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PubMed1980

Health care in modern Cuba.

An extensively organized, centrally controlled system, aimed at equalizing and improving the distribution and quality of medical services according to population and geography, characterizes the modern Cuban health care complex. Facilities of increasing sophistication are located in urban areas while an expanding series of ambulatory, multipotential polyclinics attempts to provide most health services in both urban and rural settings. Maternal and child care, immunization programs and other forms of preventive medicine represent major priorities for expenditures. Occupational health is increasingly understood as a valuable resource, and medical professionals on all levels are being trained in significant numbers for Cuba and its allies.

Cuba↗
PubMed1981

Rubella exposure in an obstetric clinic.

Despite a massive national rubella immunization program, rubella infection remains a public health problem. When a nurse employed in a hospital-based obstetric clinic became ill with rubella, a crisis was precipitated. The hospital staff implemented a plan to inform the exposed 151 patients and 44 employees of the potential danger to themselves and their fetuses. To identify persons at risk, a program of rubella antibody testing of contacts was instituted. In 3 distinct attempts to obtain blood specimens, patient compliance rates fell progressively from 79 to 14%. One additional infected employee was detected. A list of recommendations designed to prevent or lessen the impact of future rubella exposures in hospitals is presented.

Adolescent↗
PubMed1994

The immunisation coordinator: improving uptake of childhood immunisation.

Attention to local uptake of childhood immunisation is fundamental to the achievement of national targets. The aim of this investigation was to discover whether local interventions by the immunisation coordinator in a district health authority improved uptake. The immunisation coordinator and a public health nurse determined the immunisation uptake in their locality. They made inquiries, and responded to general practitioners and health visitors who asked them to help encourage persistent non-attenders to consent to immunisation. All interventions intended to encourage parents to consent to immunisation (such as telephone calls, letters, and home visits), and their outcomes, were monitored. The uptake of immunisation was remeasured after one year. Ninety-three children were identified whose parents had not responded to repeated invitations for immunisation. Eleven cases were lost to follow up: the families of 10 children had moved out of the area, and one child had died. The remaining 82 children could be divided into two groups: one group, of 49 children, was due for primary vaccination (diphtheria, tetanus, pertussis, and polio, and measles, mumps, and rubella), and a second group, of 33 children, was due for the preschool (diphtheria, tetanus, and polio) booster. Fifty-eight of the 82 children were vaccinated as a result of the intervention. All but two general practices achieved the 90% target for uptake. The review showed that the locality as a whole achieved greater vaccine coverage. The biggest improvement was in the preschool booster uptake, which rose from 87% to 90%.

Age Factors↗
PubMedDate not supplied

Neonatal tetanus among rural-born Nigerian infants.

PROBLEM: Identify factors that influence the high rate of tetanus among infants born in rural areas. SUBJECTS: Home-born infants (n = 39) admitted to a medical center with fever. Males (n = 24) and females (n = 15); age range 3-15 days. METHOD: Retrospective, descriptive design. The author used a 10-item interview schedule and a 9-item clinical checklist, including observation of infants' umbilical cords and physical state. FINDINGS: Of the 39 infants, 27 contracted neonatal tetanus; 11 died. All infants with tetanus were delivered at home by traditional, nonprofessional attendants. Factors contributing to high tetanus incidence included: lack of sepsis control, cord care, mothers' lack of immunization, delivery in settings. CONCLUSIONS & IMPLICATIONS FOR NURSING: Traditional nonprofessional attendants need training by professional nurses and midwives, and integration into the national health services. Immunization programs and health education are necessary, and can be delivered by nurses and midwives.

Female↗
PubMed1995

[Poliomyelitis].

The epidemiology of poliomyelitis, the poliovaccines and the present state of the WHO campaign for world-wide eradication of the polioviruses until the year 2000 are reviewed. In a second part, the recommendations of the "Ständige Impfkommission (STIKO, immunization task force)" from 1994 for Germany concerning poliovaccination are discussed. In contrast to the industrialized countries, the oral vaccination of infants in protection rates. After changes in vaccination strategy including mass vaccination days, the eradication campaign has succeeded in a considerable number of developing nations. However, because of limited financial resources and organizational difficulties the year 2000 goal for global eradication of polioviruses will hardly be met. The vaccination strategy of the STIKO continues to rely essentially on the trivalent oral poliovirus vaccine. The enhanced-potency inactivated polio vaccine is recommended for immunodeficient and all HIV-positive vaccinees as well as vaccinees with immunodeficient or HIV-positive contacts. Combined use of oral live vaccine and inactivated poliovirus vaccine induces an excellent local and systemic immunity. A combined vaccination strategy should be of particular interest in situations where other strategies fail.

Adult↗
PubMed1994

[Whooping cough epidemiology in Chile (1950-1990). The adult as new reservoir of infection?].

The epidemiology of whooping cough is analyzed using the disease notifications in Metropolitan Region and some rural areas from 1950 to 1990. Morbidity rate tendencies show a decreasing endemic disease interrupted by irregular increases, the last in 1985. Mortality fell from 11.9 per 100,000 in 1950 (60% of deaths in boys of less than one year old), to less than 1 per 100,000 since 1967. Since 1982, all deaths occurred in less than one year old boys. Lethality was high initially, specially in rural areas but the differences with Metropolitan area decreased since 1975. Approximately 90% of notifications are in less than one year old boys. However, there is a sustained rate elevation in boys older than 10 years old, predicting the increasing importance of the infection in young adults. The described changes antedate and are intensified by the immunization program. Their relationship to the lack of compliance with the program and the vaccine efficacy are discussed.

Adolescent↗
PubMed1994

Eradication of poliomyelitis in Bulgaria--problem encountered.

The authors analyze the effectiveness of the National Vaccination Programme with regard to poliomyelitis eradication in Bulgaria and the difficulties encountered in the 1980s and at the beginning of the 1990s. An account is presented on the eradication achieved, interrupted by an outbreak of 46 cases in 1991. The critical analysis points out the negative influence of several factors, disrupted by the failure in 1991. Based on these fact conclusions are drawn on a prolongation of the period needed to achieve the Eradication Programme goal. The main reasons for the delay are as follows: the intensive migration process, the existence of small non-immunized groups of population (gipsy population) as well as some shortcomings in the organization of the health services. According to the authors, stricter epidemiologic supervision is imperative for the country as well as coordination of similar approach to the problem in countries of the region.

Adolescent↗
PubMed1994

[The use of finite population sampling and lot quality assurance sampling in estimating "immunization coverage rate" in villages (towns)].

We have used Finite Population Sampling and Lot Quality Assurance Sampling (LQAS) in a field survey of "immunization coverage rate" for EPI in three villages (towns) in Lanxi Zhejiang Province. The results showed that there was no significant difference (P > 0.05) between the rates of two samplings and between the rate of sampling and population. These results indicated that both Finite population Sampling and LQAS are cheap and simple, and can represent the immunization coverage level of population.

Female↗
PubMedDate not supplied

Improving the immunization coverage of children less than 7 years old in a family practice residency.

BACKGROUND: This prospective cohort study was designed to evaluate the effectiveness of mail and telephone contact with parents as a means to improve the immunization coverage of children less than 7 years old in a family practice residency clinic. METHODS: Immunization records for 519 children enrolled in an outpatient clinic were reviewed and updated. Children whose immunizations were current (55) were excluded, which left 464 children whose immunizations were more than 1 month behind for their age groups. A random sample of one-half of these children (231) were mailed a postcard listing the immunizations that they required to be up to date. The mailing was followed up with telephone contact, when necessary, to prompt compliance. The other one-half of the children were not contacted and served as the control group. Immunizations provided to the two groups were compared 6 months after the initial mailing. RESULTS: Before the initiation of the study, only 10.6 percent of the infants and children in the practice had their immunizations completed or were up to date. There were 124 immunizations given to 49 children in the intervention group compared with 84 immunizations to 33 children in the control (P < 0.047). Thirty-four children were brought up to date in the control group compared with 17 in the intervention cohort (P < 0.011). CONCLUSIONS: Direct mail reminders and telephone contact with parents of children who were behind in their immunizations were effective methods to encourage compliance. The increased number of immunizations received by the children in the intervention group was overshadowed by the poor coverage of the entire practice, a highly mobile and predominantly indigent group. Additional interventions are urgently needed to improve immunization levels in infants and children.

Appointments and Schedules↗