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PubMed1999

[Access to health services: difficulties encountered by refugees residing on Ile-de-France. Charity and full-coverage health care: two divergent concepts?].

Theoretically, since 1992, 100% of socially underprivileged persons residing in France have unlimited access to health care. However, before they become fully integrated into the society, many refugees in various legal situations do not have access to health care. The mechanisms behind this exclusion unmask the difficulties the health care system has in managing the underprivileged population. This work was conducted at the Comede health care facility specially designed to care for refugees. According to the current French legislation, health care protection and medical insurance coverage is a right of all persons living in France. Although the establishment of a large number of centers specifically designated for the underprivileged population has improved access to health care, repeat visits and uninterrupted care cannot be assured unless the patient has been awarded 100% free health care status. There are several obstacles to acquiring this status: complexity of the legal procedures, recipients unaware of their rights and the procedures of the health care system, information limited to specialized journals, restrictive or illegal action by the health protection services. All of these obstacles can be overcome if the patients are given precise information, notably by their physician. Instead of effectively applying the procedures concerning patients rights to health care, the system has developed free health care facilities which do not necessarily provide uninterrupted care. To provide the universal health care coverage promised by the legislators, the only criteria for access to care must be residence in France. Acquiring this status should be considerably simplified and requires the active participation of the entire health care community.

Health Services Accessibility↗
PubMed1999

Vaccine-preventable diseases: improving vaccination coverage in children, adolescents, and adults. A report on recommendations from the Task Force on Community Preventive Services.

The delivery and acceptance of recommended vaccinations is an ongoing challenge for health-care providers and health-care and public health systems, but specific interventions can increase levels of vaccination coverage. The Task Force on Community Preventive Services has conducted systematic reviews of 17 interventions designed to raise vaccination coverage levels in children, adolescents, and adults and made recommendations regarding the use of those interventions. This report provides a summary of the recommendations; informs readers of sources from which they can obtain the full review of the interventions and more detail regarding the application of the interventions at the local level; and informs readers regarding other work of the Task Force.

Adolescent↗
PubMed1999

Free flaps for soft tissue coverage in the hand and fingers.

With mastery of conventional methods, free flaps are indicated in selected cases for coverage of the hand and fingers. Careful preoperative planning, delicate intraoperative management, and postoperative physiotherapy are the mainstays for success in functional recovery and aesthetic result. Thin flaps of good vascularity are favored for coverage of the hand and finger. For hand surgeons, the lateral arm fasciocutaneous or fascia flap, toe flaps, and the latissimus dorsi flap seem to be the easiest and most useful free flaps applicable to most situations.

Contracture↗
PubMed1999

Periodontal esthetics and soft-tissue root coverage for treatment of cervical root caries.

As the pace of change accelerates in periodontics and esthetic dentistry, an increasing number of procedures are being developed that require knowledge and treatment from both fields. The synergy developed by combining these two fields of dentistry allows for better esthetic outcomes for our patients. Two of these procedures include esthetic crown lengthening and soft-tissue root coverage. As demonstrated in this article, soft-tissue root coverage can be performed on previously restored roots and as an option for treating root caries.

Anti-Bacterial Agents↗
PubMed1999

Successful root coverage: a human histologic evaluation of a case.

Connective tissue grafts combined with pedicle grafts (subepithelial grafts) have been shown to be effective in obtaining root coverage. Unfortunately, little is known about the histology of the results in humans. This is a case report of a tooth with a recession defect that was treated with a subepithelial graft. Complete root coverage was obtained. However, at 5 months postoperative the tooth had to be extracted because of a vertical root fracture. With the patient's permission, a small collar of tissue was removed with the tooth. The sample was processed and evaluated histologically. The results revealed areas of regeneration, with new bone, cementum, and connective tissue attachment coronal to the original gingival margin. No bone grafts or guided tissue regeneration membranes were used. This case report confirms that regeneration is possible with subepithelial grafts.

Adult↗
PubMed1999

Magnitude of recall bias in the estimation of immunization coverage and its determinants.

OBJECTIVE: To study the magnitude of recall bias in the estimation of immunization coverage and to identify its determinants. DESIGN: A follow-up study of cohort of children for one year; followed by a cross-sectional recall survey. SUBJECTS: All live births in two contiguous PHC areas in Villupuram district, Tamil Nadu. METHODS: The prospective data collected from mothers of 774 children was considered as 'Gold Standard' and the retrospective recall data from them was compared with it. This was carried out for individual immunization schedules, namely, DPT, OPV, BCG and measles and for the combined immunization status. Measures such as sensitivity, specificity, positive and negative predictive values were computed. Logistic Regression technique was employed for evaluating the determinants of agreement. RESULTS: Less than 50% of mothers has immunization cards with them and more than 70% of the cards did not have complete information. The sensitivity of the recall method was 41.3% and the specificity was 79.5% when the complete immunization status was considered. For individual immunization schedules, the sensitivity ranged from 95% for BCG to 53% for measles vaccination and the specificity ranged from 30% for BCG to 68% for measles vaccination. Mother's age emerged out as a significant determinant in the agreement of two methods. Maintenance of immunization cards were very poor. CONCLUSIONS: Method of obtaining immunization status through recall survey is not sensitive. Proper maintenance of immunization cards and ensuring the availability of them with mothers for inspection are recommended for obtaining accurate estimation of vaccine coverages.

Adult↗
PubMed1999

Interproximal integrity of posterior partial-coverage ceramic restorations: sequence of delivery and finishing.

The conservative, nonretentive cavity design of partial-coverage ceramic restorations provides a number of distinct advantages over traditional cast-metal options. However, unique challenges are associated with precise delivery of the restoration and the cleanup of excess luting resin. Restorative success and long-term gingival health are dependent on interproximal integrity at the restoration-tooth interface. This article examines the variables that affect this integrity and introduces a number of innovative techniques that assure meticulous delivery of posterior partial-coverage ceramic restorations.

Acid Etching, Dental↗
PubMed2000

Estimating the balance of general practice versus family planning clinic coverage of contraception services in London.

OBJECTIVE: To compare levels of provision of contraception from general practice and family planning clinics for the populations of the 32 London Boroughs. METHOD: Retrospective analysis of routine activity data, including the estimated numbers of first attendance, for 295 family planning clinics (managed by 28 NHS Trusts) and more than 1800 GP partnerships in Greater London, supplemented by data from a survey of family planning clinics. The results were expressed as the estimated percentage of women aged 16-49 obtaining advice on contraception from GPs and family planning clinics. These results were compared to those expected based on results in the General Household Survey. RESULTS: Across London in 1995/96, 12% of women aged 16-49 obtained contraception services from family planning clinics, and 24% obtained contraception services from a GP. At a borough level there was variation from 11% to 25% in coverage by family planning clinics, and from 11% to 41% in coverage by GPs. Estimates of the proportion of women in this age group not using NHS-provided medical or surgical contraception ranged from 0 to 30%. Across all boroughs, there was no consistent relationship between levels of GP activity and family planning clinic activity. CONCLUSION: The results indicate substantial variations between boroughs in the proportion of women using NHS-provided medical or surgical methods of contraception. The absence of any clear inverse relationship between activity in family planning clinics and activity in general practice suggests that changes to one will not be compensated by changes in the other. More specifically, health authorities that opt to purchase lower levels of family planning clinic activity cannot assume that women may opt to use GPs as an alternative. Such a strategy may increase the likelihood that women who would have used family planning clinic services will either not use contraception at all, or will use less effective 'over the counter' methods.

Adolescent↗
PubMed2000

Providing after-hours on-call clinical coverage in academic health sciences centres: the Hospital for Sick Children experience.

An increasing number of admissions of patients requiring complex and acute care coupled with a decreasing number of pediatric postgraduate trainees has caused a shortage of house staff available to provide after-hours on-call coverage in the Department of Pediatrics at Toronto's Hospital for Sick Children. The Clinical Assistant program created to deal with this problem was short on staff, did not provide adequate continuity of care and was becoming increasingly unaffordable. The Clinical Departmental Fellowship program was created to address the problem of after-hours clinical coverage. The program is aimed at qualified pediatricians seeking additional clinical or research training in one of the subspecialty divisions in the Department of Pediatrics. We describe the hiring process, job description and evolution of the program since its inception in 1996. This program has been mutually advantageous for the individual fellows and their sponsoring divisions as well as the Department of Pediatrics and the Hospital for Sick Children. We recommend the introduction of similar programs to other academic medical departments facing staff shortages.

Academic Medical Centers↗
PubMed1999

Immunization coverage among children born between 1989 and 1994 in Saladdin Governorate, Iraq.

We assessed vaccination coverage rates among children born between 1989 and 1994 (0-2 years of age) and tried to find the underlying causes of incomplete immunization. Of 662 children surveyed, 326 were from Tikrit city (urban) and 336 were from three rural villages. The coverage rates for BCG, DPT-OPV (first dose), DPT-OPV (second dose), DPT-OPV (third dose), measles, MMR, and DPT-OPV (first booster) were 97%, 97%, 94%, 92%, 83%, 70% and 59% respectively in Tikrit city; in rural areas they were 92%, 65%, 57%, 41%, 42%, 32%, and 25% respectively. The most common causes of incomplete immunization were unawareness and ignorance for both urban and rural areas. The percentage of children completely immunized declined between 1989 and 1994, both in urban and rural areas.

Attitude to Health↗
PubMed2000

Cataract surgical coverage: results of a population-based survey at Nkhoma, Malawi.

AIM: To determine the cataract surgical coverage (CSC) in the close proximity of Nkhoma Hospital, Malawi. METHOD: A rapid epidemiological assessment of the population aged 40 years and over was undertaken to determine the proportion of eyes and patients with cataract blindness that had previously received cataract surgery within a 10-mile radius of the hospital. RESULTS: A total of 993 people aged 40 years and above from all 31 small villages in the 10-mile radius were examined. The prevalence of blindness in this age group was 3.72%, of which 62% was due to cataract. The cataract surgical coverage for people with blinding cataract was calculated at 14.8%, and for eyes with cataract (visual acuity <3/60) 8.5%. CONCLUSION: Nkhoma Hospital has provided affordable cataract surgery for more than 20 years. Despite this, within a ten-mile radius of the hospital, only 1 in 7 people with bilateral blindness from cataract has received surgery.

Adult↗
PubMed2000

Improved bone regeneration and root coverage using a resorbable membrane with physically assisted cell migration and DFDBA.

Twelve patients with 2 Miller Class I or II buccal recession defects measuring > or = 3.0 mm were treated using the principles of guided tissue regeneration and followed for 12 months. The effectiveness of a polylactide (Guidor) resorbable membrane (GA sites) was compared to a combination treatment of polylactide membrane plus polyglactin root-lining mesh (Vicryl) and demineralized freeze-dried bone allograft (DFDBA) (GVB sites) designed to enhance cell migration and bone regeneration. There was 90% mean soft tissue root coverage for the GVB sites and 78% for the GA sites. The mean osseous dehiscence area coverage with hard tissue was 75% for GVB sites and 30% for GA sites.

Absorbable Implants↗
PubMed2001

[Construction of a deep coverage rice BAC library and identification of clones associated with disease-resistant genes].

A BAC library for IRBB56, an accession pyramiding Xa4, xa5 and xa13 three bacterial blight resistance genes, was constructed. The library contains 55,296 clones with an average insert size of 132 kb. Based on a haploid genome size of 450 Mb, the coverage of the library was about 14 genome equivalents that make it one of the most comprehensive BAC libraries available in rice and provide 99.99% possibility to isolate any interested rice genes or sequences in the library. To determine the representation of organelle DNA homologues in the library, the library was screened with three different chloroplast genes and four mitochondrial genes, respectively. Results from this screening showed that less than 1% of clones in the library contain organelle genomic DNA homologues. Then, DNA markers on three different chromosomes linked to Xa4, xa5, and xa13, and a PCR fragment of rice UROD gene, were used to screen the library resulting in a range of 11-106 hits that will promote the isolation of these genes. The deep coverage and the large insert size of the library will facilitate physical mapping, isolation, and cloning of rice genes.

Chromosomes, Artificial, Bacterial↗
PubMed2001

Medicare. Can its benefits be sustained as cost of coverage grows?

By many measures Medicare is one of the most successful government programs ever instituted, and its benefit to the health of older citizens is unquestioned. Yet it is not without chronic problems and challenges, including the cost of administering the program, limited insurance coverage for certain services and conditions, lack of standardization, and fraud. Moreover, new challenges arise as societal circumstances change and political demands fluctuate. Chief among the concerns are the imminent influx of baby boomers into the system and the debate over expanding the limited scope of Medicare coverage.

Aged↗
PubMedDate not supplied

Connective tissue grafting for root coverage in multiple Class III gingival recessions with enamel matrix derivative: a case report.

This case presentation demonstrates an innovative approach to root coverage that uses an enamel matrix derivative in conjunction with periosteal connective tissue grafting in a patient with multiple gingival facial recessions. A 22-year-old female patient presented for the resolution of aesthetic concerns associated with multiple gingival recessions for teeth #23(32) through #25(41). This technique achieved soft tissue coverage of the root surfaces and effectively improved the patient's aesthetic appearance. These satisfactory clinical results have been maintained for 12 months.

Acid Etching, Dental↗
PubMed1998

A simulation study on +Gz protection afforded by extended coverage anti-G suits.

Computer simulation studies using our newly developed mathematical model of human cardiovascular (CV) system were performed to investigate the effect of bladder coverage and inflation schedule of anti-G suit on G protection and CV response. The simulation results agree well with centrifuge experiments. The study demonstrates that additional +Gz protection provided by the extension of the bladder coverage depends mainly upon the pressure transmission efficiency to the underlying tissues and vessels. Although G tolerance increases clearly with the increase of suit inflation schedule, the tendency of increase seems slower when inflation schedule becomes higher than 10 kPa/G.

Acceleration↗
PubMed2001

Connective tissue grafting employing the tunnel technique: a case report of complete root coverage in the anterior maxilla.

Techniques for surgical root coverage have been continuously revised over the past few decades. With increased knowledge on the etiopathogenesis of gingival recessions and on the repair/regeneration mechanisms of deep and superficial periodontal tissues, procedure simplification has been possible, and more predictable and stable results have been obtained. The maintenance of maximal blood supply has brought major changes in flap design. The coverage of contiguous recessions on the maxillary central incisors using a conservative technique for the incision of the recipient site is presented, along with the 11-month follow-up from surgery. A supraperiosteal tunnel was performed for the insertion and stabilization of a connective tissue autograft.

Adult↗
PubMedDate not supplied

Coverage of Maternal Care Services in the state of West Bengal.

Evaluation of the Coverage of Maternal Care Services was conducted during the year 1999 in the entire State of West Bengal, Urban poor localities of randomly selected three Municipal Corporation areas and 'high-risk' urban wards or villages of West Bengal that had reported AFP cases in 1998. It was observed that mothers who had three or more antenatal check-ups varied between 54% to 82% in different study areas. Tetanus Toxoid coverage varied between 83.5% to 93.4% being lowest in high-risk areas. Only a very small section of mothers (12.7% to 23.7%) consumed 100 or more Iron and Folic acid tablets during pregnancy. 'Danger Signs' of pregnancy were informed to only 21.1% to 38.2% of the pregnant mothers. Proportion of home deliveries varied between 16.7% (Calcutta) to as high as 72.7% (high-risk areas). Deliveries conducted by untrained personnel were 60.8% in high risk areas, 38.1% in State clusters and between 14.2% to 29.4% in the three urban areas. Vast majority of mothers (78.8% to 88.4%) received no post-natal check-up.

Blood Pressure↗