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PubMed1995

Vaccination coverage surveys in county health departments--Kansas, 1993-1994.

The objective of the Childhood Immunization Initiative (CII) is to protect all children in the United States by their second birthday against nine vaccine-preventable diseases. Specific objectives for 1994 were to increase coverage levels to at least 85% for the third dose of diphtheria and tetanus toxoids and pertussis vaccine (DTP3) and the first dose of measles, mumps, and rubella vaccine (MMR1); 75% for the third doses of oral poliovirus vaccine (OPV3) and Haemophilus influenzae type b vaccine (Hib3); and 30% for the third dose of hepatitis B vaccine (HepB3) (1). To determine whether county health departments in Kansas had achieved the national vaccination objectives, in 1993 staff from the Kansas Department of Health and Environment (KDHE) began assessing vaccination coverage rates for children aged 2 years served by county health departments in that state. This report presents the results of the first vaccination coverage assessments of all 105 county health departments in Kansas during November 1993-November 1994.

Child↗
PubMed1994

Increased G-suit coverage improves cardiac preloading conditions during positive pressure breathing.

A miniaturized nuclear probe (MNP) and multiple gated cardiac blood pool imaging (RCBI) were used to measure left ventricular function during positive pressure breathing (PPB) while wearing an extended-coverage (EC) vs. standard-coverage (SC) anti-G-suit. Seven subjects were exposed to 4.0 and 9.3 kPa PPB wearing each anti-G-suit during 3 min of PPB at ground level. Ejection fraction was unchanged using both techniques. The atrial component to diastolic filling was greater with the SC suit (p < 0.02). Using the MNP, end-diastolic and end-systolic volumes declined non-linearly over time at both PPB levels; these declines were greater with the SC G-suit (p < 0.001). Left ventricular preload declines during PPB. This is attenuated with increased G-suit coverage, confirming prior results using impedance cardiography. RCBI is less sensitive than MNP's for measuring non-steady-state cardiac physiology such as PPB.

Adult↗
PubMed1994

Immunization coverage and its relationship to preventive health care visits among inner-city children in Baltimore.

OBJECTIVE: To provide empirical data on immunization coverage and the receipt of preventive health care to inform policy makers' efforts to improve childhood immunization. DESIGN AND METHODS: We surveyed a random sample drawn from a birth cohort of 557 2-year-old children living in the inner-city of Baltimore. Complete information on all their preventive health care visits and immunization status was obtained from medical record audits of their health care providers. MAIN OUTCOME MEASURES: Age-appropriate immunizations and preventive health care visits. RESULTS: By 3 months of age, nearly 80% made an age-appropriate preventive health visit, but by 7 months of age, less than 40% had a preventive visit that was age-appropriate. In the second year of life, 75% made a preventive health visit between their 12- and 17-month birthdays. The corresponding age-appropriate immunization levels were 71% for DTP1, 39% for DTP3, and 53% for measles-mumps-rubella vaccine. Infants who received their DTP1 on-time were twice as likely to be up-to-date by 24 months of age. CONCLUSIONS: Our analyses focus attention on the performance of the primary health care system, especially during the first 6 months of life. Many young infants are underimmunized despite having age-appropriate preventive visits, health insurance coverage through Medicaid, and providers who receive free vaccine from public agencies. Measles vaccination coverage could be improved by initiating measles-mumps-rubella vaccine vaccination, routinely, at 12 months among high risk populations.

Baltimore↗
PubMed1994

Low vaccination levels of US preschool and school-age children. Retrospective assessments of vaccination coverage, 1991-1992.

OBJECTIVE: To obtain estimates on (1) the percentage of children who were up-to-date on the recommended childhood vaccination series, (2) the percentage of children who were age-appropriately immunized, and (3) coverage levels by individual vaccines. DESIGN: Vaccination levels were estimated by conducting retrospective immunization coverage surveys of the school health records of children entering kindergarten or first grade in the 1990-1991 or 1991-1992 school year. A multistage cluster survey design was used. SETTING: Survey sites were selected from among the 60 largest urban areas in the United States. One small city and one rural area were selected for comparison. RESULTS: By their second birthday, 11% to 58% (median, 44%) of the children were fully vaccinated. Stricter measurement criteria lowered coverage levels further. Completed series levels at school entry were 71% to 96% (median, 87%). CONCLUSIONS: Vaccination levels at the second birthday were far below the goal for the year 2000. All health providers need to administer vaccines according to the recommended schedule.

Child↗
PubMed1993

Estimation of immunisation coverages in children by WHO 30-cluster survey.

A WHO 30-cluster survey for estimating immunisation coverages in infancy was undertaken in each of 5 districts in Tamil Nadu, strictly according to the specifications laid out in the WHO manual. The main aim was to examine whether the technique would provide estimates with the required degree of precision under Indian conditions. Of 60 sample survey estimates, 57 had the targeted degree of precision (i.e., 95% confidence limits of +/- 10 percentage points), which is in excellent agreement with expectation. The proportions of infants on whom immunisation was initiated, were very high for DPT vaccine (88-99%) and polio vaccine (85-99%); however, of those who had received the first dose, 23-39 per cent did not complete the 3-dose schedule. Estimated coverage with measles vaccine ranged from 15 to 54 per cent, while BCG coverage ranged from 53 to 97 per cent. Better health education regarding the need and correct age for immunisation, and more effective motivation at the time of administration of the first dose of DPT/polio vaccine, are recommended.

Diphtheria-Tetanus-Pertussis Vaccine↗
PubMed1994

Vaccination coverage of 2-year-old children--United States, 1992-1993.

The principal goal of the Childhood Immunization Initiative (CII) is to increase, by 1996, vaccination levels for 2-year-old children to at least 90% for the most critical doses in the vaccination series (i.e., one dose of measles-mumps-rubella vaccine [MMR] and at least three doses each of diphtheria and tetanus toxoids and pertussis vaccine [DTP], oral poliovirus vaccine [OPV], and Haemophilus influenzae type b vaccine [Hib]) and to at least 70% for at least three doses of hepatitis B vaccine (Hep B). Since 1991, annual national estimates of vaccination coverage levels of preschool-aged children have been available through the National Health Interview Survey (NHIS) conducted by CDC. This report presents vaccination coverage levels of children aged 19-35 months for 1992 and provisional estimates of vaccination coverage for the combined first and second quarters of 1993 (Table 1).

Bacterial Capsules↗
PubMed1993

[The coverage and quality of the follow-up in the prenatal care at a health center].

OBJECTIVE: To discover the recruitment and follow-up coverage of Prenatal Care in Parla Health Center, derivation causes and quality control of follow-up. DESIGN: Descriptive and retrospective study. PATIENTS: We obtained 445 newborns (from May 1991 to April 1992) in pediatric records of Health Center, and encountered 412 women records (93%). MEASUREMENTS AND MAIN RESULTS: We measured general practitioner coverage, obstetric derivation and causes, and audit of 23 quality markers selected. General practitioner diagnosed pregnancy in 142 cases (32%). Of them, 63 were derivated at the beginning, 19 at the following-up, and 60 cases (13.5% of total newborns known) were completed in primary care. In these, 19 of 23 quality markers were fulfilled over 80%. CONCLUSIONS: We emphasized the poor capacity of primary care for recruiting pregnancies in the moment (most of them went straight to obstetric), and the excellent results of quality control markers. These situations can be as similar as many others Health Centers in urban areas. Coordination with Reference Obstetric Services is necessary as a strategy to increased the coverage of these programs.

Community Health Centers↗
PubMed1993

Soft tissue reconstruction. Coverage of hand injuries.

The complexity of the hand necessitates careful assessment of an injury. Wound coverage requires careful appraisal of the tissue available for coverage and consideration of its functional and cosmetic aspects. The simplest yet most appropriate flap should be chosen. Local flaps can cover many wounds. Larger wounds may require significant debridement, which should be performed early using the pseudotumor technique. Free flap coverage is then indicated and should be completed within 3 days of injury if no extenuating circumstances exist.

Finger Injuries↗
PubMed1993

The effect of health coverage for uninsured pregnant women on maternal health and the use of cesarean section.

OBJECTIVES: Although there has been substantial policy interest in interventions to improve the neonatal outcomes of disadvantaged women, little attention has been paid to the health status of pregnant women themselves. We therefore examined whether the provision of health coverage to uninsured low-income pregnant women affects maternal health status or the use of cesarean section. DESIGN: Natural experiment in Massachusetts. PATIENTS: All in-hospital, single-gestation births in 1984 (N = 57,257) and 1987 (N = 64,346). INTERVENTION: Healthy Start is a statewide health coverage program for uninsured pregnant women. In 1985, it covered women with incomes below 185% of the federal poverty level. MAIN OUTCOME MEASURES: Rates of adverse maternal outcome (severe pregnancy-related hypertension, placental abruption, and a length of stay at least 1 day longer than infants' stay) and cesarean section for uninsured women, and for two concurrent control groups, women with Medicaid and women with private insurance. We calculated the difference in rates between the uninsured and each concurrent control. We then examined the change in these interpayer differences in rates between 1984 and 1987 to measure the effect of Healthy Start. MAIN RESULTS: In 1984, uninsured women had higher rates of adverse maternal health outcome than privately insured women (5.5% vs 5.1%, respectively; interpayer difference, 0.4%) and received fewer cesarean sections (17.2% vs 23.0%; interpayer difference, -5.8%). Between 1984 and 1987 there was no statistically significant change in the interpayer difference in adverse outcome relative to women with private insurance. However, the interpayer difference in cesarean sections between the uninsured and the privately insured was reduced by 2.3% (95% confidence interval [CI], +0.4% to +4.2%), although the uninsured continued to undergo fewer cesarean sections (22.4% vs 25.9%). Similar results were observed when the uninsured women were compared with women with Medicaid. CONCLUSIONS: The provision of health insurance alone to low-income pregnant women may not be associated with an improvement in maternal health. Expanded coverage was associated, however, with an increase in the rate of cesarean section.

Adult↗
PubMed1995

Root coverage techniques: a review.

Gingival recession with the exposure of root surfaces is a significant treatment problem facing the clinician. Controversy relative to treatment continues and centers primarily around the need for gingival width augmentation. In 1972, Lang and Löe advanced the concept that a true minimal width of keratinized gingival tissue was necessary for health. They showed that all surfaces with less than 2 mm of keratinized gingiva exhibited clinical inflammation and varying amounts of gingival exudate. In contrast, 80% of the surfaces with more than 2 mm of keratinized gingiva were clinically healthy, and 76% of these same surfaces failed to show gingival exudate. Since 1972, the majority of studies have found that minimizing inflammation is sufficient to maintain attachment levels, even in the absence of "adequate" widths of keratinized and attached gingiva. Certain situations may enhance recession, such as subgingival restorations and toothbrushing trauma, but if inflammation is controlled and the etiology eliminated, minimal amounts of keratinized gingiva can be maintained in a state of health without further recession. Such findings have led to the current concept that deemphasizes a need for gingival augmentation surgery when there is no accompanying need for root coverage. A requirement for root surface coverage arises when gingival recession has esthetic implications, where exposure has resulted in root sensitivity, or where recession complicates routine home care procedures. While agreement exists relative to the indications for root coverage, there are a variety of surgical techniques that can accomplish this end. The purpose of this paper is to review these techniques and to examine the indications for choosing one procedure over another.

Connective Tissue↗
PubMed1996

National, state, and urban area vaccination coverage levels among children aged 19-35 months--United States, April 1994-March 1995.

The National Immunization Survey (NIS) is an ongoing survey to provide national, state, and selected urban area estimates of vaccination coverage levels among children aged 19-35 months. CDC implemented NIS in April 1994 as one element of the five-part Childhood Immunization Initiative (CII), a national strategy to achieve and maintain high vaccination levels among children during the first 2 years of life; CII contains interim goals to the year 2000 national objectives. NIS collects quarterly data from all 50 states, the District of Columbia, and 27 urban areas considered to be at high risk for undervaccination. This report provides the results of national, state, and urban area vaccination coverage levels for April 1994-March 1995, which document the highest overall vaccination levels ever achieved for preschool-aged children in the United States, but a wide range (41 percentage points) between areas with the highest and lowest vaccination coverage levels.

Communicable Disease Control↗
PubMed1995

A concurrent comparison of a WHO-recommended 30-cluster survey and a modified version of it under Indian conditions in the estimation of immunization coverages.

A concurrent comparison of the WHO 30-cluster sample survey method for estimating immunization coverages (DPT, Polio, BCG, Measles) and an Indian modification of (GOI) was undertaken in five districts in South India. The essential difference between the two methods is the manner in which the first household is selected in the chosen clusters. With the WHO method, it is chosen clusters. With the WHO method, it is chosen at random, whereas with the GOI method it is often close to the village centre. Estimates with the required degree of precision, i.e., 95% confidence limits of +/- 10 percentage points, were provided in 18 (90%) of 20 instances by the WHO method and in 19 (95%) by the GOI method, findings which are in accordance with expectation. The estimated coverages were, however, higher by the GOI method than by the WHO method in two districts, lower in one district, and in the remaining two districts there was no clear pattern. On the average, there was a suggestion that the GOI method yielded slightly higher coverages, but the differences were not statistically significant.

Health Surveys↗
PubMed1996

[Physicians and the mass media. Opinion of physicians on the coverage of medicine, health policy and the medical profession by the mass media].

Every fourth physician disapproves of mass media coverage of health policy questions. Four out of ten physicians are dissatisfied with the way scientific medical issues are covered, and seven out of ten are dissatisfied with articles and programmes about the medical profession. The physicians' dissatisfaction was predicted by a low level of perceived job autonomy and a high level of perceived unrealistic expectations from patients, families, superiors and politicians. The doctors' disapproval of press coverage of the medical profession increased with perceived stress. The dissatisfaction was clearly greater among younger than among older physicians. Internists and surgeons tended to be more dissatisfied than physicians in other specialties. Dissatisfaction with mass media was not, however, a question of personal grudge: respondents who felt that they themselves had been unfairly spoken of by the media did not disapprove of the media coverage of health issue, or of the medical profession in general, to any greater degree than did doctors who had no such personal complaints.

Adult↗
PubMed1996

Effect of the Medicare Catastrophic Coverage Act on payer source changes among nursing home residents.

The Medicare Catastrophic Coverage Act (MCCA) of 1989 was designed to expand Medicare's post-acute care benefits, reduce copayments, and raise the asset limit for Medicaid eligibility. This analysis uses a semi-Markov transition model to estimate the effect of the MCCA on changes to Medicare coverage and the spend-down rate among 5,551 new nursing home admissions followed for an average of 2.5 years. We found that Medicare use increased in 1989 and the risk of transiting from Medicare to self-pay decreased compared to 1988. Spend-down from self-pay to Medicaid was 60% more likely in 1990. The MCCA clearly increased access to Medicare coverage of nursing home care among individuals previously paying privately.

Aged↗
PubMedDate not supplied

Denominators for estimation of influenza vaccine coverage among high risk persons aged 15 to 64 years.

PURPOSE: To propose and demonstrate a method for the estimation of the denominators required for the calculation of vaccine coverage for persons aged 15 to 64 years who are recommended to receive influenza vaccine. METHODS: The age-sex-specific proportions of persons aged 15 to 64 years who self reported having relevant chronic health conditions were estimated from Cycle 6 of the General Social Survey, and applied to 1996 Alberta census estimates to calculate a denominator for the calculation of vaccine coverage for Alberta for 1996. RESULTS: For the province of Alberta for 1996, it was estimated that about 281,000 persons aged 15 to 64 had a health condition that was an indication for influenza vaccination. CONCLUSION: The application of age-sex-specific Canadian proportions to provincial census data will provide denominators for the estimation and comparison of vaccine coverage among high risk adults from year to year.

Adolescent↗
PubMed1995

The performance of conventional, fixed bridgework, retained by partial coverage crowns.

A retrospective study was carried out on 248 partial coverage retained fixed bridges, in 211 patients. All were inserted at an undergraduate dental clinic and their length of service ranged from 1 to 19 years. In 211 prostheses, on which current information was available a total of 20 (9.5%) bridges had failed. The reasons for failure were loss of retention and, to a lesser extent, caries. Using a LIFE TABLE of survival, it was calculated that the percentage of short span, partial veneer retained prostheses that would survive TEN years was 76.5% +/- 5.99% (standard error). This figure is comparable to that quoted for resin-bonded bridges, and hence would militate against the use of conventional partial coverage fixed retainers on intact teeth. Where abutment teeth are heavily restored, full coverage retainers provide a more predictable, long term result.

Adolescent↗
PubMed1996

Maximizing immunization coverage through home visits: a controlled trial in an urban area of Ghana.

A strategy of home visits to maximize children's immunization coverage was implemented in three towns in Ghana. The strategy was tested in town 1 in a controlled trial where clusters of children were allocated to the intervention and control groups. A total of 200 mothers in the intervention group were visited at home by non-health workers and their children were referred to a routine under-fives' clinic. Subsequent home visits targeted at those who failed to complete immunization schedules were made by nurses. After 6 months, coverage had risen from 60% to 85%, which was 20% higher than in the town 1 control group of 219 age-matched children (P < 0.005). A similar home-visiting strategy in a neighbouring town resulted in a rise in coverage from 38% to 91% (n = 55), mainly through home immunizations. Children were more likely to complete the schedule if their fathers were interviewed and participated in the decision to send them to the clinic. Countries with national service programmes can use a home-visiting strategy to supplement and strengthen their routine immunization programmes. A wide range of other community-based primary health care interventions could also be tested and implemented using this methodology.

Adult↗