Use of pneumococcal vaccine in people with chronic disease in United States

Objective. The risk of complications and deaths related to pneumococcal infections is high among high risk population (i.e. those with chronic diseases such as diabetes or asthma), despite current immunization recommendations. The aim of this study is to evaluate the use of pneumonia vaccine in adults with and without diabetes or asthma by year of age and whether immunization practices conform to policy recommendations. ^ Methods. Data were drawn from 2005 Behavioral Risk Factor Surveillance Study. Age specific estimated counts and proportions of pneumonia vaccination status were computed. The association of socio-demographic factors with vaccination status was estimated from multiple logistic regression and results were presented for adults (18-64yrs) and elderly (65 or older). ^ Results. Overall 12.3% of the adults and 61.5% of elderly reported ever received pneumonia vaccine. 66.8% of diabetics and 72.6% of asthmatics received the vaccine among elderly. 33.4% of diabetics and 21.6% of asthmatics received the vaccine among adults. These numbers are far away from Healthy people 2010 objective coverage rates of 90% for elderly and 60% for high risk adults. Though diabetes was one of the recommendations for the pneumonia vaccine still the status was less than 70% even at older ages. Although asthma was not an indication for pneumonia vaccine, asthmatics still achieved 50% level by an early age of 60 and reached up to 80% at as early as 75 years. In those having both asthma and diabetes, although the curve reaches to 50% level at a very early age of 40yrs, it is not stable until the age of 55 and percentages reached to as high as 90% in older ages. Odds of receiving pneumonia vaccine were high in individuals with diabetes or asthma in both the age groups. But the odds were stronger for diabetics in adults compared to those in the elderly [2.24 CI (2.08-2.42) and 1.32 CI (1.18-1.47)]. The odds were slightly higher in adults than in elderly for asthmatics [1.92 CI (1.80-2.04) and 1.73 CI (1.50-2.00)].The likelihood of vaccination also differed by gender, ethnicity, marital status, income category, having a health insurance, current employment, physician visit in last year, reporting of good to excellent health and flu vaccine status. ^ Conclusion. There is a very high proportion of high risk adults and elderly that remain unvaccinated. Given the proven efficacy and safety of vaccine there is a need for interventions targeting the barriers for under-vaccination with more emphasis on physician knowledge and practice as well as the recipient attitudes.^

PRETERM BIRTH AND OCCUPATIONAL PHYSICAL ACTIVITY: A CASE-CONTROL STUDY OF THE RELATIONSHIP BETWEEN LENGTH OF GESTATION AND THE PHYSICAL DEMAND OF U.S. ARMY MILITARY OCCUPATIONAL SPECIALTIES (UNITED STATES)

A case-control study has been conducted examining the relationship between preterm birth and occupational physical activity among U.S. Army enlisted gravidas from 1981 to 1984. The study includes 604 cases (37 or less weeks gestation) and 6,070 controls (greater than 37 weeks gestation) treated at U.S. Army medical treatment facilities worldwide. Occupational physical activity was measured using existing physical demand ratings of military occupational specialties.^ A statistically significant trend of preterm birth with increasing physical demand level was found (p = 0.0056). The relative risk point estimates for the two highest physical demand categories were statistically significant, RR's = 1.69 (p = 0.02) and 1.75 (p = 0.01), respectively. Six of eleven additional variables were also statistically significant predictors of preterm birth: age (less than 20), race (non-white), marital status (single, never married), paygrade (E1 - E3), length of military service (less than 2 years), and aptitude score (less than 100).^ Multivariate analyses using the logistic model resulted in three statistically significant risk factors for preterm birth: occupational physical demand; lower paygrade; and non-white race. Controlling for race and paygrade, the two highest physical demand categories were again statistically significant with relative risk point estimates of 1.56 and 1.70, respectively. The population attributable risk for military occupational physical demand was 26%, adjusted for paygrade and race; 17.5% of the preterm births were attributable to the two highest physical demand categories. ^

North American Free Trade Agreement between the government of the United States of America, the government of Canada, and the government of the United Mexican States.

Shipping list no. 93-0534-P.

The effect on Minnesota of a liberalization of United States foreign trade policy; report of Business Executives' Research Committee study,

Mode of access: Internet.

Eleventh census of the United States, 1890.

Originally published: Washington : G.P.O., 1892-1897.

Reports of the secretary of the Treasury of the United States,

Reports for 1801-1828 were also reprinted in 2 vols. with the reports of Alexander Hamilton on public credit, on a national bank, on manufactures, and on the establishment of a mint, prefixed. Washington, Printed by D. Green, 1828-29.

Index digest of the published decisions of the Comptroller General of the United States /

Latest issue consulted: Vols. 66-70 (Oct. 1, 1986 to Sept. 30, 1991).

Personal recollections of the war of the rebellion; addresses delivered before the New York Commandery of the Loyal Legion of the United States, 1883-1912. [First]-4th series...

Vol. 2-4 have imprint: New York, London, G. P. Putnam's sons. Editors: [1st ser.] J. G. Wilson, T. M. Coan.-2d ser., A. N. Blakeman.

Report of the United States Trade Representative's Intergovernmental Policy Advisory Committee (IGPAC), to the agreements reached in the Uruguay Round of multilateral trade negotiations : submitted to the Congress, January 14, 1994.

Shipping list no.: 94-0061-P.

A report to the President, the Congress, and the United States Trade Representative concerning the Uruguay Round of negotiations on the General Agreement on Tariffs and Trade /

"January 15, 1994."

Trade agreement between the United States and Canada ... 2d report.

Processed.

Trade agreement between the United States and Peru.

Processed.

Multilateral trade negotiations briefing [microform] : hearing before the Committee on Agriculture, Nutrition, and Forestry, United States Senate, Ninety-sixth Congress, first session, February 26, 1979.

Reuse of record except for individual research requires license from Congressional Information Service, Inc.

Register of officers and agents, civil, military, and naval, in the service of the United States, on the ... : showing the state or territory from which each person was appointed to office, the state or country in which he was born, and the compensation, pay, and emoluments allowed to each; together with the names and compensation of all printers in any way employed by Congress, or any department or officer of the government.

Description based on: 1863.

Thackeray in the United States, 1852-3, 1855-6 : including a record of a variety of Thackerayana /

Includes index.