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PubMed1999

Progress in coverage with hepatitis B vaccine among US children, 1994-1997.

OBJECTIVES: This study was done to assess progress in hepatitis B vaccination of children from 1994 through 1997. METHODS: We used data from the National Immunization Survey (NIS), a random-digit-dialed telephone survey that includes a mail survey to verify vaccination providers' records. The NIS is conducted in 78 geographic areas (50 states and 28 selected urban areas) in the United States. RESULTS: A total of 32,433 household interviews were completed in the 1997 NIS. An estimated 83.7% of children aged 19 to 35 months received 3 or more doses of hepatitis B vaccine. Coverage with 3 doses was greater (86.7%) among children in states that had day care entry requirements for hepatitis B vaccination than among children in states without such requirements (83.0%) and was greater among children from families with incomes at or above the poverty level (85.0%) than among children below the poverty level (80.6%). Hepatitis B vaccination of children increased from 1994 through 1996, from 41% to 84%, but coverage reached a constant level of 84% to 85% in 1996/97. CONCLUSION: Although substantial progress has been made in fully vaccinating children against hepatitis B, greater efforts are needed to ensure that all infants receive 3 doses of hepatitis B vaccine.

Child↗
PubMed2003

Universal coverage and public health: new state studies.

Recent evaluations of the California Health Service Plan (CHSP) confirmed that financing health care through a single government payer can provide universal coverage-while saving significantly on health care spending-to a degree unparalleled by alternative approaches. Public ownership of the delivery system can further provide authority and accountability for critical reforms that improve the population's health and quality of care, including coordination of the delivery system. The federal government's State Planning Grant Program provides states with funding to develop plans to cover their uninsured populations. California created a Health Care Options Project that requested proposals that could expand coverage and contracted with a financial modeler and a qualitative analyst to evaluate the resulting plans. The CHSP was one of 9 plans evaluated through this process.

California↗
PubMed2004

Health service access, use, and insurance coverage among American Indians/Alaska Natives and Whites: what role does the Indian Health Service play?

OBJECTIVES: We compared access and utilization of health services among American Indians/Alaska Natives (AIANs) with that among non-Hispanic Whites. METHODS: We used data from the 1997 and 1999 National Survey of America's Families to estimate odds ratios for several measures of access and utilization and the effects of Indian Health Service (IHS) coverage. RESULTS: AIANs had less insurance coverage and worse access and utilization than Whites. Over half of low-income uninsured AIANs did not have access to the IHS. However, among the low-income population, AIANs with only IHS access fared better than uninsured AIANs and as well as insured Whites for key measures but received less preventive care. CONCLUSIONS: The IHS partially offsets lack of insurance for some uninsured AIANs, but important needs were potentially unmet.

Adolescent↗
PubMed2000

Rotation of the clavicular portion of the pectoralis major for soft-tissue coverage of the clavicle. An anatomical study and case report.

BACKGROUND: The purposes of this study were to describe the anatomical features of a rotational flap consisting of the clavicular portion of the pectoralis major and to report the surgical technique and the outcome of use of this flap in a patient with poor soft-tissue coverage following multiple operations for a clavicular fracture complicated by nonunion and infection. METHODS: Ten shoulders from five cadavera were dissected to isolate the clavicular portion of the pectoralis major. The vascular pedicle, thoracoacromial artery, and axillary artery were identified, and the length of the vascular pedicle from the axillary artery to the muscle was measured. The angle of rotation of the flap about its intact clavicular origin was measured before and after division of the acromial branch of the thoracoacromial artery. The clavicular origin was then incised, and the overall length, width, and thickness of the muscle as well as the distance from each end of the muscle to the vascular pedicle were measured. RESULTS: The average length of the vascular pedicle from the axillary artery to the pectoralis muscle belly was 5.3 centimeters (range, 3.7 to 6.5 centimeters). The average maximum angle of rotation with the clavicular origin intact was 60 degrees (range, 55 to 67 degrees) before division of the acromial branch and 73 degrees (range, 65 to 82 degrees) after division. The average total length of the clavicular head was 20.2 centimeters (range, 18.0 to 23.0 centimeters). The average width of the clavicular head was 2.9 centimeters (range, 2.0 to 4.0 centimeters), and the average thickness was 0.5 centimeter (range, 0.2 to 0.7 centimeter). The vascular pedicle entered the muscle an average of 8.7 centimeters (range, 5.2 to 10.7 centimeters) lateral to the most medial extent of the muscle and an average of 11.5 centimeters (range, 9.5 to 14.0 centimeters) medial to the most lateral extent of the muscle. The rotational flap was successfully used clinically to provide soft-tissue coverage after bone-grafting and internal fixation of a clavicular nonunion that had been complicated by infection. CONCLUSIONS: The clavicular head of the pectoralis major may be used as a local rotational flap to cover soft-tissue deficiencies over the clavicle. It can be harvested with relative ease without damaging the sternocostal head.

Aged↗
PubMed1991

The short life and painful death of the Medicare Catastrophic Coverage Act.

This article draws upon a combined political and moral economy theoretical framework to explicate the rise and fall of the Medicare Catastrophic Coverage Act (CHI). Underlying factors, including the legacy of Medicare, the politics of austerity, and the declining political legitimacy of the aged in the 1970s and 1980s, are seen to have heavily shaped the unique characteristics of the legislation, such as its unpopular self-financing mechanism. Moral economy concerns with reciprocity, fairness, and just taxation are used to help explain the intensity of the "senior revolt" against CHI, which ultimately led to the legislation's repeal. The "Catastrophic catastrophe" is seen as having further eroded the political legitimacy of the old, while at the same time demonstrating the raw political muscle of this population group. Implications of the repeal of CHI for future health coverage legislation, and the impact of repeal on the states and other stakeholders, also are discussed.

Aged↗
PubMedDate not supplied

Medical expenditures and insurance coverage for people with diabetes: estimates from the National Medical Care Expenditure Survey.

Access to health insurance and protection against expenditures for medical care are of special concern to diabetic patients in the United States. This study examines some information on the extent and breadth of public and private health insurance for individuals with diabetes, as well as some estimates of their use of health-care services and their mean expenses for this care. About 12% of all diabetic patients less than 65 yr old (approximately 311,000 individuals) were uninsured throughout 1977, a rate not much different from that for the rest of the United States population. Those with diabetes who are uninsured tend to be younger, Black or Hispanic, in excellent or good health, and live outside of metropolitan areas and in the South or West. As expected, diabetic patients use more medical care than others of their age and sex, and their medical expenses are also much higher, particularly in younger age groups. In 1977, average total medical-care expenses for people with diabetes were $1514 compared with $548 for the rest of the population. They and their families paid approximately 20% out of pocket (approximately $355). Their health insurance premiums were not much different from those without diabetes, averaging approximately $1000 in 1977 for those under age 65. The private insurance coverage for diabetic patients was similar to that for others, although slightly fewer had major medical coverage than the general population.

Adult↗
PubMed1992

Third-party reimbursement coverage for diabetes outpatient education programs.

The purpose of this study was to report on current third-party reimbursement coverage for diabetes outpatient education programs. In 1986, the Centers for Disease Control began to collect and analyze information about reimbursement of outpatient diabetes education programs. Data compiled in the Diabetes Outpatient Education Reimbursement Database represented various information sources, including contact people in 42 states, surveys, government publications, the American Diabetes Association, the American Association of Diabetes Educators, and Communicating for Agriculture. The purpose of the data base was twofold: 1) to track national reimbursement trends and 2) to support health-care professional efforts in obtaining third-party reimbursement for education services. This article analyzes the Diabetes Outpatient Education Reimbursement Database. This study is a descriptive analysis of the major carriers that reimburse, legislation for reimbursement of education programs, and state risk-sharing insurance pools. Currently, Medicaid (in 37 states), Medicare (in 49 states), Blue Cross/Blue Shield (in 43 states), and private carriers (in 48 states) reimburse diabetes outpatient education programs. Sixteen states have operational pooled risk health insurance plans. This represents an increase in the number of states that report reimbursement from 1986. Progress has been made in procuring reimbursement coverage for diabetes outpatient education programs. However, progress does not imply that third-party reimbursement is uniform nationwide or effortlessly achieved. Many challenges must be addressed before reimbursement is no longer an issue in the management of diabetes education programs and the provision of essential services for people with diabetes.

Blue Cross Blue Shield Insurance Plans↗
PubMed2003

Association between number of physician visits and influenza vaccination coverage among diabetic adults with access to care.

OBJECTIVE: The proportion of diabetic adults that receives the influenza vaccine is less than ideal. This study determined the relationship between the number of physician visits in the previous 12 months and the likelihood of influenza vaccination among diabetic adults with access to care. RESEARCH DESIGN AND METHODS: Data on 1807 diabetic adults with access to care in the 1999 National Health Interview Survey (NHIS) were analyzed. Prevalence of influenza vaccination was determined by number of physician visits. Logistic regression was used to determine the independent association between number of physician visits and influenza vaccination coverage, controlling for age, sex, race/ethnicity, education, income, employment census region, and comorbidity. STATA was used for analyses to account for the complex sampling design of NHIS. RESULTS: Overall, 56% of subjects received the influenza vaccine. Proportions vaccinated by number of physician visits were as follows: 35% (no visit), 47% (1-3 visits), 58% (4-9 visits), and 61% (>or=10 visits). Compared with people with no physician visit, people with 4-9 visits (odds ratio [OR] 2.61) and >or=10 visits (2.96) were significantly more likely to be vaccinated. However, after controlling for covariates, only people with >or=10 visits (2.34) were significantly more likely to be vaccinated. CONCLUSIONS: In this nationally representative sample, repeated physician visits by diabetic adults with access to care were associated with only modest increases in influenza vaccination coverage. In adjusted analysis, odds of influenza vaccination were not significantly associated with number of physician visits, except in people with >or=10 visits.

Adult↗
PubMed2000

Psychology of the scientist: LXXXII. Coverage of classical conditioning in textbooks in the psychology of learning, 1952-1995.

Objective information was obtained from 89 textbooks in the psychology of learning published from 1952 through 1995 to answer questions about their coverage of classical conditioning. We found (a) that classical conditioning consistently received less coverage than instrumental and operant conditioning, (b) that the distinction of classical and instrumental conditioning has become established as a textbook-construction device, (c) that use of the classical-instrumental distinction by textbook authors has "hardened" after a period of "fluidity" in the 1970s, (d) that the currency of references in the basic classical (as well as instrumental) conditioning chapters diminished from 1952 to 1995. Findings are discussed in regard to the possibility that, as a class, and in comparison to other textbooks, the textbooks of the psychology of learning fall short of fulfilling some of their recognized roles.

Animals↗
PubMed2006

Improving birth dose coverage of hepatitis B vaccine.

Administration of a birth dose of hepatitis B vaccine (HepB vaccine) to neonates is recommended to prevent mother-to-infant transmission and chronic infection with the hepatitis B virus (HBV). Although manufacturers recommend HepB vaccine distribution and storage at 2-8 degrees C, recognition of the heat stability of hepatitis B surface antigen stimulated research into its use after storage at, or exposure to, ambient or high temperatures. Storage of HepB vaccine at ambient temperatures would enable birth dosing for neonates delivered at home in remote areas or at health posts lacking refrigeration. This article reviews the current evidence on the thermostability of HepB vaccine when stored outside the cold chain (OCC). The reports reviewed show that the vaccines studied were safe and effective whether stored cold or OCC. Field and laboratory data also verifies the retained potency of the vaccine after exposure to heat. The attachment of a highly stable variety of a vaccine vial monitor (measuring cumulative exposure to heat) on many HepB vaccines strongly supports policies allowing their storage OCC, when this will benefit birth dose coverage. We recommend that this strategy be introduced to improve birth dose coverage, especially in rural and remote areas. Concurrent monitoring and evaluation should be undertaken to affirm the safe implementation of this strategy, and assess its cost, feasibility and effect on reducing HBV infection rates. Meanwhile, release of manufacturer data verifying the potency of currently available HepB vaccines after exposure to heat will increase confidence in the use of vaccine vial monitors as a managerial tool during storage of HepB vaccine OCC.

Drug Storage↗
PubMed1998

Comparison of 6- and 7-day physical therapy coverage on length of stay and discharge outcome for individuals with total hip and knee arthroplasty.

Providing physical therapy service on Sundays is a much debated topic among hospital administrators. The purpose of this study was to determine if 7 days per week of physical therapy coverage results in shorter lengths of stay and differing discharge status than 6 days per week. A total of 140 subjects with hip or knee arthroplasty participated; there were 80 in the 6-day groups and 60 in the 7-day groups. Data on postoperative length of stay, discharge destination, and discharge disposition were collected by retrospective medical record review. The Mann-Whitney U test was used to test for differences in length of stay data, and the chi-squared test was used to test for differences in discharge disposition and discharge destination. No significant differences in postoperative length of stay, discharge destination, nor discharge disposition existed between the 6- and 7-day physical therapy coverage hip or knee arthroplasty groups. However, the power of the statistical tests applied was low. This study provides no evidence that 7-day per week physical therapy results in shortened postoperative length of stay, differing discharge destination, nor differing discharge disposition for patients undergoing hip or knee arthroplasty.

Aged↗
PubMed2001

Influenza vaccination coverage in elderly people, Campania (Italy), 1999.

A study on the coverage of influenza vaccination among elderly people was carried out. Fity-six per cent of those interviewed had been vaccinated (weighted coverage 50%), compared with the target of 75%, but higher rates were reported in those older than 74 years and those with chronic diseases.

Aged↗
PubMed2002

Measles in France: the epidemiological impact of suboptimal immunisation coverage.

The promotion of immunisation in France since 1983 has resulted in a 97% reduction in morbidity and a reduction of 60% of mortality. However, the stable and sub-optimal coverage around 84% leads to a shift in higher age groups, where complications are more frequent and serious. The proportion of those aged over 10 years was 13% in 1985 and reached 48% in 1997, the transmission of measles being maintained in France. To eliminate the disease, vaccine coverage with 2 doses and over 95% would be necessary.

Adolescent↗
PubMed1986

Flap coverage for post-traumatic nerve pain in the arm.

14 patients with painful neuroma, skin hyperesthesia or neuralgic rest pain were followed up (mean 20 months) after excision of skin and scar, neurolysis and coverage with pedicled or free flaps. Painful neuroma had improved in 3 of 7 patients. Skin hyperesthesia had been eliminated in 8 of 11 patients, and had improved in 3. Neuralgic rest pain had been eliminated in 5 of 6 patients, and was partially relieved in one. It is concluded that painful neuroma in continuity is not relieved by flap coverage, whereas skin hyperesthesia and neuralgic rest pain are appropriate for this type of treatment.

Adolescent↗
PubMed1994

Health insurance coverage and medical care utilization among working-age Americans with visual impairment.

As access and cost of medical care emerge as the fundamental issues in the discussion of reforming the nation's health care system, more attention needs to be devoted to the understanding of how visual impairment and functional disability in general affects an individual's access to health insurance as well as medical care utilization. Based on the 1984 Survey of Income and Program Participation (SIPP), we estimate that only 57.5% of 7.0 million working-age (15-64 years old) visually impaired Americans, compared with 79.0% of those not visually impaired, have private health insurance coverage. Moreover, an estimated 1.5 million visually impaired working-age Americans are not covered by any form of health insurance, public or private. This 20.7% uninsurance rate is significantly higher than the 14.1% reported among those who are not visually impaired (p < 0.001). Multivariate logistic regression also supports the inverse association between visual impairment and insurance coverage. On the other hand, multivariate logistic regression suggests a positive association between visual impairment and utilization of outpatient medical services. Although there is a trend toward higher utilization of inpatient services as well among the visually impaired, the finding is not statistically significant. These findings suggest that visual impairment poses a barrier to accessing health insurance, even when controlling for income, education, and employment status. On the other hand, regardless of the health insurance status, visually impaired Americans are likely to have utilized more physician services, but not the hospital services, than the non-visually impaired.

Adult↗
PubMed2006

A potential function approach to surface coverage for a surgical robot.

This paper considers some implementation issues in a path planner for achieving uniform coverage of a non-Euclidean bony surface embedded in R3 space. The target application for this planner is bone removal in orthopaedic surgery, but the technique can also be applied to other general surface-coverage problems. Specifically, we use cellular decomposition and sweep lines to generate a set of meaningful way-points for the bone-burring robot to visit, then navigate between these way-points using potential functions.

Humans↗
PubMed2001

Measles outbreak in a community with very low vaccine coverage, the Netherlands.

A 1999-2000 measles epidemic in the Netherlands started with an outbreak in an orthodox reformed elementary school with 7% vaccine coverage. The overall attack rate was 37%: 213 clinical cases among the 255 participating pupils (response 62%) and 327 household members. The attack rate ranged from 0% for the oldest groups of pupils to 88% for the youngest, who had not been exposed in previous measles epidemics. None of 25 vaccinated pupils had clinical symptoms. Among pupils with clinical symptoms, the self-reported complication rate was 25%. These data confirm that measles infection causes severe disease and that vaccination is the most effective means of preventing the disease and its complications. The data also show that clusters of persons refraining from vaccination interfere with measles elimination even in populations with very high overall vaccine coverage (96%).

Adolescent↗
PubMed2005

The reverse sural neurocutaneous flap for hindfoot and ankle coverage: experience and review of the literature.

Soft-tissue defects about the ankle are common in orthopedic surgery. The wounds usually involve exposed bone or hardware, making skin grafting a poor option. Free tissue transfer remains a mainstay of treatment. Recently, the reverse sural neurocutaneous flap has gained popularity. At our institution, 11 fasciocutaneous flaps have been performed for defects averaging 53cm2. All flaps achieved stable coverage. One patient required repeat skin grafting. Given its reliability, easy dissection, and outpatient capability, this flap should be considered for coverage in this region.

Adult↗