The efficacy and cost effectiveness of vaccination against influenza among elderly persons living in the community

BACKGROUND: Despite recommendations for annual vaccination against influenza, more than half of elderly Americans do not receive this vaccine. In a serial cohort study, we assessed the efficacy and cost effectiveness of influenza vaccine administered to older persons living in the community. METHODS: Using administrative data bases, we studied men and women over 64 years of age who were enrolled in a large health maintenance organization in the Minneapolis-St. Paul area. We examined the rate of vaccination and the occurrence of influenza and its complications in each of three seasons: 1990-1991, 1991-1992, and 1992-1993. Outcomes were adjusted for age, sex, diagnoses indicating a high risk, use of medications, and previous use of health care services. RESULTS: Each cohort included more than 25,000 persons 65 years of age or older. Immunization rates ranged from 45 percent to 58 percent. Although the vaccine recipients had more coexisting illnesses at base line than those who did not receive the vaccine, during each influenza season vaccination was associated with a reduction in the rate of hospitalization for pneumonia and influenza (by 48 to 57 percent, P < or = 0.002) and for all acute and chronic respiratory conditions (by 27 to 39 percent, P < or = 0.01). Vaccination was also associated with a 37 percent reduction (P = 0.04) in the rate of hospitalization for congestive heart failure during the 1991-1992 season, when influenza A was epidemic. The costs of hospitalization for all types of illness studied were lower in the vaccinated group during 1991-1992 (range of reduction, 47 to 66 percent; P < 0.005) and for acute and chronic respiratory conditions and congestive heart failure in 1990-1991 (reductions of 37 percent and 43 percent, respectively; P < or = 0.05). Direct savings per year averaged $117 per person vaccinated (range, $21 to $235), with cumulative savings of nearly $5 million. Vaccination was also associated with reductions of 39 to 54 percent in mortality from all causes during the three influenza seasons (P < 0.001). CONCLUSIONS: For elderly citizens living in the community, vaccination against influenza is associated with reductions in the rate of hospitalization and in deaths from influenza and its complications, as compared with the rates in unvaccinated elderly persons, and vaccination produces direct dollar savings.     

Trends and patterns of mortality associated with birth defects and genetic diseases in the United States, 1979-1992: an analysis of multiple-cause mortality data

Contemporary information on the trends and patterns of mortality associated with birth defects and genetic diseases is lacking in the United States. To study these trends and patterns, we used the Multiple-Cause Mortality Files of the National Center for Health Statistics. From 1979 through 1992, 320,208 deaths in the United States were associated with birth defects and genetic diseases. The age-adjusted mortality rates for people with birth defects declined from about 8.2/100,000 in 1979 to about 6.7/100,000 in 1992, and the mortality rates for people with genetic diseases increased from 2.2/100,000 in 1979 to 2.5/100,000 in 1992. The mortality rate was higher among men than among women and higher among blacks than among whites or other races for both birth defect- and genetic disease-associated deaths. The rate among infants with birth defects was more than 25 times higher than that among other age groups. About half of the children whose deaths were associated with birth defects had cardiovascular system defects, 15% had central nervous system defects, and 12% had chromosomal defects. For deaths associated with genetic diseases, hereditary neurologic or storage disorders were the most common genetic diseases (38%), followed by metabolic disorders (21%), sickle cell and thalassemia (12%). The decline in the rate of mortality from birth defects in the United States probably reflects improvements in medical and surgical care and other factors. Most of the mortality associated with birth defects remains in the pediatric age group (less than 15 years old). The upward trend we detected for the deaths with genetic diseases was most likely related to improved recognition and reporting of some genetic diseases rather than to the increased prevalence.     

Effect of organisational downsizing on health of employees

BACKGROUND: Reduction of personnel by businesses and other organisations (organisational downsizing) is common in Europe, but little is known about its effects on the health of employees. METHODS: We used employers' records to investigate the relation between downsizing and subsequent absenteeism because of ill health in 981 local-government workers who remained in employment in Raisio, south-western Finland, during a period of economic decline (1991-95). Data were separated into three time periods: 1991, before downsizing; 1993, major downsizing in some workplaces and occupations; and 1993-95, after downsizing. We obtained data on sick leave from records kept by the occupational health-care unit in Raisio. We also investigated whether the effects of downsizing were dependent on ten other predictors of sick leave. FINDINGS: There was a significant association between downsizing and medically certified sick leave. The rate of absenteeism was 2.3 times greater (95% CI 2.0-2.7) after major downsizing, classified by occupation, than after minor downsizing. The corresponding rate ratios for musculoskeletal disorders and trauma were 5.7 (4.1-8.0) and 2.7 (1.7-4.2), respectively. The effects of downsizing by workplace depended on the age distribution of the staff. When the proportion of employees who were older than 50 years was high, downsizing increased the individual risk of absence because of ill health by 3.2-14.0 times, depending on diagnostic category. When the proportion of employees over 50 years was low, downsizing had only slight effects on health. Other risk factors that increased rates of sick leave after downsizing were age over 44 years, a large workplace, poor health before downsizing, and high income. INTERPRETATION: Downsizing is a risk to the health of employees. But this risk varies according to individual factors, such as age, socioeconomic status, and health, as well as factors related to place of work, for example, size and age structure of the staff.     

Usability for genetic evaluations of records from herds participating in progeny test programs of artificial insemination organizations

Thirteen AI organizations provided identification of herds that participated in their progeny test programs in 1989 and 1990; 15% of those herds participated in programs of more than one AI organization, but only 2.6% participated in programs of more than two AI organizations. Of the 19,589 participating herds, 82 and 76% were enrolled in DHI test plans that were considered to be usable for genetic evaluations during 1991 and 1992. For herds that had participated in AI progeny test programs, mean percentages of usable records were 77% in 1991 and 78% in 1992; the mean percentages of usable records for nonparticipating herds were 62% in 1991 and 60% in 1992. Participating herds had larger mean herd sizes, higher means and standard deviations of milk yields, younger cows, and a lower percentage of registered cows than did nonparticipating herds. Analysis of variance was used to explain the variation in the percentage of records that were usable for genetic evaluations. Herds that participated in AI progeny test programs or that had smaller herd sizes, higher mean milk yields, younger cows, or larger percentages of registered cows had higher percentages of records that were usable for genetic evaluations. Improved usability of records for genetic evaluations would increase the efficiency of AI progeny testing, and consideration of herd characteristics associated with higher percentages of usable records should aid AI organizations in evaluating prospective herds for progeny test programs.     

Comparative study of the cytoplasmic domain of band 3 from human and rabbit erythrocyte membranes

OBJECTIVE: To identify sociodemographic characteristics associated with induced abortion of the first pregnancy and quantify the strength of association between them. MATERIAL AND METHODS: Data were gathered from a survey conducted in the district of Diez de Octubre, Havana, Cuba throughout 1991 and the beginning of 1992. The study population was divided into two comparable groups: one group of women whose first pregnancy terminated in induced abortion and a second group of women whose pregnancy terminated in childbirth. For the variables with statistically significant differences, both the crude and adjusted odds ratio were obtained for the one potentially confounding factor:age. Multivariate logistic regression analysis was employed in the final stage. RESULTS: The sociodemographic characteristic identified as risk factor for induced abortion during the first pregnancy is being younger than 24 years of age, a risk which increased with women who were less than 20 years old, whether single or in union. CONCLUSIONS: Recurrence risk of induced abortion during the first pregnancy is higher in younger women who have not achieved their professional, working or marrying expectations. This situation seem to be incompatible with maternity in the studied group.     

Psychiatric aspects of hyperemesis gravidarum

In this paper, we calculate a base line of statistical data on the frequency of sexual activity at various ages of Taiwanese women. A cross-sectional study using questionnaires administered during personal interviews was conducted on more than seventeen thousand women who attended family planning clinics in the Taipei metropolitan area in 1991 and 1992. Of the women surveyed, 2.8 per cent were sexually inactive in the previous month, 83.67 per cent had intercourse one to nine times in the previous month, and 13.56 per cent had intercourse ten times or more. The mean frequency of sexual activity was 6.8 times a month. Age-specific mean coital frequencies for the age groups of less than 25 years, of 25-34 years, and of 35-44 years were 10.3, 7.3, and 6.6 times per month, respectively. Increased sexual frequency was associated with the following factors: young age, unmarried, lower educational level, fewer years of marriage and being on the pill. When logistic regression was used to control for confounding variables, we found that a woman's age is the most significant factor in predicting her sexual frequency.     

Women in low income groups smoke more: Canterbury 1976-92

AIM: To examine the relationship between income and levels of smoking in women of child-bearing age. METHODS: Census area units within the Christchurch region were divided into five groups according to average income for each of the census years 1976, 1981 and 1991 respectively. Smoking rates were obtained from census data for 1976 and 1981. For 1992, data from a questionnaire on smoking during pregnancy and obstetric records were used. RESULTS: For all years, higher proportions of women from low income groups smoked. The overall percentage of female smokers in Canterbury fell slightly from 31.6% in 1976 to 27.5% in 1981. There were 27.1% of pregnant women smoking in 1992. There were marked changes by economic groups. The percentage of smokers in the highest income group fell from 24.8% in 1976 to 21.0% in 1981: an 18% fall. Smokers in the lowest income group increased from 36.8% in 1976 to 39.8% in 1981. The same patterns were seen for smoking in pregnancy in the 1992 data. CONCLUSION: While the downward trend for smokers in the high income groups is good news, it is of concern that the proportion of smokers in the lower income groups remains so high. Young women have the highest rates of smoking, which is of special concern when they become pregnant. Smokefree intervention programmes need to be specifically targeted at these groups.     

An evaluation of preemployment drug testing.

As part of a blind longitudinal study, 5,465 job applicants were tested for use of illicit drugs, and the relationships between these drug-test results and absenteeism, turnover, injuries, and accidents on the job were evaluated. After an average 1.3 yrs of employment, employees who had tested positive for illicit drugs had an absenteeism rate 59.3% higher than employees who had tested negative (6.63% vs 4.16% of scheduled work hours, respectively). Employees who had tested positive also had a 47% higher rate of involuntary turnover than employees who had tested negative (15.41% vs 10.51%, respectively). No significant associations were detected between drug-test results and measures of injury and accident occurrence. The practical implications of these results, in terms of economic utility and prediction errors, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gram-negative enteric bacteremia in children in the Negev (1989-1994)

During 1989-1994, there were 322 episodes of Gram-negative enteric bacteremia in 308 children. The incidence increased from 31/100,000 in children younger than 15 years of age during 1989-1991, to 50/100,000 during 1992-1994. The most common pathogens were Klebsiella, E. Coli, Salmonella and Enterobacter. 39% of episodes were nosocomial and a significant increase was recorded for each species during the last 3 years of the study. Klebsiella represented the most common pathogen causing nosocomial bacteremia, while E. coli and Salmonella were the main pathogens causing community-acquired bacteremia. In this study in southern Israel, the incidence of Gram-negative enteric bacteremia was significantly higher in Bedouin children, with the exception of bacteremia due to Salmonella, which occurred mainly in Jewish children.     

Epidemiological trends for malaria in the cities of the upper Paraguay River basin, Mato Grosso do Sul, Brazil 1990-1996

Through the Regional Office of the Brazilian National Health Foundation in the State of Mato Grosso do Sul, we obtained numerical data on malaria for the upper Paraguay basin (UPB): 159 cases in 1990, 126 in 1991, 135 in 1992, 61 in 1993, 143 in 1994, 41 in 1995, and 20 in 1996, the majority of which were imported cases. There were no autochthonous cases in 1990, and since 1991 the rates of over 15% dropped to around 1.60%. Imported cases, corresponding to 0. 63% in 1990, increased in 1991 and 1992 to some 1.50%, and to 3.28% in 1993. Induced cases were recorded only in 1991 and 1992 (less than 1%). Most cases were between 16 and 45 years of age. There was a predominance of Plasmodium vivax in the thick blood smears. Although autochthonous cases of malaria are not the majority, the disease is still an important public health problem in the UPB in the presence of the Anopheles (N.) darlingi vector and human migration into the region.     

Helicobacter pylori infection: prevalence and clinical relevance in a large company

Although gastrointestinal (GI) illnesses account for considerable sick absenteeism, there have been few workplace studies of GI disorders. We determined the prevalence of Helicobacter pylori infection by serology and assessed its relation to upper GI tract complaints, personal ulcer history, and family history of stomach cancer in 6,143 employees (mean age, 40.4 years) at BASF's main chemical production facilities in Ludwigshafen, Germany. Employees were recruited during occupational health clinic visits (n = 4,488) and through broad communications efforts (n = 1,655). Participation among clinic attendees was 66%, and this recruitment method was particularly effective in reaching shift employees. Positive immunoglobulin G (IgG) serology (38.2%), ulcers (4.9%), nonulcer dyspepsia (20.4%), and a family history of stomach cancer (6.1%) were common occurrences in this work setting. Further diagnostic evaluation and eradication therapy was recommended for 795 employees (12.9%), based on a combination of positive serology and either upper GI tract complaints or family stomach cancer history, and has been completed for 541 employees. A weak but consistent association was seen between positive serology and cigarette smoking, and shift work was found to be associated with positive serology, but not with ulcer or nonulcer dyspepsia occurrence.     

Activation of a novel proto-oncogene, Frat1, contributes to progression of mouse T-cell lymphomas

In this paper we will report the results of nation-wide surveys on employee health conducted and published by the Ministry of Labour in 1982, 1987, and 1992. The subjects were approximately 20,000 employees in 1982, approximately 15,000 in 1987, and approximately 16,000 in 1992, from throughout Japan. Using the results of the surveys, we will show trends in the status of employee work-related stress, as well as trends in means of relaxation over the past decade. The percentage of employees with work-related stress among all subjects gradually increased as follows: 50.6% in 1982, 55.0% in 1987, and 57.3% in 1992. The percentage of employees with work-related stress increased remarkably from 1982 through 1992 among the following groups: the 50-59 age group in males; employees in the electricity, gas, heat and water-supply industries; those in the real estate industry; administrative and managerial workers; employees of large establishments with more than 5,000 employees; and employees performing shift work involving no night duty. The problem of "human relationships in the workplace" was associated with the increasing stress levels among 50-59-year-old males, 40-49-year-old females, employees of large establishments with more than 5,000 employees, those in the real estate industry, and service workers. In terms of means of relaxing to relieve fatigue and stress, employees tended to engage in active pursuits such as "eating out and shopping" and "driving and traveling" over the past decade. In 1992, on the other hand, 22.0% of males and 5.9% of females selected "smoking" as a means of relaxation. This shows the need for stress management in the workplace in order to prevent health problems related to smoking.     

Comparison of mortality from acute myocardial infarction between 1979 and 1992 in a geographically defined stable population

This study documents mortality from acute myocardial infarction (AMI), in hospital and at 1 year, for each of 3 selected 1-year periods in a stable community over a 13-year period beginning in 1979 and continuing into the thrombolytic era, to detect any changes occurring in conjunction with the introduction of new therapies. Every patient with AMI occurring in a geographically defined stable community (Hamilton, Ontario, Canada) in 3 1-year periods (1979 to 1980 [n = 816], 1986 to 1987 [n = 816], and 1991 to 1992 [n = 831]) was identified and clinically characterized by standardized criteria. Subsequent in-hospital and 1-year survival were ascertained prospectively. The 3 cohorts were similar in prognostic factors. Mean age was progressively greater over the study period from 63 years in 1979 to 1980, to 67 years in 1991 to 1992 (p = 0.02). There was no change in in-hospital mortality rates from 1979 to 1980 (17%) and 1986 to 1987 (16%). However, from 1986 to 1987 and 1991 to 1992, in-hospital mortality decreased from 16% to 9% (p < 0.001) and 1-year mortality decreased from 26% to 19% (p < 0.001). For patients who survived the hospital phase of AMI, 1-year mortality did not change and was between 11% and 12% in each of the 3 study periods. From 1986 to 1987 and 1991 to 1992, there was an increase in the use of thrombolytic therapy from 5% to 44% of patients. The acute use of aspirin increased from 30% to 88% and the acute use of beta blockers increased from 19% to 48% of patients. The observed increase in use of these agents could account for half of the actual mortality reduction observed. This prospective population-based survey demonstrates improved in-hospital survival after AMI associated with increased use of established effective therapies between 1987 and 1992. The 1-year mortality of hospital survivors of AMI was unchanged throughout the period of study, remaining at 11% to 12%.     

Forty years of evolution of mortality in Belgium and The Netherlands

Age adjusted mortality in Belgium (B) and The Netherlands (NL) was calculated from 5 yearly age-specific death rates between the ages 45-74 and 75-85+ years. Mortality was available in Belgium from 1954 to 1991 or 1994 (depending on the cause of death) and from 1950 to 1993 in The Netherlands. In the 45-74 years age class all-cause mortality decreased in B between 1955 and 1992 with 33% in men and 48% in women. In NL this was 11% and 40%, respectively. In the age class 75-85+ it was 21% and 37% in B, and 4% and 36% in NL, respectively. Since 1980 to the last available year there was a marked decrease in mortality in the age class 75-85+ years in men and women from B and no change in NL. Wallonia always had the highest mortality, followed by B, Flanders and NL. However, recently the observed mortality in Flanders was the lowest. Mortality trends, in both age classes and sexes, were obtained between 1980 to the last available year for 11 causes of death in men and 13 in women. Among 48 possible comparisons, 38 (79%) were in favor of B, 9 in favor of NL and 1 ex aequo. Life expectancy in 1992 was compared in the 15 EU countries. For both sexes together B ranked 8th, NL 3rd. The difference in life expectancy between the two countries was 3 year in 1967 and 1 year in 1992. Flanders ranked 5th (0.3 year lower than NL) and Wallonia 14th (2.2 years lower) when substituted for B in the EU. Portugal had the best and Denmark had the worst results between 1967 and 1992). Changes in life style-fat, salt, fruit and vegetable intake and smoking habits -which occurred since 1960 in B, its regions and in NI are consistent with the changes in mortality and life expectancy. Curative medicine and medical technology cannot explain the observed differences and trends.     

Parietal motor syndrome: a clinical description in 32 patients in the acute phase of pure parietal strokes studied prospectively

Although survival rates are useful for monitoring progress in the early detection and treatment of cancer and are of particular interest to patients with new diagnoses, there are limited population-based estimates of long-term survival rates. We used data collected by the Surveillance, Epidemiology, and End Results Program for cases diagnosed during 1974-1991 and followed through 1992 to estimate relative survival at 5, 10, and 15 years after diagnosis of cancer of the breast, prostate, colon and rectum, and lung. Relative survival after diagnosis of breast and prostate cancer continued to decline up through 15 years after diagnosis, whereas survival after diagnosis of lung and colon or rectal cancer remained approximately constant after 5 and 10 years, respectively. Age-specific patterns of survival varied by site, stage, and demographics. Among patients with localized breast and prostate cancer, women who were younger than age 45 at breast cancer diagnosis and men who were 75 years and older at prostate cancer diagnosis had the poorest relative survival. Relative survival among lung cancer patients decreased with age at diagnosis, regardless of stage or demographics, and age-specific patterns of relative survival for patients with cancer of the colon and rectum differed according to race. Among white patients diagnosed with cancers of the colon and rectum, relative survival did not vary by age at diagnosis; among black patients older than 45 at diagnosis, relative survival decreased with age. This study provides population-based estimates of long-term survival and confirms black/white, male/female, and stage- and age-specific differences for the major cancers.     

Managers' practices related to work–family balance predict employee cardiovascular risk and sleep duration in extended care settings.

An increasing proportion of U.S. workers have family caregiving responsibilities. The purpose of this study was to determine whether employees in extended care settings whose managers are supportive, open, and creative about work–family needs, such as flexibility with work schedules, have lower cardiovascular disease (CVD) risk and longer sleep than their less supported counterparts. From semistructured interviews with managers, we constructed a work–family balance score of manager openness and creativity in dealing with employee work–family needs. Trained interviewers collected survey and physiologic outcome data from 393 employees whose managers had a work–family score. Employee outcomes are sleep duration (actigraphy) and CVD risk assessed by blood cholesterol, high glycosylated hemoglobin/diabetes, blood pressure/hypertension, body-mass index, and tobacco consumption. Employees whose managers were less supportive slept less (29 min/day) and were over twice as likely to have 2 or more CVD risk factors (ORs = 2.1 and 2.03 for low and middle manager work–family scores, respectively) than employees whose managers were most open and creative. Employees who provide direct patient care exhibited particularly elevated CVD risk associated with low manager work–family score. Managers' attitudes and practices may affect employee health, including sleep duration and CVD risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sources of discrimination among employees: A survey investigation.

Interviewed 588 state employees to determine the types of discriminatory feelings that exist in the work environment. Using a 2–4 repeated measures design, it was found that race, sex, age, and competence were significant forms of discrimination. Employees would prefer not to work with Blacks, women, older individuals, or barely competent persons. One significant interaction, sex by competence, was found. Employees made little distinction between barely competent males and females, but in the choice between highly competent males and females, they indicated a clear preference for highly competent males. When the sample was split on the basis of the demographic characteristics of sex, age, and race, it was found that Blacks preferred working with other Blacks, whereas females preferred working with other females. Older employees indicated that age made no difference in their preference for fellow employees. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Work and nonwork outcomes of workplace incivility: Does family support help?

This study extended incivility research beyond the confines of the workplace by exploring the relationships between incivility, work-to-family conflict and family support. Data collected from 180 employees from various organizations in Singapore showed that incivility is not a rare phenomenon in Asian cultures. Employees experienced more incivility from superiors than coworkers or subordinates, and these experiences were related to different outcomes. Coworker-initiated incivility was associated with decreased coworker satisfaction, increased perceptions of unfair treatment, and increased depression. On the other hand, superior-initiated incivility was associated with decreased supervisor satisfaction and increased work-to-family conflict. Results also revealed that employees with high family support showed stronger relationships between workplace incivility and negative outcomes, compared with employees with low family support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outbreak of serogroup C meningococcal disease associated with campus bar patronage

Between February 1991 and April 1992, eight undergraduates at a US residential university and one at a nearby 2-year college contracted serogroup C meningococcal disease. A case-control investigation with 20 controls per case, oropharyngeal carriage surveys, and multilocus enzyme electrophoresis (MEE) of serogroup C isolates were used to identify factors contributing to the outbreak. All eight sterile-site isolates from cases were closely related by MEE and were similar (though not identical) to the strain associated with the 1991-1992 epidemic of meningococcal disease in eastern Canada. Disease was associated with cigarette smoking (p = 0.012), recent patronage of campus-area bars (p = 0.034), estimated amount of time spent in campus-area bars (p = 0.0003), and, especially, recent patronage of one specific bar, bar A (p = 0.0006; odds ratio = 23.1, 95% confidence interval 3.0-571.5). In carriage surveys, 1,528 throat cultures taken from (primarily student) noncases yielded only five (0.3%) strains that were identical by MEE to those from cases. Two of these were found among 22 cultures obtained from bar A employees in spring 1992. Some cases in this outbreak may have followed transmission of the epidemic strain in bar A. Campus bar environments may facilitate the spread of meningococcal disease among teenagers and young adults.     

A note on the possibility of explaining why a color cannot be both red and green

OBJECTIVE: This study was a blinded, concurrent assessment of a historical cohort derived from a provincial registry (1978 to 1986) of breast implant recipients (cosmetic, not reconstructive) and controls (other cosmetic surgery) to test the hypothesis that connective tissue disease (CTD) is increased in breast implant recipients. METHODS: Women who underwent breast implant or other cosmetic surgery during the interval from 1978 to 1986 were contacted confidentially by Alberta Health and asked to participate in the study. Those willing to participate completed an extensive questionnaire and supplied a blood sample, subsequent to which all surgical records were reviewed to confirm implant type(s) or cosmetic surgery(ies). All participants with any suggestion of rheumatic disease were assessed blindly by a rheumatologist for CTD. RESULTS: One thousand five hundred seventy-six breast implant recipients were recruited, including 1112 who had received silicone gel-filled implants (> 13,500 person yrs exposure). Seven hundred twenty-six controls were recruited. Prevalence rates adjusted for sex and age for rheumatoid arthritis, systemic lupus erythematosus, scleroderma, and Sj?gren's syndrome (the principal targeted conditions) were consistent with published reports for Caucasian women. While breast implant recipients self-reported significantly greater rates of symptoms than controls, post-surgical diagnoses of the principal targeted conditions did not indicate an increased incidence of typical or atypical CTD. CONCLUSION: The results of the study do not support the hypothesis that silicone gel-filled implants induce or promote CTD.