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PubMed1994

Synaptic terminal coverage of primate triceps surae motoneurons.

This study examined the synaptic terminal coverage of primate triceps surae (TS) motoneurons at the electron microscopic level. In three male pigtail macaques, motoneurons were labeled by retrograde transport of cholera toxin-horseradish peroxidase that was injected into TS muscles bilaterally and visualized with tetramethylbenzidine stabilized with diaminobenzidine. Somatic, proximal dendritic, and distal dendritic synaptic terminals were classified by standard criteria and measured. Overall and type-specific synaptic terminal coverages and frequencies were determined. Labeled cells were located in caudal L5 to rostral S1 ventral horn and ranged from 40 to 74 microns in diameter (average, 54 microns). The range and unimodal distribution of diameters, the label used, and the presence of C terminals on almost all cells indicated that the 15 cell bodies and associated proximal dendrites analyzed here probably belonged to alpha-motoneurons. Synaptic terminals covered 39% of the cell body membrane, 60% of the proximal dendritic membrane, and 40% of the distal dendritic membrane. At each of these three sites, F terminals (flattened or pleomorphic vesicles, usually symmetric active zones, average contact length 1.6 microns) were most common, averaging 52%, 56%, and 58% of total coverage and 56%, 57%, and 58% of total number of cell bodies, proximal dendrites, and distal dendrites respectively. S terminals (round vesicles, usually asymmetric active zones, average contact length 1.3 microns) averaged 24%, 29%, and 33% of coverage and 33%, 35%, and 36% of number at these three sites, respectively. Thus, S terminals were slightly more prominent relative to F terminals on distal dendrites than on cell bodies. C terminals (spherical vesicles, subsynaptic cisterns associated with rough endoplasmic reticulum, average contact length 3.5 microns) constituted 24% and 11% of total terminal coverage on cell bodies and proximal dendrites, respectively, and averaged 11% and 6% of terminal number at these two locations. M terminals (spherical vesicles, postsynaptic Taxi bodies, some with presynaptic terminals, average contact length 2.7 microns) were absent on cell bodies and averaged 3% and 7% of total coverage and 2% and 5% of terminals on proximal and distal dendrites, respectively. Except for M terminals, which tended to be smaller distally, terminal contact length was not correlated with location. Total and type-specific coverages and frequencies were not correlated with cell body diameter. Primate TS motoneurons are similar to cat TS motoneurons in synaptic terminal morphology, frequency, and distribution. However, primate terminals appear to be smaller, so that the fraction of membrane covered by them is lower.

Animals↗
PubMed1989

Effect of muscle flap coverage on bone blood flow following devascularization of a segment of tibia: an experimental investigation in the dog.

Severe tibial fractures may be associated with soft tissue loss, devascularization of cortical bone, and significant morbidity. Local rotational muscle flap coverage is used to obtain coverage of acute open tibial fractures and to treat chronic osteomyelitis of the tibia. The purpose of this study was to determine (a) the longitudinal and cross-sectional regional blood flow characteristics of the canine tibia and (b) whether a muscle flap was superior to vascularized skin coverage in restoring blood flow to devascularized canine tibial cortex. A 2.5-cm segment of tibia between two standardized osteotomies was devascularized. The segment was replaced anatomically and stabilized with a plate. The animals were divided into two experimental groups: (a) skin coverage (n = 8), and (b) muscle flap coverage (n = 8). Thirty-one days postoperatively Ce141 microspheres were injected to measure bone blood flow. The tibial diaphysis was divided into proximal, middle (devascularized), and distal segments. The unoperated leg was used as a control. In the control tibiae, the middle segment was less vascular than either the proximal or distal segment and no difference between anterior and posterior cortical blood flow was observed. Blood flow to the devascularized segment of tibia was significantly greater when it was covered with a muscle flap (p less than 0.025). The most significant increase in bone blood flow in the muscle flap coverage group versus the skin coverage group occurred in the anterior cortex of the tibia (p less than 0.005). This may be clinically important since the soft tissues over the anterior tibia are commonly deficient following open fractures.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Deposition of particles in the impinging-jet cell for the high coverage regime.

Particle deposition in the radial impinging-jet cell for the high coverage regime was studied theoretically and experimentally. A detailed description of the flow distribution in the cell was attained by solving the governing Navier-Stokes equation numerically. The macroscopic flow pattern was decomposed into simpler local flows. It was demonstrated that for tangential distances r/R>0.5 the overall flow at the interface was dominated by the simple shear. The intensity of this flow was calculated numerically as a function of the Reynolds number and the distance from the cell center. Knowing the fluid velocity field the convective diffusion equation was formulated describing a two-dimensional transport of particles. As a result of nonlinearity of the boundary condition this equation was solved in an exact manner for low coverage only. For higher coverage, approximate methods were proposed exploiting the random sequential adsorption (RSA) approach. The validity of the theoretical predictions was verified experimentally using the direct microscope observation method and polystyrene latex particles of the size 0.87 mum. Particle coverage distribution was studied in detail as a function of the Re number governing the local shear rate. It was demonstrated that for low Re number (Re<4) uniform particle monolayers of high coverage can be attained. On the other hand, for Re>8 the particle coverage distribution became nonuniform as a result of the hydrodynamic scattering. This effect, leading to an apparent kinetic saturation of the surface at coverages of a few percents, was quantitatively interpreted in terms of the theoretical model.

Journal Article↗
PubMed2004

[Vaccination coverage in Germany].

Up-to-date information on vaccination coverage and seroprevalence are the basis for enhancing the acceptance of vaccination and increasing vaccination coverage. In Germany these data are currently only available to a limited extent. Existent data sources only permit estimates of vaccination coverage or are not age appropriate, such as the representative data from the school entry examinations. Despite increasing vaccination coverage of children and adolescents in recent years, existent data indicate important coverage gaps for certain vaccines. In addition, the vaccination status in adults is often incomplete. Improved surveillance of vaccination coverage and seroprevalence could make an important contribution to closing gaps in vaccination coverage.

Adolescent↗
PubMed1995

The impact of mandated in-hospital coverage on primary cesarean delivery rates in a large nonuniversity teaching hospital.

OBJECTIVE: Our purpose was to determine whether attending physician call status affected the primary cesarean delivery rates of the resident or private services after institution of in-hospital coverage. STUDY DESIGN: Data for the study year, during which in-hospital attending coverage was in place, were compared with those of the previous year, during which in-hospital attending coverage of residents was not in place. Birth records were analyzed retrospectively for physician and patient factors. RESULTS: For the year before in-hospital coverage the institutional total cesarean rate was 24.9%, with a primary cesarean section rate of 17.6%. In the first year of coverage the total cesarean delivery was 21.7%, with a decrease in the primary rate to 15.3%. The resident service primary cesarean delivery rate was 10.6% during the study year, which was unchanged from 10.9% the prior year and did not contribute to the overall decrease. Conversely, the private service primary cesarean rate decreased from 18.0% in the prestudy year to 13.4% when the attending physician was on call in the hospital but remained higher at 17.5% when the attending physician was on call not in the hospital. CONCLUSIONS: In-hospital attending physician coverage lowered individual attending physicians' private service primary cesarean rates. Resident service primary cesarean rates were lower than private service and were unaffected by the initiation of in-hospital coverage.

Adult↗
PubMed2006

Coverage of emergency after-hours ultrasound cases: survey of practices at U.S. Teaching hospitals.

RATIONALE AND OBJECTIVES: Diagnostic ultrasound examinations may be performed after-hours by physicians if technologists are not available or cases are complex. Our experience suggested there is wide variability in how ultrasound coverage is provided after-hours, which motivated us to conduct a formal survey of teaching programs around the country. METHODS: Four hundred five members of the Association of Program Directors in Radiology were contacted by e-mail and sent a link to a five-part questionnaire posted on the Web. Respondents were asked whether ultrasound cases after-hours are performed in their institutions by radiology residents, technologists on the premises after-hours, technologists on-call, or some combination. Data on the type of program, number of beds in the primary hospital, number of residents in the program, and geographic location of the program were recorded. Responses were automatically written to a data file stored on a Web server and the imported into an Excel spreadsheet for data analysis. A chi(2) analysis was performed to assess associations among the variables and statistical significance. RESULTS: A total of 79 programs responded to the survey. Of those, 32% provided coverage with ultrasound technologists on call, 24% by ultrasound technologists on the premises, 13% provided combination coverage, and 10% provided coverage solely with residents on call. There was no association among number of residents in the program, location of the program, or type of program (university, community, or affiliated) and type of coverage provided. CONCLUSION: There is wide variability in methods for providing coverage of after-hours ultrasound cases. However, on-site or on-call coverage of emergency cases by technologists did not appear to depend significantly on program location, program type, or program size.

After-Hours Care↗
PubMed2005

Immunization coverage among Hispanic ancestry, 2003 National Immunization Survey.

BACKGROUND: The Hispanic population is increasing and heterogeneous (Hispanic refers to persons of Spanish, Hispanic, or Latino descent). The objective was to examine immunization rates among Hispanic ancestry for the 4:3:1:3:3 series (> or = 4 doses diphtheria, tetanus toxoids, and pertussis vaccine; > or = 3 doses poliovirus vaccine; > or = 1 doses measles-containing vaccine; > or = 3 doses Haemophilus influenzae type b vaccine; and > or = 3 doses hepatitis B vaccine). METHODS: The National Immunization Survey measures immunization coverage among 19- to 35-month-old U.S. children. Coverage was compared from combined 2001-2003 data among Hispanics and non-Hispanic whites using t-tests, and among Hispanic ancestry using a chi-square test. Hispanics were categorized as Mexican, Mexican American, Central American, South American, Puerto Rican, Cuban, Spanish Caribbean (primarily Dominican Republic), other, and multiple ancestry. RESULTS: Children of Hispanic ancestry increased from 21% in 1999 to 25% in 2003. These Hispanic children were less well immunized than non-Hispanic whites (77.0%, +/-2.1% [95% confidence interval] compared to 82.5%, +/-1.1% (95% CI) > in 2003). Immunization coverage did not vary significantly among Hispanics of varying ancestries (p=0.26); however, there was substantial geographic variability. In some areas, immunization coverage among Hispanics was significantly higher than non-Hispanic whites. CONCLUSIONS: Hispanic children were less well immunized than non-Hispanic whites; however, coverage varied notably by geographic area. Although a chi-square test found no significant differences in coverage among Hispanic ancestries, the range of coverage, 79.2%, +/-5.1% for Cuban Americans to 72.1%, +/-2.4% for Mexican descent, may suggest a need for improved and more localized monitoring among Hispanic communities.

Child, Preschool↗
PubMed2006

Immunization coverage in Mozambique: from concepts to decision-making.

Immunization is an effective strategy to reduce morbidity and mortality among children. This recognition has led many countries to concentrate efforts in establishing desirable achievements in the form of immunization coverage figures. However, less focus has been placed on effort made by different countries to attain high immunization coverage. During August 2002, 14 district health directors in a remote province of Mozambique (Niassa) were interviewed. The objective was to ascertain the construction of immunization coverage and how they implement the desired program strategies in order to improve the health status of the region. We found that most managers regarded the immunization coverage as data and thus high coverage as an end in itself, rather than as a reflection of the reality. We also found that there are uncertainties in population data which makes it difficult to plan activities bellow the level of a district. We argue further that the innovative distinction between the views proposed on the immunization coverage, provided us with an insight of the different challenges that district health directors face as leaders of the district health management team in Niassa. Clues on the implications of certain views of immunization coverage for policy and local decision-making in the national and global pursuit of immunization targets are provided.

Attitude of Health Personnel↗
PubMed2005

Assessment of sociodemographic factors and socio-economic status affecting the coverage of compulsory and private immunization services in Istanbul, Turkey.

OBJECTIVES: The primary objective of this study was to determine the coverage of the Expanded Programme of Immunization (EPI) of the Ministry of Health and the coverage of private vaccines in the Umraniye Health District in order to establish approaches for improving vaccination services. Other objectives were to define the areas that present higher risks for non-vaccination and to determine the factors that influence vaccination coverage. METHODS: A '30 x 7' cluster sampling design was adopted as the sampling method. Thirty streets were selected at random from each health care region. Sociodemographic and socio-economic characteristics of the population, utilization of vaccination services and vaccination status of children under the age of 5 years were determined by face-to-face interviews. Odds ratios for the sociodemographic and socio-economic characteristics, health centre region and inner country immigration were assessed as possible related factors with the vaccination coverage rates for children under 5 years and under 1 year using the backward elimination method in logistic regression. RESULTS: Vaccination coverage was as follows: hepatitis B third dose, 84.6%; Bacille Calmette-Guérin, 94.8%; diphtheria, tetanus, pertussis (DPT) third dose, 90.1%; oral polio virus (OPV) third dose, 90.0%; measles, 88.7%; DPT booster dose, 79.1%; OPV booster dose, 79.0%; measles, mumps, rubella (MMR), 13.3%; haemophilus influenza type b (Hib), 9.3%; and Varicella vaccine, 3.3%. The full vaccination rates for children under 5 years and under 1 year were 68.3 and 79.5%, respectively. Higher socio-economic status was associated with a higher rate of full vaccination and private vaccination for children under 5 years of age. CONCLUSIONS: Full vaccination rates for children aged less than 1 year and less than 5 years were higher in our district than in Istanbul. However, we did not meet the EPI aims for any of the vaccines, and differences were observed in vaccination coverage rates between different socio-economic groups in the district. Therefore, an intervention programme should be considered to achieve the EPI's goals, particularly in socio-economically disadvantaged groups. Also, the coverage of private vaccination (MMR, Hib, Varicella) is low and more children from higher socio-economic groups receive these vaccines.

Adolescent↗
PubMed2000

Improving the dosimetric coverage of interstitial high-dose-rate breast implants.

PURPOSE/OBJECTIVE: We performed a retrospective computed tomography (CT)-based three-dimensional (3D) dose-volume analysis of high-dose-rate (HDR) interstitial breast implants to evaluate the adequacy of lumpectomy cavity coverage, and then designed a simple, reproducible algorithm for dwell-time adjustment to correct for underdosage of the lumpectomy cavity. METHODS AND MATERIALS: Since March 1993, brachytherapy has been used as the sole radiation modality after lumpectomy in selected protocol patients with early-stage breast cancer treated with breast-conserving therapy. In this protocol, all patients received 32 Gy in 8 fractions of 4 Gy over 4 days. Eleven patients treated with HDR brachytherapy who underwent CT scanning after implant placement were included in this analysis. For each patient, the postimplant CT dataset was transferred to a 3D treatment planning system, and the relevant tissue volumes were outlined on each axial slice. The implant dataset, including the dwell positions and dwell times, were imported into the 3D planning system and then registered to the visible implant template in the CT dataset. The calculated dose distribution was analyzed with respect to defined volumes via dose-volume histograms. Due to the variability of lumpectomy cavity coverage discovered in this 3D quality assurance analysis, dwell times at selected positions were adjusted in an attempt to improve dosimetric coverage of the lumpectomy cavity. Using implant data from 5 cases, a dwell-time adjustment algorithm was designed and was then tested on 11 cases. In this algorithm, a point P was identified using axial CT images, which was representative of the underdosed region within the cavity. The distance (d) from point P to the nearest dwell position was measured. A number of dwell positions (N) nearest to point P were selected for dwell time adjustment. The algorithm was tested by increasing the dwell times of a variable number of positions (N = 1, 3, 5, 7, 10, and 20) by a weighting factor (alpha), where alpha = f(d) and alpha > 1, and subsequently performing 3D dose-volume analysis to evaluate the improvement in lumpectomy cavity coverage. RESULTS: Before adjustment in the 11 implants, the median proportion of the lumpectomy cavity and target volume that received at least the prescription dose was 85% and 68%, respectively. After dwell-time adjustment, lumpectomy cavity coverage was significantly improved in all 11 cases. The median distance from point P to the nearest dwell position (d) was 1.4 cm (range 0.9-1.9). The median volume of the lumpectomy cavity receiving 32 Gy increased from 85.3% in the actual implant to 97.0% (range 74-100%) by increasing the dwell time of a single dwell position by a median factor (alpha) of 12.2 according to the above algorithm. With N = 3, the median proportion of the cavity volume receiving 32 Gy was improved to 97.5% (range 77-100%), with a median alpha of 5.7. Further improvement in lumpectomy cavity coverage was relatively small by increasing additional dwell times. In addition, with N = 20, the median absolute volume of breast tissue receiving 150% of the prescription dose was 70.3 cm3 compared to 26.3 cm3 in the actual implant; whereas with N = 1 or N = 3, this median volume was only 35.9 and 42.0 cm3, respectively. CONCLUSION: Lumpectomy cavity coverage sometimes appears suboptimal with interstitial HDR breast brachytherapy using our current technique. A simple dwell-time increase at only 1-3 dwell positions can compensate for some underdosage without creating significant regions of overdosage. Using simple methodology, a single reference point representing the underdosed region can be utilized for initial selection of the dwell positions to be increased.

Algorithms↗
PubMed2000

Emergency department coverage by academic departments of radiology.

RATIONALE AND OBJECTIVES: The purpose of this study was to survey academic radiology departments to determine how emergency radiology coverage is handled and whether there are any prerequisites for those individuals providing this coverage. MATERIALS AND METHODS: The authors developed a simple two-page survey and sent it to a total of 608 program directors, chiefs of diagnostic radiology, chairpersons, and chief residents at academic departments of radiology. RESULTS: Of the 608 surveys sent, 278 (46%) were returned. More than half of the departments have an emergency radiology section that provides "wet read" coverage during the day, and most academic departments cover the emergency department during the night and on weekends. Nighttime and weekend coverage is handled mostly by residents. Most departments give time off for lunch, with few other prerequisites for faculty who provide emergency coverage. Sixty percent of the departments have teleradiology capability, and many use it for emergency department coverage. CONCLUSION: These results can serve as the basis for discussion and comparison with other institutions regarding a variety of aspects of emergency department coverage.

Data Collection↗
PubMed2006

Coverage dependent supramolecular structures: C60:ACA monolayers on Ag(111).

The dependence of supramolecular structure on fractional molecular coverage has been investigated for acridine-9-carboxylic acid (ACA) and the C(60):ACA binary molecular system. The coverage-dependent phase diagram for ACA is first determined from room-temperature STM imaging. At low molecular coverages (theta < 0.4 ML, ML = monolayer), ACA forms a 2-D gas phase. Ordered ACA structures appear with increasing coverage: first a chain structure composed of ACA molecules linked by consecutive O-H...N hydrogen bonds (theta > 0.4 ML), then a dimer structure composed of ACA dimers linked by paired carboxyl-carboxyl hydrogen bonds (theta approximately equal to 1.0 ML). Structures of the C(60):ACA binary system depend on the coverage of predeposited ACA. At intermediate (0.4 ML approximately 0.8 ML) ACA coverages, C(60) deposition results in a hexagonal cooperative structure with the C(60) periodicity nearly 3 times that of the normal C(60) 2-D packing of 1 nm and exists in enantiopure domains. At higher ACA coverages, a C(60) quasi-chain structure is formed in which parallel C(60) chains are spaced by ACA dimer domains. The mechanistic role of the initial ACA phase in the formation of C(60):ACA supramolecular structures is described. Chemically intuitive molecular packing models are presented based on the observed STM images.

Acridines↗
PubMed2003

Fully vaccinated children are rare: immunization coverage and seroprevalence in Austrian school children.

Vaccination coverage for vaccine-preventable diseases in Austria as well as in many Central European countries has been reported to be too low to eradicate such diseases and prevent further outbreaks. Austria lacks an adequate surveillance system to monitor prevalence of the diseases, the vaccination coverage and seroconversion. School children aged 10-14 years (n = 1077) were recruited in all four schools in the city of Schwaz, Austria, to present their vaccination documents and to give blood for serological testing (diphtheria, pertussis, measles, mumps, rubella, varicella). All participants received a report with a personal guideline for (re-) vaccination. Overall vaccination coverage was 86.4% for measles, 85.5% for mumps and 35.0% for rubella. Tetanus vaccination coverage was 98.4% for the first, 97.8% for the second and 96.7% for the third dose, while 55.4% of the study subjects received the recommended two booster injections. For diphtheria the corresponding vaccination coverage was found to be almost identical. Pertussis coverage was lower in general (first dose: 90.9%; second dose: 89.0%; third dose: 86.5%). Oral poliomyelitis vaccination showed a coverage of 98.6, 96.5, 95.3%, with 78.7% receiving the fourth dose. Overall 38.7% were classified as fully vaccinated. Seropositivity for measles was found in 90.4%, for mumps in 61.8%, for rubella in 82.3%, for diphtheria in 65.8%, for pertussis in 35.6% and for varicella in 95.0%. In summary, fully vaccinated children are rare and intensive public health efforts will be necessary to reach higher levels of immunity and prevent further outbreaks.

Adolescent↗
PubMed2002

Exploring the effects of population mobility on cervical screening coverage.

London has the lowest cervical screening coverage in England and in 1998/1999 accounted for 11 of the 13 health authorities that fell below the national 80% coverage target. There are several factors which may contribute to the difference in coverage between the capital and the rest of the country. London's population is much more diverse, there is greater deprivation and there are well-established structural differences in primary care. London has high levels of population mobility which will also affect the ability of GPs to achieve high population coverage. This paper explores the possible size of the effect that population mobility is likely to have on coverage of the cervical screening programme in London. The analysis estimates the size of 'missing populations' that may not receive an invitation for a smear test, or artificially inflate the list size of registered patients. A simple model suggests that in some London Health Authorities up to 14% of residents, and 11% of patients on GP lists, may miss out on invitations for screening as a result of population mobility. Moreover the large differences between list and resident populations in some areas mean that the current government target of 80% coverage of the registered population will be largely unattainable for many London Health Authorities and Primary Care Trusts. Moving towards a resident-based system, whereby the numbers screened are related to the number of residents, avoids some of the problems associated with list inflation and gives a fairer picture of coverage of the eligible population.

Adult↗
PubMed2003

Urine calcium and volume predict coverage of renal papilla by Randall's plaque.

BACKGROUND: Renal papillary plaques are common in calcium stone formers. We hypothesized that plaque should increase directly with urine calcium excretion, and inversely with urine volume. To test this, we measured papillary plaque areas in both idiopathic calcium oxalate stone formers and nonstone formers and examined 24-hour urine data to identify significant correlations. METHODS: Fourteen stone formers and four nonstone forming controls underwent papillary mapping with flexible nephroscopy. For each papillum, representative still images and moving pictures expert group (MPEG) movies were used to identify plaque extent and papillary borders. The mean fractional plaque coverage for each polar region (upper, inter, lower) and per papillum was calculated. The relationship of the plaque coverage data to urine measurements was assessed with general multivariate linear modeling. RESULTS: Mean polar fractional plaque coverage was higher in the calcium oxalate stone formers (7.4% vs. 0.5%, P= 0.012) as was mean fractional plaque per papillum (7.6% vs. 0.6%, P= 0.011). When correlating mean polar plaque coverage to urine data, urine volume and calcium excretion were the only measurements with independent relationships to plaque (P= 0.002, adjusted multiple R2= 0.521), with higher calcium and lower volume increasing coverage. The same relationships hold for mean plaque per papillum, except that urine pH also becomes an independent factor (P= 0.001, adjusted multiple R2= 0.606). CONCLUSION: Utilizing advanced digital video and endoscopic equipment, we have achieved the most accurate estimation of papillary plaque coverage to date. Our findings support the idea that urine volume and calcium are the main correlates of plaque coverage.

Calcium↗
PubMed2006

Enhanced sequence coverage of proteins in human cerebrospinal fluid using multiple enzymatic digestion and linear ion trap LC-MS/MS.

The cerebrospinal fluid (CSF) provides a ready access into the health state of the central nervous system, and alterations in some CSF proteins have been documented in brain disease. However, the complete variety of proteins is not known and methods to identify protein components are still being developed. The goal of this study was to examine the sequence coverage obtained from human CSF digests produced with different proteases. Enzymatic digests of CSF proteins were obtained with arginine-C endopeptidase (ArgC), glutamic acid endopeptidase (GluC), chymotrypsin, trypsin and their combinations, and then examined using reverse phase chromatography and a Finnigan LTQ linear ion trap mass spectrometer. Peptide sequences were identified with BioWorks 3.1 and sequence coverage calculated for the 38 most confidently identified proteins. Trypsin and GluC yielded greater coverage than chymotrypsin, while ArgC had the least sequence coverage. Protein sequence coverage was affected only slightly over four orders of magnitude dynamic range of abundance. Combining the peptides derived from different proteases further increased the coverage. Maximal sequence coverage was achieved by combining digest results from both GluC and trypsin. These results have implications for future studies to identify CSF proteins and their post-translational modifications.

Amino Acid Sequence↗
PubMed2006

Measuring immunization coverage among preschool children: past, present, and future opportunities.

Control of vaccine-preventable diseases depends on maintaining high levels of immunization coverage. Immunization coverage among preschool children remains suboptimal in some areas and sociodemographic subgroups, as well as for more recently introduced vaccines, leaving susceptible young children vulnerable to complications from vaccine-preventable diseases. This paper reviews approaches historically used to measure immunization coverage among preschool children in the United States. The strengths and weaknesses of various approaches to measuring immunization coverage among preschool children are explored, with emphasis on the current means to measure national immunization coverage-the National Immunization Survey. Methods for measuring immunization coverage among preschool children at local and state levels are also evaluated. Future opportunities and challenges for measuring immunization coverage at the local, state, and national levels are explored.

Centers for Disease Control and Prevention, U.S.↗
PubMed2005

Understanding variation in measles-mumps-rubella immunization coverage--a population-based study.

BACKGROUND: Coverage of the Measles-Mumps-Rubella combined vaccine (MMR) has declined in recent years in the UK, following adverse publicity about possible links between the vaccine, autism, and Crohn's disease. The objectives of this study were to assess geographical variation in trends in MMR coverage and to identify the factors affecting MMR uptake at population level. METHODS: We conducted an ecological study of immunization coverage by second birthday, based on routinely collected data from 1993-2004 for England. Trends in MMR uptake were assessed in 95 District Health Authorities in England over the study period. We investigated the relationship between MMR immunization uptake and deprivation, ethnicity, education, population density, rurality, and socioeconomic class. RESULTS: Since 2000, MMR coverage has declined significantly in virtually all areas of England. Population density and deprivation were both strongly correlated with low MMR uptake. The decline in coverage since 1993-94 was significantly related to the proportion of educated population and was greater in densely populated areas. CONCLUSION: Decline in MMR coverage now affects most areas of England. The lowest rates of MMR coverage remain in urban areas, particularly in inner cities, which also tend to show high levels of deprivation. Public health resources should continue to target inner city areas, as well as focus on the concerns of the better educated about vaccine safety.

Catchment Area, Health↗