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PubMed1991

Immunization coverage survey in eight regions of Saudi Arabia.

A study of 1916 children in eight regions in the Kingdom of Saudi Arabia was conducted to find out the immunization coverage of the six expanded programme on immunization (EPI) target diseases. The eight regions surveyed were selected because they showed less than 80% coverage in a previous survey. The WHO cluster sampling technique was employed. The field workers were trained to conduct house-to-house surveys, inspect the children's immunization cards or health registers and complete the data forms. The overall coverage in the eight regions was found to be 97.5% for BCG, 94.3% for DPT and polio and 86.0% for measles. Altogether, 84.8% of the children had completed their immunization schedule by the end of their 1st year of life. The situation improved further in the 2nd year of life to reach 91.9%. The immunization coverage varied from region to region and from one EPI target disease to another. The partially immunized children represented 6-18% while those who did not receive any immunization represented only 0-8%. The drop-out rate between BCG and the third dose of DPT ranged from 1.9% to 9%. The factors behind the success are discussed and recommendations made for further improvement and maintenance of high immunization coverage.

Humans↗
PubMedDate not supplied

Effect of media coverage and physician advice on utilization of breast cancer screening by women 40 years and older.

The purpose of this study is to examine the relative importance of media coverage and physician advice on the decision of women 40 years and older to obtain a mammogram. Five theoretical models, by which media coverage and physician advice may interact to affect individual health behavior, are presented. These models are tested with time-series regression analysis based on national-level data on mammography utilization and physician advice from the Behavioral Risk Factor Surveillance System (BRFSS) and content analysis of mammography-related national news coverage. Results suggest that although physician advice plays a key role in women's decisions to have mammograms, media coverage of mammography screening also contributes to mammography utilization by women. In particular, media coverage seems to be important for women who do not have regular contact with a physician or access to physicians. A possible conclusion is that mass media and physician advice complement one another in persuading individuals to adopt preventive health behavior.

Adult↗
PubMed2003

Measles vaccination coverage during poliomyelitis national immunization days in Burkina Faso, 1999.

In 1999, Burkina Faso added measles vaccine during the second round of its poliomyelitis national immunization days (NIDs). A cluster survey was conducted in each of the country's 53 health districts to assess vaccination coverage achieved by the campaign. Forty-four percent of children aged 9-59 months had a documented prior measles vaccination, and 88% were vaccinated during NIDs. Eighty-five percent of children not previously vaccinated received measles vaccine during the campaign. Although routine vaccination coverage varied substantially among children from various socioeconomic groups, the campaign appeared to almost equally reach all groups of children surveyed. Poliovirus vaccine coverage was 90% when measles vaccine was added to the campaign, compared with 88% during the first round. In Burkina Faso, the addition of measles vaccine to poliomyelitis NIDs achieved greater equity in measles vaccination coverage according to a number of socioeconomic factors without compromising the coverage of poliovirus vaccination.

Burkina Faso↗
PubMed1995

An investigation of the association between overjet size, lip coverage, and traumatic injury to maxillary incisors.

This study investigated the association between overjet size and lip coverage when assessing the likelihood of traumatic injury to maxillary incisors. Eleven-hundred-and-thirty-seven 11- and 12-year-olds were examined in school for traumatic injury to their maxillary incisors. The size of overjet and the adequacy of lip coverage of the maxillary incisors was assessed for each child. One-hundred-and-sixty-seven (15 per cent) had experienced traumatic injury to their maxillary incisors. Both increased overjet and inadequate lip coverage of the maxillary incisors were found to be significant risk factors. However, inadequate lip coverage was the single most important independent predictor of traumatic injury (P < 0.001), with a relative odds ratio of 2.62. The results suggest that much of the predictive value of increased overjet may be explained by inadequate lip coverage.

Chi-Square Distribution↗
PubMed1998

Assessment of vaccine coverage of schoolchildren in three primary health care areas in rural Crete, Greece.

OBJECTIVE: A school-based immunization survey was used to assess vaccination coverage of a population of children in the region of three Primary Health Care Centres in rural Crete. METHODS: The medical charts of 771 (92.6% of the total) students attending primary schools at the municipalities of Archanes and Hersonissos in the district of Heraklion, and Neapolis in the district of Lasithi, as well as the charts of 438 (68.9% of the total) students attending the secondary school at Neapolis, Lasithi, were obtained. The immunization records from these charts were then compiled and analysed. All information was based on the standardized procedures of the Spili Health Centre, Crete. The age-specific vaccination rate was calculated for children of both primary and secondary school age. RESULTS: The vaccination coverage against diphtheria and tetanus was high (82%, 1035 pupils had received the fifth dose) for both groups of students, while the coverage for pertussis was incomplete, especially the fifth dose, which had been received by only 17% (n = 131) of the children of primary school age and 4.3% (n = 19) of the children of secondary school age. In total, 638 of the children of primary school age (82.7%) and 257 (58.7%) of the children of secondary school age were immunized against measles. The corresponding numbers and the percentages of children of primary and secondary school age immunized against mumps and rubella were: 75.6% (n = 583) and 36.3% (n = 159) for mumps, and 74.7% (n = 576) and 32% (n = 140) for rubella. CONCLUSION: Immunization coverage of schoolchildren in the studied areas is inadequate in a number of instances. This appears to be most pronounced in children of secondary school age. The school-based immunization survey, which is an accurate and inexpensive tool for assessing vaccination coverage, is suggested as an appropriate means for primary health care workers in Greece to develop further and increase the immunization rate.

Adolescent↗
PubMed1996

The extent of private and public health insurance coverage among adult Hispanics.

Data from the Health and Retirement Survey reveal extremely low levels of health insurance coverage among Hispanics and, especially, among Mexican Americans. The data reveal that this lack of insurance is associated with lower rates of employer-based and privately purchased coverage. Even after controlling for a large number of insurance-related factors, Hispanics have rates of health insurance coverage that are lower than those of either non-Hispanic blacks or whites. This serious lack of health insurance coverage among preretirement-age Hispanics has serious implications both for health, because the lack of insurance represents a major barrier to health care, and for the adequacy of retirement coverage, because private insurance represents an important supplement to Medicare.

Adult↗
PubMed2001

Want to understand how Americans viewed long-term care in 1998? Start with media coverage.

PURPOSE: This analysis describes media coverage of long-term care in 1998. DESIGN AND METHODS: Several sources were used to place coverage of long-term care in 1998 in the context of recent years and other health issues. For the primary analysis, stories in which long-term care was a major topic were collected from Lexis-Nexis Academic Universe. Media sources included major newspapers, network news, CNN, and NPR. Stories were coded for topic, details about the topic, physical placement within the overall coverage, and underlying issues. RESULTS: A small percentage of media coverage in 1998 concerned long-term care. Among long-term care topics, nursing homes received the most coverage. A small percentage of long-term care topics were reported on the front page, and few underlying issues framed these topics. IMPLICATIONS: To ensure that Americans receive a comprehensive view of long-term care issues, gerontologists must work with reporters to influence how they report on long-term care.

Adolescent↗
PubMed1999

Early two-dose measles vaccination schedule in Guinea-Bissau: good protection and coverage in infancy.

BACKGROUND: Previous studies from Africa have suggested that there is little benefit to be gained from early two-dose measles vaccination schedules. Two-dose schedules have been associated with no improvement in coverage due to immunization of the same individuals on both occasions, low return rate, high refusal rate, low vaccine efficacy, and fear of blunting of the antibody response. Because of the poor results achieved previously with two-dose measles vaccination schedules, we studied patterns of participation, reasons for non-participation, vaccination coverage and relative efficacy of a one-dose versus a two-dose schedule in connection with the implementation of an early two-dose trial in Guinea-Bissau. METHODS: Children born from September 1994 to January 1996 were randomized into two groups receiving either two doses of measles vaccine at 6 and 9 months or one dose of inactivated polio vaccine (IPV) at 6 months and measles vaccine at 9 months. RESULTS: At 6 months of age 86% (1869/2181) of the children participated, and at 9 months of age participation was 87% (1775/2035). The return rate for obtaining a second dose of vaccine was 93% (1647/1773). The main reason for not participating was travelling (78%). Around 50% of those who did not take part in one vaccination took part in the other. When only children participating the first time they were called for a measles vaccination were included, the measles vaccination coverage in the one-dose group was 59% versus 80% in the two-dose group, i.e. a 50% reduction in the risk of not being vaccinated (relative risk [RR] 0.50; confidence interval [CI]: 0.43-0.57). Few measles cases have occurred in the study area since the implementation of the trial making precise estimation of the relative efficacy of the two vaccine strategies difficult, but all seven clinically diagnosed measles cases occurred in the one-dose group making the relative efficacy for the two-dose group compared with the one-dose group 100% (95% CI: 35%-100%; two-tailed P = 0.016). When including maternal reports, the relative efficacy was 90% (95% exact confidence interval; two-tailed P = 25%-97%, P = 0.022). CONCLUSION: In this study of a two-dose measles immunization schedule at 6 and 9 months of age there was no sign of low participation or poor return rates. The risk of not being vaccinated was lower in the two-dose group than in the one-dose group, and the relative efficacy of a two-dose versus a one-dose schedule was high. Although our results were obtained within a trial where dedicated personnel informed every participant personally about the study, we believe our results indicate that with thorough information about the population it may be possible to achieve a higher coverage with a two-dose measles vaccination schedule than a one-dose schedule. A two-dose schedule may be a feasible way to resolve the problems of low coverage and severe measles infection among infants.

Confidence Intervals↗
PubMed1981

Determining health insurance coverage of technology: problems and options.

By deciding which medical procedures are eligible for reimbursement, health insurance programs possess the potential to affect significantly technology use and health care spending. Traditionally, insurers have adopted a passive stance and made relatively few negative coverage determinations. However, resistance to rapidly rising costs has created a powerful inducement for third-party payors to become more prudent purchasers of health care services. Consequently, both Medicare and Blue Cross--Blue Shield are considering the implementation of changes that may ultimately result in more restrictive coverage decisions. This article examines the coverage process of Medicare and Blue Cross--Blue Shield and the policy changes that both programs are considering. In addition, it discusses the strengths and drawbacks of four coverage policy options: restricting insurance coverage of unproven procedures, introducing cost-effectiveness criteria, educating physicians and educating consumers.

Blue Cross Blue Shield Insurance Plans↗
PubMed1987

The influence of muscle flap coverage on the repair of devascularized tibial cortex: an experimental investigation in the dog.

Segments (2 cm) of canine tibial diaphyseal bone were devascularized and internally fixed with a plate. The medial cortex of the devascularized tibia was covered with skin in one experimental group (n = 7) and a local muscle flap in the other (n = 6). The animals were given intravenous fluorochrome dye and killed 42 days postoperatively. Enveloping callus formed around the cortex which was repaired by the formation of resorptive cavities on its external surface. New bone formation occurred within the resorptive cavities. Muscle flap coverage was associated with a sixfold increase in cortical porosity (p less than 0.005) and a fourfold increase in the area of enveloping callus (p less than 0.05). The area of intracortical new bone formation was greater in the cortex with muscle flap coverage (p less than 0.05). The maximum depth of intracortical new bone formation increased from 0.46 +/- 0.14 mm with skin coverage to 0.95 +/- 0.14 mm with muscle flap coverage (p less than 0.001). This study demonstrates that muscle flaps are superior to skin coverage in initiating the repair of devascularized cortical bone.

Animals↗
PubMed2004

Surgical technique for an 'almost' percutaneous triple pelvic osteotomy for femoral head coverage in children 6-14 years of age.

A relatively simple triple pelvic osteotomy using two cosmetically small skin incisions can provide excellent coverage of the femoral head. An adductor approach and a bikini approach are used to do the osteotomy. The 'almost' percutaneous pelvic osteotomy successfully increases femoral head coverage in a concentric hip joint. The VCA angle of Lequesne and the center-edge angle of Wiberg both show significant improvement in the coverage of the femoral head. Three-dimensional computed tomography scanograms may provide a more graphic representation before and after surgery. Preoperatively, this is especially useful in evaluating posterior acetabular coverage of the femoral head. The almost percutaneous pelvic osteotomy is another possible triple pelvic osteotomy for procedures for hip dysplasia. It has a relatively low learning curve in comparison with other triple pelvic osteotomies for hip dysplasia in children aged 6-14 years. With careful patient selection, femoral head coverage can be improved with small incisions that are cosmetically acceptable.

Acetabulum↗
PubMed2006

Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty.

UNLABELLED: Skin necrosis after total knee arthroplasty is a rare complication that can rapidly lead to deep infection of the prosthetic components. The medial gastrocnemius transposition flap usually provides adequate soft tissue coverage to salvage the total knee arthroplasty. However, variations in defect location and excursion of the muscle flap can affect results. Twelve patients were treated with a medial gastrocnemius transposition flap after total knee arthroplasty. The skin defect that required flap coverage was located over the tibial tubercle or patellar tendon in eight patients (Group 1). The defect extended proximally to the patella or quadriceps tendon in four patients (Group 2). A functioning total knee arthroplasty was salvaged in 11 patients (92%). The medial gastrocnemius flap healed primarily in all patients in Group 1. Three patients in Group 2 required additional fasciocutaneous, lateral gastrocnemius, or free flap coverage, and one patient underwent above knee amputation. The medial gastrocnemius flap is most effective for coverage of distal defects over the tibial tubercle or patellar tendon. Defects that extend more proximally over the patella or quadriceps tendon are more likely to require additional procedures to achieve adequate soft tissue coverage. LEVEL OF EVIDENCE: Therapeutic study, level IV (case series). See Author Guidelines for a complete description of levels of evidence.

Adult↗
PubMed2025

Blended Length Genome Sequencing (blend-seq): Combining Short Reads with Low-Coverage Long Reads to Maximize Variant Discovery.

We introduce blend-seq, a workflow for combining data from traditional short-read sequencing pipelines with low-coverage long reads, to improve variant discovery for single samples without the full cost of high-coverage long reads. We demonstrate that with only 4x long-read coverage augmenting 30x short reads, we can improve SNP discovery across the genome, exceeding performance beyond even high-coverage short reads (60x). For genotype-agnostic discovery of structural variants, we see a threefold improvement in recall while maintaining precision by using the low-coverage long reads on their own, and show how we can improve genotyping accuracy by adding in the short-read data. In addition, we demonstrate how the long reads can better phase these variants, incorporating long-context information in the genome to substantially outperform phasing with short reads alone. Our experiments highlight the complementary nature of short- and long-read technologies: the former contributing higher depth for genotyping and the latter better resolution of larger events or those in difficult regions.

cost optimization↗
PubMed2001

Heat-capacity studies of (3)He in (3)He-(4)He mixture films and the coverage dependence of the two-dimensional (3)He Landau Fermi-liquid parameters.

The heat capacity of (3)He in (3)He-(4)He mixture films on a nuclepore substrate is reported over the temperature range 90<T<124 mK, for (3)He coverages between 0.05 and 1.4 bulk-density atomic layers, and a (4)He film thickness of 4.33 bulk-density atomic layers. A step structure appears in the specific heat as a function of (3)He coverage. Combining NMR and specific heat data for (3)He atoms on the same substrate and for the same (4)He coverage allows the two-dimensional Landau Fermi-liquid parameters F(A)(0) and F(S)(1) to be extracted as a function of (3)He coverage. We conclude that in the submonalayer (3)He coverage regime p-state pairing is favored.

Journal Article↗
PubMed2005

Use of intermittent preventive treatment for malaria in pregnancy in a rural area of western Kenya with high coverage of insecticide-treated bed nets.

Kenya established intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) for malaria in pregnancy as national policy in 1998. We assessed the coverage of IPT among women who had recently delivered in a rural area of western Kenya with perennial malaria transmission and high coverage with insecticide treated nets (ITNs) through a cross-sectional, community-based survey in December 2002. Antenatal clinic (ANC) attendance was high (89.9% of the 635 participating women); 77.5% of attendees visited an ANC before the third trimester and 91.9% made more than one visit. Delivery of SP by the ANC was reported by 19.1% of all women but only 6.8% reported receiving more than one dose. Given the high rate of use of ANC services, if SP were given at each visit after the first trimester, the potential coverage of IPT (two doses of SP) would be 80.3% in this study population. ITNs were used by 82.4% of women during pregnancy, and almost all mothers (98.5%) who slept under an ITN shared the nets with their newborns after delivery. Women who thought malaria in pregnancy caused foetal problems were more likely to have used an ITN (adjusted odds ratio [AOR] 1.6, 95% confidence interval [CI] 1.0-2.4), and to have visited ANC more than once (AOR 2.4, 95% CI 1.2-4.7) compared to women who thought malaria in pregnancy was either not a problem or caused problems for the mother only. These findings illustrate the need for improved IPT coverage in this rural area. Identification and removal of the barriers to provision of IPT during ANC visits can help to increase coverage. In this area of Kenya, health messages stressing that foetal complications of malaria in pregnancy may occur in the absence of maternal illness may improve the demand for IPT.

Adult↗
PubMed2005

Integrating insecticide-treated bednets into a measles vaccination campaign achieves high, rapid and equitable coverage with direct and voucher-based methods.

Population coverage of insecticide-treated nets (ITNs) in Africa falls well below the Abuja target of 60% while coverage levels achieved during vaccination campaigns in the same populations typically exceed 90%. Household (HH) cost of ITNs is an important barrier to their uptake. We investigated the coverage, equity and cost of linking distribution of free ITNs to a measles vaccination campaign. During a national measles vaccination campaign in Zambia, children in four rural districts were given a free ITN when they received their measles vaccination. In one urban district, children were given a voucher, which could be redeemed for a net at a commercial distribution site. About 1700 HHs were asked whether they received vaccination and an ITN during a measles campaign, as well as questions on assets (e.g. type roofing material or bicycle ownership) to assess HH wealth. Net ownership was calculated for children in each wealth quintile. In the rural areas, ITN coverage among children rose from 16.7% to 81.1% and the equity ratio from 0.32 to 0.88 and in the urban area from 50.7% to 76.2% (equity ratio: 0.66-1.19). The operational cost per ITN delivered was dollar 0.35 in the rural area with direct distribution and $1.89 in the urban areas with voucher distribution. Mass distribution of ITNs through vaccination campaigns achieves rapid, high and equitable coverage at low cost.

Adolescent↗
PubMed2007

A model to simulate the impact of timing, coverage and transmission intensity on the effectiveness of indoor residual spraying (IRS) for malaria control.

OBJECTIVE: (i) To develop a temperature- and rainfall-driven model of malaria transmission capable of prediction. (ii) To use the model to examine the relationship between the intervention timing and transmission intensity on the effectiveness of indoor residual spraying (IRS). METHODS: A dynamic model of malaria transmission was developed from existing models of malaria transmission dynamics. The model was used to retrospectively predict actual malaria cases from Hwange district in Zimbabwe using actual meteorological and IRS timing and coverage data. Simulations of alternative intervention scenarios (timing and coverage) examined the effectiveness of earlier and later interventions, at higher and lower coverage levels in epidemic and non-epidemic years. FINDINGS: The model was able to predict actual malaria cases in Hwange over a four-and-a-half-year period with a lead time of 4 months (e.g. January rainfall and temperature predicts April malaria) and a correlation coefficient of 0.825 (r(2) = 0.6814). The IRS simulations show that the marginal benefits of increasing IRS coverage are higher in high-transmission (HT) years relative to lower transmission years. This implies that over a period of years, maximum impact could be achieved with a given quantity of insecticide by increasing coverage in HT years. However, the model also shows that earlier spraying is more effective in all years, especially so in epidemic years, and that IRS has limited impact if it is carried out too late in relation to peak transmission. CONCLUSION: Temperature- and rainfall-driven models of malaria transmission have the potential to predict malaria epidemics. Early intervention based on prior knowledge of the magnitude of the malaria season can be more effective and efficient than carrying out routine activities every year. Malaria control planners need improved access to the technology that would allow them to better predict malaria epidemics and develop Malaria Early Warning Systems (MEWS). MEWS can then be linked to intervention planning to reduce the devastating impact of malaria epidemics on populations.

Animals↗
PubMed2005

Access to and coverage of renal replacement therapy in minorities and ethnic groups in Venezuela.

Access to and coverage of renal replacement therapy in minorities and ethnic groups in Venezuela. Numerous studies have documented the presence of racial and minority disparities regarding the impact of renal disease and access to renal replacement therapy (RRT). This problem is less well documented in Latin America. Venezuela, like most countries in the region, is subject to severe constraints in the allocation of resources for high-cost chronic diseases, which limits the access of patients with chronic kidney disease to RRT. Although access to health care is universal, there is both a deficit in coverage and disparity in the access to RRT, largely as a result of socioeconomic limitations and budget constrains. With current rising trends of the incidence of end-stage renal disease (ESRD) and costs of medical technology, the long-term goal of complete RRT coverage will become increasingly out of reach. Current evidence suggests that prevention of progression of renal disease is possible at relatively low cost and broad coverage. Based on this evidence, the Ministry of Health has redesigned its policy with respect to renal disease based on 4 elements: 1. Prevention by means of early detection and referral to multidisciplinary health teams, as well as promotion of health habits in the community. 2. Prevention of progression of renal disease by pharmacologic and nonpharmacologic means. 3. An increase in the rate of coverage and reduction of disparities in the access to dialysis. 4. An increase in the rates of renal transplantation through better organ procurement programs and reinforcement of transplant centers. However, the projected increase in the number of patients with ESKD receiving RRT will represent a serious burden to the health care system. Therefore, implementation of these policies will require the involvement of international agencies as well as an adequate partnership between nephrologists and health care planners, so that meeting the increasing demands of ESKD programs may be balanced with other priorities of our national health system.

Ethnicity↗