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PubMed2001

The impact of record scattering on the measurement of immunization coverage.

BACKGROUND: Lack of a consolidated immunization record may lead to problems with determining individual immunization needs at office visits as well as measuring vaccination coverage levels of a clinician's practice or a community's population. OBJECTIVES: For children with multiple immunization providers, evaluate the difference in coverage levels using data from all responding immunization providers compared with: 1) the most recent immunization provider's records, 2) the first immunization provider's records, and 3) a randomly selected immunization provider's records. Identify characteristics of the most recent provider that may be associated with reporting incomplete immunization histories. METHODS: Data from the 1995 National Immunization Provider Record Check Study (NIPRCS) were used for analysis. The NIPRCS is a provider validation study of the household reported immunization histories of all children 19 to 35 months of age included in the National Health Interview Survey (NHIS). Providers identified by the child's parent during the NHIS interview are mailed a 2-page survey to report all immunizations (type and date) the child received, regardless of the provider who administered the shots, and child's first and most recent visit dates to the practice. RESULTS: Of the 1352 children with provider data, 304 (22%) had received immunizations from more than one provider. Compared with information from all providers and depending on the vaccine, the most recent provider records underestimated coverage by 9.6 to 13.4 percentage points; the initial provider records underestimated coverage by 15.6 to 34.6 percentage points; and the randomly selected provider records underestimated coverage by 10.0 to 20.7 percentage points. Public facilities and having an immunization summary sheet in the patient's chart were associated with having complete records. CONCLUSION: Scattered immunization records significantly compromise the ability of clinicians to determine the immunization status of their patients who received immunizations at other sites of health care. Routinely assessing immunization coverage levels at the practice level, implementing a recall system, and developing community-wide immunization registries are some strategies to reduce the problem of scattered immunization records.immunization, assessment, provider validation, record scattering.

Child, Preschool↗
PubMed2006

Advocacy and coverage of needle exchange programs: results of a comparative study of harm reduction programs in Brazil, Bangladesh, Belarus, Ukraine, Russian Federation, and China.

To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs), effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex. Recent work by UNAIDS on "high coverage sites", adopting the above strategies, has shown that one of the key elements in achieving high coverage is ongoing and sophisticated advocacy. High coverage harm reduction sites were studied through literature search and site visits, including key informant interviews, review of service statistics, and data analysis, in order to document the steps that led to scaling up, the way coverage was defined in these sites, and the lessons learned from their efforts. Syringe-exchange programs can achieve high coverage of IDUs. Monitoring to determine regular reach (those who are in regular contact with harm reduction services) should be added to uniform data collection carried out by harm reduction programs. Advocacy is crucial to achieving high coverage.

Bangladesh↗
PubMed2000

[Vaccination coverage in the first year of life in 4 cities of the state of São Paulo, Brazil].

Immunization is an important disease prevention measure, and evaluating the effectiveness of immunization programs is crucial to ensuring their success. This study describes the results of a household survey in four cities in the state of São Paulo, Brazil: Francisco Morato, Guarulhos, Osasco, and São Paulo. The survey was done in order to estimate immunization coverage for the cohort of children born in 1996. The city of São Paulo was divided into five strata, according to socioeconomic and living conditions. The survey followed the methodology that the Pan American Health Organization recommends for immunization coverage surveys. The proportion of children who had received a complete set of the recommended vaccinations at the time of the interview, taking into account both oral reports and information recorded on the children's immunization cards, was above 90% for all the cities except Francisco Morato, which had the worst living conditions. In the city of São Paulo, the worst coverage was found in the lowest and highest strata. When only the doses received during the first year of life were considered, the coverage was not adequate to produce herd immunity. The use of private vaccination services was higher in the areas with better living conditions. The difference between the coverage calculated based on data from health services and the coverage calculated based on the survey was inversely proportional to living conditions. Our results suggest that surveys similar to the one described here should be carried out in other cities. Employees who provide vaccination services should be trained to correctly record vaccination data. In addition, it is important to make health professionals aware of the official immunization calendar, and to facilitate the public's access to health services.

BCG Vaccine↗
PubMedDate not supplied

[Coverage and association with clinical variables of antipneumococcal vaccination of the population over 65 years old in Tarragona-Valls].

BACKGROUND: In Catalonia, a polyanccharide pneumococcal vaccine (PPV) programme which includes subjects over 65 years old, was started in 1999. Three years later, we study the vaccine cover in relation to the presence of risk factors for pneumonia. METHODS: Cross-sectional observational study conducted in 8 Basic Health Areas (BHA) of Tarragona. All the subjects over 65 years old and assigned to one of the 8 basic health areas participating in the study were included (n=11241). Using computerized clinical records and vaccination records we evaluated whether each patient had received PPV before January 2002, and the presence of disease or risk factors for pneumonia. RESULTS: Global vaccination coverage was 44.4% (37.1% in 65-74 years, 53.9% in 75-84 and 51.5% in 85-99 years). The greatest coverage was recorded in subjects with active neoplasm (56.7%), chronic necropathy (55.3%). chronic lung disease (54.2%) and chronic cardiopathy (53.5%). The least coverage was recorded in smokers (38.9%), alcoholic patients (43.6%) and chronic liver disease (46.5%). AVP coverage was 38.9% (CI 95%: 37.6-40.2) in subjects without any risk factors, 47.7% (CI 95%: 46.1-49.4) in those with one factor, and 52.7% (CI 95%: 52.6-54.8) in those with two or more factors. CONCLUSIONS: In spite of an acceptable global coverage, there are large subgroups of high risk patients who have not received PPV. The results suggest that, in an attempt to achieve extended global coverage, the presence of risk factors is largely ignored when deciding whether to prescribe PPV or not.

Age Factors↗
PubMedDate not supplied

[Resistance to fracture of direct restorations with cuspal coverage in endodontically treated upper bicuspids].

Endodontically treated teeth are considered more susceptible to fracture because of the loss of tooth structure. The aim of this study was to evaluate the increase of resistance to fracture of upper bicuspids that underwent endodontic access and were restored with composite resin, with cuspal coverage. Forty extracted human maxillary premolars were divided in 4 groups: I--intact teeth; II--teeth with endodontic access and MOD preparation, restored with composite resin, without cuspal coverage; III--teeth with endodontic access, MOD preparation and occlusal reduction, restored with composite resin, with cuspal coverage; IV--teeth with endodontic access and MOD preparation, without any restoration. The test specimens were submitted to compression test up to their fracture. The test of Turkey and the ANOVA analysis were used to compare and test the results. The teeth from group III (with cuspal coverage) presented with significantly greater resistance to fracture, when compared with those from groups II (restored without cuspal coverage) and IV (not restored). The composite restoration with cuspal coverage can be considered an alternative for endodontically treated premolars.

Bicuspid↗
PubMed2001

Predictable multiple site root coverage using an acellular dermal matrix allograft.

BACKGROUND: The primary aim of this randomized, controlled, blinded clinical investigation was to determine if orientation of an acellular dermal matrix (ADM) allograft, basement membrane side against the tooth or connective tissue side against the tooth, affected the percent root coverage. Additional aims were to: 1) compare results of this study with results obtained from other root coverage studies; 2) determine if multiple additional sites could be successfully covered with the same surgery; 3) determine the effect of the procedure on keratinized tissue; and 4) evaluate the amount of creeping attachment obtained. METHODS: Ten patients with 2 Miller Class I or II buccal recession defects > or =3 mm were treated with a coronally positioned flap plus ADM and followed for 12 months. Test sites received ADM with the basement membrane side against the root (AB), while the control sites received the connective tissue side against the root (AC). Multiple additional recession sites were treated with the same flap procedure. RESULTS: Mean baseline recession for the AB sites was 4.2 mm and for the AC sites, 3.7 mm. Mean root coverage of 95% was obtained for both AB and AC sites. Sixty-eight additional Class I or II AB and AC sites obtained about 93% root coverage. The mean increase in keratinized tissue for both treatments was 0.80 mm. No additional root coverage was gained due to creeping attachment between 2 and 12 months. CONCLUSIONS: Treatment with ADM was an effective and predictable procedure for root coverage. The orientation of the material did not affect the treatment outcome for any of the parameters tested.

Adult↗
PubMed2001

Coronally advanced flap procedure: is the interdental papilla a prognostic factor for root coverage?

BACKGROUND: This study was designed to verify if the dimension of the interdental papilla may be a prognostic factor for the clinical outcome of the coronally advanced flap (CAF) in the treatment of gingival recessions. METHODS: Thirty-three Miller Class I recessions were treated in 33 patients using the CAF procedure. Two types of measurements were performed: 1) clinical measurements (probing depth, recession depth, width of keratinized tissue, clinical attachment level) were recorded at baseline and 3 months after surgery and 2) all recessions were photographed and transformed into computer images. A specific software allowed recording of both linear and square measurements. The following digital measurements were recorded at baseline: 1) base, height, and area of the mesial and distal papillae adjacent to the involved tooth and 2) width/depth of the recession and the area of the exposed root surface of the involved tooth. The residual recession area, if any, was recorded 3 months after surgery. The digital measurements of the height and of the area of the papilla were used in statistical analysis (multiple linear regression and logistic regression) to evaluate a possible correlation with root coverage (mm2) and/or with complete root coverage. RESULTS: Root coverage was not significantly correlated to the papilla area (P= 0.3692) or to papilla height (P= 0.0968). The complete root coverage was not correlated to the papilla area (P= 0.3181), but it was correlated to papilla height (P= 0.0499). CONCLUSIONS: This study indicates that the root coverage following CAF procedure is not significantly correlated to papilla dimension. However, complete root coverage is significantly more frequent in sites with lower height of the adjacent papilla.

Adult↗
PubMed2004

A multicenter comparative study of two root coverage procedures: coronally advanced flap with addition of enamel matrix proteins and subpedicle connective tissue graft.

BACKGROUND: Free grafts, pedicle flaps, and barrier membranes have been used to cover exposed root surfaces. The aim of the present study was to evaluate the clinical efficacy of a coronally advanced flap procedure with the additional use of enamel matrix protein derivative (EMD) to treat gingival recession and to compare it to the subpedicle connective tissue graft procedure (CTG). METHODS: The study was conducted in six different periodontal clinics. Miller Class I or II buccal recession type defects in the anterior or premolar teeth were treated in 70 consecutive patients, 30 with EMD and 40 with CTG. At baseline and 6 and 12 months post-surgical treatment, vertical recession defect, defined as the distance from cemento-enamel junction to gingival margin; width of keratinized tissue; and probing depth were recorded and the percentage of coverage of the original defect was calculated. Statistical analyses consisted of t-test, analysis of variance, and analysis of covariance. RESULTS: At 6 months, percent of root coverage was 77.4% +/- 11.92% in EMD and 84.1% +/- 11.97% in CTG (statistically significant at P = 0.024). At 12 months, percent of root coverage in EMD was 71.7% +/- 16.14% and 87.0% +/- 12.22% in CTG; again, differences between groups were statistically significant (P < 0.001). Differences between the 6- and 12-month vertical recession defect and percent of root coverage recordings within each group were also statistically significant. CONCLUSIONS: The connective tissue graft procedure was superior to the coronally positioned flap with the addition of enamel matrix proteins derivative in percentage of coverage and increase in width of keratinized tissue. The EMD procedure is a predictable treatment for root coverage that is relatively easy to perform and presents low patient morbidity, and is appropriate especially where a substantial increase in the width of keratinized tissue is not of prime importance.

Adolescent↗
PubMed2004

Relative connective tissue graft size affects root coverage treatment outcome in the envelope procedure.

BACKGROUND: This study investigated the correlation between the connective tissue graft size and the percentage of root coverage. METHODS: Fifteen patients with Miller Class I or II recession defects (one tooth/defect per patient) were treated using an envelope connective tissue graft procedure. Clinical parameters including gingival recession depth (RD), clinical attachment level (CAL), keratinized tissue width (KW), and the probing depth (PD) were measured. Visible denuded area (VDA) and graft tissue area (GTA) were indirectly measured in mm2 using computer software. Graft tissue thickness (GTT) and graft tissue width (GTW) were also measured. All clinical parameters and VDA were recorded at baseline and 3 and 6 months. The RD, CAL, KW, PD, and VDA were evaluated by Friedman test. The correlation between the percentage of root coverage (PRC) and factors related to graft size were determined by Spearman rank correlation and nonparametric regression analysis. RESULTS: The percent of root coverage at 3 and 6 months postoperatively was statistically significantly associated with the GTA:VDA ratio (P<0.01); it did not correlate with GTA, GTT, or RD, and was inconsistently correlated to GTW and VDA. In patients who had 100% root coverage, the GTA:VDA ratio ranged between 10.92:1 and 21.95:1; in patients with <100% root coverage, the ratio was between 4.54:1 and 11.06:1. CONCLUSION: The GTA:VDA ratio should be at least 11:1, which is a significant factor for optimal root coverage result in the envelope procedure.

Adult↗
PubMed2005

Factors affecting the outcomes of coronally advanced flap root coverage procedure.

BACKGROUND: The coronally advanced flap (CAF) has been used to treat gingival recession. However, the final outcomes (percentage of root coverage) vary from case to case. Hence, the purpose of this study was to analyze the factors that may affect the results of CAF root coverage procedures. METHODS: Twenty-three systemically healthy patients (mean age, 43.8 +/- 11.9 years) each with one Miller's Class I buccal recession defect were included. Baseline clinical parameters included recession depth (RD), recession width (RW), gingival thickness (GT), width of keratinized tissue (WKT), clinical attachment level (CAL), probing depth (PD), plaque index (PI), and gingival index (GI). CAF root coverage procedures were performed to correct the recession defects. Patients were followed at 2, 4, 12, and 24 weeks post-surgery, at which time wound healing index (WHI) and other measurements were recorded. RESULTS: The mean baseline RD was 2.9 +/- 0.4 mm; RW, 3.4 +/- 0.6 mm; WKT, 2.7 +/- 1.3 mm; and GT, 1.1 +/- 0.3 mm. At mid-buccal, the mean CAL was 4.5 +/- 0.8 mm. Six months after surgery, the average RC was 82.3% +/- 24.7%; RD, 0.5 +/- 0.7 mm; RW, 0.4 +/- 0.9 mm; WKT, 3.2 +/- 0.9 mm; and GT, 1.5 +/- 0.5 mm. At mid-buccal, the mean CAL was 1.8 +/- 1.1 mm. From baseline to the 6-month follow-up, the changes of RC, RD, RW, WKT, GT, and CAL showed statistical significance (P < 0.05). Fourteen patients achieved 100% RC. The mean RC in partial coverage cases was 54.8% +/- 16.8%. Analysis revealed that an initial GT thicker than 1.2 +/- 0.3 mm was associated with complete root coverage at the 6-month follow-up (P < 0.05). CONCLUSIONS: CAF is a predictable procedure to treat Miller's Class I mucogingival defects. Initial GT was the most significant factor associated with complete root coverage.

Adult↗
PubMed2006

Coronally positioned flap for root coverage: poorer outcomes in smokers.

BACKGROUND: Gingival recession is significantly more common among smokers, while the relative outcome of various root coverage procedures in smokers, compared to non-smokers, is debatable. The objective of this study was to evaluate the influence of cigarette smoking on the outcome of coronally positioned flap (CPF) in the treatment of Miller Class I gingival recession defects. METHODS: Ten current smokers (> or = 10 cigarettes daily for at least 5 years) and 10 non-smokers (never smokers), each with one 2- to 3-mm Miller Class I recession defect in an upper canine or bicuspid, were treated with CPF. At baseline and 6 months, clinical parameters, probing depth (PD), clinical attachment level (CAL), recession depth (RD), and apico-coronal width of keratinized tissue (KT) were determined. RESULTS: Intragroup analysis showed that CPF was able to reduce RD and improve CAL in both groups (P <0.05). Intergroup analysis demonstrated that smokers presented greater residual RD at 6 months and lower percentage of root coverage (69.3% versus 91.3%; P <0.05). No smokers obtained complete root coverage compared to 50% of non-smokers (P <0.05). CONCLUSIONS: Within the limits of the present study, it can be concluded that CPF provides benefits for both smokers and non-smokers in terms of root coverage of shallow Miller Class I recession defects. However, cigarette smoking negatively impacts the clinical outcomes, specifically residual recession, percent root coverage, and frequency of complete root coverage.

Adult↗
PubMed1993

Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph. A new computerized technique.

We developed a method for the estimation of three-dimensional acetabular coverage of the femoral head with use of only an anteroposterior radiograph of the hip. This technique also allows recalculation of the corrected value for coverage at neutral pelvic tilt. Provided that the acetabulum and femoral head are spherical and congruent, the results are as accurate as those obtained with computerized tomographic reconstruction, the dose of radiation is much lower, and much less time is required for calculation. The hips of 286 normal subjects showed increases with age in both anterior and posterior coverage and backward tilt of the pelvis, along with a decrease in the anterior-posterior ratio of coverage. The proportion of anterior acetabular coverage in female subjects was smaller than that in male subjects. There was more backward tilt of the pelvis and the anterior-posterior ratio of coverage was smaller when the subjects were standing than when they were supine.

Acetabulum↗
PubMed2002

Amount of photographic coverage for boys and girls on the sports page of newspapers as related to circulation size.

The present study analyzed the amount of photographic coverage devoted to high school athletics over 1 year. Previous research pertaining to sex differences in newspaper coverage of sports has focused on the amount of written coverage given. Present findings indicated that, as with written coverage given female athletes, photographic coverage differed significantly by newspaper circulation. Specifically, the larger the newspaper circulation, the more inequitable the photographic coverage of high school athletics was for girls.

Adolescent↗
PubMed2005

Influenza and pneumococcal vaccine coverage among a random sample of hospitalised persons aged 65 years or more, Victoria.

This study was undertaken to assess the uptake of influenza and pneumococcal vaccination based on provider records of the hospitalised elderly, a group at high risk of influenza and pneumococcal disease. The study used a random sample of 3,204 admissions at two Victorian teaching hospitals for patients, aged 65 years or more who were discharged between 1 April 2000 and 31 March 2002. Information on whether the patient had received an influenza vaccination within the year prior to admission or pneumococcal vaccination within the previous five years was ascertained from the patient's nominated medical practitioner/vaccine provider. Vaccination records were obtained from providers for 82 per cent (2,804/2,934) of eligible subjects. Influenza vaccine coverage was 70.9 per cent (95% CI 68.9-72.9), pneumococcal coverage was 52.6 per cent (95% CI 50.4-54.8) and 46.6 per cent (95% CI 44.4-48.8) had received both vaccines. Coverage for each vaccine increased seven per cent over the two study years. For pneumococcal vaccination, there was a marked increase in 1998 coinciding with the introduction of Victoria's publicly funded program. Influenza and pneumococcal vaccine coverage in eligible hospitalised adults was similar to, but did not exceed, estimates in the general elderly population. Pneumococcal vaccination coverage reflected the availability of vaccine through Victoria's publicly funded program. A nationally funded pneumococcal vaccination program for the elderly, as announced recently, should improve coverage. However, these data highlight the need for greater awareness of pneumococcal vaccine among practitioners and for systematic recording of vaccination status, as many of these subjects will soon become eligible for revaccination.

Aged↗
PubMed2005

Determinants of immunisation coverage in Butere-Mumias district, Kenya.

BACKGROUND: Butere-Mumias district is one of the districts which performs poorly on immunisation coverage, as observed from the Kenya Expanded Programme of Immunisation reports. OBJECTIVE: To identify factors that contribute to the low level of immunisation coverage in the district among children under the age of five years. DESIGN: Cross-sectional descriptive study. SETTING: Butere-Mumias district. RESULTS: Out of the 293 mothers who were sampled, 238 (80%) had attained primary level of education while, 55 (20%) attained secondary level and above. Immunisation coverage was found to be 35% in this district. Long distances to health facilities, poor states of the roads, age, attitude and knowledge regarding immunisation among mothers were significant factors that determined immunisation coverage. CONCLUSION: Low levels of education, long distances to the nearest health facilities, lack of knowledge on immunisations and lack of staff were responsible for the low coverage. There is therefore, need to act on these factors which hamper the immunisation coverage in order to reduce child mortality rate which are attributable to non-immunisation.

Adolescent↗
PubMed1997

[The role of similarity and category in confirmation judgement of category-based induction: an examination of the similarity-coverage model].

Induction is called category-based induction if its premises and conclusion are of the form "All members of a category C have property P." Osherson, Smith, Wilkie, Lopez, and Shafir (1990) advanced similarity-coverage model. But their data from a quantitative test of specific induction did not necessarily support the model. Three experiments investigate whether their modeling of similarity and coverage was not valid or their experiments were not valid. The following results were obtained. Coverage did not affect confirmation judgement in premise-variation type induction which Osherson et al. (1990) dealt with, and coverage effect was verified in conclusion-variation type induction which is more everyday and needs less processing load. In the latter case, coverage had to be weighted by typicality of conclusion in an inclusive category. And when mixed inductions were included, confirmation judgement was based not on coverage but on a belonging relation to an upper category and similarity between premise categories and a conclusion category.

Adult↗
PubMed1984

The process of evaluating medical technologies for third-party coverage.

A detailed review of records and documentation considered more than 100 technology evaluations performed in conjunction with coverage decisions by the Medicare program and by a major Blue Cross/blue Shield plan. Medicare evaluations were highly structured, synthesizing thorough literature reviews, recommendations from the National Institutes of Health and other governmental agencies, and information solicited from medical specialty societies and independent practitioners; however, the material supplied by nongovernmental sources seldom influenced the coverage recommendations. In contrast, the Blue plan's evaluations were based largely on presentations and discussions at advisory committee meetings, after receiving informational inputs that were more limited than those used in Medicare evaluations. The fraction of technologies recommended for coverage was slightly over 50% for each carrier. If information was strongly positive about either a technology's safety, its effectiveness, or both, then coverage was nearly always recommended. Still, the carriers differed significantly in the stage of development of the practices evaluated and in their willingness to make a coverage decision in the face of both safety and effectiveness data that were regarded as tentative. Because coverage decisions, and the speed with which they are conducted, may be crucial to the rate of a technology's diffusion--and possibly even to the rate of innovation--the authors conclude that it is important to understand clearly the process by which this type of technology assessment is performed.

Blue Cross Blue Shield Insurance Plans↗
PubMed1999

Health care coverage of high school athletics in South Carolina: does school size make a difference?

Despite an apparently high injury rate, medical coverage available to these high school athletes is often not immediately present during practice and games. The purpose of the present study was to examine the current conditions of health care coverage and delivery to the football program and associated athletic departments in the public and private high schools in South Carolina. Additionally, the relationship between student enrollment and medical coverage was examined. A survey, based upon previously utilized instruments, was sent to the athletic directors at the public and private high schools with interscholastic football programs in South Carolina. The survey included questions pertaining to the medical coverage, including personnel, equipment, and record systems, for football practices and games. Based upon the results of the survey, a majority of high schools in South Carolina appear to have adequate sports medicine coverage and compare favorably with the results of similar data from other states. The medical coverage does significantly vary depending upon the enrollment size of the high school. In spite of this finding, the health care provided high school athletes is often inconsistent and training and equipment required for basic first aid is often absent.

Adolescent↗