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PubMed1997

A randomised intervention study to examine the effect on immunisation coverage of making influenza vaccine available at no cost.

AIMS: This study aims to assess the effects of two interventions on influenza vaccination coverage: a simple organisational strategy, and making the vaccine available free. METHODS: Sixteen general practitioners in the Auckland region were randomly selected to participate. Patients over 65 years of these general practitioners were randomly allocated to control, letter of invitation for a flu vaccine, or offer of a free flu vaccine. Administration of a flu vaccine for each person in the study was documented in each general practitioner surgery. Vaccine coverage for each of the three groups was measured. RESULTS: Results were available for 15 of the 16 participating general practitioners, a total of 2791 subjects. Immunisation coverage rates for control, letter of invitation and vaccine at no cost, were 17%, 27% and 45% respectively. Statistical analysis, allowing for the cluster method used to obtain subjects, showed risk ratios of 1.55 and 2.65 for the two interventions, with p values of < 0.00001. CONCLUSIONS: A potential source of bias in this study is underreporting of administration of vaccine to people in group 1. Notwithstanding this potential bias, both interventions were highly effective at increasing the uptake of influenza vaccine in the elderly population. General practitioners should be recommended to routinely invite patients over 65 years to have a flu vaccine. Given the commitment of the Ministry of Health to the vaccination against influenza of people over 65, this study would suggest that serious consideration should be given to making the vaccine available at no cost to this age group.

Aged↗
PubMed1996

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

The National Immunization Survey (NIS) is an ongoing survey to provide estimates of vaccination coverage levels among children aged 19-35 months in the United States, all 50 states, and selected urban areas. 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. 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 NIS findings for July 1994-June 1995, which indicate that coverage levels for diphtheria and tetanus toxoids and pertussis vaccine (DPT), Haemophilus influenzae type b vaccine (Hib), poliovirus vaccine, and hepatitis B vaccine have met or exceeded the 1995 interim goals of the CII and that coverage for measles-mumps-rubella vaccines (MMR) is within 1 percentage point of the objective.

Child, Preschool↗
PubMed1997

Pedicle flaps for coverage of the wrist and hand.

The coverage of wounds about the hand and wrist may be accomplished by numerous pedicled flaps. Attention must be given to preservation of the perforating arteries that supply these fasciocutaneous flaps. Difficulties with wound healing over the area of flap harvest may occur and care must be given to preservation of the peritenon in the distal forearm. The use of fascial flaps may allow coverage that is quite pliable and the radial forearm fascial flap may be performed with preservation of the radial artery. In some cases, the use of a groin flap may be required for coverage of large wounds that do not have arteries available for sacrifice.

Forearm↗
PubMed1997

[Is there a relationship between vaccination coverage and pediatric health care?].

OBJECTIVE: The aims of this study were to evaluate the relationship between pediatric health care visits and immunization coverage. PATIENTS AND METHODS: The study was made in a rural health care center. All of the children between 3 months and 14 years old were included. The data were obtained directly from their clinical histories. The quality of the health care visits was evaluated according to the fulfillment of A.E.P. patterns of health care. RESULTS: We observed that 87% of infants, 74% of preschool children and 74% of school children were correctly vaccinated. We observed a significantly lower (p < 0.05) coverage of the MMR vaccine in respect to the first three doses of DPT and OPV vaccines; and the coverage of OPV and DT at 6 years old was even lower. The quality of health care visits was good in 67% of infants, 10% of preschool children and 12% of school children. There was a relationship between incomplete vaccinations and missed visits (p < 0.001) and also with low quality health care visits (p < 0.001). CONCLUSIONS: We conclude that there is a significant relationship between missed visits and low quality health care visits with delayed immunization.

Adolescent↗
PubMed1996

[Supervision and evaluation of vaccination coverage rates in Jiangsu province].

Comprehensively, this paper evaluated the actual vaccination coverage rates in Jiangsu province, using geometric averages to weigh vaccination coverage rates through a) regular and irregular investigation b) conventional report rates and c) registration rates of children at the right age of vaccination. Results showed that the comprehensive method of using vaccination coverage rates for evaluation was better than the conventioned index which had been used before.

Child↗
PubMed1997

Immunization coverage among urban and rural children in the Shimla hills.

A cross sectional study was carried out to assess immunisation coverage among 257 urban and 339 rural children aged 13-36 months who were vaccinated at pulse polio booths in Shimla hills. 84.37% urban children and 57.59% rural children were fully vaccinated. BCG scar was negative in a large number of children, especially from rural areas. Increasing maternal education was associated with complete immunisation. OPV I-III dropouts were 3% among urban children and 15% among rural. The corresponding dropout rates for DPT I-III were 1% and 8% respectively. The immunisation coverage in this region was higher than others. Sustained efforts are required to achieve full immunisation coverage and eradicate polio and measles.

Child Welfare↗
PubMed1997

[Overestimate of vaccine coverage? New evidence from a survey in Pau da Lima].

To evaluate vaccination coverage in children 0 to 5 years of age, a cross-sectional study based on a household survey was carried out in 1992 in the Pau de Lima Health District, Salvador, Bahia, Brazil, using a cluster sampling technique. The district was subdivided into 30 small areas that were homogeneous with respect to socioeconomic characteristics. Information on the vaccination status of 385 children was obtained through verification of a vaccination card or campaign voucher, or, in the absence of these items, through verbal confirmation from the mother or other responsible person. Based on all the sources of information, the study found vaccination coverage rates in the entire age range of 69% for polio vaccine; 56% for DTP; 74% for measles vaccine; and 87% for BCG. These results suggest that rates obtained from routine records of the health services and vaccination campaigns may be overestimates. The authors discuss the implications of the low coverage rates found in the entire age group and especially among children under 1 year old.

BCG Vaccine↗
PubMedDate not supplied

Vaccine coverage during a school-based hepatitis B immunization program.

Ontario initiated a universal hepatitis B immunization program for grade seven students in the fall of 1994. An ecological study was conducted within seven health units of the Greater Toronto Area to assess vaccine coverage. The study population consisted of all grade seven students enrolled within schools in the participating health units, on October 1, 1994. There were 39,935 students enrolled in 604 schools eligible for inclusion in the study. Consent to receive the vaccine series was obtained for 88% (range across health units from 81.5% to 96.3%) of the students. Among students for whom consent was obtained, an average of 95% (range 88.1% to 99.5%) completed the series. Therefore, the total vaccine coverage for the study population was 84% (range 77.5% to 89.5%). Series completion varied by school board, education provider and the use of Ministry of Health educational material. A limiting factor in achieving high vaccination coverage among grade seven students was obtaining consent to receive the vaccine series.

Adolescent↗
PubMed1997

Root coverage of large localized gingival recession: a biometric study.

With the objective of obtaining root coverage in areas of large localized gingival recessions, 16 cases of localized gingival recessions varying from 3.5 to 10 mm (total recession) were treated with a coronally positioned gingival autograft in conjunction with mechanical (root planing) and chemical (saturated citric acid) treatment of the exposed root surfaces. Changes in sulcus depth, percentage of root coverage, and gain in attached gingiva were observed over the course of a 6-month period. The results showed no significant change in sulcus depth, coverage of 72.17% of the exposed root surfaces, and a gain of 3.0 +/- 1.4 mm in attached gingiva in areas where little or no attached gingiva had existed prior to treatment. A positive correlation between the bone level and total visible recession before treatment was also demonstrated. We conclude that the coronally positioned gingival autograft is a highly predictable surgical technique for the treatment of large localized gingival recessions.

Adult↗
PubMed1998

MMR immunisation coverage in Christchurch. Christchurch Immunisation Coordination Committee.

AIM: To measure measles-mumps-rubella (MMR) immunisation status of a birth cohort at 18 months of age. METHOD: All children born in Christchurch in June, July and August 1995 who were alive at 18 months of age (n = 999), were matched with MMR immunisation benefit claims. Those not listed were traced. RESULT: The final immunisation coverage rate was estimated at 85%. CONCLUSION: An 85% coverage rate at 18 months fell well short of the Immunisation 2000 target of 95% coverage by two years of age.

Humans↗
PubMed1998

[Factors influencing coverage, response and participation in breast cancer screening program].

BACKGROUND: The objective was to analyze sociodemographic, organizational and health care-related factors associated to level of enrollment in a breast cancer screening program developed in one area of Barcelona (Spain). MATERIAL AND METHODS: Three types of indicators were used: coverage, response and participation. The influence of age, educational level, previous clinical contacts, the person who received the citation and the reason for not attending after the first citation were studied. The odds ratio (OR) was used to estimate the magnitude of the association between variables. The OR were adjusted by age and education through unconditional logistic regression. RESULTS: The rates were: coverage 79.2%, response 74.6%, and participation 61%. The response after the first citation was influenced by the recipient of the letter (p < 0.001); when it was the target-woman, the response was 75%. The response after the successive citations was 50.5% if the reason for not attending previously was circumstantial, and 11.5% when it was lack of interest. Having had previous clinical contacts in the primary care centre or in the reference hospital multiplied by 4 to 7 times the response. Coverage decreased with age, and it presented a curvilinear pattern with respect to educational level. Multivariate analyses emphasized the importance of previous clinical contacts (ORs between 3.5 and 8.1; p < 0.001). CONCLUSIONS: Previous contacts with the health system, the method of citation and the reason for not attending after the initial phase were factors clearly associated with participation in a breast cancer screening program. Research on factors influencing participation would contribute to improve the results of screening programs currently underway in Spain.

Breast Neoplasms↗
PubMed1998

Tetanus toxoid immunization coverage among women in zone 3 of Dhaka city: the challenge of reaching all women of reproductive age in urban Bangladesh.

Neonatal tetanus is still an important public health problem in both urban and rural Bangladesh, with an estimated 41,000 cases occurring annually. This article analyses the coverage of tetanus toxoid (TT) immunizations among women of reproductive age in Zone 3 of Dhaka City in 1995. Although 85% of women with a child under 1 year of age had received two TT immunizations, only 11% of women of reproductive age had obtained the complete series of five TT immunizations and only 52% of women of reproductive age had received one or more TT immunizations. Access to TT immunization, as defined by having had at least one such immunization, was lower among women aged over 30 years and also among those aged under 20 years, especially those who were not yet married or who had not yet become pregnant. Characteristics associated with TT immunization status included the following: educational level of the woman, distance from the nearest immunization centre, and level of contact with family planning field workers. Additional characteristics that influenced women's TT immunization status included age, marital and working status, recency of migration from rural to urban area, and number of children. The relationships were complex and varied depending on the number of TT immunizations received (one or two) and on the type of analysis being carried out (bivariate or multivariate). The findings point to the need for a broad-based campaign to promote access to TT immunization as well as to promote the completion of all five TT doses in Bangladesh. Reducing missed opportunities for promotion of immunization as well as targeting home visitation of women in need of additional immunizations constitute further approaches to improving coverage. Although TT coverage rates were only marginally lower among women in slum households, such women were more likely than those in non-slum households to be pregnant and hence more likely to bear a baby at risk of neonatal tetanus. Furthermore, the environment of slum households, where deliveries normally take place, is more conducive to the development of neonatal tetanus among unprotected neonates; a strategy of focusing on slum households is therefore also needed.

Adolescent↗
PubMed2025

4CMenB vaccine coverage of invasive serogroup B meningococci collected in Belgium between 2016 and 2022.

Neisseria meningitidis infections can cause life-threatening meningitis and septicemia. In Europe, serogroup B (MenB) is the leading cause of invasive meningococcal disease (IMD), particularly in young children. Genomic surveillance of circulating MenB strains through whole genome sequencing (WGS) provides a powerful tool to assess the potential impact of vaccination strategies, including the 4CMenB vaccine, which is available for infants from 2 months of age. Here, we present a retrospective WGS-based analysis of clinical MenB IMD cases (n&#x2009;=&#x2009;311) recovered in Belgium from 2016 to 2022 by the Belgian National Reference Center. High-quality WGS data were obtained for 281 of these strains, demonstrating high genetic diversity of the antigen targets included in the 4-component meningococcal serogroup B vaccine 4CMenB (fHbp, PorA, NHBA and NadA) and at the 4CMenB Antigen Sequence Types (BAST) level. Novel antigen combinations, not yet assigned a BAST ID, were detected in 23.5% of isolates. Vaccine coverage was predicted using the Genetic Meningococcal Antigen Typing System (gMATS) and the Meningococcal Deduced Vaccine Antigen Reactivity (MenDeVAR) index. Of the 281 strains, 79.5% (lower limit-upper limit: 68.0-91.5%) were predicted to be covered by the vaccine by gMATS, and 80.7% (lower limit-upper limit: 66.5-95.4%) by MenDeVAR. No evidence of variation in vaccine coverage was found throughout the study period nor between different age groups, demonstrating the broad applicability of 4CMenB. This study highlights the benefits of a pathogen surveillance program and the need for experimental characterization of continuously evolving antigenic subvariants of Neisseria meningitidis.

Humans↗
PubMed2004

Effects of health maintenance organization coverage of self-monitoring devices on diabetes self-care and glycemic control.

BACKGROUND: Increasingly, government mandates require insurance coverage of blood glucose monitors and test strips for patients with type 1 and type 2 diabetes. No data exist on the effects of such coverage on self-monitoring of blood glucose (SMBG), medication compliance, or blood glucose control. We evaluated whether a policy providing free blood glucose monitors increased SMBG and whether initiating SMBG was associated with increased regularity of medication use and improved glucose control (hemoglobin A(1c) [HbA(1c)] level). METHODS: Using interrupted time-series analysis and controlling for preintervention trends, we determined changes in rates of SMBG 2 years before and after the policy among 3219 continuously enrolled patients with diabetes receiving drug therapy within a multispecialty medical group (part of a health maintenance organization) serving approximately 300 000 patients. We also compared changes over time in regularity of medication use (mean days between dispensings) and mean HbA(1c) level among initiators and noninitiators of SMBG. RESULTS: The policy resulted in a small, significant increase in SMBG among insulin-treated patients (n = 1428). Among sulfonylurea-treated patients (n = 1791), the monthly initiation rate of SMBG increased by 14 new patients per 1000 (95% confidence interval [CI], 10 to 17), a doubling of the expected initiation rate. Test strip consumption increased during the first 6 months after the policy by 17.9 strips per cohort member (75% relative increase by 6 months; 95% CI, 50% to 101%). Compared with noninitiators of SMBG, initiators (n = 593) showed sudden, significant improvements in regularity of medication use by 6 months after initiation (-19.5 days between dispensings among those with low refill regularity [95% CI, -27.7 to -11.3]; -9.7 days among those with moderate regularity [95% CI, -12.3 to -7.1]), and in glucose control (-0.63% mean HbA(1c) level [as percentage of total hemoglobin] among those with poor baseline glycemic control [HbA(1c) >10%; 95% CI, -1.14% to -0.12%]). CONCLUSIONS: Providing free glucose monitors improved rates of self-monitoring in this health maintenance organization population, possibly by offering an initial incentive for patients to engage in more desirable patterns of care. Initiating SMBG was associated with increased regularity of medication use and a reduction in high blood glucose levels.

Adolescent↗
PubMed2006

Medicare coverage of tumor necrosis factor alpha inhibitors as an influence on physicians' prescribing behavior.

BACKGROUND: Rheumatoid arthritis is a chronic debilitating disease that affects 1% of the population. Tumor necrosis factor alpha inhibitors, such as etanercept and infliximab, have revolutionized the treatment of rheumatoid arthritis by averting disability but at great financial expense, generally borne by third-party payors. Prior to implementation of the Medicare Modernization Act, Medicare reimbursed for the infusion drug infliximab but not for the self-injectable drug etanercept. To determine the impact of this differential Medicare drug coverage on physicians' prescribing behavior in clinical practice, we analyzed patterns of prescribing etanercept and infliximab for patients with rheumatoid arthritis who had public insurance compared with those who had private insurance. METHODS: We conducted an observational cohort study of 1663 patients with rheumatoid arthritis newly prescribed etanercept or infliximab after enrollment in the National Databank for Rheumatic Diseases. Univariate and multivariable analyses of patient demographic and disease characteristics were conducted to characterize predictors of the biologic drug prescribed. RESULTS: Treatment groups who received etanercept and infliximab differed in 6 of 8 demographic variables and in 8 of 10 disease variables. However, stratification by type of insurance reduced many of these differences. In multivariable analyses, type of insurance plan and demographic factors were strong predictors of differential prescribing of etanercept compared with prescribing of infliximab, whereas disease characteristics generally were not. Patients with public insurance were 30% more likely to receive infliximab than those who were privately insured (P<.001). CONCLUSIONS: Public insurance predicted prescription of infliximab, reflecting preferential Medicare reimbursement for infusion drugs. Financial considerations are influential in physicians' prescription decisions. Differential drug coverage has an impact on patient care and health care costs because it influences physicians' prescribing behavior.

Age Distribution↗
PubMed2000

Transforming insurance coverage into quality health care: voltage drops from potential to delivered quality.

Although the US health care system is often touted as one of the best in the world, disparities exist in quality of care received by different populations, in different regions, and across different institutions and clinicians. Initiatives to provide access to health insurance have been a major policy tool to ensure that Americans receive high-quality health care. However, availability of insurance coverage does not automatically lead to high-quality care. This article explores points of vulnerability in the US health care system at which the potential to achieve high-quality care can be lost: (1) access to insurance coverage; (2) enrollment in available insurance plans; (3) access to covered services, clinicians, and health care institutions; (4) choice of plans, clinicians, and health care institutions; (5) access to a consistent source of primary care; (6) access to referral services; and (7) delivery of high-quality health care services. Ensuring high-quality health care requires that each of these "voltage drops" be recognized and addressed. JAMA. 2000;284:2100-2107.

Delivery of Health Care↗
PubMed1998

The effect of employment status on private health insurance coverage: 1977 and 1987.

Analyzing cross-sectional data from the National Medical Expenditure Survey (NMES), we find that the predicted probability of private insurance coverage for low-income individuals as a group fell dramatically from 1977 to 1987. The results of a decompositional technique show that the relationship between full-time employment and private insurance has weakened over the period for low-income females, but has strengthened for males in this group. While it appears that low-income females benefit from part-time employment relative to their unemployed cohorts, no discernible difference is found in the likelihood of being covered by private insurance for part-time and unemployed males. Finally, evidence suggesting a weakening over time in the relationship between part-time employment and private insurance coverage is found among middle-income females and high-income males. From a policy perspective, passage of the Health Insurance Portability and Accountability Act of 1996 has taken an important first step in attempting to lower the number of uninsured, especially among full-time workers. Our findings, however, suggest that this legislation may be too limited in scope to effectively reach part-time workers presently uninsured.

Adolescent↗
PubMed2005

Medicaid coverage and medical interventions during pregnancy.

This paper extends prior research on the effect of Medicaid coverage on medical interventions during pregnancy (prenatal ultrasound) and birth (ultrasound during delivery, cesarean delivery, inducement, and fetal monitor). The data are from two sources: the New York State Vital Statistics (VS) matched infant birth-death file and the Statewide Planning and Research Cooperative System (SPARCS) file for 1993--1996. Medicaid coverage increases the likelihood of teens and adults receiving prenatal care relative to being uninsured. Overall, the effect of insurance type varies depending on whether the procedure is part of standard care (ultrasound and fetal monitor) or more likely to be elective (inducement and cesarean delivery). Insurance type has a greater effect for elective procedures than for procedures that are part of standard care.

Adolescent↗