or community setting. MAIN RESULTS: Although intranasal interferons have high preventive efficacy against experimental colds (protective efficacy 46%, 37% to 54%) and to a lesser extent against natural colds (protective efficacy 24%, 21% to 27%) and are also significantly more effective than placebo in attenuating the course of experimental colds (WMD 15.90, 13.42 to 18.38), their safety profile makes compliance with their use difficult. For example, prolonged prevention of community colds with interferons causes blood-tinged nasal discharge (OR 4.52, 3.78 to 5.41). Dipyridamole (protective efficacy against natural colds 49%, 30% to 62%), ICI 130, 685 (protective efficacy against experimental colds 58%, 35% to 74% ), Impulsin (palmitate) (protective efficacy against natural colds 44%, CI 35% to 52% ) and Pleconaril (protective efficacy against experimental colds 71%, 15% to 90% ) appear to have important antiviral properties and are well-tolerated. The evidence of effectiveness of other compounds in the treatment of experimental or natural colds is sparse. REVIEWER'S CONCLUSIONS: There are no licensed effective antivirals for the common cold. Because prolonged intranasal administration causes a clinical picture which is not distinguishable from the common cold, interferons have no place in everyday use. Further assessment of the effects of dipyridamole, palmitate, ICI 130, 685, Impulsin and Pleconaril in preventing the common cold should be carried out. Given the multi-agent nature of the causes of the common cold, future research efforts should focus on non virus-specific compounds.

Administration, Intranasal↗
PubMed2000

Vaccines for preventing influenza in people with asthma.

BACKGROUND: Influenza vaccination is recommended for asthmatic patients in many countries as observational studies have shown that influenza infection can be associated with asthma exacerbations, but influenza vaccination itself has the potential to adversely affect pulmonary function. A recent overview concluded that there was no clear benefit of influenza vaccination in patients with asthma but this conclusions was not based on a systematic search of the literature. OBJECTIVES: Whilst influenza may cause asthma exacerbations, there is controversy about the use of influenza vaccinations, since they may precipitate an asthma attack in some people. The objective of this review was to assess the effects of influenza vaccination in children and adults with asthma. SEARCH STRATEGY: We searched the Cochrane Airways Group trials register and checked reference lists of articles. SELECTION CRITERIA: Randomised trials of influenza vaccination in children (over two years of age) and adults with asthma. Studies involving people with chronic obstructive pulmonary disease were excluded. DATA COLLECTION AND ANALYSIS: Inclusion criteria and assessment of trial quality were applied by two reviewers independently. Data extraction was done by two reviewers independently. Study authors were contacted for missing information. MAIN RESULTS: Nine trials were included. Four of these trials were of high quality. One further article has been included since the previous version of this review. Inclusion of the new trial has not altered the conclusions of this review. The included studies covered a wide diversity of people, settings and types of influenza vaccination, so data from the different trials were not pooled. In one trial, no protective effect of influenza vaccination against asthma exacerbation was demonstrated, but the incidence of influenza was low during the study period. A higher number of asthma exacerbations following killed influenza vaccination was found in one trial (risk difference 3 1%, 95% confidence interval 0.3% to 5.8%). When people with upper respiratory tract infections were excluded, this difference was no longer significant. A small trial using recombinant vaccine found no significant difference in asthma exacerbations between the vaccinated and placebo groups. REVIEWER'S CONCLUSIONS: There is not enough evidence to assess the benefits and risks of influenza vaccination for people with asthma.

Adult↗
PubMed2000

Amantadine and rimantadine for preventing and treating influenza A in adults.

OBJECTIVES: Amantadine hydrochloride and rimantadine hydrochloride have antiviral properties, but they are not widely used due to a lack of knowledge of their properties and concerns about possible adverse effects. The objective of this review was to assess the effects and safety of amantadine and rimantadine in healthy adults. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, Medline, Embase and reference lists of articles. We also contacted manufacturers, researchers and authors. SELECTION CRITERIA: Randomised and quasi-randomised studies comparing amantadine and/or rimantadine with placebo, control antivirals or no intervention, or comparing doses or schedules of amantadine and/or rimantadine in healthy adults. DATA COLLECTION AND ANALYSIS: For prevention trials the numbers of participants with clinically defined influenza, with serologically confirmed clinical influenza A and adverse effects were analysed. Analysis for treatment trials was of the mean duration of fever and adverse effects. MAIN RESULTS: Amantadine prevented 23% of clinical influenza cases (95% confidence interval 11% to 34%), and 63% of serologically confirmed clinical influenza A cases (95% confidence interval 42% to 76%) Amantadine reduced duration of fever by one day (95% confidence interval 0.7 to 1.3). Rimantadine demonstrated comparable effectiveness, but there were fewer trials and the results for prevention were not statistically significant. Both amantadine and rimantadine induced significant gastrointestinal adverse effects. Adverse effects of the central nervous system adverse and study withdrawals were significantly more common with amantadine than rimantadine. REVIEWER'S CONCLUSIONS: Amantadine and rimantadine have comparable effectiveness in the prevention and treatment of influenza A in healthy adults, although rimantadine induces fewer adverse effects than amantadine.

Adult↗
PubMed2000

Vaccines for preventing influenza in healthy adults.

OBJECTIVES: To identify, retrieve and assess all studies evaluating the effects of vaccines on influenza in healthy adults. To assess the effectiveness of vaccines in preventing cases of influenza in healthy adults. To estimate the frequency of adverse effects associated with influenza vaccination in healthy adults. SEARCH STRATEGY: MEDLINE was searched using the strategy of the Cochrane Acute Respiratory Infections Group. The bibliography of retrieved articles, the Cochrane Controlled Trials Register (CCTR), and EMBASE (1990 to 1997) were also searched. Handsearch of the journal Vaccine from its first issue to the end of 1997 (Jefferson and Jefferson, 1996; Jefferson, 1998). We wrote to vaccine manufacturers and first or corresponding authors of studies in the review. SELECTION CRITERIA: Any randomised or quasi-randomised studies comparing influenza vaccines in humans with placebo, control vaccines or no intervention, or comparing types, doses or schedules of influenza vaccine. Live, attenuated or killed vaccines or fractions thereof administered by any route, irrespective of antigenic configuration were considered. Only studies assessing protection from exposure to naturally occurring influenza in healthy individuals aged 14 to 60 (irrespective of influenza immune status) were considered. DATA COLLECTION AND ANALYSIS: Both clinically defined cases and serologically confirmed cases of influenza were considered as outcomes according to the authors' definitions. Time off work, complication and hospitalisation rates were considered, together with adverse effects. Vaccine schedules were analysed including one component matching the recommended vaccine (WHO or government recommendations) for the year of the study, and whether they matched the circulating viral subtypes. MAIN RESULTS: The recommended live aerosol vaccines reduced the number of cases of serologically confirmed influenza A by 48% (95% confidence interval 24% to 64%), whilst recommended inactivated parenteral vaccines had a vaccine efficacy of 68% (95% confidence interval 49% to 79%). The vaccines were less effective in reducing clinical influenza cases, with efficacies of 13% and 24% respectively. Use of the vaccine significantly reduced time off work, but only by 0.4 days for each influenza episode (95% confidence interval 0.1 to 0.8 days). Analysis of vaccines matching the circulating strain gave higher estimates of efficacy, whilst inclusion of all other vaccines reduced the efficacy. REVIEWER'S CONCLUSIONS: Influenza vaccines are effective in reducing serologically confirmed cases of influenza A. However, they are not as effective in reducing cases of clinical influenza. The use of WHO recommended vaccines appears to enhance their effectiveness in practice.

Adult↗
PubMed2000

The development of a health policy for the Army.

This paper describes the development of the Army Health Policy (AHP), which is a key component of the Army Human Resources Strategy (AHRS). The work on the AHP provided an opportunity for a fundamental review of the delivery of health support to the Army. The AHP will provide the strategic framework by which the Army will ensure the health of its workforce and, where appropriate, their dependents. The methodology used for this work may be a useful model for the development of a health policy for occupational populations.

Delivery of Health Care↗
PubMed1999

Assessing the potential cost effectiveness of pneumococcal vaccines in the US: methodological issues and current evidence.

Pneumococcal disease imposes a notable burden on society, particularly in the elderly and those at high risk of complications. Preventive strategies, especially vaccines, are possibly the best way to minimise such a burden. We report on the conduct and results of a preliminary exploratory review of the economics of pneumococcal vaccines in the elderly population in the US. After extensive electronic and manual searches, we identified 5 economic evaluations that fulfilled our study criteria. From these we extracted key economic variables and assessed the quality of the studies against the criteria in the checklist for authors and peer reviewers of economic submissions to the British Medical Journal. We found variation of quality of study design such as a lack of clarity in the treatment of indirect costs and a failure to present the data on resource use and costs separately. We carried out supplementary searches to assess the quality of the epidemiological and efficacy evidence upon which the economic models were based and found contradictory evidence of effects of the vaccines, which included the results of 2 meta-analyses. One of these meta-analyses reported that retrospective studies, especially case-control studies, tended to underestimate the protective efficacy of the vaccine by as much as 20%. We believe that a well resourced Cochrane review of the clinical evidence of the effects of the vaccines should be carried out before any further economic studies. No more economic modelling should take place before such a review is undertaken.

Bacterial Vaccines↗
PubMed1998

Morbidity surveillance in the British Army--the first 12 months.

This paper describes the data obtained during the first 12 months of the morbidity surveillance system used, world-wide, by the British Army in operational and non-operational settings and the economic impact of such morbidity in terms of estimated working days lost. Analysis is provided on primary health care and dental morbidity, the surveillance of patients undergoing physiotherapy and those Service personnel cared for by the NHS. The surveillance of the latter population shows a high burden of morbidity which, previously, has never been quantified. The most frequent cause of attendance within primary health care is injuries (all causes) with an annual total of 77,254--a rate per 1,000 personnel per month of 51.92. This leads to an annual loss of manpower, in terms of estimated working days lost of 127,839--a rate per 1,000 personnel per month of 85.91. Army Training Regiments (ATRs-5 sites), Infantry Training Centres (ITCs-2 sites) and the Royal Military Academy Sandhurst (RMAS) are grouped together as Selected Training Establishments (STEs) and show attendance rates higher than the mean for all causes. Summary results of Cochrane systematic reviews presenting up-to-date concise information on experimental evidence as to which preventive interventions should be used to diminish the notable impact of injuries on Army personnel are also given.

Absenteeism↗
PubMed1998

J95-EPINATO based planning parameters for medical support to Operations Other Than War (OOTW).

As with increasing frequency the armies of NATO member states deploy on Operations Other Than War (OOTW), there is a requirement to define predictory variables of consumption of healthcare assets by type and geographical location of operations. This report presents the results of the analysis of the J95/EPINATO database of operational and exercise deployments. Although the database is limited in size and scope results show a marked difference in rates of incidence of EVENTS and in the proportion of first attendances to working days lost, both in general and when analysed by deployment type. For instance Service Assisted or Protected Evacuations (SA/PE) showed a relatively high incidence of first attendances and low incidence of working days lost for all reasons (or EVENTS) (214.5 per 1,000 personnel at risk per month-95% Confidence Interval-CI: 198.8 to 230.3 and 23.9 working days lost per 1,000 personnel at risk per month-95% CI 18.0 to 29.8). The reverse is true for Counter Insurgency (COIN) type operations (111.55 per 1,000 personnel at risk per month-95% CI: 110.9 to 112.2 and 161.25 working days lost per 1,000 personnel at risk per month 95% CI: 160.5 to 162.0). Other findings include highest attendance rates in exercise deployments for all reasons (264.7 per 1,000 personnel per month 95% CI: 261.2 to 268.1), highest hospitalisation rates in exercise and PSO deployments for all reasons (8.7 per 1,000 personnel per month 95% CI: 7.9 to 9.4 and 9.9 per 1,000 personnel per month 95% CI: 9.6 to 10.1) and the seasonal pattern, high incidence and low manpower impact (26.2 per 1,000 personnel per month 95% CI: 25.9 to 26.5 and 3.5 per 1,000 personnel per month 95% CI: 3.4 to 3.6) of dermatological consultations on all operational deployments (the lowest of the spectrum being in COIN operations). No relationship was found between incidence of consultations, working days lost, hospitalisations and distance of the deployment from the UK. Deployments to Africa show the highest incident of attendances and working days lost for all reasons (530.7 per 1,000 personnel per month 95% CI: 524.2 to 537.3 and 106.5 per 1,000 personnel per month 95% CI: 102.5 to 110.6). The variability in epidemiological profiles in this analysis demonstrates the dangers of exclusive reliance on synthetic classifications of reasons for attendances such as the traditional DNBI breakdown and on point estimates of incidence. As the database expands, further analysis will become possible.

Databases, Factual↗
PubMed1996

Economic aspects of a small epidemic of hepatitis A in a religious community in Northern Italy.

We report on a small (11 cases) outbreak of hepatitis A (HA) which occurred in the village of Narzole in the province of Cuneo, Northern Italy. Cases were reported during the period December 1993-March 1994 and centred around a Christian community centre caring for broken homes. Eight cases were children aged 7-13 and three were adults. The incidence for all ages was 354.8 per 100,000 inhabitants. Due to local resistance to the investigation of the outbreak we were unable to identify the source of the outbreak. Marginal and average costs were identified during the outbreak using a proforma and include costs of the investigation. The mean costs per case were $7899 (average) and $1793 (marginal). The main cost generators were costs of care if average costs only are considered (81% of total costs) or loss of productivity if only marginal costs are calculated (60% of total marginal costs). Small epidemics such as the one described appear to use a considerable amount of health care and personal resources. However, when marginal and opportunity considerations are applied (value of opportunities foregone for alternative use of resources), such costs decrease. This is especially valid for all treatment costs, as the majority of hospital running costs are fixed. The small number of cases and the high hospitalization rate (100%) make the epidemic of uncertain extrapolation.

Adolescent↗
PubMed1996

Pilot study of the introduction of the J95 health data collection system.

J95 is a health data collection system aimed at gathering information on the weight of health problems facing the Army in order to allow rational and effective prioritization. Before implementing the system Army-wide, a pilot study has been undertaken to validate the J95 ICD 9-based classification system, to test the practical problems encountered with operating the system and its practical value to decision-makers. Both internal and external coding validity were tested in terms of agreement with a "gold standard' and in terms of repeatability and they scored highly. A number of problems were identified analysing discordances and using the comments raised by the participants. A final shortened version of the classification was developed accordingly. The report also contains a number of examples of the potential of the system which is due to be implemented by 1 January 1996.

Humans↗
PubMed1995

A panel priority rating exercise for the British Forces Germany Health Services Market test.

We report on the application to the BFG Health Services Market Testing (MT) study of the response to a users' questionnaire and panel discussions to determine in which priority and how services should be provided. The questionnaire served to inform lay and health care panel members on users' views on the relative importance of future health services and the way they will be provided. Based on the questionnaire results and data contained in the BAOR Report of Public Health for 1992/93 the panel assigned the highest priorities to emergency services, followed by routine General Practitioner services and essential hospital services. The lowest ranking were non-essential hospital services, health care for children with special needs and provision of designated transport. There was a high consistency in views between the lay and health care members of the panel.

Adult↗
PubMed1994

Should British soldiers be vaccinated against hepatitis A? An economic analysis.

We conducted a study to analyse the efficiency of introducing vaccination against hepatitis A to the schedule for troops in the British Army. The study design included a cost-effectiveness analysis (CEA) of cost per case avoided comparing active and passive immunization and a cost-benefit analysis (CBA). The study population comprised all British Army personnel as well as those soldiers assumed to be deployed to high-risk areas a variable number of times in 5 years. The average cost of one case of hepatitis A avoided by vaccination was calculated and compared with the average cost of achieving the same outcome by passive immunization. In a 5-year four-exposure scenario at a low incidence and using a 3% discount rate, avoiding one case of hepatitis A by vaccination would cost 52,865 pounds, against 97,305 pounds by passive immunization. The equivalent cost-benefit ratios are 13.4 for gammaglobulin and 7.2 for vaccine. For fewer exposures the break-even point for vaccine is two exposures in 4 years. Although our estimates are sensitive to direct costs and relatively sensitive to the estimated incidence, vaccinating troops against hepatitis A appears to be a more efficient procedure than passive immunization, especially as a long-term investment in troops likely to effect several operational deployments. Given the difficulty of forecasting which troops would deploy, the best-buy strategy may be vaccination of troops most likely to deploy repeatedly.

Cost-Benefit Analysis↗
PubMed1992

Cost-benefit analysis of the introduction of mass vaccination against hepatitis B in Italy.

The aim of the study was to evaluate the costs and benefits of introducing mass vaccination against hepatitis B in Italy, given the announcement of compulsory vaccination of all newborn babies from 1991. Benefits were calculated by summarizing the clinical course of hepatitis B in Italy and projecting its incidence rates to the next 30 years using Brown's exponential smoothing technique. Incidence rates were then applied to the survivors of a cohort of newborns in 1992, and the total number of cases avoidable through vaccination was derived. Direct and indirect marginal costs were estimated for these cases. The marginal costs of the vaccination campaign were estimated. Cost and benefits were compared for 99 years following the introduction of the vaccination, using an 8 per cent discount rate and a sensitivity analysis. Despite difficulties in data gathering, susceptibility to discounting and estimating costs, results show an unfavourable cost-benefit ratio which is influenced by a declining incidence of the disease. Vaccination of high-risk groups is probably more efficient.

Cost-Benefit Analysis↗