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At least 19 recordsLinked to original sources
PubMed2000

Vaccination practices, policies, and management factors associated with high vaccination coverage levels in Georgia public clinics. Georgia Immunization Program Evaluation Team.

BACKGROUND: Controlling vaccine-preventable diseases by achieving high childhood vaccination coverage levels is a national priority. However, there are few, if any, comprehensive evaluations of state immunization programs in the United States, and little attention has been given to the importance of vaccination clinic management style and staff motivation. OBJECTIVE: To evaluate the factors associated with the increase in childhood vaccination coverage levels from 53% in 1988 to 89% in 1994 in Georgia's public health clinics. DESIGN: A 1994 mail survey obtaining information on clinic vaccination policies and practices and management practices. SETTING: All 227 public health clinics in Georgia. PARTICIPANTS: Clinic nurses responsible for vaccination services. OUTCOME MEASURE: The 1994 clinic-specific coverage level for 21- to 23-month-old children for 4 doses of diphtheria and tetanus toxoids and pertussis vaccine, 3 doses of polio vaccine, and 1 dose of a measles-containing vaccine as determined by an independent state assessment of clinic coverage levels. RESULTS: Univariate analysis showed that higher coverage levels were significantly (P<.05) associated with smaller clinic size, higher proportions of clientele enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), being a nonurban clinic, and numerous vaccination practices and policies. Multivariable analysis showed that only 8 of greater than 150 factors remained associated with higher coverage levels, including having no waiting time to be seen, having telephone reminder systems, conducting home visits for defaulters, and restricting WIC vouchers when a child was undervaccinated. Motivational factors related to higher coverage included clinic lead nurses receiving an incentive to raise coverage and lead nurses participating in assessments of clinic coverage levels by state immunization staff. CONCLUSIONS: No single factor is responsible for raising vaccination coverage levels. Efforts to improve coverage should include local assessment to provide feedback on performance and identify appropriate local solutions. Coordinating with WIC, conducting recall and reminder activities, motivating clinic staff, and having staff participate in decisions are important in raising vaccination levels.

Ambulatory Care Facilities↗
PubMed1999

Twinning project: Israel and Georgia--the birth of a diabetes-in-pregnancy centre in Georgia.

AIMS: To determine the effectiveness of a joint Israeli-Georgian twinning project aimed at introducing modern methods of perinatal care to Georgian women with pregestational diabetes mellitus. METHODS: A Diabetes-in-Pregnancy Centre was established in Georgia (in the former USSR). Thirty-two women with Type 1 diabetes mellitus participated in the first stage of the study (January 1997-June 1998). All were maintained under strict metabolic surveillance starting at least three months prior to conception and were given organized instruction in methods of self-monitoring of glucose levels, insulin dose adjustment, dietary management and close fetal surveillance throughout pregnancy. A second stage of the project was started in January 1998 and aimed at the diagnosis of gestational diabetes mellitus (GDM). RESULTS: Of the 32 women, 20 had had a total of 44 prior pregnancies without proper perinatal care (1990-96); only five (11.3%) ended in the birth of a healthy infant. On entry to the study, all 32 patients had unsatisfactory metabolic indices. HbA1c levels decreased significantly from the preconception period (P<0.001) and were maintained at the lower level throughout pregnancy; insulin doses decreased significantly until the third trimester (P<0.01) and then increased (P<0.001). Since January 1997, 21 women have become pregnant. Eighteen have given birth, 12 (67%) by Caesarean section and six (33%) by vaginal delivery. Gestational age at birth was 36-39 weeks, and birth weight ranged from 2300 to 4100 g. The only neonatal complications were mild respiratory distress syndrome and hypoglycaemia. There were no significant maternal complications in the 236 women screened, eight were diagnosed as having GDM and 12 impaired glucose tolerance. They were actively managed to a successful outcome. CONCLUSIONS: The establishment of the Diabetes-in-Pregnancy Centre in the Republic of Georgia has significantly reduced the prior high pre-programme perinatal morbidity and mortality as well as the incidence of maternal complications in pre-GDM as well as in GDM.

Adult↗
PubMed1997

Epidemiology of HIV-1 infection in rural Georgia: demographic trends and analysis at the Medical College of Georgia.

We have conducted a retrospective study of 100 HIV-infected patients enrolled in an AZT monotherapy clinical study at the Medical College of Georgia (MCG) in Augusta, Georgia. When compared to the national trends, our results confirm previous studies that describe an overall increase in the burden of HIV infections among blacks, and, in particular, black women in the rural Southeast. In our cohort, infections due to homosexual contact accounted for approximately 40% of all cases while heterosexual contact and intravenous drug use (IDU) comprised 33% and 13%, respectively. Infections attributable to all other risk factors accounted for the remaining 14%. Relative to national surveillance data, we observed an increase in the prevalence of HIV infections among blacks, and heterosexually acquired infections, particularly among black women. Our analysis illustrates the dynamic nature of the current U.S. epidemic which appears to be shifting both in terms of its demographic and epidemiological profile. These data may indicate that national surveillance data may not reflect the dynamic nature of current demographic trends in HIV incidence, particularly as evidenced in the rural Southeast. This suggests that hospital or laboratory based cross-sectional studies, like ours, that analyze demographic variables of HIV-infected clinic attendees may be necessary to more accurately assess the leading edge of the HIV epidemic in rural, non-metropolitan areas.

Female↗
PubMedDate not supplied

Isolation of Georgia variant (Georgia isolate 1992) infectious bronchitis virus but not Ornithobacterium rhinotracheale from a Kentucky broiler complex.

Integrated broiler production operations in western Kentucky have been very successful. The reason for this success includes the fact that flocks are free of many endemic diseases for a period of time, often years, because birds are raised in virgin, disease-free territory. This case report documents that importation of birds from an area with endemic Georgia variant (GA-92) infectious bronchitis virus and Ornithobacterium rhinotracheale (ORT) bacterial infection resulted in introduction of GA-92, but not ORT, to Kentucky farms. As more broiler production units locate in western Kentucky, in the early phases of operation, they may not experience the "virgin territory," disease-free advantage.

Animals↗