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PubMedDate not supplied

[Major measles epidemic in the region of Quebec despite a 99% vaccine coverage].

The 1989 measles outbreak in the province of Quebec has been largely attributed to an incomplete vaccination coverage. In the Quebec City area (pop. 600,000) 1,363 confirmed cases of measles did occur. A case-control study conducted to evaluate risk factors for measles allowed us to estimate vaccination coverage. It was measured in classes where cases did occur during the outbreak. This population included 8,931 students aged 5 to 19 years old. The 563 cases and a random sample of two controls per case selected in the case's class were kept for analysis. The vaccination coverage among cases was at least 84.5%. Vaccination coverage for the total population was 99.0%. Incomplete vaccination coverage is not a valid explanation for the Quebec City measles outbreak.

Adolescent↗
PubMed1990

Twenty-four hour in-house coverage for neonatal intensive care units in academic centers: who, how, and why?

Twenty-four-hour in-house coverage by attending physicians is becoming more common in academic centers in certain subspecialties in pediatrics. The actual percentage of programs providing this coverage in most subspecialties is not documented. We report the results of a survey of in-house coverage by attending physicians in neonatal intensive care units at academic centers in the United States. Of the 238 surveys distributed, 204 (86%) were returned and completed. At the time of the survey, 47 of 204 programs (23%) provided 24-hour in-house coverage for their neonatal intensive care units. These programs had more manpower than those programs not providing this coverage. If this trend continues, it will significantly alter projections for neonatal manpower needs in the United States.

Academic Medical Centers↗
PubMedDate not supplied

Expanding Medicaid coverage for pregnant women: estimates of the impact and cost.

An estimated 361,000 pregnant women are expected to be newly eligible for Medicaid coverage when all states raise the income ceiling for such coverage to 100 percent of the federal poverty level by 1990, as Congress has mandated. According to a methodology for projecting the effects of recent congressional changes in the Medicaid program, about 64 percent of these women would be otherwise uninsured, at least for maternity care, and the rest would have some insurance, so Medicaid would be the payer of last resort. Congress has also given states the option to cover pregnant women with incomes from 100 to 185 percent of poverty. If all states were to do so, another 552,000 women would become eligible, 29 percent of whom would otherwise have no insurance coverage for maternity care. The estimate of newly eligible women with incomes below 185 percent of poverty represents 24 percent of the 3.8 million women who give birth in the United States each year. Under the 100-percent-of-poverty ceiling, the estimated number of poor women eligible for coverage ranges from 4,000 or fewer in 18 states and the District of Columbia to 41,000 in California and Texas. At 185 percent of poverty, the number ranges from 4,000 or fewer in 11 states and the District of Columbia to more than 90,000 in California and Texas. Eight states have already elected to extend Medicaid coverage to the 185-percent-of-poverty ceiling.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1981

Coverage patterns of full-time employees under private retirement plans.

This article reports on the pension plan participation rate of full-time private wage and salary workers. Data are from a May 1979 Bureau of the Census survey on the pension plan coverage and vesting status of employed workers. The survey results indicate that about half of all full-time private sector workers were covered by a pension plan, with male employees having a 55-percent coverage rate compared with 40 percent for female employees. The survey also found significant variations in coverage by such factors as age, tenure, industry, size of establishment, occupation, income, and membership in a collective bargaining unit. The relationships between coverage and these variables are examined and comparisons are made between the May 1979 survey findings and the findings from a similar survey on coverage status conducted in April 1972.

Adult↗
PubMed1995

How complete is influenza immunization coverage? A study in 75 nursing and residential homes for elderly people.

BACKGROUND: Elderly people in residential accommodation are particularly susceptible to outbreaks of influenza. Up to 70% of residents can become ill and many will develop complications or die. Immunization can prevent such outbreaks and is cost-effective. AIM: A study was undertaken to measure influenza immunization coverage in residential accommodation for elderly people and to identify factors that might influence uptake. METHOD: In March 1992, a questionnaire survey was conducted of all 113 registered nursing and residential homes for elderly people, in South Glamorgan. It asked about the demographic characteristics of people resident on 1 October 1991, their influenza immunization history and the homes' arrangements for administering immunizations. RESULTS: Questionnaires were returned by respondents from 75 homes (66%). Mean influenza vaccine uptake was 67%. Uptake was higher in nursing homes (mean of 82% in eight nursing homes) than in homes registered as both nursing and residential homes (mean of 76% in six homes) or in residential homes (mean of 65% in 61 homes). Nearly all of those immunized (94%) had been immunized by the end of November 1991. Residents who were reported to have underlying disease that increased their risk of complications if they contracted influenza were no more likely to have been immunized than those without risk factors. Immunization coverage varied considerably both between homes and between general practices. Most general practices in South Glamorgan had several elderly people in residential accommodation on their list, but only nine out of 64 practices had immunized all the elderly residents on their list and 12 practices had immunized fewer than half. Routine recording of immunization status in nursing and residential homes was variable, often as a consequence of poor communication between the primary health care team and staff at the home. Even where recorded, retrieval of the data was sometimes a problem. CONCLUSION: Influenza immunization coverage could be improved if general practices held a case register of all at-risk patients including elderly residents, and if nursing and residential homes were encouraged to keep better immunization records. These measures would facilitate year-on-year monitoring of influenza immunization coverage and the targeting of homes with low immunization coverage.

Adult↗
PubMed1995

Dental care coverage among older Americans.

Dental expenditures increased by almost $20 billion during the past twenty years. A contributing factor to this growth was the rapid proliferation of dental insurance. Unfortunately, dental care coverage is not uniformly distributed. For instance, while many younger Americans are offered assistance in paying for dental care through dental insurance, few older Americans are offered coverage because it is usually job related. Whereas several studies reported that dental care coverage is directly related to dental utilization, no significant empirical study of multiple factors has shown who is most likely to have dental insurance. The purpose of this study was to determine who is most apt to have dental insurance and what factors may influence or be related to having dental care coverage. Findings indicated that individuals with low income, large families, those having a poor health status, who are not married, are older, unemployed or female were least likely to have dental care coverage.

Age Factors↗
PubMed1995

Compliance with the 24-hour, in-house attending coverage requirement. A survey.

Fifty-six residency training programs in Region I Council on Resident Education in Obstetrics and Gynecology/Association of Professors in Gynecology and Obstetrics were surveyed for compliance with the 24-hour, in-house attending coverage requirement, which took effect July 1991. Forty-six program directors responded to a questionnaire, for a response rate of 82.1%. Each had plans to implement this coverage in the 1991-1992 academic year. Two programs were unable to implement coverage because of inadequate financing or insufficient staffing. There were no differences in the types of programs (community, university, public or private university, or New York State program) in respondents as compared to non respondents. All the programs had overnight staff coverage for an average of 13 hours (range, 12-15) and had 24-hour, continuous coverage on the weekend. There was a wide variation in the attending/resident ratio. Twenty-eight programs (60.8%) reported that they compensated their attendings. Revenue for this compensation came from the hospitals (14), direct billing (8), faculty practice plans (6) or New York State (3). Of the 28 programs that offered compensation, 20 were private community hospitals, 6 were private university programs, 1 was a public university program and 1 was a public community hospital. Of the 28 programs compensating faculty, 17 were able to cite figures that had been approved by their respective institutions or practice plans. The annual cost ranged from $130,300 to $901,887 per program for institutions that compensated their attendings (mean, $340,402).

Gynecology↗
PubMed1995

Press coverage of the Cleveland child sexual abuse enquiry: a source of public enlightenment?

BACKGROUND: The objective of this study was to assess national and local newspaper reporting of events considered by a Public Enquiry which investigated a major crisis involving child protection services. The Judicial Enquiry, held in Cleveland, North East England, examined the actions of statutory bodies and the professionals working within them following the diagnosis of suspected sexual abuse in 121 children. METHODS: This is a descriptive study using analysis of legal transcripts and newspaper reports. The data involved a total of 216,360 lines of transcript evidence given by 111 witnesses and lawyers representing them at the Judicial Enquiry which lasted 74 days; together with 344,899 words in reports covering 17 newspapers (seven local and ten national). The main outcome measures were based on the volume and type of newspaper coverage including that for each witness' and lawyer's evidence. A coverage index related the amount of newspaper reporting to the extent of evidence given. RESULTS: The highest coverage of any single day of the Enquiry in both local and national newspapers occurred when Dr Marietta Higgs (one of the two principal paediatricians involved) made her first appearance. However, the highest interest (coverage index) was shown in evidence given by lawyers for the parents and the least in evidence given by public bodies. The evidence of witnesses was used very selectively by the press in emotive headlines to imply blame or support for the main protagonists or their actions. This sustained several lines of reporting: criticism of the doctors and social workers, inter-professional conflicts, damage and wrong-doing to the families and the search for someone to blame. CONCLUSIONS: The Cleveland crisis occupied newspaper headlines in the United Kingdom for more than a year. Much of the newspaper coverage took an adversarial approach which sought to apportion blame and take sides. The press appeared to report negative issues which were newsworthy and did not give a balanced view. Broader policy issues, which formed an important part of the Enquiry report's influence on subsequent child protection legislation, were largely ignored.

Child↗
PubMed1995

Vaccination coverage of 2-year-old children--United States, January-March, 1994.

The Childhood Immunization Initiative (CII) was initiated to increase vaccination coverage among 2-year-old children. The 1996 objective is to have at least 90% coverage for four of the five critical vaccines routinely recommended for children (i.e., one dose of measles-mumps-rubella vaccine [MMR] and at least three doses each of diphtheria and tetanus toxoids and pertussis vaccine [DTP], oral poliovirus vaccine, and Haemophilus influenzae type b vaccine [Hib]), and at least 70% coverage for three doses of hepatitis B vaccine (Hep B) (1). These objectives are an interim step toward the year 2000 goal of at least 90% coverage for the recommended series of vaccinations and are being monitored on an ongoing basis. This report presents national estimates of vaccination coverage among 2-year-old children derived from provisional data from the National Health Interview Survey (NHIS) for the first quarter of 1994 and compares these with the last two quarters of 1993.

Child, Preschool↗
PubMed1995

Health insurance coverage and receipt of preventive health services--United States, 1993.

In 1992, an estimated 38.5 million U.S. residents aged < 65 years did not have health insurance (1). Efforts by states to expand health-care coverage will require surveillance for and state-specific information about coverage for acute care and the receipt of preventive services. This report summarizes state-specific and aggregated data from the 1993 Behavioral Risk Factor Surveillance System (BRFSS) regarding the status of health insurance coverage and the receipt of preventive health services among adults aged 18-64 years. In addition, findings from the analysis of supplemental questions added to the BRFSS in Minnesota are included that address health-care utilization, source of health-care coverage, and coverage of children.

Adult↗
PubMed1994

Coverage List: a provider-patient database supporting advanced hospital information services.

We have developed a provider-patient database system, known as Coverage List, which maintains the associations between house staff and inpatients in a teaching hospital. Coverage List automatically links each patient to the proper resident when the patient is admitted, and updates the linkage whenever the resident coverage changes due to night or weekend coverage, physician illness, changes in clinical rotations, and other factors. Using this association, decision-support applications that detect significant clinical events can transmit them directly to the responsible resident. Sign-out and patient-review systems, which collect information on all of a physician's patients, always know the patients for whom that physician is responsible. Nurses who need to contact a physician about a patient issue always know which physician is covering that patient. Coverage List also manages schedule entry and display for physicians, or for any other staff members. A physician can enter individual schedule changes, sign out her service and her pager for the day, and page consultants automatically without going through an operator. These functions support clinical practice directly and enhance the value of other clinical programs.

Algorithms↗
PubMed1997

Wound coverage after modified hip disarticulation using a total adductor myocutaneous flap.

There are several options available for wound coverage after hip disarticulation and hemipelvectomy. Standard flaps for closure are not always available due to the 3-dimensional extent of the tumor and availability of satisfactory tissue for coverage. This article details a new coverage technique after a modified hip disarticulation using a total adductor myocutaneous flap in a patient with radiation induced osteosarcoma of the femur after Ewing's sarcoma. In this case, neither the commonly used posterior flap nor an anterior flap could be used because of the location of the tumor and the presence of radiation induced skin and soft tissue changes. The total adductor myocutaneous flap allowed for wide surgical margins, avoided soft tissue coverage using previously irradiated soft tissue flaps, and provided excellent coverage without requiring the use of free or pedicle based flaps.

Adult↗
PubMed1997

Vaccination coverage by race/ethnicity and poverty level among children aged 19-35 months -- United States, 1996.

The Childhood Immunization Initiative (CII), implemented in 1993, is an intensive program to increase vaccination coverage among preschool-aged children and to reduce or eliminate vaccine-preventable diseases. In 1996, national coverage goals were achieved for 2-year-old children for the most critical doses of each routinely recommended vaccine. Disparities in vaccination coverage have been documented previously among different racial/ethnic groups. This report presents findings from CDC's National Immunization Survey (NIS), which document progress toward achieving the 1996 CII vaccination coverage goals by racial/ethnic group and by level of poverty. The findings indicate that, for each of five racial/ethnic groups, most of the national CII vaccination coverage goals were met and that, based on poverty level, all the goals were met for children living at or above the poverty level, and two of the five goals were met for children living below the poverty level.

Child, Preschool↗
PubMedDate not supplied

Individuals with COBRA coverage, 1994-1995. Consolidated Omnibus Budget Reconciliation Act.

COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) coverage can be considered advantageous for most workers. Although an employee can be required to pay 102 percent of the premium for COBRA coverage, workers can usually realize significant savings compared to purchasing the equivalent health insurance policy in the private market. Many employers consider COBRA to be a costly mandate for three reasons. First, premiums collected from COBRA beneficiaries typically do not cover the costs of the health care services rendered. Second, COBRA imposes an additional administrative cost on employers. Third, many employers view the penalties for noncompliance as excessively large. We examined data from the 1993 panel of the Survey of Income and Program Participation (SIPP) to gain a better understanding of the COBRA population. The COBRA population was found to be much older than the population of individuals with employment-based coverage through their current employer. COBRA beneficiaries were also more likely than individuals with coverage through a current employer to be male, married, white and to have a graduate school education. They were also less likely to be working and were more likely to have retirement income. Any attempt to expand COBRA coverage, either through subsidies or by allowing workers to choose from plans with lower premiums, will likely result in increased employer health care costs. Survey data indicate that the primary issue concerning COBRA is its impact on claims experience and administrative costs on active employees, employers and COBRA beneficiaries. If the cost issues are not addressed with future COBRA expansions, employers may consider various alternatives to reduce, shift or eliminate the impact of this increased cost.

Adult↗
PubMed1998

National, state, and urban area vaccination coverage levels among children aged 19-35 months--United States, 1997.

CDC's National Immunization Survey (NIS) provides ongoing national estimates of vaccination coverage among children aged 19-35 months, based on the data for the most recent 12 months, for each of the 50 states and for 28 selected urban areas. The NIS was implemented in April 1994 to monitor vaccination coverage levels as part of the Childhood Immunization Initiative (CII), a national strategy to ensure high vaccination coverage of children during the first 2 years of life. This report presents the findings of the 1997 NIS, which indicate that vaccination coverage among U.S. children aged 19-35 months remains at the highest levels ever, but that some new vaccines or recommended vaccine doses are below 90% coverage levels.

Child, Preschool↗
PubMed1998

Educational status and resources for child care as predictors of TBE vaccination coverage in schoolchildren of an endemic area in Austria.

Since the introduction of the Austrian tick-borne encephalitis (TBE) vaccination program in 1981 vaccination coverage of children has not been investigated sufficiently. Numerous socioeconomic and demographic factors have been identified as being associated with low vaccination coverage in childhood for most vaccinations. This study focuses on parental educational status and on resources for child care as determinants of tick-borne encephalitis (TBE) vaccination coverage of schoolchildren in an endemic TBE area of Austria. The target population were children in the first, fourth and seventh year of school education in Styria, Austria. Therefore, the sample consisting of 2470 children was divided into three age groups, children aged 7, 10 and 13 years. We performed a representative cross-sectional study. The information concerning the vaccination status of each child was recorded by means of an anonymous questionnaire given to the parents by the classroom teachers. This procedure ensured a high overall response rate of 79.8%. The prevalence of at least one TBE vaccination was 93.9% for the 7 year old, 97.8% for the 10 and 97.9% for the 13 year old. The lowest vaccination rates were found in families with four or more children (94.0%) and for those children who had unemployed parents (92.9%). The multivariate analysis indicates that TBE vaccination coverage is affected by a large number of children in the family (p = 0.0003), an urban place of residence (p = 0.0001) and by a low level of education of the mother (p = 0.013). The results suggest that, though overall high coverage in schoolchildren, vaccination programmes should be focused on large and socially deprived families.

Adolescent↗
PubMed2002

Insurance coverage, medical conditions, and visits to alternative medicine providers: results of a national survey.

BACKGROUND: In 1997, patients made an estimated 629 million visits to complementary and alternative medicine (CAM) providers; however, little is known about factors associated with visits to CAM providers. OBJECTIVE: To examine the effect of insurance coverage on frequency of use of CAM providers. METHODS: We conducted a nationally representative, random household telephone survey of 2055 adults. MAIN OUTCOME MEASURE: The number of visits made to CAM providers. RESULTS: An estimated 44% of the US population used at least 1 CAM therapy in 1997. Of those using CAM, 52% had seen at least 1 CAM provider in the last year. Among those who used a CAM therapy, factors independently associated with seeing a provider were having been in the upper quartile of visits to conventional providers in the last year (adjusted odds ratio [AOR], 2.00; 95% confidence interval [CI], 1.33-3.01), female sex (AOR, 1.67; 95% CI, 1.17-2.38), and having used the therapy to treat diabetes (AOR, 5.20; 95% CI, 1.40-19.40), cancer (AOR, 2.99; 95% CI, 1.04-8.62), or back or neck problems (AOR, 1.51; 95% CI, 1.02-2.23). Factors independently associated with frequent use (. or = 8 visits per year) of a CAM provider were full insurance coverage of the CAM provider (AOR, 5.06; 95% CI, 2.45-10.47), partial insurance coverage (AOR, 3.26; 95% CI, 1.72-6.19), having used the therapy for wellness (AOR, 2.85; 95% CI, 1.63-4.98), and having seen the provider for back or neck problems (AOR, 2.26; 95% CI, 1.29-3.94). Conservative extrapolation to national estimates suggests that 8.9% of the population (17.5 million adults) accounted for more than 75% of the 629 million visits made to CAM providers in 1997. CONCLUSIONS: A small minority of persons accounted for more than 75% of visits to CAM providers. Extent of insurance coverage for CAM providers and use for wellness are strong correlates of frequent use of CAM providers.

Adult↗
PubMed2006

Bringing 'the public' into health technology assessment and coverage policy decisions: from principles to practice.

Those making health care coverage decisions rely on health technology assessment (HTA) for crucial technical information. But coverage decision-making, and the HTA that informs it, are also inherently political. They involve the values and judgments of a range of stakeholders as well as the public. Moreover, governments are politically accountable for their resource allocation decisions. Canadian policy makers are at an early stage in the design of legitimate mechanisms for the public to contribute to, and to be apprised of, HTA and coverage decisions. As they consider the options, questions arise about whom to involve (e.g., which publics), how to engage them (e.g., through what public involvement or accountability mechanisms), and for what purpose (e.g., to inform the public of decisions and their rationales, or to have the public directly affect those decisions). Often key concepts, such as the difference between public accountability and public participation, are not well articulated or distinguished in these debates. Guidance is needed regarding both rationales and methods for involving the public in HTA and technology coverage decisions. We offer a framework that clearly distinguishes specific roles for the public, and relates them to several layers of policy analysis and policy making where 'the public' may engage in different tasks. The framework offers a menu of choices for policy makers contemplating changes to public involvement, as well as a model that can be used to characterize and analyze different approaches across jurisdictions.

Community Participation↗