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PubMed1994

Potential impact on vaccination coverage levels by administering vaccines simultaneously and reducing dropout rates.

BACKGROUND: Retrospective immunization coverage surveys conducted during 1991 and 1992 demonstrated that coverage levels for the routine childhood vaccines by 24 months of age in selected urban areas of the United States ranged from 10% to 52%, far below the US Public Health Service goal of 90%. Therefore, appropriate programmatic changes must be identified and incorporated. METHODS: We analyzed coverage survey data collected from 21 sites to measure the potential impact on coverage levels of implementing selected changes in vaccination practices. In a multistaged cluster survey design, school health records of kindergarten or first-grade students were randomly selected and dates of vaccination assessed. We evaluated changes in the vaccination practices, such as eliminating missed opportunities for simultaneous administration of vaccines and ensuring that children initiated the vaccination series on time (ie, by 3 months of age). We then calculated potential increases in coverage levels for a best-case scenario. RESULTS: From 77% to 96% of all children in the 21 sites had received at least one vaccination by their first birthday. Children were 2.3 to 17 times more likely to be up to date on their vaccinations by 24 months of age if they were up to date at 3 months of age. Each child had many opportunities for the simultaneous administration of diphtheria and tetanus toxoids and pertussis (DTP) vaccine, oral polio vaccine (OPV), and measles-mumps-rubella (MMR) vaccine that, if used appropriately, could have potentially raised coverage levels by 12% to 22% (median, 17%). The highest coverage levels could have been attained if all children had started the series on time and if advantage had been taken of all opportunities for simultaneous vaccination. Coverage levels for four doses of DTP vaccine, three doses of OPV, and one dose of MMR vaccine would have increased from a baseline of 10% to 52% to levels of 54% to 83%. CONCLUSIONS: Although the majority of children received a vaccination by their first birthday, the coverage level at 24 months of age was low. Tracking systems are needed to ensure that children do not drop out of the system once they have begun the vaccination series. In addition, all children who are late in beginning their vaccination series are at increased risk of not completing the recommended vaccination series on time, and these children need intensive follow-up and recall efforts. Also, providers need to administer all needed vaccines simultaneously.

Child, Preschool↗
PubMed1975

Correlates of initial client disturbance: expectations for therapy, dropout, resistance, and demographic description.

Relationships were investigated between initial levels of client disturbance in each of 10 problem areas and client drop-out, lateness to, and absence from therapy, expectations with regard to therapy, and various demographic variables. Data were obtained from 154 outpatients at a university psychological clinic. Correlations computed between initial disturbance scores and all other variables revealed many significant relationships. Most noteworthy were the significant relationships betwee initial disturbance levels in the areas of future goals and self-satisfaction and expectations in a psychodynamically oriented therapist. Results were discussed in terms of client's awareness of the need to deal with the psychological factors that underlie their problems and their desire for the therapist to focus on such material.

Adolescent↗
PubMed1983

Comparative functional and physiologic status of active and dropout coronary bypass patients of a rehabilitation program.

To assess the benefits of regular participation in a medically supervised cardiac rehabilitation program, 22 patients who had undergone coronary artery bypass (2 groups of 11 each) were studied retrospectively. Group I (mean age 53 years) was currently enrolled in the rehabilitation program. Group II (mean age 56 years) had begun but had discontinued the program. The stated reasons for discontinuation were not medical. There was no difference in entry exercise tests, and presurgical catheterization data in both groups were comparable. Mean peak oxygen consumption (VO2) by modified Douglas bag technique, heart rate X systolic blood pressure product, and treadmill duration time were recorded in a single testing period. Results revealed that Group I had higher peak VO2 (30 ml/kg/min) than Group II (24) (p less than 0.005) and greater treadmill time (11 minutes) than Group II (8) (p less than 0.01). Nine of 11 subjects in Group I were fully employed, versus 4 of 11 in Group II (p less than 0.01). One of 11 subjects in Group I had been rehospitalized versus 5 in Group II. None in Group I but 4 of 11 subjects in Group II smoked. Thus, based on the sampling and methodology of this study, it is concluded that coronary artery bypass patients in rehabilitation programs have greater peak VO2 and treadmill test time, smoke less, are less often rehospitalized, and are more often fully employed than those who are not in such programs.

Adult↗
PubMed1989

Adjustment to illness and dropout of chemotherapy.

The study compares the adjustment to illness of a group of 53 cancer patients who dropped out of chemotherapy with a matched group of 53 cancer patients who completed their treatment. The patients were treated in five oncological institutes in Israel. We found differences both in the Psychosocial Adjustment to Illness Scale (PAIS) and Brief Symptom Inventory Scale (BSI). In both scales we found significant differences indicating that the degree of adjustment and the psychosocial distress of patients who dropped out of treatment was worse than that of patients who completed treatment.

Adaptation, Psychological↗