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PubMed2007

The on-call crisis: a statewide assessment of the costs of providing on-call specialist coverage.

STUDY OBJECTIVE: A recent change in the delivery of emergency care is a growing reluctance of specialists to take call. The objective of this study is to survey Oregon hospitals about the prevalence and magnitude of stipends for taking emergency call and to assess the ways in which hospitals are limiting services. METHODS: This was a cross-sectional, standardized survey of chief executive officers from all hospitals with emergency departments in Oregon (N=56). This e-mail-based survey asked about payments made to specialists to take call and examined changes in hospitals' trauma designation and ability to provide continuous coverage for certain specialties. RESULTS: We received responses from 54 of 56 hospitals, representing a 96% response rate (100% of trauma centers). Twenty-three of 54 (43%) Oregon hospitals pay a stipend to at least 1 specialty, and 17 (31%) hospitals guarantee pay for uninsured patients treated on call. Stipends ranged from $300 per month to more than $3,000 per night, with a median stipend of $1,000 per night to take call. Trauma surgeons, neurosurgeons, and orthopedists were the specialists most likely to receive stipends. Seven of 54 (13%) hospitals have had their trauma designation affected by on-call issues. Twenty-six hospitals (48%) have lost the ability to provide continuous coverage for at least 1 specialty. CONCLUSION: Problems with on-call coverage are prevalent in Oregon and affect hospital financing and delivery of services. A continuation of the current situation could degrade the effectiveness of the trauma system and adversely affect the quality of emergency care.

Cross-Sectional Studies↗
PubMed2005

The application of new biosynthetic artificial skin for long-term temporary wound coverage.

Temporary dressings protect wounds from desiccation and infection. In our previous study, we used meshed acellular porcine dermis (APD) to enhance wound healing and decrease wound contraction; however, the wounds showed meshed scar. In this study, we produced an artificial skin composed of a cross-linked silicon sheet on the surface of APD which we have called silicone acellular porcine dermis (SAPD). This new artificial skin can protect the wound long enough to promote wound healing either by second intention or covered long enough until cultured epithelium autograft (CEA) or autologous skin graft can be harvested for permanent coverage. We delivered 4 cm x 5 cm full-thickness wound on the back of 350 g Sprague-Dawley rats. Thirty-six rats were divided into two groups. Eighteen rats had SAPD and the other 18 were covered with Biobrane. The wounds were first examined 2 weeks after grafting and followed weekly for an additional 4 weeks to evaluate the wound and study pathological changes by using H.E. and Masson's stains. Wound size was calculated by ruler and analyzed by Student's t-test. At the 2-week inspection, both SAPD and Biobrane showed tight adherence to the wound with no change of wound size. Both the SAPD and Biobrane dermal templates were pink. In the Biobrane-covered group, the wounds contracted soon after the tie-over dressing was removed. Its dermal layer is a layer of thin porcine dermal substance, which was promptly digested by tissue hyaluronidase and provides no real dermal template. In the SAPD-covered group however, the wound size was maintained significantly from third to sixth week after grafting (p<0.001). SAPD was designed with thick epidermal silicone and a well-organized porcine dermis so that it incorporates into the recipient wound. Clinically the silicone layer of SAPD dislodged from APD about 6-7 weeks after grafting and was followed by dermal matrix exposure and infection. In pathological examination, much like a human skin graft, new vessels were found in APD about 1 week after grafting with minimal inflammatory cells infiltrated in the graft and wound. Six weeks after grafting, the collagen of APD incorporated into the wound, showing palisade arrangement and no sign of rejection. In the Biobrane group however, the wounds showed severe inflammation, the porcine dermal matrix was digested and disappeared 3 weeks after coverage. In conclusion, SAPD is a thick biosynthetic artificial skin, which protects the rat wound significantly longer than Biobrane and prevents contraction. We expect that using of SAPD for temporary wound coverage will provide enough time to grow autologous-cultured epithelium or to reharvest skin grafts.

Animals↗
PubMed2005

Comparison of vancomycin-based stationary phases with different chiral selector coverage for enantioselective separation of selected drugs in high-performance liquid chromatography.

Two vancomycin-based chiral stationary phases (CSPs) with different coverage of the chiral selector vancomycin (Chirobiotic V and Chirobiotic V2) were compared. beta-Blockers and profens, as structurally diverse groups of drugs, were chosen as analytes. Retention and enantioseparation of beta-blockers were studied in reversed-phase (RP) and polar-organic (PO) separation modes. Higher retention and better enantioresolution were obtained on the CSP with higher coverage of vancomycin in the both separation modes. Baseline separation of four beta-blockers (eight enantiomers) in the PO mode was achieved on the Chirobiotic V2 column within 15 min. The enantioseparation of profens did not bring so excellent and easy to interpret results. Higher retention of profens on the Chirobiotic V2 column was not always accompanied by an improvement of their chiral separation in the RP mode. The polar-organic mode was not suitable for these derivatives at all. The most interesting result was obtained with flobufen; its chiral center is further away from the rigid part of the molecule, which mostly causes difficulties in enantioselective recognition. Nevertheless, the enantiomers of flobufen were shown to be much better (baseline) resolved on the CSP with lower coverage of the chiral selector (Chirobiotic V).

Chromatography, High Pressure Liquid↗
PubMed2006

Effect of the density of the C(18) surface coverage on the adsorption mechanism of a cationic compound and on the silanol activity of the stationary phase in reversed phase liquid chromatography.

RPLC columns with different surface coverages (a C(1) endcapped column with a bonding density of 3.92 micromol/m(2) and four C(18)-bonded, endcapped columns, with octadecyl chain densities of 0.42, 1.01, 2.03, and 3.15 micromol/m(2)) were used to investigate the effects of the density of the surface coverage of RPLC columns on the adsorption mechanism of a cationic compound, amitriptyline chloride, and on the silanol activity of these columns. The mobile phases used were acetonitrile-water (30/70, v/v) solutions, buffered at either pH 2.7 or pH 6.9. At pH 2.7, the residual silanol groups are not ionized. At pH 6.9, some of these groups are ionized and these surface anions can strongly interact with the cationic compound. The adsorption isotherms were measured by frontal analysis (FA) at pH 2.7 and by frontal analysis by characteristic points (FACP) at pH 6.9, because the very high retention observed at neutral pH made FA measurements excessively long and poorly accurate. The adsorption energy distributions (AEDs) were calculated when possible, according to the expectation-maximization (EM) algorithm. A bimodal and a trimodal energy distribution were found for all the columns at pH 2.7 and 6.9, respectively. The third site measured at pH 6.9 was attributed to the strong ion-exchange interactions between the ionized silanol groups and the amitriptylinium cation. The contribution of the ionized silanol groups to the overall retention is maximum for the phases with intermediary bonding densities (1.01 and 2.03 micromol/m(2)). The peak tailing is most pronounced for the lowest (C(1) column) and the highest (3.15 micromol/m(2)) surface coverages.

Adsorption↗
PubMed2005

Posterior capsule opacification-like changes in rat lens explants cultured with TGFbeta and FGF: effects of cell coverage and regional differences.

Following cataract surgery, many patients suffer secondary loss of vision because of posterior capsule opacification (PCO), which arises when residual lens epithelial cells become aberrant and migrate into the light path. Transforming growth factor-beta (TGFbeta)-induced transdifferentiation of lens cells appears to play a key role in this process. Fibroblast growth factor (FGF) may also play a role by promoting the survival of TGFbeta-affected cells and influencing their subsequent behaviour. In the present study, the effects of two different TGFbeta and FGF treatment regimes were compared in rat lens epithelial explants with either low or high initial cell coverage. Explants treated with 50 pg ml(-1) TGFbeta2 and 20 ng ml(-1) FGF-2 sequentially (day 0, day 1) or simultaneously (day 0), then cultured for up to 30 days with FGF, were assessed by light microscopy and immunolocalisation of markers for transdifferentiation (alpha-smooth muscle actin (alphaSMA) and type I collagen) or lens epithelial phenotype (Pax6) and fibre differentiation (beta-crystallin). By day 4, most cells had lost Pax6 reactivity, alphaSMA reactivity was evident, and there were differences between growth factor treatment groups, low and high initial cell coverage explants, and peripheral and central regions of explants. On day 30 of culture, all explants were well populated with cells, irrespective of treatment and initial cell coverage, and exhibited diverse PCO-like morphological changes, with expression of transdifferentiation markers and beta-crystallin in virtually all cells. Such overall resilience to variations in conditions may contribute to the insidious nature of PCO, while factors related to observed early differences between groups may contribute to PCO pleiomorphism.

Actins↗
PubMed2006

Soft tissue coverage for posttraumatic reconstruction.

Posttraumatic foot and ankle reconstruction requires careful preoperative planning to reduce wound complications. Systemic and local factors need to be considered. A careful surgical technique can avoid the need for surgical soft tissue coverage. Recognition of the need for coverage preoperatively improves outcomes. Often, dressings and time allow minor wound complications to heal. More severe wound issues require early soft tissue coverage by local or free flaps to prevent failure of the surgery.

Ankle Injuries↗
PubMed2005

The cost of epidemiological transition: a study of a decrease in pertussis vaccination coverage.

Based on a transfer function intervention model applied to epidemiological data of pertussis incidence and pertussis vaccination in England and Wales, the consequences of pertussis vaccination strategies were estimated in terms of health effects and economic direct costs. It was established that sixth dose pertussis vaccination programs at 90% coverage were the most cost saving for short-term and for long-term vaccination prevention strategies. We considered two alternative strategies with whole-cell or acellular vaccines for primary course and acellular vaccine for two booster doses in children and one booster in adolescents. As a rule, programs based on exclusive use of acellular vaccines for all the doses were more expensive. Direct costs of programs with the vaccination rate at 90% remained systematically lower than the expected cost of pertussis disease in the case of non prevention. The stability over time of the vaccination coverage at a constant level of 90% made it possible to ensure the largest cost saving strategy during the period of 14 years of analysis. Transitions to programs with a lower proportion of vaccinated children systematically incurred an incremental direct cost for society. The amount of that cost rose with the size of the drop in the new vaccination coverage and diminished, due to the J-curve optimistic effect, when the fall in vaccination rate generated a delayed increase in notification cases of pertussis.

Adolescent↗
PubMed2005

Improvement of coverage and utilization of EmOC services in southwestern Bangladesh.

OBJECTIVE: The Government of Bangladesh has implemented safe motherhood programs throughout the country supported by the United Nations Children's Fund (UNICEF) and United Nations Population Fund (UNFPA) aimed at reducing maternal morbidity and mortality. The objective of this study is to assess the effect of the interventions on the UN emergency obstetric care (EmOC) process indicators in Khulna division, Bangladesh. METHODS: Of the 71 government health facilities in Khulna division, 32 were providing comprehensive and 20 were providing basic EmOC services. Another 4 facilities were providing comprehensive or basic EmOC services during the first three-quarters but became non-functional during the last quarter. EmOC data, from January to December 2002, were collected from all these 56 facilities to determine the levels of EmOC process indicators relative to the UN guidelines and compared with baseline data from 1998 to 1999. RESULTS: There were 1.04 and 0.64 comprehensive and basic EmOC facilities respectively per 500,000 population. When compared with the baseline data, the coverage of comprehensive EmOC services was substantially increased from 0.23 to 1.04 per 500,000 population, which achieves the minimum UN standards but the coverage of basic EmOC services remained the same. The data also showed that, compared with the baseline survey, the proportion of births at the EmOC facilities increased 119% from 5.3% to 11.7% (p<0.001), met need increased 141% from 11.1% to 26.6% (p<0.001), and cesarean section as a proportion of all expected births, increased 151% from 0.5% to 1.3% (p<0.001), while the overall case fatality rate (CFR) decreased by 51% (p<0.001). CONCLUSION: With the exception of coverage of basic EmOC after the interventions, there was significant improvement in all the EmOC process indicators in Khulna division. However, most of the process indicators are still far from the minimum recommended UN standards. RECOMMENDATIONS: Efforts should continue to keep the EmOC facilities functional 24/7 while increasing the number of basic EmOC facilities, and improving utilization of services to reach the minimum UN standards. Community mobilization should be directed to understand the danger signs and utilization of services at functional facilities when necessary. Further research to identify the factors influencing utilization of EmOC services and continuous monitoring and periodical assessment of the process indicators are recommended to evaluate the overall situation from time to time.

Bangladesh↗
PubMed2005

Analysis of axillary coverage during tangential radiation therapy to the breast.

PURPOSE: To evaluate the percent of the prescribed radiation dose to the breast delivered to the axillary tissue and to evaluate the volume of the axilla receiving 95% of the prescribed dose with normal and with high tangential fields. METHODS AND MATERIALS: Computed tomographic scan images with 5-mm sections were retrospectively analyzed for 35 patients who had undergone three-dimensional (3D) planning for whole-breast radiation. The axillary nodal region was identified and divided into Levels I to III and Rotter's nodes (RN). Digitally reconstructed radiographs were created, and two plans were developed: (a) the standard clinical opposed tangential irradiation fields and (b) the high-tangential irradiation fields. Axillary coverage was examined by use of dose-volume histograms (DVH), and the average coverage for the four nodal groups was obtained. RESULTS: The data show that with the standard tangential irradiation fields, the average dose delivered to Levels I, II, III, and RN is 66% (standard deviation, or SD = 13%), 44% (SD = 18%), 31% (SD = 20%), and 70% (SD = 19%) of the prescribed dose, respectively. The coverage increases to 86% (SD = 9%), 71% (SD = 19%), 73% (SD = 17%), and 94% (SD = 8%) of the prescribed dose, respectively, for Levels I, II, III, and RN when the high tangential irradiation fields are used. 51% of Level I, 26% of Level II, and 15% of Level III receive 95% of the prescribed dose with normal tangents. The volume increases to 79%, 51%, and 49% of Levels I, II, and III, respectively, with high tangents. CONCLUSION: The tangential fields designed to treat only the breast do not adequately cover the axillary region and, therefore, cannot be relied upon for prophylactic therapy of the axilla. The high tangential irradiation fields increase the dosages received by the axillary region, but the average dosages received by the lower axillary regions are still less than 90% of the prescribed dose.

Adult↗
PubMed2005

Organ sparing by conformal avoidance intensity-modulated radiation therapy for anal cancer: dosimetric evaluation of coverage of pelvis and inguinal/femoral nodes.

PURPOSE: To describe a novel and straightforward conformal avoidance intensity-modulated radiation therapy (IMRT) technique for coverage of pelvis and inguinal/femoral nodes and to compare the dosimetry of the new method with that of other traditional methods of radiation treatment. METHODS AND MATERIALS: Data of 2 patients with anal cancer were used as example cases to illustrate details and advantages of conformal avoidance IMRT technique. Conventional photons with enface electrons design was created first, thereby providing "outermost boundaries" defined as planning target volume (PTV) for subsequent conformal avoidance IMRT design. Organs at risk (OARs), including femoral head and neck and external genitalia, were contoured as conformal avoidance structures. A step-and-shoot inverse IMRT planning was subsequently generated. For dosimetric comparison, a recently published technique by modified segmental boost was also generated. These treatment techniques were evaluated by dose-volume histogram (DVH) of PTV and OARs. Dose profiles at four different depths from each treatment planning were generated for comparison. RESULTS: The DVH of PTV showed that coverage of the PTV was comparable among three treatment techniques. Percent volume of PTV receiving more than 90% prescription dose was in the range 94-98% for the three treatment techniques, and all had only 0-2% of PTV receiving more than 110% of prescription dose. The DVH of OARs confirmed that both femoral head and neck and external genitalia could be spared well by conformal avoidance IMRT as compared with the other two techniques. Although greater inhomogeneity of dose distribution within the PTV was noted by conformal avoidance IMRT technique, as shown by dose profiles at four different depths, the maximum doses at different depths were less than 115%, which was comparable to those planned by modified segmental boost technique. Planning by photons and enface electrons technique, however, showed a greater dose variation up to 134% of the prescription dose at 1.5 cm depth along photon-electron match-line. CONCLUSIONS: To cover pelvis and inguinal/femoral nodes, conformal avoidance IMRT is technically simple to simulate, plan, and execute. Dosimetric study has demonstrated that it achieves comparable PTV coverage compared with other approaches while at the same time significantly sparing the surrounding OARs.

Aged↗
PubMed2005

Use of CT simulation for treatment of cervical cancer to assess the adequacy of lymph node coverage of conventional pelvic fields based on bony landmarks.

PURPOSE: To assess the adequacy of nodal coverage of "conventional" pelvic radiation fields for carcinoma of the cervix, with contoured pelvic vessels on simulation computed tomography (CT) as surrogates for lymph node location. METHODS AND MATERIALS: Pelvic arteries were contoured on non-contrast-enhanced CT simulation images of 43 patients with cervix cancer, FIGO Stages I-III. Vessel contours were hidden, and conventional pelvic fields were outlined: (1) anterior/posterior fields (AP): superior border, L5-S1 interspace; inferior border, obturator foramina; lateral border, 2 centimeters lateral to pelvic brim. (2) Lateral fields (LAT): Anterior border, symphysis pubis; posterior border, S2-S3 interspace. Distances were measured between the following: (1) bifurcation of the common iliac artery and superior border, (2) external iliac artery and lateral border of the AP field, and (3) external iliac artery and anterior border of the LAT field. The distances were considered as "inadequate" if <15 mm, "adequate" if 15-20 mm, and "generous" if >20 mm. RESULTS: Superiorly, 34 patients (79.1%) had inadequate coverage. On the AP, margins were generous in 19 (44.2%), but inadequate in 9 (20.9%). On the LAT, margins were inadequate in 30 (69.8%) patients. Overall, 41 (95.4%, CI, 84.2%-99.4%) patients had at least 1 inadequate margin, the majority located superiorly. Twenty-four (55.8%; CI, 39.9%-70.9%) patients had at least 1 generous margin, the majority located laterally on the AP field. CONCLUSION: Conventional pelvic fields based on bony landmarks do not provide optimal lymph node coverage in a substantial proportion of patients and may include excess normal tissue in some. CT simulation with vessel contouring as a surrogate for lymph node localization provides more precise and individualized field delineation.

Feasibility Studies↗
PubMed2006

A protein database constructed from low-coverage genomic sequence of Bacillus megaterium and its use for accelerated proteomic analysis.

Peptide mass fingerprint (PMF) matching is a high-throughput method used for protein spot identification in connection with two-dimensional gel electrophoresis (2DE). However, the success of PMF matching largely depends on whether the proteins to be identified exist in the database searched. Consequently, it is often necessary to apply other more sophisticated but also time-consuming technologies to generate sequence-tags for definitive protein identification. On the other hand, modern sequencing technologies are generating a large quantity of DNA sequences, first in unfinished form or with low genome coverage due to the time-consuming and thus limiting steps of finishing and annotation. We recently started to sequence the genome of Bacillus megaterium DSM 319, a bacterium of industrial interest. In this study, we demonstrate that a protein database generated from merely three-fold coverage, unfinished genomic sequences of this bacterium allows a fast and reliable protein spot identification solely based on PMF from high-throughput MALDI-TOF MS analysis. We further show that the strain-specific protein database from low coverage genomic sequence greatly outperforms the commonly used cross-species databases constructed from 13 completely sequenced Bacillus strains for protein spot identification via PMF.

Algorithms↗
PubMed2005

A quantitative and selective chromatography method for determining coverages of multiple proteins on surfaces.

Competitive protein adsorption plays a key role in the surface hemocompatibility of biological implants. We describe a quantitative chromatography method to measure the coverage of multiple proteins physisorbed to surfaces. In this method adsorbed proteins are displaced by CHAPS (3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonate) and then analyzed by high performance liquid chromatography to separate and quantify the individual proteins, in this case bovine serum albumin (BSA) and bovine fibrinogen (Fg). CHAPS displaced over 95% of the adsorbed proteins and was easily removed from solution by dialysis. This method was tested by measuring the coverage of BSA, 66 kDa, and Fg, 340 kDa, simultaneously adsorbed from solutions with concentration of 20 microg/ml, on bare and dextranized silicon. Relative to silicon, the dextranized surfaces were found to strongly inhibit protein adsorption, decreasing BSA and Fg coverages by 76 and 60%, respectively.

Adsorption↗
PubMed2004

The adipofascial turn-over flap for coverage of the dorsum of the finger: a modified surgical technique.

PURPOSE: The exact distances from the cutaneous dorsal branches of the digital artery to the proximal interphalangeal joint have been established in a previous anatomic study. The aim of this report is to incorporate these anatomic data into the current way of designing the homodigital adipofascial turn-over flap for cutaneous coverage of the dorsum of the finger. Our clinical experience with this modified surgical technique to this flap is reported. METHODS: The clinical series presented here consists of 40 patients with loss of cutaneous coverage at the dorsal aspect of the middle and distal phalanges. Based on our anatomic findings the flap was designed to include at least 1 dorsal branch in its pedicle. RESULTS: The flap survival was excellent and no donor site complications were observed. CONCLUSIONS: The adipofascial turn-over arterial flap has appeared as an excellent alternative for achieving early coverage of cutaneous wounds at the dorsal aspect of middle and distal phalanges of the long fingers. This flap can be designed as an arterial flap in a predictable and reliable way based on new anatomic data on the vascularization of the dorsum of the finger.

Adolescent↗
PubMed2006

The influence of the acromial coverage index in rotator cuff tears.

Several intrinsic and extrinsic factors have been advocated in the pathogenesis of rotator cuff tears, but it is still unclear whether the origin of the tear is related to tendon degeneration itself or induced by several morphologic changes. The purpose of this study is to determine the relationship between the acromial coverage of the humeral head and the presence of a cuff tear. We evaluated 148 shoulders, including 45 that underwent surgical rotator cuff repair (group I), 26 with documented rotator cuff tears treated conservatively (group II), and 77 with no cuff pathology as a control group (group III). The mean acromial coverage index was 0.68 in group I, 0.72 in group II, and 0.59 in group III, giving a highly significant difference (P < .0001) between the control group and both cuff tear groups. Patients with a cuff tear have a significantly higher acromial coverage index than the control group.

Acromioclavicular Joint↗
PubMed2005

Spatial and temporal variation in seagrass coverage in Southwest Florida: assessing the relative effects of anthropogenic nutrient load reductions and rainfall in four contiguous estuaries.

The estuaries of Tampa Bay, Sarasota Bay, Lemon Bay, and Upper Charlotte Harbor are contiguous waterbodies located within the subtropical environment of Southwest Florida. Based on an examination of rainfall data over the period of record (1916-2001) within the watersheds of these estuaries, there is no evidence for spatial differences (at the watershed level) or monotonic trends in annual rainfall. During the 1980s, nitrogen loads into Tampa Bay and Sarasota Bay (generated primarily by domestic wastewater treatment facilities) were reduced by 57% and 46%, respectively. In response, both Tampa Bay and Sarasota Bay have lower phytoplankton concentrations, greater water clarity and more extensive seagrass coverage in 2002 than in the early 1980s. As there is no evidence of a concurrent trend in rainfall during the period of 1982-2001, it is unlikely that variation in rainfall can account for the observed increase in seagrass coverage in these two bays. In contrast, seagrass coverage has remained relatively constant since the mid 1980s in Lemon Bay and Charlotte Harbor. Domestic wastewater treatment facilities are minor sources of nitrogen to Lemon Bay, and water clarity in Charlotte Harbor varies mostly as a function of dissolved organic matter and non-chlorophyll associated turbidity, not phytoplankton levels. Even in estuaries that share boundaries and are within 100 km of each other, varied responses to anthropogenic changes and natural phenomena were observed in water quality and associated seagrass extent. Resource management strategies must take into account system-specific factors-not all strategies will result in similar results in different systems.

Analysis of Variance↗
PubMed2005

[Coverage rates of influenza vaccination in France: a population-based cross-sectional analysis of seasons 2001-2002 and 2002-2003].

INTRODUCTION: Influenza is a serious health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. OBJECTIVES: The authors had for aim to assess influenza vaccination coverage during two seasons in France, to understand the incentives and barriers to vaccination and to determine vaccination intentions for the following winter. METHODS: A random-sampling, mail-based household survey was made among non-institutionalised individuals aged 15 and over. The surveys for 2001-2002 and 2002-2003 used the same questionnaire and were subsequently pooled. Three target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field and (3) persons aged 65 and over or working in the medical field. RESULTS: Influenza vaccination coverage in France decreased from 23.0% in 2001-2002 to 22.4% in 2002-2003. Most frequent reasons for being vaccinated were advice from the family doctor (50.8%), influenza considered as a serious illness (45.3%) and free vaccine (44.1%). Reasons for not being vaccinated mentioned by people who had never been vaccinated were young age (27.0%), not considering vaccination (18.9%), and not expecting to catch influenza (13.9%). CONCLUSION: Vaccination coverage decreased during the 2002-2003 season in comparison to the 2001-2002 season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. We therefore suggest 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↗
PubMed2007

Coverage, utilization and barriers to cataract surgical services in rural South India: results from a population-based study.

OBJECTIVES: To determine the cataract surgical coverage, utilization and barriers to cataract surgery in a rural taluk of south India. STUDY DESIGN: A cross-sectional, community-based survey. METHODS: A house-to-house survey was carried out in 15 villages that were selected by cluster sampling during January to October, 2002. A total of 1505 people aged 50 years and above were tested for visual acuity (VA) and their eyes examined. Cataract surgical coverage was calculated for people and eyes, and for VA levels of <3/60 and <6/60. Information about details of cataract surgery and barriers to cataract surgery were collected using a pre-designed proforma. RESULTS: Cataract surgical coverage was 63% (people) and 51% (eyes) for VA<3/60 compared with 49% (people) and 36% (eyes) for VA<6/60. Of 109 operated eyes, 51.2% of operations were carried out in private hospitals and 33.3% in voluntary/charitable hospitals. Inability to afford the operation (22.9%) and fear of the operation (19.2%) were the main barriers to cataract surgery. CONCLUSIONS: The reasons for underutilization of government hospitals are to be investigated. Awareness of low-cost cataract intraocular lens (IOL) non-governmental organization (NGO) surgery and free-of-cost NGO services available in the region needs to be raised. Barriers to cataract surgical services should be addressed by community-based health-education programmes to improve the uptake of existing services.

Aged↗