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PubMed2000

Immunisation coverage reporting through the Australian Childhood Immunisation Register--an evaluation of the third-dose assumption.

OBJECTIVE: The Australian Childhood Immunisation Register (ACIR) currently classifies those children who have the third dose recorded as fully immunised at 12 months of age, even if records of earlier doses are missing. This analysis assesses the impact this "third-dose assumption" has on immunisation coverage estimates for children aged 12 months. METHODS: ACIR records from three equally spaced cohorts of children at 12 months of age, which relied on the third-dose assumption, were examined for variation in doses and vaccine types recorded by jurisdiction and Medicare registration status. RESULTS: Although the percentage reduction in coverage without application of the third-dose assumption decreased through the three cohorts examined, the proportion classified as fully immunised still decreased by 11-12% (to < 75%) if the third-dose assumption was not used in the most recent cohort. "Fully immunised" status among children with delayed Medicare registration or in jurisdictions with a high proportion of paper reporting to the ACIR was disproportionately reduced without use of the assumption. CONCLUSIONS AND IMPLICATIONS: While independent sources of data continue to show that the ACIR incorrectly classifies some children as not fully immunised even with the third-dose assumption, its use seems appropriate for reporting population trends in immunisation coverage. Earlier Medicare registration and increased electronic reporting to the ACIR, together with incentives for parents and providers to ensure complete ACIR records, should eventually eliminate the need for the third-dose assumption.

Australia↗

PubMed2002

Poor health care worker vaccination coverage and knowledge of vaccination recommendations in a tertiary Australia hospital.

OBJECTIVES: Guidelines for vaccination of health care workers (HCWs) have been available in Victoria since 1998. We estimated knowledge and attitudes towards vaccination among HCWs as well as self-reported vaccination status in a tertiary adult hospital in Melbourne, Australia. METHODS: A cross-sectional survey was conducted in July 2000 using a telephone questionnaire and proportionate random sampling. RESULTS: Only 18% of 269 HCWs were fully vaccinated. Most (76%) had not heard of or seen current guidelines for HCW vaccination despite a stated belief in the importance of full vaccination (94%) and a willingness to update their vaccination status if necessary (96%). Less than half kept vaccination records (39%). Hepatitis B vaccination (95%) was most commonly completed. However, only half of all HCWs had received influenza vaccination in the past 12 months and other vaccines often had suboptimal coverage. A common reason cited for avoiding vaccination was concern over vaccine side effects (17%). While the hospital staff clinic was an acceptable site for vaccination, improved access was seen as important. CONCLUSIONS: HCW vaccination coverage and knowledge of vaccination requirements were poor. Concerns about vaccine side effects were common. IMPLICATIONS: Adequately resourced HCW vaccination programs that include ongoing education for HCWs and improved access to vaccination are necessary to improve vaccination coverage and reduce the risk of vaccine-preventable diseases among staff and patients.

Attitude of Health Personnel↗

PubMed2006

Changes in newspaper coverage about hormone therapy with the release of new medical evidence.

BACKGROUND: Results of 2 trials of postmenopausal hormone therapy (HT) challenged established practice patterns; 1 was not associated with changes in HT use, whereas the other was associated with substantial decline. Differential coverage by lay newspapers may have contributed to the differential impact. OBJECTIVE: To examine newspaper coverage of HT before and after the publication of the Heart and Estrogen Replacement Study (HERS) in August 1998, and the main findings of the estrogen plus progestin therapy arm of the Women's Health Initiative (EPT-WHI) in July 2002. DESIGN: Longitudinal review of newspaper articles, 1998 to 2003 (n=663). SETTING: Twenty local and 6 regional/national newspapers. MEASUREMENTS: Number and content of articles about HT. RESULTS: The average number of articles about HT published during the month of the publication of the EPT-WHI was at least 8-fold greater than the number of articles published on the topic during any prior period. While the majority of articles in all periods presented information about the potential benefits of HT, information about harms became more common than information about benefits during the 2 months before the publication of the EPT-WHI, when the trial participants were notified of the early termination of the study. The presentation of specific health harms was more common after the publication of the EPT-WHI than after the publication of HERS. Few articles in any period used visual aids. CONCLUSIONS: The publication of the EPT-WHI was associated with a change in both the volume and content of newspaper coverage about HT.

Estrogen Replacement Therapy↗

PubMed1997

Subpedicle connective tissue graft versus free gingival graft in the coverage of exposed root surfaces. A 5-year clinical study.

The authors compared the clinical results obtained in gingival recession correction treatment using free gingival and bilaminar connective subpedicle grafts. 35 patients were treated with free gingival grafts (Group A) and 35 with subpedicle grafts (Group B). Class I and II Miller gingival recessions were chosen for treatment by the 2 procedures. The degree of gingival recession (GR), keratinized tissue (KT) and the exposed root surface area (ERSA) were measured preoperatively and again 5 years post-surgery. Bilaminar connective grafting showed better results in reducing the amount of GR while both techniques significantly increased the width of KT (p > 0.05). The mean % of root coverage obtained in patients in group A was 53.19% +/- 21.48, whereas for the group B, 85.23% +/- 17.86 of exposed root surface was covered post surgical intervention (p < 0.001). In group A, only 3 patients (8.75%) showed a complete resolution of gingival recession after treatment, whereas in group B, 17 subjects (48.57%) presented with complete coverage. On the basis of these results, the authors conclude that the subpedicle graft promises better results in the coverage of exposed root surfaces when compared with the free gingival graft.

Adult↗

PubMed2006

Clinical evaluation of direct cuspal coverage with posterior composite resin restorations.

BACKGROUND: Composite resins have esthetic properties; they join the ability to preserve and reinforce sound tooth structure. Conservation is becoming popular for both small to medium defects and more compromised teeth. PURPOSE: This study aimed to evaluate the clinical performance of Class II cuspal coverage direct composite restorations. MATERIALS AND METHODS: Twenty patients, 18 years or older, were included in this clinical trial restoring 25 vital molar teeth with one or two missing cusps. Criteria for inclusion are two or three surface restorations, replacement of composite and amalgam fillings (secondary decay, fracture of either filling material or tooth structure, aesthetic considerations), or virgin teeth with decay undermining a cusp. Teeth with residual cavity walls less than 1 mm or with complete loss of the clinical crown were excluded. Teeth were restored using a combination of Ultra-Etch 35% phosphoric acid, PQ1 adhesive system, and Vit-l-escence microhybrid composite resin (Ultradent Products, Inc., South Jordan, UT, USA). The enamel peripheral skeleton of the restoration was built up first, followed by dentin and enamel occlusal surface stratification. Wedge-shaped increments of composite resin were placed and cured using the variable intensity polimerizer (VIP) light (Bisco Inc., Schaumburg, IL, USA) through a combination of a pulse and progressive curing technique. RESULTS: All 25 restorations were evaluated at 6-month intervals during the 30-month period using a modified US Public Health Service (USPHS) criteria by two independent evaluators precalibrated at 85% reliability. No failures were reported and alpha scores were recorded for all parameters. Statistical analysis was performed using a Chi-square test (chi(2)) and the Fisher's exact test. Sixteen of the 25 samples (64%) exhibited preoperative sensitivity to air (chi(2)=10.6; p=0.001). A significant difference in tooth sensitivity was reported after completion of the restorations. No teeth exhibited sensitivity both at the 2-week recall and the 30-month follow-up (chi(2)=23.5; p < 0.0001). CONCLUSION: Microhybrid composite resin demonstrated excellent clinical performance in direct cuspal coverage at completion of a 30-month evaluation. CLINICAL SIGNIFICANCE In selected clinical situations, cuspal coverage direct posterior composite restorations may represent a valid alternative to conventional indirect restorations.

Acrylic Resins↗

PubMed1994

Contracting for emergency room coverage by rural hospitals.

Obtaining adequate physician availability remains a challenge to many rural communities. To ensure 24-hour emergency room physician coverage, many rural hospitals contracted for emergency room services from out-of-area and/or local physician. Survey findings for 99 rural and rural referral Iowa hospitals addressing the nature, extent, and cost of contracting physician coverage of the emergency room are presented. While nearly two-thirds of the hospitals reported contracting for at least some emergency room coverage, the extent and costs of contracts vary widely. Advantages and disadvantages of contracting for emergency room services are discussed.

Contract Services↗

PubMed1995

Changes in health insurance coverage within rural and urban environments--1977 to 1987.

This study examines changes in the health insurance coverage of the nonelderly population in rural and urban areas between 1977 and 1987, using data from the National Medical Care Expenditure Survey (NMCES) and the National Medical Expenditure Survey (NMES). It was designed to test the hypothesis that differences in the rates of health insurance coverage in rural and urban areas have diminished over time, and to explore the composition of changes in coverage within rural and urban environments. The data suggest that the proportions of the populations that are without health insurance in rural and urban areas have converged since 1977. Although both rural and urban settings witnessed increases in the proportion of their populations without health insurance from any source, urban regions experienced a greater increase than did rural areas. These changes occurred among most subgroups within the population. In no subgroup did the percentage of the population without insurance in urban areas exceed that found in rural areas in either 1977 or 1987.

Adolescent↗

PubMed2004

Coverage and quality of oral cancer information in selected popular press: May 1998 to July 2003.

OBJECTIVES: A 1998 study demonstrated a lack of coverage about oral cancer in the popular press between April 1987 and April 1997. Since that study, several oral cancer-related activities took place, many of which could have increased the media's attention to oral cancer. Therefore, this study analyzed coverage and quality of oral cancer information in selected popular press between May 1998 and July 2003. METHODS: Articles from magazines and newspapers were retrieved from three databases and were analyzed by specific topics and subtopics for adequacy of content and accuracy of information. Articles were categorized as either "primarily oral cancer-related" or "primarily tobacco-related." RESULTS: Sixty articles were identified, 39 of which were included in the analysis (14 magazines; 25 newspapers). Seventeen articles were "primarily oral cancer-related," and 22 were "primarily tobacco-related." Seventy-two percent of the articles mentioned at least one risk factor for oral cancer, the most common being tobacco use (69%). Far fewer articles noted alcohol (10%) or the combined use of tobacco and alcohol (5%) as risk factors. Only 8 percent of the articles recommended an oral cancer examination. CONCLUSION: Despite local and limited national efforts and activities aimed at increasing public awareness of oral cancer, the popular press coverage of those activities was minimal or nonexistent.

Age Factors↗

PubMed1995

A population-based survey of immunisation coverage in two-year-old children.

A cross-sectional, population-based, cluster-sample survey of 187 children was conducted in the Newcastle area to assess the proportion of two-year-old children who were fully immunised, to ascertain whether administration of these vaccines was age-appropriate and to look for factors predicting incomplete immunisation. Parents or guardians were interviewed at their homes and the immunisation status of the children was verified either by the parent-held record or by the immunisation-provider-held record. Levels of full immunisation were 77 per cent at the time of interview and 72 per cent at the second birthday if Haemophilus influenzae type b (Hib) vaccine was excluded. If it was included, the full immunisation level was 51 per cent. Coverage was highest for oral polio vaccine and lowest for Hib vaccine. Twenty-nine per cent of all immunisations were given early, 44 per cent were given on time and 20 per cent were given late. Doses of vaccines due at older ages were more likely to be given late or not at all. Factors predicting incomplete immunisation were: the principal caregiver being aged under 25 years, being born outside Australia, having post-secondary qualifications, being female and having more than one child in the household. Immunisation coverage levels were not high enough to protect against outbreaks of pertussis and measles and cases of Haemophilus influenzae type b. Immunisation providers should aim to increase coverage to protect the population against all vaccine preventable diseases, and aiming at high-risk groups could more effectively do this.

Adult↗

PubMed2006

Impacts of media coverage on the community stress level in Hong Kong after the tsunami on 26 December 2004.

STUDY OBJECTIVES: The study investigated the prevalence and associated factors (media coverage in particular) of stress related responses to the December 2004 tsunami. DESIGN: An anonymous population based cross sectional telephone survey was conducted. Post-traumatic stress symptom was measured by the locally validated Chinese impact of event scale (CIES) and whether the respondent felt disturbed, apprehensive, or horrified because of the tsunami. Items related to media coverage included measures on frequency of exposure, level of distress caused by different types of images, and contents of the news messages were measured. Two summative scores, the weighted image unrest score (WIUS) and weighted content unrest score (WCUS) were formed. SETTING: Hong Kong, China. PARTICIPANTS: A total of 604 adult Chinese respondents were interviewed. MAIN RESULTS: Of the respondents, 33.8% were exposed to tsunami related mass media news reports >10 times per day; 56.5% to 64.7% felt severely or very severely disturbed by the six studied types of distressful messages; 52.6% to 71.4% felt similarly because of the eight studied types of distressful contents. Of the male respondents, 30% and 5.9% respectively showed signs of mild or moderate/severe post-traumatic stress symptoms (39% and 8.7%, respectively for women). Higher WIUS and higher WCUS were associated with mild or moderate/severe post-traumatic stress symptoms (multivariate OR = 1.72 to 14.67, p<0.05). These media exposure indicators, together with some other perception variables, were significantly associated with other stress indicators. CONCLUSIONS: The intensive media coverage of the tsunami was consistently associated with different types of tsunami related stress indicators.

Adolescent↗

PubMed2001

News media coverage of smoking and health is associated with changes in population rates of smoking cessation but not initiation.

OBJECTIVE: To determine whether changes in news media coverage of smoking and health issues are associated with changes in smoking behaviour in the USA. DESIGN AND MAIN OUTCOME MEASURES: Issue importance in the US news media is assessed by the number of articles published annually in major magazines indexed in The Reader's Guide to Periodical Literature. Annual incidence rates for cessation and initiation in the USA were computed from the large, representative National Health Interview Surveys (1965-1992). Patterns in cessation incidence were considered for ages 20-34 years and 35-50 years. Initiation incidence was examined for adolescents (14-17 years) and young adults (18-21 years) of both sexes. RESULTS: From 1950 to the early 1980s, the annual incidence of cessation in the USA mirrored the pattern of news media coverage of smoking and health, particularly for middle aged smokers. Cessation rates in younger adults increased considerably when second hand smoke concerns started to increase in the US population. Incidence of initiation in young adults did not start to decline until the beginning of the public health campaign against smoking in the 1960s. Among adolescents, incidence rates did not start to decline until the 1970s, after the broadcast ban on cigarette advertising. CONCLUSIONS: The level of coverage of smoking and health in the news media may play an important role in determining the rate of population smoking cessation, but not initiation. In countries where cessation has lagged, advocates should work to increase the newsworthiness of smoking and health issues.

Adolescent↗

PubMed2003

Press coverage of public expenditure of Master Settlement Agreement funds: how are non-tobacco control related expenditures represented?

OBJECTIVE: To examine newspaper reports of Master Settlement Agreement (MSA) allocation decisions outside of tobacco control, focusing on the arguments being put forth in favour of competing claims on MSA funds. The major aims were to identify newsworthy non-tobacco control areas for which MSA funds have been applied and to examine how non-tobacco control spending has been presented through the US press. DESIGN: A qualitative textual analysis was performed on 94 articles taken from a sample of 322 newspapers over a 12 month period (October 2000 through September 2001) that related to the allocation of MSA funds to non-tobacco control causes. Articles were coded for general content areas of MSA allocation as well as for rhetorical and framing devices employed to explain and justify allocation decisions. MAIN OUTCOME MEASURES: (1) Areas of non-tobacco control allocation; (2) rhetorical devices and framing techniques employed in the articles to discuss the allocation. RESULTS: The analysis identified a wide variety of issues for which MSA funds were being appropriated. Three main frames emerged in relation to justifying or appealing for particular spending decisions: (1) funds should be allocated to the needy and/or the deserving; (2) funds should be spent on state development; (3) funds should be put towards helping the state weather a crisis. Claims for each such issue were made using strategies such as presenting the MSA funds as a "windfall", focusing coverage on the merits of the cause rather than the issue of resource allocation, and stressing links between the particular claim and the stated objectives of the MSA. CONCLUSIONS: Press coverage of MSA non-tobacco control spending suggests that the funds have been quickly formulated as fodder for state spending, rather than to support tobacco control efforts. Thus, caution is required in pursuing settlements with the industry where the objective is better funding for tobacco control efforts, particularly in light of the possibility that press coverage of MSA allocation may actually serve as positive publicity for the tobacco industry.

Health Expenditures↗

PubMed2000

Four multidetector-row helical CT: image quality and volume coverage speed.

PURPOSE: To evaluate the imaging performance characteristics of four multidetector-row helical computed tomography (CT) and assess improvement in volume coverage speed over that with single multidetector-row helical CT. MATERIALS AND METHODS: The section-sensitivity profile and image noise of a four multidetector-row scanner were measured with phantom scans and compared with predictions from theoretic models. Nominal section thickness ranged from 1.25 to 10.00 mm, beam collimation from 1.25 to 5.00 mm, and table speed from 3.75 to 30.00 mm per rotation. Image artifacts with four and single multidetector-row helical CT were compared in both a phantom study and a subjective rating analysis of clinical images. RESULTS: Compared with single multidetector-row helical CT, the volume coverage speed of four multidetector-row helical CT (range, 3.75-30.00 mm per rotation) is at least twice as fast as that with single multidetector-row helical CT (1.0-10.0 mm per rotation) with fully comparable image quality or, in many cases, three times as fast with diagnostically comparable image quality. CONCLUSION: Compared with single multidetector-row helical CT, four multidetector-row helical CT provides a two- to threefold improvement in volume coverage speed with comparable diagnostic image quality.

Adult↗

PubMedDate not supplied

Histological and immunohistochemical study of the bronchial stump with flap coverage in an animal model.

OBJECTIVE: The purpose of our study was to evaluate the healing process of the bronchial stump after pneumonectomy reinforced with different pedicled flaps in an animal model. The specimens were analyzed by means of histology and immunohistochemistry. MATERIALS AND METHODS: We have considered 45 New Zealand White male rabbits that underwent a left pneumonectomy under general anesthesia. Nine animals had no bronchial coverage and represented the controls. The other 36 rabbits were divided into three groups of 12 and had bronchial coverage with either diaphragmatic, intercostal or pericardial flaps. The histological examinations were performed on the animals sacrificed 7, 14 and 30 days after surgery. Immunohistochemical analyses were done on the specimens on postoperative day 7 and 14. On postoperative day 7, the specimens were examined for expression of proliferating cell nuclear antibody (PCNA) expression. On postoperative day 14, neoangiogenesis was measured by CD31 expression. The measurements of antibody expression were done with a computer-assisted morphometric count and analyzed with the t test. RESULTS: On postoperative day 14, standard histology showed more evident neoangiogenesis in the bronchial stump specimens covered with intercostal and diaphragmatic flaps compared to pericardial flaps and controls. The immunohistochemical evaluation of PCNA by morphometric computer-assisted analysis did not show any statistically significant differences among the groups. The CD31 morphometric count revealed a higher and statistically significant antibody expression in muscular flaps compared to pericardial flaps and controls. CONCLUSIONS: Our study showed that bronchial coverage with a pedicled muscular flaps promotes the production of new vessels and gives the possibilities to optimize the healing process of a bronchial stump after pneumonectomy.

Animals↗

PubMed1986

Trends in private insurance coverage for mental illness.

The authors analyzed data from the U.S. Bureau of Labor Statistics Level of Benefits Surveys for the period 1979-1984 to examine coverage for psychiatric disorders in the private sector. While the overall number of employees with psychiatric benefits has increased, a greater percentage have more restrictions on those benefits. The extent of coverage is wide ranging, but there is little depth and the majority of psychiatric care expenses are not insured. Although the figures do not suggest a dramatic cutback in insurance coverage, the trends toward increased reductions in benefits for all health care threaten the more vulnerable psychiatric benefits.

Alcoholism↗

PubMed1977

State laws mandating mental health insurance coverage.

Insurance companies and administrators of group insurance plans have accepted the premise that coverage for mental illness must be different from coverage for other health problems, and thus insurers continue to limit their liability through various exclusions and restrictions. For several years providers and consumers of services have worked for the enactment of state laws that mandate or regulate certain kinds of coverage for mental illness; as of January 1, 1977, a total of 22 states had such statutes. The author presents a state-by-state summary of the provisions. He also classifies many of the provisions into six categories and discusses the probable basis for their enactment.

Ambulatory Care↗

PubMed1982

Encouraging third-party coverage of partial hospitals.

Despite the proven clinical effectiveness and cost-effectiveness of partial hospitals programs, any third-party insurers still refuse to offer coverage of their services. A number of clinical, administrative, and fiscal issues involving current partial hospital programming and the health care system in general have led to this difficulty. The author outlines these barriers, which include concerns about lack of cost accountability, lack of financial incentive to third parties, and lack of consumer interest, and makes specific recommendations on pursuing coverage of partial hospital programs. He urges a redefinition of the scope of partial hospital services and the development of detailed standards of treatment as prerequisites to pursuing third-party coverage.

Day Care, Medical↗

PubMedDate not supplied

Measles immunization coverage determined by serology and immunization record from children in two Chicago communities.

OBJECTIVES: We compared the prevalence of measles immunization determined by serology with the prevalence of measles immunization determined by immunization records, and identified factors predictive of measles immunization among a sample of children from two Chicago communities. METHODS: We collected demographic information and blood specimens from a sample of children aged 12-71 months in two Chicago communities at risk for low measles immunization coverage levels. We collected immunization information from provider records, parent-held records, and the statewide immunization registry. We compared evidence of immunization determined by serology with evidence of immunization from these three sources of immunization records. RESULTS: The sample of children from the two communities had serologic measles immunity levels of 85% and 90%. Significantly fewer children had evidence of immunization by record in both communities (45% and 63%, respectively). CONCLUSIONS: Immunization coverage levels determined using immunization records were significantly lower than immunization coverage determined using serology. A fully populated immunization registry used by all immunization providers could prevent the problems of record loss and scatter.

Chicago↗