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PubMed2003

Racial and ethnic disparities in prescription coverage and medication use.

This study compared drug coverage and prescription drug use by race and Hispanic ethnicity for Medicare beneficiaries with three chronic conditions: diabetes, hypertension, or heart disease. We found that among beneficiaries without any drug coverage black persons and Hispanics used 10 to 40 percent fewer medications, on average, than white persons with the same illness, and spent up to 60 percent less in total drug costs. Having drug coverage somewhat lessened these differences although the effect was consistent with only M + C prescription benefits. Substantially lower medication use remained for dually eligible black beneficiaries and Hispanics with employer-sponsored drug benefits.

Black or African American↗

PubMed1992

Epidemiology of pertussis in a developed country with low vaccination coverage: the Italian experience.

In Italy pertussis vaccination is optional. Fewer than 40% of children younger than 5 years of age are vaccinated, and pertussis remains a common childhood disease. We use data from a variety of sources to examine trends and characteristics of Italian children with pertussis and reasons behind the low vaccine coverage. Approximately 25% of Italian children have experienced clinical pertussis by their fifth birthday. The disease is most severe in those less than 1 year of age; in this group an estimated 1 in 14 cases are hospitalized and 1 in 850 die. The incidence appears to be increasing in the 1- to 4-year age group despite increased vaccination coverage. The low vaccine coverage appears to be caused by the ambivalence of the Italian pediatric community about the vaccine rather than parental concerns about vaccine safety. Legislation is being considered to make pertussis vaccination mandatory.

Child↗

PubMedDate not supplied

Fatigue resistance of teeth restored with cuspal-coverage composite restorations.

PURPOSE: This study assessed the influence of palatal cuspal coverage on the in vitro fatigue resistance and failure mode of Class II resin composite restorations including replacement of the buccal cusp in premolars. MATERIALS AND METHODS: A master model was made of a maxillary premolar with an MOD amalgam cavity and a simulated fracture of the buccal cusp from the isthmus floor to the CEJ. Using a copy-milling machine, this preparation was copied to 20 extracted human maxillary premolars (group A). Subsequently, the palatal cusp was reduced by 1.5 mm; this modified preparation was copied to 20 additional maxillary premolars (group B). Direct resin composite restorations were made in all teeth. Cyclic load (5 Hz) was applied, starting with a load of 200 N (10,000 cycles), followed by stages of 400, 600, 800, and 1,000 N at a maximum of 50,000 cycles each. Samples were loaded until fracture or to a maximum of 210,000 cycles. RESULTS: Of the restored premolars of group A, 20% withstood all 210,000 loading cycles; in group B, this figure was 55%. In group A, 19% of the fractures ended below the CEJ; in group B, 78% did. CONCLUSION: Palatal cuspal coverage increased the fatigue resistance of Class II resin composite restorations with replacement of the buccal cusp in premolars. However, fractures of restorations with cuspal coverage led to more dramatic failures that made restoration virtually impossible. This suggests caution in lowering remaining cusps for these adhesive restorations in the clinical situation.

Bicuspid↗

PubMed2003

Detection of gaps in the spatial coverage of coral reef monitoring projects in the US Caribbean and Gulf of Mexico.

As part of the US Coral Reef Task Force's National Program to Map, Assess, Inventory, and Monitor US Coral Reef Ecosystems, a comprehensive survey of projects/programs monitoring coral reef ecosystems and related habitats (i.e., seagrass beds and mangroves) in the US Caribbean and Pacific was undertaken. Information was gathered on a total of 296 monitoring and assessment projects conducted since 1990 in the US Caribbean and the Gulf of Mexico. Substantial gaps in monitoring coverage of US coral reef ecosystems were revealed through geographic information system (GIS) analysis of survey metadata. Although southern Florida contains approximately two-thirds of all marine monitoring projects found in the US Caribbean and Gulf of Mexico, we were unable to identify any ongoing projects that monitor coral reefs along Florida's western coast and off of the Florida Middle Grounds. Additionally, Florida is covered by approximately 1 900 km2 of mangroves, yet there were only four ongoing projects that monitor this ecosystem, leaving gaps in coverage in the Lower and Middle Keys and along the eastern and western coasts. The Flower Garden Banks National Marine Sanctuary, located offshore of the Texas/Louisiana border, has an integral long-term monitoring program, but lacks a monitoring project that gathers long-term, quantitative data on reef lish abundance and certain water quality parameters. Numerous coral reef monitoring projects in Puerto Rico are concentrated on the island's southwestern coast surrounding La Parguera, while far fewer monitoring projects are conducted along the northern and southeastern coasts and around Vieques Island. In the US Virgin Islands, the paucity of monitoring projects in large areas of St. Croix and St. Thomas contrasts with monitoring activity in three marine protected areas (MPAs), where 66% of the US Virgin Islands' coral reef monitoring sites were found. Only a series of assessments have been conducted at Navassa, a small, uninhabited island located 55 km west of Haiti and 137 km northeast of Jamaica. In order to better understand changes in coral reef communities and to produce a series of biennial reports on the status of US coral reef ecosystems, the National Oceanic and Atmospheric Administration (NOAA) is developing a national coral reef monitoring network. This network has already begun to fill some of these gaps in monitoring coverage through issuing cooperative grants to states and territories to build long-term monitoring capacity.

Animals↗

PubMedDate not supplied

Analysis of freshwater pathogens: a guide to rational empiric antibiotic coverage.

Fresh water injuries are often contaminated with bacteria that are not typically encountered in other wounds. Their treatment should include empiric administration of appropriate antibiotics. This study identifies the most common pathogens found in the Lake of the Ozarks and their antibiotic sensitivity. Eleven of the twelve lake water samples (92%) had a positive culture result. Sixty-seven percent of lake water samples contained at least two strains of bacteria. Five different bacterial species of gram negative rods were isolated. All isolates were sensitive to Cefotetan, Ceftazidime, Ceftriaxone, Imipenem, Levofloxacin, Tobramycin, and Trimetheprim/sulfa. Antibiotic coverage after traumatic wounds required gram positive coverage. Our study suggests the addition of gram negative coverage for penetrating trauma contaminated by fresh water.

Aeromonas↗

PubMed2004

[Hepatitis B vaccination in France: vaccination coverage in 2002].

In parts of Europe where the relevant data are available, the vaccinal coverage rate of children against hepatitis B virus ranges from 27.5 to 99.0% and that of adolescents from 52 to 98%. In France, an exhaustive population survey conducted in 2002 revealed an overall vaccine coverage rate of over 21.7% and very low three-dose coverage rates among infants (19.8%), children (23.3%), and adolescents (46.2%) which are inadequate to protect future generations from HBV infection and its consequences. Unless major efforts are made to vaccinate these populations and high-risk groups, complete elimination of HBV transmission might take another 20 years to achieve.

Adolescent↗

PubMed2004

Childhood influenza-vaccination coverage--United States, 2002-03 influenza season.

Children aged <2 years are at increased risk for influenza-related hospitalizations. Beginning in 2002, the Advisory Committee on Immunization Practices (ACIP) encouraged that, when feasible, all children aged 6-23 months, as well as household contacts and out-of-home caregivers for children aged <2 years, receive influenza vaccinations each influenza season. Beginning with the 2004-05 influenza season, ACIP strengthened the encouragement to a recommendation. Other children recommended to receive influenza vaccine continue to include those aged 6 months--18 years with certain high-risk medical conditions and those aged 6 months-18 years who are household contacts of persons at high risk for influenza complications. This report on childhood influenza-vaccination coverage for the 2002-03 influenza season provides a baseline for the continuing assessment of coverage among children aged 6-23 months. The findings demonstrate that, during the first year of the ACIP encouragement to vaccinate children aged 6-23 months against influenza, vaccination coverage was low, with substantial variability among states and urban areas.

Humans↗

PubMedDate not supplied

[Measles in the Local Health Unit Naples 4: vaccination coverage, epidemic 2001-2002 and prevention strategies].

The authors have analysed vaccination coverage for measles. The active offer of the vaccine brought about an increase of the vaccination coverage but participation to vaccination proved unsatisfactory between 1995 and 2000. The measles epidemic reported 1367 cases, of which 125 were hospitalised (3 cases presented complications). The target for the next years is to reach a vaccination coverage of 95% or more and recuperate the non vaccinated, starting with the 1990 birth cohort.

Adolescent↗

PubMedDate not supplied

[Coverage of anti-tetanus vaccinations in adults in Canada-year 2002. ].

INTRODUCTION: The rare cases of tetanus that have occurred in Canada were in adults whose vaccination was not up-to-date. The objective of this study was to estimate the vaccine coverage in Canadian adults. METHODS: 1,002 individuals 18 years of age and older selected by random digit dialing were interviewed by telephone in February 2002. Information was collected about their vaccination status, the circumstances of their vaccination, and their opinion about the duration of the protection of the tetanus vaccine and the recommended interval between booster doses. RESULTS: The participation rate was 38%. Overall, 54% of participants reported having received one dose of tetanus vaccine during the last 10 years: 58% for men and 51% for women. The vaccine coverage was lower in adults > or =60 years of age than in those under 60 (38% vs. 59%). Most doses (57%) were administered as part of treatment for a wound. 30% of participants thought they were protected for life by their childhood immunization against tetanus, whereas 52% knew they had to receive a booster dose each 6-10 years. CONCLUSION: Vaccine coverage against tetanus is insufficient in adults, especially those > or =60 years of age. As most doses are administered as part of wound treatment, it is not likely that this situation will improve without developing specific interventions.

Adult↗

PubMed1992

[Vaccine coverage in the Noun Department, Cameroon, 1 1/2 year following the 1986-1987 National Vaccination Days].

In 1988, one and a half year after the National Immunization Days (NID) the coverage of fully immunized children is 19.1% in the Noun district of Cameroon. This coverage is identical to that of 1984. At district level, the Expanded Programme on Immunization (EPI) does not seem to increase the immunization coverage with the acutal efforts. The advantages and constraints of mass-campaigns as NID are discussed. Even without considering the financial aspects it seem preferable to integrate the EPI in a Mother and Child Health Programme.

Cameroon↗

PubMed1992

[Vaccinal coverage at 2 years of age in a socially disadvantaged urban area].

OBJECTIVE: To assess vaccination coverage at two years of age among the children of the Old City District of Barcelona (Spain), a socially deprived urban area. DESIGN: Cross-sectional, based on a random sample of the children born in 1987. SETTING: Community. PARTICIPANTS: A random sample of children born in 1987 from mothers resident in the district. MEASUREMENTS AND MAIN RESULTS: 83.8% had a vaccination card. Vaccination coverage is 68.1% for measles, mumps and rubella and 65.5% with four doses of DTP and OVP. Of these children, 16.2% were not found in the computerized City Vaccination Program, based on births records, and these children have very low immunization levels: their vaccination cover is only 42.1% for measles, mumps and rubella and 28.9% with four doses of DTP and OPV. CONCLUSIONS: These results confirm a lower immunization coverage in this area. Although artifactual explanations for this finding have to be ruled out, these results suggest that the health indicators in this district are influenced by a concentration of population with severe problems instead of reflecting a higher diffuse frequency of problems in the whole population.

Child, Preschool↗

PubMedDate not supplied

[Vaccine coverage survey of the elderly in 11 Italian regions].

In 2002, a sample survey of the population > or =65 years of age was conducted in 11 Italian regions that included information on the influenza, pneumococcal, and tetanus vaccination status. In each region, cluster sampling was used to select 210 individuals. In the Campania region, a separate random sample of 100 individuals was selected for Naples. Information on vaccination status was collected via an interview conducted in the participants' homes. A total of 2299 persons participated in the survey. During the 2001--2002 influenza season, 61% of the population reported that they had been vaccinated (regional range 39%-70%). The proportion of the population that had received an influenza vaccine increased with age and was higher than those with underlying diseases and conditions (70% of those > or =75 years of age with underlying problems). The percentage of those who reported having been vaccinated against tetanus was 54% (regional range 11% to 79%); coverage was higher among males and decreased with age. Only 24% of the sample reported having been adequately vaccinated (at least 3 doses, of which the last was administered during the last 10 years). Five percent had been vaccinated against pneumococcus, and none of the regions had a coverage higher than 15%. The elderly represent a segment of the population that is especially vulnerable to infectious diseases and often have problems with access to health services. These findings underline the need to improve vaccine coverage using strategies specifically targeted for this age group.

Age Factors↗

PubMed2005

The New Zealand Hepatitis B Screening Programme: screening coverage and prevalence of chronic hepatitis B infection.

AIM: To report on screening coverage and the distribution of HBsAg (a marker of chronic hepatitis B virus infection) among participants in the New Zealand Hepatitis B Screening Programme. METHOD: Coverage and crude and age-standardised prevalence rates of HBsAg by age group, sex, ethnic group, and region were calculated from data held by the two providers and the New Zealand 2001 Census. RESULTS: 177,000 people were tested for hepatitis B virus infection (51% of the programme targets and 27% of Census 2001 eligible population), with highest coverage among women (28.9%) and Pacific people (34.9%). Overall, 5.7% (10,176) of participants were HBsAg-positive and there were significant regional, ethnic group, and gender differences. 5.6% of Maori, 7.3% of Pacific people, and 6.2% of Asians were HBsAg-positive, and men were more likely to test HBsAg-positive (6.1%) than women (5.4%). CONCLUSIONS: Previous estimates of HBsAg prevalence among Maori and Pacific people from smaller surveys were confirmed and new information obtained about the distribution of hepatitis B virus infection among Pacific Islands and Asian populations in New Zealand. Opportunistic screening of adults in these populations should continue in order to identify others with (as yet undetected) infection. Regular follow-up of people with chronic hepatitis B virus infection should also continue. Ongoing outcome monitoring is now needed to judge whether this unique programme has been an effective component of New Zealand's hepatitis B control strategy and whether it is a worthwhile investment of resources.

Adolescent↗

PubMed2004

Increasing hepatitis B vaccine coverage in prisons in England and Wales.

The most frequently reported risk factor for hepatitis B infection in England and Wales is injecting drug use (38%). Since approximately 61% of injecting drug users (IDUs) had been imprisoned and less than 40% had received hepatitis B vaccine, a prison based hepatitis B vaccination programme was set up in 2001. At the 42 establishments participating in this study, all prisoners were offered vaccine at reception. Prisoners over 18 years were vaccinated using the 0, 7 and 21 days schedule and those under 18 years, using the 0, 1 and 2 months schedule. As far as possible a fourth dose was given to all after 12 months. In 2003, 14,163 prisoners received at least one dose of vaccine and altogether 26,265 doses were administered. A further 1111 prisoners reported they had already been vaccinated against hepatitis B. The median vaccine coverage rate was 17% (range 0-94%). Despite low coverage levels, the vaccination programme in prisons can be said to have vaccinated a sizable number of young, male prisoners, a group that have previously been shown to be at high risk of infection. The prisons which achieved vaccine coverage levels over 50% had designated nursing staff who ran the vaccination clinics.

Adolescent↗

PubMed2005

National, state, and urban area vaccination coverage among children aged 19-35 months--United States, 2004.

The National Immunization Survey (NIS) provides vaccination coverage estimates for children aged 19-35 months for each of the 50 states and 28 selected urban areas. This report summarizes results from the 2004 NIS, which indicated nationwide increases in coverage with at least 1 dose of varicella vaccine (VAR), pneumococcal conjugate vaccine (PCV), and the 4:3:1, 4:3:1:3:3, and 4:3:1:3:3:1 vaccine series. These levels represent an important accomplishment by exceeding for the first time the Healthy People 2010 goal of >/=80% coverage for the 4:3:1:3:3 vaccine series.

Child, Preschool↗

PubMed2005

Atypical antipsychotics: considerations for Medicaid coverage.

In every state across America, Medicaid programs are under serious budgetary pressure. The need to contain costs has led to various forms of restriction in the coverage for drug therapy, including psychiatric pharmacotherapy. Compared with conventional antipsychotic drugs, the atypical agents have higher acquisition costs but offer greater tolerability. Thus, the atypicals are widely accepted as first-line therapy for patients with schizophrenia, and they are also now being recognized for their efficacy in treating bipolar disorder. Nevertheless, the atypicals carry their own characteristic adverse effects, of which weight gain is among the most distressing, with the potential to interfere with compliance to treatment. Treatment compliance is crucial in terms of clinical outcome as well as cost containment, as inadequate compliance is clearly associated with a higher risk of relapse requiring costly rehospitalization. Therefore, antipsychotic therapy that is individually tailored to the patient's needs and thereby improves compliance may be more cost effective than restrictive drug coverage policies based only on acquisition costs. Conversely, individualization of pharmacotherapy is not feasible if some or all of the atypical antipsychotics are excluded from coverage.

Antipsychotic Agents↗

PubMed2005

Acetabular coverage in bladder exstrophy: role of 3-dimensional computed tomography.

We studied the acetabular coverage in bladder exstrophy patients and normal control children. The study included 13 patients with bladder exstrophy, who were divided according to their ages into group I below 5 years, group II between 5 and 10 years, and group III above 10 years of age. Four normal children served as controls, 2 were below 5 years, one was 7 and one was 12 years old. We measured the acetabular coverage (AC) and the center-edge-angle (CEA) by utilising the reconstructed 3-dimensional CT images. The mean right and left AC angles were 82 +/- 12 and 82 +/- 20 degrees in group-I, 107 +/- 15 and 103 +/- 17 in group-II and 119 +/- 24 and 116 +/- 22 in group-lII, respectively (p < 0.05). The mean right and left CEA angles were 33 +/- 4 and 32 +/- 4 degrees in group-I, 30 +/- 4 and 29 +/- 5 in group-II and 25 +/- 2 and 24 +/- 1 in group-III, respectively (p < 0.05). In controls, the mean right and left AC angles were 151 +/- 2 and 153 +/- 2 degrees for children below 5 years, 166 and 165 degrees in the 7 year-old child and 180 and 180 degrees in the 12 year-old child. The CEA angle ranged from 15 to 25 degrees. Acetabular coverage in bladder exstrophy patients is deficient during the first 5 years of life. Although it gradually improves over time, it does not reach to normal value.

Acetabulum↗

PubMed2005

Complete root coverage at multiple sites using an acellular dermal matrix allograft.

This study reports results of root coverage treatment with a coronally positioned flap and an acellular dermal matrix allograft. The same protocol was followed as in a previous university study to determine if the results could be duplicated in a private practice setting. Complete root coverage was obtained on most defects. Use of an acellular dermal matrix allograft avoided the postoperative morbidity associated with harvesting palatal connective tissue. The unlimited supply of the allograft allowed extended flaps to achieve multiple site root coverage, which proved to be a practical and predictable procedure in these cases.

Biocompatible Materials↗