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PubMedDate not supplied

Measles immunisation coverage in urban slums.

A cross-sectional, community-based study was conducted in 32 slums of Udaipur city to assess the prevalence of missed opportunities for measles immunization, reason for their occurrence and potential impact of avoiding them on measles immunization coverage. Two hundred and sixty-five children, between the age of 9 and 24 months were enlisted for the study, using a practical cluster sampling method. Immunization status of the children, visits to health facilities after 9 months of age and reasons for non-immunization were noted. Missed opportunities for measles immunization was defined as any visit by an eligible child to a health facility, which did not result in his/her vaccination. Measles immunization coverage amongst the study population was 50.61%. The prevalence of missed opportunities for measles immunization was 14.3%. Not offering measles immunization at curative visits (86.9%) was the major reason for missing opportunities. Avoiding all missed opportunities could have increased the measles immunization coverage to 64.9%.

Child, Preschool↗
PubMed2005

Influenza vaccination coverage rates in Germany a population-based cross-sectional analysis of the seasons 2002/2003 and 2003/2004.

BACKGROUND AND PURPOSE: Influenza continues to be a considerable health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. The objectives of this survey were to assess the level of influenza vaccination coverage in the 2002/2003 season compared with the 2003/2004 season in Germany, to understand the driving forces and barriers to vaccination, and to determine vaccination intentions for the following winter. METHODS: The authors conducted a random-sampling, telephone-based household survey among noninstitutionalized individuals representative of the population aged > or = 14. The surveys for 2002/2003 and 2003/2004 used the same questionnaire and were subsequently pooled. Four target groups were determined for analysis: (1) persons aged > or = 60; (2) people working in the medical field; (3) persons suffering from chronic illness; and (4) a group composed of persons aged > or = 60 or working in the medical field or suffering from a chronic illness. RESULTS: The overall sample consisted of 4,011 people. The influenza vaccination coverage rate in Germany increased from 22.3% in 2002/2003 to 25.1% in 2003/2004. This increase is not significant. The most frequent reasons for being vaccinated given by vaccinees were: influenza considered to be a serious illness, which people wanted to avoid (90.1%), having received advice from the family doctor or nurse to be vaccinated (71.3%), and not wanting to infect family and friends (70.4%). Reasons for not being vaccinated mentioned by people who have never been vaccinated were: thinking about it, however, not being vaccinated in the end (47.7%), not expecting to catch influenza (43.6%), and not having received a recommendation from the family doctor to be vaccinated (36.6%). Options encouraging influenza vaccination are: recommendation by the family doctor or nurse (66.6%), more available information on the vaccine regarding efficacy and tolerance (54.2%), and more information available about the disease (52.4%). CONCLUSION: The vaccination coverage in the 2003/2004 season increased in comparison to the 2002/2003 season, although not significantly. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. It is therefore suggested that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.

Adolescent↗
PubMed2001

Early soft tissue coverage after complex foot trauma.

Complex foot injuries require early and durable soft tissue coverage to reduce infection rates and fibrosis, thereby improving the functional outcome. Definitive wound closure with tissue transfer was achieved as an emergency procedure within 24 hours in 2 of 28 cases, as urgent revision within 72 hours in 9 of 28 cases, and as early revision within 120 hours in 15 of 28 patients. To evaluate the global foot function the Maryland Foot Score was applied to 17 of 28 patients at the 1-year follow-up. The mean score was 74.2 (of 100) points, indicating "good" to "sufficient" foot function. The outcome was superior compared with a series of 18 consecutive open calcaneus fractures with delayed soft tissue coverage (64.4 points). These results were confirmed with a modified Merle d'Aubigné Score. The overall infection rate could be lowered to 7.1% after complex foot injuries with early soft tissue coverage compared to 26 open calcaneus fractures (19.2%). Functional scores allow a reasonable overall assessment of the results, but they are centered on subjective criteria. Thus they must be viewed in conjunction with radiologic and biometric factors as well as criteria valuable for plastic reconstruction, such as two-point discrimination and durability. Unfortunately, emergency flap procedures are still rare in foot surgery, although they permit primary stable osteosynthesis even with complex foot trauma. The foot should gain the same functional rank as the hand with respect to acute or emergency flap procedures to avoid further complications.

Adolescent↗
PubMed2003

Percutaneous fetoscopic patch coverage of experimental lumbosacral full-thickness skin lesions in sheep.

BACKGROUND: In order to minimize maternal trauma from open fetal surgery for prenatal coverage of fetal myelomeningoceles in humans, we assessed the feasibility of a percutaneous fetoscopic approach in sheep. METHODS: In seven ewes between 90 and 100 days of gestation, the amniotic cavity was entered percutaneously. Each fetus was postured and a full-thickness skin lesion was created in the lumbosacral region. Then, the feasibility of covering this lesion with a patch and fetal skin by standard endoscopic suturing techniques (n = 3) or robot assistance (n = 4) was assessed. RESULTS: Percutaneous fetoscopic patch and skin coverage of the full-thickness skin lesion was achieved in six of the seven fetal sheep. Five fetuses survived gestation and were delivered healthy. CONCLUSIONS: Percutaneous fetoscopic posturing and patch coverage of lumbosacral full-thickness skin lesions can effectively and safely be achieved in sheep. This approach promises to provide a substantial reduction of maternal trauma from fetal surgery for myelomeningoceles.

Animals↗
PubMed2006

Primary and secondary tissue expansion gives high quality skin and subcutaneous coverage in children with a large myelomeningocele and kyphosis.

When operating on a child with a large myelomeningocele and kyphosis, coverage with skin of high quality and a supporting layer of subcutaneous tissue can be difficult. The dermal circulation in the newborn is finite and an extensive mobilisation of the skin is a risky venture. Between 1988 and 2003 five children with large thoraco-lumbal myelomeningocele and kyphosis underwent subcutaneous insertion of silicon tissue expanders due to skin cover difficulties. In three children the skin surface was allowed to granulate over the myelomeningocele. In the other two children closure of the myelomeningocele was attempted but failed leading to secondary epithelialisation. Four of the children had two tissue expanders inserted at the age of 8-12 months; two of them before delayed operation for the myelomeningocele and two before elective spinal column surgery. The fifth child was nine years old when two tissue expanders were inserted before delayed myelomeningocele repair. Saline was injected into the expanders every 3-7 days during six to eight weeks. The expansion treatment was well tolerated. The result was an excellent skin and subcutaneous coverage in four of the children. For the fifth child who was the oldest and obese, one filling port was damaged during one of the injections, leading to insufficient tissue expansion. An extensive skin mobilisation was required and the result was not optimal. Tissue expansion is a simple, but a less known technique for acquiring good skin and subcutaneous coverage in children with large myelomeningocele and kyphosis. The expansion can be done either before delayed myelomeningocele repair or after failed primary operation thus eliminating the need for extensive musculo-cutaneous flaps.

Age Factors↗
PubMed2002

Carotid artery reconstruction combined with myocutaneous flap coverage: a complex and durable rescue operation.

Carotid reconstruction combined with myocutaneous flap coverage is a rare and challenging operation. We reviewed our experience to define the indications and outcome of this complex procedure. Clinical data and neurologic, wound, and vascular complications of all patients who underwent carotid artery reconstruction combined with myocutaneous flap coverage over a 17-year period were retrospectively reviewed. Results from this procedure indicate that pectoralis major myocutaneous flap is a safe and durable option for wound coverage in patients who undergo carotid endarterectomy, resection, and/or reconstruction for neck malignancy, previous irradiation or graft infection. Late outcome is favorable with low neurologic, vascular, and wound complication rates.

Adult↗
PubMed2006

Occupancy modeling of coverage distribution for whole genome shotgun DNA sequencing.

Expected-value models have long provided a rudimentary theoretical foundation for random DNA sequencing. Here, we are interested in improving characterization of genome coverage in terms of its underlying probability distributions. We find that the mathematical notion of occupancy serves as a good model for evolution of the coverage distribution function and reveals new insights related to sequence redundancy. Established concepts, such as "full shotgun depth," have been assumed invariant, but actually depend on project size and decrease over time. For most microbial projects, the full shotgun milestone should be revised downward by about 30%. Accordingly, many already-completed genomes appear to have been over-sequenced. Results also suggest that read lengths for emerging high-throughput sequencing methods must be increased substantially before they can be considered as possible successors to the standard Sanger method. In particular, gains in throughput and sequence depth cannot be made to compensate for diminished read length. Limits are well approximated by a simple logarithmic equation, which should be useful in estimating maximum coverage-based redundancy for future projects.

Algorithms↗
PubMed1985

The relationships among driving while impaired charges, police drinking-driving roadcheck activity, media coverage and alcohol-related casualty traffic accidents.

A correlational examination of 54 consecutive months of data from British Columbia on the relationships among the number of vehicles checked in police drinking-driving roadchecks, the number of driving while impaired (DWI) charges laid, the number and percent of alcohol-related casualty traffic accidents, and the extent of media coverage on drinking-driving (as measured by print media coverage), revealed that: the extent of media coverage, and not the extent of roadchecks or charging activity is probably the critical element in the reduction of drinking-driving accidents. The failure of the minimally publicized April-May 1984 British Columbia police roadcheck "blitz" to reduce either the number or proportion of alcohol-related casualty traffic accidents lent support to these correlational findings.

Accidents, Traffic↗
PubMed1995

Septohippocampal neurons in the rat septal complex have substantial glial coverage and receive direct contacts from noradrenaline terminals.

The ultrastructure of septohippocampal neurons in the septal complex and their relations with catecholamine, principally noradrenaline, terminals were examined in single thin sections. Projection neurons were identified by retrograde transport of wheat-germ agglutinated apo-horseradish peroxidase conjugated to colloidal gold particles (WAHG) following an injection into the hippocampal formation of anesthetized adult rats. After a 1 day survival, sections through the septal complex were labeled with antibodies to tyrosine hydroxylase (TH) or dopamine-beta-hydroxylase (DBH). By light microscopy, numerous processes with TH- and DBH-immunoreactivity were near neurons containing retrogradely transported WAHG. By electron microscopy, most WAHG was associated with lysosomes, multivesicular and 'sequestration' bodies in the cytoplasm of perikarya and large dendrites. WAHG-labeled perikarya (n = 114) had a large amount of astrocytic coverage (> 60% of surface) and a low amount of terminal coverage (< 25%). WAHG-labeled perikarya and dendrites were either directly contacted by TH- or DBH-labeled terminals or abutted glial processes apposed to TH- or DBH-labeled terminals. Immunoreactivity for TH and DBH was found primarily in axons and axon terminals. The morphology and synaptic associations of TH-labeled terminals was similar to that reported previously. DBH-labeled terminals (n = 314; 0.5 +/- 0.2 microns in diameter) contained numerous small clear vesicles and from 0-4 large, dense-core vesicles. DBH-containing terminals: (1) contacted perikarya and dendrites (58%), 10% of which contained WAHG; (2) were closely apposed to other terminals (7%); or (3) were separated by glial processes (35%). DBH-labeled terminals formed chiefly symmetric synapses on perikarya. However, most DBH-containing terminals formed both asymmetric and symmetric synapses on the shafts of small dendrites, suggesting both excitatory and inhibitory functions for noradrenaline terminals on septal neurons. The results demonstrate that septohippocampal neurons (1) are mostly engulfed by astrocytes and have very little terminal coverage; (2) are both directly contacted (synapses) and indirectly contacted (appositions to apposing astrocytes or axon terminals) by catecholamine, particularly noradrenaline, terminals.

Adrenergic Fibers↗
PubMed1992

Immunization coverage, infant morbidity and infant mortality in Freetown, Sierra Leone.

The study, which is based on data from a household level health survey conducted in 1990 in Freetown, Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant mortality, and infant morbidity among children in Greater Freetown, capital of Sierra Leone. The results of the study indicate that there was a decline in infant mortality in the recent period of the survey, 1988-89, compared to earlier periods. This decline seemed to have been the result of immunization coverage, which considerably increased by 1989-90, reaching above 70% of the children under age 5. The study further reveals that the increased immunization coverage of children and their mothers might have considerably reduced the incidence of tetanus. While reduction of tetanus might have played the leading role in the latest reduction in infant mortality, the incidence of diarrhea, measles, and malaria continued to be high, suggesting that the increase in the quality and quantity of basic immunizations, oral therapy for diarrheal disease, and provision of chloroquine and improved drugs for malaria disease could further reduce most of the deaths from these prevailing diseases among children under age 5.

Child, Preschool↗
PubMed1995

Urban economic reform and access to health care coverage in the People's Republic of China.

While the economic reforms since 1978 have brought about substantial changes in the rural health care system, there have been many and far-reaching implications for the urban health insurance system as well. This paper describes the evolving urban economy and examines the implications of these changes for access to health care coverage. Provided first is a brief description of the Chinese urban health care system. Three major areas of urban economic reform since 1984 are outlined and the possible effects of these reforms on health care coverage are discussed. The analysis reveals, first, the emergence of insurance coverage inequities under employment-based health insurance as China moves toward a open market economy. Second, the process of focusing on health services in rural and urban areas as separate systems is unnecessary and even counter-productive in light of the emerging integration of China's urban and rural-economies. Finally, some reasons for why China continues to search for employment-based health financing approaches are offered.

China↗
PubMed1996

Immunization coverage and child mortality in two rural districts of Sierra Leone.

The study, which is based on data from a household level health survey conducted in early 1993 in the rural areas of the districts of Western Area and Port Loko of Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant and child mortality, and disease symptoms in children who died under age five in the study area. The results of the study indicated that the infant and child mortality rate per thousand live births declined from about 162 in the mid 1980s to about 77 in 1993. This decline was associated with immunization coverage which considerably increased by 1993, reaching as high as above 60% of the eligible children. The study further reveals that the major symptoms of disease at the time of death of an infant or a child were fever, cough, troubled breathing, and diarrhea in that order. While fever and cough could reflect the persistence of malaria and pneumonia-two major causes of infant and child deaths not covered by existing EPI-the study also revealed that many children failed to take full doses of immunization. Similarly, inadequate coverage of domiciliary oral rehydration therapy (ORT) might have been the reason of high incidence of diarrhea-related deaths. Simple medical technologies to eliminate many of the existing major causes of infant and child mortality in rural Sierra Leone are now available. Perhaps, a strengthened primary health care service, including an extensive rural health care network, aimed at eliminating these diseases, would go a long way in reducing infant and child mortality to irreducible minimum.

Cause of Death↗
PubMed1989

Optimal coverage of peritoneal surface in whole abdominal radiation for ovarian neoplasms.

Patterns of failure in ovarian carcinoma include early seeding of the entire peritoneal cavity. Inability to encompass the anatomic extent of the peritoneal cavity is a possible factor leading to relapse. However, little has been published regarding technical advances in optimal coverage of the peritoneal surface in whole abdominal radiation. In the Department of Radiation Oncology at the University of Michigan, 21 consecutive patients were analyzed prospectively in regard to adequate coverage of peritoneum in the treatment of advanced ovarian carcinoma. Simulation and focused blocks were designed to treat the whole abdomen. CT treatment planning studies were obtained with the entire peritoneum identified as the target volume. Simulator designed blocks were projected over the CT scans throughout the treatment volume. Dose volume histograms were used to calculate the amount of target volume missed for each treatment plan. All treatment plans demonstrated different degrees of volume miss, ranging from 1 cm3 to 837.3 cm3 with a median of 137.9 cm3 overall. Volume missed directly correlated with increasing patient weight and flatter pelvic shape, but poorly with AP separation. This was especially evident for patients requiring treatment at extended distances in both the supine and prone positions. We conclude that bony landmarks are poor guidelines in designing pelvic blocks, especially in heavy patients and patients requiring treatment in both prone and supine positions. CT treatment planning is helpful to ensure optimal peritoneal coverage.

Abdomen↗
PubMed2005

Obtaining high sequence coverage in matrix-assisted laser desorption time-of-flight mass spectrometry for studies of protein modification: analysis of human serum albumin as a model.

Several approaches were explored for obtaining high sequence coverage in protein modification studies performed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Human serum albumin (HSA, 66.5kDa) was used as a model protein for this work. Experimental factors considered in this study included the type of matrix used for MALDI-TOF MS, the protein digestion method, and the use of fractionation for peptide digests prior to MALDI-TOF MS analysis. A mixture of alpha-cyano-4-hydroxycinnamic acid and 2,5-dihydroxybenzoic acid was employed as the final matrix for HSA. When used with a tryptic digest, this gave unique information on only half of the peptides in the primary structure of HSA. However, the combined use of three enzyme digests based on trypsin, endoproteinase Lys-C, and endoproteinase Glu-C increased this sequence coverage to 72.8%. The use of a ZipTip column to fractionate peptides in these digests prior to analysis increased the sequence coverage to 97.4%. These conditions made it possible to examine unique peptides from nearly all of the structure of HSA and to identify specific modifications to this protein (e.g., glycation sites). For instance, Lys199 was confirmed as a glycation site on normal HSA, whereas Lys536 and Lys389 were identified as additional modification sites on minimally glycated HSA.

Amino Acid Sequence↗
PubMed2006

Angioscopic evaluation of neointima coverage: sirolimus drug-eluting stent versus bare metal stent.

BACKGROUND: The process of neointima formation after bare metal stent (BMS) implantation has been previously elucidated by angioscopic observations; however, that after drug-eluting stent (DES) implantation has not been clarified. Therefore, we compared the angioscopic appearance of neointima over DESs with that over BMSs 6 months after implantation. METHODS AND RESULTS: Patients who received an implantation of a BMS (n = 13) or a sirolimus DES (n = 24) were included in this study. Angiographic and angioscopic examinations were performed at 6 months. The color of the stented lesion (white or yellow), coverage of stent by neointima (not covered, covered by a thin layer, or buried under neointima), and thrombus at the stented lesion (presence or absence) were angioscopically evaluated. Of the 24 lesions in which a DES was implanted, 11 (46%) had a part where the stent strut had no coverage, 21 (88%) had a part where it was covered by a thin layer, and 11 (46%) had a part where it was buried under neointima. Of the 13 lesions in which a BMS was implanted, 1 (8%) lesion had a part where the stent strut had no coverage, 4 (31%) lesions had a part where it was covered by a thin layer, and 13 (100%) lesions had a part where it was buried under neointima. The prevalence of a stent buried under neointima (46% vs 100%, P = .001) was lower and that of thrombus (42% vs 8%, P = .03) was higher in DES-implanted lesions as compared with BMS-implanted lesions. The prevalence of thrombus (64% vs 17%, P = .005) was higher in the yellow area than in the white area when a DES was implanted. CONCLUSION: Sirolimus DESs, as compared with BMSs, were poorly covered by neointima and were accompanied by thrombus especially when there was a yellow plaque under the stents. Thus, the thrombogenic potential in DES-implanted lesions may be sustained by the inhibition of neointima formation over thrombogenic plaques.

Aged↗
PubMed2003

Occupational exposure to needlestick injuries and hepatitis B vaccination coverage among health care workers in Egypt.

BACKGROUND: The health care worker (HCW) is at substantial risk of acquiring bloodborne pathogen infections through exposure to blood or infectious body fluids. Hepatitis B vaccination of HCWs and optimal HCW practices regarding management of sharps can minimize these risks. This study explores the frequency of exposure to needlestick injuries and the hepatitis B vaccination coverage among HCWs in Egypt. METHODS: All HCWs available in a 25% random sample of different types of health care facilities from 2 governorates in Egypt (Nile Delta and Upper Egypt) were included in the study. A total of 1485 HCWs were interviewed. History of exposure to needlestick injuries, vaccination status, and socioeconomic data were collected. RESULTS: Of the 1485 HCWs interviewed, 529 (35.6%) were exposed to at least 1 needlestick injury during the past 3 months with an estimated annual number of 4.9 needlesticks per worker. The most common behavior associated with needlestick injuries was 2-handed recapping. Overall, 64% of HCWs disposed of needles unsafely in nonpuncture-proof containers. Overall 15.8% of HCWs reported receiving 3 doses of hepatitis B vaccine. Vaccination coverage was highest among professional staff (38%) and lowest among housekeeping staff (3.5%). Using Kane's model to predict infections after needlestick exposures, we estimate 24,004 hepatitis C virus and 8617 hepatitis B virus infections occur each year in Egypt as a result of occupational exposure in the health care environment. CONCLUSION: High rates of needlestick injuries and low vaccination coverage contribute highly to the rates of viral hepatitis infections among HCWs. Prevention of occupational infection with bloodborne pathogens should be a priority to the national program for promotion of infection control. Training of HCWs on safe handling and collection of needles and sharps, and hepatitis B vaccination of all HCWs is required to reduce transmission.

Accidents, Occupational↗
PubMed2004

Risk behaviors and healthcare coverage among adults by frequent mental distress status, 2001.

BACKGROUND: Given the increased emphasis on chronic diseases in the United States, physicians and health survey analysts are now gathering information on patients' subjective measures of health, also known as health-related quality-of-life measures. Studies indicate that these measures can be more powerful predictors of chronic disease-related morbidity and mortality than objective measures. METHODS: The Behavioral Risk Factor Surveillance System (BRFSS) is an ongoing, state-based, random-digit-dialed telephone survey of the non-institutionalized U.S. population aged 18 years or older. This study examined frequent mental distress (FMD), defined as self-reported 14 or more mentally unhealthy days in the past 30 days, and its association with adverse health behaviors and lack of healthcare coverage. RESULTS: In 2001, approximately 10% of adults reported FMD. Persons reporting FMD had a higher prevalence of smoking, drinking heavily, physical inactivity, and obesity than did persons without FMD. They were also more often without healthcare coverage. In addition, persons with FMD were more likely to engage in multiple adverse behaviors than were persons without FMD. CONCLUSIONS: Persons reporting FMD are at higher risk of chronic diseases because they engage in risky health behaviors and lack healthcare coverage. This study provides further support that mental health screening as well as physical health screening is important in clinical practice. Further research is needed to identify therapeutic or mental health-promoting interventions to reduce mental distress and reinforce healthy behaviors.

Adolescent↗
PubMed2006

Monitoring county-level vaccination coverage during the 2004-2005 influenza season.

BACKGROUND: During the 2004-2005 influenza season, the United States faced a sudden shortage of influenza vaccine. In response, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommended prioritizing vaccination for persons aged 65 and older and others at high risk. To monitor subsequent vaccination coverage, several questions about influenza vaccination were added to the ongoing Behavioral Risk Factor Surveillance System (BRFSS). This study provided real-time county-level estimates of influenza vaccination coverage from the BRFSS each month from October 2004 through January 2005. METHOD: The methods used a variation of small area estimation procedures suitable for situations in which most small areas have few or no survey respondents, and rapid assessment is essential. Both model-based methods and nonparametric spatial-smoothing methods were used in a three-step procedure. RESULTS: The highest vaccination rates during the 2004-2005 influenza season were seen in the upper Midwest and the Southeast. Areas with the lowest vaccination rates were the intermountain West, southern California, portions of Washington and Oregon, and various areas across the Eastern United States, often coinciding with urban areas. Intrastate variations were especially pronounced in the Eastern United States, particularly in Georgia, Florida, Tennessee, Kentucky, North Carolina, Virginia, and New York. These states all had areas with low immunization rates as well as areas with high rates. CONCLUSIONS: The results showed that vaccination coverage varied significantly across states and substate regions. Our findings show that this methodology can provide estimates with reasonable reliability for planning during public health emergencies.

Adult↗