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PubMed2000

Recent trends in children's health insurance coverage: no gains for low-income children.

The percentage of low-income children who have health insurance has not changed over the last few years, despite expansions in public coverage through Medicaid and the State Children's Health Insurance Program (SCHIP). Data from 1996-1997 and 1998-1999 from the Center for Studying Health System Change (HSC) find that while the proportion of low-income children with public coverage has increased, the percentage with private insurance coverage has decreased sharply, resulting in no net change in the percentage who are uninsured. This Issue Brief describes these recent changes in public and private coverage. Possible factors that may explain these changes are discussed, including increases in private insurance premiums, substitution of public for private coverage and changes in the characteristics of low-income persons. The study did not determine conclusively the causes of the changes in coverage.

Child↗
PubMed2001

Coordination of health coverage for Medicare enrollees: a case study of HIV/AIDS.

When people with HIV/AIDS become eligible for Medicare, they find that it does not pay for a significant share of their health care needs. As enrollees seek supplemental health coverage (e.g., Medicaid, employer-sponsored and individually-purchased insurance, and premium payment programs), they find that though there are numerous potential benefit and insurance options, the rules are complex and often conflicting. The search for comprehensive health coverage is further complicated by the fact that each program is separately administered, with different eligibility requirements and application processes. Because each program and agency's staff knows little about other programs, they are often unable to help coordinate coverage. Respondents to the study believe that people with a serious chronic condition would benefit from reforms that make Medicare's benefits more comprehensive and its eligibility, coverage, and payment rules less complicated. They also said that enrollees need better access to Medicare information and enhanced mechanisms to coordinate Medicare with supplemental health coverage. Some HIV/AIDS organizations have developed benefits counseling programs that help their clients piece together a synthetic health coverage "system." These and other issues discussed in this Medicare Brief illustrate possible policy reforms that could help enrollees with HIV/AIDS and other serious chronic conditions.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2006

Coverage for mental health treatment: do the gaps still persist?

BACKGROUND: Consumers have long faced high out-of-pocket costs for mental health and substance abuse treatment in private health insurance plans, the predominant form of insurance coverage in the United States. Nominal mental health benefits may have improved from the mid-1990s onwards, as many states passed mental health parity mandates and other employers voluntarily improved coverage. However, the rapid rise of managed behavioral health care organizations (MBHOs) may have effectively offset these gains in nominal coverage. AIMS OF THE STUDY: We examine how effective mental health benefits, as measured by actual out-of-pocket expenses, compares to coverage for non-mental health treatment and how this has changed in recent years. METHODS: We used detailed data on health care use and expenses from the nationally representative, Medical Expenditure Panel Survey (MEPS) to describe the distribution of out-of-pocket expenses for mental health and non-mental health ambulatory visits and prescription drug fills and demonstrate how this changed between 1996 and 2003. In addition, we use two-limit tobit regression models to descriptively examine the factors associated with higher out-of-pocket costs for ambulatory mental health treatment. RESULTS: While out-of-pockets shares generally decreased over the 1996-2003 period, from 39 to 35 percent of total expenses for ambulatory mental health visits and from 31 to 26 percent for non-mental health ambulatory visits, the ratio of out-of-pockets costs is still significantly higher for mental health care. Out-of-pocket expenses per visit fell as the number of non-mental health visits increased but out-of-pocket expenses for mental health visits rose with more visits. Out-of-pocket expenses for visits to specialty mental health providers were substantially higher than for non-psychiatrist physicians. Though prescription drug spending increased substantially, the percent paid out-of-pocket did not change for mental health and non-mental health related fills. DISCUSSION: Our results suggest that expenses for ambulatory mental health visits, especially for specialty providers, effectively remain less well covered than other medical visits. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Continued high out-of-pocket expenses for mental health treatment may impede access to mental health treatment, especially for those who need greater treatment intensity. IMPLICATIONS FOR HEALTH POLICIES: Mental health parity may not ensure that coverage for mental health services is, in actuality, equal. IMPLICATIONS FOR FURTHER RESEARCH: Additional research is needed in understanding relative changes in nominal vs. actual or effective coverage.

Adult↗
PubMed2005

Distributing insecticide-treated bednets during measles vaccination: a low-cost means of achieving high and equitable coverage.

OBJECTIVE: To achieve high and equitable coverage of insecticide-treated bednets by integrating their distribution into a measles vaccination campaign. METHODS: In December 2002 in the Lawra district in Ghana, a measles vaccination campaign lasting 1 week targeted all children aged 9 months-15 years. Families with one or more children less than five years old were targeted to receive a free insecticide-treated bednet. The Ghana Health Service, with support from the Ghana Red Cross and UNICEF, provided logistical support, volunteer workers and social mobilization during the campaign. Volunteers visited homes to inform caregivers about the campaign and encourage them to participate. We assessed pre-campaign coverage of bednets by interviewing caregivers leaving vaccination and distribution sites. Five months after distribution, a two-stage cluster survey using population-proportional sampling assessed bednet coverage, retention and use. Both the pre-campaign and post-campaign survey assessed household wealth using an asset inventory. FINDINGS: At the campaign exit interview 636/776 (82.0%) caregivers reported that they had received a home visit by a Red Cross volunteer before the campaign and that 32/776 (4.1%) of the youngest children in each household who were less than 5 years of age slept under an insecticide-treated bednet. Five months after distribution caregivers reported that 204/219 (93.2%) of children aged 9 months to 5 years had been vaccinated during the campaign; 234/248 (94.4%) of households were observed to have an insecticide-treated bednet; and 170/249 (68.3%) were observed to have a net hung over a bed. Altogether 222/248 (89.5%) caregivers reported receiving at least one insecticide-treated bednet during the campaign, and 153/254 (60.2%) said that on the previous night their youngest child had slept under a bednet received during the campaign. For households in the poorest quintile, post-campaign coverage of insecticide-treated bednets was 10 times higher than pre-campaign coverage of households in the wealthiest quintile (46/51 (90.2%) versus 14/156 (9.0%)). The marginal operational cost was 0.32 US dollars per insecticide-treated bednet delivered. CONCLUSION: These findings suggest that linking bednet distribution to measles vaccination campaigns may provide an important opportunity for achieving high and equitable coverage of bednets.

Adolescent↗
PubMed2003

The effectiveness of assessment and referral on immunization coverage in the special supplemental nutrition program for women, infants, and children.

BACKGROUND: The use of immunization assessment and referral (A/R) in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to produce dramatic improvements in vaccination coverage when coupled with parental incentive; however, data are lacking to support the use of A/R alone. OBJECTIVE: To determine the effectiveness of A/R in increasing immunization coverage among WIC participants. DESIGN: Participating WIC centers were assigned to1 of 3 interventions that delivered A/R of varying frequency or a control group. SETTING: Twenty of the largest Public Health Foundation Enterprises-WIC centers in Los Angeles County. PARTICIPANTS: Children continuously enrolled in participating WIC centers from 6 to 24 months of age. INTERVENTION: Assessment of child's vaccination status followed by referral to a health care provider for those lacking indicated vaccinations. MAIN OUTCOME MEASURE: Up-to-date (UTD) status at 24 months of age for all recommended vaccines. RESULTS: Baseline coverage rates were similar among all study sites (overall, 77% UTD). After the study period, compared with the controls (88% UTD), we found no differences in immunization coverage among WIC centers that administered A/R at every visit (every 2 months) to all children (90% UTD; adjusted odds ratio [OR], 1.02; 95% confidence interval [CI], 0.54-1.94), every 6 months to all children (89% UTD; OR, 0.98; 95% CI, 0.62-1.56), or every visit to children found to be behind at 8 months of age (89% UTD; OR, 0.89; 95% CI, 0.48-1.68). CONCLUSION: In this urban population of WIC children with high baseline immunization coverage, A/R was not effective in increasing immunization coverage.

Child Health Services↗
PubMed2004

Impact of thimerosal-related changes in hepatitis B vaccine birth-dose recommendations on childhood vaccination coverage.

CONTEXT: In July 1999, the longstanding preference to begin hepatitis B vaccination of all US infants at birth was temporarily suspended because of concerns about exposure to mercury contained in the vaccine preservative thimerosal. The suspension was lifted in September 1999 when preservative-free hepatitis B vaccine became available. OBJECTIVE: To determine the effects of changes in recommendations regarding administration of a hepatitis B birth dose on vaccination coverage. DESIGN, SETTING, AND PARTICIPANTS: Cohort analysis of vaccination status of 41,589 US children born before, during, and after the recommendation to suspend the birth dose. MAIN OUTCOME MEASURES: Association between birth cohort and age at receipt of hepatitis B vaccine dose 1, and receipt by 19 months of age of all recommended vaccines. RESULTS: The proportion of US infants who received dose 1 of hepatitis B vaccine at birth declined from 47% among those born 7 to 12 months before the suspension to 11% among those born during the suspension. Birth-dose coverage remained significantly lower in the year after the suspension was lifted (23% in the first 6 months and 33% in months 7-12). Coverage with 3 doses of hepatitis B vaccine by 19 months of age declined from 88% among those born 7 to 12 months before the suspension to 81% among those born during the suspension and 85% among those born in the 6 months after the suspension, but returned to baseline levels for those born 7 to 12 months after the suspension was lifted. These reductions represent 750,000 fewer newborns vaccinated during 2000 compared with 1998, and an excess 182,000 children undervaccinated for hepatitis B at 19 months of age compared with 1998 coverage levels. Coverage with other recommended vaccinations did not decline over this time. CONCLUSIONS: Reductions in hepatitis B vaccine birth-dose coverage persisted after recommendations were made to resume previous newborn vaccination practices. Although the recommendation to complete the series by 19 months of age was never changed, infants born between July and December 1999 were less likely to have completed the series by 19 months, compared with infants born during the previous year. The lack of impact on other vaccinations suggests that public confidence in immunization remained strong.

Cohort Studies↗
PubMed2005

Empiric antibiotic coverage of atypical pathogens for community acquired pneumonia in hospitalized adults.

BACKGROUND: Community acquired pneumonia (CAP) is caused by various pathogens, traditionally divided to 'typical' and 'atypical'. Initial antibiotic treatment of CAP is usually empirical, customarily covering both typical and atypical pathogens. To date, no sufficient evidence exists to support this broad coverage, while limiting coverage is bound to reduce toxicity, resistance and expense. OBJECTIVES: Assess the efficacy and need of adding antibiotic coverage for atypical pathogens in hospitalized patients with CAP, in terms of mortality and successful treatment. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2005) which includes the Acute Respiratory Infection Group's specialized register; MEDLINE (January 1966 to January Week 2 2005); and EMBASE (January 1980 to January Week 2 2005). SELECTION CRITERIA: Randomized trials of adult patients hospitalized due to CAP, comparing antibiotic regimens with atypical antibiotic coverage to a regimen without atypical antibiotic coverage. DATA COLLECTION AND ANALYSIS: Two reviewers independently appraised the quality of each trial and extracted the data from included trials. Relative risks (RR) with 95% confidence intervals (CI) were estimated, assuming an intention-to-treat (ITT) basis for the outcome measures. MAIN RESULTS: Twenty four trials were included, encompassing 5015 randomized patients. There was no difference in mortality between the atypical arm and the non-atypical arm (RR 1.13; 95% CI 0.82 to 1.54). The atypical arm showed an insignificant trend toward clinical success and a significant advantage to bacteriological eradication, which disappeared when evaluating methodologically high-quality studies alone. Clinical success for the atypical arm was significantly higher for Legionella pneumophilae (L. pneumophilae) and non-significantly lower for pneumococcal pneumonia. There was no significant difference between the groups in the frequency of (total) adverse events, or those requiring discontinuation of treatment. However, gastrointestinal events were more common in the non-atypical arm (RR 0.73, 95% CI 0.54 to 0.99). AUTHORS' CONCLUSIONS: No benefit of survival or clinical efficacy was shown to empirical atypical coverage in hospitalized patients with CAP. This conclusion relates mostly to the comparison of quinolone monotherapy to non-atypical monotherapy. Further trials, comparing beta-lactam (BL) or cephalosporin therapy to BL or cephalosporin combined with a macrolide in this population, using mortality as its primary outcome, should be performed.

Adult↗
PubMed1998

Peptide mass fingerprint sequence coverage from differently stained proteins on two-dimensional electrophoresis patterns by matrix assisted laser desorption/ionization-mass spectrometry (MALDI-MS).

Identification of proteins separated by two-dimensional electrophoresis (2-DE) is a necessary task to overcome the purely descriptive character of 2-DE and a prerequisite to the construction of 2-DE databases in proteome projects. Matrix assisted laser desorption/ionization-mass spectrometry (MALDI-MS) has a sensitivity for peptide detection in the lower fmol range, which should be sufficient for an analysis of even weakly silver-stained protein spots by peptide mass fingerprinting. Unfortunately, proteins are modified by the silver staining procedure, leading to low sequence coverage. Omission of glutaraldehyde increased the sequence coverage, but this improved sequence coverage is still clearly below the sequence coverage starting with Coomassie Brilliant Blue (CBB) R-250-stained spots. Other factors additionally seem to modify proteins during silver staining. By decreasing the protein amount, the advantage of very sensitive detection on the gel is lost during identification, because the resulting low sequence coverage is not sufficient for secure identification. Low-quantity proteins can be identified better starting with CBB G-250 or Zn-imidazol-stained proteins. In contrast, for high-quantity CBB R-250-stained spots, a sequence coverage of up to 90% can be obtained by using only one cleaving enzyme, and up to 80% was reached for medium-quantity spots after combination of tryptic digest with Asp-N- and Glu-C digest.

Electrophoresis, Gel, Two-Dimensional↗
PubMedDate not supplied

Will more inputs improve the delivery of health services? Analysis of district vaccination coverage in Pakistan.

In order to determine whether physical resources or technical inputs can make a difference to the delivery of health services, we carried out a study that examined the large variation in district level vaccination coverage in Pakistan. Vaccination coverage was assessed by district-wise cluster surveys and the predictor variables were collected from census data and from a survey of 99 district health offices. Information was collected on basic supplies, physical infrastructure, management, training, socio-economic variables, and a variety of other indicators. Univariate and multivariate analyses were carried out. A model including female literacy rate, TV ownership, and provincial dummies explained 48% of the variation in DTP3 coverage. Very few of the other variables examined were significantly correlated to coverage. Possible explanatory variables like adequacy of syringe and vaccine supply, the number of vaccinators per capita, recent training of managers, frequency of supervision, availability of micro-plans, and turnover of managers were not correlated with coverage. While the Government of Pakistan has ensured that many physical resources and technical inputs have been provided to the district health offices, this does not appear able to explain the relatively low overall coverage or the variation between districts. Bolder initiatives and innovations are likely needed to improve delivery of basic health services.

Data Collection↗
PubMed1991

Coverage and the design of striate cortex.

Hubel and Wiesel (1977) suggested that ocular dominance and orientation columns in the macaque monkey striate cortex might be bands of uniform width that intersected orthogonally. They pointed out that if this were the case, there would be an equal allocation of cells of different orientation preference to each eye and to each point in visual space. However, orientation and ocular dominance columns have a more complex structural organization than is implied by this model: for example, iso-orientation domains do not intersect ocular dominance stripes at right angles and the two columnar systems have different periodicities. This raises the question as to how well the striate cortex manages to allocate equal numbers of neurons of different orientation preference to each eye and to each region of visual space, a factor referred to here as coverage. This paper defines a measure of uniformity of coverage, c', and investigates its dependence on several different parameters of columnar organisation. Calculations were done first using a simplified one-dimensional model of orientation and ocular dominance columns and were then repeated using more realistic two-dimensional models, generated with the algorithms described in the preceding paper (Swindale 1991). Factors investigated include the relative periodicities of the two columnar systems, the size of the cortical point image, the width of orientation tuning curves, whether columns are spatially anisotropic or not, and the role of the structural relationships between columns described by Blasdel and Salama (1986). The results demonstrate that coverage is most uniform when orientation hypercolumns are about half the size of ocular dominance hypercolumns. Coverage is most uneven when the hypercolumns are the same size, unless they are related in the way described by Blasdel and Salama, in which case coverage gets only slightly worse as the size ratio (ori/od) increases above 0.5. The minimum diameter of cortical point image that ensures reasonably uniform coverage is about twice the size of an ocular dominance hypercolumn i.e. about 1.5-2.0 mm.

Animals↗
PubMed2004

Choosing immunisation coverage indicators at the local level.

BACKGROUND: The reliability of information sources, as well as the precision of coverage indicators are open questions for immunisation coverage surveys. METHODS: A sample survey of 323 children from two birth cohorts (1991-1992 and 1979-1981) was done. The sample was selected from seven health districts out of 51 in the Lazio region. The information was collected from vaccination cards or from parents, using a mail-in questionnaire. We computed three indicators of coverage at 24 months of age for polio, diphtheria-tetanus, pertussis (P), hepatitis B, and measles (M), depending on the value given to parental recall. We also compared up-to-date (UTD) (immunised children at 24 months) and age-appropriate (months at risk per child) indicators at the local level. RESULTS: Response rate was 68.2%. The two birth cohorts were similarly immunised for polio (coverage 95%); the younger cohort had higher coverage levels for diphtheria-tetanus (93% vs. 75%), for P (30% vs. 22%), for M (43% vs. 16%) than the older one, even on the basis of parental recall. In the older cohort, diphtheria-tetanus, P and M coverage levels were 75, 22 and 15%, respectively, on the basis of parental recall and 66, 17 and 4% on certification. The age-appropriate indicator revealed four districts that completed vaccinations significantly too late, while the UTD indicator showed only one district significantly below the threshold of 95% of immunized children at 24 months. CONCLUSIONS: Parental recall and data from cards are comparable sources, but the former is more sensitive than the latter in retrospective studies. Verbal recall should be accepted as reasonably reliable in the absence of cards. Age-appropriate indicators give a more complete evaluation of the susceptibility in the population, and are more precise at the local level.

Adolescent↗
PubMed1990

Benign moral hazard and the cost-effectiveness analysis of insurance coverage.

When a medical intervention is found to be cost effective, what level of insurance coverage should apply to it? The optimal level of coverage may be less than or greater than full coverage of medical care costs; a finding of cost effectiveness for a service does not necessarily imply v full coverage or coverage at the same rate as other services. If there is some imperfection in the ability to translate higher insurance benefits into higher insurer revenues, the optimal level of coverage will be greater the higher the degree of moral hazard applying to the service.

Aged↗
PubMed1984

Village health workers in Java, Indonesia: coverage and equity.

Village health workers are often the main vehicle for promoting the primary health care approach in developing countries. Services provided by these workers are expected to be more appropriate to the health needs of populations than those of clinic-based services, to be less expensive and to foster self-reliance and local participation. Because village workers are more accessible and acceptable to clients in their communities, they are expected to improve the overall coverage of services as well as equity--increased service use by poorer individuals and households. This paper presents research on coverage and equity from village health worker programs in Java, Indonesia. Rural health and nutrition projects in Java using village-level volunteers with limited training have grown since the early 1970s to include large national programs managed by the government's rural health system. Volunteer village workers are now the most extensive link between the rural population and the formal health service structure. Previous research on coverage and equity of these village worker activities is reviewed and results from the author's own study are presented. Services provided by village health workers achieve significantly higher levels of population coverage than similar clinic-based services. In most cases, village workers show no bias towards better-off clients and they may favor poorer beneficiaries. These findings show that village workers are meeting the coverage and equity objectives of the primary health care approach. However, some of the research reviewed raises questions about the ability of village worker activities to maintain these results over a longer period. The rapid expansion of these programs requires continued research, not only on coverage and equity, but also on health outcomes, costs, and participation.

Adult↗
PubMedDate not supplied

Attending physician coverage in a teaching hospital's emergency department: effect on malpractice.

It seems self-evident that the establishment of 24-hour per day attending physician coverage in a teaching hospital's emergency department would enhance risk management. However, prior to this study, little investigation had been done to corroborate the effects of full-time emergency department attending physician coverage. In a retrospective study from a large teaching hospital's emergency department, malpractice claims filed for 1985-1987 (part-time attending physician coverage) were analyzed and compared to those for 1987-1989 (full-time attending physician coverage). A total of 98 claims were filed; these data were derived from 466,862 patient visits. Attending physician presence increased from 6000 hours per year in 1985-1987 to 26,280 hours per year in 1987-1989. There was an 18.5% decrease in claims filed, and a 70.1% decrease in disbursements for the first 2 years after the introduction of full-time attending physician coverage as compared with the preceding 2 years. These findings suggest that full-time attending physician coverage in the emergency department is associated with improved risk management.

Emergency Service, Hospital↗
PubMed2005

CT-guided multi-catheter insertion technique for partial breast brachytherapy: reliable target coverage and dose homogeneity.

PURPOSE: To evaluate the feasibility and dosimetric reliability of a CT-guided method of catheter insertion for accelerated partial breast brachytherapy (APBB). MATERIALS AND METHODS: From 1995 to 2002, 77 patients were treated with APBB using a multi-catheter low-dose-rate or high-dose-rate approach. Within that timeframe, 29 patients with early stage invasive breast cancer were treated with high-dose-rate partial breast brachytherapy and had CT scans of the brachytherapy implant available for analysis. Initially, catheter insertion was accomplished in the operating room at the time of lumpectomy using standard free-hand insertion techniques under fluoroscopic guidance and subsequent orthogonal film dosimetry. To improve the efficiency and quality of the technique, the procedure was moved to the departmental CT-simulation suite where the catheters were placed with CT guidance. Basic guidelines of needle insertion and implant construction were followed to assure appropriate intercatheter and interplanar spacing that allowed optimal dosimetric coverage of the target volume. Target volumes were delineated and a treatment plan generated using a 3D planning system (Varian Brachyvision). PTV 1 cm was defined as the lumpectomy cavity plus 1 cm and PTV 2 cm as the lumpectomy cavity plus 2 cm. Target coverage goals were set as delivery of 100% of the prescribed dose to >95% of PTV 1 cm and >90% of the dose to >90% of PTV 2 cm. Dose homogeneity index (DHI) was defined as (V150%-V100%/V100%) with a goal of achieving >0.75. Fifteen patients were treated using the initial method and 14 patients using the CT-guided technique. Targets were retrospectively entered in the initial group and dose volume histogram analysis completed on all patients. The ability of each technique to achieve the target coverage and homogeneity goals was compared. RESULTS: With the change from traditional techniques to a CT-guided technique, the percentage of patients satisfying all dosimetric goals increased from 42% to 93%. Mean dose coverage (defined as the percentage of PTV 2 cm receiving 90% of the prescribed dose) increased from 89% to 95% (p=0.007) and the mean DHI increased from 0.77 to 0.82 with the new technique (p < 0.005). CONCLUSIONS: Reproducible target coverage and dose homogeneity were achieved with CT-guided catheter insertion and 3D planning software. Catheters can be optimally placed with intraoperative CT evaluation and 3D planning software allows improved implant visualization resulting in optimized dosimetry. Improvements in target coverage and DHI may translate into optimized local control and improved cosmesis with a corresponding reduction in the risk of complications.

Aged↗
PubMed2005

Zn2+ and Sr2+ adsorption at the TiO2 (110)-electrolyte interface: influence of ionic strength, coverage, and anions.

The X-ray standing wave technique was used to probe the sensitivity of Zn2+ and Sr2+ ion adsorption to changes in both the adsorbed ion coverage and the background electrolyte species and concentrations at the rutile (alpha-TiO2) (110)-aqueous interface. Measurements were made with various background electrolytes (NaCl, NaTr, RbCl, NaBr) at concentrations as high as 1 m. The results demonstrate that Zn2+ and Sr2+ reside primarily in the condensed layer and that the ion heights above the Ti-O surface plane are insensitive to ionic strength and the choice of background electrolyte (with <0.1 A changes over the full compositional range). The lack of any specific anion coadsorption upon probing with Br-, coupled with the insensitivity of Zn2+ and Sr2+ cation heights to changes in the background electrolyte, implies that anions do not play a significant role in the adsorption of these divalent metal ions to the rutile (110) surface. Absolute ion coverage measurements for Zn2+ and Sr2+ show a maximum Stern-layer coverage of approximately 0.5 monolayer, with no significant variation in height as a function of Stern-layer coverage. These observations are discussed in the context of Gouy-Chapman-Stern models of the electrical double layer developed from macroscopic sorption and pH-titration studies of rutile powder suspensions. Direct comparison between these experimental observations and the MUltiSIte Complexation (MUSIC) model predictions of cation surface coverage as a function of ionic strength revealed good agreement between measured and predicted surface coverages with no adjustable parameters.

Journal Article↗
PubMed2007

Influenza vaccination among persons with chronic respiratory diseases: coverage, related factors and time-trend, 1993-2001.

BACKGROUND: Influenza vaccination has shown itself to be effective in reducing morbidity and mortality in patients with underlying chronic respiratory diseases. This study sought to: (1) estimate influenza vaccination coverage among asthma and chronic bronchitis sufferers; (2) ascertain which variables were associated with vaccination; and (3) analyse the time-trend in coverage between 1993 and 2001. METHODS: This was a descriptive study covering the 2611 subjects included in the 1993, 1995, 1997 and 2001 Spanish National Health Surveys who reported suffering from asthma or chronic bronchitis. Vaccination coverage was calculated for each year and the influence of socio-demographic and health-related variables analysed. Using logistic regression, we assessed which of the variables had an independent effect on vaccination, and analysed the time-trend. RESULTS: The proportions of vaccinated subjects in 1993, 1995-1997 and 2001 were 44.7%, 45.6% and 44.4%, respectively. Variables that increased the likelihood of having been vaccinated were: higher age, presence of another concomitant chronic disease, poor perception of health, non-smoker status, and being married. There was no significant variation in coverage over the study period. CONCLUSION: Influenza vaccination coverage among Spanish asthma and/or chronic bronchitis sufferers is below desirable levels and showed no improvement over the period 1993-2001. Implementation of strategies to improve coverage is necessary.

Adolescent↗
PubMed2005

Assessment of vaccine coverage following the introduction of a publicly funded pneumococcal vaccine program for the elderly in Victoria, Australia.

In 1998, a publicly funded pneumococcal vaccine program was introduced for persons aged > or = 65 years in Victoria, Australia. In 2000, vaccine coverage over the previous 5 years was assessed through a telephone survey of 385 randomly selected subjects aged > or = 65 years. Self-reported pneumococcal vaccine coverage within the previous 5 years was 46.0% (95% CI 40.5-51.6). Self-report was validated against the medical records of the nominated provider for 278 (72%) subjects. Among this subgroup, self-reported coverage was 51.1% but was 57.9% according to medical records (positive predictive value 91.5%, negative predictive value 77.2%, sensitivity 80.7%, specificity 89.7%). After accounting for response bias among those subjects for whom self-report was not validated, the revised estimate of pneumococcal vaccine coverage within the previous 5 years was 50.5% (95% CI 44.8-56.1). Comparison of vaccine coverage over time suggests the introduction of the publicly funded program in Victoria has dramatically increased coverage among the elderly.

Aged↗