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PubMed2002

Increases in vaccination coverage for children in child care, 1997 to 2000: an evaluation of the impact of government incentives and initiatives.

OBJECTIVE: To compare vaccination coverage of children in child care before (1997) and after (2000) implementation of government immunisation strategies including parent/providers incentives and surveillance of vaccination uptake. METHODS: Cross-sectional parent surveys of vaccination coverage for children (<3 years old regularly attending child care) in 47 child care centres and 19 councils operating family day care in metropolitan Melboume. RESULTS: Data were collected for 1,578 (72%) children in 1997 and 1,793 (72%) in 2000. In 2000, 93% were completely immunised, a 9% (95% CI 6%-11%, p<0.001) increase from 1997. Less than 1% of children were unimmunised (0.8% in 1997, 0.5% in 2000). For those >2 years, 94% were completely immunised before their second birthday in 2000 compared with 80% in 1997. Immunisation levels were 10% (95% Cl 6-12) higher in 2000 than in 1997 for those receiving child care benefits compared with a 7% (95% Cl 3-10) increase for families not receiving benefits. In 1997, 8 (17%) child care centres and 4 (21%) councils reported > or = 90% children completely immunised increasing to 33 (70%) and 16 (84%) in 2000 respectively. Fewer families reported delaying immunisations because of minor illness in 2000 (27%) compared to 1997 (44%, p<.001). Updating immunisation data by child care coordinators increased from 51% in 1997 to 98% in 2000. CONCLUSION: A substantial increase in immunisation uptake has been achieved for this population of young children attending child care. This study provides evidence that the increase in vaccination rates is attributable to some extent to increased surveillance of immunisation rates and both parent and provider incentives to immunise.

Australia↗
PubMed2005

The new medicare drug benefit: formularies and their potential effects on access to medications.

During congressional debate over the Medicare Part D prescription drug benefit, much attention was focused on nominal benefit design. Relatively little attention was paid to details about how plans would operate, such as the design of drug formularies. Yet, formularies will be important tools for controlling costs, and may be as important as nominal benefit design in determining enrollees' access to medications and out-of-pocket costs. We describe Part D plan incentives and how they may influence formulary design, and then provide recommendations for Part D formulary implementation. We encourage the Centers for Medicare & Medicaid Services (CMS) to develop standardized tools to provide physicians and patients with up-to-date and easily accessible information about covered drugs on each plan's formulary (perhaps via a central website) and a national set of easy-to-follow procedures for reconsideration and appeals. Such efforts should reduce administrative burden and better allow physicians to help patients obtain needed medications.

Aged↗
PubMed2000

Abortion trends in Japan, 1975-95.

In this study, recent trends in the incidence of induced abortion are analyzed in order to identify the target population and its requirements for family planning policy in Japan. Abortion statistics from 1975 to 1995 from the Ministry of Health and Welfare are reviewed. The abortion rate (the number of cases of induced abortion per 1,000 women per year) for women younger than 20 increased during the study period. The abortion ratio (number of cases per 1,000 live births) remained the highest among women aged 40-44. An increase in the abortion ratio was seen in the two youngest groups (younger than 20 and 20-24), especially among those who were born after 1955. The proportion of abortions experienced by women younger than 25 increased from 18 percent between 1976 and 1980 to 30 percent between 1991 and 1995, and a slight increase was also observed among women aged 40-44. The proportion of abortions performed after eight weeks of a pregnancy for the two youngest groups remained higher than that for older age groups during 1975-95. The analysis demonstrates that women younger than 25 should be the principal concern of family planning policy in Japan. Further investigations on unintended pregnancy are recommended.

Abortion, Induced↗
PubMed2000

Negotiating ethical and legal mazes in the federal workplace.

The mandates that control actions in the federal workplace often challenge academic principles of conduct. Particularly vulnerable is the anthropologists' image of themselves as champions of powerless and voiceless groups in an arena perceived as dominated by a hostile government. This is coupled with convictions that socially responsible anthropology respects individual privacy while disseminating data to encourage culturally informed public and federal decisions. Using examples involving federal cultural and natural resources, we show conflicts within this suite of perspectives and with the demands of the federal workplace. The need for legally defensible decisions, responses to publics with diverse agendas, and requirements for confidentiality and public access to government records test our anthropological convictions as well as available legal protections of individual privacy and the public's right to know. Perhaps the anthropological community will strategize about more effective remedies for the problems of meeting the concerns of the individuals and the publics it cares about.

Anthropology, Cultural↗
PubMedDate not supplied

The oral health of children with Down syndrome in Ireland.

The authors investigated the oral health of a convenience sample of 71 children with Down syndrome. The study group had a lower caries prevalence but similar levels of unmet treatment needs as children at special and mainstream schools. Treatment experience varied with age: 5-year-olds had more extractions and fewer restorations, and 15-year olds had fewer extractions and more restorations. The number of teeth with fissure sealants was comparable to that of other children in Special Needs Schools. Although the study group had poor oral hygiene, a need for advanced periodontal treatment was not evident. Few had evidence of dental trauma. Malocclusion was prevalent. Through a government-funded program, most of the sample had seen a dentist within the previous year, and few parents reported problems accessing dental care. This study suggests that services targeted toward groups with special needs could generate outcomes comparable to those seen in other service users. A finding that also may hold true for other underserved populations.

Adolescent↗
PubMed2006

Accessing government subsidized specialist orthodontic services in Western Australia.

BACKGROUND: In Australia there is growing demand for dental services. This leads to more pressure on the oral health service providers, and in particular government subsidized dental care. Against this backdrop it is important that government dental services (rationed to health care cardholders) are provided equitably on a basis of need, not access. The primary hypothesis investigated in this study was that there would be an even distribution of patients referred for government subsidized orthodontic care across Western Australia when regionally adjusted for socio-economic status. METHODS: Data were obtained as a de-identified waiting list for orthodontic treatment at The University of Western Australia. The data included all patients on the orthodontic waiting list as at December 2003. RESULTS: Significant differences between ARIA categories were detected when all waiting list entries were distributed. However, the trend was towards more entries (adjusted for population) in highly accessible areas. It was found that people from relatively wealthy areas tended to be more likely to be on the waiting list than those from more disadvantaged regions. CONCLUSION: In summary, the results of this study indicate that there is an uneven distribution of demand for orthodontics waiting list positions across Western Australian postcode areas by remoteness (ARIA) and by socio-economic disadvantage (IRSD). The results suggest that demand for subsidized orthodontic care may be influenced by the general demand for treatment of that region and not on what would be expected to be an even need for treatment across all health care cardholders.

Adolescent↗
PubMedDate not supplied

A framework for selecting performance measures for opioid treatment programs.

As a result of new federal regulations released in early 2001 that move the monitoring and evaluation of opioid treatment programs from a government regulation to an accreditation model, program staff members are now being challenged to develop performance measurement systems that improve care and service. Using measurement selection criteria is the first step in developing a performance measurement system as a component of an overall quality management (QM) strategy. Opioid treatment programs can "leapfrog" the development of such systems by using lessons learned from the healthcare quality industry. This article reviews performance measurement definitions, proposes performance measurement selection criteria, and makes a business case for Internet automation and accessibility. Performance measurement sets that are appropriate for opioid treatment programs are proposed, followed by a discussion on how performance measurement can be used within a comprehensive QM program. It is hoped that through development, adoption, and implementation of such a performance measurement program, treatment for clients and their families will continuously improve.

Accreditation↗