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PubMed1997

Estimating coverage of a community-based home care programme.

The Family AIDS Caring Trust (FACT) was formed in Mutare, Zimbabwe's third largest city, in 1987. FACT's home care programme started in 1992. The programme operates in the urban area of Mutare which contains three townships with a population of 131,367. The area employs a trained nurse as a coordinator and four assistants, each assigned a zone within the city, who carry out the bulk of the visits. As part of an evaluation of the programme we attempted to estimate its coverage using different models. Using these models the FACT programme has a coverage of between 2.5%-23%. It is important that all home care programmes think in terms of coverage and do not simply strive to provide high quality services to a few patients.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Prescription drug coverage and medical indigence among the elderly.

When Medicare extends catastrophic coverage to outpatient prescription drugs in 1991, the program will benefit an estimated 15% to 25% of the aged population. For some of these individuals Medicare coverage will mean the difference between economic self-sufficiency and impoverishment due to high medical bills. This article provides empirical estimates of the relationship between third-party coverage of outpatient pharmaceuticals and the risk of medical indigence based on the experience in Pennsylvania following enactment of that state's Pharmaceutical Assistance Contract for the Elderly (PACE), a lottery-financed drug benefit program that currently enrolls nearly half a million residents age 65 and older. The study provides data on the distribution of billed charges for outpatient drugs by income class for PACE enrollees and then uses a time series analysis to estimate the impact of PACE implementation (July 1984) on monthly changes in Medicaid enrollments and expenditures by category of elderly Medicaid recipient over the period July 1981 through June 1987. Study findings are discussed in the context of the forthcoming Medicare drug benefit.

Aged↗
PubMed1994

Immunization coverage and infant mortality rate in developing countries.

We examined whether immunization coverage (IMC) is one of the predictors of infant mortality rate (IMR), as a single indicator representing the availability of primary health care (PHC) services in developing countries. Multiple regression analysis showed that partial correlation coefficients for IMR with immunization coverage (-0.224), logarithm of per capita GNP (-0.294), total fertility rate (0.269), and adult literacy rate (-0.325) were all statistically significant (p < 0.001) in 97 developing countries which make up more than 97% of the population in all the developing countries of the world. Multiple correlation coefficients of IMR with these four variables in 97 countries was 0.921. Thus, more than 80% of variation of IMR in developing countries were explained by the variation of the four variables. The study also showed that IMC was well correlated (simple correlation) with the four indicators of the availability of primary health care services; access to local care (0.730), care of pregnant women (0.603), delivery care (0.666), and infant care (0.553), all of which were statistically significant (p < 0.001) in the 48 developing countries which make up 42% of the population of all developing countries. Multiple correlation coefficients of these four variables was 0.787. About 60% of the variation of IMC will be explained by the variation of the four variables. Thus we conclude that immunization coverage is one of the main predictors of the infant mortality rate. It represents one of the health intervention components which can be used as a proxy indicator of the availability of PHC service in developing countries.

Adult↗
PubMedDate not supplied

Free flap coverage of deep tissue defects of the foot.

This is a review of seven cutaneous or myocutaneous free flaps performed at the Duke University Medical Center for coverage of foot defects. The average follow-up is 19.3 months. The average anesthetic time was 7 h and 45 min. The average length of hospitalization was 14.1 days. There were no failures. The flaps provided excellent skin coverage and a good bed for further reconstructive procedures. Free myocutaneous and cutaneous flaps are useful tools in reconstructive surgery of the foot. The recently developed cutaneous scapular free flap is the authors' preference for foot defect coverage.

Adolescent↗
PubMed2006

What happens to children who lose public health insurance coverage?

Little is known about what happens to children who disenroll from public health-insurance programs. A telephone survey was conducted of children who recently had disenrolled from either Oregon's State Children's Health Insurance Program (SCHIP) or FHIAP (premium assistance) programs, both of which have identical eligibility requirements. Access for these disenrolled children was driven largely by health insurance coverage. Insured children were more likely to have a usual source of care and to have seen a physician when they needed one. While FHIAP-disenrolled children were more likely to have private health-insurance coverage than those leaving SCHIP, absolute levels were low (53 percent and 33 percent, respectively). Thus, these programs generally did not provide a bridge to nonsubsidized private health insurance. Despite higher incomes (the main reason for losing coverage), many families did not purchase private health insurance, presumably because they still could not afford to do so.

Adolescent↗
PubMed2006

The development and validation of a coding protocol to measure change in tobacco-control newspaper coverage.

The national ASSIST newspaper coding protocol model was used as a template to adapt a system for measuring tobacco-related newspaper coverage in Colorado newspapers. Over a 3-month period, tobacco-related articles were clipped from 180 daily and weekly newspapers. Variables coded included adaptations of the original ASSIST categories. During development and testing, additional variables were added to make the protocol more comprehensive and sensitive to tobacco policy media coverage. Inter-coder reliabilities were calculated for all non-static variables using Cohen's kappa. Disagreements were resolved through group discussions. Two rounds of testing achieved ratings above .70 for all variables. The protocol improves dramatically upon the ASSIST model by providing greater breadth and depth of analysis and more sensitivity to the nuances of newspaper coverage of tobacco-related issues. Given its simplicity, the protocol could also prove valuable for anti-tobacco advocacy groups who wish to track the changes in public and media opinions.

Bibliometrics↗
PubMedDate not supplied

Construction and characterization of a bovine BAC library with four genome-equivalent coverage.

A bovine artificial chromosome (BAC) library of 105 984 clones has been constructed in the vector pBeloBAC11 and organized in 3-dimension pools and high density membranes for screening by PCR and hybridization. The average insert size, determined after analysis of 388 clones, was estimated at 120 kb corresponding to a four genome coverage. Given the fact that a male was used to construct the library, the probability of finding any given autosomal and X or Y locus is respectively 0.98 and 0.86. The library was screened for 164 microsatellite markers and an average of 3.9 superpools was positive for each PCR system. None of the 50 or so BAC clones analysed by FISH was chimeric. This BAC library increases the international genome coverage for cattle to around 28 genome equivalents and extends the coverage of the ruminant genomes available at the Inra resource center to 15 genome equivalents.

Animals↗
PubMed2006

Measles transmission following the tsunami in a population with a high one-dose vaccination coverage, Tamil Nadu, India 2004-2005.

BACKGROUND: On 26 December 2004, a tsunami struck the coast of the state of Tamil Nadu, India, where one-dose measles coverage exceeded 95%. On 29 December, supplemental measles immunization activities targeted children 6 to 60 months of age in affected villages. On 30 December, Cuddalore, a tsunami-affected district in Tamil Nadu reported a cluster of measles cases. We investigated this cluster to estimate the magnitude of the problem and to propose recommendations for control. METHODS: We received notification of WHO-defined measles cases through stimulated passive surveillance. We collected information regarding date of onset, age, sex, vaccination status and residence. We collected samples for IgM antibodies and genotype studies. We modeled the accumulation of susceptible individuals over the time on the basis of vaccination coverage, vaccine efficacy and birth rate. RESULTS: We identified 101 measles cases and detected IgM antibodies against measles virus in eight of 11 sera. Cases were reported from tsunami-affected (n = 71) and unaffected villages (n = 30) with attack rates of 1.3 and 1.7 per 1000, respectively. 42% of cases in tsunami-affected villages had an onset date within 14 days of the tsunami. The median ages of case-patients in tsunami-affected and un-affected areas were 54 months and 60 months respectively (p = 0.471). 36% of cases from tsunami-affected areas were above 60 months of age. Phylogenetic analyses indicated that the sequences of virus belonged to genotype D8 that circulated in Tamil Nadu. CONCLUSION: Measles virus circulated in Cuddalore district following the tsunami, although there was no association between the two events. Transmission despite high one-dose vaccination coverage pointed to the limitations of this vaccination strategy. A second opportunity for measles immunization may help reducing measles mortality and morbidity in such areas. Children from 6 month to 14 years of age must be targeted for supplemental immunization during complex emergencies.

Adolescent↗
PubMed2005

Impact of the introduction of pneumococcal conjugate vaccine on immunization coverage among infants.

BACKGROUND: The introduction of pneumococcal conjugate vaccine (PCV) to the U.S. recommended childhood immunization schedule in the year 2000 added three injections to the number of vaccinations a child is expected to receive during the first year of life. Surveys have suggested that the addition of PCV has led some immunization providers to move other routine childhood vaccinations to later ages, which could increase the possibility of missing these vaccines. The purpose of this study was to evaluate whether introduction of PCV affected immunization coverage for recommended childhood vaccinations among 13-month olds in four large provider groups. METHODS: In this retrospective cohort study, we analyzed computerized data on vaccinations for 33,319 children in four large provider groups before and after the introduction of PCV. The primary outcome was whether the child was up to date for all non-PCV recommended vaccinations at 13 months of age. Logistic regression was used to evaluate the association between PCV introduction and the primary outcome. The secondary outcome was the number of days spent underimmunized by 13 months. The association between PCV introduction and the secondary outcome was evaluated using a two-part modelling approach using logistic and negative binomial regression. RESULTS: Overall, 93% of children were up-to-date at 13 months, and 70% received all non-PCV vaccinations without any delay. Among the entire study population, immunization coverage was maintained or slightly increased from the pre-PCV to post-PCV periods. After multivariate adjustment, children born after PCV entered routine use were less likely to be up-to-date at 13 months in one provider group (Group C: OR = 0.5; 95% CI: 0.3-0.8) and were less likely to have received all vaccine doses without any delay in two Groups (Group B: OR = 0.4, 95% CI: 0.3 - 0.6; Group C: OR = 0.5, 95% CI: 0.4-0.7). This represented 3% fewer children in Group C who were up-to-date and 14% (Group C) to 16% (Group B) fewer children who spent no time underimmunized at 13 months after PCV entered routine use compared to the pre-PCV baseline. Some disruptions in immunization delivery were also observed concurrent with temporary recommendations to suspend the birth dose of hepatitis B vaccine, preceding the introduction of PCV. CONCLUSION: These findings suggest that the introduction of PCV did not harm overall immunization coverage rates in populations with good access to primary care. However, we did observe some disruptions in the timely delivery of other vaccines coincident with the introduction of PCV and the suspension of the birth dose of hepatitis B vaccine. This study highlights the need for continued vigilance in coming years as the U.S. introduces new childhood vaccines and policies that may change the timing of existing vaccines.

Cohort Studies↗
PubMed2006

Variation in hepatitis B immunization coverage rates associated with provider practices after the temporary suspension of the birth dose.

BACKGROUND: In 1999, the American Academy of Pediatrics and U.S. Public Health Service recommended suspending the birth dose of hepatitis B vaccine due to concerns about potential mercury exposure. A previous report found that overall national hepatitis B vaccination coverage rates decreased in association with the suspension. It is unknown whether this underimmunization occurred uniformly or was associated with how providers changed their practices for the timing of hepatitis B vaccine doses. We evaluate the impact of the birth dose suspension on underimmunization for the hepatitis B vaccine series among 24-month-olds in five large provider groups and describe provider practices potentially associated with underimmunization following the suspension. METHODS: Retrospective cohort study of children enrolled in five large provider groups in the United States (A-E). Logistic regression was used to evaluate the association between the birth dose suspension and a child's probability of being underimmunized at 24 months for the hepatitis B vaccine series. RESULTS: Prior to July 1999, the percent of children who received a hepatitis B vaccination at birth varied widely (3% to 90%) across the five provider groups. After the national recommendation to suspend the hepatitis B birth dose, the percent of children who received a hepatitis B vaccination at birth decreased in all provider groups, and this trend persisted after the policy was reversed. The most substantial decreases were observed in the two provider groups that shifted the first hepatitis B dose from birth to 5-6 months of age. Accounting for temporal trend, children in these two provider groups were significantly more likely to be underimmunized for the hepatitis B series at 24 months of age if they were in the birth dose suspension cohort compared with baseline (Group D OR 2.7, 95% CI 1.7-4.4; Group E OR 3.1, 95% CI 2.3-4.2). This represented 6% more children in Group D and 9% more children in Group E who were underimmunized in the suspension cohort compared with baseline. Children in the reversal cohort in these groups remained significantly more likely to be underimmunized compared with baseline. In contrast, in a third provider group where the typical timing of the third dose was unchanged and in two other provider groups whose hepatitis B vaccination schedules were unaffected by the birth dose suspension, hepatitis B vaccination coverage either was maintained or improved. CONCLUSION: When the hepatitis B birth dose was suspended, provider groups that moved the first dose of vaccination to 5-6 months of age or later had decreases in hepatitis B vaccine coverage at 24 months. These findings suggest that as vaccine policy changes occur, providers could attempt to minimize underimmunization by adopting vaccination schedules that minimize delays in the recommended timing of vaccine doses.

Cohort Studies↗
PubMed2026

COSIGT: population-scalable genotyping of complex loci from low-coverage sequencing data using pangenome graphs.

Pangenome graphs capture extensive structural diversity, but resolving complex loci from shallow sequencing remains challenging, particularly when samples are of low quality such as in ancient DNA. We introduce COSIGT (COsine SImilarity-based GenoTyper), which assigns diploid genotypes by matching read-depth distributions to haplotype paths via cosine similarity. Because this metric evaluates relative coverage profiles rather than absolute read counts, COSIGT substantially outperforms existing likelihood-based tools at low coverage (1-2X). We demonstrate scalability to thousands of modern and ancient genomes, enabling robust, population-scale analyses of complex variation directly from low-coverage datasets.

Humans↗
PubMed2006

Unified medical language system coverage of emergency-medicine chief complaints.

BACKGROUND: Emergency department (ED) chief-complaint (CC) data increasingly are important for clinical-care and secondary uses such as syndromic surveillance. There is no widely used ED CC vocabulary, but experts have suggested evaluation of existing health-care vocabularies for ED CC. OBJECTIVES: To evaluate the ED CC coverage in existing biomedical vocabularies from the Unified Medical Language System (UMLS). METHODS: The study sample included all CC entries for all visits to three EDs over one year. The authors used a special-purpose text processor to clean CC entries, which then were mapped to UMLS concepts. The UMLS match rates then were calculated and analyzed for matching concepts and nonmatching entries. RESULTS: A total of 203,509 ED visits was included. After cleaning with the text processor, 82% of the CCs matched a UMLS concept. The authors identified 5,617 unique UMLS concepts in the ED CC data, but many were used for only one or two visits. One thousand one hundred thirty-six CC concepts were used more than ten times and covered 99% of all the ED visits. The largest biomedical vocabulary in the UMLS is the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), which included concepts for 79% of all ED CC entries. However, some common CCs were not found in SNOMED CT. CONCLUSIONS: The authors found that ED CC concepts are well covered by the UMLS and that the best source of vocabulary coverage is from SNOMED CT. There are some gaps in UMLS and SNOMED CT coverage of ED CCs. Future work on vocabulary control for ED CCs should build upon existing vocabularies.

Data Collection↗
PubMed2006

Newspaper coverage of youth and tobacco: implications for public health.

The presentation of smoking as a "youth" issue is a powerful component of current tobacco-control efforts. Agenda setting theory demonstrates that the media serve as a potent forum in which the consideration and presentation of perspectives of social problems take place. This analysis of 643 U.S. youth-focused newspaper articles examines the messages being conveyed to the public and policymakers through coverage of tobacco issues focused on youth. Data illustrate that the issue of youth tobacco use is newsworthy but also suggest that youth-focused issues garner little commentary coverage. Rather, straightforward reports of "feel good" stories dominate the coverage, and youth-focused articles tend to conceptualize the problem of tobacco as being one of a need for greater individual-level education rather than structural or policy changes.

Adolescent↗
PubMed1990

Expanding health insurance coverage: who will pay?

Recent discussions on extending health insurance to the more than thirty million uninsured Americans have focused on two strategies: expanding the Medicaid program and mandating that employers sponsor coverage for their employees. This analysis, using a microsimulation model of the U.S. health care financing system, suggests that these two options would result in very different distributions of financial burden. Employer-sponsored coverage is financed in a highly regressive fashion, in contrast to the Medicaid program, which is proportional to income. Furthermore, the burden of paying for health care under Medicaid varies little among generations, whereas the cost of employer-sponsored care is lowest in households headed by persons over sixty-five years old. Low health status populations do not pay disproportionately higher taxes or premiums to finance either the Medicaid program or employer-sponsored coverage. Their incomes, however, are more effectively protected by Medicaid, because it offers more comprehensive benefits.

Costs and Cost Analysis↗
PubMed2005

Coverage of painful peripheral nerve neuromas with vascularized soft tissue: method and results.

OBJECTIVE: Our goals are to describe a method of treating painful peripheral nerve neuromas by means of vascularized tissue coverage, report the results in seven patients, and discuss the indications for this treatment modality. An analysis of pain, functionality of the affected body part, professional activities of the patients, and medications before and after surgery is presented. METHODS: Seven male patients (mean age, 45.1 yr) with posttraumatic nerve injuries, who had developed painful stump neuromas or neuromas-in-continuity, and who had unsuccessfully undergone several treatment procedures, were selected for the surgery described here. The operation included resection of the stump neuroma (four patients) or neurolysis of the neuroma-in-continuity (three patients) and coverage of the nerve with a vascularized fascial, fasciocutaneous, or perforator flap (three pedicled regional flaps and four free flaps). A modified quadruple visual analog scale was used to quantify pain before and after surgical treatment. The mean follow-up was 16.6 months. RESULTS: The mean values of the quadruple visual analog scale (pain now/typically/at its best/at its worst) before surgery were 6.5/6.5/4.7/7.9. These values changed to 0.3/0.4/0/0.9 at a mean follow-up of 16.6 months after surgery. Five patients returned to their original profession, one receives a pension, and one began a less demanding job after undergoing surgery. Six of the seven patients received opioids before surgery (one had a spinal cord stimulator). After surgery, all patients stopped taking regular pain killers and the spinal cord stimulator was deactivated in one; two patients still take nonsteroidal anti-inflammatory drugs occasionally, but not on a regular basis. CONCLUSION: Vascularized soft tissue coverage of painful peripheral nerve neuromas seems to be an effective and attractive, but also complex, method of treatment. This option may be considered and reserved for patients who have already undergone several pain treatment modalities without success.

Adult↗
PubMed1990

The need for consumer behavior analysis in health care coverage decisions.

Demographic analysis has been the primary form of analysis connected with health care coverage decisions. This paper reviews past demographic research and shows the need to use behavioral analyses for health care coverage policy decisions. A behavioral model based research study is presented and a case is made for integrated study into why consumers make health care coverage decisions.

Arkansas↗
PubMed1993

Issues in the consumer choice of health care coverage plans.

Developing and implementing successful marketing strategies for prepaid health care coverage plans is becoming an important issue as managers of these plans struggle to remain competitive in the market place. This paper provides insight into the reasons why consumers make choices among varying types of health care coverage plans. Some suggestions are made to plan managers for incorporating these results into the development of marketing strategies for prepaid health care coverage plans.

Arkansas↗
PubMed2006

A prescription for more retirement income security: retiree health insurance coverage in an era of declining access to employer-sponsored insurance.

As health care costs have been rising, especially for prescription drugs, employers have curtailed access to employer-sponsored retiree health insurance, especially for future retirees. This paper studies the question whether declining access has already translated into measurable loss of coverage for retirees. Based on data from the Current Population Survey and the Medical Expenditures Panel Survey, we find that retirees have lost health insurance and prescription drug coverage since 1996. The declines are especially pronounced for men before age 65 and for all Medicare-eligible retirees between the ages of 65 and 74. Our results also suggest that coverage will decline in the future.

Aged↗