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At least 1,711 records · Page 95Linked to original sources
PubMed1988

The straw men of primary health care.

The following paper discusses the progress made in providing primary health care (PHC) to the developing world in the 10 years following the joint WHO/UNICEF International Conference on Primary Health Care held at Alma Ata, U.S.S.R., in 1978. UNICEF is now 12 years from the goal to provide Health for All by the Year 2000. In this context, the authors describe UNICEF's 'country programming approach' to PHC as part of the child survival and development revolution (CSDR), articulated by the agency in 1982. A polarization between the two concepts of 'selective' and 'comprehensive' PHC is examined in the light of quotations from the original conference document which set forth strategies and priorities. The authors, a consultant and a staff member of UNICEF, respond to criticism of the agency in this regard by drawing directly on UNICEF's own work in the field and its record of success, even at a time when developing countries are battling severe economic constraints and health budgets are being slashed--a contingency not foreseen at Alma Ata. WHO evaluations of both the Expanded Program on Immunization (EPI) and oral rehydration therapy (ORT) show that accelerated programs develop best when underpinned by a good health infrastructure. The challenge is to develop priority programs in such a way as to build on or strengthen this infrastructure. Flexibility is the key in adapting national priorities to local programs. The point is made that international agencies should be careful to limit themselves to advocacy and support.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed2005

Financing vaccines in the 21st century: recommendations from the National Vaccine Advisory Committee.

In 2003, the National Vaccine Advisory Committee (NVAC) formed a working group to examine recommendations related to vaccine financing contained in the 2003 Institute of Medicine report on financing immunizations, "Financing Vaccines in the 21st Century: Assuring Access and Availability." During 2003-2004, the working group conducted a series of activities leading to a meeting with stakeholders in June 2004. Based on these discussions and meetings, NVAC recommended that the Department of Health and Human Services (DHHS) not adopt the Institute of Medicine (IOM) recommendation to replace the current immunization financing system with an insurance mandate and system of subsidies and vouchers. NVAC instead proposed substantial, but incremental, changes to the current system that would go a long way toward stabilizing the financing of immunizations in the United States. The proposed changes include expanded and stable funding for the existing immunization grant program, expansion of the Vaccines for Children program, regulatory harmonization, promotion of "first dollar" insurance coverage for immunizations, and the assurance of adequate reimbursement for the administration of vaccines.

Advisory Committees↗
PubMed2005

The causes of racial and ethnic differences in influenza vaccination rates among elderly Medicare beneficiaries.

OBJECTIVE: To explore three potential causes of racial/ethnic differences in influenza vaccination rates in the elderly: (1) resistant attitudes and beliefs regarding vaccination by African-American and Hispanic Medicare beneficiaries, (2) poor access to care during influenza vaccination weeks, and (3) discriminatory behavior by providers. DATA SOURCES: Medicare beneficiaries who responded to both the 1995 and 1996 Medicare Current Beneficiary Survey (MCBS) (n=6,746). STUDY DESIGN: We combined survey information from the MCBS with Medicare claims. We measured resistance to vaccination by self-reported reasons for not receiving vaccination, access to care by claims submitted during vaccination weeks, and discrimination by racial differences in vaccinations among beneficiaries who visited the same providers during vaccination weeks. PRINCIPAL FINDINGS: White beneficiaries (66.6 percent) were more likely to self-report having received vaccination than were African Americans (43.3 percent) or Hispanics (52.5 percent). Resistance to vaccination plays a role in low vaccination rates of African-American (-11.8 percentage points), but not Hispanic beneficiaries. Unequal access accounts for <2 percent of the disparity. Minority beneficiaries remained unvaccinated despite having medical encounters with their usual providers on days when those same providers were administering vaccinations to white beneficiaries. This disparity is attributable not to provider discrimination but to a 1.6-5 x higher likelihood of white beneficiaries initiating encounters for the purpose of receiving vaccination. CONCLUSION: Disparities in access to care and provider discrimination play little role in explaining racial/ethnic disparities in influenza vaccination. Eliminating missed opportunities for vaccination in 1995 would have raised vaccination rates in three racial/ethnic groups to the Healthy People 2000 goal of 60 percent vaccination.

Black or African American↗
PubMed1982

Public health implications of rubella antibody levels in California.

Rubella hemaggluttination inhibition (HI) antibody determinations were performed in 1977 on a sample of California school children and in 1977-1979 on young women who were about to be married or who were pregnant. Among the pupils, 66 per cent reported prior rubella immunization; immunization history was more common in younger pupils. Seventy-seven per cent had detectable antibody, with little trend of greater seropositivity at older ages. Over 86 per cent of those with a written record of immunization had detectable antibody. There was no consistent indication of loss of seropositivity with increasing time since immunization. Children immunized at 12-14 months of age tended to have a lower seropositivity rate than those immunized at older ages. Among young women, the prevalence of detectable antibody was 80-83 per cent. Comparison with data obtained in 1968-1969 indicates that rubella immunization has had a marked impact on antibody levels in children but less impact on levels in teenagers and adults. The pool of rubella-susceptibles entering secondary schools will probably not decrease soon, so that rubella outbreaks may continue in high school and college-age populations. Ultimately, school entry immunization requirements should drastically curtail disease activity. In the interim, programs to immunize teenagers and young adult females must be strengthened. (Am J Public Health 1982; 72:167-172.)

Adolescent↗
PubMed1992

[The monitor method of immunization coverage].

A comprehensive monitor method of immunization coverage is suggested to be applied to the expanded program on immunization. The routine coverage reporting system should be set up combined with surveys in selected townships. The criteria for doing survey is expressed in the flow chart. Two sampling methods are presented based on the principle of lot quality assurance sampling (LQAS) and coverage rate could be estimated after the surveys.

Child↗
PubMed1991

The measles epidemic. The problems, barriers, and recommendations. The National Vaccine Advisory Committee.

The nation has experienced a marked increase in measles cases during 1989 and 1990. Almost one half of all cases have occurred in unvaccinated preschool children, mostly minorities. The principal cause for the epidemic is failure to provide vaccine to vulnerable children on schedule. Major reasons for the low vaccine coverage exist within the health care system itself, which creates barriers to obtaining immunization and fails to take advantage of many opportunities to provide vaccines to children. Ideally, immunizations should be given as part of a comprehensive child health care program. However, immunization cannot await the development of such an ideal system. Essential changes can and should be made now. Specific recommendations include improved availability of immunization; improved management of immunization services; improved capacity to measure childhood immunization status; implementation of the two-dose measles vaccine strategy; and laboratory, epidemiologic, and operational studies to further define the determinants of decreased vaccine coverage and to develop new combinations of vaccines that can be administered earlier in life. The measles epidemic may be a warning flag of problems with our system of primary health care.

Adolescent↗
PubMed2005

Prenatal alcohol exposure and fetal programming: effects on neuroendocrine and immune function.

Alcohol abuse is known to result in clinical abnormalities of endocrine function and neuroendocrine regulation. However, most studies have been conducted on males. Only recently have studies begun to investigate the influence of alcohol on endocrine function in females and, more specifically, endocrine function during pregnancy. Alcohol-induced endocrine imbalances may contribute to the etiology of fetal alcohol syndrome. Alcohol crosses the placenta and can directly affect developing fetal cells and tissues. Alcohol-induced changes in maternal endocrine function can disrupt maternal-fetal hormonal interactions and affect the female's ability to maintain a successful pregnancy, thus indirectly affecting the fetus. In this review, we focus on the adverse effects of prenatal alcohol exposure on neuroendocrine and immune function, with particular emphasis on the hypothalamic-pituitary-adrenal (HPA) axis and the concept of fetal programming. The HPA axis is highly susceptible to programming during fetal development. Early environmental experiences, including exposure to alcohol, can reprogram the HPA axis such that HPA tone is increased throughout life. We present data that demonstrate that maternal alcohol consumption increases HPA activity in both the maternal female and the offspring. Increased exposure to endogenous glucocorticoids throughout the lifespan can alter behavioral and physiologic responsiveness and increase vulnerability to illnesses or disorders later in life. Alterations in immune function may be one of the long-term consequences of fetal HPA programming. We discuss studies that demonstrate the adverse effects of alcohol on immune competence and the increased vulnerability of ethanol-exposed offspring to the immunosuppressive effects of stress. Fetal programming of HPA activity may underlie some of the long-term behavioral, cognitive, and immune deficits that are observed following prenatal alcohol exposure.

Alcohol Drinking↗
PubMed1997

Immunity to tetanus and diphtheria in rural Africa.

To assess the effect of the Expanded Program on Immunization (EPI) in rural Africa, blood samples were collected in two Kenyan sublocations. Serum antibodies against tetanus toxoid were measured in 155 individuals 1-70 years of age. Titers greater than the protective level of 0.01 IU/ml were found in 47% of the population. Protection was significantly higher in children born after the launching of the EPI (68%) and in women who had been at childbearing age since then (69%). Significantly lower protection was demonstrated in other age and sex-groups. The level of protection in children was equal in the two populations, whereas protection in fertile women was significantly lower in the population living a long distance from a health center. Diphtheria anti-toxin was measured in the samples from one sublocation, and 70 of 84 individuals (83%) had antibody levels greater than the protective level. No age or sex difference could be found, and there was no correlation between response levels to diphtheria and tetanus. This implicates natural infections as an important source of diphtheria antibodies. Our findings demonstrate a need for better coverage of the adult population against tetanus. Furthermore, diphtheria transmission still appears to take place, underscoring the importance of diphtheria vaccination of travelers to rural Africa.

Adolescent↗
PubMed1995

Programmed T-cell death in experimental chagas disease.

In mature T cells, programmed cell death is thought to serve a regulatory function by limiting both the duration and amplitude of immune responses. Programmed cell death might also be involved in immuno-pathogenesis of certain infectious diseases: recent evidence suggests that programmed T-cell death plays an important role in immune suppression during viral infections. In this article, George DosReis, Maria Evangelina Fonseca and Marcela Lopes review their findings on programmed T-cell death in experimental infection induced by the protozoan parasite Trypanosoma cruzi, the causative agent of Chagas disease. They also discuss the differential behavior of CD4(+) and CD8(+) T-cell subsets regarding programmed cell death, and same possible pathogenic aspects of host-parasite interaction, where abnormal or exaggerated programmed T-cell death could be involved.

Journal Article↗