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PubMed1999

Root coverage using Alloderm acellular dermal graft material.

This report describes a surgical technique for root coverage using an acellular dermal graft material and a coronally positioned flap. Video clips of a root coverage surgery are included using the graft material to cover multiple teeth in the same quadrant. Three additional completed cases are presented in which a mean root coverage of 97% was achieved, resulting in 100% coverage on 9 of 11 teeth. The results from this case series conform with the available evidence on the use of acellular dermal graft material in root coverage procedures.

Adult↗
PubMed2003

Vaccination coverage among children enrolled in Head Start programs, licensed child care facilities, and entering school--United States, 2000-01 school year.

The implementation of state and local requirements for vaccination before entry to Head Start programs, licensed child care facilities, and school has resulted in high vaccination levels among preschool and school children. One of the national health objectives for 2010 is to maintain > or = 95% vaccination coverage among children attending licensed child care centers and kindergarten through postsecondary school (objective 12-23). National estimates of vaccination coverage among children in Head Start programs, licensed child care facilities, and those entering school have been published each year since 1997 on the basis of reports from federally funded immunization programs (IPs) in the 50 states, five cities, eight territories, and the District of Columbia. This report summarizes data reported by states, cities, and the District of Columbia for the 2000-01 school year. Although vaccination coverage for 2000-01 appears similar to that for previous years, the number of programs reporting and the completeness of the reports are lower than in previous years and do not permit precise estimation of coverage at the national level. IPs use school data to identify undervaccinated children enrolled in Head Start programs, licensed child care facilities, and those entering school; evaluate the success of prevention programs targeting these children; and document the proportion of children whose parents claim exemptions from one or more vaccines. Plans are ongoing to assist IPs in applying successful strategies for collecting, reporting, and increasing the precision of coverage estimates for these populations.

Child↗
PubMed1992

Immunization coverage in India for areas served by the Integrated Child Development Services programme. The Integrated Child Development Services Consultants.

The Integrated Child Development Services (ICDS) programme was launched by the Indian government in October 1975 to provide a package of health, nutrition and informal educational services to mothers and children. In 1988 we studied the impact of ICDS on the immunization coverage of children aged 12-24 months and of mothers of infants in 19 rural, 8 tribal, and 9 urban ICDS projects that had been operational for more than 5 years. Complete coverage with BCG, diphtheria-pertussis-tetanus (DPT) and poliomyelitis vaccines was recorded for 65%, 63%, and 64% of children, respectively, in the ICDS population. By comparison, the coverage in the non-ICDS group was only 22% for BCG, 28% for DPT, and 27% for poliomyelitis. Complete immunization with tetanus toxoid was recorded for 68% of the mothers in the ICDS group and for 40% in the non-ICDS group. Coverage was greater in the urban and lower in the tribal projects. Scheduled castes, scheduled tribes, backward communities, and minorities (groups that have a high priority for social services) had immunization coverages in ICDS projects that were similar to those of higher castes.

Child, Preschool↗
PubMed1992

Health insurance coverage of adolescents: a current profile and assessment of trends.

Data from the National Health Interview Survey reveal that 4.7 million or 15% of US adolescents aged 10 through 18 were uninsured in 1989. Among adolescents, 73% were privately insured, 10% were publicly insured, and 2% were both privately and publicly insured. Poor, near-poor, and minority adolescents were at the greatest risk for lack of health insurance coverage. Among adolescents without insurance, cost continued to be cited as the leading barrier to obtaining coverage. A comparison of 1989 National Health Interview Survey data with a previous analysis, in which 1984 data were used, revealed a 10% increase in the proportion of adolescents without insurance coverage. The increase in the proportion of uninsured adolescents was entirely attributable to an erosion of private health insurance coverage. No significant change occurred in the proportion of adolescents with coverage under public programs. Planned expansions of the federally and state-financed Medicaid programs will help to stem further increases in the size of the uninsured adolescent population. However, unless marked improvements occur in the private health insurance sector, progress will be limited.

Adolescent↗
PubMed1992

[Coverage of 4 health programs for pre-school children in marginal urban areas in Mexico City].

The aim this paper was to evaluate the coverage provided by four preschool child health programs (vaccinations, oral hydration therapy, healthy child care and sick child care). To make coverage operational, we designed indicators to compare the utilization of each program with the condition or health problems considered as needed. These results are part of a broad evaluative research called "Coverage and Quality of Primary Health Care" (CQPHC) carried out by the National Institute of Public Health (NIPH) in the State of Mexico in 1988. The population under study was a random sample of the total of preschool children detected in the household survey. We only analyzed data including children from 1-4 years to ensure that all studied children had completed the basic vaccination schemes. For the vaccination program, we observed a coverage of 47.7%, twice as much as that of the oral hydration program that only reached was 21.9%, whereas that of the sick child care program was 63.8%, the former being 2.0 times less than the latter. We can conclude that the different coverage found for each program is basically due to the lack socialization of the concept of need and to the extent of participation of the concept to make these services available to the population.

Child Health Services↗
PubMedDate not supplied

[An immunisation coverage survey in the Kouilou area of Congo-Brazzaville].

An internal review of the expanded program of immunisation undertaken on the basis of daily data collected over the past five years from 1993 to 1997 in the region of Kouilou revealed a weak coverage level for all the antigens, associated with a strong dropout rate. In August 1999, a vaccination coverage survey was carried out on three strata of the Kouilou area in order to determine the proportion of children vaccinated by antigens. The method used is that of sampling clusters. It concerned 663 children aged between 12 and 23 months chosen among 30 urban, 30 periurban and 30 rural clusters. The BCG scar was found in 82.8% children while 71.8% had received the third dose of VIP-OPV. Some 62.6% were immunised against measles. Within the region, the coverage rates varied from 87.9 to 57.1% for BCG; 80.3 to 41% for DTP-OPV3 and 7.3 to 41% for measles. A considerable variation of dropout rates was observed at area level: 8.9 to 14.7% for DTP-OPV3 and 9 to 11% for measles immunisation. The average interval observed between VPT-OVP 1 and VPT-OVP 2 was, respectively, 6.1 and 6.2 weeks in urban areas against 6.4 and 6.9 weeks in periurban areas. On the other hand in rural zones, the interval was of 7.6 weeks between VPT-OVP and DPT-OPV2 and of 10.1 weeks between DPT-OVP2 and DPT-OVP3. The median interval was of 5 weeks for the different DPT-OVP doses in all the strata. The vaccination card was found in 90% of cases in urban areas, 96% in urban zones and 55% in rural zones. The coverage level attained per antigen is satisfactory, but remains to be strengthened. Dropout rates are high enough and they should be corrected. Follow-up actions should focus on raising a strong awareness for vaccination in rural areas. Besides, the vaccination of target populations living in remote areas by way of mobile and outreach strategies could improve the immunisation coverage rate.

Congo↗
PubMed2004

Influenza and pneumococcal vaccination coverage among persons aged > or =65 years and persons aged 18-64 years with diabetes or asthma--United States, 2003.

Vaccination of persons at risk for complications from influenza and pneumococcal disease is a key public health strategy for preventing associated morbidity and mortality in the United States. Risk factors include older age and medical conditions that increase the risk for complications from infections. During the 1990-1999 influenza seasons, more than 32,000 deaths each year among persons aged > or =65 years were attributed to complications from influenza infection. National health objectives for 2010 call for 90% influenza and pneumococcal vaccination coverage among noninstitutionalized persons aged > or =65 years and 60% coverage among noninstitutionalized persons aged 18-64 years who have risk factors (e.g., diabetes or asthma) for complications from infections. To estimate influenza and pneumococcal vaccination coverage among these populations, CDC analyzed data from the 2003 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated that 1) influenza vaccination levels among adults aged 18-64 with diabetes or asthma, 2) pneumococcal vaccination levels among adults aged 18-64 years with diabetes, and 3) influenza and pneumococcal vaccination levels among adults aged > or =65 years all were below levels targeted in the national health objectives for 2010. Moreover, vaccination coverage levels varied among states for both vaccines and both age groups. Innovative approaches and adequate, reliable supplies of vaccine are needed to increase vaccination coverage, particularly among adults with high-risk conditions.

Adult↗
PubMed2004

Dose coverage evaluation for lung cancer radiation therapy.

UNLABELLED: Purpose of the study was to evaluate adequacy of target volume coverage with conventional two-dimensional radiotherapy; and to estimate potential of three-dimensional conformal radiotherapy for increasing dose to the target. MATERIAL AND METHODS: Analysis was performed for 34 lung cancer patients referred for curative intend two-dimensional radiation therapy. For the same patients two independent specialist teams created conventional two-dimensional plans according to "gold standard" radiotherapy and three-dimensional conformal plans. Evaluation of target coverage adequacy and normal tissue complication probability parameters was performed on two-dimensional isodose distributions overlay over outlined clinical target volumes. Maximum total dose for three-dimensional conformal radiotherapy was estimated keeping normal tissue complication probability on the same level as for two-dimensional plans. Conformity was evaluated. RESULTS: For two-dimensional planning maximum target dose was on average 52 Gy (3 Gy 1 standard deviation). Clinical target volumes coverage was poor for most plans; 95% isodose surface covers 57%. This percentage was consistent with 1 standard deviation of 10-17%. Minimum target dose was low - 5-10% of prescribed dose. Three-dimensional conformal radiotherapy allows increasing dose to clinical target volume with elective nodes irradiation up to 68-72 Gy and up to 78-90 Gy without it. Conformity of clinical target volume coverage was acceptable for all patients; 95% isodose surface covered on average 95% of target. CONCLUSION: Three-dimensional conformal radiotherapy allows increasing of total dose to the target keeping tolerable dose to functional tissues for most patients. However, only combinations of modern imaging, planning and delivery techniques enable providing adequate and homogeneous clinical target volume coverage with therapeutically significant dose for lung tumors.

Humans↗
PubMedDate not supplied

Effect of Surgecel coverage with topical electrocauterization for preventing and sealing pulmonary air leakage.

Pleural tears usually occur after pneumolysis for dense adhesion or after cone biopsy of lung parenchyma. Repair of the tears is sometimes very difficult. Herein we compared different methods on a pig lung air leak model. Twenty pigs with pleural tears by surgical manipulation through sternotomy were not treated (n = 5) or treated by simple electroablation (n = 5), pleural coverage (n = 5), or Surgecel coverage with surface electroablation (n = 5). We evaluated their immediate and delayed treatment effect by measuring the critical leak pressure, degree of air leakage, and air leakage period and histological examination. It was found that Surgecel coverage with surface electrocauterization had similar early and delayed effects in sealing air leakage to pleural coverage and was much better than the other two groups (P < 0.05). We conclude that coverage with Surgicel with local electroablation can significantly decrease immediate and late air leakage from pleural tears.

Analysis of Variance↗
PubMed2005

A strategy to increase and assess vaccine coverage in the north of Portugal.

In the Northern Health Region of Portugal, vaccine coverage is measured by checking and studying individual vaccination records in health centres. Each year from 2001-2004, birth cohorts completing 2, 6 and 14 years of age were selected for assessment. Data collection occurred on January the following year and meetings with district immunisation coordinators took place every March. For all vaccines and birth cohorts considered, vaccine coverage values observed in the north of Portugal were excellent. In this paper, we make comparisons with published international data on vaccine coverage and discuss validity issues; we believe that no serious biases have affected the validity of our vaccine coverage data but comparisons with international data must be addressed with caution; the methods we used have been useful in increasing vaccination coverage.

Adolescent↗
PubMed2005

Understanding and addressing childhood immunization coverage in urban slums.

The National Population Policy (2000) aims at complete protection of all children against vaccine preventable diseases by 2010. Urban poor, many residing in slums, comprise about one fourth of India's 285 million urban population. 60% of the children aged 12-23 months in urban India are fully immunized; coverage among urban poor children is a dismal 43%. The inter state variations of immunization coverage in urban areas, reveals a service coverage gap which calls for a rethink on resource allocation and strengthening processes to improve immunization coverage amongst urban poor. Debilitating environmental conditions and high population density in slums expedite disease transmission. Comparisons of urban rural disease incidence indicate a particular urban risk for vaccine preventable diseases. This paper attempts to understand the current scenario and challenges in improving immunization coverage in urban slums; immunization being one of the most successful public health interventions of the past century. It also discusses possible mechanisms for effectively reaching the often left out urban poor. Coordinated activities by the multitude of providers, accurate information based outreach, effective monitoring and community enablement to demand quality services are critical for improving utilization of immunization services by a heterogeneous urban poor population.

Child↗
PubMed1992

Reform of financing for health coverage: what can reinsurance accomplish?

Reinsurance is one way that insurance companies pool risk, in this case, across insurance companies. Under conventional private practice, primary health insurers, including self-insured groups and HMOs, voluntarily contract with reinsurers to share some risk and some premiums. Because the primary carrier mainly wants to protect its solvency against unpredictable variation in claims experience, it normally reinsures only the "high end" of claims risk. This retrospective coverage of unusually high losses helps primary insurers take on more risk than they otherwise could. But it does not help secure affordable coverage for people with prospectively known high risks. Some plans for reforming private health insurance also invoke reinsurance-like mechanisms, especially in the markets for individual and small group coverage. There, reinsurance serves as part of a strategy for requiring that primary insurance be made available to all applicants, regardless of risk. Reinsurance or similar rules for allocating the burden of unusually high risks can help keep any one private insurer from having to bear a disproportionate share of high risks, and thus extend the reach of private insurance markets through regulation. But reinsurance alone does not reduce the underlying high cost of providing such primary coverage. Nor can reinsurance alone provide the resources to cover the uninsured, ensure that insurers will want to cover them, or make them voluntarily buy private coverage. Only some combination of new subsidies and mandates can do that.

Economic Competition↗
PubMedDate not supplied

[Systematic preventive rodents control: correlation between mode of finance and level of coverage].

The aim of this article was to define correlation between the mode of financing systematic prventive rodents control and the level of coverage, by method of professional supervision in the area of Virovitica-Podravina county. Obtained results show significant diversity in the level of coverage between local self management units. In some cases, only 18% of households were covered by treatment, while in some other, where coverage was maximal, it reached 100%. We can conclude that community leaders of some local self management units do not recognize the importance of systematic preventive rodents control as a major public health measure. A portion of treatments executed under professional supervision results with low coverage because of mode of finance. Systematic preventive rodents control must be financed completely from budget resources of local self management units, which results in satisfying coverage and efficacious prevetive measure.

Animals↗
PubMed2005

[Quantitative estimation of vegetation coverage in Mu Us sandy land based on RS and GIS].

On the basis of oriented field investigation data and corresponding RS and GIS information, and by the method of ridge estimation, this paper studied the estimation model of vegetation coverage and its affecting factors in Yijinholo County of northeast Mu Us sandy land. The results showed that the vegetation coverage was affected by NDVI, and closely linked with such RS and GIS information as, TM7, TM2, TM 4/3 and gradient. Ridge estimation method could obviously improve the limitation of Least Square method, eliminate the adverse effects caused by existing complex estimation relation towards uncoiling undetermined parameter among the variables, and improve the estimate precision. The vegetation coverage estimation model taking pixel as unit was established, and its test precision could reach 98.7%. In addition, a regional vegetation coverage GIS was established, which could realize the inquiry, regeneration, and drawing of any spot (pixel) or any land unit of vegetation coverage automatically.

China↗
PubMed2006

Root coverage in a class IV recession defect achieved by creeping attachment: a case report.

BACKGROUND AND OBJECTIVES: The amount of root coverage obtained after a graft procedure may be improved after the early phase of healing by a coronal displacement of the gingival attachment. The aim of this report is to present a clinical case of complete root coverage of a Miller's class IV recession achieved by creeping attachment subsequent to a laterally repositioned flap. METHODS: In 1995, a 44-year-old male patient was referred for a root coverage graft on the upper right central incisor. Clinical examination revealed that the upper right central incisor had a recession of 7 mm. The defect was classified as class IV according to Miller's classification of marginal tissue recession. It was decided that root coverage would be attempted using a laterally repositioned flap from the upper right lateral incisor and upper right canine. Sutures were removed ten days after surgery. RESULTS: Four months after grafting, the amount of root coverage obtained was 4 mm. After an 8-year period, the previously denuded root surfaces were entirely covered by soft tissue. The marginal position of the gingiva appeared stable, the gingival tissue became firmly attached to the root surface and probing showed a shallow sulcular depth. CONCLUSION: Several interesting observations were made after 8 years. In conclusion, the most significant and interesting finding of this report is that the amount of interdental papilla and marginal gingival tissue covering donor and recipient areas improved with time, providing an excellent aesthetic appearance.

Adult↗
PubMedDate not supplied

Root coverage with subepithelial connective tissue grafts and modified tunnel technique. An evaluation of long-term results.

Subepithelial connective tissue grafts (SCTG) have been shown to be effective in obtaining root coverage. Recent advances have focused on subepithelial connective tissue grafting by the tunnel technique to achieve successful root coverage. However, little is known about the long-term results of SCTG with tunnel technique procedure. The goal of the present study was to evaluate and compare the short-term and long-term (36 months) root coverage results of SCTG and the modified tunnel procedure. Patients, each contributing at least two adjacent buccal gingival recessions, were treated with SCTG and modified tunnel technique. The changes in the clinical measurements were compared at baseline, short-term and long-term. The mean root coverage was 95% and 92.2% at eight months and 36 months postsurgery, respectively. These differences were statistically significant compared to the baseline. The mean gain in attachment was 3.79 mm, and the mean root coverage was 3.14 mm after 36 months. The results of the present clinical study demonstrated that the SCTG with modified tunnel approach was an effective periodontal plastic surgery method to cover the exposed roots.

Connective Tissue↗
PubMed2006

Influenza and pneumococcal vaccination coverage among persons aged > or = 65 years--United States, 2004-2005.

Vaccination of persons at increased risk for complications from influenza and pneumococcal disease is a key public health strategy in the United States. During the 1990-1999 influenza seasons, approximately 36,000 deaths were attributed annually to influenza infection, with approximately 90% of deaths occurring among adults aged > or = 65 years. In 1998, an estimated 3,400 adults aged > or = 65 years died as a result of invasive pneumococcal disease. One of the Healthy People 2010 objectives is to achieve 90% coverage of noninstitutionalized adults aged > or = 65 years for both influenza and pneumococcal vaccinations (objective 14-29). To assess progress toward this goal, this report examines vaccination coverage for persons interviewed in the 2004 and 2005 Behavioral Risk Factor Surveillance System (BRFSS) surveys. The 2004-05 influenza season was characterized by an influenza vaccine shortage. As a result, the Advisory Committee on Immunization Practices (ACIP) issued recommendations that influenza vaccine be reserved for persons in priority groups, including persons aged > or = 65 years, and that others should defer vaccination until supply was sufficient. The results of this assessment indicated that, overall, influenza vaccination coverage was lower in the 2005 survey year than in 2004, whereas pneumococcal vaccination coverage was nearly unchanged from 2004 to 2005. In both years, influenza and pneumococcal vaccination coverage varied from state to state. Continued measures are needed to increase the proportion of older adults who receive influenza and pneumococcal vaccines; health-care providers should offer pneumococcal vaccine all year and should continue to offer influenza vaccine during December and throughout the influenza season, even after influenza activity has been documented in the community.

Aged↗
PubMed2006

Association of income and prescription drug coverage with generic medication use among older adults with hypertension.

OBJECTIVE: To determine whether low-income seniors and those without prescription drug coverage are more likely to use generic cardiovascular drugs than more affluent and better insured adults. STUDY DESIGN: Cross-sectional analysis. METHODS: We used data from the 2001 Medicare Current Beneficiary Survey. Analyses included noninstitutionalized survey respondents over age 65 years with hypertension who used > or =1 multisource cardiovascular drugs (N = 1710). We examined the association of income and prescription coverage with use of generic versions of multisource drugs from 5 classes: angiotensin-converting enzyme (ACE) inhibitors, beta-adrenergic receptor antagonists (beta-blockers), calcium channel blockers, alpha1-adrenergic receptor antagonists (alpha-blockers), and thiazide diuretics. RESULTS: Rates of generic medication use were 88.5% (beta-blockers); 92.8% (thiazides); 58.7% (calcium channel blockers); 60.7% (ACE inhibitors); and 52.6% (alpha-blockers). In multivariate analysis of generic medication use aggregated across the 5 drug classes, individuals with incomes below 200% of the federal poverty level were modestly more likely to use generic medications compared with seniors with incomes above 300% of the poverty level. Seniors who lacked prescription coverage were more likely to use generics than those who had employer-sponsored coverage, although the association was of marginal statistical significance (relative risk = 1.29, 95% confidence interval = 1.00, 1.60). CONCLUSION: Seniors with low incomes or no prescription coverage were only somewhat more likely to use generic cardiovascular drugs than more affluent and insured seniors. These findings suggest that physicians and policy makers may be missing opportunities to reduce costs for Medicare and its economically disadvantaged beneficiaries.

Aged↗