Sample records for vulnerable group coverage
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Killeen, Gerry F; Smith, Tom A; Ferguson, Heather M; Mshinda, Hassan; Abdulla, Salim; Lengeler, Christian; Kachur, Steven P
2007-01-01
Background Malaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. Insecticide-treated nets (ITNs) represent a practical means to prevent malaria in Africa, so scaling up coverage to at least 80% of young children and pregnant women by 2010 is integral to the Millennium Development Goals (MDG). Targeting individual protection to vulnerable groups is an accepted priority, but community-level impacts of broader population coverage are largely ignored even though they may be just as important. We therefore estimated coverage thresholds for entire populations at which individual- and community-level protection are equivalent, representing rational targets for ITN coverage beyond vulnerable groups. Methods and Findings Using field-parameterized malaria transmission models, we show that high (80% use) but exclusively targeted coverage of young children and pregnant women (representing <20% of the population) will deliver limited protection and equity for these vulnerable groups. In contrast, relatively modest coverage (35%–65% use, with this threshold depending on ecological scenario and net quality) of all adults and children, rather than just vulnerable groups, can achieve equitable community-wide benefits equivalent to or greater than personal protection. Conclusions Coverage of entire populations will be required to accomplish large reductions of the malaria burden in Africa. While coverage of vulnerable groups should still be prioritized, the equitable and communal benefits of wide-scale ITN use by older children and adults should be explicitly promoted and evaluated by national malaria control programmes. ITN use by the majority of entire populations could protect all children in such communities, even those not actually covered by achieving existing personal protection targets of the MDG, Roll Back Malaria Partnership, or the US President's Malaria Initiative. PMID:17608562
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2013-01-01
Background One of the most crucial steps towards delivering judicious and comprehensive mental health care is the formulation of a policy and plan that will navigate mental health systems. For policy-makers, the challenges of a high-quality mental health system are considerable: the provision of mental health services to all who need them, in an equitable way, in a mode that promotes human rights and health outcomes. Method EquiFrame, a novel policy analysis framework, was used to evaluate the mental health policies of Malawi, Namibia, and Sudan. The health policies were assessed in terms of their coverage of 21 predefined Core Concepts of human rights (Core Concept Coverage), their stated quality of commitment to said Core Concepts (Core Concept Quality), and their inclusion of 12 Vulnerable Groups (Vulnerable Group Coverage). In relation to these summary indices, each policy was also assigned an Overall Summary Ranking, in terms of it being of High, Moderate, or Low quality. Results Substantial variability was identified across EquiFrame’s summary indices for the mental health policies of Malawi, Namibia, and Sudan. However, all three mental health policies scored high on Core Concept Coverage. Particularly noteworthy was the Sudanese policy, which scored 86% on Core Concept Coverage, and 92% on Vulnerable Group Coverage. Particular deficits were evident in the Malawian mental health policy, which scored 33% on Vulnerable Group Coverage and 47% on Core Concept Quality, and was assigned an Overall Summary Ranking of Low accordingly. The Overall Summary Ranking for the Namibian Mental Health Policy was High; for the Sudanese Mental Health Policy was Moderate; and for the Malawian Mental Health Policy was Low. Conclusions If human rights and equity underpin policy formation, it is more likely that they will be inculcated in health service delivery. EquiFrame may provide a novel and valuable tool for mental health policy analysis in relation to core concepts of human rights and inclusion of vulnerable groups, a key practical step in the successful realization of the Millennium Development Goals. PMID:23406583
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Aaron, Grant J; Friesen, Valerie M; Jungjohann, Svenja; Garrett, Greg S; Myatt, Mark
2017-01-01
Background: Large-scale food fortification (LSFF) of commonly consumed food vehicles is widely implemented in low- and middle-income countries. Many programs have monitoring information gaps and most countries fail to assess program coverage. Objective: The aim of this work was to present LSFF coverage survey findings (overall and in vulnerable populations) from 18 programs (7 wheat flour, 4 maize flour, and 7 edible oil programs) conducted in 8 countries between 2013 and 2015. Methods: A Fortification Assessment Coverage Toolkit (FACT) was developed to standardize the assessments. Three indicators were used to assess the relations between coverage and vulnerability: 1) poverty, 2) poor dietary diversity, and 3) rural residence. Three measures of coverage were assessed: 1) consumption of the vehicle, 2) consumption of a fortifiable vehicle, and 3) consumption of a fortified vehicle. Individual program performance was assessed based on the following: 1) achieving overall coverage ≥50%, 2) achieving coverage of ≥75% in ≥1 vulnerable group, and 3) achieving equity in coverage for ≥1 vulnerable group. Results: Coverage varied widely by food vehicle and country. Only 2 of the 18 LSFF programs assessed met all 3 program performance criteria. The 2 main program bottlenecks were a poor choice of vehicle and failure to fortify a fortifiable vehicle (i.e., absence of fortification). Conclusions: The results highlight the importance of sound program design and routine monitoring and evaluation. There is strong evidence of the impact and cost-effectiveness of LSFF; however, impact can only be achieved when the necessary activities and processes during program design and implementation are followed. The FACT approach fills an important gap in the availability of standardized tools. The LSFF programs assessed here need to be re-evaluated to determine whether to further invest in the programs, whether other vehicles are appropriate, and whether other approaches are needed. PMID:28404836
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Aaron, Grant J; Friesen, Valerie M; Jungjohann, Svenja; Garrett, Greg S; Neufeld, Lynnette M; Myatt, Mark
2017-05-01
Background: Large-scale food fortification (LSFF) of commonly consumed food vehicles is widely implemented in low- and middle-income countries. Many programs have monitoring information gaps and most countries fail to assess program coverage. Objective: The aim of this work was to present LSFF coverage survey findings (overall and in vulnerable populations) from 18 programs (7 wheat flour, 4 maize flour, and 7 edible oil programs) conducted in 8 countries between 2013 and 2015. Methods: A Fortification Assessment Coverage Toolkit (FACT) was developed to standardize the assessments. Three indicators were used to assess the relations between coverage and vulnerability: 1 ) poverty, 2 ) poor dietary diversity, and 3 ) rural residence. Three measures of coverage were assessed: 1 ) consumption of the vehicle, 2 ) consumption of a fortifiable vehicle, and 3 ) consumption of a fortified vehicle. Individual program performance was assessed based on the following: 1 ) achieving overall coverage ≥50%, 2) achieving coverage of ≥75% in ≥1 vulnerable group, and 3 ) achieving equity in coverage for ≥1 vulnerable group. Results: Coverage varied widely by food vehicle and country. Only 2 of the 18 LSFF programs assessed met all 3 program performance criteria. The 2 main program bottlenecks were a poor choice of vehicle and failure to fortify a fortifiable vehicle (i.e., absence of fortification). Conclusions: The results highlight the importance of sound program design and routine monitoring and evaluation. There is strong evidence of the impact and cost-effectiveness of LSFF; however, impact can only be achieved when the necessary activities and processes during program design and implementation are followed. The FACT approach fills an important gap in the availability of standardized tools. The LSFF programs assessed here need to be re-evaluated to determine whether to further invest in the programs, whether other vehicles are appropriate, and whether other approaches are needed.
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van Ginneken, Ewout; Rice, Thomas
2015-08-01
Experience from the Netherlands, Switzerland, and Germany suggests that there may be a looming problem concerning uninsured individuals and defaulters that could derail coverage projection numbers in the United States under the Affordable Care Act. In those countries, the young, people with migrant backgrounds, and those with lower incomes-precisely the groups the Affordable Care Act is seeking to cover-are overrepresented in the numbers of the uninsured and defaulters, frequently because of difficulty in paying for their premiums. In these three countries, penalties or suspension of coverage alone has not led everyone to purchase coverage or prevented some from defaulting. Help in addressing the vulnerable position of the uninsured may be needed. Examples include using a multifaceted approach in which public authorities help with debt restructuring, freeing some funds in the exchanges to help vulnerable groups, and compensating insurers for their outstanding payments if they follow an agreed protocol instead of canceling coverage. © The Author(s) 2015.
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Chinyama, Mathews Junior; MacLachlan, Malcolm; McVeigh, Joanne; Huss, Tessy; Gawamadzi, Sylvester
2018-01-01
Background: Equity and social inclusion for vulnerable groups in policy development processes and resulting documents remain a challenge globally. Most often, the marginalization of vulnerable groups is overlooked in both the planning and practice of health service delivery. Such marginalization may occur because authorities deem the targeting of those who already have better access to healthcare a cheaper and easier way to achieve short-term health gains. The Government of Malawi wishes to achieve an equitable and inclusive HIV and AIDS Policy. The aim of this study is to assess the extent to which the Malawi Policy review process addressed regional and international health priorities of equity and social inclusion for vulnerable groups in the policy content and policy revision process. Methods: This research design comprised two phases. First, the content of the Malawi HIV and AIDS Policy was assessed using EquiFrame regarding its coverage of 21 Core Concepts of human rights and inclusion of 12 Vulnerable Groups. Second, the engagement of vulnerable groups in the policy process was assessed using the EquIPP matrix. For the latter, 10 interviews were conducted with a purposive sample of representatives of public sector, civil society organizations and development partners who participated in the policy revision process. Data was also collected from documented information of the policy processes. Results: Our analyses indicated that the Malawi HIV and AIDS Policy had a relatively high coverage of Core Concepts of human rights and Vulnerable Groups; although with some notable omissions. The analyses also found that reasonable steps were taken to engage and promote participation of vulnerable groups in the planning, development, implementation, monitoring and evaluation processes of the HIV and AIDS Policy, although again, with some notable exceptions. This is the first study to use both EquiFrame and EquIPP as complimentary tools to assess the content and process of policy. Conclusion: While the findings indicate inclusive processes, commitment to Core Concepts of human rights and inclusion of Vulnerable Groups in relation to the Malawi HIV and AIDS Policy, the results also point to areas in which social inclusion and equity could be further strengthened. PMID:29626397
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Vilcu, Ileana; Mathauer, Inke
2016-01-15
Many countries from the European region, which moved from a government financed and provided health system to social health insurance, would have had the risk of moving away from universal health coverage if they had followed a "traditional" approach. The Eastern European high-income countries studied in this paper managed to avoid this potential pitfall by using state budget revenues to explicitly pay health insurance contributions on behalf of certain (vulnerable) population groups who have difficulties to pay these contributions themselves. The institutional design aspects of their government revenue transfer arrangements are analysed, as well as their impact on universal health coverage progress. This regional study is based on literature review and review of databases for the performance assessment. The analytical framework focuses on the following institutional design features: rules on eligibility for contribution exemption, financing and pooling arrangements, and purchasing arrangements and benefit package design. More commonalities than differences can be identified across countries: a broad range of groups eligible for exemption from payment of health insurance contributions, full state contributions on behalf of the exempted groups, mostly mandatory participation, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. In terms of performance, all countries have high total population coverage rates, but there are still challenges regarding financial protection and access to and utilization of health care services, especially for low income people. Overall, government revenue transfer arrangements to exempt vulnerable groups from contributions are one option to progress towards universal health coverage.
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Vilcu, Ileana; Probst, Lilli; Dorjsuren, Bayarsaikhan; Mathauer, Inke
2016-10-04
Many low- and middle-income countries with a social health insurance system face challenges on their road towards universal health coverage (UHC), especially for people in the informal sector and vulnerable population groups or the informally employed. One way to address this is to subsidize their contributions through general government revenue transfers to the health insurance fund. This paper provides an overview of such health financing arrangements in Asian low- and middle-income countries. The purpose is to assess the institutional design features of government subsidized health insurance type arrangements for vulnerable and informally employed population groups and to explore how these features contribute to UHC progress. This regional study is based on a literature search to collect country information on the specific institutional design features of such subsidization arrangements and data related to UHC progress indicators, i.e. population coverage, financial protection and access to care. The institutional design analysis focuses on eligibility rules, targeting and enrolment procedures; financing arrangements; the pooling architecture; and benefit entitlements. Such financing arrangements currently exist in 8 countries with a total of 14 subsidization schemes. The most frequent groups covered are the poor, older persons and children. Membership in these arrangements is mostly mandatory as is full subsidization. An integrated pool for both the subsidized and the contributors exists in half of the countries, which is one of the most decisive features for equitable access and financial protection. Nonetheless, in most schemes, utilization rates of the subsidized are higher compared to the uninsured, but still lower compared to insured formal sector employees. Total population coverage rates, as well as a higher share of the subsidized in the total insured population are related with broader eligibility criteria. Overall, government subsidized health insurance type arrangements can be effective mechanism to help countries progress towards UHC, yet there is potential to improve on institutional design features as well as implementation.
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Robertson, Laura; Mushati, Phyllis; Skovdal, Morten; Eaton, Jeffrey W.; Makoni, Jeremiah C.; Crea, Tom; Mavise, Gideon; Dumba, Lovemore; Schumacher, Christina; Sherr, Lorraine; Nyamukapa, Constance; Gregson, Simon
2014-01-01
Summary We used baseline data, collected in July–September 2009, from a randomized controlled trial of a cash transfer program for vulnerable children in eastern Zimbabwe to investigate the effectiveness, coverage, and efficiency of census- and community-based targeting methods for reaching vulnerable children. Focus group discussions and in-depth interviews with beneficiaries and other stakeholders were used to explore community perspectives on targeting. Community members reported that their participation improved ownership and reduced conflict and jealousy. However, all the methods failed to target a large proportion of vulnerable children and there was poor agreement between the community- and census-based methods. PMID:24748713
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[Immunization and equity in the Regional Initiative of the Mesoamerican Health Initiative].
Franco-Paredes, Carlos; Hernández-Ramos, Isabel; Santos-Preciado, José Ignacio
2011-01-01
National immunization rates indicate high vaccine coverage in Mesoamerica, but there is growing evidence that the most vulnerable groups are not being reached by immunization programs. Therefore, there is likely low effective vaccine coverage in the region, leading to persistent and growing health inequity. The planning phase of this project was from June to December 2009. The project will be conducted in the target populations which includes children under five, pregnant women, and women of child-bearing age from the most vulnerable populations within countries of the Mesoamerican region, as indicated geographically by a low human development index (HDI) and/or high prevalence of poverty at the municipal level and through the use of participatory methods to define poverty and vulnerability in local contexts. We defined three lines of action for vaccine-preventable disease interventions: 1) pilot projects to fill gaps in knowledge; 2) strengthening immunization policy; and 3) implementation of evidence-based practices. Health system strengthening through health equity is the central regional objective of the immunization workgroup. We hope to have a transformational impact on health systems so as to improve effective coverage, including vaccine and other integrated primary healthcare services.
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Chinyama, Mathews Junior; MacLachlan, Malcolm; McVeigh, Joanne; Huss, Tessy; Gawamadzi, Sylvester
2017-07-29
Equity and social inclusion for vulnerable groups in policy development processes and resulting documents remain a challenge globally. Most often, the marginalization of vulnerable groups is overlooked in both the planning and practice of health service delivery. Such marginalization may occur because authorities deem the targeting of those who already have better access to healthcare a cheaper and easier way to achieve short-term health gains. The Government of Malawi wishes to achieve an equitable and inclusive HIV and AIDS Policy. The aim of this study is to assess the extent to which the Malawi Policy review process addressed regional and international health priorities of equity and social inclusion for vulnerable groups in the policy content and policy revision process. This research design comprised two phases. First, the content of the Malawi HIV and AIDS Policy was assessed using EquiFrame regarding its coverage of 21 Core Concepts of human rights and inclusion of 12 Vulnerable Groups. Second, the engagement of vulnerable groups in the policy process was assessed using the EquIPP matrix. For the latter, 10 interviews were conducted with a purposive sample of representatives of public sector, civil society organizations and development partners who participated in the policy revision process. Data was also collected from documented information of the policy processes. Our analyses indicated that the Malawi HIV and AIDS Policy had a relatively high coverage of Core Concepts of human rights and Vulnerable Groups; although with some notable omissions. The analyses also found that reasonable steps were taken to engage and promote participation of vulnerable groups in the planning, development, implementation, monitoring and evaluation processes of the HIV and AIDS Policy, although again, with some notable exceptions. This is the first study to use both EquiFrame and EquIPP as complimentary tools to assess the content and process of policy. While the findings indicate inclusive processes, commitment to Core Concepts of human rights and inclusion of Vulnerable Groups in relation to the Malawi HIV and AIDS Policy, the results also point to areas in which social inclusion and equity could be further strengthened. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Transplant recipients are vulnerable to coverage denial under Medicare Part D.
Potter, Lisa M; Maldonado, Angela Q; Lentine, Krista L; Schnitzler, Mark A; Zhang, Zidong; Hess, Gregory P; Garrity, Edward; Kasiske, Bertram L; Axelrod, David A
2018-02-15
Transplant immunosuppressants are often used off-label because of insufficient randomized prospective trial data to achieve organ-specific US Food and Drug Administration (FDA) approval. Transplant recipients who rely on Medicare Part D for immunosuppressant drug coverage are vulnerable to coverage denial for off-label prescriptions, unless use is supported by Centers for Medicare & Medicaid Services (CMS)-approved compendia. An integrated dataset including national transplant registry data and 3 years of dispensed pharmacy records was used to identify the prevalence of immunosuppression use that is both off-label and not supported by CMS-approved compendia. Numbers of potentially vulnerable transplant recipients were identified. Off-label and off-compendia immunosuppression regimens are frequently prescribed (3-year mean: lung 66.5%, intestine 34.2%, pancreas 33.4%, heart 21.8%, liver 16.5%, kidney 0%). The annual retail cost of these at-risk medications exceeds $30 million. This population-based study of transplant immunosuppressants vulnerable to claim denials under Medicare Part D coverage demonstrates a substantial gap between clinical practice, current FDA approval processes, and policy mandates for pharmaceutical coverage. This coverage barrier reduces access to life-saving medications for patients without alternative resources and may increase the risk of graft loss and death from medication nonadherence. © 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.
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Marital disruption and health insurance.
Peters, H Elizabeth; Simon, Kosali; Taber, Jamie Rubenstein
2014-08-01
Despite the high levels of marital disruption in the United States and the fact that a significant portion of health insurance coverage for those less than age 65 is based on family membership, surprisingly little research is available on the consequences of marital disruption for the health insurance coverage of men, women, and children. We address this shortfall by examining patterns of coverage surrounding marital disruption for men, women, and children, further subset by educational level. Using the 1996, 2001, and 2004 panels of the Survey of Income and Program Participation (SIPP), we find large differences in health insurance coverage across marital status groups in the cross-section. In longitudinal analyses that focus on within-person change, we find small overall coverage changes but large changes in type of coverage following marital disruption. Both men and women show increases in private coverage in their own names, but offsetting decreases in dependent coverage tend to be larger. One surprising result is that dependent coverage for children also declines after marital dissolution, even though children are still likely to be eligible for that coverage. Children and (to a lesser extent) women show increases in public coverage around the time of divorce or separation. We also find that these patterns differ by education. The most vulnerable group appears to be lower-educated women with children because the increases in private, own-name, and public insurance are not large enough to offset the large decrease in dependent coverage. As the United States implements federal health reform, it is critical that we understand the ways in which life course events-specifically, marital disruption-shape the dynamic patterns of coverage.
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Medication coverage for lawmakers may worsen access for everyone else.
Taglione, Michael S; Boozary, Andrew; Persaud, Nav
2018-03-01
Despite numerous recommendations for universal public coverage of prescription drugs in Canada based on evidence that millions of Canadians cannot afford medications, no province or territory has adopted first dollar coverage for all residents. However, one group unaffected by the lack of public coverage are lawmakers. Lawmakers receive excellent drug coverage plans for themselves and their immediate families. Evidence suggests that lawmakers' decisions are influenced by their personal circumstances; in this case, they are insulated from the effects of poor access to medications by their drug coverage plans. In contrast, a patchwork system of 46 programs across Canada provides some drug coverage to vulnerable populations. Reducing the disparity in prescription drug access between Canadian lawmakers and the public may promote progress towards better medication access for everyone. This could be achieved either by reducing lawmaker coverage or improving upon the public patchwork system. Since the goal should be to improve the overall access of medications for all Canadians, lawmakers included, the latter method is preferred. A universal drug plan with first dollar coverage could replace the current patchwork system and expand coverage to all Canadians. Copyright © 2017 Elsevier Inc. All rights reserved.
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Bodenmann, Patrick; Baggio, Stéphanie; Iglesias, Katia; Althaus, Fabrice; Velonaki, Venetia-Sofia; Stucki, Stephanie; Ansermet, Corine; Paroz, Sophie; Trueb, Lionel; Hugli, Olivier; Griffin, Judith L; Daeppen, Jean-Bernard
2015-12-09
Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability's different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability. A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson's Chi-squared test and Fisher's exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used. We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2). Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted.
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ERIC Educational Resources Information Center
Chang, Mae Chu; Joshi, Arun R.; Winkler, Donald; Yano, Satoko
In 1996 the government of the Arab Republic of Egypt initiated a basic education enhancement program to extend full coverage to vulnerable groups, especially girls, and to raise the quality of instruction. The basic education reform program was followed in 1998 by the government's secondary education reform program, supported by the World Bank. In…
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MacLachlan, Malcolm; Amin, Mutamad; Mannan, Hasheem; El Tayeb, Shahla; Bedri, Nafisa; Swartz, Leslie; Munthali, Alister; Van Rooy, Gert; McVeigh, Joanne
2012-01-01
While many health services strive to be equitable, accessible and inclusive, peoples’ right to health often goes unrealized, particularly among vulnerable groups. The extent to which health policies explicitly seek to achieve such goals sets the policy context in which services are delivered and evaluated. An analytical framework was developed – EquiFrame – to evaluate 1) the extent to which 21 Core Concepts of human rights were addressed in policy documents, and 2) coverage of 12 Vulnerable Groups who might benefit from such policies. Using this framework, analysis of 51 policies across Malawi, Namibia, South Africa and Sudan, confirmed the relevance of all Core Concepts and Vulnerable Groups. Further, our analysis highlighted some very strong policies, serious shortcomings in others as well as country-specific patterns. If social inclusion and human rights do not underpin policy formation, it is unlikely they will be inculcated in service delivery. EquiFrame facilitates policy analysis and benchmarking, and provides a means for evaluating policy revision and development. PMID:22649488
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Chuma, Jane; Okungu, Vincent; Ntwiga, Janet; Molyneux, Catherine
2010-03-16
Ensuring that the poor and vulnerable population benefit from malaria control interventions remains a challenge for malaria endemic countries. Until recently, ownership and use of insecticides treated nets (ITNs) in most countries was low and inequitable, although coverage has increased in countries where free ITN distribution is integrated into mass vaccination campaigns. In Kenya, free ITNs were distributed to children aged below five years in 2006 through two mass campaigns. High and equitable coverage were reported after the campaigns in some districts, although national level coverage remained low, suggesting that understanding barriers to access remains important. This study was conducted to explore barriers to ownership and use of ITNs among the poorest populations before and after the mass campaigns, to identify strategies for improving coverage, and to make recommendations on how increased coverage levels can be sustained. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: cross-sectional surveys (n = 708 households), 24 focus group discussions and semi-structured interviews with 70 ITN suppliers. Affordability was reported as a major barrier to access but non-financial barriers were also shown to be important determinants. On the demand side key barriers to access included: mismatch between the types of ITNs supplied through interventions and community preferences; perceptions and beliefs on illness causes; physical location of suppliers and; distrust in free delivery and in the distribution agencies. Key barriers on the supply side included: distance from manufacturers; limited acceptability of ITNs provided through interventions; crowding out of the commercial sector and the price. Infrastructure, information and communication played a central role in promoting or hindering access. Significant resources have been directed towards addressing affordability barriers through providing free ITNs to vulnerable groups, but the success of these interventions depends largely on the degree to which other barriers to access are addressed. Only if additional efforts are directed towards addressing non-financial barriers to access, will high coverage levels be achieved and sustained.
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Velez, Diane; Palomo-Zerfas, Ana; Nunez-Alvarez, Arcela; Ayala, Guadalupe X; Finlayson, Tracy L
2017-10-01
To qualitatively examine facilitators and barriers to dental care access and quality services among Mexican migrant women and their families living in North San Diego County, California. Six focus groups were conducted, with 52 participants. Three focus groups were with community residents (average group size of 10), and three were with community health workers/leaders (called Lideres; average group size of 7). The behavioral model for vulnerable populations theoretical framework guided qualitative data analyses. Predisposing factors to dental care access varied and included immigration status, language, and dental care experiences. Barriers to accessing quality dental services included high cost, lack of insurance coverage, dissatisfaction with providers, long wait times and discrimination. Participants expressed a desire for health policy changes, including affordable coverage for immigrants and their families. This study provided insights into how dental care providers, community health centers, and policymakers can improve dental care access and services to migrant populations.
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Knowledge and understanding of health insurance: challenges and remedies.
Barnes, Andrew J; Hanoch, Yaniv
2017-07-13
As coverage is expanded in health systems that rely on consumers to choose health insurance plans that best meet their needs, interest in whether consumers possess sufficient understanding of health insurance to make good coverage decisions is growing. The recent IJHPR article by Green and colleagues-examining understanding of supplementary health insurance (SHI) among Israeli consumers-provides an important and timely answer to the above question. Indeed, their study addresses similar problems to the ones identified in the US health care market, with two notable findings. First, they show that overall-regardless of demographic variables-there are low levels of knowledge about SHI, which the literature has come to refer to more broadly as "health insurance literacy." Second, they find a significant disparity in health insurance literacy between different SES groups, where Jews were significantly more knowledgeable about SHI compared to their Arab counterparts.The authors' findings are consistent with a growing body of literature from the U.S. and elsewhere, including our own, presenting evidence that consumers struggle with understanding and using health insurance. Studies in the U.S. have also found that difficulties are generally more acute for populations considered the most vulnerable and consequently most in need of adequate and affordable health insurance coverage.The authors' findings call attention to the need to tailor communication strategies aimed at mitigating health insurance literacy and, ultimately, access and outcomes disparities among vulnerable populations in Israel and elsewhere. It also raises the importance of creating insurance choice environments in health systems relying on consumers to make coverage decisions that facilitate the decision process by using "choice architecture" to, among other things, simplify plan information and highlight meaningful differences between coverage options.
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Raghavan, Ramesh; Aarons, Gregory A.; Roesch, Scott C.; Leslie, Laurel K.
2008-01-01
Objectives. We sought to describe health insurance coverage over time among a national sample of children who came into contact with child welfare or child protective services agencies. Methods. We used data from 4 waves of the National Survey of Child and Adolescent Well-Being to examine insurance coverage among 2501 youths. Longitudinal insurance trajectories were identified using latent class analyses, a technique used to classify individuals into groupings of observed variables, and survey-weighted logistic regression was used to identify variables associated with class membership. Results. We identified 2 latent insurance classes—1 contained children who gained health insurance, and the other contained children who stably maintained coverage over time. History of sexual abuse, and race/ethnicity other than White, Black, and Hispanic, were associated with membership in the “gainer” class. Foster care placement and poorer health status were associated with membership in the “maintainer” class. Caregiver characteristics were not associated with class membership. Conclusions. The majority of children in child welfare had stable health insurance coverage over time. Given this vulnerable population’s dependence upon Medicaid, protection of existing entitlements to Medicaid is essential to preserve their stable insurance coverage. PMID:18235059
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NASA Astrophysics Data System (ADS)
Oulahen, Greg
2015-03-01
Insurance coverage of damage caused by overland flooding is currently not available to Canadian homeowners. As flood disaster losses and water damage claims both trend upward, insurers in Canada are considering offering residential flood coverage in order to properly underwrite the risk and extend their business. If private flood insurance is introduced in Canada, it will have implications for the current regime of public flood management and for residential vulnerability to flood hazards. This paper engages many of the competing issues surrounding the privatization of flood risk by addressing questions about whether flood insurance can be an effective tool in limiting exposure to the hazard and how it would exacerbate already unequal vulnerability. A case study investigates willingness to pay for flood insurance among residents in Metro Vancouver and how attitudes about insurance relate to other factors that determine residential vulnerability to flood hazards. Findings indicate that demand for flood insurance is part of a complex, dialectical set of determinants of vulnerability.
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Poverty, vulnerability, and provision of healthcare in Afghanistan.
Trani, Jean-Francois; Bakhshi, Parul; Noor, Ayan A; Lopez, Dominique; Mashkoor, Ashraf
2010-06-01
This paper presents findings on conditions of healthcare delivery in Afghanistan. There is an ongoing debate about barriers to healthcare in low-income as well as fragile states. In 2002, the Government of Afghanistan established a Basic Package of Health Services (BPHS), contracting primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled persons, and the poorest households. In 2005, we conducted a nationwide survey, and using a logistic regression model, investigated provider choice. We also measured associations between perceived availability and usefulness of healthcare providers. Our results indicate that the implementation of the package has partially reached its goal: to target the most vulnerable. The pattern of use of healthcare provider suggests that disabled people, female-headed households, and poorest households visited health centres more often (during the year preceding the survey interview). But these vulnerable groups faced more difficulties while using health centres, hospitals as well as private providers and their out-of-pocket expenditure was higher than other groups. In the model of provider choice, time to travel reduces the likelihood for all Afghans of choosing health centres and hospitals. We situate these findings in the larger context of current debates regarding healthcare delivery for vulnerable populations in fragile state environments. The 'scaling-up process' is faced with several issues that jeopardize the objective of equitable access: cost of care, coverage of remote areas, and competition from profit-orientated providers. To overcome these structural barriers, we suggest reinforcing processes of transparency, accountability and participation. Copyright 2010 Elsevier Ltd. All rights reserved.
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Mathauer, Inke; Theisling, Mareike; Mathivet, Benoit; Vilcu, Ileana
2016-04-02
Many low-and middle-income countries (LMIC) of the World Health Organization (WHO) European Region have introduced social health insurance payroll taxes after the political transition in the late 1980s, combined with budget transfers to allow for exempting specific population groups from paying contributions, such as those outside formal sector work and in particular vulnerable groups. This paper assesses the institutional design aspects of such financing arrangements and their performance with respect to universal health coverage progress in LMIC of the European region. The study is based on a literature review and review of secondary databases for the performance assessment. Such financing arrangements currently exist in 13 LMIC of that region, with strong commonalities in institutional design: This includes a wide range of different eligible population groups, mostly mandatory membership, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. Performance is more varied. Enrolment rates range from about 65 % to above 95 %, and access to care and financial protection has improved in several countries. Yet, inequities between income quintiles persist. Budget transfers to health insurance arrangements have helped to deepen UHC or maintain achievements with respect to UHC in these European LMICs by covering those outside formal sector work, and in particular vulnerable population groups. However, challenges remain: a comprehensive benefit package on paper is not enough as long as supply side constraints and quality gaps as well as informal payments prevail. A key policy question is how to reach those so far uncovered.
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Impact of health financing policies in Cambodia: A 20 year experience.
Ensor, Tim; Chhun, Chhim; Kimsun, Ton; McPake, Barbara; Edoka, Ijeoma
2017-03-01
Improving financial access to services is an essential part of extending universal health coverage in low resource settings. In Cambodia, high out of pocket spending and low levels of utilisation have impeded the expansion of coverage and improvement in health outcomes. For twenty years a series of health financing policies have focused on mitigating costs to increase access particularly by vulnerable groups. Demand side financing policies including health equity funds, vouchers and community health insurance have been complemented by supply side measures to improve service delivery incentives through contracting. Multiple rounds of the Cambodia Socio-Economic Survey are used to investigate the impact of financing policies on health service utilisation and out of pocket payments both over time using commune panel data from 1997 to 2011 and across groups using individual data from 2004 and 2009. Policy combinations including areas with multiple interventions were examined against controls using difference-in-difference and panel estimation. Widespread roll-out of financing policies combined with user charge formalisation has led to a general reduction in health spending by the poor. Equity funds are associated with a reduction in out of pocket payments although the effect of donor schemes is larger than those financed by government. Vouchers, which are aimed only at reproductive health services, has a more modest impact that is enhanced when combined with other schemes. At the aggregate level changes are less pronounced although there is evidence that policies take a number of years to have substantial effect. Health financing policies and the supportive systems that they require provide a foundation for more radical extension of coverage already envisaged by a proposed social insurance system. A policy challenge is how disparate mechanisms can be integrated to ensure that vulnerable groups remain protected. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Salinas-Rodríguez, Aarón; Manrique-Espinoza, Betty Soledad
2013-07-08
Immunization is one of the most effective ways of preventing illness, disability and death from infectious diseases for older people. However, worldwide immunization rates are still low, particularly for the most vulnerable groups within the elderly population. The objective of this study was to estimate the effect of the Oportunidades -an incentive-based poverty alleviation program- on vaccination coverage for poor and rural older people in Mexico. Cross-sectional study, based on 2007 Oportunidades Evaluation Survey, conducted in low-income households from 741 rural communities (localities with <2,500 inhabitants) of 13 Mexican states. Vaccination coverage was defined according to three individual vaccines: tetanus, influenza and pneumococcal, and for complete vaccination schedule. Propensity score matching and linear probability model were used in order to estimate the Oportunidades effect. 12,146 older people were interviewed, and 7% presented cognitive impairment. Among remaining, 4,628 were matched. Low coverage rates were observed for the vaccines analyzed. For Oportunidades and non-Oportunidades populations were 46% and 41% for influenza, 52% and 45% for pneumococcal disease, and 79% and 71% for tetanus, respectively. Oportunidades effect was significant in increasing the proportion of older people vaccinated: for complete schedule 5.5% (CI95% 2.8-8.3), for influenza 6.9% (CI95% 3.8-9.6), for pneumococcal 7.2% (CI95% 4.3-10.2), and for tetanus 6.6% (CI95% 4.1-9.2). The results of this study extend the evidence on the effect that conditional transfer programs exert on health indicators. In particular, Oportunidades increased vaccination rates in the population of older people. There is a need to continue raising vaccination rates, however, particularly for the most vulnerable older people.
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2013-01-01
Background Immunization is one of the most effective ways of preventing illness, disability and death from infectious diseases for older people. However, worldwide immunization rates are still low, particularly for the most vulnerable groups within the elderly population. The objective of this study was to estimate the effect of the Oportunidades -an incentive-based poverty alleviation program- on vaccination coverage for poor and rural older people in Mexico. Methods Cross-sectional study, based on 2007 Oportunidades Evaluation Survey, conducted in low-income households from 741 rural communities (localities with <2,500 inhabitants) of 13 Mexican states. Vaccination coverage was defined according to three individual vaccines: tetanus, influenza and pneumococcal, and for complete vaccination schedule. Propensity score matching and linear probability model were used in order to estimate the Oportunidades effect. Results 12,146 older people were interviewed, and 7% presented cognitive impairment. Among remaining, 4,628 were matched. Low coverage rates were observed for the vaccines analyzed. For Oportunidades and non-Oportunidades populations were 46% and 41% for influenza, 52% and 45% for pneumococcal disease, and 79% and 71% for tetanus, respectively. Oportunidades effect was significant in increasing the proportion of older people vaccinated: for complete schedule 5.5% (CI95% 2.8-8.3), for influenza 6.9% (CI95% 3.8-9.6), for pneumococcal 7.2% (CI95% 4.3-10.2), and for tetanus 6.6% (CI95% 4.1-9.2). Conclusions The results of this study extend the evidence on the effect that conditional transfer programs exert on health indicators. In particular, Oportunidades increased vaccination rates in the population of older people. There is a need to continue raising vaccination rates, however, particularly for the most vulnerable older people. PMID:23835202
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Pérez-Núñez, Ricardo; Medina-Solis, Carlo Eduardo; Maupomé, Gerardo; Vargas-Palacios, Armando
2006-10-01
To determine the level of dental health care coverage in people aged > or =18 years across the country, and to identify the factors associated with coverage. Using the instruments and sampling strategies developed by the World Health Organization for the World Health Survey, a cross-sectional national survey was carried out at the household and individual (adult) levels. Dental data were collected in 20 of Mexico's 32 states. The relationship between coverage and environmental and individual characteristics was examined through logistic regression models. Only 6098 of 24 159 individual respondents reported having oral problems during the preceding 12 months (accounting for 14 284 621 inhabitants of the country if weighted). Only 48% of respondents reporting problems were covered, although details of the appropriateness, timeliness and effectiveness of the intervention(s) were not assessed. The multivariate regression model showed that higher level of education, better socioeconomic status, having at least one chronic disease and having medical insurance were positively associated with better dental care coverage. Age and sex were also associated. Overall dental health care coverage could be improved, assuming that ideal coverage is 100%. Some equality of access issues are apparent because there are differences in coverage across populations in terms of wealth and social status. Identifying the factors associated with sparse coverage is a step in the right direction allowing policymakers to establish strategies aimed at increasing this coverage, focusing on more vulnerable groups and on individuals in greater need of preventive and rehabilitative interventions.
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Arsenault, Catherine; Harper, Sam; Nandi, Arijit; Mendoza Rodríguez, José M; Hansen, Peter M; Johri, Mira
2017-02-07
(1) To conduct a systematic analysis of inequalities in childhood vaccination coverage in Gavi-supported countries; (2) to comparatively assess alternative measurement approaches and how they may affect cross-country comparisons of the level of inequalities. Using the most recent Demographic and Health Surveys (2005-2014) in 45 Gavi-supported countries, we measured inequalities in vaccination coverage across seven dimensions of social stratification and of vulnerability to poor health outcomes. We quantified inequalities using pairwise comparisons (risk differences and ratios) and whole spectrum measures (slope and relative indices of inequality). To contrast measurement approaches, we pooled the estimates using random-effects meta-analyses, ranked countries by the magnitude of inequality and compared agreement in country ranks. At the aggregate level, maternal education, multidimensional poverty, and wealth index poverty were the dimensions associated with the largest inequalities. In 36 out of 45 countries, inequalities were substantial, with a difference in coverage of 10 percentage points or more between the top and bottom of at least one of these social dimensions. Important inequalities by child sex, child malnutrition and urban/rural residence were also found in a smaller set of countries. The magnitude of inequality and ranking of countries differed across dimension and depending on the measure used. Pairwise comparisons could not be estimated in certain countries. The slope and relative indices of inequality were estimated in all countries and produced more stable country rankings, and should thus facilitate more reliable international comparisons. Inequalities in vaccination coverage persist in a large majority of Gavi-supported countries. Inequalities should be monitored across multiple dimensions of vulnerability. Using whole spectrum measures to quantify inequality across multiple ordered social groups has important advantages. We illustrate these findings using an equity dashboard designed to support decision-making in the Sustainable Development Goals period. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Jorgensen, Pernille; Mereckiene, Jolita; Cotter, Suzanne; Johansen, Kari; Tsolova, Svetla; Brown, Caroline
2018-01-25
Influenza vaccination is recommended especially for persons at risk of complications. In 2003, the World Health Assembly urged Member States (MS) to increase vaccination coverage to 75% among older persons by 2010. To assess progress towards the 2010 vaccination goal and describe seasonal influenza vaccination recommendations in the World Health Organization (WHO) European Region. Data on seasonal influenza vaccine recommendations, dose distribution, and target group coverage were obtained from two sources: European Union and European Economic Area MS data were extracted from influenza vaccination surveys covering seven seasons (2008/2009-2014/2015) published by the Vaccine European New Integrated Collaboration Effort and European Centre for Disease Prevention and Control. For the remaining WHO European MS, a separate survey on policies and uptake for all seasons (2008/2009-2014/2015) was distributed to national immunization programmes in 2015. Data was available from 49 of 53 MS. All but two had a national influenza vaccination policy. High-income countries distributed considerably higher number of vaccines per capita (median; 139.2 per 1000 population) compared to lower-middle-income countries (median; 6.1 per 1000 population). Most countries recommended vaccination for older persons, individuals with chronic disease, healthcare workers, and pregnant women. Children were included in < 50% of national policies. Only one country reached 75% coverage in older persons (2014/2015), while a number of countries reported declining vaccination uptake. Coverage of target groups was overall low, but with large variations between countries. Vaccination coverage was not monitored for several groups. Despite policy recommendations, influenza vaccination uptake remains suboptimal. Low levels of vaccination is not only a missed opportunity for preventing influenza in vulnerable groups, but could negatively affect pandemic preparedness. Improved understanding of barriers to influenza vaccination is needed to increase uptake and reverse negative trends. Furthermore, implementation of vaccination coverage monitoring is critical for assessing performance and impact of the programmes. Copyright © 2017. Published by Elsevier Ltd.
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Cook, Won Kim; Tseng, Winston; Ko Chin, Kathy; John, Iyanrick; Chung, Corina
2014-11-01
Working in small businesses has been identified as a key factor for low coverage rates in immigrant communities. In this study, we identify specific cultural and socioeconomic predictors of Asian Americans who work in small businesses to identify subgroups at a greater disadvantage than others in obtaining health insurance. Logistic regression models were fitted using a sample of 3,819 Asian American small business owners and employers extracted from pooled 2005–2012 California Health Interview Survey data. We found that individuals with low income levels, Korean Americans, U.S.-born South Asian and Southeast Asian (other than Vietnamese) Americans, immigrants without citizenship (particularly those lacking a green card), and individuals with limited English proficiency had higher odds of lacking coverage. The odds of being uninsured did not differ between small business owners and employees. Based upon these key findings, we propose several strategies to expand coverage for Asian Americans working in small businesses and their most vulnerable subgroups.
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Vulnerability of global food production to extreme climatic events.
Yeni, F; Alpas, H
2017-06-01
It is known that the frequency, intensity or duration of the extreme climatic events have been changing substantially. The ultimate goal of this study was to identify current vulnerabilities of global primary food production against extreme climatic events, and to discuss potential entry points for adaptation planning by means of an explorative vulnerability analysis. Outcomes of this analysis were demonstrated as a composite index where 118 country performances in maintaining safety of food production were compared and ranked against climate change. In order to better interpret the results, cluster analysis technique was used as a tool to group the countries based on their vulnerability index (VI) scores. Results suggested that one sixth of the countries analyzed were subject to high level of exposure (0.45-1), one third to high to very high level of sensitivity (0.41-1) and low to moderate level of adaptive capacity (0-0.59). Proper adaptation strategies for reducing the microbial and chemical contamination of food products, soil and waters on the field were proposed. Finally, availability of data on food safety management systems and occurrence of foodborne outbreaks with global coverage were proposed as key factors for improving the robustness of future vulnerability assessments. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Govender, Veloshnee; Chersich, Matthew F; Harris, Bronwyn; Alaba, Olufunke; Ataguba, John E; Nxumalo, Nonhlanhla; Goudge, Jane
2013-01-24
In 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants. In light of the global emphasis on universal coverage, empirical evidence is needed to understand the relationship between new health financing strategies and health care access thereby improving global understanding of these issues. This study analysed coverage of the South African government health insurance scheme, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment. Multi-stage random sampling was used to select 1,329 civil servants from the health and education sectors in four of South Africa's nine provinces. They were interviewed to determine factors associated with enrolment in the scheme. The analysis included both descriptive statistics and multivariate logistic regression. Notwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. The relatively poor uptake of the contributory and non-contributory insurance options was mostly attributed to insufficient information, perceived administrative challenges of taking up membership, and payment costs. Barriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. Achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms.
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Govender, Veloshnee; Chersich, Matthew F.; Harris, Bronwyn; Alaba, Olufunke; Ataguba, John E.; Nxumalo, Nonhlanhla; Goudge, Jane
2013-01-01
Background In 2005, the South African government introduced a voluntary, subsidised health insurance scheme for civil servants. In light of the global emphasis on universal coverage, empirical evidence is needed to understand the relationship between new health financing strategies and health care access thereby improving global understanding of these issues. Objectives This study analysed coverage of the South African government health insurance scheme, the population groups with low uptake, and the individual-level factors, as well as characteristics of the scheme, that influenced enrolment. Methods Multi-stage random sampling was used to select 1,329 civil servants from the health and education sectors in four of South Africa's nine provinces. They were interviewed to determine factors associated with enrolment in the scheme. The analysis included both descriptive statistics and multivariate logistic regression. Results Notwithstanding the availability of a non-contributory option within the insurance scheme and access to privately-provided primary care, a considerable portion of socio-economically vulnerable groups remained uninsured (57.7% of the lowest salary category). Non-insurance was highest among men, black African or coloured ethnic groups, less educated and lower-income employees, and those living in informal-housing. The relatively poor uptake of the contributory and non-contributory insurance options was mostly attributed to insufficient information, perceived administrative challenges of taking up membership, and payment costs. Conclusion Barriers to enrolment include insufficient information, unaffordability of payments and perceived administrative complexity. Achieving universal coverage requires good physical access to service providers and appropriate benefit options within pre-payment health financing mechanisms. PMID:23364093
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Older women's health and financial vulnerability: implications of the Medicare benefit structure.
Sofaer, S; Abel, E
1990-01-01
Elderly women and men have different patterns of disease and utilize health services differently. This essay examines the extent to which Medicare covers the specific conditions and services associated with women and men. Elderly women experience higher rates of poverty than elderly men; consequently, elderly women are especially likely to be unable to pay high out-of-pocket costs for health care. Using a new method for simulating out-of-pocket costs, the Illness Episode Approach, the essay shows that Medicare provides better coverage for illnesses which predominate among men than for those which predominate among women. In addition, women on Medicare who supplement their basic coverage by purchasing a typical private insurance "Medigap" policy do not receive as much of an advantage from their purchases as do men. The calculations also show that the Medicare Catastrophic Coverage Act would have had little impact on the gender gap in financial vulnerability.
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Van Minh, Hoang; Oh, Juhwan; Giang, Kim Bao; Kien, Vu Duy; Nam, You-Seon; Lee, Chul Ou; Huong, Tran Thi Giang; Hoat, Luu Ngoc
2016-01-01
Background Knowledge of the aggregate effects of multiple socioeconomic vulnerabilities is important for shedding light on the determinants of growing health inequalities and inequities in maternal healthcare. Objective This paper describes patterns of inequity in maternal healthcare utilization and analyzes associations between inequity and multiple socioeconomic vulnerabilities among women in Vietnam. Design This is a repeated cross-sectional study using data from the Vietnam Multiple Indicator Cluster Surveys 2000, 2006, and 2011. Two maternal healthcare indicators were selected: (1) skilled antenatal care and (2) skilled delivery care. Four types of socioeconomic vulnerabilities – low education, ethnic minority, poverty, and rural location – were assessed both as separate explanatory variables and as composite indicators (combinations of three and four vulnerabilities). Pairwise comparisons and adjusted odds ratios were used to assess socioeconomic inequities in maternal healthcare. Results In all three surveys, there were increases across the survey years in both the proportions of women who received antenatal care by skilled staff (68.6% in 2000, 90.8% in 2006, and 93.7% in 2011) and the proportions of women who gave birth with assistance from skilled staff (69.9% in 2000, 87.7% in 2006, and 92.9% in 2011). The receipt of antenatal care by skilled staff and birth assistance from skilled health personnel were less common among vulnerable women, especially those with multiple vulnerabilities. Conclusions Even though Vietnam has improved its coverage of maternal healthcare on average, policies should target maternal healthcare utilization among women with multiple socioeconomic vulnerabilities. Both multisectoral social policies and health policies are needed to tackle multiple vulnerabilities more effectively by identifying those who are poor, less educated, live in rural areas, and belong to ethnic minority groups. PMID:26950561
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Van Minh, Hoang; Oh, Juhwan; Giang, Kim Bao; Kien, Vu Duy; Nam, You-Seon; Lee, Chul Ou; Huong, Tran Thi Giang; Hoat, Luu Ngoc
2016-01-01
Knowledge of the aggregate effects of multiple socioeconomic vulnerabilities is important for shedding light on the determinants of growing health inequalities and inequities in maternal healthcare. This paper describes patterns of inequity in maternal healthcare utilization and analyzes associations between inequity and multiple socioeconomic vulnerabilities among women in Vietnam. This is a repeated cross-sectional study using data from the Vietnam Multiple Indicator Cluster Surveys 2000, 2006, and 2011. Two maternal healthcare indicators were selected: (1) skilled antenatal care and (2) skilled delivery care. Four types of socioeconomic vulnerabilities - low education, ethnic minority, poverty, and rural location - were assessed both as separate explanatory variables and as composite indicators (combinations of three and four vulnerabilities). Pairwise comparisons and adjusted odds ratios were used to assess socioeconomic inequities in maternal healthcare. In all three surveys, there were increases across the survey years in both the proportions of women who received antenatal care by skilled staff (68.6% in 2000, 90.8% in 2006, and 93.7% in 2011) and the proportions of women who gave birth with assistance from skilled staff (69.9% in 2000, 87.7% in 2006, and 92.9% in 2011). The receipt of antenatal care by skilled staff and birth assistance from skilled health personnel were less common among vulnerable women, especially those with multiple vulnerabilities. Even though Vietnam has improved its coverage of maternal healthcare on average, policies should target maternal healthcare utilization among women with multiple socioeconomic vulnerabilities. Both multisectoral social policies and health policies are needed to tackle multiple vulnerabilities more effectively by identifying those who are poor, less educated, live in rural areas, and belong to ethnic minority groups.
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Vaccination coverage among children in kindergarten - United States, 2013-14 school year.
Seither, Ranee; Masalovich, Svetlana; Knighton, Cynthia L; Mellerson, Jenelle; Singleton, James A; Greby, Stacie M
2014-10-17
State and local vaccination requirements for school entry are implemented to maintain high vaccination coverage and protect schoolchildren from vaccine-preventable diseases. Each year, to assess state and national vaccination coverage and exemption levels among kindergartners, CDC analyzes school vaccination data collected by federally funded state, local, and territorial immunization programs. This report describes vaccination coverage in 49 states and the District of Columbia (DC) and vaccination exemption rates in 46 states and DC for children enrolled in kindergarten during the 2013-14 school year. Median vaccination coverage was 94.7% for 2 doses of measles, mumps, and rubella (MMR) vaccine; 95.0% for varying local requirements for diphtheria, tetanus toxoid, and acellular pertussis (DTaP) vaccine; and 93.3% for 2 doses of varicella vaccine among those states with a 2-dose requirement. The median total exemption rate was 1.8%. High exemption levels and suboptimal vaccination coverage leave children vulnerable to vaccine-preventable diseases. Although vaccination coverage among kindergartners for the majority of reporting states was at or near the 95% national Healthy People 2020 targets for 4 doses of DTaP, 2 doses of MMR, and 2 doses of varicella vaccine, low vaccination coverage and high exemption levels can cluster within communities. Immunization programs might have access to school vaccination coverage and exemption rates at a local level for counties, school districts, or schools that can identify areas where children are more vulnerable to vaccine-preventable diseases. Health promotion efforts in these local areas can be used to help parents understand the risks for vaccine-preventable diseases and the protection that vaccinations provide to their children.
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Social protection systems in vulnerable families: their importance for the public health
Arcos, Estela; Sanchez, Ximena; Toffoletto, Maria Cecilia; Baeza, Margarita; Gazmuri, Patricia; Muñoz, Luz Angélica; Vollrath, Antonia
2014-01-01
OBJECTIVE To analyze the effectiveness of the Chilean System of Childhood Welfare in transferring benefits to socially vulnerable families. METHODS A cross-sectional study with a sample of 132 families from the Metropolitan Region, Chile, stratified according to degree of social vulnerability, between September 2011 and January 2012. Semi-structured interviews were conducted with mothers of the studied families in public health facilities or their households. The variables studied were family structure, psychosocial risk in the family context and integrated benefits from the welfare system in families that fulfill the necessary requirements for transfer of benefits. Descriptive statistics to measure location and dispersion were calculated. A binary logistic regression, which accounts for the sample size of the study, was carried out. RESULTS The groups were homogenous regarding family size, the presence of biological father in the household, the number of relatives living in the same dwelling, income generation capacity and the rate of dependency and psychosocial risk (p ≥ 0.05). The transfer of benefits was low in all three groups of the sample (≤ 23.0%). The benefit with the best coverage in the system was the Single Family Subsidy, whose transfer was associated with the size of the family, the presence of relatives in the dwelling, the absence of the father in the household, a high rate of dependency and a high income generation capacity (p ≤ 0.10). CONCLUSIONS The effectiveness of benefit transfer was poor, especially in families that were extremely socially vulnerable. Further explanatory studies of benefit transfers to the vulnerable population, of differing intensity and duration, are required in order to reduce health disparities and inequalities. PMID:25119935
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Mbachu, Chinyere O; Onwujekwe, Obinna E; Uzochukwu, Benjamin S C; Uchegbu, Eloka; Oranuba, Joseph; Ilika, Amobi L
2012-05-22
In order to achieve universal health coverage, the government of Anambra State, southeast Nigeria has distributed free Long-lasting Insecticide treated Nets (LLINs) to the general population and delivered free Artemisinin-based Combination Therapy (ACT) to pregnant women and children less than 5 years. However, the levels of coverage with LLINS and ACTs is not clear, especially coverage of different socio-economic status (SES) population groups. This study was carried out to determine the level of coverage and access to LLINs and ACTs amongst different SES groups. A questionnaire was used to collect data from randomly selected households in 19 local government areas of the State. Selected households had a pregnant woman and/or a child less than 5 years. The lot quality assurance sampling (LQAS) methodology was used in sampling. The questionnaire explored the availability and utilization of LLINs and ACTs from 2394 households. An asset-based SES index was used to examine the level of access of LLINS and ACTs to different SES quintiles. It was found that 80.5% of the households had an LLIN and 64.4% of the households stated that they actually used the nets the previous night. The findings showed that 42.3% of pregnant women who had fever within the past month received ACTs, while 37.5% of children<5 years old who had malaria in the past month had received ACTs. There was equity in ownership of nets for the range 1-5 nets per household. No significant SES difference was found in use of ACTs for treatment of malaria in children under five years old and in pregnant women. The free distribution of LLINs and ACTs increased household coverage of both malaria control interventions and bridged the equity gap in access to them among the most vulnerable groups.
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2012-01-01
Background In order to achieve universal health coverage, the government of Anambra State, southeast Nigeria has distributed free Long-lasting Insecticide treated Nets (LLINs) to the general population and delivered free Artemisinin-based Combination Therapy (ACT) to pregnant women and children less than 5 years. However, the levels of coverage with LLINS and ACTs is not clear, especially coverage of different socio-economic status (SES) population groups. This study was carried out to determine the level of coverage and access to LLINs and ACTs amongst different SES groups. Methods A questionnaire was used to collect data from randomly selected households in 19 local government areas of the State. Selected households had a pregnant woman and/or a child less than 5 years. The lot quality assurance sampling (LQAS) methodology was used in sampling. The questionnaire explored the availability and utilization of LLINs and ACTs from 2394 households. An asset-based SES index was used to examine the level of access of LLINS and ACTs to different SES quintiles. Results It was found that 80.5 % of the households had an LLIN and 64.4 % of the households stated that they actually used the nets the previous night. The findings showed that 42.3 % of pregnant women who had fever within the past month received ACTs, while 37.5 % of children ≪5 years old who had malaria in the past month had received ACTs. There was equity in ownership of nets for the range 1–5 nets per household. No significant SES difference was found in use of ACTs for treatment of malaria in children under five years old and in pregnant women. Conclusions The free distribution of LLINs and ACTs increased household coverage of both malaria control interventions and bridged the equity gap in access to them among the most vulnerable groups. PMID:22545723
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Vaccination of healthcare workers: A review
Haviari, Skerdi; Bénet, Thomas; Saadatian-Elahi, Mitra; André, Philippe; Loulergue, Pierre; Vanhems, Philippe
2015-01-01
Vaccine-preventable diseases are a significant cause of morbidity and mortality. As new vaccines are proving to be effective and as the incidence of some infections decreases, vaccination practices are changing. Healthcare workers (HCWs) are particularly exposed to and play a role in nosocomial transmission, which makes them an important target group for vaccination. Most vaccine-preventable diseases still carry a significant risk of resurgence and have caused outbreaks in recent years. While many professional societies favor vaccination of HCWs as well as the general population, recommendations differ from country to country. In turn, vaccination coverage varies widely for each microorganism and for each country, making hospitals and clinics vulnerable to outbreaks. Vaccine mandates and non-mandatory strategies are the subject of ongoing research and controversies. Optimal approaches to increase coverage and turn the healthcare workforce into an efficient barrier against infectious diseases are still being debated. PMID:26291642
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Strategies for expanding health insurance coverage in vulnerable populations.
Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue
2014-11-26
Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence).In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence). Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies evaluating the effectiveness of different strategies for expanding health insurance coverage in vulnerable population are needed in different settings, with careful attention given to study design.
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Kaewkungwal, Jaranit; Apidechkul, Tawatchai; Jandee, Kasemsak; Khamsiriwatchara, Amnat; Lawpoolsri, Saranath; Sawang, Surasak; Sangvichean, Aumnuyphan; Wansatid, Peerawat; Krongrungroj, Sarinya
2015-01-14
Studies of undervaccinated children of minority/stateless populations have highlighted significant barriers at individual, community, and state levels. These include geography-related difficulties, poverty, and social norms/beliefs. The objective of this study was to assess project outcomes regarding immunization coverage, as well as maternal attitudes and practices toward immunization. The "StatelessVac" project was conducted in Thailand-Myanmar-Laos border areas using cell phone-based mechanisms to increase immunization coverage by incorporating phone-to-phone information sharing for both identification and prevention. With limitation of the study among vulnerable populations in low-resource settings, the pre/post assessments without comparison group were conducted. Immunization coverage was collected from routine monthly reports while behavior-change outcomes were from repeat surveys. This study revealed potential benefits of the initiative for case identification; immunization coverage showed an improved trend. Prevention strategies were successfully integrated into the routine health care workflows of immunization activities at point-of-care. A behavior-change-communication package contributes significantly in raising both concern and awareness in relation to child care. The mobile technology has proven to be an effective mechanism in improving a children's immunization program among these hard-to-reach populations. Part of the intervention has now been revised for use at health centers across the country.
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Marmamula, Srinivas; Ravuri, L. V. Chandra Sekhar; Boon, Mei Ying; Khanna, Rohit C.
2013-01-01
Background. There is limited research conducted on uncorrected refractive errors, presbyopia, and spectacles use among the elderly population in residential care in developing countries such as India. We conducted a cross-sectional study among elderly in residential care to assess the spectacle coverage and spectacles usage in the south Indian state of Andhra Pradesh. Methods. All 524 residents in the 26 “homes for aged” institutions in the district were enumerated. Eye examination was performed that included visual acuity (VA) assessment for distant and near vision. A questionnaire was used to collect information on spectacles use. Results. 494/524 individuals were examined, 78% were women, and 72% had no education. The mean age of participants was 70 years. The spectacle coverage for refractive errors was 35.1% and 23.9% for presbyopia. The prevalence of current use and past use of spectacles was 38.5% (95% CI: 34.2–42.8; n = 190) and 17.2% (95% CI: 13.9–42.8), respectively. Conclusions. There is low spectacle coverage for both refractive errors and presbyopia among elderly individuals in residential care in the south Indian state of Andhra Pradesh. Appropriate service delivery systems should be developed to reach out this vulnerable group of seniors on a priority basis. PMID:23865041
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Schindler, Mélinée; Danis, Marion; Goold, Susan D; Hurst, Samia A
2018-04-14
Approaches to priority-setting for scarce resources have shifted to public deliberation as trade-offs become more difficult. We report results of a qualitative analysis of public deliberation in Switzerland, a country with high health-care costs, an individual health insurance mandate and a strong tradition of direct democracy with frequent votes related to health care. We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex health-care allocation decisions into easily understandable choices, for use in Switzerland. We conducted focus groups in twelve Swiss cities, recruiting from a range of socio-economic backgrounds in the three language regions. Participants developed strategic arguments based on the importance of basic coverage for all, and of cost-benefit evaluation. They also expressed arguments relying on a principle of solidarity, in particular the importance of protection for vulnerable groups, and on the importance of medical care. They struggled with the place of personal responsibility in coverage decisions. In commenting on the exercise, participants found the degree of consensus despite differing opinions surprising and valuable. The Swiss population is particularly attentive to the costs of health care and means of reducing these costs. Swiss citizens are capable of making trade-offs and setting priorities for complex health issues. © 2018 The Authors Health Expectations published by John Wiley & Sons Ltd.
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Bosch-Capblanch, Xavier; Zuske, Meike-Kathrin; Auer, Christian
2017-06-07
Equity remains a priority in the international health development agenda. However, major inequities in vaccination coverage jeopardise the achievement of the Sustainable Development Goals. We aim at comprehensively describing how research has addressed equity issues related to vaccination. We carried out an overview of systematic reviews (SRs) that explicitly explored the effects of interventions to improve vaccination in any context; for any vaccine and, in any language. We followed standard research synthesis methods to systematically search for SR, assess them for inclusion and extracting relevant data, particularly on vaccination related outcomes. To gather evidence on equity issues addressed in the SR, we used the PROGRESS-plus framework. Our search obtained 2,003 hits which resulted in 54 included SRs, published between 1994 and 2014. The quality of SRs was generally poor, with less than half complying with most of the quality criteria. Reported vaccines included, by order of frequency, influenza and Expanded Programme on Immunisation vaccines. The types of interventions more frequently reported were related to vaccination delivery strategies, financial support and information, education and communication. Most of the SRs suggested effects favouring intervention groups as opposed to comparison groups. The most frequently reported equity attribute was 'place of residence' and the least reported equity attributes were sexual orientation and religion. Very few estimates of effects actually measured differences or changes between groups having those attributes and all of them referred to the place of residence. No data was found about reducing equity gaps for vulnerable groups or minorities, or attributes such as sexual orientation, education or specific religious groups. Although research on vulnerable populations as a subgroup is abundant, it fails to report on the interventions that will actually reduce inequities and consider how redistribution of health care resources could shrink the gap between the privileged and most vulnerable groups including minorities. Research, if aiming at being responsive to global health policy trends, needs to report not only on specific attributes but also on how a better redistribution of health care resources could contribute to alleviating the unjust situation of the most vulnerable populations.
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Utazi, C Edson; Thorley, Julia; Alegana, Victor A; Ferrari, Matthew J; Takahashi, Saki; Metcalf, C Jessica E; Lessler, Justin; Tatem, Andrew J
2018-03-14
The expansion of childhood vaccination programs in low and middle income countries has been a substantial public health success story. Indicators of the performance of intervention programmes such as coverage levels and numbers covered are typically measured through national statistics or at the scale of large regions due to survey design, administrative convenience or operational limitations. These mask heterogeneities and 'coldspots' of low coverage that may allow diseases to persist, even if overall coverage is high. Hence, to decrease inequities and accelerate progress towards disease elimination goals, fine-scale variation in coverage should be better characterized. Using measles as an example, cluster-level Demographic and Health Surveys (DHS) data were used to map vaccination coverage at 1 km spatial resolution in Cambodia, Mozambique and Nigeria for varying age-group categories of children under five years, using Bayesian geostatistical techniques built on a suite of publicly available geospatial covariates and implemented via Markov Chain Monte Carlo (MCMC) methods. Measles vaccination coverage was found to be strongly predicted by just 4-5 covariates in geostatistical models, with remoteness consistently selected as a key variable. The output 1 × 1 km maps revealed significant heterogeneities within the three countries that were not captured using province-level summaries. Integration with population data showed that at the time of the surveys, few districts attained the 80% coverage, that is one component of the WHO Global Vaccine Action Plan 2020 targets. The elimination of vaccine-preventable diseases requires a strong evidence base to guide strategies and inform efficient use of limited resources. The approaches outlined here provide a route to moving beyond large area summaries of vaccination coverage that mask epidemiologically-important heterogeneities to detailed maps that capture subnational vulnerabilities. The output datasets are built on open data and methods, and in flexible format that can be aggregated to more operationally-relevant administrative unit levels. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Intersectional inequalities in immunization in India, 1992-93 to 2005-06: a progress assessment.
Joe, William
2015-05-01
Immunization in India is marked with stark disparities across gender, caste, wealth and place of residence with severe shortfalls among those disadvantaged in more than one dimension. In this regard, an explicit recognition of intersectionality and intersectional inequalities has 2-fold relevance; one, being the pathway of health inequality and the other being its role as a deterrent of progress particularly at higher (better) levels of health. Against this backdrop, this study examines intersectional inequalities in immunization in India and also suggests a level-sensitive progress assessment method. The study uses group analogue of Gini coefficient for highlighting the magnitude of intersectional inequality and for comprehending its association with immunization level. The results unravel the plight of vulnerable intersectional groups and draw attention to disquieting shortfalls among female SCST (scheduled castes and tribes) children from rural areas. There is also some evidence to indicate leveraging among rural males in matters of immunization and it is further discerned that such gender advantage is greater among rural non-SCST community than the rural SCST group. In concluding, the study calls for intensive immunization planning to improve coverage among vulnerable communities in both rural and urban areas. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.
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Health insurance coverage and healthcare utilization among homeless young adults in Venice, CA
Winetrobe, H.; Rice, E.; Rhoades, H.; Milburn, N.
2016-01-01
Background Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. Methods All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Results Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Conclusions Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. PMID:25635142
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Apidechkul, Tawatchai; Jandee, Kasemsak; Khamsiriwatchara, Amnat; Lawpoolsri, Saranath; Sawang, Surasak; Sangvichean, Aumnuyphan; Wansatid, Peerawat; Krongrungroj, Sarinya
2015-01-01
Background Studies of undervaccinated children of minority/stateless populations have highlighted significant barriers at individual, community, and state levels. These include geography-related difficulties, poverty, and social norms/beliefs. Objective The objective of this study was to assess project outcomes regarding immunization coverage, as well as maternal attitudes and practices toward immunization. Methods The “StatelessVac” project was conducted in Thailand-Myanmar-Laos border areas using cell phone-based mechanisms to increase immunization coverage by incorporating phone-to-phone information sharing for both identification and prevention. With limitation of the study among vulnerable populations in low-resource settings, the pre/post assessments without comparison group were conducted. Immunization coverage was collected from routine monthly reports while behavior-change outcomes were from repeat surveys. Results This study revealed potential benefits of the initiative for case identification; immunization coverage showed an improved trend. Prevention strategies were successfully integrated into the routine health care workflows of immunization activities at point-of-care. A behavior-change-communication package contributes significantly in raising both concern and awareness in relation to child care. Conclusions The mobile technology has proven to be an effective mechanism in improving a children’s immunization program among these hard-to-reach populations. Part of the intervention has now been revised for use at health centers across the country. PMID:25589367
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Leyva-Flores, Rene; Servan-Mori, Edson; Infante-Xibille, Cesar; Pelcastre-Villafuerte, Blanca Estela; Gonzalez, Tonatiuh
2014-01-01
Objective To analyze the relationship between primary health care utilization and extended health insurance coverage under the Seguro Popular (SP) among Mexican indigenous people. Methodology A cross-sectional analysis was conducted using data from the Mexican National Nutrition Survey 2012 (n = 194,758). Quasi-experimental matching methods and nonlinear regression probit models were used to estimate the influence of SP on primary health care utilization. Results 25% of the Mexican population reported having no health insurance coverage, while 59% of indigenous versus 35% of non-indigenous reported having SP coverage. Health problems were reported by 13.9% of indigenous vs. 10.5% of non-indigenous; of these, 52.8% and 57.7% respectively, received primary health care (p<0.05). Economic barriers were the most frequent reasons for not using primary health care services. The probability of utilizing primary health care services was 11.5 percentage points higher (p<0.01) for indigenous SP affiliates in comparison with non-indigenous, in similar socioeconomic conditions. Conclusion Socioeconomic conditions, not ethnicity per-se, determine whether people utilize primary health care services. Therefore, SP can be conceived as a public policy strategy which acts as a social buffer by enhancing health care utilization regardless of ethnicity. Further analysis is required to explore the potential gaps as a result of SP coverage among socially vulnerable groups. PMID:25099399
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Al-Tawil, M M; El-Gohary, E E; El-Sayed, M H
2013-01-01
Health care workers (HCWs) and hematological patients needing blood/ blood product transfusion are particularly vulnerable to blood born infections (BBI) including viral hepatitis. To evaluate knowledge, attitude and practice (KAP) of these target groups regarding viral hepatitis B (HBV) transmission and its change with implementing infection control policy and procedures. An anonymous questionnaire with closed questions was used to evaluate KAP including vaccination status in 2 target groups, in Children Hospital, Ain Shams University, Cairo, Egypt: 184 nurses and 210 children and adolescents with blood diseases. One year after instituting infection control as a part of hospital procedures, the same questionnaire was reused to evaluate KAP towards HBV. Baseline knowledge regarding HBV transmission, sequelae and preventive measures, was poor in both groups. Among nurses, only 62% wore gloves on withdrawing or giving blood to patients, 43.5% routinely washed hands between patients and 37.5% reported exposure after sharp injury. Only 38% of patients and 40% of nurses received HBV vaccination. Targeted infection control policy and procedures significantly improved KAP regarding HBV in both groups. Vaccination coverage significantly increased and reached 88.7% for nurses and 72% for patients. Hospital based infection control units with established policy and procedures against BBI significantly improved KAP towards HBV including a significant increase in vaccination intake.
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Cristancho, Sergio; Garces, D Marcela; Peters, Karen E; Mueller, Benjamin C
2008-05-01
Hispanic immigrants are increasingly residing in rural communities, including in the midwestern United States. Limitations in the ability of rural Hispanics to access and utilize health care contribute to patterns of poor health and health disparity. A conceptual model of "vulnerability" guides this community-based participatory assessment project designed to explore rural Hispanics' perceived barriers to accessing and utilizing health care. Findings from a series of 19 focus groups with 181 participants from three communities in the upper Midwest identified perceived barriers at the individual and health care system levels. The most commonly perceived barriers were the lack of and limitations in health insurance coverage, high costs of health care services, communication issues involving patients and providers, legal status/discrimination, and transportation concerns. Findings imply that these barriers could be addressed using multiple educational and health service delivery policy-related strategies that consider the vulnerable nature of this growing population.
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[Inequality in access to health care services. Policy recommendations aimed at achieving equity].
Urbanos-Garrido, Rosa
2016-11-01
This article reveals the presence of inequalities in access to health care that may be considered unfair and avoidable. These inequalities are related to coverage of clinical needs, to the financial problems faced by families in completing medical treatments, or to disparities in waiting times and the use of services for equal need. A substantial proportion of inequalities appears to have increased as a result of the measures adopted to face the economic crisis. The recommendations aimed at improving equity affect different pillars of the taxpayer-funded health system, including, among others, the definition of the right to public health care coverage, the formulas of cost-sharing, the distribution of powers between primary and specialty care, the reforms of clinical management, and the production and dissemination of information to facilitate the decision-making processes of health authorities, professionals and citizens. Moreover, it is recommended to focus on particularly vulnerable population groups. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.
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Vulnerabilities, Influences and Interaction Paths: Failure Data for Integrated System Risk Analysis
NASA Technical Reports Server (NTRS)
Malin, Jane T.; Fleming, Land
2006-01-01
We describe graph-based analysis methods for identifying and analyzing cross-subsystem interaction risks from subsystem connectivity information. By discovering external and remote influences that would be otherwise unexpected, these methods can support better communication among subsystem designers at points of potential conflict and to support design of more dependable and diagnosable systems. These methods identify hazard causes that can impact vulnerable functions or entities if propagated across interaction paths from the hazard source to the vulnerable target. The analysis can also assess combined impacts of And-Or trees of disabling influences. The analysis can use ratings of hazards and vulnerabilities to calculate cumulative measures of the severity and importance. Identification of cross-subsystem hazard-vulnerability pairs and propagation paths across subsystems will increase coverage of hazard and risk analysis and can indicate risk control and protection strategies.
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Strategies for expanding health insurance coverage in vulnerable populations
Jia, Liying; Yuan, Beibei; Huang, Fei; Lu, Ying; Garner, Paul; Meng, Qingyue
2014-01-01
Background Health insurance has the potential to improve access to health care and protect people from the financial risks of diseases. However, health insurance coverage is often low, particularly for people most in need of protection, including children and other vulnerable populations. Objectives To assess the effectiveness of strategies for expanding health insurance coverage in vulnerable populations. Search methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.thecochranelibrary.com (searched 2 November 2012), PubMed (searched 1 November 2012), EMBASE (searched 6 July 2012), Global Health (searched 6 July 2012), IBSS (searched 6 July 2012), WHO Library Database (WHOLIS) (searched 1 November 2012), IDEAS (searched 1 November 2012), ISI-Proceedings (searched 1 November 2012),OpenGrey (changed from OpenSIGLE) (searched 1 November 2012), African Index Medicus (searched 1 November 2012), BLDS (searched 1 November 2012), Econlit (searched 1 November 2012), ELDIS (searched 1 November 2012), ERIC (searched 1 November 2012), HERDIN NeON Database (searched 1 November 2012), IndMED (searched 1 November 2012), JSTOR (searched 1 November 2012), LILACS(searched 1 November 2012), NTIS (searched 1 November 2012), PAIS (searched 6 July 2012), Popline (searched 1 November 2012), ProQuest Dissertation &Theses Database (searched 1 November 2012), PsycINFO (searched 6 July 2012), SSRN (searched 1 November 2012), Thai Index Medicus (searched 1 November 2012), World Bank (searched 2 November 2012), WanFang (searched 3 November 2012), China National Knowledge Infrastructure (CHKD-CNKI) (searched 2 November 2012). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via Web of Science to find other potentially relevant studies. Selection criteria Randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and Interrupted time series (ITS) studies that evaluated the effects of strategies on increasing health insurance coverage for vulnerable populations. We defined strategies as measures to improve the enrolment of vulnerable populations into health insurance schemes. Two categories and six specified strategies were identified as the interventions. Data collection and analysis At least two review authors independently extracted data and assessed the risk of bias. We undertook a structured synthesis. Main results We included two studies, both from the United States. People offered health insurance information and application support by community-based case managers were probably more likely to enrol their children into health insurance programmes (risk ratio (RR) 1.68, 95% confidence interval (CI) 1.44 to 1.96, moderate quality evidence) and were probably more likely to continue insuring their children (RR 2.59, 95% CI 1.95 to 3.44, moderate quality evidence). Of all the children that were insured, those in the intervention group may have been insured quicker (47.3 fewer days, 95% CI 20.6 to 74.0 fewer days, low quality evidence) and parents may have been more satisfied on average (satisfaction score average difference 1.07, 95% CI 0.72 to 1.42, low quality evidence). In the second study applications were handed out in emergency departments at hospitals, compared to not handing out applications, and may have had an effect on enrolment (RR 1.5, 95% CI 1.03 to 2.18, low quality evidence). Authors' conclusions Community-based case managers who provide health insurance information, application support, and negotiate with the insurer probably increase enrolment of children in health insurance schemes. However, the transferability of this intervention to other populations or other settings is uncertain. Handing out insurance application materials in hospital emergency departments may help increase the enrolment of children in health insurance schemes. Further studies evaluating the effectiveness of different strategies for expanding health insurance coverage in vulnerable population are needed in different settings, with careful attention given to study design. PLAIN LANGUAGE SUMMARY Strategies for expanding health insurance coverage in vulnerable populations Researchers in The Cochrane Collaboration conducted a review of the effect of strategies to increase the number of people from vulnerable populations that are enrolled into health insurance programmes. They searched for all relevant studies and found two studies. Their findings are summarised below. What is a health insurance programme? Governments in many countries offer healthcare services at low rates or free of charge to all their citizens, often paying for these services through taxes. However, in many developing countries and some developed countries this is not the case. In these countries, many people get their healthcare expenses covered through government health insurance programmes, which are often paid for through membership fees. But certain groups of people, such as children, the elderly, women, people with low incomes, people living in rural areas, racial and ethnic minorities, immigrants, and people with chronic diseases or disabilities, are less likely to be members of these programmes even though they are more likely to have health problems. In some of these countries governments have tried to make sure that health insurance programmes cover these vulnerable groups. One way of doing this is to improve the design of the programme. For instance, governments can change the rules for who can join the programme or they can make it cheaper to join. But even if a programme is well-designed, people may still not join it. For instance, they may not know that they can become members or they may find the application process too difficult. To address these problems, for instance, governments can give people more information about the programme and who can join, or can make the application process easier. What this research says Both studies in this review took place in the USA and were aimed at uninsured children. In the first study, case managers contacted the families of uninsured Latin American children, gave them information about health insurance, helped them apply, and helped them appeal when a wrong decision was made. In the second study, insurance application forms were handed out to the families of children visiting hospital emergency departments. In both studies, these families were compared to families who were not given additional information or support. The studies showed the following: People who are offered health insurance information and application support: - are probably more likely to enrol their children into health insurance programmes (moderate quality evidence); - are probably more likely to continue insuring their children (moderate quality evidence); - may be quicker at getting insurance (low quality evidence); - may be more satisfied with the process of enrolment (low quality evidence). People who are given insurance application forms in the emergency departments of hospitals: - may be more likely to enrol their children into health insurance programmes (low quality evidence). No unwanted effects were reported in the studies. A possible unwanted effect might be that people could experience the information and support as annoying or unhelpful. However, in the one study that measured the parents' satisfaction, people were more satisfied when given information and support. PMID:25425010
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Health insurance coverage and healthcare utilization among homeless young adults in Venice, CA.
Winetrobe, H; Rice, E; Rhoades, H; Milburn, N
2016-03-01
Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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A heat vulnerability index to improve urban public health management in San Juan, Puerto Rico.
Méndez-Lázaro, Pablo; Muller-Karger, Frank E; Otis, Daniel; McCarthy, Matthew J; Rodríguez, Ernesto
2018-05-01
Increased frequency and length of high heat episodes are leading to more cardiovascular issues and asthmatic responses among the population of San Juan, the capital of the island of Puerto Rico, USA. An urban heat island effect, which leads to foci of higher temperatures in some urban areas, can raise heat-related mortality. The objective of this research is to map the risk of high temperature in particular locations by creating heat maps of the city of San Juan. The heat vulnerability index (HVI) maps were developed using images collected by satellite-based remote sensing combined with census data. Land surface temperature was assessed using images from the Thermal Infrared Sensor flown on Landsat 8. Social determinants (e.g., age, unemployment, education and social isolation, and health insurance coverage) were analyzed by census tract. The data were examined in the context of land cover maps generated using products from the Puerto Rico Terrestrial Gap Analysis Project (USDA Forest Service). All variables were set in order to transform the indicators expressed in different units into indices between 0 and 1, and the HVI was calculated as sum of score. The tract with highest index was considered to be the most vulnerable and the lowest to be the least vulnerable. Five vulnerability classes were mapped (very high, high, moderate, low, and very low). The hottest and the most vulnerable tracts corresponded to highly built areas, including the Luis Munoz International Airport, seaports, parking lots, and high-density residential areas. Several variables contributed to increased vulnerability, including higher rates of the population living alone, disabilities, advanced age, and lack of health insurance coverage. Coolest areas corresponded to vegetated landscapes and urban water bodies. The urban HVI map will be useful to health officers, emergency preparedness personnel, the National Weather Service, and San Juan residents, as it helps to prepare for and to mitigate the potential effects of heat-related illnesses.
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A heat vulnerability index to improve urban public health management in San Juan, Puerto Rico
NASA Astrophysics Data System (ADS)
Méndez-Lázaro, Pablo; Muller-Karger, Frank E.; Otis, Daniel; McCarthy, Matthew J.; Rodríguez, Ernesto
2018-05-01
Increased frequency and length of high heat episodes are leading to more cardiovascular issues and asthmatic responses among the population of San Juan, the capital of the island of Puerto Rico, USA. An urban heat island effect, which leads to foci of higher temperatures in some urban areas, can raise heat-related mortality. The objective of this research is to map the risk of high temperature in particular locations by creating heat maps of the city of San Juan. The heat vulnerability index (HVI) maps were developed using images collected by satellite-based remote sensing combined with census data. Land surface temperature was assessed using images from the Thermal Infrared Sensor flown on Landsat 8. Social determinants (e.g., age, unemployment, education and social isolation, and health insurance coverage) were analyzed by census tract. The data were examined in the context of land cover maps generated using products from the Puerto Rico Terrestrial Gap Analysis Project (USDA Forest Service). All variables were set in order to transform the indicators expressed in different units into indices between 0 and 1, and the HVI was calculated as sum of score. The tract with highest index was considered to be the most vulnerable and the lowest to be the least vulnerable. Five vulnerability classes were mapped (very high, high, moderate, low, and very low). The hottest and the most vulnerable tracts corresponded to highly built areas, including the Luis Munoz International Airport, seaports, parking lots, and high-density residential areas. Several variables contributed to increased vulnerability, including higher rates of the population living alone, disabilities, advanced age, and lack of health insurance coverage. Coolest areas corresponded to vegetated landscapes and urban water bodies. The urban HVI map will be useful to health officers, emergency preparedness personnel, the National Weather Service, and San Juan residents, as it helps to prepare for and to mitigate the potential effects of heat-related illnesses.
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A heat vulnerability index to improve urban public health management in San Juan, Puerto Rico
NASA Astrophysics Data System (ADS)
Méndez-Lázaro, Pablo; Muller-Karger, Frank E.; Otis, Daniel; McCarthy, Matthew J.; Rodríguez, Ernesto
2017-02-01
Increased frequency and length of high heat episodes are leading to more cardiovascular issues and asthmatic responses among the population of San Juan, the capital of the island of Puerto Rico, USA. An urban heat island effect, which leads to foci of higher temperatures in some urban areas, can raise heat-related mortality. The objective of this research is to map the risk of high temperature in particular locations by creating heat maps of the city of San Juan. The heat vulnerability index (HVI) maps were developed using images collected by satellite-based remote sensing combined with census data. Land surface temperature was assessed using images from the Thermal Infrared Sensor flown on Landsat 8. Social determinants (e.g., age, unemployment, education and social isolation, and health insurance coverage) were analyzed by census tract. The data were examined in the context of land cover maps generated using products from the Puerto Rico Terrestrial Gap Analysis Project (USDA Forest Service). All variables were set in order to transform the indicators expressed in different units into indices between 0 and 1, and the HVI was calculated as sum of score. The tract with highest index was considered to be the most vulnerable and the lowest to be the least vulnerable. Five vulnerability classes were mapped (very high, high, moderate, low, and very low). The hottest and the most vulnerable tracts corresponded to highly built areas, including the Luis Munoz International Airport, seaports, parking lots, and high-density residential areas. Several variables contributed to increased vulnerability, including higher rates of the population living alone, disabilities, advanced age, and lack of health insurance coverage. Coolest areas corresponded to vegetated landscapes and urban water bodies. The urban HVI map will be useful to health officers, emergency preparedness personnel, the National Weather Service, and San Juan residents, as it helps to prepare for and to mitigate the potential effects of heat-related illnesses.
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Alcala, Emanuel; Cisneros, Ricardo; Capitman, John A
2017-12-20
California's San Joaquin Valley is a region with a history of poverty, low health care access, and high rates of pediatric asthma. It is important to understand the potential barriers to care that challenge vulnerable populations. The objective was to describe pediatric asthma-related utilization patterns in the emergency department (ED) and hospital by insurance coverage as well as to identify contributing individual-level indicators (age, sex, race/ethnicity, and insurance coverage) and neighborhood-level indicators of health care access. This was a retrospective study based on secondary data from California hospital and ED records 2007-2012. Children who used services for asthma-related conditions, were aged 0-14 years, Hispanic or non-Hispanic white, and resided in the San Joaquin Valley were included in the analysis. Poisson multilevel modeling was used to control for individual- and neighborhood-level factors. The effect of insurance coverage on asthma ED visits and hospitalizations was modified by the neighborhood-level percentage of concentrated poverty (RR = 1.01, 95% CI = 1.01-1.02; RR = 1.03, 95% CI = 1.02-1.04, respectively). The effect of insurance coverage on asthma hospitalizations was completely explained by the neighborhood-level percentage of concentrated poverty. Observed effects of insurance coverage on hospital care use were significantly modified by neighborhood-level measures of health care access and concentrated poverty. This suggests not only an overall greater risk for poor children on Medi-Cal, but also a greater vulnerability or response to neighborhood social factors such as socioeconomic status, community cohesiveness, crime, and racial/ethnic segregation.
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Ffuzz: Towards full system high coverage fuzz testing on binary executables.
Zhang, Bin; Ye, Jiaxi; Bi, Xing; Feng, Chao; Tang, Chaojing
2018-01-01
Bugs and vulnerabilities in binary executables threaten cyber security. Current discovery methods, like fuzz testing, symbolic execution and manual analysis, both have advantages and disadvantages when exercising the deeper code area in binary executables to find more bugs. In this paper, we designed and implemented a hybrid automatic bug finding tool-Ffuzz-on top of fuzz testing and selective symbolic execution. It targets full system software stack testing including both the user space and kernel space. Combining these two mainstream techniques enables us to achieve higher coverage and avoid getting stuck both in fuzz testing and symbolic execution. We also proposed two key optimizations to improve the efficiency of full system testing. We evaluated the efficiency and effectiveness of our method on real-world binary software and 844 memory corruption vulnerable programs in the Juliet test suite. The results show that Ffuzz can discover software bugs in the full system software stack effectively and efficiently.
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Inadequate prescription-drug coverage for Medicare enrollees--a call to action.
Soumerai, S B; Ross-Degnan, D
1999-03-04
In summary, most low-income elderly and disabled persons lack coverage for important medications, resulting in avoidable deterioration of health among those with chronic illnesses and use of expensive institutional services. Rapidly escalating drug costs, more restrictive drug-coverage policies, and a dramatic increase in the population of elderly and disabled persons will exacerbate these problems. With the current budget surplus, as well as bipartisan concern about health care needs and public concern about drug costs and coverage, it is time to act responsibly and aggressively. We recommend a national replication of the best features of state pharmacy-assistance programs in a federal-state insurance program for low-income Medicare enrollees, either alone or in combination with expanded Medicare coverage. Such a program will reduce the current inequitable situation in which the most vulnerable patients have the least access to medications, with serious medical and economic consequences.
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Impact of Universal Health Coverage on Child Growth and Nutrition in Argentina.
Nuñez, Pablo A; Fernández-Slezak, Diego; Farall, Andrés; Szretter, María Eugenia; Salomón, Oscar Daniel; Valeggia, Claudia R
2016-04-01
To estimate trends of undernutrition (stunting and underweight) among children younger than 5 years covered by the universal health coverage programs Plan Nacer and Programa Sumar. From 2005 to 2013, Plan Nacer and Programa Sumar collected high-quality information on birth and visit dates, age (in days), gender, weight (in kg), and height (in cm) for 1.4 million children in 6386 health centers (13 million records) with broad coverage of vulnerable populations in Argentina. The prevalence of stunting and underweight decreased 45.0% (from 20.6% to 11.3%) and 38.0% (from 4.0% to 2.5%), respectively, with differences between rural versus urban areas, gender, regions, age, and seasons. Undernutrition prevalence substantially decreased in 2 programs in Argentina as a result of universal health coverage.
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Bednarczyk, Robert A; Chu, Samantha L; Sickler, Heather; Shaw, Jana; Nadeau, Jessica A; McNutt, Louise-Anne
2015-03-30
Annual influenza vaccine coverage for young adults (including college students) remains low, despite a 2011 US recommendation for annual immunization of all people 6 months and older. College students are at high risk for influenza morbidity given close living and social spaces and extended travel during semester breaks when influenza circulation typically increases. We evaluated influenza vaccine uptake following an on-campus vaccine campaign at a large, public New York State university. Consecutive students visiting the University Health Center were recruited for a self-administered, anonymous, written survey. Students were asked about recent influenza vaccination, barriers to influenza vaccination, and willingness to get vaccinated to protect other vulnerable individuals they may encounter. Frequencies and proportions were evaluated. Of 653 students approached, 600 completed surveys (92% response proportion); respondents were primarily female (61%) and non-Hispanic white (59%). Influenza vaccine coverage was low (28%). Compared to coverage among non-Hispanic white students (30%), coverage was similar among Hispanic (30%) and other race/ethnicity students (28%) and lowest among non-Hispanic black students (17%). Among the unvaccinated, the most commonly selected vaccination barriers were "Too lazy to get the vaccine" (32%) and "Don't need the vaccine because I'm healthy" (29%); 6% of unvaccinated students cited cost as a barrier. After being informed that influenza vaccination of young, healthy people can protect other vulnerable individuals (e.g., infants, elderly), 71% of unvaccinated students indicated this would increase their willingness to get vaccinated. Influenza vaccine uptake among college students is very low. While making vaccine easily obtained may increase vaccine uptake, college students need to be motivated to get vaccinated. Typically healthy students may not perceive a need for influenza vaccine. Education about vaccinating healthy individuals to prevent the spread of influenza to close contacts, such as vulnerable family members, may provide this motivation to get vaccinated. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Risky Business - Questions To Ask Your Liability Insurance Agent and Attorney.
ERIC Educational Resources Information Center
Strickland, James
2000-01-01
Discusses the unique vulnerabilities of the child care industry related to liability insurance. Presents questions for beginning liability- and coverage-related dialogue between the caregiver or center director and the attorney and insurance agent. (KB)
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20 CFR 404.1205 - Absolute coverage groups.
Code of Federal Regulations, 2011 CFR
2011-04-01
... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Absolute coverage groups. 404.1205 Section... Covered § 404.1205 Absolute coverage groups. (a) General. An absolute coverage group is a permanent... are not under a retirement system. An absolute coverage group may include positions which were...
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20 CFR 404.1205 - Absolute coverage groups.
Code of Federal Regulations, 2014 CFR
2014-04-01
... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Absolute coverage groups. 404.1205 Section... INSURANCE (1950- ) Coverage of Employees of State and Local Governments What Groups of Employees May Be Covered § 404.1205 Absolute coverage groups. (a) General. An absolute coverage group is a permanent...
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20 CFR 404.1205 - Absolute coverage groups.
Code of Federal Regulations, 2013 CFR
2013-04-01
... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Absolute coverage groups. 404.1205 Section... INSURANCE (1950- ) Coverage of Employees of State and Local Governments What Groups of Employees May Be Covered § 404.1205 Absolute coverage groups. (a) General. An absolute coverage group is a permanent...
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20 CFR 404.1205 - Absolute coverage groups.
Code of Federal Regulations, 2012 CFR
2012-04-01
... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Absolute coverage groups. 404.1205 Section... INSURANCE (1950- ) Coverage of Employees of State and Local Governments What Groups of Employees May Be Covered § 404.1205 Absolute coverage groups. (a) General. An absolute coverage group is a permanent...
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Impact of Universal Health Coverage on Child Growth and Nutrition in Argentina
Fernández-Slezak, Diego; Farall, Andrés; Szretter, María Eugenia; Salomón, Oscar Daniel; Valeggia, Claudia R.
2016-01-01
Objectives. To estimate trends of undernutrition (stunting and underweight) among children younger than 5 years covered by the universal health coverage programs Plan Nacer and Programa Sumar. Methods. From 2005 to 2013, Plan Nacer and Programa Sumar collected high-quality information on birth and visit dates, age (in days), gender, weight (in kg), and height (in cm) for 1.4 million children in 6386 health centers (13 million records) with broad coverage of vulnerable populations in Argentina. Results. The prevalence of stunting and underweight decreased 45.0% (from 20.6% to 11.3%) and 38.0% (from 4.0% to 2.5%), respectively, with differences between rural versus urban areas, gender, regions, age, and seasons. Conclusions. Undernutrition prevalence substantially decreased in 2 programs in Argentina as a result of universal health coverage. PMID:26890172
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An equity dashboard to monitor vaccination coverage.
Arsenault, Catherine; Harper, Sam; Nandi, Arijit; Rodríguez, José M Mendoza; Hansen, Peter M; Johri, Mira
2017-02-01
Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The 2030 agenda for sustainable development . For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi's equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi's previous approach to measuring equity was the difference in vaccination coverage between a country's richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool - the equity dashboard - to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d'Ivoire and Haiti.
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An equity dashboard to monitor vaccination coverage
Harper, Sam; Nandi, Arijit; Rodríguez, José M Mendoza; Hansen, Peter M; Johri, Mira
2017-01-01
Abstract Equity monitoring is a priority for Gavi, the Vaccine Alliance, and for those implementing The 2030 agenda for sustainable development. For its new phase of operations, Gavi reassessed its approach to monitoring equity in vaccination coverage. To help inform this effort, we made a systematic analysis of inequalities in vaccination coverage across 45 Gavi-supported countries and compared results from different measurement approaches. Based on our findings, we formulated recommendations for Gavi’s equity monitoring approach. The approach involved defining the vulnerable populations, choosing appropriate measures to quantify inequalities, and defining equity benchmarks that reflect the ambitions of the sustainable development agenda. In this article, we explain the rationale for the recommendations and for the development of an improved equity monitoring tool. Gavi’s previous approach to measuring equity was the difference in vaccination coverage between a country’s richest and poorest wealth quintiles. In addition to the wealth index, we recommend monitoring other dimensions of vulnerability (maternal education, place of residence, child sex and the multidimensional poverty index). For dimensions with multiple subgroups, measures of inequality that consider information on all subgroups should be used. We also recommend that both absolute and relative measures of inequality be tracked over time. Finally, we propose that equity benchmarks target complete elimination of inequalities. To facilitate equity monitoring, we recommend the use of a data display tool – the equity dashboard – to support decision-making in the sustainable development period. We highlight its key advantages using data from Côte d’Ivoire and Haiti. PMID:28250513
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Hing, Nerilee; Russell, Alex Myles Thomas; Lamont, Matthew; Vitartas, Peter
2017-12-01
Promotions for online sports betting during televised sports broadcasts are regularly viewed by millions of Australians, raising concerns about their impacts on vulnerable groups including at-risk and problem gamblers. This study examined whether responses to these promotions varied with problem gambling severity amongst 455 Australian Internet sports bettors participating in an online survey. Results indicated that young male Internet sports bettors are especially vulnerable to gambling problems, particularly if they hold positive attitudes to gambling sponsors who embed promotions into sports broadcasts and to the promotional techniques they use and this heightens the risk that alluring messages contribute to excessive gambling. As problem gambling severity increased, so too did recognition that these promotions have impacted negatively on their sports betting behaviour. Because a plethora of sports betting brands and promotions are now heavily integrated into sports coverage, social marketing efforts are needed to offset their persuasive appeal and counter the positive attitudes towards them that appear linked to excessive gambling amongst Internet sports bettors.
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Drought, Agriculture, and Labor: Understanding Drought Impacts and Vulnerability in California
NASA Astrophysics Data System (ADS)
Greene, C.
2015-12-01
Hazardous drought impacts are a product of not only the physical intensity of drought, but also the economic, social, and environmental characteristics of the region exposed to drought. Drought risk management requires understanding the complex links between the physical and human dimensions of drought. Yet, there is a research gap in identifying and explaining the socio-economic complexities of drought in the context of the first world, especially for economic and socially marginal groups who rely on seasonal and temporary jobs. This research uses the current drought in California as a case study to identify the socioeconomic impacts of drought on farmworker communities in California's San Joaquin Valley, with a specific focus on the relationship between drought and agricultural labor. Through both a narrative analysis of drought coverage in newspaper media, drought policy documents, and interviews with farmworkers, farmers, community based organizations, and government officials in the San Joaquin Valley, this research aims to highlight the different understandings and experiences of the human impacts of drought and drought vulnerability in order to better inform drought risk planning and policy.
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Out-of-Pocket Payments and Subjective Unmet Need of Healthcare.
Schokkaert, Erik; Steel, Jonas; Van de Voorde, Carine
2017-10-01
We present a critical review of the literature that discusses the link between the level of out-of-pocket payments in developed countries and the share of people in these countries reporting that they postpone or forgo healthcare for financial reasons. We discuss the pros and cons of measuring access problems with this subjective variable. Whereas the quantitative findings in terms of numbers of people postponing care must be interpreted with utmost caution, the picture for the vulnerable groups in society is reasonably robust and unsurprising: people with low incomes and high morbidity and incomplete (or non-existent) insurance coverage are most likely to postpone or forgo healthcare for financial reasons. It is more surprising that people with high incomes and generous insurance coverage also report that they postpone care. We focus on some policy-relevant issues that call for further research: the subtle interactions between financial and non-financial factors, the possibility of differentiation of out-of-pocket payments between patients and between healthcare services, and the normative debate around accessibility and affordability.
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Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon.
Wright, Bill J; Garcia-Alexander, Ginny; Weller, Margarette A; Baicker, Katherine
2017-05-01
Efforts to reduce the ranks of the uninsured hinge on take-up of available programs and subsidies, but take-up of even free insurance is often less than complete. The evidence of the effectiveness of policies aiming to increase take-up is limited. We used a randomized controlled design to evaluate the impact of improved communication and behaviorally informed "nudges" designed to increase Medicaid take-up among eligible populations. Fielding randomized interventions in two different study populations in Oregon, we found that even very low-cost interventions substantially increased enrollment. Effects were larger in a population whose members had already expressed interest in obtaining coverage, but the effects were more persistent in low-income populations whose members were already enrolled in other state assistance programs but had not expressed interest in health insurance. The effects were similar across different demographic groups. Our results suggest that improving the design of enrollment processes and using low-cost mass-outreach efforts have the potential to substantially increase insurance coverage of vulnerable populations. Project HOPE—The People-to-People Health Foundation, Inc.
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Yang, Hao; Luo, Peng; Wang, Jun; Mou, Chengxiang; Mo, Li; Wang, Zhiyuan; Fu, Yao; Lin, Honghui; Yang, Yongping; Bhatta, Laxmi Dutt
2015-01-01
Climate and human-driven changes play an important role in regional droughts. Northwest Yunnan Province is a key region for biodiversity conservation in China, and it has experienced severe droughts since the beginning of this century; however, the extent of the contributions from climate and human-driven changes remains unclear. We calculated the ecosystem evapotranspiration (ET) and water yield (WY) of northwest Yunnan Province, China from 2001 to 2013 using meteorological and remote sensing observation data and a Surface Energy Balance System (SEBS) model. Multivariate regression analyses were used to differentiate the contribution of climate and vegetation coverage to ET. The results showed that the annual average vegetation coverage significantly increased over time with a mean of 0.69 in spite of the precipitation fluctuation. Afforestation/reforestation and other management efforts attributed to vegetation coverage increase in NW Yunnan. Both ET and WY considerably fluctuated with the climate factors, which ranged from 623.29 mm to 893.8 mm and –51.88 mm to 384.40 mm over the time period. Spatially, ET in the southeast of NW Yunnan (mainly in Lijiang) increased significantly, which was in line with the spatial trend of vegetation coverage. Multivariate linear regression analysis indicated that climatic factors accounted for 85.18% of the ET variation, while vegetation coverage explained 14.82%. On the other hand, precipitation accounted for 67.5% of the WY. We conclude that the continuous droughts in northwest Yunnan were primarily climatically driven; however, man-made land cover and vegetation changes also increased the vulnerability of local populations to drought. Because of the high proportion of the water yield consumed for subsistence and poor infrastructure for water management, local populations have been highly vulnerable to climate drought conditions. We suggest that conservation of native vegetation and development of water-conserving agricultural practices should be implemented as adaptive strategies to mitigate climate change. PMID:26237220
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Yang, Hao; Luo, Peng; Wang, Jun; Mou, Chengxiang; Mo, Li; Wang, Zhiyuan; Fu, Yao; Lin, Honghui; Yang, Yongping; Bhatta, Laxmi Dutt
2015-01-01
Climate and human-driven changes play an important role in regional droughts. Northwest Yunnan Province is a key region for biodiversity conservation in China, and it has experienced severe droughts since the beginning of this century; however, the extent of the contributions from climate and human-driven changes remains unclear. We calculated the ecosystem evapotranspiration (ET) and water yield (WY) of northwest Yunnan Province, China from 2001 to 2013 using meteorological and remote sensing observation data and a Surface Energy Balance System (SEBS) model. Multivariate regression analyses were used to differentiate the contribution of climate and vegetation coverage to ET. The results showed that the annual average vegetation coverage significantly increased over time with a mean of 0.69 in spite of the precipitation fluctuation. Afforestation/reforestation and other management efforts attributed to vegetation coverage increase in NW Yunnan. Both ET and WY considerably fluctuated with the climate factors, which ranged from 623.29 mm to 893.8 mm and -51.88 mm to 384.40 mm over the time period. Spatially, ET in the southeast of NW Yunnan (mainly in Lijiang) increased significantly, which was in line with the spatial trend of vegetation coverage. Multivariate linear regression analysis indicated that climatic factors accounted for 85.18% of the ET variation, while vegetation coverage explained 14.82%. On the other hand, precipitation accounted for 67.5% of the WY. We conclude that the continuous droughts in northwest Yunnan were primarily climatically driven; however, man-made land cover and vegetation changes also increased the vulnerability of local populations to drought. Because of the high proportion of the water yield consumed for subsistence and poor infrastructure for water management, local populations have been highly vulnerable to climate drought conditions. We suggest that conservation of native vegetation and development of water-conserving agricultural practices should be implemented as adaptive strategies to mitigate climate change.
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Oxytocin motivates non-cooperation in intergroup conflict to protect vulnerable in-group members.
De Dreu, Carsten K W; Shalvi, Shaul; Greer, Lindred L; Van Kleef, Gerben A; Handgraaf, Michel J J
2012-01-01
Intergroup conflict is often driven by an individual's motivation to protect oneself and fellow group members against the threat of out-group aggression, including the tendency to pre-empt out-group threat through a competitive approach. Here we link such defense-motivated competition to oxytocin, a hypothalamic neuropeptide involved in reproduction and social bonding. An intergroup conflict game was developed to disentangle whether oxytocin motivates competitive approach to protect (i) immediate self-interest, (ii) vulnerable in-group members, or (iii) both. Males self-administered oxytocin or placebo (double-blind placebo-controlled) and made decisions with financial consequences to themselves, their fellow in-group members, and a competing out-group. Game payoffs were manipulated between-subjects so that non-cooperation by the out-group had high vs. low impact on personal payoff (personal vulnerability), and high vs. low impact on payoff to fellow in-group members (in-group vulnerability). When personal vulnerability was high, non-cooperation was unaffected by treatment and in-group vulnerability. When personal vulnerability was low, however, in-group vulnerability motivated non-cooperation but only when males received oxytocin. Oxytocin fuels a defense-motivated competitive approach to protect vulnerable group members, even when personal fate is not at stake.
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The impact and cost of the HIV/AIDS investment framework for adolescents.
Stover, John; Rosen, Jim; Kasedde, Susan; Idele, Priscilla; McClure, Craig
2014-07-01
In 2005, the resources needed to support orphans and vulnerable children in sub-Saharan Africa were estimated at US$ 1.1-4.1 billion. Approaches to support vulnerable children have changed considerably since then. This study updates previous estimates by including new types of support and information on support costs. We considered 16 types of support categorized as economic strengthening, education support, social care and community outreach, and program support. The estimates combine the number of children in need of each intervention with unit costs derived from the literature and coverage goals based on current coverage and feasible future improvements. The number of children affected by AIDS in low- and middle-income countries varies from 58 million to 315 million depending on the definition of need. The resources required to provide support to children living in poor households will grow from US$ 4.2 billion in 2012 to US$ 5-8 billion by 2020. Almost two-thirds of these resources will be needed for Sub-Saharan Africa. The largest needs are for cash transfers, community care workers, early childhood development, block grants for education, M&E monitoring and evaluation, and direct material support. The results show that we can significantly improve the coverage of services for vulnerable children with only modest increases in resources. This results from stable or declining numbers of orphans and children living with HIV plus economic growth that is moving more households out of poverty. The results also reflect an important shift toward providing support to strengthen families and communities that care for children rather than direct material support. More resources are required to support children affected by AIDS, but new approaches to provide that support will be cost effective and have broad social and economic benefits.
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[Measles vaccination campaign for vulnerable populations: lessons learned].
Laurence, Sophie; Chappuis, Marielle; Lucas, Dorinela; Duteurtre, Martin; Corty, Jean-François
2013-01-01
Between 2008 and 2011, a measles epidemic raged in France. Immunization coverage in France, already insufficient in the general population, is even more worrying for deprived populations in whom exposure to the disease and the risk of complications are much higher. In this context, Medecins du Monde (MdM), the General Council of the Seine-Saint-Denis (CG93) and the Territorial Directorate of the Regional Health Agency (DTARS) implemented a measles vaccination campaign among the Rom population of the department. The objective was to improve coverage of this population by providing ambulatory services in collaboration between various field partners in a single public health project. Twenty-two of the known Rom settlements were selected to receive vaccination. MdM was in charge of logistics, mediation and vaccinations at 13 sites and the DTARS and CG93 were in charge of vaccination at another 9 sites with support from MdM for mediation and logistics. Between January and June 2012, 250 persons were vaccinated, 34.7% of the target population. Coverage of the population after the vaccination campaign was still very low. The partnership between MdM, DTARS and CG93 helped to create a positive mobile action experience and extended prevention actions towards the most vulnerable populations excluded from conventional health care structures.
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Groups have a larger cognitive capacity than individuals.
Sasaki, Takao; Pratt, Stephen C
2012-10-09
Increasing the number of options can paradoxically lead to worse decisions, a phenomenon known as cognitive overload [1]. This happens when an individual decision-maker attempts to digest information exceeding its processing capacity. Highly integrated groups, such as social insect colonies, make consensus decisions that combine the efforts of many members, suggesting that these groups can overcome individual limitations [2-4]. Here we report that an ant colony choosing a new nest site is less vulnerable to cognitive overload than an isolated ant making this decision on her own. We traced this improvement to differences in individual behavior. In whole colonies, each ant assesses only a small subset of available sites, and the colony combines their efforts to thoroughly explore all options. An isolated ant, on the other hand, must personally assess a larger number of sites to approach the same level of option coverage. By sharing the burden of assessment, the colony avoids overtaxing the abilities of its members. Copyright © 2012 Elsevier Ltd. All rights reserved.
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Wen, Shameng; Meng, Qingkun; Feng, Chao; Tang, Chaojing
2017-01-01
Formal techniques have been devoted to analyzing whether network protocol specifications violate security policies; however, these methods cannot detect vulnerabilities in the implementations of the network protocols themselves. Symbolic execution can be used to analyze the paths of the network protocol implementations, but for stateful network protocols, it is difficult to reach the deep states of the protocol. This paper proposes a novel model-guided approach to detect vulnerabilities in network protocol implementations. Our method first abstracts a finite state machine (FSM) model, then utilizes the model to guide the symbolic execution. This approach achieves high coverage of both the code and the protocol states. The proposed method is implemented and applied to test numerous real-world network protocol implementations. The experimental results indicate that the proposed method is more effective than traditional fuzzing methods such as SPIKE at detecting vulnerabilities in the deep states of network protocol implementations.
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ASSESSING THE VULNERABILITY OF AQUIFERS USING REGULARIZED POINT DATA.
The approach will be to collect available data on concentrations of dissolved nitrate. The data will be areally-averaged using covariance functions as Bras and Rodriguez-Iturbe (1993) described for the averaging of rainfall data. Polygon coverages of nitrate will be defined bas...
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Ffuzz: Towards full system high coverage fuzz testing on binary executables
2018-01-01
Bugs and vulnerabilities in binary executables threaten cyber security. Current discovery methods, like fuzz testing, symbolic execution and manual analysis, both have advantages and disadvantages when exercising the deeper code area in binary executables to find more bugs. In this paper, we designed and implemented a hybrid automatic bug finding tool—Ffuzz—on top of fuzz testing and selective symbolic execution. It targets full system software stack testing including both the user space and kernel space. Combining these two mainstream techniques enables us to achieve higher coverage and avoid getting stuck both in fuzz testing and symbolic execution. We also proposed two key optimizations to improve the efficiency of full system testing. We evaluated the efficiency and effectiveness of our method on real-world binary software and 844 memory corruption vulnerable programs in the Juliet test suite. The results show that Ffuzz can discover software bugs in the full system software stack effectively and efficiently. PMID:29791469
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Oxytocin Motivates Non-Cooperation in Intergroup Conflict to Protect Vulnerable In-Group Members
De Dreu, Carsten K. W.; Shalvi, Shaul; Greer, Lindred L.; Van Kleef, Gerben A.; Handgraaf, Michel J. J.
2012-01-01
Intergroup conflict is often driven by an individual's motivation to protect oneself and fellow group members against the threat of out-group aggression, including the tendency to pre-empt out-group threat through a competitive approach. Here we link such defense-motivated competition to oxytocin, a hypothalamic neuropeptide involved in reproduction and social bonding. An intergroup conflict game was developed to disentangle whether oxytocin motivates competitive approach to protect (i) immediate self-interest, (ii) vulnerable in-group members, or (iii) both. Males self-administered oxytocin or placebo (double-blind placebo-controlled) and made decisions with financial consequences to themselves, their fellow in-group members, and a competing out-group. Game payoffs were manipulated between-subjects so that non-cooperation by the out-group had high vs. low impact on personal payoff (personal vulnerability), and high vs. low impact on payoff to fellow in-group members (in-group vulnerability). When personal vulnerability was high, non-cooperation was unaffected by treatment and in-group vulnerability. When personal vulnerability was low, however, in-group vulnerability motivated non-cooperation but only when males received oxytocin. Oxytocin fuels a defense-motivated competitive approach to protect vulnerable group members, even when personal fate is not at stake. PMID:23144787
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Pauna, Henrique F.; Monsanto, Rafael C.; Schachern, Patricia A.; Costa, Sady S.; Kwon, Geeyoun; Paparella, Michael M.; Cureoglu, Sebahattin
2016-01-01
Objective Endoscopic procedures are becoming common in middle ear surgery. Inflammation due to chronic ear disease can cause bony erosion of the carotid artery and Fallopian canals, making them more vulnerable during surgery. The objective of this study was to determine whether or not chronic ear disease increases dehiscence of the carotid artery and Fallopian canals. Design Comparative human temporal bone study. Setting Otopathology laboratory. Participants We selected 78 temporal bones from 55 deceased donors with chronic otitis media or cholesteatoma, and then compared those 2 groups with a control group of 27 temporal bones from 19 deceased donors with no middle ear disease. Main outcome measures We analyzed the middle ear, carotid artery canal, and Fallopian canal, looking for signs of dehiscence of its bony coverage, using light microscopy. Results We found an increased incidence in dehiscence of the carotid artery and Fallopian canals in temporal bones with chronic middle ear disease. The size of the carotid artery canal dehiscence was larger in the middle ear diseased groups, and its bony coverage, when present, was also thinner compared to the control group. Dehiscence of the carotid artery canal was more frequently located closer to the promontory. The incidence of Fallopian canal dehiscence was significantly higher in temporal bones from donors older than 18 years with chronic middle ear disease. Conclusion The increased incidence of the carotid artery and Fallopian canal dehiscence in temporal bones with chronic middle ear disease elevates the risk of adverse events during middle ear surgery. Level of Evidence N/A. PMID:27455393
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Wooten, Karen G; Wortley, Pascale M; Singleton, James A; Euler, Gary L
2012-11-06
Knowledge and beliefs about influenza vaccine that differ across racial or ethnic groups may promote racial or ethnic disparities in vaccination. To identify associations between vaccination behavior and personal beliefs about influenza vaccine by race or ethnicity and education levels among the U.S. elderly population. Data from a national telephone survey conducted in 2004 were used for this study. Responses for 3875 adults ≥ 65 years of age were analyzed using logistic regression methods. Racial and ethnic differences in beliefs were observed. For example, whites were more likely to believe influenza vaccine is very effective in preventing influenza compared to blacks and Hispanics (whites, 60%; blacks, 47%, and Hispanics, 51%, p<0.01). Among adults who believed the vaccine is very effective, self-reported vaccination was substantially higher across all racial/ethnic groups (whites, 93%; blacks, 76%; Hispanics, 78%) compared to adults who believed the vaccine was only somewhat effective (whites 67%; blacks 61%, Hispanics 61%). Also, vaccination coverage differed by education level and personal beliefs of whites, blacks, and Hispanics. Knowledge and beliefs about influenza vaccine may be important determinants of influenza vaccination among racial/ethnic groups. Strategies to increase coverage should highlight the burden of influenza disease in racial and ethnic populations, the benefits and safety of vaccinations and personal vulnerability to influenza disease if not vaccinated. For greater effectiveness, factors associated with the education levels of some communities may need to be considered when developing or implementing new strategies that target specific racial or ethnic groups. Published by Elsevier Ltd.
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20 CFR 404.1207 - Divided retirement system coverage groups.
Code of Federal Regulations, 2010 CFR
2010-04-01
... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Divided retirement system coverage groups. 404.1207 Section 404.1207 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE... retirement system coverage group. A divided retirement system coverage group is a grouping under a retirement...
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Oswald, William E.; Stewart, Aisha E. P.; Flanders, W. Dana; Kramer, Michael R.; Endeshaw, Tekola; Zerihun, Mulat; Melaku, Birhanu; Sata, Eshetu; Gessesse, Demelash; Teferi, Tesfaye; Tadesse, Zerihun; Guadie, Birhan; King, Jonathan D.; Emerson, Paul M.; Callahan, Elizabeth K.; Moe, Christine L.; Clasen, Thomas F.
2016-01-01
This study developed and validated a model for predicting the probability that communities in Amhara Region, Ethiopia, have low sanitation coverage, based on environmental and sociodemographic conditions. Community sanitation coverage was measured between 2011 and 2014 through trachoma control program evaluation surveys. Information on environmental and sociodemographic conditions was obtained from available data sources and linked with community data using a geographic information system. Logistic regression was used to identify predictors of low community sanitation coverage (< 20% versus ≥ 20%). The selected model was geographically and temporally validated. Model-predicted probabilities of low community sanitation coverage were mapped. Among 1,502 communities, 344 (22.90%) had coverage below 20%. The selected model included measures for high topsoil gravel content, an indicator for low-lying land, population density, altitude, and rainfall and had reasonable predictive discrimination (area under the curve = 0.75, 95% confidence interval = 0.72, 0.78). Measures of soil stability were strongly associated with low community sanitation coverage, controlling for community wealth, and other factors. A model using available environmental and sociodemographic data predicted low community sanitation coverage for areas across Amhara Region with fair discrimination. This approach could assist sanitation programs and trachoma control programs, scaling up or in hyperendemic areas, to target vulnerable areas with additional activities or alternate technologies. PMID:27430547
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Pignone, Michael P; Crutchfield, Trisha M; Brown, Paul M; Hawley, Sarah T; Laping, Jane L; Lewis, Carmen L; Lich, Kristen Hassmiller; Richardson, Lisa C; Tangka, Florence Kl; Wheeler, Stephanie B
2014-11-30
Screening for colorectal cancer (CRC) is suboptimal, particularly for vulnerable populations. Effective intervention programs are needed to increase screening rates. We used a discrete choice experiment (DCE) to learn about how vulnerable individuals in North Carolina value different aspects of CRC screening programs. We enrolled English-speaking adults ages 50-75 at average risk of CRC from rural North Carolina communities with low rates of CRC screening, targeting those with public or no insurance and low incomes. Participants received basic information about CRC screening and potential program features, then completed a 16 task DCE and survey questions that examined preferences for four attributes of screening programs: testing options available; travel time required; money paid for screening or rewards for completing screening; and the portion of the cost of follow-up care paid out of pocket. We used Hierarchical Bayesian methods to calculate individual-level utilities for the 4 attributes' levels and individual-level attribute importance scores. For each individual, the attribute with the highest importance score was considered the most important attribute. Individual utilities were then aggregated to produce mean utilities for each attribute. We also compared DCE-based results with those from direct questions in a post-DCE survey. We enrolled 150 adults. Mean age was 57.8 (range 50-74); 55% were women; 76% White and 19% African-American; 87% annual household income under $30,000; and 51% were uninsured. Individuals preferred shorter travel; rewards or small copayments compared with large copayments; programs that included stool testing as an option; and greater coverage of follow-up costs. Follow-up cost coverage was most frequently found to be the most important attribute from the DCE (47%); followed by test reward/copayment (33%). From the survey, proportion of follow-up costs paid was most frequently cited as most important (42% of participants), followed by testing options (32%). There was moderate agreement (45%) in attribute importance between the DCE and the single question in the post-DCE survey. Screening test copayments and follow-up care coverage costs are important program characteristics in this vulnerable, rural population.
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The likely effects of employer-mandated complementary health insurance on health coverage in France.
Pierre, Aurélie; Jusot, Florence
2017-03-01
In France, access to health care greatly depends on having a complementary health insurance coverage (CHI). Thus, the generalisation of CHI became a core factor in the national health strategy created by the government in 2013. The first measure has been to compulsorily extend employer-sponsored CHI to all private sector employees on January 1st, 2016 and improve its portability coverage for unemployed former employees for up to 12 months. Based on data from the 2012 Health, Health Care and Insurance survey, this article provides a simulation of the likely effects of this mandate on CHI coverage and related inequalities in the general population by age, health status, socio-economic characteristics and time and risk preferences. We show that the non-coverage rate that was estimated to be 5% in 2012 will drop to 4% following the generalisation of employer-sponsored CHI and to 3.7% after accounting for portability coverage. The most vulnerable populations are expected to remain more often without CHI whereas non coverage will significantly decrease among the less risk averse and the more present oriented. With its focus on private sector employees, the policy is thus likely to do little for populations that would benefit most from additional insurance coverage while expanding coverage for other populations that appear to place little value on CHI. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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Costs and effects of the Tanzanian national voucher scheme for insecticide-treated nets
Mulligan, Jo-Ann; Yukich, Joshua; Hanson, Kara
2008-01-01
Background The cost-effectiveness of insecticide-treated nets (ITNs) in reducing morbidity and mortality is well established. International focus has now moved on to how best to scale up coverage and what financing mechanisms might be used to achieve this. The approach in Tanzania has been to deliver a targeted subsidy for those most vulnerable to the effects of malaria while at the same time providing support to the development of the commercial ITN distribution system. In October 2004, with funds from the Global Fund to Fight AIDS Tuberculosis and Malaria, the government launched the Tanzania National Voucher Scheme (TNVS), a nationwide discounted voucher scheme for ITNs for pregnant women and their infants. This paper analyses the costs and effects of the scheme and compares it with other approaches to distribution. Methods Economic costs were estimated using the ingredients approach whereby all resources required in the delivery of the intervention (including the user contribution) are quantified and valued. Effects were measured in terms of number of vouchers used (and therefore nets delivered) and treated nets years. Estimates were also made for the cost per malaria case and death averted. Results and Conclusion The total financial cost of the programme represents around 5% of the Ministry of Health's total budget. The average economic cost of delivering an ITN using the voucher scheme, including the user contribution, was $7.57. The cost-effectiveness results are within the benchmarks set by other malaria prevention studies. The Government of Tanzania's approach to scaling up ITNs uses both the public and private sectors in order to achieve and sustain the level of coverage required to meet the Abuja targets. The results presented here suggest that the TNVS is a cost-effective strategy for delivering subsidized ITNs to targeted vulnerable groups. PMID:18279509
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Peeters Grietens, Koen; Gryseels, Charlotte; Dierickx, Susan; Bannister-Tyrrell, Melanie; Trienekens, Suzan; Uk, Sambunny; Phoeuk, Pisen; Suon, Sokha; Set, Srun; Gerrets, René; Hoibak, Sarah; Muela Ribera, Joan; Hausmann-Muela, Susanna; Tho, Sochantha; Durnez, Lies; Sluydts, Vincent; d’Alessandro, Umberto; Coosemans, Marc; Erhart, Annette
2015-01-01
Human population movements currently challenge malaria elimination in low transmission foci in the Greater Mekong Subregion. Using a mixed-methods design, combining ethnography (n = 410 interviews), malariometric data (n = 4996) and population surveys (n = 824 indigenous populations; n = 704 Khmer migrants) malaria vulnerability among different types of mobile populations was researched in the remote province of Ratanakiri, Cambodia. Different structural types of human mobility were identified, showing differential risk and vulnerability. Among local indigenous populations, access to malaria testing and treatment through the VMW-system and LLIN coverage was high but control strategies failed to account for forest farmers’ prolonged stays at forest farms/fields (61% during rainy season), increasing their exposure (p = 0.002). The Khmer migrants, with low acquired immunity, active on plantations and mines, represented a fundamentally different group not reached by LLIN-distribution campaigns since they were largely unregistered (79%) and unaware of the local VMW-system (95%) due to poor social integration. Khmer migrants therefore require control strategies including active detection, registration and immediate access to malaria prevention and control tools from which they are currently excluded. In conclusion, different types of mobility require different malaria elimination strategies. Targeting mobility without an in-depth understanding of malaria risk in each group challenges further progress towards elimination. PMID:26593245
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-06-17
... 45 CFR Part 147 Group Health Plans and Health Insurance Coverage Relating to Status as a... for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan... group health plans and health insurance coverage in the group and individual markets under provisions of...
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77 FR 8667 - Summary of Benefits and Coverage and Uniform Glossary
Federal Register 2010, 2011, 2012, 2013, 2014
2012-02-14
... group health plans and health insurance coverage in the group and individual markets under the Patient... to participants and beneficiaries who enroll or re-enroll in group health coverage through an open... beneficiaries who enroll in group health plan coverage other than through an open enrollment period (including...
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20 CFR 404.1207 - Divided retirement system coverage groups.
Code of Federal Regulations, 2012 CFR
2012-04-01
... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Divided retirement system coverage groups..., SURVIVORS AND DISABILITY INSURANCE (1950- ) Coverage of Employees of State and Local Governments What Groups of Employees May Be Covered § 404.1207 Divided retirement system coverage groups. (a) General. Under...
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20 CFR 404.1206 - Retirement system coverage groups.
Code of Federal Regulations, 2013 CFR
2013-04-01
... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Retirement system coverage groups. 404.1206... DISABILITY INSURANCE (1950- ) Coverage of Employees of State and Local Governments What Groups of Employees May Be Covered § 404.1206 Retirement system coverage groups. (a) General. Section 218(d) of the Act...
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20 CFR 404.1206 - Retirement system coverage groups.
Code of Federal Regulations, 2012 CFR
2012-04-01
... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Retirement system coverage groups. 404.1206... DISABILITY INSURANCE (1950- ) Coverage of Employees of State and Local Governments What Groups of Employees May Be Covered § 404.1206 Retirement system coverage groups. (a) General. Section 218(d) of the Act...
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20 CFR 404.1206 - Retirement system coverage groups.
Code of Federal Regulations, 2014 CFR
2014-04-01
... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Retirement system coverage groups. 404.1206... DISABILITY INSURANCE (1950- ) Coverage of Employees of State and Local Governments What Groups of Employees May Be Covered § 404.1206 Retirement system coverage groups. (a) General. Section 218(d) of the Act...
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20 CFR 404.1205 - Absolute coverage groups.
Code of Federal Regulations, 2010 CFR
2010-04-01
... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Absolute coverage groups. 404.1205 Section 404.1205 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND DISABILITY... grouping of employees, e.g., all the employees of a city or town. It is a coverage group for coverage and...
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Song, In Gyu; Lee, Haewon; Yi, Jinseon; Kim, Min Sun; Park, Sang Min
2015-09-01
This study aimed to examine influenza vaccination coverage of North Korean defectors (NKD) in the Republic of Korea (Korea) and explore the factors affected the vaccination coverage. Total 378 NKD were analyzed. Four Korean control subjects were randomly matched by age and gender from the Korea National Health and Nutrition Examination Survey V (n = 1,500). The adjusted vaccination coverage revealed no statistical difference between the defectors group and indigenous group (29.1% vs. 29.5%, P = 0.915). In the aged under 50 group, the vaccination coverage of NKD was higher than that of Korean natives (37.8% vs. 25.8%, P = 0.016). However in the aged 50 yr and over group, the vaccination coverage of North Korean defectors was lower than that of the natives (28.0% vs. 37.6%, P = 0.189). Even the gap was wider in the aged 65 yr and over group (36.4% vs. 77.8%, P = 0.007). Gender and medical check-up experience within 2 yr showed association with the vaccination coverage of NKD. Influenza vaccination coverage of aged defectors' group (aged 50 yr and over) was lower than indigenous people though overall vaccination coverage was similar. Further efforts to increase influenza vaccination coverage of this group are needed.
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Realization of the international human right to health in an economically integrated North America.
Kinney, Eleanor D
2009-01-01
With the North American Free Trade Agreement (NAFTA), the health care sectors of the United States, Canada, and Mexico are becoming more economically integrated. NAFTA poses major challenges to the realization of the international human right. These include: (1) Cross Border Trade in Medical Products, (2) Cross Border Trade in Medical Services, and the attendant investment protections, (3) Portability and Comparability of Health Insurance Coverage, and (4) Protection of Public Health Insurance Programs. The United States, Mexico, and Canada all provide public health insurance programs either to the entire population as in Canada or to vulnerable groups as in the United States. In none of these countries have private, for-profit providers and insurers been able to provide universal and affordable health coverage and care in a truly free market. Private insurers and for-profit providers should not profit from the care of the healthy and wealthy in ways that compromise the public programs that serve the poor and seriously ill. Nor should they be allowed to use NAFTA processes to compromise public programs. Policy makers must consider implications of NAFTA and move toward assuring access to affordable health care for all people on the North American continent.
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Universal Health Coverage and the Right to Health: From Legal Principle to Post-2015 Indicators.
Sridhar, Devi; McKee, Martin; Ooms, Gorik; Beiersmann, Claudia; Friedman, Eric; Gouda, Hebe; Hill, Peter; Jahn, Albrecht
2015-01-01
Universal Health Coverage (UHC) is widely considered one of the key components for the post-2015 health goal. The idea of UHC is rooted in the right to health, set out in the International Covenant on Economic, Social, and Cultural Rights. Based on the Covenant and the General Comment of the Committee on Economic, Social, and Cultural Rights, which is responsible for interpreting and monitoring the Covenant, we identify 6 key legal principles that should underpin UHC based on the right to health: minimum core obligation, progressive realization, cost-effectiveness, shared responsibility, participatory decision making, and prioritizing vulnerable or marginalized groups. Yet, although these principles are widely accepted, they are criticized for not being specific enough to operationalize as post-2015 indicators for reaching the target of UHC. In this article, we propose measurable and achievable indicators for UHC based on the right to health that can be used to inform the ongoing negotiations on Sustainable Development Goals. However, we identify 3 major challenges that face any exercise in setting indicators post-2015: data availability as an essential criterion, the universality of targets, and the adaptation of global goals to local populations. © SAGE Publications 2015.
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45 CFR 146.117 - Special enrollment periods.
Code of Federal Regulations, 2010 CFR
2010-10-01
... coverage under any group health plan or health insurance coverage; and (C) The employee satisfies the... REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET Requirements Relating to Access and Renewability of Coverage... health insurance issuer offering health insurance coverage in connection with a group health plan, is...
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Inclusion of vulnerable groups in health policies: Regional policies on health priorities in Africa
Eide, Arne Henning; Amin, Mutamad; MacLachlan, Malcom; Mannan, Hasheem
2013-01-01
Background If access to equitable health care is to be achieved for all, policy documents must mention and address in some detail different needs of groups vulnerable to not accessing such health care. If these needs are not addressed in the policy documents, there is little chance that they will be addressed at the stage of implementation. Objectives This paper reports on an analysis of 11 African Union (AU) policy documents to ascertain the frequency and the extent of mention of 13 core concepts in relation to 12 vulnerable groups, with a specific focus on people with disabilities. Method The paper applied the EquiFrame analytical framework to the 11 AU policy documents. The 11 documents were analysed in terms of how many times a core concept was mentioned and the extent of information on how the core concept should be addressed at the implementation level. Each core concept mention was further analysed in terms of the vulnerable group in referred to. Results The analysis of regional AU policies highlighted the broad nature of the reference made to vulnerable groups, with a lack of detailed specifications of different needs of different groups. This is confirmed in the highest vulnerable group mention being for ‘universal’. The reading of the documents suggests that vulnerable groups are homogeneous in their needs, which is not the case. There is a lack of recognition of different needs of different vulnerable groups in accessing health care. Conclusion The need for more information and knowledge on the needs of all vulnerable groups is evident. The current lack of mention and of any detail on how to address needs of vulnerable groups will significantly impair the access to equitable health care for all. PMID:28729986
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Developmental Complexity in Student Conduct: An Extended Case Analysis of Student Board Members
ERIC Educational Resources Information Center
Bittinger, Joshua D.; Reif, Gabriel; Kimball, Ezekiel W.
2018-01-01
College students frequently serve on boards that hear cases of alleged student misconduct. These students contribute to decisions that can affect their peers' lives and make their colleges vulnerable to litigation and negative media coverage. It is critical that student board members carefully interpret all information presented in disciplinary…
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Ensor, Tim
2004-01-01
There is increasing awareness that supply subsidies for health and education services often fail to benefit those that are most vulnerable in a community. This recognition has led to a growing interest in and experimentation with, consumer-led demand side financing systems (CL-DSF). These mechanisms place purchasing power in the hands of consumers to spend on specific services at accredited facilities. International evidence in education and health sectors suggest a limited success of CL-DSF in raising the consumption of key services amongst priority groups. There is also some evidence that vouchers can be used to improve targeting of vulnerable groups. There is very little positive evidence on the effect of CL-DSF on service quality as a consequence of greater competition. Location of services relative to population means that areas with more provider choice, particularly in the private sector, tend to be dominated by higher and middle-income households. Extending CL-DSF in low-income countries requires the development of capacity in administering these financing schemes and also accrediting providers. Schemes could focus primarily on fixed packages of key services aimed at easily identifiable groups. Piloting and robust evaluation is required to fill the evidence gap on the impact of these mechanisms. Extending demand financing to less predictable services, such as hospital coverage for the population, is likely to require the development of a voucher scheme to purchase insurance. This suggests an already developed insurance market and is unlikely to be appropriate in most low-income countries for some time.
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Heintzman, John; Bailey, Steffani R; DeVoe, Jennifer; Cowburn, Stuart; Kapka, Tanya; Duong, Truc-Vi; Marino, Miguel
2017-06-01
Early survey evidence suggests a reduction of disparities in insurance coverage between Latinos and non-Hispanic Whites post-Affordable Care Act (ACA). These findings may not describe the insurance status of vulnerable, low-income Latino populations served in community health centers (CHCs) over the course of this policy change. Cross-sectional surveys also may be of limited use in describing longitudinal phenomena such as changes in health insurance status. Using electronic health record (EHR) data, we compared the insurance status of N = 42,392 low-income patients served in 23 CHCs in Oregon, by race/ethnicity and language, over a period of 6 years straddling the implementation of ACA-related Medicaid expansion on January 1, 2014. Prior to 2014, Spanish-preferring Latinos were more likely to be uninsured than English-preferring Latinos and non-Hispanic Whites. Among uninsured patients who returned for at least one visit in 2014, Spanish-preferring Latinos had the largest increase in insurance coverage rates, and all three racial/ethnic/language groups had similar rates of insurance coverage. There were no racial/ethnic/language differences between those who did and did not have visit in 2014. Among previously uninsured low-income patients returning to Oregon CHCs, insurance disparities were eliminated after Medicaid expansion, especially in Spanish-speaking Latinos. Further study is needed to understand the elimination of insurance disparities in this cohort.
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Bailey, Steffani R.; DeVoe, Jennifer; Cowburn, Stuart; Kapka, Tanya; Duong, Truc-Vi; Marino, Miguel
2016-01-01
Background Early survey evidence suggests a reduction of disparities in insurance coverage between Latinos and non-Hispanic Whites post-Affordable Care Act (ACA). These findings may not describe the insurance status of vulnerable, low-income Latino populations served in community health centers (CHCs) over the course of this policy change. Cross-sectional surveys also may be of limited use in describing longitudinal phenomena such as changes in health insurance status. Methods Using electronic health record (EHR) data, we compared the insurance status of N = 42,392 low-income patients served in 23 CHCs in Oregon, by race/ethnicity and language, over a period of 6 years straddling the implementation of ACA-related Medicaid expansion on January 1, 2014. Findings Prior to 2014, Spanish-preferring Latinos were more likely to be uninsured than English-preferring Latinos and non-Hispanic Whites. Among uninsured patients who returned for at least one visit in 2014, Spanish-preferring Latinos had the largest increase in insurance coverage rates, and all three racial/ethnic/language groups had similar rates of insurance coverage. There were no racial/ethnic/language differences between those who did and did not have visit in 2014. Conclusion Among previously uninsured low-income patients returning to Oregon CHCs, insurance disparities were eliminated after Medicaid expansion, especially in Spanish-speaking Latinos. Further study is needed to understand the elimination of insurance disparities in this cohort. PMID:27105630
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Medicaid Disenrollment Patterns Among Children Coming into Contact with Child Welfare Agencies.
Raghavan, Ramesh; Allaire, Benjamin T; Brown, Derek S; Ross, Raven E
2016-06-01
Objectives To examine retention of Medicaid coverage over time for children in the child welfare system. Methods We linked a national survey of children with histories of abuse and neglect to their Medicaid claims files from 36 states, and followed these children over a 4 year period. We estimated a Cox proportional hazards model on time to first disenrollment from Medicaid. Results Half of our sample (50 %) retained Medicaid coverage across 4 years of follow up. Most disenrollments occurred in year 4. Being 3-5 years of age and rural residence were associated with increased hazard of insurance loss. Fee-for-service Medicaid and other non-managed insurance arrangements were associated with a lower hazard of insurance loss. Conclusions for Practice A considerable number of children entering child environments seem to retain Medicaid coverage over multiple years. Finding ways to promote entry of child welfare-involved children into health insurance coverage will be critical to assure services for this highly vulnerable population.
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Sustaining enrollment in health insurance for vulnerable populations: lessons from Massachusetts.
Capoccia, Victor; Croze, Colette; Cohen, Martin; O'Brien, John P
2013-04-01
Since 2008 Massachusetts has had universal health insurance with an individual mandate. As a result, only about 3% of the population is uninsured. However, patients who use behavioral health services are uninsured at much higher rates. This 2011 study sought to understand reasons for the discrepancy and identify approaches to reduce disenrollment and sustain coverage. The qualitative study was based on structured interviews and focus groups. Structured interviews were conducted with 15 policy makers, consumer advocates, and chief executive officers of provider organizations, and three focus groups were held with 33 patient volunteers. The interviews and focus groups identified several disenrollment opportunities, all of which contribute to "churn" (the process by which disenrolled persons who remain eligible are reenrolled in the same or a different plan): missing and incomplete documentation, acute and chronic conditions and long-term disabilities that interfere with a patient's ability to respond to program communications, and lack of awareness among beneficiaries of the consequences of changes that trigger termination and the need to transfer to another program. Although safeguards are built into the system to avoid some disenrollments, the policies and procedures that drive the system are built on a default assumption of ineligibility or disenrollment until the individual establishes eligibility and completes requirements. Practices that can sustain enrollment include real-time Web-based prepopulated enrollment and redetermination processes, redetermination flexibility for designated chronic illnesses, and standardized performance metrics for churn and associated costs. Changes in the information system infrastructure and in outreach, enrollment, disenrollment, and reenrollment procedures can improve continuity and retention of health insurance coverage.
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20 CFR 404.1217 - Continuation of coverage.
Code of Federal Regulations, 2011 CFR
2011-04-01
... employees continues as follows: (a) Absolute coverage group. Generally, the services of an employee covered as a part of an absolute coverage group (see § 404.1205) continue to be covered indefinitely. A position covered as a part of an absolute coverage group continues to be covered even if the position later...
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20 CFR 404.1217 - Continuation of coverage.
Code of Federal Regulations, 2010 CFR
2010-04-01
... employees continues as follows: (a) Absolute coverage group. Generally, the services of an employee covered as a part of an absolute coverage group (see § 404.1205) continue to be covered indefinitely. A position covered as a part of an absolute coverage group continues to be covered even if the position later...
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Protocol vulnerability detection based on network traffic analysis and binary reverse engineering.
Wen, Shameng; Meng, Qingkun; Feng, Chao; Tang, Chaojing
2017-01-01
Network protocol vulnerability detection plays an important role in many domains, including protocol security analysis, application security, and network intrusion detection. In this study, by analyzing the general fuzzing method of network protocols, we propose a novel approach that combines network traffic analysis with the binary reverse engineering method. For network traffic analysis, the block-based protocol description language is introduced to construct test scripts, while the binary reverse engineering method employs the genetic algorithm with a fitness function designed to focus on code coverage. This combination leads to a substantial improvement in fuzz testing for network protocols. We build a prototype system and use it to test several real-world network protocol implementations. The experimental results show that the proposed approach detects vulnerabilities more efficiently and effectively than general fuzzing methods such as SPIKE.
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45 CFR 146.101 - Basis and scope.
Code of Federal Regulations, 2010 CFR
2010-10-01
... FOR THE GROUP HEALTH INSURANCE MARKET General Provisions § 146.101 Basis and scope. (a) Statutory... access to group health insurance coverage, to guarantee the renewability of all coverage in the group... group health plan or health insurance issuer offering group health insurance coverage may provide...
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García, Vanessa; Amigo, Hugo; Bustos, Patricia
2002-12-01
The study was based on a cross-sectional design of children from six to nine year olds. Indigenous children were those whose parents had all surnames of this ethnic origin. Non-indigenous children were those with Hispanic surnames. Participants belonged to one of the three social vulnerability groups: high vulnerability (extreme poverty) living in rural communities in a southern region of the country (n = 184); medium vulnerability living in urbanized settings in the same region (n = 248); low vulnerability living in Santiago of Chile (n = 336). Food intake was estimated using a 24-hours recall questionnaire. Total energy intake was similar in the two ethnic groups in all vulnerabilities. It was observed that energy and macronutrient intake increased with the improvement of the social vulnerability: High 1679 kcal. with a standard deviation (SD) of 461, Medium 1878 (SD 484), Low 1894 (SD 495). Children in the high social vulnerability group had a total energy intake below the WHO/FAO recommendations. Consumption of milk, meat, vegetables and fruits was insufficient in all social vulnerability levels but it was closer to the recommendation in the low vulnerability group. Bread accounted for almost 50% of the total energy intake in the high and medium vulnerability groups. It is concluded that differences in the access to an adequate feeding are related to social vulnerability and not ethnicity.
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McIntosh, Belinda J; Compton, Michael T; Druss, Benjamin G
2012-01-01
A growing trend in college and university health care is the requirement that students demonstrate proof of health insurance prior to enrollment. An increasing number of schools are contracting with insurance companies to provide students with school-based options for health insurance. Although this is advantageous to students in some ways, tying health insurance coverage to school enrollment can leave students vulnerable when they are most in need of help. Students whose health insurance is contingent upon their enrollment face significant lapses in coverage when they are required to leave school. This is especially challenging for students with mental illnesses whose treatment needs often go unmet in the absence of that coverage. The limitations in this system must be addressed as an increasing number of universities and students opt for university-based health insurance plans.
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Mack, Natasha; Robinson, Elizabeth T; MacQueen, Kathleen M; Moffett, Jill; Johnson, Laura M
2010-06-01
media coverage influences how clinical trials are perceived internationally and in communities where trials occur, affecting recruitment, retention, and political support for research. We conducted a discourse analysis of news coverage from 2004-2005 of a trial in Cameroon on oral PrEP for HIV prevention, to identify messages, communication techniques, and sources of messages that were amplified via media. We identified two parallel discourses: one on ethical concerns about the Cameroon trial, and a second, more general "science exploitation" discourse concerned with the potential for trials with vulnerable participant populations to be conducted unethically, benefiting only wealthy populations. Researchers should overtly address exploitation as an integral, ongoing component of research, particularly where historical or cultural conditions set the stage for controversy to emerge.
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Ivanova, Olena; Dræbel, Tania; Tellier, Siri
2015-08-12
Health policies are important instruments for improving population health. However, experience suggests that policies designed for the whole population do not always benefit the most vulnerable. Participation of vulnerable groups in the policy-making process provides an opportunity for them to influence decisions related to their health, and also to exercise their rights. This paper presents the findings from a study that explored how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies of 4 selected countries (Spain, Scotland, Republic of Moldova, and Ukraine). It also aimed at discussing the involvement of vulnerable groups in SRH policy development from the perspective of policy-makers. Literature review, health policy analysis and 5 semi-structured interviews with policy-makers were carried out in this study. Content analysis of SRH policies was performed using the EquiFrame analytical framework. The study revealed that vulnerable groups and core principles of human rights are differently addressed in SRH policies within 4 studied countries. The opinions of policy-makers on the importance of mentioning vulnerable groups in policy documents and the way they ought to be mentioned varied, but they agreed that a clear definition of vulnerability, practical examples, and evidences on health status of these groups have to be included. In addition, different approaches to vulnerable group's involvement in policy development were identified during the interviews and the range of obstacles to this process was discussed by respondents. Incorporation of vulnerable groups in the SRH policies and their involvement in policy development were found to be important in addressing SRH of these groups and providing an opportunity for them to advocate for equal access to healthcare and exercise their rights. Future research on this topic should include representatives of vulnerable communities which could help to build a dialogue and present the problem from multiple perspectives. © 2015 by Kerman University of Medical Sciences.
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Hummer, Robert A; Hayward, Mark D
2015-01-01
The Hispanic population aged sixty-five and over - the most socioeconomically disadvantaged subset of America's elderly - is projected to quintuple between 2012 and 2050. While current longevity patterns for Hispanics relative to whites are favorable, old-age functioning and disability patterns for Hispanics are unfavorable and have serious implications for caregivers; families; and local, state, and federal governments. Troubling signs for the future Hispanic population (which are shared to varying degrees with other vulnerable groups) include the unresolved legal status of unauthorized immigrants, continued low levels of insurance coverage even after health care reform, some unfavorable trends in health behaviors, and continued disadvantages in educational attainment and income relative to whites. We urge policy-makers to deal with these potentially problematic health and well-being issues. Not doing so could have detrimental consequences for the future of the Hispanic population as well as other at-risk groups and, by extension, the U.S. elderly population as a whole.
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Health sector solidarity: a core European value but with broadly varying content.
Saltman, Richard B
2015-01-01
Although the concept of solidarity sits at the center of many European health sector debates, the specific groups eligible for coverage, the financing arrangements, and the range of services and benefits that, together, compose the operational content of solidarity have all changed considerably over time. In prior economic periods, solidarity covered considerably fewer services or groups of the population than it does today. As economic and political circumstances changed, the content of solidarity changed with them. Recent examples of these shifts are illustrated through a discussion of health reforms in Netherlands, Germany and also Israel (although not in Europe, the Israeli health system is similar in structure to European social health insurance systems). This article suggests that changed economic circumstances in Europe since the onset of the 2008 financial crisis may lead to re-configuring the scope and content of services covered by solidarity in many European health systems. A key issue for policymakers will be protecting vulnerable populations as this re-design occurs.
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Paulsson Do, Ulrica; Edlund, Birgitta; Stenhammar, Christina; Westerling, Ragnar
2014-01-01
Purpose: There is lack of evidence on the effects of health-promoting programmes among adolescents. Health behaviour models and studies seldom compare the underlying factors of unhealthy behaviours between different adolescent age groups. The main objective of this study was to investigate factors including sociodemographic parameters that were associated with vulnerability to health-damaging behaviours and non-adoption of health-enhancing behaviours in different adolescent age groups. Methods: A survey was conducted among 10,590 pupils in the age groups of 13–14, 15–16 and 17–18 years. Structural equation modelling was performed to determine whether health-damaging behaviours (smoking and alcohol consumption) and non-adoption of health-enhancing behaviours (regular meal habits and physical activity) shared an underlying vulnerability. This method was also used to determine whether gender and socio-economic status were associated with an underlying vulnerability to unhealthy behaviours. Results: The findings gave rise to three models, which may reflect the underlying vulnerability to health-damaging behaviours and non-adoption of health-enhancing behaviours at different ages during adolescence. The four behaviours shared what was interpreted as an underlying vulnerability in the 15–16-year-old age group. In the youngest group, all behaviours except for non-participation in physical activity shared an underlying vulnerability. Similarly, alcohol consumption did not form part of the underlying vulnerability in the oldest group. Lower socio-economic status was associated with an underlying vulnerability in all the age groups; female gender was associated with vulnerability in the youngest adolescents and male gender among the oldest adolescents. Conclusions: These results suggest that intervention studies should investigate the benefits of health-promoting programmes designed to prevent health-damaging behaviours and promote health-enhancing behaviours in adolescents of different ages. Future studies should examine other factors that may contribute to the underlying vulnerability in different age groups. PMID:25750783
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Ivanova, Olena; Dræbel, Tania; Tellier, Siri
2015-01-01
Background: Health policies are important instruments for improving population health. However, experience suggests that policies designed for the whole population do not always benefit the most vulnerable. Participation of vulnerable groups in the policy-making process provides an opportunity for them to influence decisions related to their health, and also to exercise their rights. This paper presents the findings from a study that explored how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies of 4 selected countries (Spain, Scotland, Republic of Moldova, and Ukraine). It also aimed at discussing the involvement of vulnerable groups in SRH policy development from the perspective of policy-makers. Methods: Literature review, health policy analysis and 5 semi-structured interviews with policy-makers were carried out in this study. Content analysis of SRH policies was performed using the EquiFrame analytical framework. Results: The study revealed that vulnerable groups and core principles of human rights are differently addressed in SRH policies within 4 studied countries. The opinions of policy-makers on the importance of mentioning vulnerable groups in policy documents and the way they ought to be mentioned varied, but they agreed that a clear definition of vulnerability, practical examples, and evidences on health status of these groups have to be included. In addition, different approaches to vulnerable group’s involvement in policy development were identified during the interviews and the range of obstacles to this process was discussed by respondents. Conclusion: Incorporation of vulnerable groups in the SRH policies and their involvement in policy development were found to be important in addressing SRH of these groups and providing an opportunity for them to advocate for equal access to healthcare and exercise their rights. Future research on this topic should include representatives of vulnerable communities which could help to build a dialogue and present the problem from multiple perspectives. PMID:26673176
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A spatial evaluation of global wildfire-water risks to human and natural systems
Francois-Nicolas Robinne; Kevin D. Bladon; Carol Miller; Marc-Andre Parisien; Jerome Mathieu; Mike D. Flannigan
2017-01-01
The large mediatic coverage of recent massive wildfires across the world has emphasized the vulnerability of freshwater resources. The extensive hydrogeomorphic effects from a wildfire can impair the ability of watersheds to provide safe drinking water to downstream communities and high-quality water to maintain riverine ecosystem health. Safeguarding water use for...
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Mobile health clinics in the era of reform.
Hill, Caterina F; Powers, Brian W; Jain, Sachin H; Bennet, Jennifer; Vavasis, Anthony; Oriol, Nancy E
2014-03-01
Despite the role of mobile clinics in delivering care to the full spectrum of at-risk populations, the collective impact of mobile clinics has never been assessed. This study characterizes the scope of the mobile clinic sector and its impact on access, costs, and quality. It explores the role of mobile clinics in the era of delivery reform and expanded insurance coverage. A synthesis of observational data collected through Mobile Health Map and published literature related to mobile clinics. Analysis of data from the Mobile Health Map Project, an online platform that aggregates data on mobile health clinics in the United States, supplemented by a comprehensive literature review. Mobile clinics represent an integral component of the healthcare system that serves vulnerable populations and promotes high-quality care at low cost. There are an estimated 1500 mobile clinics receiving 5 million visits nationwide per year. Mobile clinics improve access for vulnerable populations, bolster prevention and chronic disease management, and reduce costs. Expanded coverage and delivery reform increase opportunities for mobile clinics to partner with hospitals, health systems, and insurers to improve care and lower costs. Mobile clinics have a critical role to play in providing high-quality, low-cost care to vulnerable populations. The postreform environment, with increasing accountability for population health management and expanded access among historically underserved populations, should strengthen the ability for mobile clinics to partner with hospitals, health systems, and payers to improve care and lower costs.
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45 CFR 147.128 - Rules regarding rescissions.
Code of Federal Regulations, 2010 CFR
2010-10-01
... HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS § 147.128... insurance issuer offering group or individual health insurance coverage, must not rescind coverage under the... of the plan or coverage. A group health plan, or a health insurance issuer offering group or...
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Lee, Ayoung; Cho, Joonmo
2016-12-01
The vulnerability approach suggests that disasters such as epidemics have different effects according not only to physical vulnerability but also to economic class (status). This paper examines the effect of the Middle East Respiratory Syndrome epidemic on the labor market to investigate whether vulnerable groups become more vulnerable due to an interaction between the socio-economic structure and physical risk. This paper examines the effect of the Middle East Respiratory Syndrome epidemic on the labor market by considering unemployment status, job status, working hours, reason for unemployment and underemployment status. In particular, the study investigates whether the U-shaped curve becomes a J-shaped curve due to the interaction between medical vulnerability and labor market vulnerability after an outbreak, assuming that the relative vulnerability in the labor market by age shows a U curve with peaks for the young group and middle aged and old aged groups using the Economically Active Population Survey. We use the difference in difference approach and also conduct a falsification check and robustness check. The results suggest that older workers faced a higher possibility of unemployment after the Middle East Respiratory Syndrome outbreak. In particular, they experienced higher involuntary unemployment and underemployment status as well as decreased working hours. It was confirmed that the relative vulnerability of the labor market for older workers was higher than for the other age groups after the epidemic outbreak due to the double whammy of vulnerability in the medical and labor market. The vulnerability in the young group partially increased compared to the 30s and 40s age groups due to their relative vulnerability in the labor market despite being healthy. We find that assuming the relative vulnerability in the existing labor market shows a U shape with age increase, the U-shaped curve became J-shaped after the outbreak. Disasters like epidemics can occur unexpectedly and affect certain groups more than other. Therefore, medical protection should be enhanced for groups vulnerable to disease and economic measures are also required for the protection of their livelihoods in the labor market to prevent unemployment stemming from inequality.
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Eisenberg, Marla E; Gower, Amy L; McMorris, Barbara J; Bucchianeri, Michaela M
2015-09-01
We examined perpetration of bullying among youths in vulnerable groups relative to youths in peer groups not categorized as vulnerable. Data were collected in 2013 from a large school-based survey of adolescents conducted in Minnesota (n = 122,180). We used the χ(2) test and logistic regression to compare measures of perpetration of physical and relational bullying, as well as experiences of victimization and perpetration (or both), across categories of sexual orientation, weight status, and disability status. Rates of physical and relational bullying perpetration were significantly higher among youths in vulnerable groups than among those not in vulnerable groups. With respect to context of victimization experiences, young men and women from vulnerable groups were overrepresented in the group comprising both perpetrators and victims. For example, odds of being both a perpetrator and a victim were 1.41 to 3.22 times higher among gay, lesbian, and bisexual youths than among heterosexual youths. Vulnerable youths, who are prone to peer harassment, may also act as perpetrators of bullying. Prevention strategies should address the particular needs of these populations; targeted programming may be appropriate.
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Assaad, Ramia; Rebeschini, Arianna; Hamadeh, Randa
2016-01-01
Introduction With the high proportion of refugee population throughout Lebanon and continuous population movement, it is sensible to believe that, in particular vulnerable areas, vaccination coverage may not be at an optimal level. Therefore, we assessed the vaccination coverage in children under 5 in a district of the Akkar governorate before and after a vaccination campaign. During the vaccination campaign, conducted in August 2015, 2,509 children were vaccinated. Materials and Methods We conducted a pre- and post-vaccination campaign coverage surveys adapting the WHO EPI cluster survey to the Lebanese MoPH vaccination calendar. Percentages of coverage for each dose of each vaccine were calculated for both surveys. Factors associated with complete vaccination were explored. Results Comparing the pre- with the post-campaign surveys, coverage for polio vaccine increased from 51.9% to 84.3%, for Pentavalent from 49.0% to 71.9%, for MMR from 36.2% to 61.0%, while the percentage of children with fully updated vaccination calendar increased from 32.9% to 53.8%. While Lebanese children were found to be better covered for some antigens compared to Syrians at the first survey, this difference disappeared at the post-campaign survey. Awareness and logistic obstacles were the primary reported causes of not complete vaccination in both surveys. Discussion Vaccination campaigns remain a quick and effective approach to increase vaccination coverage in crisis-affected areas. However, campaigns cannot be considered as a replacement of routine vaccination services to maintain a good level of coverage. PMID:27992470
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The financial crisis and the expected effects on vaccinations in Europe: a literature review.
Maltezou, Helena C; Lionis, Christos
2015-07-01
Starting in 2008 several European countries experienced a financial crisis. Historically, diseases whose prevention and treatment depend highly on the continuity of healthcare re-emerge during political and financial crises. Evidence suggests that the current financial crisis has had an impact on the health and welfare of Europeans and that population health status and morbidity as well as mortality patterns may change in the coming years. At the same time decisions about expenditure for health services may impact the ability of public health providers to respond. It is expected that the current crisis will further exacerbate socioeconomic and health inequalities and novel vulnerable groups will emerge in addition to existing ones. We review the available evidence and discuss how the current crisis may have an impact on vaccine-preventable diseases and influence vaccination coverage rates in Europe.
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Availability of Advanced Breast Imaging at Screening Facilities Serving Vulnerable Populations.
Lee, Christoph I; Bogart, Andy; Germino, Jessica C; Goldman, L Elizabeth; Hubbard, Rebecca A; Haas, Jennifer S; Hill, Deirdre A; Tosteson, Anna Na; Alford-Teaster, Jennifer A; DeMartini, Wendy B; Lehman, Constance D; Onega, Tracy L
2016-03-01
Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavourable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound, magnetic resonance imaging [MRI], and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations. 73 imaging facilities across five Breast Cancer Surveillance Consortium regional registries in the United States during 2011 and 2012. We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence.We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women. Facilities serving vulnerable populations were as likely (Relative risk [RR] for MRI = 0.71, 95% Confidence Interval [CI] 0.42, 1.19; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for ultrasound = 1.38 [95% CI 1.09, 1.74]; RR for ultrasound-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations. Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use. © The Author(s) 2015.
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Availability of Advanced Breast Imaging at Screening Facilities Serving Vulnerable Populations
Lee, Christoph I.; Bogart, Andy; Germino, Jessica C.; Goldman, L. Elizabeth; Hubbard, Rebecca A.; Haas, Jennifer S.; Hill, Deirdre A.; Tosteson, Anna N.A.; Alford-Teaster, Jennifer A.; DeMartini, Wendy B.; Lehman, Constance D.; Onega, Tracy L.
2015-01-01
Objective Among vulnerable women, unequal access to advanced breast imaging modalities beyond screening mammography may lead to delays in cancer diagnosis and unfavorable outcomes. We aimed to compare on-site availability of advanced breast imaging services (ultrasound (US), magnetic resonance imaging (MRI), and image-guided biopsy) between imaging facilities serving vulnerable patient populations and those serving non-vulnerable populations. Setting 73 United States imaging facilities across five Breast Cancer Surveillance Consortium regional registries during calendar years 2011–2012. Methods We examined facility and patient characteristics across a large, national sample of imaging facilities and patients served. We characterized facilities as serving vulnerable populations based on the proportion of mammograms performed on women with lower educational attainment, lower median income, racial/ethnic minority status, and rural residence. We performed multivariable logistic regression to determine relative risks of on-site availability of advanced imaging at facilities serving vulnerable women versus facilities serving non-vulnerable women. Results Facilities serving vulnerable populations were as likely (RR for MRI = 0.71 [95% CI 0.42, 1.19]; RR for MRI-guided biopsy = 1.07 [0.61, 1.90]; RR for stereotactic biopsy = 1.18 [0.75, 1.85]) or more likely (RR for US = 1.38 [95% CI 1.09, 1.74]; RR for US-guided biopsy = 1.67 [1.30, 2.14]) to offer advanced breast imaging services as those serving non-vulnerable populations. Conclusions Advanced breast imaging services are physically available on-site for vulnerable women in the United States, but it is unknown whether factors such as insurance coverage or out-of-pocket costs might limit their use. PMID:26078275
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Essential health care among Mexican indigenous people in a universal coverage context.
Servan-Mori, Edson; Pelcastre-Villafuerte, Blanca; Heredia-Pi, Ileana; Montoya-Rodríguez, Arain
2014-01-01
To analyze the influence of indigenous condition on essential health care among Mexican children, older people and women in reproductive age. The influence of indigenous condition on the probability of receiving medical care due to acute respiratory infection (ARI) and acute diarrheal disease (ADD), vaccination coverage; and antenatal care (ANC) was analyzed using the 2012 National Health Survey and non-experimental matching methods. Indigenous condition does not influence per-se vaccination coverage (in < 1 year), probability of attention of ARI's and ADD's as well as, timely, frequent, and quality ANC. Being indigenous and older adult increases 9% the probability of receiving a fulfilled vaccination schedule. Unfavorable structural conditions in which Mexican indigenous live constitutes the persistent mechanisms of their health vulnerability. Public policy should consider this level of intervention, in a way that intensive and focalized health strategies contribute to improve their health condition and life.
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Affordable Care Act and Diabetes Mellitus.
Shi, Qian; Nellans, Frank P; Shi, Lizheng
2015-12-01
The Affordable Care Act (ACA) has the potential for great impact on U.S. health care, especially for chronic disease patients requiring long-term care and management. The act was designed to improve insurance coverage, health care access, and quality of care for all Americans, which will assist patients with diabetes mellitus in acquiring routine monitoring and diabetes-related complication screening for better health management and outcomes. There is great potential for patients with diabetes to benefit from the new policy mandating health insurance coverage and plan improvement, Medicaid expansion, minimum coverage guarantees, and free preventative care. However, policy variability among states and ACA implementation present challenges to people with diabetes in understanding and optimizing ACA impact. This paper aims to select the most influential components of the ACA as relates to people with diabetes and discuss how the ACA may improve health care for this vulnerable population.
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Angel, Ronald J.; Angel, Jacqueline L.; Markides, Kyriakos S.
2002-01-01
Objectives. This study examined the association between health insurance coverage, medical care use, limitations in activities of daily living, and mortality among older Mexican-origin individuals. Methods. We analyzed longitudinal data from the Hispanic Established Populations for Epidemiologic Study of the Elderly (H-EPESE). Results. The uninsured tend to be younger, female, poor, and foreign born. They report fewer health care visits, are less likely to have a usual source of care, and more often receive care in Mexico. Conversely, those with private health insurance are economically better off and use more health care services. Over time, the data reveal substantial changes in type of insurance coverage. Conclusions. The data reveal serious vulnerabilities among older Mexican Americans that result from a lack of private Medigap supplemental coverage. (Am J Public Health. 2002;92:1264–1271) PMID:12144982
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Thompson, Kirrilly; Every, Danielle; Rainbird, Sophia; Cornell, Victoria; Smith, Bradley; Trigg, Joshua
2014-05-07
Increased vulnerability to natural disasters has been associated with particular groups in the community. This includes those who are considered de facto vulnerable (children, older people, those with disabilities etc.) and those who own pets (not to mention pets themselves). The potential for reconfiguring pet ownership from a risk factor to a protective factor for natural disaster survival has been recently proposed. But how might this resilience-building proposition apply to vulnerable members of the community who own pets or other animals? This article addresses this important question by synthesizing information about what makes particular groups vulnerable, the challenges to increasing their resilience and how animals figure in their lives. Despite different vulnerabilities, animals were found to be important to the disaster resilience of seven vulnerable groups in Australia. Animal attachment and animal-related activities and networks are identified as underexplored devices for disseminating or 'piggybacking' disaster-related information and engaging vulnerable people in resilience building behaviors (in addition to including animals in disaster planning initiatives in general). Animals may provide the kind of innovative approach required to overcome the challenges in accessing and engaging vulnerable groups. As the survival of humans and animals are so often intertwined, the benefits of increasing the resilience of vulnerable communities through animal attachment is twofold: human and animal lives can be saved together.
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Twyman, Laura; Bonevski, Billie; Paul, Christine; Bryant, Jamie
2014-01-01
Objectives To identify barriers that are common and unique to six selected vulnerable groups: low socioeconomic status; Indigenous; mental illness and substance abuse; homeless; prisoners; and at-risk youth. Design A systematic review was carried out to identify the perceived barriers to smoking cessation within six vulnerable groups. Data sources MEDLINE, EMBASE, CINAHL and PsycInfo were searched using keywords and MeSH terms from each database's inception published prior to March 2014. Study selection Studies that provided either qualitative or quantitative (ie, longitudinal, cross-sectional or cohort surveys) descriptions of self-reported perceived barriers to quitting smoking in one of the six aforementioned vulnerable groups were included. Data extraction Two authors independently assessed studies for inclusion and extracted data. Results 65 eligible papers were identified: 24 with low socioeconomic groups, 16 with Indigenous groups, 18 involving people with a mental illness, 3 with homeless groups, 2 involving prisoners and 1 involving at-risk youth. One study identified was carried out with participants who were homeless and addicted to alcohol and/or other drugs. Barriers common to all vulnerable groups included: smoking for stress management, lack of support from health and other service providers, and the high prevalence and acceptability of smoking in vulnerable communities. Unique barriers were identified for people with a mental illness (eg, maintenance of mental health), Indigenous groups (eg, cultural and historical norms), prisoners (eg, living conditions), people who are homeless (eg, competing priorities) and at-risk youth (eg, high accessibility of tobacco). Conclusions Vulnerable groups experience common barriers to smoking cessation, in addition to barriers that are unique to specific vulnerable groups. Individual-level, community-level and social network-level interventions are priority areas for future smoking cessation interventions within vulnerable groups. Trial registration number: A protocol for this review has been registered with PROSPERO International Prospective Register of Systematic Reviews (Identifier: CRD42013005761). PMID:25534212
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-11-17
... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... contracts of insurance. The temporary regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The IRS is issuing the temporary...
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29 CFR 2590.712 - Parity in mental health and substance use disorder benefits.
Code of Federal Regulations, 2010 CFR
2010-07-01
..., coverage unit refers to the way in which a plan (or health insurance coverage) groups individuals for... ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH PLANS Other... of specified benefits that may be paid under a group health plan (or health insurance coverage...
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26 CFR 54.9801-6 - Special enrollment periods.
Code of Federal Regulations, 2010 CFR
2010-04-01
...) When coverage under the plan was previously offered, the employee had coverage under any group health plan or health insurance coverage; and (C) The employee satisfies the conditions of paragraph (a)(3)(i... imposed on a health insurance issuer offering group health insurance coverage.) (2) Individuals eligible...
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Experts' perspectives on SwissDRG: Second class care for vulnerable patient groups?
Leu, A; Wepf, H; Elger, B; Wangmo, T
2018-03-14
On the 1st of January 2012, Switzerland introduced the diagnosis-related group hospital tariff structure (SwissDRG). It was recognised that healthcare provided to the most vulnerable patient groups would be a challenge for the new SwissDRG. Coincident with the implementation of SwissDRG, we explored hospital experts' perceptions of which patient groups are vulnerable under the SwissDRG system, what has changed for this group, as well as solutions to ensure adequate access to health care for them. We interviewed 43 experts from 40 Swiss hospitals. Participating experts named several vulnerable patient groups who share some common characteristics. These hospital experts were concerned about the patient groups that are not financially profitable and questioned the practicability of the current regulation. At the same time, they highlighted the complexity associated with caring for this group under the new SwissDRG and reported measures at the macro, meso, and micro levels to protect vulnerable patient groups from negative effects. To curb negative outcomes for vulnerable patient groups after the introduction of the SwissDRG, the Swiss legislation has introduced various instruments including the acute and transitional care (ATC) measures. We conclude that ATC measures do not produce the expected effect the legislators had hoped for. More health data is needed to identify situations where vulnerable patient groups are more susceptible to inadequate health care access in Switzerland. Copyright © 2018 Elsevier B.V. All rights reserved.
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Climate Change 2014: Technical Summary
Field, Chrisopher B.; Barros, Vicente; Mach, Katherine; Mastrandrea, Michael; van Aalst, Maarten; Adger, Niel; Arent, Douglas J; Barnett, Jonathan; Betts, Richard; Bilir, Eren; Birkmann, Joern; Carmin, Joann; Chadee, Dave; Challinor, Andrew; Chaterjee, Monalisa; Cramer, Wolfgang; Davidson, Debra; Estrada, Yuka; Gatusso, Jean-Pierre; Hijioka, Yasuakai; Yohe, Gary; Hiza, Margaret; Hoegh-Guldberg, Ove; Huang, He-Qing; Insarov, Gregory; Jones, Roger; Kovats, Sari; Lankao, Patricia Romero; Larsen, Joan Nymand; Losada, Iñigo; Marengo, José; McLean, Roger; Mearns, Linda; Mechler, Reinhard; Morton, John; Niang, Isabelle; Oki, Taikan; Olwoch, Jane Mukarugwiza; Opondo, Maggie; Poloczanska, Elvira; Pörtner, Hans -O.; Reisinger, Andy; Revi, Aromar; Schmidt, Daniela; Shaw, Rebecca; Solecki, William; Stone, Dáithí; Stone, John; Strzepek, Ken; Suarez, Avelino G.; Tschakert, Petra; Valentini, Riccardo; Vicuna, Sebastian; Villamizar, Alicia; Vincent, Katharine; Warren, Rachel; White, Leslie; Wilbanks, Thomas; Wong, Poh Poh
2014-01-01
Human interference with the climate system is occurring (WGI AR5 SPM Section D.3; WGI AR5 Sections 2.2, 6.3, 10.3 to 10.6, 10.9). Climate change poses risks for human and natural systems. The assessment of impacts, adaptation, and vulnerability in the Working Group II contribution to the IPCC’s Fifth Assessment Report (WGII AR5) evaluates how patterns of risks and potential benefits are shifting due to climate change. It considers how impacts and risks related to climate change can be reduced and managed through adaptation and mitigation. The report assesses needs, options, opportunities, constraints, resilience, limits, and other aspects associated with adaptation. It recognizes that risks of climate change will vary across regions and populations, through space and time, dependent on myriad factors including the extent of adaptation and mitigation. For the past 2 decades, IPCC’s Working Group II has developed assessments of climate change impacts, adaptation, and vulnerability. The WGII AR5 builds from the WGII contribution to the IPCC’s Fourth Assessment Report (WGII AR4), published in 2007, and the Special Report on Managing the Risks of Extreme Events and Disasters to Advance Climate Change Adaptation (SREX), published in 2012. It follows the Working Group I contribution to the AR5. The WGII AR5 is presented in two parts (Part A: Global and Sectoral Aspects, and Part B: Regional Aspects), reflecting the expanded literature basis and multidisciplinary approach, increased focus on societal impacts and responses, and continued regionally comprehensive coverage. [1.1 to 1.3] The number of scientific publications available for assessing climate change impacts, adaptation, and vulnerability more than doubled between 2005 and 2010, with especially rapid increases in publications related to adaptation, allowing for a more robust assessment that supports policymaking (high confidence). The diversity of the topics and regions covered has similarly expanded, as has the geographic distribution of authors contributing to the knowledge base for climate change assessments. Authorship of climate change publications from developing countries has increased, although it still represents a small fraction of the total. The unequal distribution of publications presents a challenge to the production of a comprehensive and balanced global assessment.
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[Media coverage of suicide: From the epidemiological observations to prevention avenues].
Notredame, Charles-Édouard; Pauwels, Nathalie; Walter, Michel; Danel, Thierry; Vaiva, Guillaume
2015-12-01
Media coverage of suicide can result in increased morbi-mortality suicidal rates, due to an imitation process in those who are particularly vulnerable. This phenomenon is known as "Werther effect". Werther effect's magnitude depends on several qualitative and quantitative characteristics of the media coverage, in a dose-effect relationship. An extensive (in terms of audience and history repetition) and salient coverage (glorification of suicide, description of the suicidal method, etc.) increases the risk of contagion. Celebrities' suicide is particularly at risk of Werther effect. Media may also have a preventive role with respect to suicide. Indeed, according to "Papageno effect", journalists could, under certain conditions, help preventing suicide when reporting suicide stories. Two main theories in the field of social psychology have been proposed to account for Werther and Papageno effects: social learning theory and differential identification. Identification of Werther and Papageno effects uncovers new responsibilities and potentialities for the journalists in terms of public health. Their description provides a basis for promising targeted prevention actions. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
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Ponsar, Frédérique; Van Herp, Michel; Zachariah, Rony; Gerard, Séco; Philips, Mit; Jouquet, Guillaume
2011-11-01
Malaria is the most common cause of morbidity and mortality in children under 5 in Mali. Health centres provide primary care, including malaria treatment, under a system of cost recovery. In 2005, Médecins sans Frontieres (MSF) started supporting health centres in Kangaba with the provision of rapid malaria diagnostic tests and artemisinin-based combination therapy. Initially MSF subsidized malaria tests and drugs to reduce the overall cost for patients. In a second phase, MSF abolished fees for all children under 5 irrespective of their illness and for pregnant women with fever. This second phase was associated with a trebling of both primary health care utilization and malaria treatment coverage for these groups. MSF's experience in Mali suggests that removing user fees for vulnerable groups significantly improves utilization and coverage of essential health services, including for malaria interventions. This effect is far more marked than simply subsidizing or providing malaria drugs and diagnostic tests free of charge. Following the free care strategy, utilization of services increased significantly and under-5 mortality was reduced. Fee removal also allowed for more efficient use of existing resources, reducing average cost per patient treated. These results are particularly relevant for the context of Mali and other countries with ambitious malaria treatment coverage objectives, in accordance with the United Nations Millennium Development Goals. This article questions the effectiveness of the current national policy, and the effectiveness of reducing the cost of drugs only (i.e. partial subsidies) or providing malaria tests and drugs free for under-5s, without abolishing other related fees. National and international budgets, in particular those that target health systems strengthening, could be used to complement existing subsidies and be directed towards effective abolition of user fees. This would contribute to increasing the impact of interventions on population health and, in turn, the effectiveness of aid.
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Nandi, Sulakshana; Schneider, Helen; Dixit, Priyanka
2017-01-01
Research on impact of publicly financed health insurance has paid relatively little attention to the nature of healthcare provision the schemes engage. India's National Health Insurance Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public and private sectors provide hospital services in a context of extensive gender, social, economic and geographical inequities. This study examined enrolment, utilization (public and private) and out of pocket (OOP) expenditure for the insured and uninsured, in Chhattisgarh. The Chhattisgarh State Central sample (n = 6026 members) of the 2014 National Sample Survey (71st Round) on Health was extracted and analyzed. Variables of enrolment, hospitalization, out of pocket (OOP) expenditure and catastrophic expenditure were descriptively analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by sector) and OOP expenditure were conducted, taking into account gender, socio-economic status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization were 33/1000 population among the insured and 29/1000 among the uninsured. Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents, Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations. Although the insured were less likely to incur out of pocket (OOP) expenditure, 95.1% of insured private sector users and 66.0% of insured public sector users, still incurred costs. Median OOP payments in the private sector were eight times those in the public sector. Of households with at least one member hospitalized, 35.5% experienced catastrophic health expenditures (>10% monthly household consumption expenditure). The study finds that despite insurance coverage, the majority still incurred OOP expenditure. The public sector was nevertheless less expensive, and catered to the more vulnerable groups. It suggests the need to further examine the roles of public and private sectors in financial risk protection through government health insurance.
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Schneider, Helen; Dixit, Priyanka
2017-01-01
Research on impact of publicly financed health insurance has paid relatively little attention to the nature of healthcare provision the schemes engage. India’s National Health Insurance Scheme or RSBY was made universal by Chhattisgarh State in 2012. In the State, public and private sectors provide hospital services in a context of extensive gender, social, economic and geographical inequities. This study examined enrolment, utilization (public and private) and out of pocket (OOP) expenditure for the insured and uninsured, in Chhattisgarh. The Chhattisgarh State Central sample (n = 6026 members) of the 2014 National Sample Survey (71st Round) on Health was extracted and analyzed. Variables of enrolment, hospitalization, out of pocket (OOP) expenditure and catastrophic expenditure were descriptively analyzed. Multivariate analyses of factors associated with enrolment, hospitalization (by sector) and OOP expenditure were conducted, taking into account gender, socio-economic status, residence, type of facility and ailment. Insurance coverage was 38.8%. Rates of hospitalization were 33/1000 population among the insured and 29/1000 among the uninsured. Of those insured and hospitalized, 67.2% utilized the public sector. Women, rural residents, Scheduled Tribes and poorer groups were more likely to utilize the public sector for hospitalizations. Although the insured were less likely to incur out of pocket (OOP) expenditure, 95.1% of insured private sector users and 66.0% of insured public sector users, still incurred costs. Median OOP payments in the private sector were eight times those in the public sector. Of households with at least one member hospitalized, 35.5% experienced catastrophic health expenditures (>10% monthly household consumption expenditure). The study finds that despite insurance coverage, the majority still incurred OOP expenditure. The public sector was nevertheless less expensive, and catered to the more vulnerable groups. It suggests the need to further examine the roles of public and private sectors in financial risk protection through government health insurance. PMID:29149181
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[Influenza, tetanus, and pertussis vaccination coverage among adults in Germany].
Bödeker, Birte; Remschmidt, C; Müters, S; Wichmann, O
2015-02-01
In order to be adequately protected throughout life and to protect specific risk groups from particular diseases, regular booster or specific indicator vaccinations are also recommended during adulthood. Adults should be vaccinated against seasonal influenza (annually, e.g., persons with underlying chronic diseases and persons aged ≥ 60 years), tetanus (every 10 years), and pertussis (as a one-time vaccination with the next due tetanus vaccine and, e.g., when people have close contact to newborn babies). The aim of this study was to provide an overview of the current status of vaccination uptake among adults living in Germany, focusing on these three vaccines. In line with nationwide continuous health monitoring, the Robert Koch Institute conducted the representative study "German Health Update" (GEDA 2012) between 2012 and 2013. The survey is conducted regularly and adults are asked questions relating to their vaccination status through computer-assisted telephone interviews. Overall, 19,294 interviews were held. In 2010/2011 and 2011/2012, seasonal influenza uptake among persons aged ≥ 60 years was 54.3 and 52.6 % and among individuals with underlying chronic diseases 46.2 and 42.9 %. 7.6 and 75.6 % of participants reported up-to-date pertussis and tetanus vaccination, respectively. 22 % of people living with a baby in one household were vaccinated against pertussis. In general, vaccination rates against seasonal influenza, pertussis, and tetanus among adults are still low, but differ depending on the specific vaccination. The required aim of the European Commission to reach influenza vaccination coverage by the 2014/2015 winter season of 75 % of higher age groups has not yet been reached. The low pertussis vaccination coverage among persons in close household contact to infants poses a big challenge to the implementation of the cocooning strategy to protect the very vulnerable newborns. To emphasize the importance of a complete vaccination schedule and to increase vaccination uptake, tailored interventions should be provided for both physicians and adults.
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Public health surveillance and infectious disease detection.
Morse, Stephen S
2012-03-01
Emerging infectious diseases, such as HIV/AIDS, SARS, and pandemic influenza, and the anthrax attacks of 2001, have demonstrated that we remain vulnerable to health threats caused by infectious diseases. The importance of strengthening global public health surveillance to provide early warning has been the primary recommendation of expert groups for at least the past 2 decades. However, despite improvements in the past decade, public health surveillance capabilities remain limited and fragmented, with uneven global coverage. Recent initiatives provide hope of addressing this issue, and new technological and conceptual advances could, for the first time, place capability for global surveillance within reach. Such advances include the revised International Health Regulations (IHR 2005) and the use of new data sources and methods to improve global coverage, sensitivity, and timeliness, which show promise for providing capabilities to extend and complement the existing infrastructure. One example is syndromic surveillance, using nontraditional and often automated data sources. Over the past 20 years, other initiatives, including ProMED-mail, GPHIN, and HealthMap, have demonstrated new mechanisms for acquiring surveillance data. In 2009 the U.S. Agency for International Development (USAID) began the Emerging Pandemic Threats (EPT) program, which includes the PREDICT project, to build global capacity for surveillance of novel infections that have pandemic potential (originating in wildlife and at the animal-human interface) and to develop a framework for risk assessment. Improved understanding of factors driving infectious disease emergence and new technological capabilities in modeling, diagnostics and pathogen identification, and communications, such as using the increasing global coverage of cellphones for public health surveillance, can further enhance global surveillance.
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National red listing beyond the 2010 target.
Zamin, Tara J; Baillie, Jonathan E M; Miller, Rebecca M; Rodríguez, Jon Paul; Ardid, Ana; Collen, Ben
2010-08-01
Following creation of the 2010 Biodiversity Target under the Convention on Biological Diversity and adoption of the United Nations Millennium Development Goals, information on status and trends of biodiversity at the national level has become increasingly important to both science and policy. National red lists (NRLs) of threatened species may provide suitable data for reporting on progress toward these goals and for informing national conservation priority setting. This information will also become increasingly important for developing species- and ecosystem-based strategies for climate change adaptation. We conducted a thorough global review of NRLs in 109 countries and analyzed gaps in NRL coverage in terms of geography and taxonomy to determine priority regions and taxonomic groups for further investment. We then examined correlations between the NRL data set and gross domestic product (GDP) and vertebrate species richness. The largest geographic gap was in Oceania, followed by middle Africa, the Caribbean, and western Africa, whereas the largest taxonomic gaps were for invertebrates, fungi, and lichens. The comprehensiveness of NRL coverage within a given country was positively correlated with GDP and negatively correlated with total vertebrate richness and threatened vertebrate richness. This supports the assertion that regions with the greatest and most vulnerable biodiversity receive the least conservation attention and indicates that financial resources may be an integral limitation. To improve coverage of NRLs, we propose a combination of projects that target underrepresented taxa or regions and projects that provide the means for countries to create or update NRLs on their own. We recommend improvements in knowledge transfer within and across regions as a priority for future investment.
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Hafiz, Israt; Berhan, Meklit; Keller, Angela; Haq, Rouseli; Chesnaye, Nicholas; Koporc, Kim; Rahman, Mujibur; Rahman, Shamsur; Mathieu, Els
2015-01-01
Bangladesh's national deworming program targets school-age children (SAC) through bi-annual school-based distributions of mebendazole. Qualitative and quantitative methods were applied to identify challenges related to treatment monitoring within the Munshiganj and Lakshmipur Districts of Bangladesh. Key stakeholder interviews identified several obstacles for successful treatment monitoring within these districts; ambiguity in defining the target population, variances in the methods used for compiling and reporting treatment data, and a general lack of financial and human resources. A treatment coverage cluster survey revealed that bi-annual primary school-based distributions proved to be an effective strategy in reaching school-attending SAC, with rates between 63.0% and 73.3%. However, the WHO target of regular treatment of at least 75% of SAC has yet to be reached. Particularly low coverage was seen amongst non-school attending children (11.4-14.3%), most likely due to the lack of national policy to effectively target this vulnerable group. Survey findings on water and sanitation coverage were impressive with the majority of households and schools having access to latrines (98.6-99.3%) and safe drinking water (98.2-100%). The challenge now for the Bangladesh control program is to achieve the WHO target of regular treatment of at least 75% of SAC at risk, irrespective of school-enrollment status. Copyright © 2013 The Authors. Published by Elsevier B.V. All rights reserved.
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ERIC Educational Resources Information Center
Hill, Paul; Hannaway, Jane
2006-01-01
Long before the onslaught of Hurricane Katrina or the chaos of evacuation, New Orleans' social infrastructure was failing. News coverage of the overcrowded Superdome and the city's flooded streets exposed the poverty and vulnerability of many residents, especially African Americans. As New Orleans begins to rebuild, can the city avoid the mistakes…
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SAPT units turn-on in an interference-dominant environment. [Stand Alone Pressure Transducer
NASA Technical Reports Server (NTRS)
Peng, W.-C.; Yang, C.-C.; Lichtenberg, C.
1990-01-01
A stand alone pressure transducer (SAPT) is a credit-card-sized smart pressure sensor inserted between the tile and the aluminum skin of a space shuttle. Reliably initiating the SAPT units via RF signals in a prelaunch environment is a challenging problem. Multiple-source interference may exist if more than one GSE (ground support equipment) antenna is turned on at the same time to meet the simultaneity requirement of 10 ms. A polygon model for orbiter, external tank, solid rocket booster, and tail service masts is used to simulate the prelaunch environment. Geometric optics is then applied to identify the coverage areas and the areas which are vulnerable to multipath and/or multiple-source interference. Simulation results show that the underside areas of an orbiter have incidence angles exceeding 80 deg. For multipath interference, both sides of the cargo bay areas are found to be vulnerable to a worst-case multipath loss exceeding 20 dB. Multiple-source interference areas are also identified. Mitigation methods for the coverage and interference problem are described. It is shown that multiple-source interference can be eliminated (or controlled) using the time-division-multiplexing method or the time-stamp approach.
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A coverage and slicing dependencies analysis for seeking software security defects.
He, Hui; Zhang, Dongyan; Liu, Min; Zhang, Weizhe; Gao, Dongmin
2014-01-01
Software security defects have a serious impact on the software quality and reliability. It is a major hidden danger for the operation of a system that a software system has some security flaws. When the scale of the software increases, its vulnerability has becoming much more difficult to find out. Once these vulnerabilities are exploited, it may lead to great loss. In this situation, the concept of Software Assurance is carried out by some experts. And the automated fault localization technique is a part of the research of Software Assurance. Currently, automated fault localization method includes coverage based fault localization (CBFL) and program slicing. Both of the methods have their own location advantages and defects. In this paper, we have put forward a new method, named Reverse Data Dependence Analysis Model, which integrates the two methods by analyzing the program structure. On this basis, we finally proposed a new automated fault localization method. This method not only is automation lossless but also changes the basic location unit into single sentence, which makes the location effect more accurate. Through several experiments, we proved that our method is more effective. Furthermore, we analyzed the effectiveness among these existing methods and different faults.
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Chomat, Anne Marie; Grundy, John; Oum, Sophal; Bermudez, Odilia I
2011-01-01
Facility delivery and skilled birth attendance are two of the most effective strategies for decreasing maternal mortality. The objectives of this study were to further define utilisation of these services in Cambodia and to uncover socio-economic or location-specific coverage gaps that may exist. We performed a cross-sectional analysis of the 2005 Cambodia Demographic Health Survey (CDHS) to determine prevalence, and determinants, of service utilisation. Out of 6069 women aged 15-49 years, 77% delivered at home, three-fourths without a skilled birth attendant. Poverty, lower education and rural residence were associated with the highest likelihood of poor utilisation of services. Discussion. While there has been an overall increase in facility deliveries and skilled birth attendance since 2000, improvements have been spread unevenly across the population, benefiting mostly urban, wealthier and better educated women. While recent financing initiatives and health system developments appear to have further increased service utilisation since 2005, the extent of their reach to the most vulnerable populations, and their ultimate impact on maternal mortality reduction, remain to be elucidated. Further expanding successful initiatives, particularly among vulnerable populations, is essential. Longitudinal evaluation of ongoing strategies and their impact remains critical.
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The effect of Health Savings Accounts on group health insurance coverage.
Ye, Jinqi
2015-12-01
This paper presents new empirical evidence on the impact of tax subsidies for Health Savings Accounts (HSAs) on group insurance coverage. HSAs are tax-free health care expenditure savings accounts. Coupled with high deductible health insurance plans (HDHPs), they together represent new health insurance options. The tax advantage of HSAs expands the group health insurance market by making health care more affordable. Using individual level data from the Current Population Survey and exploiting policy variation by state and year from 2004 to 2012, I find that HSA tax subsidies increase small-group coverage by a statistically significant 2.5 percentage points, although not coverage in larger firms. Moreover, if the tax price of HSA contribution decreases by 10 cents, small-group insurance coverage increases by almost 2 percentage points. I also find that for older workers or less-educated workers, HSA subsidies are associated with 2-3 percentage point increase in their group insurance coverage. Copyright © 2015 Elsevier B.V. All rights reserved.
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Gower, Amy L.; McMorris, Barbara J.; Bucchianeri, Michaela M.
2015-01-01
Objectives. We examined perpetration of bullying among youths in vulnerable groups relative to youths in peer groups not categorized as vulnerable. Methods. Data were collected in 2013 from a large school-based survey of adolescents conducted in Minnesota (n = 122 180). We used the χ2 test and logistic regression to compare measures of perpetration of physical and relational bullying, as well as experiences of victimization and perpetration (or both), across categories of sexual orientation, weight status, and disability status. Results. Rates of physical and relational bullying perpetration were significantly higher among youths in vulnerable groups than among those not in vulnerable groups. With respect to context of victimization experiences, young men and women from vulnerable groups were overrepresented in the group comprising both perpetrators and victims. For example, odds of being both a perpetrator and a victim were 1.41 to 3.22 times higher among gay, lesbian, and bisexual youths than among heterosexual youths. Conclusions. Vulnerable youths, who are prone to peer harassment, may also act as perpetrators of bullying. Prevention strategies should address the particular needs of these populations; targeted programming may be appropriate. PMID:26180987
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Lawson, David W.; Borgerhoff Mulder, Monique; Ghiselli, Margherita E.; Ngadaya, Esther; Ngowi, Bernard; Mfinanga, Sayoki G. M.; Hartwig, Kari; James, Susan
2014-01-01
The Maasai of northern Tanzania, a semi-nomadic ethnic group predominantly reliant on pastoralism, face a number of challenges anticipated to have negative impacts on child health, including marginalisation, vulnerabilities to drought, substandard service provision and on-going land grabbing conflicts. Yet, stemming from a lack of appropriate national survey data, no large-scale comparative study of Maasai child health has been conducted. Savannas Forever Tanzania surveyed the health of over 3500 children from 56 villages in northern Tanzania between 2009 and 2011. The major ethnic groups sampled were the Maasai, Sukuma, Rangi, and the Meru. Using multilevel regression we compare each ethnic group on the basis of (i) measurements of child health, including anthropometric indicators of nutritional status and self-reported incidence of disease; and (ii) important proximate determinants of child health, including food insecurity, diet, breastfeeding behaviour and vaccination coverage. We then (iii) contrast households among the Maasai by the extent to which subsistence is reliant on livestock herding. Measures of both child nutritional status and disease confirm that the Maasai are substantially disadvantaged compared to neighbouring ethnic groups, Meru are relatively advantaged, and Rangi and Sukuma intermediate in most comparisons. However, Maasai children were less likely to report malaria and worm infections. Food insecurity was high throughout the study site, but particularly severe for the Maasai, and reflected in lower dietary intake of carbohydrate-rich staple foods, and fruits and vegetables. Breastfeeding was extended in the Maasai, despite higher reported consumption of cow's milk, a potential weaning food. Vaccination coverage was lowest in Maasai and Sukuma. Maasai who rely primarily on livestock herding showed signs of further disadvantage compared to Maasai relying primarily on agriculture. We discuss the potential ecological, socioeconomic, demographic and cultural factors responsible for these differences and the implications for population health research and policy. PMID:25353164
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Breeze, J; Fryer, R; Hare, J; Delaney, R; Hunt, N C; Lewis, E A; Clasper, J C
2015-04-01
There is a requirement in the Ministry of Defence for an objective method of comparing the area of coverage of different body armour designs for future applications. Existing comparisons derived from surface wound mapping are limited in that they can only demonstrate the skin entry wound location. The Coverage of Armour Tool (COAT) is a novel three-dimensional model capable of comparing the coverage provided by body armour designs, but limited information exists as to which anatomical structures require inclusion. The aim of this study was to assess the utility of COAT, in the assessment of neck protection, using clinically relevant injury data. Hospital notes and post mortem records of all UK soldiers injured by an explosive fragment to the neck between 01 Jan 2006 and 31 December 2012 from Iraq and Afghanistan were analysed to determine which anatomical structures were responsible for death or functional disability at one year post injury. Using COAT a comparison of three ballistic neck collar designs was undertaken with reference to the percentage of these anatomical structures left exposed. 13/81 (16%) survivors demonstrated complications at one year, most commonly upper limb weakness from brachial plexus injury or a weak voice from laryngeal trauma. In 14/94 (15%) soldiers the neck wound was believed to have been the sole cause of death, primarily from carotid artery damage, spinal cord transection or rupture of the larynx. COAT objectively demonstrated that despite the larger OSPREY collar having almost double the surface area than the two-piece prototype collar, the percentage area of vulnerable cervical structures left exposed only reduced from 16.3% to 14.4%. COAT demonstrated its ability to objectively quantify the potential effectiveness of different body armour designs in providing coverage of vulnerable anatomical structures from different shot line orientations. To improve its utility, it is recommended that COAT be further developed to enable weapon and tissue specific information to be modelled, and that clinically significant injuries to other body regions are also incorporated. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
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45 CFR 147.130 - Coverage of preventive health services.
Code of Federal Regulations, 2010 CFR
2010-10-01
... CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE MARKETS... described in paragraph (b) of this section, a group health plan, or a health insurance issuer offering group or individual health insurance coverage, must provide coverage for all of the following items and...
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29 CFR 2590.701-4 - Rules relating to creditable coverage.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 2590.701-4 Labor Regulations Relating to Labor (Continued) EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH PLANS Health Coverage... I of the Act, and without regard to whether the coverage is offered in the group market, the...
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29 CFR 2590.701-4 - Rules relating to creditable coverage.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 2590.701-4 Labor Regulations Relating to Labor (Continued) EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH PLANS Health Coverage... I of the Act, and without regard to whether the coverage is offered in the group market, the...
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29 CFR 2590.701-4 - Rules relating to creditable coverage.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 2590.701-4 Labor Regulations Relating to Labor (Continued) EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH PLANS Health Coverage... I of the Act, and without regard to whether the coverage is offered in the group market, the...
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Keygnaert, Ines
2016-02-11
Ivanova et al explored how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies in 4 countries. They adapted the EquiFrame of Amin and colleagues of 2011, to SRH vulnerable groups which we believe could now be used for analysis of national SRH polices beyond those 4 countries. Although we fully agree with the authors' two main findings that vulnerable groups and human rights' principles are not sufficiently integrated in SRH policies nor granted the possibility to participate in the process of development in those four countries, we do believe that these shortcomings are not limited to those countries only nor to the identified vulnerable groups either. We are convinced that the issue of SRH as such is still framed within a very limited logic for all with vulnerable groups being perceived as an extra threat or an extra burden. © 2016 by Kerman University of Medical Sciences.
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Spatial distribution of thermokarst terrain in Arctic Alaska
Farquharson, Louise; Mann, Dan H; Grosse, Guido; Jones, Benjamin M.; Romanovsky, Vladimir
2016-01-01
In landscapes underlain by ice-rich permafrost, the development of thermokarst landforms can have drastic impacts on ecosystem processes and human infrastructure. Here we describe the distribution of thermokarst landforms in the continuous permafrost zone of Arctic Alaska, analyze linkages to the underlying surficial geology, and discuss the vulnerability of different types of landscapes to future thaw. We identified nine major thermokarst landforms and then mapped their distributions in twelve representative study areas totaling 300-km2. These study areas differ in their geologic history, permafrost-ice content, and ground thermal regime. Results show that 63% of the entire study area is occupied by thermokarst landforms and that the distribution of thermokarst landforms and overall landscape complexity varies markedly with surficial geology. Areas underlain by ice-rich marine silt are the most affected by thermokarst (97% of total area), whereas areas underlain by glacial drift are least affected (14%). Drained thermokarst-lake basins are the most widespread thermokarst landforms, covering 33% of the entire study region, with greater prevalence in areas of marine silt (48% coverage), marine sand (47%), and aeolian silt (34%). Thermokarst-lakes are the second most common thermokarst landform, covering 16% of the study region, with highest coverage in areas underlain by marine silt (39% coverage). Thermokarst troughs and pits cover 7% of the study region and are the third most prevalent thermokarst landform. They are most common in areas underlain by deltaic sands and gravels (18% coverage) and marine sand (12%). Alas valleys are widespread in areas of aeolian silt (14%) located in gradually sloping uplands. Areas of marine silt have been particularly vulnerable to thaw in the past because they are ice-rich and have low-gradient topography facilitating the repeated development of thermokarst-lakes. In the future, ice-rich aeolian, upland terrain (yedoma) will be particularly susceptible to thaw because it still contains massive concentrations of ground ice in the form of syngenetic ice-wedges that have remained largely intact since the Pleistocene.
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Thompson, Kirrilly; Every, Danielle; Rainbird, Sophia; Cornell, Victoria; Smith, Bradley; Trigg, Joshua
2014-01-01
Simple Summary The potential for reconfiguring pet ownership from a risk factor to a protective factor for natural disaster survival has been recently proposed. But how might this resilience-building proposition apply to members of the community who are already considered vulnerable? This article addresses this important question by synthesizing information about what makes seven particular groups vulnerable, the challenges to increasing their resilience and how animals figure in their lives. It concludes that animal attachment could provide a novel conduit for accessing, communicating with and motivating vulnerable people to engage in resilience building behaviors that promote survival and facilitate recovery. Abstract Increased vulnerability to natural disasters has been associated with particular groups in the community. This includes those who are considered de facto vulnerable (children, older people, those with disabilities etc.) and those who own pets (not to mention pets themselves). The potential for reconfiguring pet ownership from a risk factor to a protective factor for natural disaster survival has been recently proposed. But how might this resilience-building proposition apply to vulnerable members of the community who own pets or other animals? This article addresses this important question by synthesizing information about what makes particular groups vulnerable, the challenges to increasing their resilience and how animals figure in their lives. Despite different vulnerabilities, animals were found to be important to the disaster resilience of seven vulnerable groups in Australia. Animal attachment and animal-related activities and networks are identified as underexplored devices for disseminating or ‘piggybacking’ disaster-related information and engaging vulnerable people in resilience building behaviors (in addition to including animals in disaster planning initiatives in general). Animals may provide the kind of innovative approach required to overcome the challenges in accessing and engaging vulnerable groups. As the survival of humans and animals are so often intertwined, the benefits of increasing the resilience of vulnerable communities through animal attachment is twofold: human and animal lives can be saved together. PMID:26480038
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45 CFR 146.152 - Guaranteed renewability of coverage for employers in the group market.
Code of Federal Regulations, 2010 CFR
2010-10-01
... REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET Provisions Applicable to Only Health Insurance Issuers § 146.152 Guaranteed renewability of coverage for employers in... insurance issuer offering health insurance coverage in the small or large group market is required to renew...
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-07-19
... Requirement for Group Health Plans and Health Insurance Issuers To Provide Coverage of Preventive Services... Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage offered in...
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Heat Vulnerability Index Mapping for Milwaukee and Wisconsin.
Christenson, Megan; Geiger, Sarah Dee; Phillips, Jeffrey; Anderson, Ben; Losurdo, Giovanna; Anderson, Henry A
Extreme heat waves elevate the population's risk for heat-related morbidity and mortality, specifically for vulnerable groups such as older adults and young children. In this context, we developed 2 Heat Vulnerability Indices (HVIs), one for the state of Wisconsin and one for the Milwaukee metropolitan area. Through the creation of an HVI, state and local agencies will be able to use the indices as a planning tool for extreme heat events. Data used for the HVIs were grouped into 4 categories: (1) population density; (2) health factors; (3) demographic and socioeconomic factors; and (4) natural and built environment factors. These categories were mapped at the Census block group level. Unweighted z-score data were used to determine index scores, which were then mapped by quantiles ranging from "high" to "low" vulnerability. Statewide, Menominee County exhibited the highest vulnerability to extreme heat. Milwaukee HVI findings indicated high vulnerability in the city's inner core versus low vulnerability along the lakeshore. Visualization of vulnerability could help local public health agencies prepare for future extreme heat events.
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Snyder, Robert E; Marlow, Mariel A; Phuphanich, Melissa E; Riley, Lee W; Maciel, Ethel Leonor Noia
2016-09-20
Brazil's National Tuberculosis Control Program seeks to improve tuberculosis (TB) treatment in vulnerable populations. Slum residents are more vulnerable to TB due to a variety of factors, including their overcrowded living conditions, substandard infrastructure, and limited access to healthcare compared to their non-slum dwelling counterparts. Directly observed treatment (DOT) has been suggested to improve TB treatment outcomes among vulnerable populations, but the program's differential effectiveness among urban slum and non-slum residents is not known. We retrospectively compared the impact of DOT on TB treatment outcome in residents of slum and non-slum census tracts in Rio de Janeiro reported to the Brazilian Notifiable Disease Database in 2010. Patient residential addresses were geocoded to census tracts from the 2010 Brazilian Census, which were identified as slum (aglomerados subnormais -AGSN) and non-slum (non-AGSN) by the Census Bureau. Homeless and incarcerated cases as well as those geocoded outside the city's limits were excluded from analysis. In 2010, 6,601 TB cases were geocoded within Rio de Janeiro; 1,874 (27.4 %) were residents of AGSN, and 4,794 (72.6 %) did not reside in an AGSN area. DOT coverage among AGSN cases was 35.2 % (n = 638), while the coverage in non-AGSN cases was 26.2 % (n = 1,234). Clinical characteristics, treatment, follow-up, cure, death and abandonment were similar in both AGSN and non-AGSN TB patients. After adjusting for covariates, AGSN TB cases on DOT had 1.67 (95 % CI: 1.17, 2.4) times the risk of cure, 0.61 (95 % CI: 0.41, 0.90) times the risk of abandonment, and 0.1 (95 % CI: 0.01, 0.77) times the risk of death from TB compared to non-AGSN TB cases not on DOT. While DOT coverage was low among TB cases in both AGSN and non-AGSN communities, it had a greater impact on TB cure rate in AGSN than in non-AGSN populations in the city of Rio de Janeiro.
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Influenza vaccination coverage among US children from 2004/2005 to 2015/2016.
Tian, Changwei; Wang, Hua; Wang, Wenming; Luo, Xiaoming
2018-05-15
Quantify the influenza vaccine coverage is essential to identify emerging concerns and to immunization programs for targeting interventions. Data from National Health Interview Survey were used to estimate receipt of at least one dose of influenza vaccination among children 6 months to 17 years of age. Influenza vaccination coverage increased from 16.70% during 2004/2005 to 49.43% during 2015/2016 (3.18% per year, P < 0.001); however, the coverage increased slightly after 2010/2011. Children at high risk of influenza complications had higher influenza vaccination coverage than non at-risk children. Boys and girls had similar coverage each year. While the coverage increased from 2004/2005 to 2015/2016 for all age groups, the coverage decreased with age each year (-0.64 to -1.58% per age group). There was a higher and rapid increase of coverage in Northeast than Midwest, South and West. American Indian or Alaskan Native and Asian showed higher coverage than other race groups (White, Black/African American, Multiple race). Multivariable analysis showed that high-risk status and region had the greatest associations with levels of vaccine coverage. Although the influenza vaccination coverage among children had increased remarkably since 2004/2005, establishing more effective immunization programs are warranted to achieve the Healthy People 2020 target.
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Massat, Nathalie J; Douglas, Elaine; Waller, Jo; Wardle, Jane; Duffy, Stephen W
2015-07-24
Reducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions where coverage is low. This study aimed to characterise districts with atypical coverage levels for cervical or breast screening. Observational study of district-level coverage in the English Cervical and Breast screening programmes in 2012. England, UK. All English women invited to participate in the cervical (age group 25-49 and 50-64) and breast (age group 50-64) screening programmes. Risk adjustment models for coverage were developed based on district-level characteristics. Funnel plots of adjusted coverage were constructed, and atypical districts examined by correlation analysis. Variability in coverage was primarily explained by population factors, whereas general practice characteristics had little independent effect. Deprivation and ethnicity other than white, Asian, black or mixed were independently associated with poorer coverage in both screening programmes, with ethnicity having the strongest effect; by comparison, the influence of Asian, black or mixed ethnic minority was limited. Deprivation, ethnicity and urbanisation largely accounted for the lower cervical screening coverage in London. However, for breast screening, being located in London remained a strong negative predictor. A subset of districts was identified as having atypical coverage across programmes. Correlates of deprivation in districts with relatively low adjusted coverage were substantially different from overall correlates of deprivation. These results inform the continuing drive to reduce avoidable cancer deaths in England, and encourage implementation of targeted interventions in communities residing in districts identified as having atypically low coverage. Sequential implementation to monitor the impact of local interventions would help accrue evidence on 'what works'. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Gingrich, Chris D; Hanson, Kara; Marchant, Tanya; Mulligan, Jo-Ann; Mponda, Hadji
2011-07-01
This study uses a partial equilibrium simulation model to explore how price subsidies for insecticide-treated mosquito nets (ITNs) affect households' purchases of ITNs. The model describes the ITN market in a typical developing country and is applied to the situation in Tanzania, where the Tanzania National Voucher Scheme (TNVS) provides a targeted subsidy to vulnerable population groups by means of a discount voucher. The data for this study come from a nationally-representative household survey completed July-August 2006 covering over 4300 households in 21 districts. The simulation results show the impact of the voucher program on ITN coverage among target households, namely those that experienced the birth of a child. More specifically, the share of target households purchasing an ITN increased from 18 to 62 percent because of the discount voucher. The model also suggests that the voucher program could cause the retail ITN price to rise due to an overall increase in demand. As a result, ITN purchases by households without a voucher may actually decline. The simulation model suggests that additional increases toward the stated goal of 80 percent ITN coverage for pregnant women and children could best be achieved through a combination of "catch up" mass distribution programs and expanding the target group for the voucher program to cover additional households. The model can be employed in other countries considering use of a targeted price subsidy for ITNs, and could be adapted to assess the impact of subsidies for other public health commodities. Copyright © 2011 Elsevier Ltd. All rights reserved.
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Lodha, A; Brown, N; Soraisham, A; Amin, H; Tang, S; Singhal, N
2017-08-01
To compare short- and long-term neurodevelopmental outcomes at 3 years of corrected age of preterm infants cared for by 24-hour in-house staff neonatologists and those cared for by staff neonatologists during daytime only. Retrospective analysis of prospectively collected follow-up data on all nonanomalous preterm infants from 1998 to 2004 excluding year 2001 as a washout period. Infants were divided into two groups based on care provided by staff neonatologists: 24-hour in-house coverage (24-hour coverage 1998-2000) and daytime coverage (day coverage 2002-2004). Short- and long-term outcomes were compared. A total of 387 (78%) of the screened infants were included. Twenty-four-hour coverage (n=179) and day coverage (n=208) groups had a median birth weight (BW) of 875 g (range 470-1250) and 922 g (480-1530; P=0.028), respectively, and both had a median gestational age of 27 weeks. In the day coverage group, a smaller proportion of mothers had chorioamnionitis (20% vs. 30%; P=0.025), received less antibiotics (62% vs. 73%; P=0.023), and infants had fewer cases of confirmed sepsis (14% vs. 23%; P=0.022). In the day coverage group, a larger number of infants had respiratory distress syndrome (87% vs. 77%; P=0.011) and required prolonged mechanical ventilation (median 31 vs. 21 days; P=0.002). The incidence of major neurodevelopmental impairment was not significantly different between the two groups (odds ratio 0.76; 95% confidence interval 0.34-1.65). Duration of mechanical ventilation was reduced with 24-hour in-house coverage by staff neonatologists. However, 24-hour coverage was not associated with any difference in neurodevelopmental (ND) outcomes at 3-year corrected age.
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Racial and Ethnic Disparities in Services and the Patient Protection and Affordable Care Act
Abdus, Salam; Mistry, Kamila B.
2015-01-01
Objectives. We examined prereform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). Methods. We used pre-ACA household data from the Medical Expenditure Panel Survey to identify groups targeted by the coverage provisions of the Act (Medicaid expansions and subsidized Marketplace coverage). We examined racial/ethnic differences in coverage, access to care, and preventive service use, across and within ACA relevant subgroups from 2005 to 2010. The study took place at the Agency for Healthcare Research and Quality in Rockville, Maryland. Results. Minorities were disproportionately represented among those targeted by the coverage provisions of the ACA. Targeted groups had lower rates of coverage, access to care, and preventive services use, and racial/ethnic disparities were, in some cases, widest within these targeted groups. Conclusions. Our findings highlighted the opportunity of the ACA to not only to improve coverage, access, and use for all racial/ethnic groups, but also to narrow racial/ethnic disparities in these outcomes. Our results might have particular importance for states that are deciding whether to implement the ACA Medicaid expansions. PMID:26447920
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Racial and Ethnic Disparities in Services and the Patient Protection and Affordable Care Act.
Abdus, Salam; Mistry, Kamila B; Selden, Thomas M
2015-11-01
We examined prereform patterns in insurance coverage, access to care, and preventive services use by race/ethnicity in adults targeted by the coverage expansions of the Patient Protection and Affordable Care Act (ACA). We used pre-ACA household data from the Medical Expenditure Panel Survey to identify groups targeted by the coverage provisions of the Act (Medicaid expansions and subsidized Marketplace coverage). We examined racial/ethnic differences in coverage, access to care, and preventive service use, across and within ACA relevant subgroups from 2005 to 2010. The study took place at the Agency for Healthcare Research and Quality in Rockville, Maryland. Minorities were disproportionately represented among those targeted by the coverage provisions of the ACA. Targeted groups had lower rates of coverage, access to care, and preventive services use, and racial/ethnic disparities were, in some cases, widest within these targeted groups. Our findings highlighted the opportunity of the ACA to not only to improve coverage, access, and use for all racial/ethnic groups, but also to narrow racial/ethnic disparities in these outcomes. Our results might have particular importance for states that are deciding whether to implement the ACA Medicaid expansions.
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Han, Wen Wen; Liu, Xiao Peng; Pei, Yin Bao; An, Qiong; Li, Yong Hong
2016-04-22
The vulnerability and influence factors of agro-household livelihood in Haiyuan County, Ningxia were empirically analyzed utilizing set pair analysis and obstacle degree model, based on field survey data of impoverished agro-households in 2014. Results showed that vulnerability of agro-household livelihood in Haiyuan County was high in general while it exhibited geomorphological and ethnical differences. Vulnerability of agro-households livelihood in plain areas, valleys and intermountain depression areas were lower than that in earth-rock areas, loess ridge areas and moderately high mountain landform areas. Moreover, vulnerability of agro-household livelihood was higher in mixed Hui and Han ethnic villages than in mono Hui or Han ethnic villages. The villagers' lacking of necessities and the stress of sensitive external geographical environment were considered to be the fundamental reasons of vulnerability of agro-household livelihood. The unreasonable livelihood structure and the unvariant livelihood strategy caused the long-term accumulation of livelihood vulnerabi-lity. The nature of the local environment, which was not easy to change, decreased the accessibility of poverty alleviation resources. Building a clear village water rights allocation system, the implementation of counterpart-assistance to educate impoverished families, increasing investment in improving the diversities of means of living, developing the chains of comprehensive commodity market among villages, were necessary to improve the response capability of agro-household livelihood. The management of vulnerability of agro-household livelihood should put the 'Extending Roads to Every Village Project' on a more prominent position in the 'Extending Radio and TV Broadcasting Coverage to Every Village Project'. Furthermore, the combination of meteorological disaster prevention and insurance enterprise disaster reduction should be sought, and the agricultural production insurance system should be developed.
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Cvetanovich, Gregory L; Levy, David M; Weber, Alexander E; Kuhns, Benjamin D; Mather, Richard C; Salata, Michael J; Nho, Shane J
2017-07-01
The literature contains conflicting reports regarding whether outcomes of hip arthroscopic surgery for patients with borderline dysplasia are inferior to outcomes in patients with normal acetabular coverage. To assess differences in the outcomes of hip arthroscopic surgery for femoroacetabular impingement (FAI) in groups of patients with borderline dysplasia and normal coverage. Cohort study; Level of evidence, 3. A registry of consecutive patients who had undergone primary hip arthroscopic surgery with capsular plication for FAI between January 2012 and January 2014 were divided based on the preoperative lateral center-edge angle (LCEA) into 2 distinct groups: (1) borderline dysplasia (LCEA 18°-25°) and (2) normal acetabular coverage (LCEA 25.1°-40°). There were 36 patients in the borderline dysplastic group and 312 patients in the normal coverage group. The primary outcome measure was the Hip Outcome Score-Activities of Daily Living (HOS-ADL) at a minimum of 2 years postoperatively. Secondary outcome measures included the HOS-Sports and modified Harris Hip Score (mHHS). The mean preoperative LCEA differed significantly between groups (23.4° ± 1.5° for borderline dysplastic, 32.5° ± 3.8° for normal coverage; P < .001). The borderline dysplastic group had a higher percentage of female patients than the normal coverage group (27/36 [75%] vs 177/312 [57%], respectively; P = .048). There were no differences in other preoperative demographics and radiographic parameters. At a minimum 2 years after hip arthroscopic surgery (mean follow-up, 2.6 ± 0.6 years), both groups demonstrated significant improvements in all patient-reported outcome scores ( P < .001 in all cases). There were no significant differences between the borderline dysplastic and normal coverage groups in final outcome scores, score improvements, or percentage of patients experiencing clinically significant improvements. One patient in the borderline dysplastic group (3%) underwent revision hip arthroscopic surgery, and none underwent total hip arthroplasty during the follow-up period. There were no differences between the borderline dysplastic and normal coverage groups with regard to subsequent surgery. Female patients in the borderline dysplastic group had greater improvements in the mean HOS-ADL (25.9 ± 16.3 vs 10.8 ± 18.5, respectively; P = .05) and mHHS (27.9 ± 12.9 vs 8.1 ± 19.0, respectively; P = .005) compared with male patients in the borderline dysplastic group, but male and female patients did not differ in outcomes for the normal coverage group. Patients who underwent hip arthroscopic surgery for FAI with capsular plication experienced significant clinical improvements with low rates of subsequent surgery, regardless of whether their acetabulum had borderline dysplasia or normal coverage.
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-06-17
... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human Services... health insurance coverage offered in connection with a group health plan under the Employee Retirement...
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-05-13
... Group Health Plans and Health Insurance Issuers Providing Dependent Coverage of Children to Age 26 Under... Information and Insurance Oversight of the U.S. Department of Health and Human Services are issuing substantially similar interim final regulations with respect to group health plans and health insurance coverage...
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SFTP: A Secure and Fault-Tolerant Paradigm against Blackhole Attack in MANET
NASA Astrophysics Data System (ADS)
KumarRout, Jitendra; Kumar Bhoi, Sourav; Kumar Panda, Sanjaya
2013-02-01
Security issues in MANET are a challenging task nowadays. MANETs are vulnerable to passive attacks and active attacks because of a limited number of resources and lack of centralized authority. Blackhole attack is an attack in network layer which degrade the network performance by dropping the packets. In this paper, we have proposed a Secure Fault-Tolerant Paradigm (SFTP) which checks the Blackhole attack in the network. The three phases used in SFTP algorithm are designing of coverage area to find the area of coverage, Network Connection algorithm to design a fault-tolerant model and Route Discovery algorithm to discover the route and data delivery from source to destination. SFTP gives better network performance by making the network fault free.
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Attending to social vulnerability when rationing pandemic resources.
Vawter, Dorothy E; Garrett, J Eline; Gervais, Karen G; Prehn, Angela Witt; DeBruin, Debra A
2011-01-01
Pandemic plans are increasingly attending to groups experiencing health disparities and other social vulnerabilities. Although some pandemic guidance is silent on the issue, guidance that attends to socially vulnerable groups ranges widely, some procedural (often calling for public engagement), and some substantive. Public engagement objectives vary from merely educational to seeking reflective input into the ethical commitments that should guide pandemic planning and response. Some plans that concern rationing during a severe pandemic recommend ways to protect socially vulnerable groups without prioritizing access to scarce resources based on social vulnerability per se. The Minnesota Pandemic Ethics Project (MPEP), a public engagement project on rationing scarce health resources during a severe influenza pandemic, agrees and recommends an integrated set of ways to attend to the needs of socially vulnerable people and avoid exacerbation of health disparities during a severe influenza pandemic. Among other things, MPEP recommends: 1. Engaging socially vulnerable populations to clarify unique needs and effective strategies; 2. Engaging socially vulnerable populations to elicit ethical values and perspectives on rationing; 3. Rejecting rationing based on race, socioeconomic class, citizenship, quality of life, length of life-extension and first-come, first-served; 4. Prioritizing those in the general population for access to resources based on combinations of risk (of death or severe complications from influenza, exposure to influenza, transmitting influenza to vulnerable groups) and the likelihood of responding well to the resource in question. 5. Protecting critical infrastructures on which vulnerable populations and the general public rely; 6. Identifying and removing access barriers during pandemic planning and response; and 7. Collecting and promptly analyzing data during the pandemic to identify groups at disproportionate risk of influenza-related mortality and serious morbidity and to optimize the distribution of resources.
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Lee, Seung-Yul; Kim, Jung-Sun; Yoon, Hyuck-Jun; Hur, Seung-Ho; Lee, Sang-Gon; Kim, Jin Won; Hong, Young Joon; Kim, Ki-Seok; Choi, So-Yeon; Shin, Dong-Ho; Nam, Chung-Mo; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Donghoon; Jang, Yangsoo; Hong, Myeong-Ki
2018-02-09
This study sought to measure early strut coverage in patients receiving drug-eluting stents (DESs) and to explore the feasibility of short-term dual antiplatelet therapy (DAPT) based on the degree of early strut coverage. Data for early strut coverage in patients receiving new-generation DESs, and its implications for DAPT continuation were limited. A randomized, multicenter trial was conducted in 894 patients treated with DESs. Patients were randomly assigned to everolimus-eluting stent (EES) (n = 444) or biolimus-eluting stent (BES) (n = 450) groups and optical coherence tomography (OCT)-guided (n = 445) or angiography-guided (n = 449) implantation groups using a 2-by-2 factorial design. Early strut coverage was measured as the percentage of uncovered struts on 3-month follow-up OCT examination. The primary outcome was the difference in early strut coverage between EES and BES groups and between OCT- and angiography-guided implantation groups. The secondary outcome was a composite of cardiac death, myocardial infarction, stent thrombosis, and major bleeding during the first 12 months post-procedure in patients receiving 3-month DAPT based on the presence of early strut coverage (≤6% uncovered) on 3-month follow-up OCT. Three-month follow-up OCT data were acquired for 779 patients (87.1%). The median percentage of uncovered struts at 3 months was 8.9% and 8.2% in the EES and BES groups, respectively (p = 0.69) and was lower in the OCT-guided group (7.5%) than in the angiography-guided group (9.9%; p = 0.009). Favorable early strut coverage (≤6% uncovered strut) was observed in 320 of 779 patients (41.1%). At 12 months, the composite event rarely occurred in the 3-month (0.3%) or 12-month (0.2%) DAPT groups (p = 0.80). OCT-guided DES implantation improved early strut coverage compared with angiography-guided DES implantation, with no difference in strut coverage between EES and BES groups. Short-term DAPT may be feasible in selected patients with favorable early strut coverage (Determination of the Duration of the Dual Antiplatelet Therapy by the Degree of the Coverage of The Struts on Optical Coherence Tomography From the Randomized Comparison Between Everolimus-eluting Stents Versus Biolimus A9-eluting Stents [DETECT-OCT]; NCT01752894). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Xu, Ye; Huang, Cheng; Colón-Ramos, Uriyoán
2015-01-01
Binagwaho and colleagues’ perspective piece provided a timely reflection on the experience of Rwanda in achieving the Millennium Development Goals (MDGs) and a proposal of 5 principles to carry forward in post-2015 health development. This commentary echoes their viewpoints and offers three lessons for health policy reforms consistent with these principles beyond 2015. Specifically, we argue that universal health coverage (UHC) is an integrated solution to advance the global health development agenda, and the three essential strategies drawn from Asian countries’ health reforms toward UHC are: (1) Public financing support and sequencing health insurance expansion by first extending health insurance to the extremely poor, vulnerable, and marginalized population are critical for achieving UHC; (2) Improved quality of delivered care ensures supply-side readiness and effective coverage; (3) Strategic purchasing and results-based financing creates incentives and accountability for positive changes. These strategies were discussed and illustrated with experience from China and other Asian economies. PMID:26673477
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Dhakal, Subas P
2018-04-01
South Asia is one of the regions of the world most vulnerable to natural disasters. Although news media analyses of disasters have been conducted frequently in various settings globally, there is little research on populous South Asia. This paper begins to fill this gap by evaluating local and foreign news media coverage of the earthquake in Nepal on 25 April 2015. It broadens the examination of news media coverage of disaster response beyond traditional framing theory, utilising community capitals (built, cultural, financial, human, natural, political, and social) lens to perform a thematic content analysis of 405 news items. Overall, financial and natural capital received the most and the least emphasis respectively. Statistically significant differences between local and foreign news media were detected vis-à-vis built, financial, and political capital. The paper concludes with a discussion of the social utility of news media analysis using the community capitals framework to inform disaster resilience. © 2018 The Author(s). Disasters © Overseas Development Institute, 2018.
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Interprofessional Graduate Students' Perspectives on Caring for Vulnerable Populations.
Wright, Patricia Moyle; Hanson, Mary Jane S
The purpose of this focus group study was to explore graduate students' clinical experiences with vulnerable populations, perceived barriers to care, and ethical issues related to caring for disenfranchised groups. Furthermore, based on their experiences, the students were asked to share suggestions for curricular changes that could enhance care for vulnerable populations through interdisciplinary collaboration and multidisciplinary projects. The responses of the participants add to what is known about the care of vulnerable populations, offering a first-hand description of students' preparation for work with vulnerable populations and the interdisciplinary team.
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29 CFR 2590.715-2714 - Eligibility of children until at least age 26.
Code of Federal Regulations, 2010 CFR
2010-07-01
... plan, or a health insurance issuer offering group health insurance coverage, that makes available... or health insurance coverage providing dependent coverage of children cannot vary based on age... of self-only or family health coverage. Dependent coverage is provided under family health coverage...
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Herrera, Juan Carlos; Lira, Mariana; Kain, Juliana
2017-12-01
Although obesity is related to socioeconomic level, studies are inconclusive. To determine obesity risk according to socioeconomic vulnerability among Chilean children (1st grade) in 2009 and 2013 and assess its change during that period, by sex and geographical area. Cross-sectional study (N = 175,462 in 2009) and (N = 189,055 in 2013) which included: weight, height, rural / urban, gender and vulnerability obtained from JUNAEB's survey. BMI Z, % obesity and 3 categories of vulnerability (very vulnerable, moderate, non-vulnerable) were determined. For the descriptive analyses, we used t tests and for predictor variables (2 categories of vulnerability) and outcome (obesity) by sex and area, we used %2. Logistic regression models determined OR to develop obesity by. % obesity was 19.6% and 24.1% in 2009 and 2013, higher in boys. In urban and rural areas respectively, OR to develop obesity were: 0.85 (0.82-0.88) and 0.70 (0.64-0.75) in the most vulnerable students and 0.94 (0.91-0.97) and 0.81 (0.74-0.88) in those with moderate vulnerability in 2009 and 0.96 (0.93-0.98) and 0.89 (0.82-0.96) in the most vulnerable students and 0.99 (0.96-1.02) and 0.94 (0.86-1.02) in students with moderate vulnerability in 2013. The highest increase in obesity was observed among the most vulnerable group from rural areas (16, 6 to 24.3%). vulnerability. The non-vulnerable group had the highest % obesity. Although the most vulnerable students in rural areas had the lowest obesity risk in both years, the highest increase in obesity during the period, occurred in that group.
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42 CFR 407.20 - Special enrollment period related to coverage under group health plans.
Code of Federal Regulations, 2013 CFR
2013-10-01
..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND... coverage under group health plans. (a) Terminology—(1) Group health plan (GHP) and large group health plan...
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42 CFR 407.20 - Special enrollment period related to coverage under group health plans.
Code of Federal Regulations, 2014 CFR
2014-10-01
..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND... coverage under group health plans. (a) Terminology—(1) Group health plan (GHP) and large group health plan...
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42 CFR 407.20 - Special enrollment period related to coverage under group health plans.
Code of Federal Regulations, 2011 CFR
2011-10-01
..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND... coverage under group health plans. (a) Terminology—(1) Group health plan (GHP) and large group health plan...
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42 CFR 407.20 - Special enrollment period related to coverage under group health plans.
Code of Federal Regulations, 2012 CFR
2012-10-01
..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND... coverage under group health plans. (a) Terminology—(1) Group health plan (GHP) and large group health plan...
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42 CFR 407.20 - Special enrollment period related to coverage under group health plans.
Code of Federal Regulations, 2010 CFR
2010-10-01
..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND... coverage under group health plans. (a) Terminology—(1) Group health plan (GHP) and large group health plan...
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Mereckiene, J; Cotter, S; Nicoll, A; Lopalco, P; Noori, T; Weber, Jt; D'Ancona, F; Levy-Bruhl, D; Dematte, L; Giambi, C; Valentiner-Branth, P; Stankiewicz, I; Appelgren, E; O Flanagan, D
2014-04-24
Since 2008, annual surveys of influenza vaccination policies, practices and coverage have been undertaken in 29 European Union (EU)/ European Economic Area (EEA) countries. After 2009, this monitored the impact of European Council recommendation to increase vaccination coverage to 75% among risk groups. This paper summarises the results of three seasonal influenza seasons: 2008/09, 2009/10 and 2010/11. In 2008/09, 27/29 countries completed the survey; in 2009/10 and 2010/11, 28/29 completed it. All or almost all countries recommended vaccination of older people (defined as those aged ≥50, ≥55, ≥59, ≥60 or ≥65 years), and people aged ≥6 months with clinical risk and healthcare workers. A total of 23 countries provided vaccination coverage data for older people, but only 7 and 10 had data for the clinical risk groups and healthcare workers, respectively. The number of countries recommending vaccination for some or all pregnant women increased from 10 in 2008/09 to 22 in 2010/11. Only three countries could report coverage among pregnant women. Seasonal influenza vaccination coverage during and after the pandemic season in older people and clinical groups remained unchanged in countries with higher coverage. However, small decreases were seen in most countries during this period. The results of the surveys indicate that most EU/EEA countries recommend influenza vaccination for the main target groups; however, only a few countries have achieved the target of 75% coverage among risk groups. Coverage among healthcare workers remained low.
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Fatemi, Farin; Ardalan, Ali; Aguirre, Benigno; Mansouri, Nabiollah; Mohammadfam, Iraj
2017-04-10
Industrial chemical accidents have been increased in developing countries. Assessing the human vulnerability in the residents of industrial areas is necessary for reducing the injuries and causalities of chemical hazards. The aim of this study was to explore the key indicators for the assessment of human vulnerability in the residents living near chemical installations. The indicators were established in the present study based on the Fuzzy Delphi method (FDM) and Fuzzy Analytic Hierarchy Process (FAHP). The reliability of FDM and FAHP was calculated. The indicators of human vulnerability were explored in two sets of social and physical domains. Thirty-five relevant experts participated in this study during March-July 2015. According to experts, the top three indicators of human vulnerability according to the FDM and FAHP were vulnerable groups, population density, and awareness. Detailed sub-vulnerable groups and awareness were developed based on age, chronic or severe diseases, disability, first responders, and residents, respectively. Each indicator and sub-indicator was weighted and ranked and had an acceptable consistency ratio. The importance of social vulnerability indicators are about 7 times more than physical vulnerability indicators. Among the extracted indicators, vulnerable groups had the highest weight and the greatest impact on human vulnerability. however, further research is needed to investigate the applicability of established indicators and generalizability of the results to other studies. Fuzzy Delphi; Fuzzy AHP; Human vulnerability; Chemical hazards.
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Fatemi, Farin; Ardalan, Ali; Aguirre, Benigno; Mansouri, Nabiollah; Mohammadfam, Iraj
2017-01-01
Introduction: Industrial chemical accidents have been increased in developing countries. Assessing the human vulnerability in the residents of industrial areas is necessary for reducing the injuries and causalities of chemical hazards. The aim of this study was to explore the key indicators for the assessment of human vulnerability in the residents living near chemical installations. Methods: The indicators were established in the present study based on the Fuzzy Delphi method (FDM) and Fuzzy Analytic Hierarchy Process (FAHP). The reliability of FDM and FAHP was calculated. The indicators of human vulnerability were explored in two sets of social and physical domains. Thirty-five relevant experts participated in this study during March-July 2015. Results: According to experts, the top three indicators of human vulnerability according to the FDM and FAHP were vulnerable groups, population density, and awareness. Detailed sub-vulnerable groups and awareness were developed based on age, chronic or severe diseases, disability, first responders, and residents, respectively. Each indicator and sub-indicator was weighted and ranked and had an acceptable consistency ratio. Conclusions: The importance of social vulnerability indicators are about 7 times more than physical vulnerability indicators. Among the extracted indicators, vulnerable groups had the highest weight and the greatest impact on human vulnerability. however, further research is needed to investigate the applicability of established indicators and generalizability of the results to other studies. Key words: Fuzzy Delphi; Fuzzy AHP; Human vulnerability; Chemical hazards PMID:28480124
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45 CFR 147.120 - Eligibility of children until at least age 26.
Code of Federal Regulations, 2010 CFR
2010-10-01
... HEALTH CARE ACCESS HEALTH INSURANCE REFORM REQUIREMENTS FOR THE GROUP AND INDIVIDUAL HEALTH INSURANCE..., or a health insurance issuer offering group or individual health insurance coverage, that makes... age. The terms of the plan or health insurance coverage providing dependent coverage of children...
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Li, Pengxiang; McElligott, Sean; Bergquist, Henry; Schwartz, J Sanford; Doshi, Jalpa A
2012-06-05
Prior studies of the Medicare Part D coverage gap are limited in generalizability and scope. To determine the effect of the coverage gap on drugs used for asymptomatic (antihypertensive and lipid-lowering drugs) and symptomatic (pain relievers, acid suppressants, and antidepressants) conditions in elderly patients with hypertension and hyperlipidemia. Quasi-experimental study using pre-post design and contemporaneous control group. Medicare claims files from 2005 and 2006 for 5% random sample of Medicare beneficiaries. Part D plan enrollees with hypertension or hyperlipidemia aged 65 years or older who had no coverage, generic-only coverage, or both brand-name and generic coverage during the gap in 2006. Patients who were fully eligible for the low-income subsidy served as the control group. Monthly 30-day supply prescriptions available, medication adherence, and continuous medication gaps of 30 days or more for antihypertensive or lipid-lowering drugs; monthly 30-day supply prescriptions available for pain relievers, acid suppressants, or antidepressants before and after coverage gap entry. Patients with no gap coverage had a decrease in monthly antihypertensive and lipid-lowering drug prescriptions during the coverage gap. Nonadherence also increased in this group (antihypertensives: odds ratio [OR], 1.60 [95% CI, 1.50 to 1.71]; lipid-lowering drugs: OR, 1.59 [CI, 1.50 to 1.68]). The proportion of patients with no gap coverage who had continuous medication gaps in lipid-lowering medication use and antihypertensive use increased by an absolute 7.3% (OR, 1.38 [CI, 1.29 to 1.46]) and 3.2% (OR, 1.35 [CI, 1.25 to 1.45]), respectively, because of the coverage gap. Decreases in use were smaller for pain relievers and antidepressants and larger for acid suppressants in patients with no gap coverage. Patients with generic-only coverage had decreased use of cardiovascular medications but no change in use of drugs for symptomatic conditions. No measures changed in the brand-name and generic coverage groups. Results of sensitivity analyses were consistent with the main findings. Because this study was nonrandomized, unobserved differences may still exist between study groups. The Part D coverage gap was associated with decreased use of medications for hypertension and hyperlipidemia in patients with no gap coverage and generic-only gap coverage. The proposed phasing out of the gap by 2020 will benefit such patients; however, use of low-value medications may also increase. Penn-Pfizer Alliance and American Heart Association.
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Vaccinating my way--use of alternative vaccination schedules in New York State.
Nadeau, Jessica A; Bednarczyk, Robert A; Masawi, Munyaradzi R; Meldrum, Megan D; Santilli, Loretta; Zansky, Shelley M; Blog, Debra S; Birkhead, Guthrie S; McNutt, Louise-Anne
2015-01-01
To identify children vaccinated following an alternative vaccine schedule using immunization information system data and determine the impact of alternative schedule use on vaccine coverage. Children born in New York State, outside New York City, between January 1, 2009 and August 14, 2011 were assessed for vaccination patterns consistent with use of an alternative schedule. Children who by 9 months of age had at least 3 vaccination visits recorded in the statewide mandatory immunization information system after 41 days of age were classified as either attempting to conform to the Centers for Disease Control and Prevention published recommended vaccination schedule or an alternative schedule. The number of vaccination visits and up-to-date status at age 9 months were compared between groups. Of the 222 628 children studied, the proportion of children following an alternative schedule was 25%. These children were significantly less likely to be up-to-date at age 9 months (15%) compared with those conforming to the routine schedule (90%, P < .05). Children following an alternative schedule on average had about 2 extra vaccine visits compared with children following a routine schedule (P < .05). Almost 1 in 4 children in this study appear to be intentionally deviating from the routine schedule. Intentional deviation leads to poor vaccination coverage leaving children vulnerable to infection and increasing the potential for vaccine-preventable disease outbreaks. Copyright © 2015 Elsevier Inc. All rights reserved.
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The use of whey or skimmed milk powder in fortified blended foods for vulnerable groups.
Hoppe, Camilla; Andersen, Gregers S; Jacobsen, Stine; Mølgaard, Christian; Friis, Henrik; Sangild, Per T; Michaelsen, Kim F
2008-01-01
Fortified blended foods (FBF), especially corn soy blend, are used as food aid for millions of people worldwide, especially malnourished individuals and vulnerable groups. There are only a few studies evaluating the effect of FBF on health outcomes, and the potential negative effect of antinutrients has not been examined. Different lines of evidence suggest that dairy proteins have beneficial effects on vulnerable groups. Here we review the evidence on the effects of adding whey or skimmed milk powder to FBF used for malnourished infants and young children or people living with HIV or AIDS. Adding whey or skimmed milk powder to FBF improves the protein quality, allowing a reduction in total amount of protein, which could have potential metabolic advantages. It also allows for a reduced content of soy and cereal and thereby a reduction of potential antinutrients. It is possible that adding milk could improve weight gain, linear growth, and recovery from malnutrition, but this needs to be confirmed. Bioactive factors in whey might have beneficial effects on the immune system and muscle synthesis, but evidence from vulnerable groups is lacking. Milk proteins will improve flavor, which is important for acceptability in vulnerable groups. The most important disadvantage is a considerable increase in price. Adding 10-15% milk powder would double the price, which means that such a product should be used only in well-defined vulnerable groups with special needs. The potential beneficial effects of adding milk protein and lack of evidence in vulnerable groups call for randomized intervention studies.
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29 CFR 2590.701-7 - HMO affiliation period as an alternative to a preexisting condition exclusion.
Code of Federal Regulations, 2010 CFR
2010-07-01
... offering health insurance coverage through an HMO, or an HMO that offers health insurance coverage in... BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH PLANS Health Coverage Portability, Nondiscrimination, and Renewability § 2590.701-7 HMO...
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29 CFR 2590.701-7 - HMO affiliation period as an alternative to a preexisting condition exclusion.
Code of Federal Regulations, 2011 CFR
2011-07-01
... offering health insurance coverage through an HMO, or an HMO that offers health insurance coverage in... BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH PLANS Health Coverage Portability, Nondiscrimination, and Renewability § 2590.701-7 HMO...
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Chiu, Christopher T; Katz, Ralph V
2011-01-01
This report presents, for the first time, findings on the vox populis as to who constitutes the "vulnerables in biomedical research" The 3-City Tuskegee Legacy Project (TLP) study used the TLP questionnaire as administered via random-digit-dial telephone interviews to 1162 adult Black people, non-Hispanic White people, and two Puerto Rican (PR) Hispanic groups: Mainland United States and San Juan (SJ) in three cities. The classification schema was based upon respondents' answers to an open-ended question asking which groups of people were the most vulnerable when participating in biomedical research. Subjects provided 749 valid open-ended responses, which were grouped into 29 direct response categories, leading to a four-tier classification schema for vulnerability traits. Tier 1, the summary tier, had five vulnerability categories: (1) Race/ ethnicity; (2) Age; (3) SES; (4) Health; and, (5) Gender. Black people and Mainland United States PR Hispanics most frequently identified Race/Ethnicity as a vulnerability trait (42.1 percent of Black people and 42.6 percent of Mainland United States. PR Hispanics versus 15.4 percent of White people and 16.7 percent of SJ R Hispanics) (P < 0.007), while White people and SJ PR Hispanics most frequently identified Age (48.3 percent and 29.2 percent) as a vulnerability trait. The response patterns on "who was vulnerable" were similar for the two minority groups (Black people and Mainland US PR Hispanics), and notably different from the response patterns of the two majority groups (White people and SJ PR Hispanics). Further, the vox populis definition of vulnerables differed from the current official definitions as used by the U.S. federal government.
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Development of vulnerability curves to typhoon hazards based on insurance policy and claim dataset
NASA Astrophysics Data System (ADS)
Mo, Wanmei; Fang, Weihua; li, Xinze; Wu, Peng; Tong, Xingwei
2016-04-01
Vulnerability refers to the characteristics and circumstances of an exposure that make it vulnerable to the effects of some certain hazards. It can be divided into physical vulnerability, social vulnerability, economic vulnerabilities and environmental vulnerability. Physical vulnerability indicates the potential physical damage of exposure caused by natural hazards. Vulnerability curves, quantifying the loss ratio against hazard intensity with a horizontal axis for the intensity and a vertical axis for the Mean Damage Ratio (MDR), is essential to the vulnerability assessment and quantitative evaluation of disasters. Fragility refers to the probability of diverse damage states under different hazard intensity, revealing a kind of characteristic of the exposure. Fragility curves are often used to quantify the probability of a given set of exposure at or exceeding a certain damage state. The development of quantitative fragility and vulnerability curves is the basis of catastrophe modeling. Generally, methods for quantitative fragility and vulnerability assessment can be categorized into empirical, analytical and expert opinion or judgment-based ones. Empirical method is one of the most popular methods and it relies heavily on the availability and quality of historical hazard and loss dataset, which has always been a great challenge. Analytical method is usually based on the engineering experiments and it is time-consuming and lacks built-in validation, so its credibility is also sometimes criticized widely. Expert opinion or judgment-based method is quite effective in the absence of data but the results could be too subjective so that the uncertainty is likely to be underestimated. In this study, we will present the fragility and vulnerability curves developed with empirical method based on simulated historical typhoon wind, rainfall and induced flood, and insurance policy and claim datasets of more than 100 historical typhoon events. Firstly, an insurance exposure classification system is built according to structure type, occupation type and insurance coverage. Then MDR estimation method based on considering insurance policy structure and claim information is proposed and validated. Following that, fragility and vulnerability curves of the major exposure types for construction, homeowner insurance and enterprise property insurance are fitted with empirical function based on the historical dataset. The results of this study can not only help understand catastrophe risk and mange insured disaster risks, but can also be applied in other disaster risk reduction efforts.
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Social vulnerabilities as determinants of overweight in 2-, 4- and 6-year-old Spanish children.
Iguacel, Isabel; Fernández-Alvira, Juan M; Labayen, Idoia; Moreno, Luis A; Samper, María Pilar; Rodríguez, Gerardo
2018-04-01
Differences in obesity prevalence among vulnerable groups exist in childhood but it remains unclear whether these differences may be partly determined by socioeconomic status (SES), parental body mass index (BMI) and early life risk factors. We aimed to explore (i) longitudinal associations between belonging to a minority group and being overweight/obese at age 2, 4 and 6 and (ii) associations between accumulation of social vulnerabilities and being overweight/obese at age 6. In total, 1031 children (53.8% boys) were evaluated at birth and re-examined during a 6-year follow-up in a representative cohort of Aragon (Spain). Children from minority (vulnerable) groups included Spanish Roma/gypsies, Eastern Europeans, Latin Americans and Africans. Two more vulnerable groups were defined at baseline as children whose parents reported low occupation and education. Ethnicity, SES and parental BMI were collected via interviews. We used logistic mixed-effects models and adjusted for parental BMI, SES, mother's tobacco use, maternal weight gain, birth weight, infant weight gain and breastfeeding practices. Regardless of confounders, Roma/gypsy children (OR = 4.63;[1.69-12.70]95%CI) and with Latin American background (OR = 3.04;[1.59-5.82]95%CI) were more likely to be overweight/obese at age 6 compared with non-gypsy Spanish group. Children with three vulnerabilities (OR = 2.18;[1.31-3.64]95%CI) were more likely to be overweight/obese at age 6 compared with children with no vulnerabilities. No associations were found between belonging to a minority group and overweight/obesity in children under 6. Interventions should target Roma/gypsy children, Latin American children and those who accumulate more vulnerabilities as they are at higher risk of being overweight/obese at age 6.
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Prioritizing vulnerable children: why should we address inequity?
Joshua, P; Zwi, K; Moran, P; White, L
2015-11-01
Children and young people from vulnerable population groups, including Indigenous Australians, those in out of home care, those with disabilities and those from refugee families, have difficulties in accessing health services and are at high risk of adverse outcomes, driving population health inequity. Although heterogeneous, these groups face common disadvantage and shared challenges in health service utilization. This study aims to analyse the demographics of vulnerable child populations in NSW, the rationale for focussing on their health needs and strategies for addressing population health inequity. A literature review was undertaken on vulnerable child populations and successful strategies for improving their health outcomes. NSW data on vulnerable children were collated. Vulnerable children in NSW are estimated to comprise 10-20% of the childhood population. Efforts to improve their health and well-being can be justified based on child rights, a focus on equity and effectiveness of care, public opinion and the evidence base supporting such interventions. Targeted (subpopulation specific) interventions and delivery of universally applied (population wide) strategies that disproportionately benefit vulnerable populations have been shown to be effective in reducing healthcare disparities. Most available information relates to specific vulnerable population groups. However, some effective strategies and key principles are broadly applicable to the vulnerable child population as a whole. Vulnerable children should be a key focus of healthcare interventions if inequities are to be addressed. © 2015 John Wiley & Sons Ltd.
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Tuells, José; García-Román, Vicente; Duro-Torrijos, José Luis
2018-04-05
Health care workers can transmit influenza to patients in health centers, therefore its vaccination is considered a preventive measure first order. The objective of this study was to know the coverage of vaccination against seasonal influenza in health professionals in two health departments of the Valencian Community (Torrevieja and Elx- Crevillent), in the seasons 2011-12, 2012-13 and 2013-14. TA cross-sectional descriptive study was carried out to determine the coverage of influenza vaccination through the Nominal Vaccine Registry (NVR) of the Conselleria de Sanitat de la Generalitat Valenciana. The services with the highest risk of contagion were detected through requests for PCR analysis in patients suspected of influenza during the 2013-14 season. A total of 2035 health professionals were surveyed who achieved an average vaccination coverage of 27.2% in the 2013-14 season, showing an upward trend from the 2011-12 season. Significant differences were observed between professional categories and, practitioners presented the lowest coverage. A total of 192 PCR requests were recorded in both departments. The services which concentrate a greater number of requests were: Internal Medicine (n = 100), urgency service (n = 37), intensive care unit (n = 25) and Pediatrics ( n=154); The influenza vaccination coverage of these services in the 2013-14 seasons was 27.0%, 32.3%, 34.3% and 25.3%, respectively. Although they show an upward trend, vaccination coverage is low in health care personnel. Nurses are the best vaccinated. It would be appropriate to implement immunization strategies aimed specifically at services that, because of their activity, pose a greater risk to the patient.
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Selby, Peter; Brosky, Gerald; Oh, Paul; Raymond, Vincent; Arteaga, Carmen; Ranger, Suzanne
2014-05-07
Many smokers find the cost of smoking cessation medications a barrier. Financial coverage for these medications increases utilization of pharmacotherapies. This study assesses whether financial coverage increases the proportion of successful quitters. A pragmatic, open-label, randomized, controlled trial was conducted in 58 Canadian sites between March 2009 and September 2010. Smokers (≥10 cigarettes/day) without insurance coverage who were motivated to quit within 14 days were randomized (1:1) in a blinded manner to receive either full coverage eligibility for 26 weeks or no coverage. Pharmacotherapies covered were varenicline, bupropion, or nicotine patches/gum. Investigators/subjects were unblinded to study group assignment after randomization and prior to choosing a smoking cessation method(s). All subjects received brief smoking cessation counseling. The primary outcome measure was self-reported 7-day point prevalence of abstinence (PPA) at week 26. Of the 1380 randomized subjects (coverage, 696; no coverage, 684), 682 (98.0%) and 435 (63.6%), respectively, were dispensed at least one smoking cessation medication dose. The 7-day PPA at week 26 was higher in the full coverage versus no coverage group: 20.8% (n = 145) and 13.9% (n = 95), respectively; odds ratio (OR) = 1.64, 95% confidence interval (CI) 1.23-2.18; p = 0.001. Urine cotinine-confirmed 7-day PPA at week 26 was 15.7% (n = 109) and 10.1% (n = 69), respectively; OR = 1.68, 95% CI 1.21-2.33; p = 0.002. After pharmacotherapy, coverage eligibility was withdrawn from the full coverage group, continuous abstinence between weeks 26 and 52 was 6.6% (n = 46) and 5.6% (n = 38), in the full coverage and no coverage groups, respectively; OR = 1.19, 95% CI 0.76-1.87; p = 0.439. In this study, the adoption of a smoking cessation medication coverage drug policy was an effective intervention to improve 26-week quit rates in Canada. The advantages were lost once coverage was discontinued. Further study is required on the duration of coverage to prevent relapse to smoking. (clinicaltrials.gov identifier: NCT00818207; the study was sponsored by Pfizer Inc.).
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78 FR 63567 - Proposed Collection; Comment Request for Regulation Project
Federal Register 2010, 2011, 2012, 2013, 2014
2013-10-24
... health insurance portability for group health plans and group health insurance issuers under HIPAA Titles... Health Coverage Portability for Group Health Plans and Group Health Insurance Issuers Under HIPAA Titles... insurance coverage offered in connection with a group health plan. The rules contained in this document...
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Group Health Insurance Plans for Public-School Personnel, 1964-65.
ERIC Educational Resources Information Center
National Education Association, Washington, DC.
This report explains the major considerations in developing group health insurance coverage for public school personnel. A general overview is given of (1) group health insurance coverage, (2) patterns of group health insurance, (3) group health insurance organizations, (4) eligibility and enrollment practices, and (5) continuous health insurance…
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26 CFR 54.9815-2713A - Accommodations in connection with coverage of preventive health services.
Code of Federal Regulations, 2014 CFR
2014-04-01
...) The organization opposes providing coverage for some or all of any contraceptive services required to... of ERISA. (b) Contraceptive coverage—self-insured group health plans. (1) A group health plan... contraceptive coverage if all of the requirements of this paragraph (b)(1) of this section are satisfied: (i...
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42 CFR 436.308 - Medically needy coverage of individuals under age 21.
Code of Federal Regulations, 2010 CFR
2010-10-01
... THE VIRGIN ISLANDS Optional Coverage of the Medically Needy § 436.308 Medically needy coverage of... (b) of this section: (1) Who would not be covered under the mandatory medically needy group of... nursing facility services are provided under the plan to individuals within the age group selected under...
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29 CFR 2590.715-2713 - Coverage of preventive health services.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 29 Labor 9 2011-07-01 2011-07-01 false Coverage of preventive health services. 2590.715-2713... ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH PLANS Other Requirements § 2590.715-2713 Coverage of preventive health services. (a) Services—(1) In general. Beginning at...
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29 CFR 2590.715-2713 - Coverage of preventive health services.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 29 Labor 9 2014-07-01 2014-07-01 false Coverage of preventive health services. 2590.715-2713... ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH PLANS Other Requirements § 2590.715-2713 Coverage of preventive health services. (a) Services—(1) In general. Beginning at...
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42 CFR 406.24 - Special enrollment period related to coverage under group health plans.
Code of Federal Regulations, 2010 CFR
2010-10-01
..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE ELIGIBILITY AND ENTITLEMENT Premium Hospital Insurance § 406.24 Special enrollment period related to coverage under group health plans... 42 Public Health 2 2010-10-01 2010-10-01 false Special enrollment period related to coverage under...
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42 CFR 457.810 - Premium assistance programs: Required protections against substitution.
Code of Federal Regulations, 2012 CFR
2012-10-01
..., must provide the protections against substitution of CHIP coverage for coverage under group health... under premium assistance programs must not be greater than the cost of other CHIP coverage for these... of coverage for children under premium assistance programs to the cost of other CHIP coverage for...
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42 CFR 457.810 - Premium assistance programs: Required protections against substitution.
Code of Federal Regulations, 2010 CFR
2010-10-01
..., must provide the protections against substitution of CHIP coverage for coverage under group health... under premium assistance programs must not be greater than the cost of other CHIP coverage for these... of coverage for children under premium assistance programs to the cost of other CHIP coverage for...
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42 CFR 457.810 - Premium assistance programs: Required protections against substitution.
Code of Federal Regulations, 2011 CFR
2011-10-01
..., must provide the protections against substitution of CHIP coverage for coverage under group health... under premium assistance programs must not be greater than the cost of other CHIP coverage for these... of coverage for children under premium assistance programs to the cost of other CHIP coverage for...
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42 CFR 457.810 - Premium assistance programs: Required protections against substitution.
Code of Federal Regulations, 2013 CFR
2013-10-01
..., must provide the protections against substitution of CHIP coverage for coverage under group health... under premium assistance programs must not be greater than the cost of other CHIP coverage for these... of coverage for children under premium assistance programs to the cost of other CHIP coverage for...
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ERIC Educational Resources Information Center
Flores, René Pedroza; Monroy, Guadalupe Villalobos; Fabela, Ana María Reyes
2015-01-01
This paper presents an estimate of the prevalence of social inequality in accessing higher education among vulnerable groups in Mexico. Estimates were determined from statistical data provided by governmental agencies on the level of poverty among the Mexican population. In Mexico, the conditions of poverty and vulnerability while trying to access…
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Virk, A K; Atun, R
2015-06-01
Many low- and middle-income countries have introduced State-funded health programmes for vulnerable groups as part of global efforts to universalise health coverage. Similarly, India introduced the Rashtriya Swasthya Bima Yojana (RSBY) in 2008, a publicly-funded national health insurance scheme for people below the poverty line. The authors explore the RSBY's genesis and early development in order to understand its conceptualisation and design principles and thereby establish a baseline for assessing RSBY's performance in the future. Qualitative case study of the RSBY in Delhi. This paper presents results from documentary analysis and semi-structured interviews with senior-level policymakers including the former Labour Minister, central government officials and affiliates, and technical specialists from the World Bank and GIZ. With national priorities focused on broader economic development goals, the RSBY was conceptualised as a social investment in worker productivity and future economic growth in India. Hence, efficiency, competition, and individual choice rather than human needs or egalitarian access were overriding concerns for RSBY designers. This measured approach was strongly reflected in RSBY's financing and benefit structure. Hence, the programme's focus on only the 'poorest' (BPL) among the poor. Similarly, only costlier forms of care, secondary treatments in hospitals, which policymakers felt were more likely to have catastrophic financial consequences for users were covered. This paper highlights the risks of a narrow approach driven by developmental considerations alone. Expanding access and improving financial protection in India and elsewhere requires a more balanced approach and evidence-informed health policies that are guided by local morbidity and health spending patterns. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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Steckley, Marylynn; Doberstein, Brent
2011-07-01
This paper presents the results of primary research with 40 survivors of the 2004 Indian Ocean tsunami in two communities: Khao Lak (n=20) and Koh Phi Phi Don (n=20), Thailand. It traces tsunami survivors' perceptions of vulnerability, determines whether residents felt that the tsunami affected different communities differently, identifies the populations and sub-community groups that survivors distinguished as being more vulnerable than others, highlights community-generated ideas about vulnerability reduction, and pinpoints a range of additional vulnerability reduction actions. Tsunami survivors most consistently identified the 'most vulnerable' community sub-populations as women, children, the elderly, foreigners, and the poor. In Khao Lak, however, respondents added 'Burmese migrants' to this list, whereas in Koh Phi Phi Don, they added 'Thai Muslims'. Results suggest that the two case study communities, both small, coastal, tourism-dominated communities no more than 100 kilometres apart, have differing vulnerable sub-groups and environmental vulnerabilities, requiring different post-disaster vulnerability reduction efforts. © 2011 The Author(s). Disasters © Overseas Development Institute, 2011.
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Fabiani, Massimo; Riccardo, Flavia; Di Napoli, Anteo; Gargiulo, Lidia; Declich, Silvia; Petrelli, Alessio
2016-01-01
Background Due to their increased vulnerability, immigrants are considered a priority group for communicable disease prevention and control in Europe. This study aims to compare influenza vaccination coverage (IVC) between regular immigrants and Italian citizens at risk for its complications and evaluate factors affecting differences. Methods Based on data collected by the National Institute of Statistics during a population-based cross-sectional survey conducted in Italy in 2012–2013, we analysed information on 42,048 adult residents (≥ 18 years) at risk for influenza-related complications and with free access to vaccination (elderly residents ≥ 65 years and residents with specific chronic diseases). We compared IVC between 885 regular immigrants and 41,163 Italian citizens using log-binomial models and stratifying immigrants by area of origin and length of stay in Italy (recent: < 10 years; long-term: ≥ 10 years). Results IVC among all immigrants was 16.9% compared to 40.2% among Italian citizens (vaccination coverage ratio (VCR) = 0.42, 95% confidence interval (CI): 0.36–0.49). Adjusting for sex, age and area of residence, this difference was greatly reduced but remained statistically significant (VCR = 0.71, 95 CI: 0.61–0.81). Further adjustment for socio-economic factors (education, occupation, family composition and economic status) and a composite indicator of health-services utilization did not affect the difference (VCR = 0.78, 95% CI: 0.68–0.90). However, after adjustments, only long-term immigrants from Africa (VCR = 0.49, 95% CI: 0.28–0.85) and recent immigrants (VCR = 0.58, 95% CI: 0.43–0.78) showed a significantly different IVC compared to Italian citizens. Conclusions Differences in demographic characteristics, socio-economic conditions and health-services utilization explained the reduced IVC in most long-term immigrants compared to Italian citizens. By contrast, these differences did not explain the reduced IVC in long-term immigrants from Africa and recent immigrants. This suggests that IVC in these sub-groups is affected by other informal barriers (e.g., cultural and linguistic) that need to be investigated to promote effective immunization access strategies. PMID:27832186
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Seidel, Bastian M; Bell, Erica
2014-11-28
Many countries are developing or reviewing national adaptation policy for climate change but the extent to which these meet the health needs of vulnerable groups has not been assessed. This study examines the adequacy of such policies for nine known climate-vulnerable groups: people with mental health conditions, Aboriginal people, culturally and linguistically diverse groups, aged people, people with disabilities, rural communities, children, women, and socioeconomically disadvantaged people. The study analyses an exhaustive sample of national adaptation policy documents from Annex 1 ('developed') countries of the United Nations Framework Convention on Climate Change: 20 documents from 12 countries. A 'critical computational linguistics' method was used involving novel software-driven quantitative mapping and traditional critical discourse analysis. The study finds that references to vulnerable groups are relatively little present or non-existent, as well as poorly connected to language about practical strategies and socio-economic contexts, both also little present. The conclusions offer strategies for developing policy that is better informed by a 'social determinants of health' definition of climate vulnerability, consistent with best practice in the literature and global policy prescriptions.
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Global Dynamic Exposure and the OpenBuildingMap
NASA Astrophysics Data System (ADS)
Schorlemmer, D.; Beutin, T.; Hirata, N.; Hao, K. X.; Wyss, M.; Cotton, F.; Prehn, K.
2015-12-01
Detailed understanding of local risk factors regarding natural catastrophes requires in-depth characterization of the local exposure. Current exposure capture techniques have to find the balance between resolution and coverage. We aim at bridging this gap by employing a crowd-sourced approach to exposure capturing focusing on risk related to earthquake hazard. OpenStreetMap (OSM), the rich and constantly growing geographical database, is an ideal foundation for us. More than 2.5 billion geographical nodes, more than 150 million building footprints (growing by ~100'000 per day), and a plethora of information about school, hospital, and other critical facility locations allow us to exploit this dataset for risk-related computations. We will harvest this dataset by collecting exposure and vulnerability indicators from explicitly provided data (e.g. hospital locations), implicitly provided data (e.g. building shapes and positions), and semantically derived data, i.e. interpretation applying expert knowledge. With this approach, we can increase the resolution of existing exposure models from fragility classes distribution via block-by-block specifications to building-by-building vulnerability. To increase coverage, we will provide a framework for collecting building data by any person or community. We will implement a double crowd-sourced approach to bring together the interest and enthusiasm of communities with the knowledge of earthquake and engineering experts. The first crowd-sourced approach aims at collecting building properties in a community by local people and activists. This will be supported by tailored building capture tools for mobile devices for simple and fast building property capturing. The second crowd-sourced approach involves local experts in estimating building vulnerability that will provide building classification rules that translate building properties into vulnerability and exposure indicators as defined in the Building Taxonomy 2.0 developed by the Global Earthquake Model (GEM). These indicators will then be combined with a hazard model using the GEM OpenQuake engine to compute a risk model. The free/open framework we will provide can be used on commodity hardware for local to regional exposure capturing and for communities to understand their earthquake risk.
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29 CFR 2590.701-2 - Definitions.
Code of Federal Regulations, 2010 CFR
2010-07-01
... Regulations Relating to Labor (Continued) EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH PLANS Health Coverage Portability, Nondiscrimination... coverage, under a group health plan, that satisfies an applicable COBRA continuation provision. (3) COBRA...
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Employer Cooperation in Group Insurance Coverage for Public-School Personnel, 1964-65.
ERIC Educational Resources Information Center
National Education Association, Washington, DC.
This study presents data on group insurance coverage for public school personnel during the 1964-65 academic year, collected from 646 school systems of all sizes throughout the United States. Areas covered include (1) group life insurance, (2) group hospitalization insurance, (3) group medical-surgical insurance, (4) group major medical insurance,…
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77 FR 4734 - Servicemembers' Group Life Insurance-Stillborn Child Coverage
Federal Register 2010, 2011, 2012, 2013, 2014
2012-01-31
... DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 9 RIN 2900-AO30 Servicemembers' Group Life Insurance... Department of Veterans Affairs (VA) proposes to amend its Servicemembers' Group Life Insurance (SGLI... to ``RIN 2900-AO30--Servicemembers' Group Life Insurance--Stillborn Child Coverage.'' Copies of...
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20 CFR 404.1206 - Retirement system coverage groups.
Code of Federal Regulations, 2010 CFR
2010-04-01
... Section 404.1206 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL OLD-AGE, SURVIVORS AND... of any one of the following groupings of employees as a separate retirement system: (1) The entire... coverage group is a grouping of employees in positions under a retirement system. Employees in positions...
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Juárez-Ramírez, Clara; Márquez-Serrano, Margarita; Salgado de Snyder, Nelly; Pelcastre-Villafuerte, Blanca Estela; Ruelas-González, María Guadalupe; Reyes-Morales, Hortensia
2014-04-01
Health vulnerability refers to a lack of protection for specific population groups with specific health problems, as well as the disadvantages they face in solving them in comparison with other population groups. This major public health problem has multiple and diverse causes, including a shortage of trained health care personnel and the lack of family, social, economic, and institutional support in obtaining care and minimizing health risks. Health vulnerability is a dynamic condition arising from the confluence of multiple social determinants. This article attempts to describe the health situation of three vulnerable groups in Mexico-older adults, indigenous people, and migrants-and, after defining the needs of each, explore measures that could contribute to the design and implementation of public health policies better tailored to their respective needs.
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Forouzan, A.; Eftekhari, M. Baradaran; Falahat, K.; Dejman, M.; Heidari, N.; Habibi, E.
2013-01-01
Introduction: Iran is one of the ten most earthquake prone countries in the world. Earthquakes not only cause new psychological needs among the population but particularly so when one considers vulnerable groups. This in - depth study was conducted with the aim of assessing psychosocial needs six months after an earthquake happened in the west of the county in Lorestan province. Methods: This is a qualitative study using focus group discussion that focuses mainly on the vulnerable groups (women, children, elderly and disabled people) after an earthquake in Boz-azna; a village in Lorestan province in western part of Iran. Findings: Results of the psychosocial assessment indicated feelings of anxiety and worries in four vulnerable groups. Horror, hyper-excitement, avoidance and disturbing thoughts were observed in all groups with the exception of the elderly. Educational failures, loneliness and isolation were highlighted in children. All groups encountered socio-economic needs that included loss of assets and sense of insecurity and also reproductive problems were reported in women's group. Discussion and Conclusion: Modification of a protocol on psychosocial support considering the context of the rural and urban areas with emphasis on the specific needs of the vulnerable groups is an appropriate strategy in crisis management. It seems that appropriate public awareness regarding assistance programs can be effective in reducing stress and needs of disaster survivors. PMID:23777724
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de Almeida Vieira Monteiro, Ana Paula Teixeira; Serra, Adriano Vaz
2011-08-01
The assessment of individual vulnerability to stress emerges as a predictive factor of a higher risk of developing stress-related disorders. In the last decade, the geography of immigration in Portugal experienced intense transformations in terms of recruitment and patterns of geographic settlement, with an increasing and exponential inflow of new and diversified migratory groups. The immigrant populations coming from Eastern European countries are a recent migratory flow, with linguistic, cultural and socio-demographic specificities which are very different from the general Portuguese population. This makes them a paradigmatic group in potential transcultural studies on mental health issues. The primary aim of the study was to describe the characteristics of vulnerability to stress and determine their impact on the mental health status of Russian-speaking immigrants residing in Portugal. The relationship between vulnerability to stress, sociodemographic variables, mental health status and social support were analyzed, using the SSQ6, GHQ28, 23QVS and a socio-demographic questionnaire. A comparative analysis was carried out, using a control group of 110 Portuguese subjects without previous migratory experiences, matched by sex, age group and academic qualifications. The eastern European immigrants reported high levels of vulnerability to stress assessed by the cut-off point of the 23QVS. Immigrants also reported higher percentage of vulnerability to stress and lower social support levels of social support versus the control group. Several factors inherent to the dynamics of the migratory process were related to the presence of vulnerability to stress. The findings suggest that vulnerability to stress is positively correlated with worse mental health outcomes and negatively correlated with the social support perceived as available--number of supporters and satisfaction with social support.
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Chen, Jing; Wilkinson, Diana; Richardson, Richard B; Waruszynski, Barbara
2009-06-01
The Workshop on Emergency Preparedness for Vulnerable Population Groups was held on 2 and 3 March 2009 in Ottawa, ON, Canada. The purpose of the workshop was to enhance communications within the emergency community response network and to identify the needs and gaps of emergency preparedness against chemical, biological, radiological, nuclear and explosives events for vulnerable population groups. The workshop was organised to enable extensive round-table discussions and provide a summary of key issues, considerations and recommendations for emergency response planners.
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Daniels, R Steven
2013-10-01
This paper examines the shift from vulnerability to political responsiveness in presidential and gubernatorial disaster decisions in the United States from 1953-2009 (President Dwight D. Eisenhower to President Barack Obama) using annual request, declaration, and approval data from multiple sources. It makes three key conclusions: first, the 1988 Stafford Act expanded federal coverage to all categories of disasters, added a significant range of individual types of assistance, and provided extensive funding for recovery planning. Second, the election effects on disaster decisions increased over time whereas the impact of social and economic vulnerability (measured by scope of disaster) declined. Third, the changes affected governors more than presidents, and the choices of governors drove those of presidents. The analysis underscores the increasingly political nature of the disaster decision-making process, as well as the difficulty in emphasising mitigation and preparedness as intensively as response and recovery. Proactive intervention yields fewer political rewards than responsiveness. © 2013 The Author(s). Disasters © Overseas Development Institute, 2013.
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Ward, Charlotte; Byrne, Lisa; White, Joanne M; Amirthalingam, Gayatri; Tiley, Karen; Edelstein, Michael
2017-04-25
In September 2013, England introduced a shingles vaccination programme to reduce incidence and severity of shingles in the elderly. This study aims to assess variation in vaccine coverage with regards to selected sociodemographic factors to inform activities for improving equity of the programme. Eligible 70year-olds were identified from a national vaccine coverage dataset in 2014/15 that includes 95% of GPs in England. NHS England Local Team (LT) and index of multiple deprivation (IMD) scores were assigned to patients based on GP-postcode. Vaccine coverage (%) with 95% confidence intervals (CIs), were calculated overall and by LT, ethnicity and IMD, using binomial regression. Of 502,058 eligible adults, 178,808 (35.6%) had ethnicity recorded. Crude vaccine coverage was 59.5% (95%CI: 59.3-59.7). Coverage was lowest in London (49.6% coverage, 95%CI: 49.0-50.2), and compared to this coverage was significantly higher in all other LTs (+6.3 to +10.4, p<0.001) after adjusting for ethnicity and IMD. Coverage decreased with increasing deprivation and was 8.2% lower in the most deprived (95%CI: 7.3-9.1) compared with the least deprived IMD quintile (64.1% coverage, 95%CI: 63.6-64.6), after adjustment for ethnicity and LT. Compared with White-British (60.7% coverage, 95%CI: 60.5-61.0), other ethnic groups had between 4.0% (Indian) and 21.8% (Mixed: White and Black African) lower coverage. After adjusting for IMD and LT, significantly lower coverage by ethnicity persisted in all groups, except in Mixed: Other, Indian and Bangladeshi compared with White-British. After taking geography and deprivation into account, shingles vaccine coverage varied by ethnicity. White-British, Indian and Bangladeshi groups had highest coverage; Mixed: White and Black African, and Black-other ethnicities had the lowest. Patients' ethnicity and IMD are predictors of coverage which contribute to, but do not wholly account for, geographical variation coverage. Interventions to address service-related, sociodemographic and ethnic inequalities in shingles vaccine coverage are required. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Emergency measles control activities--Darfur, Sudan, 2004.
2004-10-01
The Darfur region of Sudan, composed of three states with a population of approximately six million, has experienced civil conflict during the previous year, resulting in the internal displacement of approximately one million residents and an exodus of an estimated 170,000 persons to neighboring Chad. The conflict has left a vulnerable population with limited access to food, health care, and other basic necessities. In addition, measles vaccination coverage has been adversely affected; in 2003, coverage was reported to be 46%, 57%, and 77% in North, West, and South Darfur, respectively. This report describes measles-control activities in Darfur region conducted by the Federal Ministry of Health (FMOH) in Sudan in collaboration with the United Nations and nongovernmental organizations (NGOs) during March-August 2004. Ongoing measles transmission in camps for internally displaced persons (IDPs) and neighboring communities in Darfur led to a regionwide measles vaccination campaign targeting all children aged 9 months-15 years, resulting in a reduction in reported measles cases. Once security is improved, ongoing efforts to increase measles vaccine coverage will be required to eliminate persistent susceptibility to measles in the Darfur population.
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Differences in private health insurance coverage for working male Hispanics.
Fronstin, P; Goldberg, L G; Robins, P K
1997-01-01
In 1993, 33.8% of all nonelderly adult Hispanics living in the United States lacked health insurance coverage (either private or public), compared to 8.1% of the entire nonelderly population. Because Hispanics are more likely to be uninsured than any other ethnic group and because they are the fastest growing minority group in the United States, the increase in the Hispanic population is likely to increase the proportion of the population without health insurance. Particularly striking are differences in private health insurance coverage among the three major Hispanic groups--Cuban-Americans, Mexican-Americans, and Puerto Ricans. In this paper, regression-based decomposition analysis is used to explain the sources of differences in private health insurance coverage among working males in these three group. The results indicate that among the study population, Cuban-Americans have higher rates of private health insurance coverage than Mexican-Americans and Puerto Ricans, and that wage rates, levels of education, age, occupation, and marital status explain most of the difference.
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Irving, Stephanie A; Groom, Holly C; Stokley, Shannon; McNeil, Michael M; Gee, Julianne; Smith, Ning; Naleway, Allison L
2018-03-01
Human papillomavirus (HPV) vaccination has been recommended in the United States for female and male adolescents since 2006 and 2011, respectively. Coverage rates are lower than those for other adolescent vaccines. The objective of this study was to evaluate an assessment and feedback intervention designed to increase HPV vaccination coverage and quantify missed opportunities for HPV vaccine initiation at preventive care visits. We examined changes in HPV vaccination coverage and missed opportunities within the adolescent (11-17 years) population at 9 Oregon-based Kaiser Permanente Northwest outpatient clinics after an assessment and feedback intervention. Quarterly coverage rates were calculated for the adolescent populations at the clinics, according to age group (11-12 and 13-17 years), sex, and department (Pediatrics and Family Medicine). Comparison coverage assessments were calculated at 3 nonintervention (control) clinics. Missed opportunities for HPV vaccine initiation, defined as preventive care visits in which a patient eligible for HPV dose 1 remained unvaccinated, were examined according to sex and age group. An average of 29,021 adolescents were included in coverage assessments. Before the intervention, 1-dose and 3-dose quarterly coverage rates were increasing at intervention as well as at control clinics in both age groups. Postimplementation quarterly trends in 1-dose or 3-dose coverage did not differ significantly between intervention and control clinics for either age group. One-dose coverage rates among adolescents with Pediatrics providers were significantly higher than those with Family Medicine providers (56% vs 41% for 11- to 12-year-old and 82% vs 69% for 13- to 17-year-old girls; 55% vs 40% for 11- to 12-year-old and 78% vs 62% for 13- to 17-year-old boys). No significant differences in HPV vaccine coverage were identified at intervention clinics. However, coverage rates were increasing before the start of the intervention and might have been influenced by ongoing health system best practices. HPV vaccine coverage rates varied significantly according to department, which could allow for targeted improvement opportunities. Copyright © 2017 Academic Pediatric Association. All rights reserved.
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Zogg, Cheryl K; Payró Chew, Fernando; Scott, John W; Wolf, Lindsey L; Tsai, Thomas C; Najjar, Peter; Olufajo, Olubode A; Schneider, Eric B; Haut, Elliott R; Haider, Adil H; Canner, Joseph K
2016-12-21
Trauma is the leading cause of death and disability among young adults, who are also among the most likely to be uninsured. Efforts to increase insurance coverage, including passage of the Patient Protection and Affordable Care Act (ACA), were intended to improve access to care and promote improvements in outcomes. However, despite reported gains in coverage, the ACA's success in promoting use of high-quality care and enacting changes in clinical end points remains unclear. To assess for observed changes in insurance coverage and rehabilitation use among young adult trauma patients associated with the ACA, including the Dependent Coverage Provision (DCP) and Medicaid expansion/open enrollment, and to consider possible insurance and rehabilitation differences between DCP-eligible vs -ineligible patients and among stratified demographic and community subgroups. A longitudinal assessment of DCP implementation and Medicaid expansion/open enrollment using risk-adjusted before-and-after, difference-in-difference, and interrupted time-series analyses was conducted. Eleven years (January 1, 2005, to September 31, 2015) of Maryland Health Services Cost Review Commission data, representing complete patient records from all payers within the state, were used to identify all hospitalized young adult (aged 18-34 years) trauma patients in Maryland during the study period. Of the 69 507 hospitalized patients included, 50 548 (72.7%) were male, and the mean (SD) age was 25 (5) years. Before implementation of the DCP, 1 of 4 patients was uninsured. After ACA implementation, the number fell to less than 1 of 10, with similar patterns emerging in emergency department and outpatient settings. The change was primarily driven by Medicaid expansion/open enrollment, which corresponded to a 20.1 percentage-point increase in Medicaid (95% CI, 18.9-21.3) and an 18.2 percentage-point decrease in uninsured (95% CI, -19.3 to -17.2). No changes were detected among privately insured patients. Rehabilitation use increased by 5.4 percentage points (95% CI, 4.5-6.2)-a 60% relative increase from a baseline of 9%. Mortality (-0.5; 95% CI, -0.9 to -0.1) and failure-to-rescue rates (-4.5; 95% CI, -7.4 to -1.6) also significantly declined. Stratified changes point to significant differences in the percentage of uninsured patients and rehabilitation access across the board, mitigating or even eradicating disparities in certain cases. For patients who are injured, young, and uninsured, Medicaid expansion/open enrollment in Maryland changed insurance coverage and altered patient outcomes in ways that the DCP alone was never intended to do. Implementation of Medicaid expansion/open enrollment transformed the landscape of trauma coverage, directly affecting the health of one of the country's most vulnerable at-risk groups.
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Lay, A Morgan; Saunders, Ron; Lifshen, Marni; Breslin, Curtis; LaMontagne, Anthony; Tompa, Emile; Smith, Peter
2016-02-01
To describe OH&S vulnerability across a diverse sample of Canadian workers. A survey was administered to 1,835 workers employed more than 15 hrs/week in workplaces with at least five employees. Adjusted logistic models were fitted for three specific and one overall measure of workplace vulnerability developed based on hazard exposure and access to protective OH&S policies and procedures, awareness of employment rights and responsibilities, and workplace empowerment. More than one third of the sample experienced some OH&S vulnerability. The type and magnitude of vulnerability varied by labor market sub-group. Younger workers and those in smaller workplaces experienced significantly higher odds of multiple types of vulnerability. Temporary workers reported elevated odds of overall, awareness- and empowerment-related vulnerability, while respondents born outside of Canada had significantly higher odds of awareness vulnerability. Knowing how labor market sub-groups experience different types of vulnerability can inform better-tailored primary prevention interventions. © 2015 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc.
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Jin, Yinzi; Hou, Zhiyuan; Zhang, Donglan
2016-01-01
Background China is reforming and restructuring its health insurance system to achieve the goal of universal coverage. This study aims to understand the determinants of public, private and multiple insurance coverage among people of retirement-age in China. Methods We used data from the China Health and Retirement Longitudinal Survey 2011 and 2013, a nationally representative survey of Chinese people aged 45 and over. Multinomial logit regression was performed to identify the determinants of public, private and multiple health insurance coverage. We also conducted logit regression to examine the association between public insurance coverage and demand for private insurance. Results In 2013, 94.5% of this population had at least one type of public insurance, and 12.2% purchased private insurance. In general, we found that rural residents were less likely to be uninsured (Relative Risk Ratio (RRR) = 0.40, 95% Confidence Interval (CI): 0.34–0.47) and were less likely to buy private insurance (RRR = 0.22, 95% CI: 0.16–0.31). But rural-to-urban migrants were more likely to be uninsured (RRR = 1.39, 95% CI: 1.24–1.57). Public health insurance coverage may crowd out private insurance market (Odds Ratio = 0.55, 95% CI: 0.48–0.63), particularly among enrollees of Urban Resident Basic Medical Insurance. There exists a huge socioeconomic disparity in both public and private insurance coverage. Conclusion The migrants, the poor and the vulnerable remained in the edge of the system. The growing private insurance market did not provide sufficient financial protection and did not cover the people with the greatest need. To achieve universal coverage and reduce socioeconomic disparity, China should integrate the urban and rural public insurance schemes across regions and remove the barriers for the middle-income and low-income to access private insurance. PMID:27564320
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Tandon, B N; Gandhi, N
1992-01-01
The Integrated Child Development Services (ICDS) programme was launched by the Indian government in October 1975 to provide a package of health, nutrition and informal educational services to mothers and children. In 1988 we studied the impact of ICDS on the immunization coverage of children aged 12-24 months and of mothers of infants in 19 rural, 8 tribal, and 9 urban ICDS projects that had been operational for more than 5 years. Complete coverage with BCG, diphtheria-pertussis-tetanus (DPT) and poliomyelitis vaccines was recorded for 65%, 63%, and 64% of children, respectively, in the ICDS population. By comparison, the coverage in the non-ICDS group was only 22% for BCG, 28% for DPT, and 27% for poliomyelitis. Complete immunization with tetanus toxoid was recorded for 68% of the mothers in the ICDS group and for 40% in the non-ICDS group. Coverage was greater in the urban and lower in the tribal projects. Scheduled castes, scheduled tribes, backward communities, and minorities (groups that have a high priority for social services) had immunization coverages in ICDS projects that were similar to those of higher castes.
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Clarke, John S.; Sorensen, Jerry W.; Strickland, Henry G.; Collins, George
1992-01-01
Geographic information system (GIS) methods were applied to the U.S. Environmental Protection Agency's (EPA) hazard ranking system (HRS) to evaluate the vulnerability of ground water to contamination from actual or potential releases of hazardous materials from waste-disposal sites. Computerized maps of four factors influencing ground-water vulnerability - hydraulic conductivity, sorptive capacity, depth to water, and net precipitation - were derived for the Southeastern United States from digitized copies of published maps and from computerized databases, including the U.S. Geological Survey's (USGS) national water information system. To test the accuracy of the derived data coverages used to assess ground-water vulnerability, GIS-derived values for hydraulic conductivity, depth to water, and net precipitation were compared to corresponding values assigned by EPA's field investigation teams (FIT) at 28 hazardous waste sites. For each factor, site data were divided into three physiographic groupings: (1) Coastal Plain, (2) Valley and Ridge-Interior Low Plateaus, and (3) Piedmont-Blue Ridge. The best correlation between the paired data sets was for the net precipitation factor, where most GIS-derived values were within 0 to 40% of the FIT data, and 79% were within the same HRS scoring range. For the hydraulic conductivity factor, the best correlation between GIS and FIT data was for values derived from a published surficial deposits map, where most of the values were within one order of magnitude of the FIT data, and on the average were within 1.24 orders of magnitude of the FIT data. For this map, the best match between data sets was in the Coastal Plain province, where the difference in order to magnitude averaged 0.92. For the depth-to-water factor, most of the GIS derived values were within 51 to 100% of the FIT data, and only 44 to 50% of the sites were within a common scoring range. The best correlation for depth to water was in the Coastal Plain where GIS derived values were within 8 to 100% of the FIT data.
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Predicting risk for medical malpractice claims using quality-of-care characteristics.
Charles, S C; Gibbons, R D; Frisch, P R; Pyskoty, C E; Hedeker, D; Singha, N K
1992-01-01
The current fault-based tort system assumes that claims made against physicians are inversely related to the quality of care they provide. In this study we identified physician characteristics associated with elements of medical care that make physicians vulnerable to malpractice claims. A sample of physicians (n = 248) thought to be at high or low risk for claims was surveyed on various personal and professional characteristics. Statistical analysis showed that 9 characteristics predicted risk group. High risk was associated with increased age, surgical specialty, emergency department coverage, increased days away from practice, and the feeling that the litigation climate was "unfair." Low risk was associated with scheduling enough time to talk with patients, answering patients' telephone calls directly, feeling "satisfied" with practice arrangements, and acknowledging greater emotional distress. Prediction was more accurate for physicians in practice 15 years or less. We conclude that a relationship exists between a history of malpractice claims and selected physician characteristics. PMID:1462538
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Lau, Joseph T F; Tsui, H Y
2003-08-01
Male clients of female sex workers (FSWs) are an important group vulnerable to HIV infection. The goal was to administer and assess behavioral surveillance surveys of male clients of FSWs in Hong Kong. Three population-based telephone surveys of males aged 18 to 60 were conducted from 1998 to 2001 (n=5159). Of all respondents, about 10.8% to 14% had patronized FSWs in the previous 6 months. Among male clients of FSWs, about 25% did not always use condoms, 4% to 6% had contracted a sexually transmitted disease, 16% had undergone HIV antibody testing, and 20% or more reported having four or more sex partners in the previous 6 months. There was no improvement in condom use over time. Cross-border (from Hong Kong to mainland China) commercial sex was common. The level of risk behaviors associated with male clients of FSWs remained substantial. The overall effectiveness and coverage of relevant prevention programs were questioned.
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Burnett, Emma; Johnston, Bridget; Corlett, Joanne; Kearney, Nora
2014-07-01
To examine how a major Clostridium difficile outbreak in the UK was represented in the media. Clostridium difficile is a serious health care-associated infection with significant global prevalence. As major outbreaks have continued to occur worldwide over the last few decades, it has also resulted in increasing media coverage. Newspaper journalists are, however, frequently criticized for sensationalized and inaccurate reporting and alarming the public. Despite such criticisms, nothing is known about how the media frame Clostridium difficile related coverage. Qualitative interpretive descriptive study. An interpretive analysis of newspaper articles from the national press that reported about the outbreak from the first day of coverage over 3 weeks (12 June-3 July 2008). Twenty-eight newspaper articles were included in the study from tabloids, broadsheets, a regional and a Sunday newspaper. Monster and war metaphors were frequently adopted to portray the severity of Clostridium difficile and the impact it can have on patient safety. In addition, the positioning of the affected patients, their families, healthcare professionals and the Government produced representations of victims, villains and heroes. This subsequently evoked notions of vulnerability, blame and conflict. The media are and will remain critical convectors of public information and, as such, are hugely influential in risk perceptions and responses. Rather than simply dismissing media coverage, further understanding around how such stories in specific contexts are constructed and represented is needed so that it can help inform future communication and management strategies. © 2013 John Wiley & Sons Ltd.
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Women's Health Insurance Coverage
... to the non-group or individually purchased insurance market by offering premium tax credits to help individuals ... barriers to coverage in the non-group insurance market. In 2016, about 9% of non-elderly adult ...
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Kimani, James K; Ettarh, Remare; Kyobutungi, Catherine; Mberu, Blessing; Muindi, Kanyiva
2012-03-19
The government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. This paper examines the determinants associated with participation in the NHIF among residents of urban slums in Nairobi city. The study used data from the Nairobi Urban Health and Demographic Surveillance System in two slums in Nairobi city, where a total of about 60,000 individuals living in approximately 23,000 households are under surveillance. Descriptive statistics and multivariate logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with participation in the NHIF program. Only 10% of the respondents were participating in the NHIF program, while less than 1% (0.8%) had private insurance coverage. The majority of the respondents (89%) did not have any type of insurance coverage. Females were more likely to participate in the NHIF program (OR = 2.4; p < 0.001), while respondents who were formerly in a union (OR = 0.5; p < 0.05) and who were never in a union (OR = 0.6; p < 0.05) were less likely to have public insurance coverage. Respondents working in the formal employment sector (OR = 4.1; p < 0.001) were more likely to be enrolled in the NHIF program compared to those in the informal sector. Membership in microfinance institutions such as savings and credit cooperative organizations (SACCOs) and community-based savings and credit groups were important determinants of access to health insurance. The proportion of slum residents without any type of insurance is high, which underscores the need for a social health insurance program to ensure equitable access to health care among the poor and vulnerable segments of the population. As the Kenyan government moves toward transforming the NHIF into a universal health program, it is important to harness the unique opportunities offered by both the formal and informal microfinance institutions in improving health care capacity by considering them as viable financing options within a comprehensive national health financing policy framework.
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Janmohamed, Amynah; Doledec, David
2017-07-01
To compare administrative coverage data with results from household coverage surveys for vitamin A supplementation (VAS) and deworming campaigns conducted during 2010-2015 in 12 African countries. Paired t-tests examined differences between administrative and survey coverage for 52 VAS and 34 deworming dyads. Independent t-tests measured VAS and deworming coverage differences between data sources for door-to-door and fixed-site delivery strategies and VAS coverage differences between 6- to 11-month and 12- to 59-month age group. For VAS, administrative coverage was higher than survey estimates in 47 of 52 (90%) campaign rounds, with a mean difference of 16.1% (95% CI: 9.5-22.7; P < 0.001). For deworming, administrative coverage exceeded survey estimates in 31 of 34 (91%) comparisons, with a mean difference of 29.8% (95% CI: 16.9-42.6; P < 0.001). Mean ± SD differences in coverage between administrative and survey data were 12.2% ± 22.5% for the door-to-door delivery strategy and 25.9% ± 24.7% for the fixed-site model (P = 0.06). For deworming, mean ± SD differences in coverage between data sources were 28.1% ± 43.5% and 33.1% ± 17.9% for door-to-door and fixed-site distribution, respectively (P = 0.64). VAS administrative coverage was higher than survey estimates in 37 of 49 (76%) comparisons for the 6- to 11-month age group and 45 of 48 (94%) comparisons for the 12- to 59-month age group. Reliance on health facility data alone for calculating VAS and deworming coverage may mask low coverage and prevent measures to improve programmes. Countries should periodically validate administrative coverage estimates with population-based methods. © 2017 John Wiley & Sons Ltd.
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42 CFR 407.40 - Enrollment under a State buy-in agreement.
Code of Federal Regulations, 2010 CFR
2010-10-01
... group specified in the agreement. A buy-in group could include certain individuals receiving Federally... modification to include a coverage group broader than the one originally selected. (2) Section 945(e) of the... broader coverage group for an existing agreement. (3) Several laws enacted during 1980-1987 had the effect...
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5 CFR 352.309 - Retirement, health benefits, and group life insurance.
Code of Federal Regulations, 2010 CFR
2010-01-01
... Organizations § 352.309 Retirement, health benefits, and group life insurance. (a) Agency action. An employee... entitled to retain coverage for retirement, health benefits, and group life insurance purposes if he or she... he or she wishes to retain coverage under the retirement, health benefits, and group life insurance...
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Feiring, Berit; Laake, Ida; Molden, Tor; Håberg, Siri E; Nøkleby, Hanne; Seterelv, Siri Schøyen; Magnus, Per; Trogstad, Lill
2016-04-12
Selective immunisation is an alternative to universal vaccination if children at increased risk of disease can be identified. Within the Norwegian Childhood Immunisation Programme, BCG vaccine against tuberculosis and vaccine against hepatitis B virus (HBV) are offered only to children with parents from countries with high burden of the respective disease. We wanted to study whether this selective immunisation policy reaches the targeted groups. The study population was identified through the Norwegian Central Population Registry and consisted of all children born in Norway 2007-2010 and residing in Norway until their second birthday, in total 240,484 children. Information on vaccinations from the Norwegian Immunisation Registry, and on parental country of birth from Statistics Norway, was linked to the population registry by personal identifiers. The coverage of BCG and HBV vaccine was compared with the coverage of vaccines in the universal programme. Among the study population, 16.1% and 15.9% belonged to the target groups for BCG and HBV vaccine, respectively. Among children in the BCG target group the BCG vaccine coverage was lower than the coverage of pertussis and measles vaccine (83.6% vs. 98.6% and 92.3%, respectively). Likewise, the HBV vaccine coverage was lower than the coverage of pertussis and measles vaccine in the HBV target group (90.0% vs. 98.6% and 92.3%, respectively). The coverage of the targeted vaccines was highest among children with parents from South Asia and Sub-Saharan Africa. The coverage of vaccines in the universal programme was similar in targeted and non-targeted groups. Children targeted by selective vaccination had lower coverage of the target vaccines than of vaccines in the universal programme, indicating that selective vaccination is challenging. Improved routines for identifying eligible children and delivering the target vaccines are needed. Universal vaccination of all children with these vaccines could be considered. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Zhang, Yuting; Baik, Seo Hyon; Zhou, Lei; Reynolds, Charles F; Lave, Judith R
2012-07-01
Maintenance antidepressant pharmacotherapy in late life prevents recurrent episodes of major depression. The coverage gap in Medicare Part D could increase the likelihood of reducing appropriate use of antidepressants, thereby exposing older adults to an increased risk for relapse of depressive episodes. To determine whether (1) beneficiaries reduce antidepressant use in the gap, (2) the reduction in antidepressant use is similar to the reduction in heart failure medications and antidiabetics, (3) the provision of generic coverage reduces the risk of reduction of medication use, and (4) medical spending increases in the gap. Observational before-after study with a comparison group design. A 5% random sample of US Medicare beneficiaries 65 years or older with depression (n = 65,223) enrolled in stand-alone Part D plans in 2007. Antidepressant pharmacotherapy, physician, outpatient, and inpatient spending. Being in the gap was associated with comparable reductions in the use of antidepressants, heart failure medications, and antidiabetics. Relative to the comparison group (those who had full coverage in the gap because of Medicare coverage or low-income subsidies), the no-coverage group reduced their monthly antidepressant prescriptions by 12.1% (95% CI, 9.9%-14.3%) from the pregap level, whereas they reduced use of heart failure drugs and antidiabetics by 12.9% and 13.4%, respectively. Those with generic drug coverage in the gap reduced their monthly antidepressant prescriptions by 6.9% (95% CI, 4.8%-9.1%); this decrease was entirely attributable to the reduction in the use of brand-name antidepressants. Medicare spending on medical care did not increase for either group relative to the comparison group. The Medicare Part D coverage gap was associated with modest reductions in the use of antidepressants. Those with generic coverage reduced their use of brand-name drugs and did not switch from brand-name to generic drugs. The reduction in antidepressant use was not associated with an increase in nondrug medical spending.
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Wieder, Robert; Delarosa, Nila; Bryan, Margarette; Hill, Ann Marie; Amadio, William J
2014-01-01
We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain. We conducted a chart review of 360 patients treated in the Oncology Practice at University of Medicine and Dentistry of New Jersey University Hospital, who were prescribed opiate pain medications. Half the patients were charity care or self-pay (CC/SP), without the benefit of prescription coverage, and half had Medicaid, with unlimited prescription coverage. We evaluated patients discharged from a hospitalization, who had three subsequent outpatient follow-up visits. We compared demographics, pain intensity, the type and dose of opiates, adherence to prescribed pain regimen, unscheduled emergency department visits, and unscheduled hospitalizations. There was a significantly greater use of long-acting opiates in the Medicaid group than in the CC/SP group. The Medicaid group had significantly more African American patients and a greater rate of smoking and substance use, and the CC/SP group disproportionately more Hispanic and Asian patients and less smoking and substance use. Hispanic and Asian patients were less likely to have long-acting opiates prescribed to them. Pain levels and adherence were equivalent in both groups and were not affected by any of these variables except stage of disease, which was equally distributed in the two groups. Appropriate use of long-acting opiates for equivalent levels of cancer pain was influenced only by the availability of prescription coverage. The group without prescription coverage and receiving fewer long-acting opiates had disproportionately more Hispanic and Asian patients. Wiley Periodicals, Inc.
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Wieder, Robert; DeLaRosa, Nila; Bryan, Margarette; Hill, Ann Marie; Amadio, William J.
2013-01-01
Purpose We tested the hypothesis that prescription coverage affects the prescribing of long-acting opiates to indigent inner city minority patients with cancer pain. Materials and Methods We conducted a chart review of 360 patients treated in the Oncology Practice at UMDNJ-University Hospital, who were prescribed opiate pain medications. Half the patients were Charity Care or Self Pay (CC/SP), without the benefit of prescription coverage, and half had Medicaid, with unlimited prescription coverage. We evaluated patients discharged from a hospitalization, who had three subsequent outpatient follow up visits. We compared demographics, pain intensity, the type and dose of opiates, adherence to prescribed pain regimen, unscheduled Emergency Department (ED) visits and unscheduled hospitalizations. Results There was a significantly greater use of long-acting opiates in the Medicaid group than in the CC/SP group. The Medicaid group had significantly more African American patients and a greater rate of smoking and substance use and the CC/SP group disproportionately more Hispanic and Asian patients and less smoking and substance use. Hispanic and Asian patients were less likely to have long-acting opiates prescribed to them. Pain levels and adherence were equivalent in both groups and were not affected by any of these variables except stage of disease, which was equally distributed in the two groups. Conclusion Appropriate use of long-acting opiates for equivalent levels of cancer pain are influenced only by the availability of prescription coverage. The group without prescription coverage and receiving fewer long-acting opiates had disproportionately more Hispanic and Asian patients. PMID:24106748
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Subsidies and the Demand for Individual Health Insurance in California
Susan Marquis, M; Buntin, Melinda Beeuwkes; Escarce, José J; Kapur, Kanika; Yegian, Jill M
2004-01-01
Objective To estimate the effect of changes in premiums for individual insurance on decisions to purchase individual insurance and how this price response varies among subgroups of the population. Data Source Survey responses from the Current Population Survey (), the Survey of Income and Program Participation (), the National Health Interview Survey (), and data about premiums and plans offered in the individual insurance market in California, 1996–2001. Study Design A logit model was used to estimate the decisions to purchase individual insurance by families without access to group insurance. This was modeled as a function of premiums, controlling for family characteristics and other characteristics of the market. A multinomial model was used to estimate the choice between group coverage, individual coverage, and remaining uninsured for workers offered group coverage as a function of premiums for individual insurance and out-of-pocket costs of group coverage. Principal Findings The elasticity of demand for individual insurance by those without access to group insurance is about −.2 to −.4, as has been found in earlier studies. However, there are substantial differences in price responses among subgroups with low-income, young, and self-employed families showing the greatest response. Among workers offered group insurance, a decrease in individual premiums has very small effects on the choice to purchase individual coverage versus group coverage. Conclusions Subsidy programs may make insurance more affordable for some families, but even sizeable subsidies are unlikely to solve the problem of the uninsured. We do not find evidence that subsidies to individual insurance will produce an unraveling of the employer-based health insurance system. PMID:15333122
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Bozzaro, Claudia; Boldt, Joachim; Schweda, Mark
2018-05-01
The elderly are often considered a vulnerable group in public and academic bioethical debates and regulations. In this paper, we examine and challenge this assumption and its ethical implications. We begin by systematically delineating the different concepts of vulnerability commonly used in bioethics, before then examining whether these concepts can be applied to old age. We argue that old age should not, in and of itself, be used as a marker of vulnerability, since ageing is a process that can develop in a variety of different ways and is not always associated with particular experiences of vulnerability. We, therefore, turn to more fundamental phenomenological considerations in order to reconstruct from a first person perspective the intricate interconnections between the experiences of ageing and vulnerability. According to this account, ageing and old age are phenomena in which the basic anthropological vulnerability of human beings can manifest itself in an increased likelihood of harm and exploitation. Thus, we plead for a combined model of vulnerability that helps to avoid problems related to the current concepts of vulnerability. We conclude first that old age as such is not a sufficient criterion for being categorized as vulnerable in applied ethics, and second that reflections on ageing can help to develop a better understanding of the central role of vulnerability in human existence and in applied ethics. © 2018 John Wiley & Sons Ltd.
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Deandrea, S; Molina-Barceló, A; Uluturk, A; Moreno, J; Neamtiu, L; Peiró-Pérez, R; Saz-Parkinson, Z; Lopez-Alcalde, J; Lerda, D; Salas, D
2016-10-01
The European Union Council Recommendation of 2 December 2003 on cancer screening suggests the implementation of organised, population-based breast cancer screening programmes based on mammography every other year for women aged 50 to 69years, ensuring equal access to screening, taking into account potential needs for targeting particular socioeconomic groups. A European survey on coverage and participation, and key organisational and policy characteristics of the programmes, targeting years 2010 and 2014, was undertaken in 2014. Overall, 27 countries contributed to this survey, 26 of the 28 European Union member states (92.9%) plus Norway. In 2014, 25 countries reported an ongoing population-based programme, one country reported a pilot programme and another was planning a pilot. In eight countries, the target age range was broader than that proposed by the Council Recommendation, and in three countries the full range was not covered. Fifteen countries reported not reaching some vulnerable populations, such as immigrants, prisoners and people without health insurance, while 22 reported that participation was periodically monitored by socioeconomic variables (e.g. age and territory). Organised, population-based breast cancer screening programmes based on routine mammograms are in place in most EU member states. However, there are still differences in the way screening programmes are implemented, and participation by vulnerable populations should be encouraged. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.
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2014-01-01
Background The Government of Kenya is making plans to implement a social health insurance program by transforming the National Hospital Insurance Fund (NHIF) into a universal health coverage program. The objective of this study was to examine the determinants associated with health insurance ownership among women in Kenya. Methods Data came from the 2008–09 Kenya Demographic and Health Survey, a nationally representative survey. The sample comprised 8,435 women aged 15–49 years. Descriptive statistics and multivariable logistic regression analysis were used to describe the characteristics of the sample and to identify factors associated with health insurance ownership. Results Being employed in the formal sector, being married, exposure to the mass media, having secondary education or higher, residing in households in the middle or rich wealth index categories and residing in a female-headed household were associated with having health insurance. However, region of residence was associated with a lower likelihood of having insurance coverage. Women residing in Central (OR = 0.4; p < 0.01) and North Eastern (OR = 0.1; p < 0.5) provinces were less likely to be insured compared to their counterparts in Nairobi province. Conclusions As the Kenyan government transforms the NHIF into a universal health program, it is important to implement a program that will increase equity and access to health care services among the poor and vulnerable groups. PMID:24678655
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Code of Federal Regulations, 2010 CFR
2010-10-01
... INDIVIDUAL HEALTH INSURANCE MARKET Requirements Relating to Access and Renewability of Coverage § 148.120 Guaranteed availability of individual health insurance coverage to certain individuals with prior group... furnishes health insurance coverage in the individual market must meet the following requirements with...
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45 CFR 155.735 - Termination of coverage.
Code of Federal Regulations, 2014 CFR
2014-10-01
... Functions: Small Business Health Options Program (SHOP) § 155.735 Termination of coverage. (a) General requirements. The SHOP must determine the timing, form, and manner in which coverage in a QHP may be terminated. (b) Termination of employer group health coverage at the request of the employer. (1) The SHOP must...
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45 CFR 155.735 - Termination of coverage.
Code of Federal Regulations, 2013 CFR
2013-10-01
... Functions: Small Business Health Options Program (SHOP) § 155.735 Termination of coverage. (a) General requirements. The SHOP must determine the timing, form, and manner in which coverage in a QHP may be terminated. (b) Termination of employer group health coverage at the request of the employer. (1) The SHOP must...
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[Information hygiene and regulation of information for vulnerable groups of the population].
Denisov, E I; Eremin, A L; Sivochalova, O V; Kurerov, N N
2014-01-01
Development of information society engenders the problem of hygienic regulation of information load for the population, first of all for vulnerable groups. There are presented international and Russian normative legal documents and experience in this area, there are described the negative effects of information (such as stress, depression, suicidal ideations). There are considered social-psychological characteristics of vulnerable groups that requires their best protection from loads of information, doing harm, particularly in terms of reproductive health, family relationships, children, etc. There was noted the desirability of improvement of sanitary, legislation on the regulation of the information load on the population, especially in vulnerable groups, in terms of optimization of parameters of the signal-carriers on volume, brightness and the adequacy of the volume and content of information in radio and television broadcasting, in an urban environment and at the plant to preserve the health and well-being of the population.
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Code of Federal Regulations, 2010 CFR
2010-07-01
... Relating to Labor (Continued) EMPLOYEE BENEFITS SECURITY ADMINISTRATION, DEPARTMENT OF LABOR GROUP HEALTH PLANS RULES AND REGULATIONS FOR GROUP HEALTH PLANS Continuation Coverage, Qualified Medical Child Support Orders, Coverage for Adopted Children § 2590.609-1 [Reserved] ...
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Understanding Young Women's Sexual Relationship Experiences: The Nature and Role of Vulnerability
ERIC Educational Resources Information Center
Maxwell, Claire
2006-01-01
This paper seeks to operationalise the concept of social "vulnerability" and explore its usefulness as a framework for understanding sexual relationships. Data from 30 vulnerable and less vulnerable young women in one UK city were collected through in-depth interviews and focus groups. An analysis of differences and similarities in…
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-08-03
...This document contains amendments to the interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding preventive health services.
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29 CFR 2590.701-6 - Special enrollment periods.
Code of Federal Regulations, 2010 CFR
2010-07-01
... individuals who lose coverage—(1) In general. A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, is required to permit current employees... plan was previously offered, the employee had coverage under any group health plan or health insurance...
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-12-28
.... SUMMARY: The Department of Labor (DOL) hereby announces the submission of the Employee Benefits Security... coverage for group health plans and health insurance issuers offering group or individual health insurance... health insurance issuer offering group or individual health insurance coverage generally must not rescind...
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Saunders, Ron; Lifshen, Marni; Breslin, Curtis; LaMontagne, Anthony; Tompa, Emile; Smith, Peter
2015-01-01
Objective To describe OH&S vulnerability across a diverse sample of Canadian workers. Methods A survey was administered to 1,835 workers employed more than 15 hrs/week in workplaces with at least five employees. Adjusted logistic models were fitted for three specific and one overall measure of workplace vulnerability developed based on hazard exposure and access to protective OH&S policies and procedures, awareness of employment rights and responsibilities, and workplace empowerment. Results More than one third of the sample experienced some OH&S vulnerability. The type and magnitude of vulnerability varied by labor market sub‐group. Younger workers and those in smaller workplaces experienced significantly higher odds of multiple types of vulnerability. Temporary workers reported elevated odds of overall, awareness‐ and empowerment‐related vulnerability, while respondents born outside of Canada had significantly higher odds of awareness vulnerability. Conclusion Knowing how labor market sub‐groups experience different types of vulnerability can inform better‐tailored primary prevention interventions. Am. J. Ind. Med. 59:119–128, 2016. © 2015 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals, Inc. PMID:26771101
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Beyond the checklist: understanding rural health vulnerability in a South African context.
Vergunst, Richard; Swartz, Leslie; Mji, Gubela; Kritzinger, Janis; Braathen, Stine Hellum
2016-01-01
Vulnerability in the past has sometimes been measured and understood in terms of checklists or common understanding. It is argued here that vulnerability is a more complex issue than this. Although checklists of vulnerable groups are important, they do not capture the essence and dynamics of vulnerability. The case of rural health vulnerability in South Africa is discussed to show that classifying people into vulnerable groups does not portray the complexity and intricacies of what it means to have vulnerability. We also wish to show that there are different kinds of vulnerabilities, and the difference between access vulnerability and illness vulnerability is highlighted. As part of a larger study, this case study is presented to show how vulnerability in a poor rural community in South Africa has to be understood in a contextual and dynamic manner as opposed to a static manner. Family and social dynamics can influence health. For example, fractured families were seen as a vulnerable issue within the community, while being a person with a disability can lead to isolation and callous attitudes towards them. It is these family and social dynamics that lead proximally to vulnerability to ill health. A contextual approach can assist in giving a more layered understanding of vulnerability than a checklist approach can do. Interventions to change health cannot be addressed simply by medical means. Social conditions need to be changed, and part of changing social conditions is the process of assisting those who are isolated or experience themselves as vulnerable to reconnect with others in the community. Poverty leads to social exclusion; social and family inclusion may be key to well-being.
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Driezen, Pete; Abdullah, Abu S.; Nargis, Nigar; Hussain, A. K. M. Ghulam; Fong, Geoffrey T.; Thompson, Mary E.; Quah, Anne C. K.; Xu, Steve
2016-01-01
This study assessed the knowledge of the harmful effects of tobacco use among vulnerable populations in Bangladesh and whether vulnerability was associated with the presence of complete home smoking bans. Data came from Wave 3 (2011–2012) of the International Tobacco Control (ITC) Bangladesh Survey, a nationally-representative survey of 3131 tobacco users and 2147 non-users. Socio-demographic measures of disadvantage were used as proxy measures of vulnerability, including sex, residential location, education and income. Outcome measures were awareness of the harmful effects of (a) cigarette smoking and (b) smokeless tobacco use and (c) whether respondents had complete smoking bans in their homes. Logistic regression was used to examine whether the adjusted prevalence of each outcome differed by socio-demographic proxies of vulnerability. Smaller percentages of women, the illiterate, urban slum residents and low-income Bangladeshis were aware of the health harms of tobacco. These vulnerable groups generally had lower odds of awareness compared to the least disadvantaged groups. Incomplete knowledge of tobacco’s harms may prevent vulnerable groups from taking steps to protect their health. Development goals, such as increasing literacy rates and empowering women, can complement the goals of WHO’s Framework Convention on Tobacco Control. PMID:27571090
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Driezen, Pete; Abdullah, Abu S; Nargis, Nigar; Hussain, A K M Ghulam; Fong, Geoffrey T; Thompson, Mary E; Quah, Anne C K; Xu, Steve
2016-08-25
This study assessed the knowledge of the harmful effects of tobacco use among vulnerable populations in Bangladesh and whether vulnerability was associated with the presence of complete home smoking bans. Data came from Wave 3 (2011-2012) of the International Tobacco Control (ITC) Bangladesh Survey, a nationally-representative survey of 3131 tobacco users and 2147 non-users. Socio-demographic measures of disadvantage were used as proxy measures of vulnerability, including sex, residential location, education and income. Outcome measures were awareness of the harmful effects of (a) cigarette smoking and (b) smokeless tobacco use and (c) whether respondents had complete smoking bans in their homes. Logistic regression was used to examine whether the adjusted prevalence of each outcome differed by socio-demographic proxies of vulnerability. Smaller percentages of women, the illiterate, urban slum residents and low-income Bangladeshis were aware of the health harms of tobacco. These vulnerable groups generally had lower odds of awareness compared to the least disadvantaged groups. Incomplete knowledge of tobacco's harms may prevent vulnerable groups from taking steps to protect their health. Development goals, such as increasing literacy rates and empowering women, can complement the goals of WHO's Framework Convention on Tobacco Control.
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Horney, Jennifer A; Nguyen, Mai; Cooper, John; Simon, Matthew; Ricchetti-Masterson, Kristen; Grabich, Shannon; Salvesen, David; Berke, Philip
2013-01-01
Rural areas of the United States are uniquely vulnerable to the impacts of natural disasters. One possible way to mitigate vulnerability to disasters in rural communities is to have a high-quality hazard mitigation plan in place. To understand the resources available for hazard mitigation planning and determine how well hazard mitigation plans in rural counties meet the needs of vulnerable populations, we surveyed the lead planning or emergency management official responsible for hazard mitigation plans in 96 rural counties in eight states in the Southeastern United States. In most counties, emergency management was responsible for implementing the county's hazard mitigation plan and the majority of counties had experienced a presidentially declared disaster in the last 5 years. Our research findings demonstrated that there were differences in subjective measures of vulnerability (as reported by survey respondents) and objective measures of vulnerability (as determined by US Census data). In addition, although few counties surveyed included outreach to vulnerable groups as a part of their hazard mitigation planning process, a majority felt that their hazard mitigation plan addressed the needs of vulnerable populations "well" or "very well." These differences could result in increased vulnerabilities in rural areas, particularly for certain vulnerable groups.
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Climate volatility deepens poverty vulnerability in developing countries
NASA Astrophysics Data System (ADS)
Ahmed, Syud A.; Diffenbaugh, Noah S.; Hertel, Thomas W.
2009-07-01
Extreme climate events could influence poverty by affecting agricultural productivity and raising prices of staple foods that are important to poor households in developing countries. With the frequency and intensity of extreme climate events predicted to change in the future, informed policy design and analysis requires an understanding of which countries and groups are going to be most vulnerable to increasing poverty. Using a novel economic-climate analysis framework, we assess the poverty impacts of climate volatility for seven socio-economic groups in 16 developing countries. We find that extremes under present climate volatility increase poverty across our developing country sample—particularly in Bangladesh, Mexico, Indonesia, and Africa—with urban wage earners the most vulnerable group. We also find that global warming exacerbates poverty vulnerability in many nations.
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Effect of dysfunctional attitudes and postpartum state on vulnerability to depressed mood.
Dowlati, Yekta; Segal, Zindel V; Ravindran, Arun V; Steiner, Meir; Stewart, Donna E; Meyer, Jeffrey H
2014-06-01
Postpartum depression (PPD) is the most common complication of childbearing with a 13% prevalence. Vulnerability to depressed mood has an important role in the onset of major depressive episodes (MDE), but has not been investigated in postpartum. The aim is to assess whether day-5 postpartum blues and severity of dysfunctional attitudes predicts vulnerability to depressed mood. About 45 healthy women were recruited: group 1 (n=12) was day-5 postpartum during the typical peak of postpartum blues. Group 2 (n=11) was within 18 months postpartum and reported a vulnerability to cry (and had elevated dysfunctional attitudes but no MDE). Group 3 (n=11) was within 18 months postpartum and no vulnerability to cry. Group 4 (n=11) was not recently postpartum. Vulnerability to depressed mood was measured by the change in the visual analog scale from the sad mood induction procedure (MIP). Univariate analysis of covariance demonstrated that day-5 postpartum blues and level of dysfunctional attitudes were highly predictive of change in sad mood (postpartum blues: F(1,41)=12.9, p<0.005, dysfunctional attitudes scale score: F(1,41)=11.49, p<0.005). Although the effects were robust, sample sizes were 11-12 within each group. Two factors (day-5 postpartum and severity of dysfunctional attitudes) predicted vulnerability to sad mood. Since the severity of postpartum blues predicts PPD, MIP on day-5 postpartum represents a quantitative measure that can be applied to screen novel, early interventions for preventing PPD. Interventions to prevent PPD through increasing resilience against mood induction should target postpartum women with greater severity of dysfunctional attitudes. Copyright © 2014 Elsevier B.V. All rights reserved.
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Wiley, John
2011-01-01
Objectives This report presents, for the first time, findings on the vox populis as to who constitutes the ‘vulnerables in biomedical research’. Methods The 3-City Tuskegee Legacy Project (TLP) study used the TLP Questionnaire as administered via RDD telephone interviews to 1,162 adult Blacks, non-Hispanic Whites, and two Puerto Rican (PR) Hispanic groups: Mainland U.S. and San Juan (SJ) in 3 cities. The classification schema was based upon respondents’ answers to an open-ended question asking which groups of people were the most vulnerable when participating in biomedical research. Results Subjects provided 749 valid open-ended responses which were grouped into 29 direct response categories, leading to a 4 tier classification schema for vulnerability traits. Tier 1, the summary tier, had five vulnerability categories: 1) Race/ethnicity; 2) Age; 3) SES; 4) Health; and, 5) Gender. Blacks and Mainland U.S. PR Hispanics most frequently identified Race/Ethnicity as a vulnerability trait (42.1% of Blacks and 42.6% of Mainland U.S. PR Hispanics vs. 15.4% of Whites and 16.7% of San Juan R Hispanics) (p<.007), while Whites and SJ PR Hispanics most frequently identified Age (48.3% and 29.2%) as a vulnerability trait. Conclusions The response patterns on ‘who was vulnerable’ were similar for the two minority groups (Blacks and Mainland U.S. PR Hispanics), and notably different from the response patterns of the two majority groups (Whites and SJPR Hispanics). Further, the vox populis definition of vulnerables differed from the current official definitions as used by the U.S. federal government. PMID:21972462
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28 CFR 55.7 - Termination of coverage.
Code of Federal Regulations, 2011 CFR
2011-07-01
... VOTING RIGHTS ACT REGARDING LANGUAGE MINORITY GROUPS Nature of Coverage § 55.7 Termination of coverage... declaratory judgment described in section 4(a) of the Act. (b) Section 203(c). The requirements of section 203...
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28 CFR 55.7 - Termination of coverage.
Code of Federal Regulations, 2010 CFR
2010-07-01
... VOTING RIGHTS ACT REGARDING LANGUAGE MINORITY GROUPS Nature of Coverage § 55.7 Termination of coverage... declaratory judgment described in section 4(a) of the Act. (b) Section 203(c). The requirements of section 203...
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Yi, Xingyang; Lin, Jing; Luo, Hua; Zhou, Ju; Zhou, Qiang; Wang, Yanfen; Wang, Chun
2018-04-03
The associations between variants in platelet activation-relevant genes and carotid plaque vulnerability are not fully understood. The aim of the present study was to investigate the associations of the variants in platelet activation-relevant genes and interactions among these variants with carotid plaque vulnerability. There were no significant differences in the frequencies of genotypes of the 11 variants between patients and controls. Among 396 patients, 102 patients had not carotid plaque, 106 had VP, and 188 had SP. The 11 variants were not independently associated with risk of carotid plaque vulnerability after adjusting for potential confounding variables. However, the GMDR analysis showed that there were synergistic effects of gene-gene interactions among TXA2Rr s1131882, GPIIIa rs2317676 and P2Y12 rs16863323 on carotid plaque vulnerability. The high-risk interactions among the three variants were associated with high platelet activation, and independently associated with the risk of carotid plaque vulnerability. Eleven variants in platelet activation-relevant genes were examined using mass spectrometry methods in 396 ischemic stroke patients and 291controls. Platelet-leukocyte aggregates and platelet aggregation were also measured. Carotid plaques were assessed by B-mode ultrasound. According to the results of ultrasound, the patients were stratified into three groups: non-plaque group, vulnerable plaque (VP) group and stable plaque (SP) group. Furthermore, gene-gene interactions were analyzed using generalized multifactor dimensionality reduction (GMDR) methods. The rs1131882, rs2317676, and rs16863323 three-loci interactions may confer a higher risk of carotid plaque vulnerability, and might be potential markers for plaque instability.
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Wellbery, Caroline; Saunders, Pamela A; Kureshi, Sarah; Visconti, Adam
2017-12-01
As medical education curricula increasingly acknowledge the contributions of the social determinants of health to individual health, new methods of engaging students in the care of vulnerable groups are needed. Empathy is one way to connect students with patients, but little is known about how to nurture students' empathy on behalf of populations. This study examined the relationship between individual and social empathy as groundwork for cultivating students' empathy for vulnerable groups. In 2014-2015, first-year medical students completed the Social Empathy Index at the start and end of a two-semester population health course, and they completed a reflective writing assignment exploring the challenges of caring for vulnerable patients. Pre- and posttest mean survey scores were compared, and reflective writing assignments were analyzed for themes concerning social empathy. Data from 130 students were analyzed. Scores for the contextual understanding of systemic barriers domain increased significantly. There was a trend toward increased cumulative social empathy scores that did not reach statistical significance. Students' essays revealed three themes relating to individual empathy as the foundation for social empathy; civic and moral obligations; and the role of institutional practices in caring for vulnerable groups. This study extends understanding of empathy beyond care for the individual to include care for vulnerable groups. Thus, social empathy may function as a valuable concept in developing curricula to support students' commitment to care for the underserved. Educators first need to address the many barriers students cited that impede both individual and social empathy.
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The distribution of cataract surgery services in a public health eye care program in Nepal.
Marseille, E; Brand, R
1997-11-01
The cost-effectiveness of public health cataract programs in low-income countries has been well documented. Equity, another important dimension of program quality which has received less attention is analyzed here by comparisons of surgical coverage rates for major sub-groups within the intended beneficiary population of the Nepal blindness program (NBP). Substantial differences in surgical coverage were found between males and females and between different age groups of the same gender. Among the cataract blind, the surgical coverage of males was 70% higher than that of females. For both genders, the cataract blind over 55 received proportionately fewer services than younger people blind from cataract. Blind males aged 45-54 had a 500% higher rate of surgical coverage than blind males over 65. Blind females aged 35-44 had nearly a 600% higher rate of surgical coverage than blind females over 65. There was wide variation in overall surgical coverage between geographic zones, but little variation by terrain type, an indicator of the logistical difficulties in delivery of services. Members of the two highest caste groupings had somewhat lower surgical coverage than members of lower castes. Program managers should consider developing methods to increase services to women and to those over 65. Reaching these populations will become increasingly important as those most readily served receive surgery and members of the under-served groups form a growing portion of the remaining cataract backlog.
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42 CFR 457.810 - Premium assistance programs: Required protections against substitution.
Code of Federal Regulations, 2014 CFR
2014-10-01
..., must provide the protections against substitution of CHIP coverage for coverage under group health... assistance programs must not be greater than the cost of other CHIP coverage for these children; and (2) The... children under premium assistance programs to the cost of other CHIP coverage for these children, done on a...
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28 CFR 55.9 - Coverage of political units within a county.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Coverage of political units within a county. 55.9 Section 55.9 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) IMPLEMENTATION OF THE PROVISIONS OF THE VOTING RIGHTS ACT REGARDING LANGUAGE MINORITY GROUPS Nature of Coverage § 55.9 Coverage of...
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28 CFR 55.9 - Coverage of political units within a county.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Coverage of political units within a county. 55.9 Section 55.9 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) IMPLEMENTATION OF THE PROVISIONS OF THE VOTING RIGHTS ACT REGARDING LANGUAGE MINORITY GROUPS Nature of Coverage § 55.9 Coverage of...
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Lipton, Brandy J; Decker, Sandra L; Sommers, Benjamin D
2017-04-01
Prior to the Affordable Care Act, one in three young adults aged 19 to 25 years were uninsured, with substantial racial/ethnic disparities in coverage. We analyzed the separate and cumulative changes in racial/ethnic disparities in coverage and access to care among young adults after implementation of the Affordable Care Act's 2010 dependent coverage provision and 2014 Medicaid and Marketplace expansions. We find that the dependent coverage provision was associated with similar gains across racial/ethnic groups, but the 2014 expansion was associated with larger gains in coverage among Hispanics and Blacks relative to Whites. After the 2014 expansion, coverage increased by 11.0 and 10.1 percentage points among Hispanics and Blacks, respectively, compared with a 5.6 percentage point increase among Whites. The percentage with a usual source of care and a recent doctor's visit also increased more for Blacks relative to Whites. Increases in coverage were larger in Medicaid expansion compared with nonexpansion states for most racial/ethnic groups.
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Oliveira, Sandra; Félix, Fernando; Nunes, Adélia; Lourenço, Luciano; Laneve, Giovanni; Sebastián-López, Ana
2018-01-15
Vulnerability assessment is a vital component of wildfire management. This research focused on the development of a framework to measure and map vulnerability levels in several areas within Mediterranean Europe, where wildfires are a major concern. The framework followed a stepwise approach to evaluate its main components, expressed by exposure, sensitivity and coping capacity. Data on population density, fuel types, protected areas location, roads infrastructure and surveillance activities, among others, were integrated to create composite indices, representing each component and articulated in multiple dimensions. Maps were created for several test areas, in northwest Portugal, southwest Sardinia in Italy and northeast Corsica in France, with the contribution of local participants from civil protection institutions and forest services. Results showed the influence of fuel sensitivity levels, population distribution and protected areas coverage for the overall vulnerability classes. Reasonable levels of accuracy were found on the maps provided through the validation procedure, with an overall match above 72% for the several sites. The systematic and flexible approach applied allowed for adjustments to local circumstances with regards to data availability and fire management procedures, without compromising its consistency and with substantial operational capabilities. The results obtained and the positive feedback of end-users encourage its further application, as a means to improve wildfire management strategies at multiple levels with the latest scientific outputs. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Felipe, Maria Emília M C; Andrade, Patrícia F; Grisi, Marcio F M; Souza, Sérgio L S; Taba, Mário; Palioto, Daniela B; Novaes, Arthur B
2007-07-01
The aim of this randomized, controlled, clinical investigation was to compare two surgical techniques for root coverage with the acellular dermal matrix graft to evaluate which technique provided better root coverage, a better esthetic result, and less postoperative discomfort. Fifteen patients with bilateral Miller Class I or II gingival recessions were selected. Fifteen pairs of recessions were treated and assigned randomly to the test group, and the contralateral recessions were assigned to the control group. The control group was treated with a broader flap and vertical releasing incisions; the test group was treated with the proposed surgical technique, without vertical releasing incisions. The clinical parameters evaluated were probing depth, relative clinical attachment level, gingival recession (GR), width of keratinized tissue, thickness of keratinized tissue, esthetic result, and pain evaluation. The measurements were taken before the surgeries and after 6 months. At baseline, all parameters were similar for both groups. At 6 months, a statistically significant greater reduction in GR favored the control group. The percentage of root coverage was 68.98% and 84.81% for the test and control groups, respectively. The esthetic result was equivalent between the groups, and all patients tolerated both procedures well. Both techniques provided significant root coverage, good esthetic results, and similar levels of postoperative discomfort. However, the control technique had statistically significantly better results for root coverage of localized gingival recessions.
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Keeping All the PIECES: Phylogenetically Informed Ex Situ Conservation of Endangered Species.
Larkin, Daniel J; Jacobi, Sarah K; Hipp, Andrew L; Kramer, Andrea T
2016-01-01
Ex situ conservation in germplasm and living collections is a major focus of global plant conservation strategies. Prioritizing species for ex situ collection is a necessary component of this effort for which sound strategies are needed. Phylogenetic considerations can play an important role in prioritization. Collections that are more phylogenetically diverse are likely to encompass more ecological and trait variation, and thus provide stronger conservation insurance and richer resources for future restoration efforts. However, phylogenetic criteria need to be weighed against other, potentially competing objectives. We used ex situ collection and threat rank data for North American angiosperms to investigate gaps in ex situ coverage and phylogenetic diversity of collections and to develop a flexible framework for prioritizing species across multiple objectives. We found that ex situ coverage of 18,766 North American angiosperm taxa was low with respect to the most vulnerable taxa: just 43% of vulnerable to critically imperiled taxa were in ex situ collections, far short of a year-2020 goal of 75%. In addition, species held in ex situ collections were phylogenetically clustered (P < 0.001), i.e., collections comprised less phylogenetic diversity than would be expected had species been drawn at random. These patterns support incorporating phylogenetic considerations into ex situ prioritization in a manner balanced with other criteria, such as vulnerability. To meet this need, we present the 'PIECES' index (Phylogenetically Informed Ex situ Conservation of Endangered Species). PIECES integrates phylogenetic considerations into a flexible framework for prioritizing species across competing objectives using multi-criteria decision analysis. Applying PIECES to prioritizing ex situ conservation of North American angiosperms, we show strong return on investment across multiple objectives, some of which are negatively correlated with each other. A spreadsheet-based decision support tool for North American angiosperms is provided; this tool can be customized to align with different conservation objectives.
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Keeping All the PIECES: Phylogenetically Informed Ex Situ Conservation of Endangered Species
Larkin, Daniel J.; Jacobi, Sarah K.; Hipp, Andrew L.; Kramer, Andrea T.
2016-01-01
Ex situ conservation in germplasm and living collections is a major focus of global plant conservation strategies. Prioritizing species for ex situ collection is a necessary component of this effort for which sound strategies are needed. Phylogenetic considerations can play an important role in prioritization. Collections that are more phylogenetically diverse are likely to encompass more ecological and trait variation, and thus provide stronger conservation insurance and richer resources for future restoration efforts. However, phylogenetic criteria need to be weighed against other, potentially competing objectives. We used ex situ collection and threat rank data for North American angiosperms to investigate gaps in ex situ coverage and phylogenetic diversity of collections and to develop a flexible framework for prioritizing species across multiple objectives. We found that ex situ coverage of 18,766 North American angiosperm taxa was low with respect to the most vulnerable taxa: just 43% of vulnerable to critically imperiled taxa were in ex situ collections, far short of a year-2020 goal of 75%. In addition, species held in ex situ collections were phylogenetically clustered (P < 0.001), i.e., collections comprised less phylogenetic diversity than would be expected had species been drawn at random. These patterns support incorporating phylogenetic considerations into ex situ prioritization in a manner balanced with other criteria, such as vulnerability. To meet this need, we present the ‘PIECES’ index (Phylogenetically Informed Ex situ Conservation of Endangered Species). PIECES integrates phylogenetic considerations into a flexible framework for prioritizing species across competing objectives using multi-criteria decision analysis. Applying PIECES to prioritizing ex situ conservation of North American angiosperms, we show strong return on investment across multiple objectives, some of which are negatively correlated with each other. A spreadsheet-based decision support tool for North American angiosperms is provided; this tool can be customized to align with different conservation objectives. PMID:27257671
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NASA Astrophysics Data System (ADS)
van Heteren, Sytze; Moses, Cherith; van der Ven, Tamara
2017-04-01
EMODnet has changed the face of the European marine data landscape and is developing tools to connect national data and information resources to make them easily available for multiple users, for multiple purposes. Building on the results of EUROSION, an EU-project completed some ten years ago, EMODnet-Geology has been compiling coastal erosion and sedimentation data and information for all European shorelines. Coverage is being expanded, and data and information are being updated. Challenges faced during this compilation phase are posed by a) differences between parameters used as indicators of shoreline migration, b) restricted access to third-party data, and c) data gaps. There are many indicators of coastal behaviour, with inherent incompatibilities and variations between low-lying sediment and cliffed rock shorelines. Regionally, low data availability and limited access result in poor coverage. With Sentinel data expected to become increasingly available, it is time to invest in automated methods to derive coastal-erosion data from satellite monitoring. Even so, consistency of data and derived information on coastal erosion and accretion does not necessarily translate into usability in pan-European coastal-zone management. Indicators of shoreline change need to be assessed and weighted regionally in light of other parameters in order to be of value in assessing coastal resilience or vulnerability. There is no single way to portray coastal vulnerability for all of Europe in a meaningful way. A common legend, however attractive intuitively, results in data products that work well for one region but show insufficient or excessive detail elsewhere. For decision making, uniform products are often not very helpful. The ability to zoom in on different spatial levels is not a solution either. It is better to compile and visualize vulnerability studies with different legends, and to provide each map with a confidence assessment and other relevant metadata.
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Subsidies and the demand for individual health insurance in California.
Marquis, M Susan; Buntin, Melinda Beeuwkes; Escarce, José J; Kapur, Kanika; Yegian, Jill M
2004-10-01
To estimate the effect of changes in premiums for individual insurance on decisions to purchase individual insurance and how this price response varies among subgroups of the population. Survey responses from the Current Population Survey (http://www.bls.census.gov/cps/cpsmain.htm), the Survey of Income and Program Participation (http://www.sipp.census.gov/sipp), the National Health Interview Survey (http://www.cdc.gov/nchs/nhis.htm), and data about premiums and plans offered in the individual insurance market in California, 1996-2001. A logit model was used to estimate the decisions to purchase individual insurance by families without access to group insurance. This was modeled as a function of premiums, controlling for family characteristics and other characteristics of the market. A multinomial model was used to estimate the choice between group coverage, individual coverage, and remaining uninsured for workers offered group coverage as a function of premiums for individual insurance and out-of-pocket costs of group coverage. The elasticity of demand for individual insurance by those without access to group insurance is about -.2 to -.4, as has been found in earlier studies. However, there are substantial differences in price responses among subgroups with low-income, young, and self-employed families showing the greatest response. Among workers offered group insurance, a decrease in individual premiums has very small effects on the choice to purchase individual coverage versus group coverage. Subsidy programs may make insurance more affordable for some families, but even sizeable subsidies are unlikely to solve the problem of the uninsured. We do not find evidence that subsidies to individual insurance will produce an unraveling of the employer-based health insurance system.
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Woodyard, James G; Greenwell, Henry; Hill, Margaret; Drisko, Connie; Iasella, John M; Scheetz, James
2004-01-01
The primary aim of this randomized, controlled, blinded, clinical investigation was to compare the coronally positioned flap (CPF) plus an acellular dermal matrix (ADM) allograft to CPF alone to determine their effect on gingival thickness and percent root coverage. Twenty-four subjects with one Miller Class I or II buccal recession defect of > or = 3 mm were treated with a CPF plus ADM or a CPF alone. Multiple additional recession sites were treated with the same flap procedure, and all sites were studied for 6 months. Tissue thickness was measured at the sulcus base and at the mucogingival junction of all teeth, with an SDM ultrasonic gingival thickness meter. For the ADM sites, mean initial recession of 3.46 mm was reduced to 0.04 mm for defect coverage of 3.42 mm or 99% (P < 0.05). For the CPF group, mean initial recession of 3.27 mm was reduced to 1.08 mm for defect coverage of 2.19 mm or 67% (P < 0.05). The difference between ADM and CPF groups was statistically significant (P < 0.05). Marginal soft-tissue thickness was increased by 0.40 mm (P < 0.05) for the ADM group, whereas the CPF group remained essentially unchanged. Keratinized tissue was increased for the ADM group by 0.81 mm (P < 0.05), whereas the CPF group increased by 0.33 mm (P > 0.05). No additional root coverage was gained due to creeping attachment between 2 and 6 months for either group. Treatment with a CPF plus an ADM allograft significantly increased gingival thickness when compared with a CPF alone. Recession defect coverage was significantly improved with the use of ADM.
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Mangroves as a protection from storm surges in a changing climate.
Blankespoor, Brian; Dasgupta, Susmita; Lange, Glenn-Marie
2017-05-01
Adaptation to climate change includes addressing sea-level rise (SLR) and increased storm surges in many coastal areas. Mangroves can substantially reduce vulnerability of the adjacent coastal land from inundation but SLR poses a threat to the future of mangroves. This paper quantifies coastal protection services of mangroves for 42 developing countries in the current climate, and a future climate change scenario with a 1-m SLR and 10 % intensification of storms. Findings demonstrate that while SLR and increased storm intensity would increase storm surge areas, the greatest impact is from the expected loss of mangroves. Under current climate and mangrove coverage, 3.5 million people and GDP worth roughly US $400 million are at risk. In the future climate change scenario, vulnerable population and GDP at risk would increase by 103 and 233 %. The greatest risk is in East Asia, especially in Indonesia and the Philippines as well as Myanmar.
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Savini, Alessandra; Vertino, Agostina; Marchese, Fabio; Beuck, Lydia; Freiwald, André
2014-01-01
In this study, we mapped the distribution of Cold-Water Coral (CWC) habitats on the northern Ionian Margin (Mediterranean Sea), with an emphasis on assessing coral coverage at various spatial scales over an area of 2,000 km(2) between 120 and 1,400 m of water depth. Our work made use of a set of data obtained from ship-based research surveys. Multi-scale seafloor mapping data, video inspections, and previous results from sediment samples were integrated and analyzed using Geographic Information System (GIS)-based tools. Results obtained from the application of spatial and textural analytical techniques to acoustic meso-scale maps (i.e. a Digital Terrain Model (DTM) of the seafloor at a 40 m grid cell size and associated terrain parameters) and large-scale maps (i.e. Side-Scan Sonar (SSS) mosaics of 1 m in resolution ground-truthed using underwater video observations) were integrated and revealed that, at the meso-scale level, the main morphological pattern (i.e. the aggregation of mound-like features) associated with CWC habitat occurrences was widespread over a total area of 600 km(2). Single coral mounds were isolated from the DTM and represented the geomorphic proxies used to model coral distributions within the investigated area. Coral mounds spanned a total area of 68 km(2) where different coral facies (characterized using video analyses and mapped on SSS mosaics) represent the dominant macro-habitat. We also mapped and classified anthropogenic threats that were identifiable within the examined videos, and, here, discuss their relationship to the mapped distribution of coral habitats and mounds. The combined results (from multi-scale habitat mapping and observations of the distribution of anthropogenic threats) provide the first quantitative assessment of CWC coverage for a Mediterranean province and document the relevant role of seafloor geomorphology in influencing habitat vulnerability to different types of human pressures.
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Donovan, Charles A.; Turner, Grace-Marie
2016-01-01
Many Catholic leaders supported passage of legislation designed to achieve the humanitarian goal of universal or near-universal health coverage. These leaders could not imagine that the resulting law would lead to a severe assault on the practice of Christ-centered medicine. The legislative focus now is on conscience protection and making the Hyde Amendment permanent. But the real change that is needed is a culture that values life and puts doctors and patients, not secular bureaucracies, at the center of healthcare decisions. Many new proposals are being offered with the shared goals of expanding access to affordable health coverage, allowing people to make their own choices without oppressive government mandates, helping the most vulnerable, and protecting the right of citizens and medical professionals to live and work according to their religious values and principles. PMID:28392589
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Harder, Valerie S; Barry, Sara E; Ahrens, Bridget; Davis, Wendy S; Shaw, Judith S
Despite the proven benefits of immunizations, coverage remains low in many states, including Vermont. This study measured the impact of a quality improvement (QI) project on immunization coverage in childhood, school-age, and adolescent groups. In 2013, a total of 20 primary care practices completed a 7-month QI project aimed to increase immunization coverage among early childhood (29-33 months), school-age (6 years), and adolescent (13 years) age groups. For this study, we examined random cross-sectional medical record reviews from 12 of the 20 practices within each age group in 2012, 2013, and 2014 to measure improvement in immunization coverage over time using chi-squared tests. We repeated these analyses on population-level data from Vermont's immunization registry for the 12 practices in each age group each year. We used difference-in-differences regressions in the immunization registry data to compare improvements over time between the 12 practices and those not participating in QI. Immunization coverage increased over 3 years for all ages and all immunization series (P ≤ .009) except one, as measured by medical record review. Registry results aligned partially with medical record review with increases in early childhood and adolescent series over time (P ≤ .012). Notably, the adolescent immunization series completion, including human papillomavirus, increased more than in the comparison practices (P = .037). Medical record review indicated that QI efforts led to increases in immunization coverage in pediatric primary care. Results were partially validated in the immunization registry particularly among early childhood and adolescent groups, with a population-level impact of the intervention among adolescents. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-11-26
... coverage \\1\\ in the individual and small group markets, Medicaid benchmark and benchmark-equivalent plans...) Act extends the coverage of the EHB package to issuers of non-grandfathered individual and small group... small group markets, and not to Medicaid benchmark or benchmark-equivalent plans. EHB applicability to...
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42 CFR 436.217 - Individuals receiving home and community-based services.
Code of Federal Regulations, 2010 CFR
2010-10-01
... THE VIRGIN ISLANDS Options for Coverage as Categorically Needy Options for Coverage of Families and... receiving home and community-based services. The agency may provide Medicaid to any group or groups of individuals in the community who meet the following requirements: (a) The group would be eligible for Medicaid...
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The Status of Group Life Insurance Plans.
ERIC Educational Resources Information Center
Cook, Thomas J.
1981-01-01
Information on provisions of group life insurance plans and the tendency of colleges and universities to provide this coverage is considered. There has been an increase in the percentage of institutions adopting group life insurance plans over the last decade. Absence of coverage is concentrated among smaller two-year and four-year institutions…
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45 CFR 146.136 - Parity in mental health and substance use disorder benefits.
Code of Federal Regulations, 2010 CFR
2010-10-01
..., coverage unit refers to the way in which a plan (or health insurance coverage) groups individuals for... the case of an employer residing in a State that permits small groups to include a single individual... RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET Requirements Related to...
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45 CFR 146.119 - HMO affiliation period as an alternative to a preexisting condition exclusion.
Code of Federal Regulations, 2010 CFR
2010-10-01
... SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET.... (a) In general. A group health plan offering health insurance coverage through an HMO, or an HMO that offers health insurance coverage in connection with a group health plan, may impose an affiliation period...
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45 CFR 146.119 - HMO affiliation period as an alternative to a preexisting condition exclusion.
Code of Federal Regulations, 2011 CFR
2011-10-01
... SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET.... (a) In general. A group health plan offering health insurance coverage through an HMO, or an HMO that offers health insurance coverage in connection with a group health plan, may impose an affiliation period...
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Neal, Sarah; Channon, Andrew Amos; Carter, Sarah; Falkingham, Jane
2015-06-16
The drive toward universal health coverage (UHC) is central to the post 2015 agenda, and is incorporated as a target in the new Sustainable Development Goals. However, it is recognised that an equity dimension needs to be included when progress to this goal is monitored. WHO have developed a monitoring framework which proposes a target of 80% coverage for all populations regardless of income and place of residence by 2030, and this paper examines the feasibility of this target in relation to antenatal care and skilled care at delivery. We analyse the coverage gap between the poorest and richest groups within the population for antenatal care and presence of a skilled attendant at birth for countries grouped by overall coverage of each maternal health service. Average annual rates of improvement needed for each grouping (disaggregated by wealth quintile and urban/rural residence) to reach the goal are also calculated, alongside rates of progress over the past decades for comparative purposes. Marked inequities are seen in all groups except in countries where overall coverage is high. As the monitoring framework has an absolute target countries with currently very low coverage are required to make rapid and sustained progress, in particular for the poorest and those living in rural areas. The rate of past progress will need to be accelerated markedly in most countries if the target is to be achieved, although several countries have demonstrated the rate of progress required is feasible both for the population as a whole and for the poorest. For countries with currently low coverage the target of 80% essential coverage for all populations will be challenging. Lessons should be drawn from countries who have achieved rapid and equitable progress in the past.
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Donohue, Julie M.; Zhang, Yuting; Men, Aiju; Perera, Subashan; Lave, Judith R.; Hanlon, Joseph T.; Reynolds, Charles F.
2010-01-01
Objectives Depression in older adults is often undertreated due, in part, to medication costs. We examined the impact of improved prescription drug coverage under Medicare Part D on use of antidepressants, medication choice and adherence. Design, Setting and Participants Observational claims-based study of older adults with depression (ICD-9: 296.2, 296.3, 311, 300.4) continuously enrolled in a Medicare managed care plan between 2004–2007. Three groups with limited ($150 or $350 quarterly caps) or no drug coverage in 2004–2005 obtained Part D benefits in 2006. A comparison group had stable employer-sponsored coverage throughout. Measurements Any antidepressant prescription fill, antidepressant choice (tricyclics or monoamine oxidase inhibitors vs. newer antidepressants), and adherence (80% of days covered) in the first 6 months of treatment. Results Part D was associated with increased odds of any antidepressant use among those who previously lacked coverage [Odds Ratio (OR) 1.61, 95% confidence interval (CI) 1.41–1.85] but odds of use did not change among those with limited prior coverage. Use of older antidepressant agents did not change with Part D. All three groups whose coverage improved with Part D had significantly higher odds of 80% of days covered with an antidepressant [OR=1.86 (95% CI, 1.44–2.39) for No coverage, 1.74 (95% CI, 1.25–3.42) for $150 cap; and 1.19 (95% CI 1.06–1.34) for the $350 cap groups]. Conclusions Medicare Part D was associated with improvements in antidepressant use and adherence in depressed older adults who previously had no or limited drug coverage but not with changes in use of older agents. PMID:22123272
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Tatakis, Dimitris N; Chambrone, Leandro; Allen, Edward P; Langer, Burton; McGuire, Michael K; Richardson, Christopher R; Zabalegui, Ion; Zadeh, Homayoun H
2015-02-01
Management of gingival recession defects, a common periodontal condition, using root coverage procedures is an important aspect of periodontal regenerative therapy. The goal of the periodontal soft tissue root coverage procedures group was to develop a consensus report based on the accompanying systematic review of root coverage procedures, including priorities for future research and identification of the best evidence available to manage different clinical scenarios. The group reviewed and discussed the accompanying systematic review, which covered treatment of single-tooth recession defects, multiple-tooth recession defects, and additional focused questions on relevant clinical topics. The consensus group members submitted additional material for consideration by the group in advance and at the time of the meeting. The group also identified priorities for future research. All reviewed root coverage procedures provide significant reduction in recession depth, especially for Miller Class I and II recession defects. Subepithelial connective tissue graft (SCTG) procedures provide the best root coverage outcomes. Acellular dermal matrix graft (ADMG) or enamel matrix derivative (EMD) in conjunction with a coronally advanced flap (CAF) can serve as alternatives to autogenous donor tissue. Additional research is needed to do the following: 1) assess the treatment outcomes for multiple-tooth recession defects, oral sites other than maxillary canine and premolar teeth, and Miller Class III and IV defects; 2) assess the role of patient- and site-specific factors on procedure outcomes; and 3) obtain evidence on patient-reported outcomes. Predictable root coverage is possible for single-tooth and multiple-tooth recession defects, with SCTG procedures providing the best root coverage outcomes. Alternatives to SCTG are supported by evidence of varying strength. Additional research is needed on treatment outcomes for specific oral sites. Clinical Recommendation: For Miller Class I and II single-tooth recession defects, SCTG procedures provide the best outcomes, whereas ADMG or EMD in conjunction with CAF may be used as an alternative.
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[Estimated mammogram coverage in Goiás State, Brazil].
Corrêa, Rosangela da Silveira; Freitas-Júnior, Ruffo; Peixoto, João Emílio; Rodrigues, Danielle Cristina Netto; Lemos, Maria Eugênia da Fonseca; Marins, Lucy Aparecida Parreira; Silveira, Erika Aparecida da
2011-09-01
This cross-sectional study aimed to estimate mammogram coverage in the State of Goiás, Brazil, describing the supply, demand, and variations in different age groups, evaluating 98 mammography services as observational units. We estimated the mammogram rates by age group and type of health service, as well as the number of tests required to cover 70% and 100% of the target population. We assessed the association between mammograms, geographical distribution of mammography machines, type of service, and age group. Full coverage estimates, considering 100% of women in the 40-69 and 50-69-year age brackets, were 61% and 66%, of which the Brazilian Unified National Health System provided 13% and 14%, respectively. To achieve 70% coverage, 43,424 additional mammograms would be needed. All the associations showed statistically significant differences (p < 0.001). We conclude that mammogram coverage is unevenly distributed in the State of Goiás and that fewer tests are performed than required.
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de França, Viviane Helena; Modena, Celina Maria; Confalonieri, Ulisses Eugenio Cavalcanti
2016-01-01
Objective: to investigate the knowledge of managers and health professionals, social workers and education professionals regarding the principal barriers to universal health coverage and universal access to health on the part of the extremely poor population; and to point to the contributions made by nursing for the promotion of this right. Method: a qualitative study whose reference was, for ensuring the right to health, the reorientation of the Brazilian Unified Health System (SUS) towards universal coverage and access in these territories. Interviews were held with 27 members of the multi-professional team of a municipality with high social vulnerability. The data were worked on using thematic content analysis. Results: the following were ascertained as the principal barriers to universal health coverage and access to health: failures in the expansion and strengthening of the services; absence of diagnosis of the priority demands; shortage of technology, equipment, and material and human resources; poor local infrastructure; and actions with low resolutive power and absence of interdepartmental policies. Within the multi-professional team, nursing acts in the SUS in unique health actions and social practices in these territories, presenting an in-depth perspective on this harsh reality, being able to contribute with indispensable support for confronting these disparities in universal health coverage and universal access to health. Conclusion: nursing's in-depth understanding regarding these barriers is essential for encouraging the processes reorienting the SUS, geared towards equality in the right to health. PMID:27143541
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Parental stress and perceived vulnerability at 5 and 10 years after pediatric SCT.
Vrijmoet-Wiersma, C M J; Egeler, R M; Koopman, H M; Bresters, D; Norberg, A L; Grootenhuis, M A
2010-06-01
With the aim of assessing parental stress after SCT, 73 parents of children and adolescents who underwent SCT 5 or 10 years ago responded to questionnaires on general distress (General Health Questionnaire (GHQ)), disease-related stress (Pediatric Inventory for Parents-short form (PIP-SF)) and perceptions of child vulnerability (Child Vulnerability Scale (CVS)). General distress scores were comparable with the reference groups, but 40% of the mothers at 5 years after SCT reported increased stress levels as compared with 26% in the community-based reference group. Disease-related stress was comparable with the reference group of parents of children who were just off cancer treatment, 5 years after SCT. At 10 years after SCT, scores were lower than the reference group. Perceived child vulnerability did diminish over time, but remained high in parents of SCT survivors, compared with parents of healthy children: 96% of the parents at 5 years after SCT and 76% of the parents at 10 years after SCT scored above the cutoff point. Perceived vulnerability was found to be a predictor for parental disease-related stress. To conclude, although most parents of SCT survivors are resilient, the majority of parents perceive their child to be much more vulnerable as compared with parents of healthy children. This perception is associated with disease-related stress and may induce overprotective parenting.
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Mayhew, S; Collumbien, M; Qureshi, A; Platt, L; Rafiq, N; Faisel, A; Lalji, N; Hawkes, S
2009-04-01
To investigate the nature and extent of human rights abuses against three vulnerable groups (injecting drug users (IDUs) and male and female sex workers), to understand the social and sexual linkages between them and to examine how protecting their rights could enhance the impact of HIV prevention policies. In-depth interviews were carried out with 38 high-risk respondents (IDUs and female, male and transgender sex workers) and a bio-behavioural survey was performed of 813 IDU/sex worker respondents in Rawalpindi. People in all vulnerable groups interacted both sexually and socially. All groups experienced human rights abuses by state and non-state actors which increased their HIV risk. Non-state actors, including relations and sex worker clients, are responsible for verbal, physical and sexual violence. State actors (particularly police) perpetrate harassment, exploitation and abuse of all vulnerable groups with impunity. Health service providers fail to provide adequate services for vulnerable groups. High levels of discrimination and abuse of human dignity of all groups studied were revealed. This violates their physical and mental integrity and also leads to an increased risk of HIV. The sexual and social interactions between groups mean that human rights abuses experienced by one high-risk group can increase the risk of HIV both for them and other groups. The protection of human rights needs to become an integral part of a multisector response to the risk of HIV/AIDS by state and non-state agencies. The Government of Pakistan should work at both legal and programme levels to protect the rights of, and minimise discrimination against, groups vulnerable to HIV in order to reduce the potential for the spread of HIV before the epidemic takes hold.
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Shared Decision Making With Vulnerable Populations in the Emergency Department.
Castaneda-Guarderas, Ana; Glassberg, Jeffrey; Grudzen, Corita R; Ngai, Ka Ming; Samuels-Kalow, Margaret E; Shelton, Erica; Wall, Stephen P; Richardson, Lynne D
2016-12-01
The emergency department (ED) occupies a unique position within the healthcare system, serving as a safety net for vulnerable patients, regardless of their race, ethnicity, religion, country of origin, sexual orientation, socioeconomic status, or medical diagnosis. Shared decision making (SDM) presents special challenges when used with vulnerable population groups. The differing circumstances, needs, and perspectives of vulnerable groups invoke issues of provider bias, disrespect, judgmental attitudes, and lack of cultural competence, as well as patient mistrust and the consequences of their social and economic disenfranchisement. A research agenda that includes community-engaged approaches, mixed-methods studies, and cost-effectiveness analyses is proposed to address the following questions: 1) What are the best processes/formats for SDM among racial, ethnic, cultural, religious, linguistic, social, or otherwise vulnerable groups who experience disadvantage in the healthcare system? 2) What organizational or systemic changes are needed to support SDM in the ED whenever appropriate? 3) What competencies are needed to enable emergency providers to consider patients' situation/context in an unbiased way? 4) How do we teach these competencies to students and residents? 5) How do we cultivate these competencies in practicing emergency physicians, nurses, and other clinical providers who lack them? The authors also identify the importance of using accurate, group-specific data to inform risk estimates for SDM decision aids for vulnerable populations and the need for increased ED-based care coordination and transitional care management capabilities to create additional care options that align with the needs and preferences of vulnerable populations. © 2016 by the Society for Academic Emergency Medicine.
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Lewis, Rayleen M; Markowitz, Lauri E
2018-05-03
Human papillomavirus (HPV) vaccination has been routinely recommended at age 11-12 years in the United States for females since 2006 and males since 2011. Coverage can be estimated using self/parent-reported HPV vaccination collected in the National Health and Nutrition Examination Survey (NHANES) for a wider age range than other national surveys. We assessed vaccination coverage in 2015-2016, temporal trends by age, and the validity of self/parent-reported vaccination status. Participants aged 9-59 years completed an interview collecting demographic and vaccination information. Weighted coverage was estimated for two-year NHANES cycles by age group for 2007-2008 to 2015-2016 for females (N = 14318) and 2011-2012 to 2015-2016 for males (N = 7847). Temporal trends in coverage were assessed from 2007-2008 to 2011-2012 for females and from 2011-2012 to 2015-2016 for both sexes. Sensitivity and specificity of self/parent-reported vaccination were assessed using provider-verified vaccination records from a pilot study in 14-29 year-olds. In 2015-2016, ≥1 dose coverage among females was highest in 14-19 (54.7%) and 20-24 (56.0%) year-olds and lower in successively older age groups. Among males, ≥1 dose coverage was highest in 14-19 year-olds (39.5%) and lower at older ages. Coverage was similar in 9-13 year-old females and males. Between 2007-2008 and 2011-2012, there were increases among females younger than 30 years. Between 2011-2012 and 2015-2016, there were increases among female age groups including 20-39 year-olds; male coverage increased among ages 9-13, 14-19, and 20-24 years. Self/parent-reported receipt of ≥1 dose had a sensitivity and specificity of 87.0% and 83.3%. Performance was lower for 3 doses. While overall HPV vaccination coverage remains low, it is higher in females than males, except in 9-13 year-olds. There have been increases in coverage among many age groups, but coverage has stalled in younger females. Adequate validity was demonstrated for self/parent-reported vaccination of ≥1 dose, but not 3 doses, in a pilot study. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Mobilising "vulnerability" in the public health response to pandemic influenza.
Stephenson, Niamh; Davis, Mark; Flowers, Paul; MacGregor, Casimir; Waller, Emily
2014-02-01
Analysis of public health's growing interest in "vulnerability" has largely focused on health policy, with little interrogation of how vulnerability is being actively appropriated, countered, ignored or reworked by the publics whose health such policy is designed to protect. Once the assemblage of public health is understood as comprised of different forms of expertise and actors, including publics, addressing this gap matters. We examine the use of vulnerability in the specific context of pandemic influenza preparedness. Pandemic preparedness raises some familiar dilemmas for public health governance: how to engage with publics without fuelling social divisions and disruption; and whether to invoke publics as passive recipients of public health advice or to recognise publics as collective agents responding to the threat of pandemic influenza. Thus, we ask how the mobilisation of vulnerability connects with these dilemmas. To examine vulnerability in pandemic preparedness, two forms of qualitative data are analysed: 1) interviews and focus groups with "vulnerable" and "healthy" people (conducted 2011-12) discussing seasonal and pandemic influenza and; 2) international, Australian national and state level pandemic plans (1999-2013). Vulnerability is variously used in plans as a way to identify groups at particular risk of infection because of pre-existing clinical conditions, and as a free-floating social category that could apply to a broad range of people potentially involved in the social disruption a pandemic might entail. Our interview and focus group data indicate that healthy people rework the free-floating extension of vulnerability, and that people designated vulnerable encounter an absence of any collective responsibility for the threat of pandemic influenza. Our analysis suggests that vulnerability's mobilisation in pandemic preparedness limits the connection between public health governance and its publics: here, the openness and unpredictability of people's collective agency is something to be tightly controlled by a government concerned with protecting people from themselves. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Sakamoto, Shigeyuki; Kiura, Yoshihiro; Okazaki, Takahito; Shinagawa, Katsuhiro; Ishii, Daizo; Ichinose, Nobuhiko; Kurisu, Kaoru
2016-10-01
Carotid artery stenting (CAS) for internal carotid artery (ICA) stenosis with vulnerable plaques is controversial. We analyzed the effect of a dual protection and blood aspiration method during CAS in patients with vulnerable plaques. A total of 111 patients with ICA stenosis underwent CAS using the dual protection (simultaneous flow reversal and distal filter) and blood aspiration method. In 103 of 111 patients, preoperative carotid plaque was estimated by both 3 T MRI and ultrasonography (US). ICA plaques with a high intensity signal on time-of-flight-MR angiography (TOF-MRA) and/or mobile component on US were defined as vulnerable plaques. We assessed major adverse events (MAE) (ie, major stroke, myocardial infarction, and death) and hyperintense spots on diffusion-weighted images (DWI) after CAS. We then evaluated the visible debris captured by dual protection and blood aspiration during CAS. The preoperative ICA plaque on TOF-MRA and US was judged to be vulnerable in 48.5% (50/103 patients). The success rate of the CAS procedure was 100% with no MAE within 30 days. DWI showed small hyperintense spots in 18% (9/50 patients) and 18.9% (10/53 patients) in the vulnerable and non-vulnerable plaque groups, respectively. Visible debris was captured in 68% (34/50 patients) and 45.3% (24/53 patients) in the vulnerable and non-vulnerable plaque groups, respectively (p=0.0286). The combination of dual protection and blood aspiration could provide effective distal embolic protection although vulnerable plaques on TOF-MRA and US had a high incidence of debris during CAS. Thus, CAS using dual protection and blood aspiration is safe in patients with vulnerable plaques. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Rehabilitation of vulnerable groups in emergencies and disasters: A systematic review
Sheikhbardsiri, Hojjat; Yarmohammadian, Mohammad H.; Rezaei, Fatemeh; Maracy, Mohammad Reza
2017-01-01
BACKGROUND: Natural and man-made disasters, especially those occurring in large scales not only result in human mortality, but also cause physical, psychological, and social disabilities. Providing effective rehabilitation services in time can decrease the frequency of such disabilities. The aim of the current study was to perform a systematic review related to rehabilitation of vulnerable groups in emergencies and disasters. METHODS: The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The key words “recovery”, “rehabilitation”, “reconstruction”, “transformation”, “transition”, “emergency”, “disaster”, “crisis”, “hazard”, “catastrophe”, “tragedy”, “mass casualty incident”, “women”, “female”, “children”, “pediatric”, “disable”, “handicap”, “elder”, “old” and “vulnerable” were used in combination with Boolean operators OR and AND. ISI Web of Science, PubMed, Scopus, Science Direct, Ovid, ProQuest, Wiley, Google Scholar were searched. RESULTS: In this study a total of 11 928 articles were considered and 25 articles were selected for final review of rehabilitation of vulnerable groups based on the objective of this study. Twenty-five studies including six qualitative, sixteen cross-sectional and three randomized controlled trials were reviewed for rehabilitation of vulnerable groups in emergencies and disasters. Out of the selected papers, 23 were studied based on rehabilitation after natural disasters and the remaining were man-made disasters. Most types of rehabilitation were physical, social, psychological and economic. CONCLUSION: The review of the papers showed different programs of physical, physiological, economic and social rehabilitations for vulnerable groups after emergencies and disasters. It may help health field managers better implement standard rehabilitation activities for vulnerable groups. PMID:29123602
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The ethics and regulatory landscape of including vulnerable populations in pragmatic clinical trials
Welch, Mary Jane; Lally, Rachel; Miller, Jennifer E; Pittman, Stephanie; Brodsky, Lynda; Caplan, Arthur L; Uhlenbrauck, Gina; Louzao, Darcy M; Fischer, James H; Wilfond, Benjamin
2015-01-01
Policies have been developed to protect vulnerable populations in clinical research, particularly the US federal research regulations (45 CFR 46 subparts B, C, and D). These policies generally recognize vulnerable populations to include pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. The aim has been to protect these populations from harm, often by creating regulatory and ethical checks that may limit their participation in many clinical trials. The recent increase in pragmatic clinical trials (PCTs) raises at least two questions about this approach. First, is exclusion itself a harm to vulnerable populations, as these groups may be denied access to understanding how health interventions work for them in clinical settings? Second, are groups considered vulnerable in traditional clinical trials also vulnerable in PCTs? We argue first, that excluding vulnerable subjects from participation in PCTs can be harmful by preventing acquisition of data to meaningfully inform clinical decision-making in the future. Second, we argue that protections for vulnerable subjects in traditional clinical trial settings may not be translatable, feasible, or even ethical to apply in PCTs. We conclude by offering specific recommendations for appropriately protecting vulnerable research subjects in PCTs, focusing on pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. PMID:26374681
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Comparison between two surgical techniques for root coverage with an acellular dermal matrix graft.
Andrade, Patrícia F; Felipe, Maria Emília M C; Novaes, Arthur B; Souza, Sérgio L S; Taba, Mário; Palioto, Daniela B; Grisi, Márcio F M
2008-03-01
The aim of this randomized, controlled, clinical study was to compare two surgical techniques with the acellular dermal matrix graft (ADMG) to evaluate which technique could provide better root coverage. Fifteen patients with bilateral Miller Class I gingival recession areas were selected. In each patient, one recession area was randomly assigned to the control group, while the contra-lateral recession area was assigned to the test group. The ADMG was used in both groups. The control group was treated with a broader flap and vertical-releasing incisions, and the test group was treated with the proposed surgical technique, without releasing incisions. The clinical parameters evaluated before the surgeries and after 12 months were: gingival recession height, probing depth, relative clinical attachment level and the width and thickness of keratinized tissue. There were no statistically significant differences between the groups for all parameters at baseline. After 12 months, there was a statistically significant reduction in recession height in both groups, and there was no statistically significant difference between the techniques with regard to root coverage. Both surgical techniques provided significant reduction in gingival recession height after 12 months, and similar results in relation to root coverage.
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Cardaropoli, Daniele; Tamagnone, Lorenzo; Roffredo, Alessandro; Gaveglio, Lorena
2014-01-01
Multiple adjacent recession defects were treated in 32 patients using a coronally advanced flap (CAF) with or without a collagen matrix (CM). The percentage of root coverage was 81.49% ± 23.45% (58% complete root coverage) for CAF sites (control) and 93.25% ± 10.01% root coverage (72% complete root coverage) for CM plus CAF sites (test). The results achieved in the test group were significantly greater than in the control group, indicating that CM plus CAF is a suitable option for the treatment of multiple adjacent gingival recessions.
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Fracture Resistance of Teeth Restored with Direct and Indirect Composite Restorations
Torabzadeh, Hassan; Ghasemi, Amir; Dabestani, Atoosa; Razmavar, Sara
2013-01-01
Objective: Tooth fracture is a common dental problem. By extension of cavity dimensions, the remaining tooth structure weakens and occlusal forces may cause tooth fracture. The aim of this study was to evaluate and compare the fracture resistance of teeth restored with direct and indirect composite restorations. Materials and Methods: Sixty-five sound maxillary premolar teeth were chosen and randomly divided into five groups each comprising thirteen. Fifty-two teeth received mesio-occluso-distal (MOD) cavities with 4.5mm bucco-lingual width, 4mm pulpal depth and 3mm gingival depth and were divided into the following four groups. G-1: restored with direct composite (Z-250, 3M/ESPE) with cusp coverage, G-2: restored with direct composite (Z-250) without cusp coverage, G-3: restored with direct composite (Gradia, GC-international) with cusp coverage, G-4: restored with indirect composite (Gradia, GC-International) with cusp coverage. Intact teeth were used in G-5 as control. The teeth were subjected to a compressive axial loading using a 4 mm diameter rod in a universal testing machine with 1 mm/min speed. Data were analyzed using one-way ANOVA and Tukey tests. Results: The mean fracture strength recorded was: G-1: 1148.46N±262, G-2: 791.54N±235, G-3: 880.00N±123, G-4: 800.00N±187, G-5: 1051.54N±345. ANOVA revealed significant differences between groups (p<0.05). Tukey test showed significant difference between group 1 and the other groups. There was no significant difference among other groups. Conclusion: Direct composite (Z-250) with cusp coverage is a desirable treatment for weakened teeth. Treatment with Z-250 without cusp coverage, direct and indirect Gradia with cusp coverage restored the strength of the teeth to the level of intact teeth. PMID:24910649
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Shi, Xiangmin; Shan, Zhaoling; Yuan, Hongtao; Guo, Hongyang; Wang, Yutang
2014-01-01
This study aims to investigate the effect of captopril and losartan on the electrophysiology of myocardial cells parameters in ventricular vulnerable period and effective refractory period of myocardial ischemia rats. 96 wistar rats were enrolled in the study and divided into six groups: Captopril myocardial ischemia group, losartan myocardial ischemia group, myocardial ischemia control group, captopril normal group, losartan normal group and normal control group (n=16). We observed morphological changes of myocardial tissue in each group. The cardiac electrophysiological parameters in effective refractory period of each group were measured. Creatine kinase (CK), alanine aminotransferase (GOT), lactate dehydrogenase (LDH), the expression of Cardiotrophin 1 (CT-1) and malonaldehyde (MDA) were detected. Compared the losartan and captopril group with the control group, (P<0.05). Losartan and captopril can shorten the ventricular vulnerable period of the normal group and ischemic group. There was no interaction effect between losartan and captopril group and the acute myocardial ischemia group. The effect of losartan and captopril on time window in ventricular vulnerable period showed that compared with the control group (P<0.05). Losartan and captopril had a significant effect on prolonged effective refractory period of normal and ischemic rats. There was no interaction effect between losartan and captopril group and the acute myocardial ischemia group. Compared with the myocardial ischemia control group, CK, GOT, LDH and MDA decreased in captopril and losartan myocardial ischemia groups (P<0.05). Losartan and captopril had a significant effect on prolonged effective refractory period and shorten ventricular vulnerable period, they can also effectively prevent arrhythmias.
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2012-02-15
These regulations finalize, without change, interim final regulations authorizing the exemption of group health plans and group health insurance coverage sponsored by certain religious employers from having to cover certain preventive health services under provisions of the Patient Protection and Affordable Care Act.
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5 CFR 890.401 - Temporary extension of coverage and conversion.
Code of Federal Regulations, 2010 CFR
2010-01-01
..., is entitled to a 31-day extension of coverage for self alone or self and family, as the case may be... or her group coverage and must be accompanied by verification of termination of the enrollment; e.g...
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Code of Federal Regulations, 2010 CFR
2010-01-01
... retirement benefits are considered to be supplementary; (f) Are deducted as normal life insurance premiums... coverage. Federal Employees' Group Life Insurance premiums for “Basic Life” coverage are considered to be normal life insurance premiums; all optional Federal Employees' Group Life Insurance premiums and any...
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Code of Federal Regulations, 2011 CFR
2011-01-01
... retirement benefits are considered to be supplementary; (f) Are deducted as normal life insurance premiums... coverage. Federal Employees' Group Life Insurance premiums for “Basic Life” coverage are considered to be normal life insurance premiums; all optional Federal Employees' Group Life Insurance premiums and any...
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Hu, Yu; Li, Qian; Chen, Yaping
2018-01-16
We evaluated the effect of two Elaboration Likelihood Model (ELM)-based health educational interventions on varicella vaccine (VarV) vaccination among pregnant women in a province in the east China. A prospective randomized controlled trial was conducted among 200 pregnant women with ≥12 gestation weeks to test two interventions, including a messaging video and a messaging booklet. The participants were randomly assigned into the control group, the video group or the booklet group. The VarV coverage at 12 and 24 months old was compared among the children of the three groups and relative risks (RRs) were calculated, by using the coverage of the control group as reference. The timeliness of VarV was also assessed. Furthermore, differences in the effects on the knowledge and attitude of VarV vaccination between the two interventions was evaluated. The VarV coverage of their children by 24 months of age was 86.4%, 76.1% and 56.7% for the video group, the booklet group and the control group, respectively. The relative risks (RRs) for the coverage of VarV at 24 months of age were 4.8 (95% CI: 2.06-11.3) for the video group and 2.4 (95% CI: 1.2-5.1) for the booklet group. The means of delays were 57.3 days in the video group, 76.9 days in the booklet group, and 100.6 days in the control group. The proportion of women who intended to vaccinate their children with VarV was higher in the video group than the booklet group (93.9% vs. 82.1%, p < 0.05). Our findings indicated that perinatal health education through booklet or video could improve the coverage and schedule adherence for children's VarV vaccination.
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Sung, Ki Wol; Kang, Hye Seung; Nam, Ji Ran; Park, Mi Kyung; Park, Ji Hyeon
2018-04-01
This study aimed to estimate the effects of a health mentoring program on fasting blood sugar, total cholesterol, triglyceride, physical activity, self care behavior and social support changes among community-dwelling vulnerable elderly individuals with diabetes. A non-equivalent control group pre-post-test design was used. Participants were 70 community-dwelling vulnerable elderly individuals with diabetes. They were assigned to the experimental (n=30) or comparative (n=30) or control group (n=28). The experimental group participated in the health mentoring program, while the comparative group participated in health education program, the control group did not participate in any program. Data analyses involved a chi-square test, Fisher's exact test, a generalized linear model, and the Bonferroni correction, using SPSS 23.0. Compared to the control group, the experimental and comparative groups showed a significant decrease in fasting blood sugar, total cholesterol, and triglyceride. Compared to the comparative and control groups, the experimental group showed significant improvement in self care behavior. However, there were no statistical differences in physical activity or social support among the three groups. These findings indicate that the health mentoring program is an effective intervention for community-dwelling vulnerable elderly individuals with diabetes. This program can be used as an efficient strategy for diabetes self-management within this population. © 2018 Korean Society of Nursing Science.
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Sugishita, Yoshiyuki; Hayashi, Kunihiko; Mori, Toru; Horiguchi, Itsuko; Marui, Eiji
2012-03-01
The BCG immunization has long been performed in Japan. Although the BCG immunization service is the responsibility of the municipality, the manner in which the BCG immunization is delivered differs from municipality to municipality. The purpose of this study was to clarify how the different manner of the BCG immunization delivery systems influenced the BCG immunization coverage. The study of BCG immunization coverage was conducted in the Tama area located in the western suburbs of Tokyo in 2004. The birth data and the immunization history by the age of 3 years were collected in the three-year-old health check-up from a total of 2,341 children residing in the Tama area. Based on the age at immunization for each child, the BCG immunization coverage was calculated according to the types of the BCG immunization delivery system. The immunization types were defined as follows; the BCG immunization given on the occasion of the mass health check-up (Group 1); the exclusive mass BCG immunization in a monthly service (Group 2); the exclusive mass BCG immunization in a bimonthly service (Group 3); the exclusive mass BCG immunization in services of fewer than every two months (Group 4); and the immunization given on an individual basis by a general practitioner (Group 5). A univariate analysis was performed to examine the relationship between the BCG immunization coverage by the age of 6 months and the difference among the BCG immunization delivery systems, followed by a multivariate regression analysis to adjust for the factors related to the demography, health care services and the socio-economic status of the municipalities. Unadjusted odds ratios and adjusted odds ratios for BCG unimmunized children under the age of 6 months by the BCG immunization delivery manner groups were OR 1 reference, adj. OR 1 reference in Group 1; OR 1.42 CI 0.87-2.29, adj. OR 4.01 CI 2.24-7.11 in Group 2; OR 4.96 CI 3.66-6.82, adj. OR 15.59 CI 10.10-24.49 in Group 3;OR 18.60 CI 13.77-25.49, adj. OR 48.17 CI 29.62-79.75 in Group 4; and OR 4.24 CI 2.86-6.31, adj. OR 15.61 CI 9.05-27.26 in Group 5. The univariate analysis and multivariate regression analysis revealed an influence of the BCG immunization delivery manner on the BCG immunization coverage. The choice of BCG immunization delivery manner is very important to raise the BCG immunization coverage. The BCG immunization given on the occasion of the mass health check-up and the high-frequent immunization service are thought to improve the BCG immunization coverage.
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[Hospitalization due to whooping cough in Spain (1997-2011)].
Fernández-Cano, María Isabel; Armadans-Gil, Lluís; Alvarez-Bartolomé, Mercedes; Rodrigo-Pendás, José Ángel; Campins-Martí, Magda
2014-12-01
Pertussis incidence has increased in recent years in countries with high vaccination coverage. The aim of this study was to determine the health impact of pertussis in Spain in the period 1997-2011 in relation to hospitalizations, mortality, and associated costs. We retrospectively analyzed hospital discharges included in the Minimum Data Set (MDS) in Spain for the period 1997-2011, with a primary or secondary diagnosis related to pertussis. We calculated incidence rates of hospitalization for pertussis (per 100,000) per year, by age group and by Autonomous Region, along with the mortality and lethality rates. A total of 8,331 hospital discharges with a diagnosis of pertussis were recorded in Spain between 1997 and 2011. The overall incidence of pertussis hospitalizations was 1.3 cases per 100,000 inhabitants. The large majority (92%) of hospitalizations occurred in children under one year of age, with an incidence of 115.2 hospitalizations per 100,000. There were 47 deaths, 37 (79%) in the group of children under 1 year and 6 (13%) in the group older than 65 years. The estimated cost of hospitalization for pertussis was 1,841 euros. The epidemiology of severe cases of pertussis, and its clinical and economic impact, confirms the need to modify the vaccination strategies for Spain to achieve more effective control in the most vulnerable groups. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.
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Bangure, Donewell; Chirundu, Daniel; Gombe, Notion; Marufu, Tawanda; Mandozana, Gibson; Tshimanga, Mufuta; Takundwa, Lucia
2015-02-12
Globally, non-attendance for immunization appointments remains a challenge to healthcare providers. A review of the 2011 immunization coverage for Kadoma City, Zimbabwe was 74% for Oral Polio Vaccine (OPV), Pneumococcal and Pentavalent antigens. The immunization coverage was less than 90%, which is the target for Kadoma City. Adoption of short message services (SMS) reminders has been shown to enhance attendance in some medical settings. The study was conducted to determine the effectiveness of SMS reminders on immunization programme for Kadoma City. A randomized controlled trial was conducted at Kadoma City clinics in Zimbabwe. Women who delivered and were residents of Kadoma City were recruited into the study. In the intervention group, SMS reminders were sent at 6, 10 and 14 weeks in addition to routine health education. In the non-intervention no SMS reminders were used, however routine health education was offered. Data were collected using interviewer administered questionnaire. Data were analyzed using Epi Info 7™, where frequencies, means, risk ratios and risk differences were generated. A total of 304 participants were recruited, 152 for the intervention group and 152 for the non-intervention group. The immunization coverage at 6 weeks was 97% in the intervention group and 82% in the non-intervention group (p < 0.001). At 14 weeks immunization coverage was 95% for intervention and 75% for non-intervention group (p < 0.001). Those who did not delay receiving immunization at 14 weeks was 82% for the intervention and 8% for non-intervention group. Median delay for intervention was 0 days (Q1 = 0; Q3 = 0) and 10 days (Q1 = 6; Q3 = 17) for non-intervention group. The risk difference (RD) for those who received SMS reminders than those in the non intervention group was 16.3% (95% CI: 12.5-28.0) at 14 weeks. Immunization coverage in the intervention group was significantly higher than in non-intervention group. Overall increase in immunization coverage can be attributed to use of SMS. ISRCTN70918594 . Registration Date: 28 August 2014.
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Seasonal influenza vaccine coverage among high-risk populations in Thailand, 2010-2012.
Owusu, Jocelynn T; Prapasiri, Prabda; Ditsungnoen, Darunee; Leetongin, Grit; Yoocharoen, Pornsak; Rattanayot, Jarowee; Olsen, Sonja J; Muangchana, Charung
2015-01-29
The Advisory Committee on Immunization Practice of Thailand prioritizes seasonal influenza vaccinations for populations who are at highest risk for serious complications (pregnant women, children 6 months-2 years, persons ≥65 years, persons with chronic diseases, obese persons), and healthcare personnel and poultry cullers. The Thailand government purchases seasonal influenza vaccine for these groups. We assessed vaccination coverage among high-risk groups in Thailand from 2010 to 2012. National records on persons who received publicly purchased vaccines from 2010 to 2012 were analyzed by high-risk category. Denominator data from multiple sources were compared to calculate coverage. Vaccine coverage was defined as the proportion of individuals in each category who received the vaccine. Vaccine wastage was defined as the proportion of publicly purchased vaccines that were not used. From 2010 to 2012, 8.18 million influenza vaccines were publicly purchased (range, 2.37-3.29 million doses/year), and vaccine purchases increased 39% over these years. Vaccine wastage was 9.5%. Approximately 5.7 million (77%) vaccine doses were administered to persons ≥65 years and persons with chronic diseases, 1.4 million (19%) to healthcare personnel/poultry cullers, 82,570 (1.1%) to children 6 months-2 years, 78,885 (1.1%) to obese persons, 26,481 (0.4%) to mentally disabled persons, and 17,787 (0.2%) to pregnant women. Between 2010 and 2012, coverage increased among persons with chronic diseases (8.6% versus 14%; p<0.01) and persons ≥65 years (12%, versus 20%; p<0.01); however, coverage decreased for mentally disabled persons (6.1% versus 4.9%; p<0.01), children 6 months-2 years (2.3% versus 0.9%; p<0.01), pregnant women (1.1% versus 0.9%; p<0.01), and obese persons (0.2% versus 0.1%; p<0.01). From 2010 to 2012, the availability of publicly purchased vaccines increased. While coverage remained low for all target groups, coverage was highest among persons ≥65 years and persons with chronic diseases. Annual coverage assessments are necessary to promote higher coverage among high-risk groups in Thailand. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Seasonal influenza vaccine coverage among high-risk populations in Thailand, 2010–2012
Owusu, Jocelynn T.; Prapasiri, Prabda; Ditsungnoen, Darunee; Leetongin, Grit; Yoocharoen, Pornsak; Rattanayot, Jarowee; Olsen, Sonja J.; Muangchana, Charung
2015-01-01
Background The Advisory Committee on Immunization Practice of Thailand prioritizes seasonal influenza vaccinations for populations who are at highest risk for serious complications (pregnant women, children 6 months–2 years, persons ≥65 years, persons with chronic diseases, obese persons), and health-care personnel and poultry cullers. The Thailand government purchases seasonal influenza vaccine for these groups. We assessed vaccination coverage among high-risk groups in Thailand from 2010 to 2012. Methods National records on persons who received publicly purchased vaccines from 2010 to 2012 were analyzed by high-risk category. Denominator data from multiple sources were compared to calculate coverage. Vaccine coverage was defined as the proportion of individuals in each category who received the vaccine. Vaccine wastage was defined as the proportion of publicly purchased vaccines that were not used. Results From 2010 to 2012, 8.18 million influenza vaccines were publicly purchased (range, 2.37–3.29 million doses/year), and vaccine purchases increased 39% over these years. Vaccine wastage was 9.5%. Approximately 5.7 million (77%) vaccine doses were administered to persons ≥65 years and persons with chronic diseases, 1.4 million (19%) to healthcare personnel/poultry cullers, 82,570 (1.1%) to children 6 months–2 years, 78,885 (1.1%) to obese persons, 26,481 (0.4%) to mentally disabled persons, and 17,787 (0.2%) to pregnant women. Between 2010 and 2012, coverage increased among persons with chronic diseases (8.6% versus 14%; p < 0.01) and persons ≥65 years (12%, versus 20%; p < 0.01); however, coverage decreased for mentally disabled persons (6.1% versus 4.9%; p < 0.01), children 6 months–2 years (2.3% versus 0.9%; p < 0.01), pregnant women (1.1% versus 0.9%; p < 0.01), and obese persons (0.2% versus 0.1%; p < 0.01). Conclusions From 2010 to 2012, the availability of publicly purchased vaccines increased. While coverage remained low for all target groups, coverage was highest among persons ≥65 years and persons with chronic diseases. Annual coverage assessments are necessary to promote higher coverage among high-risk groups in Thailand. PMID:25454853
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Fottrell, Edward; Azad, Kishwar; Kuddus, Abdul; Younes, Layla; Shaha, Sanjit; Nahar, Tasmin; Aumon, Bedowra Haq; Hossen, Munir; Beard, James; Hossain, Tanvir; Pulkki-Brannstrom, Anni-Maria; Skordis-Worrall, Jolene; Prost, Audrey; Costello, Anthony; Houweling, Tanja A J
2013-09-01
Community-based interventions can reduce neonatal mortality when health systems are weak. Population coverage of target groups may be an important determinant of their effect on behavior and mortality. A women's group trial at coverage of 1 group per 1414 population in rural Bangladesh showed no effect on neonatal mortality, despite a similar intervention having a significant effect on neonatal and maternal death in comparable settings. To assess the effect of a participatory women's group intervention with higher population coverage on neonatal mortality in Bangladesh. A cluster randomized controlled trial in 9 intervention and 9 control clusters. Rural Bangladesh. Women permanently residing in 18 unions in 3 districts and accounting for 19 301 births during the final 24 months of the intervention. Women's groups at a coverage of 1 per 309 population that proceed through a participatory learning and action cycle in which they prioritize issues that affected maternal and neonatal health and design and implement strategies to address these issues. Neonatal mortality rate. Analysis included 19 301 births during the final 24 months of the intervention. More than one-third of newly pregnant women joined the groups. The neonatal mortality rate was significantly lower in the intervention arm (21.3 neonatal deaths per 1000 live births vs 30.1 per 1000 in control areas), a reduction in neonatal mortality of 38% (risk ratio, 0.62 [95% CI, 0.43-0.89]) when adjusted for socioeconomic factors. The cost-effectiveness was US $220 to $393 per year of life lost averted. Cause-specific mortality rates suggest reduced deaths due to infections and those associated with prematurity/low birth weight. Improvements were seen in hygienic home delivery practices, newborn thermal care, and breastfeeding practices. Women's group community mobilization, delivered at adequate population coverage, is a highly cost-effective approach to improve newborn survival and health behavior indicators in rural Bangladesh. isrctn.org Identifier: ISRCTN01805825.
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Kimura, Akiko C; Nguyen, Christine N; Higa, Jeffrey I; Hurwitz, Eric L; Vugia, Duc J
2007-04-01
We examined barriers to influenza vaccination among long-term care facility (LTCF) health care workers in Southern California and developed simple, effective interventions to improve influenza vaccine coverage of these workers. In 2002, health care workers at LTCFs were surveyed regarding their knowledge and attitudes about influenza and the influenza vaccine. Results were used to develop 2 interventions, an educational campaign and Vaccine Day (a well-publicized day for free influenza vaccination of all employees at the worksite). Seventy facilities were recruited to participate in an intervention trial and randomly assigned to 4 study groups. The combination of Vaccine Day and an educational campaign was most effective in increasing vaccine coverage (53% coverage; prevalence ratio [PR]=1.45; 95% confidence interval [CI]=1.24, 1.71, compared with 27% coverage in the control group). Vaccine Day alone was also effective (46% coverage; PR= 1.41; 95% CI=1.17, 1.71). The educational campaign alone was not effective in improving coverage levels (34% coverage; PR=1.18; 95% CI=0.93, 1.50). Influenza vaccine coverage of LTCF health care workers can be improved by providing free vaccinations at the worksite with a well-publicized Vaccine Day.
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Source Water Assessment for the Las Vegas Valley Surface Waters
NASA Astrophysics Data System (ADS)
Albuquerque, S. P.; Piechota, T. C.
2003-12-01
The 1996 amendment to the Safe Drinking Water Act of 1974 created the Source Water Assessment Program (SWAP) with an objective to evaluate potential sources of contamination to drinking water intakes. The development of a Source Water Assessment Plan for Las Vegas Valley surface water runoff into Lake Mead is important since it will guide future work on source water protection of the main source of water. The first step was the identification of the watershed boundary and source water protection area. Two protection zones were delineated. Zone A extends 500 ft around water bodies, and Zone B extends 3000 ft from the boundaries of Zone A. These Zones extend upstream to the limits of dry weather flows in the storm channels within the Las Vegas Valley. After the protection areas were identified, the potential sources of contamination in the protection area were inventoried. Field work was conducted to identify possible sources of contamination. A GIS coverage obtained from local data sources was used to identify the septic tank locations. Finally, the National Pollutant Discharge Elimination System (NPDES) Permits were obtained from the State of Nevada, and included in the inventory. After the inventory was completed, a level of risk was assigned to each potential contaminating activity (PCA). The contaminants of concern were grouped into five categories: volatile organic compounds (VOCs), synthetic organic compounds (SOCs), inorganic compounds (IOCs), microbiological, and radionuclides. The vulnerability of the water intake to each of the PCAs was assigned based on these five categories, and also on three other factors: the physical barrier effectiveness, the risk potential, and the time of travel. The vulnerability analysis shows that the PCAs with the highest vulnerability rating include septic systems, golf courses/parks, storm channels, gas stations, auto repair shops, construction, and the wastewater treatment plant discharges. Based on the current water quality data (prior to treatment), the proximity of Las Vegas Wash to the intake, and the results of the vulnerability analysis of potential contaminating activities, it is determined that the drinking water intake is at a Moderate level of risk for VOC, SOC, and microbiological contaminants. The drinking water intake is at a High level of risk for IOC contaminants. Vulnerability to radiological contamination is Moderate. Source water protection in the Las Vegas Valley is strongly encouraged because of the documented influence of the Las Vegas Wash on the quality of the water at the intake.
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Narváez, Javier; Osorio, May Bibiana; Castañeda-Orjuela, Carlos; Alvis Zakzuk, Nelson; Cediel, Natalia; Chocontá-Piraquive, Luz Ángela; de La Hoz-Restrepo, Fernando
2017-03-13
This study aimed to evaluate the coverage of the Colombian Expanded Program on Immunization among children less than 6years old, to evaluate the timeliness of immunization, to assess the coverage of newly introduced vaccines, and to identify factors associated with lack of immunization. We conducted a cross-sectional survey in 80 municipalities of Colombia, using a two-stage cluster random sampling. We attempted to contact all children less than 6years old living in the sampled blocks, and asked their caregivers to provide immunization record cards. We also collected basic sociodemographic information. We reached 81% of the attempted household contacts, identifying 18,232 children; of them, 14,805 (83%) had an immunization record card. Coverage for traditional vaccines was above 90%: BCG (tuberculosis) 95.7% (95%CI: 95.1-96.4), pentavalent vaccine 93.3% (92.4-94.3), MMR (measles, mumps, rubella) initial dose 94.5% (93.5-95.6); but it was lower for recently introduced vaccines: rotavirus 80% (77.8-82.1), influenza 48.4% (45.9-50.8). Results for timely vaccination were not equally successful: pentavalent vaccine 44.2% (41.4-47.1), MMR initial dose 71.2% (68.9-73.4). Mother's education was significantly associated with higher immunization odds. Older age, a greater number of siblings, low socioeconomic status, and not having health insurance were significantly associated with lower immunization odds. There was significant heterogeneity in immunization rates by municipality across the country. Although absolute immunization coverage for traditional vaccines met the goal of 90% for the 80 municipalities combined, disparities in coverage across municipalities, delayed immunization, and decline of coverage with age, are common problems in Colombia that may result in reduced protection. Newly introduced vaccines require additional efforts to reach the goal. These results highlight the association of health inequities with low immunization coverage and delayed immunization. Identification of vulnerable populations and their missed opportunities for vaccination may help to improve the reach of immunization programs. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Coverage Metrics for Model Checking
NASA Technical Reports Server (NTRS)
Penix, John; Visser, Willem; Norvig, Peter (Technical Monitor)
2001-01-01
When using model checking to verify programs in practice, it is not usually possible to achieve complete coverage of the system. In this position paper we describe ongoing research within the Automated Software Engineering group at NASA Ames on the use of test coverage metrics to measure partial coverage and provide heuristic guidance for program model checking. We are specifically interested in applying and developing coverage metrics for concurrent programs that might be used to support certification of next generation avionics software.
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45 CFR 146.145 - Special rules relating to group health plans.
Code of Federal Regulations, 2011 CFR
2011-10-01
... circumstances. The following benefits are excepted in all circumstances— (i) Coverage only for accident..., including general liability insurance and automobile liability insurance; (iv) Coverage issued as a supplement to liability insurance; (v) Workers' compensation or similar coverage; (vi) Automobile medical...
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45 CFR 146.145 - Special rules relating to group health plans.
Code of Federal Regulations, 2012 CFR
2012-10-01
... circumstances. The following benefits are excepted in all circumstances— (i) Coverage only for accident..., including general liability insurance and automobile liability insurance; (iv) Coverage issued as a supplement to liability insurance; (v) Workers' compensation or similar coverage; (vi) Automobile medical...
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45 CFR 146.145 - Special rules relating to group health plans.
Code of Federal Regulations, 2013 CFR
2013-10-01
... circumstances. The following benefits are excepted in all circumstances— (i) Coverage only for accident..., including general liability insurance and automobile liability insurance; (iv) Coverage issued as a supplement to liability insurance; (v) Workers' compensation or similar coverage; (vi) Automobile medical...
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45 CFR 152.28 - Preventing insurer dumping.
Code of Federal Regulations, 2010 CFR
2010-10-01
... individuals from remaining enrolled in their current coverage in instances in which such individuals...: (1) Situations where an enrollee or potential enrollee had prior coverage obtained through a group... disenrolling from their coverage, or disincentives for remaining enrolled. (2) Situations where enrollees or...
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Dominant frames in legacy and social media coverage of the IPCC Fifth Assessment Report
NASA Astrophysics Data System (ADS)
O'Neill, Saffron; Williams, Hywel T. P.; Kurz, Tim; Wiersma, Bouke; Boykoff, Maxwell
2015-04-01
The media are powerful agents that translate information across the science-policy interface, framing it for audiences. Yet frames are never neutral: they define an issue, identify causes, make moral judgements and shape proposed solutions. Here, we show how the IPCC Fifth Assessment Report (AR5) was framed in UK and US broadcast and print coverage, and on Twitter. Coverage of IPCC Working Group I (WGI) was contested and politicized, employing the `Settled Science, Uncertain Science, Political or Ideological Struggle and Role of Science’ frames. WGII coverage commonly used Disaster or Security. More diverse frames were employed for WGII and WGIII, including Economics and Morality and Ethics. Framing also varied by media institution: for example, the BBC used Uncertain Science, whereas Channel 4 did not. Coverage varied by working group, with WGIII gaining far less coverage than WGI or WGII. We suggest that media coverage and framing of AR5 was influenced by its sequential three-part structure and by the availability of accessible narratives and visuals. We recommend that these communication lessons be applied to future climate science reports.
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Analysis of Your Professional Liability Insurance Policy
Sadusk, Joseph F.; Hassard, Howard; Waterson, Rollen
1958-01-01
The most important lessons for the physician to learn in regard to his professional liability insurance coverage are the following: 1. The physician should carefully read his professional liability policy and should secure the educated aid of his attorney and his insurance broker, if they are conversant with this field. 2. He should particularly read the definition of coverage and carefully survey the exclusion clauses which may deny him coverage under certain circumstances. 3. If the physician is in partnership or in a group, he should be certain that he has contingent partnership coverage. 4. The physician should accept coverage only from an insurance carrier of sufficient size and stability that he can be sure his coverage will be guaranteed for “latent liability” claims as the years go along—certainly for his lifetime. 5. The insurance carrier offering the professional liability policy should be prepared to offer coverages up to at least $100,000/$300,000. 6. The physician should be assured that the insurance carrier has claims-handling personnel and legal counsel who are experienced and expert in the professional liability field and who are locally available for service. 7. The physician is best protected by a local or state group program, next best by a national group program, and last, by individual coverage. 8. The physician should look with suspicion on a cancellation clause in which his policy may be summarily cancelled on brief notice. 9. The physician should not buy professional liability insurance on the basis of price alone; adequacy of coverage and service and a good insurance company for his protection should be the deciding factors. PMID:13489519
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Card, David; Dobkin, Carlos; Maestas, Nicole
2008-12-01
The onset of Medicare eligibility at age 65 leads to sharp changes in the health insurance coverage of the U.S. population. These changes lead to increases in the use of medical services, with a pattern of gains across socioeconomic groups that varies by type of service. While routine doctor visits increase more for groups that previously lacked insurance, hospital admissions for relatively expensive procedures like bypass surgery and joint replacement increase more for previously insured groups that are more likely to have supplementary coverage after 65, reflecting the relative generosity of their combined insurance package under Medicare.
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The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare
Dobkin, Carlos; Maestas, Nicole
2008-01-01
The onset of Medicare eligibility at age 65 leads to sharp changes in the health insurance coverage of the U.S. population. These changes lead to increases in the use of medical services, with a pattern of gains across socioeconomic groups that varies by type of service. While routine doctor visits increase more for groups that previously lacked insurance, hospital admissions for relatively expensive procedures like bypass surgery and joint replacement increase more for previously insured groups that are more likely to have supplementary coverage after 65, reflecting the relative generosity of their combined insurance package under Medicare. PMID:19079738
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45 CFR 146.145 - Special rules relating to group health plans.
Code of Federal Regulations, 2014 CFR
2014-10-01
... benefits are excepted in all circumstances— (i) Coverage only for accident (including accidental death and... insurance and automobile liability insurance; (iv) Coverage issued as a supplement to liability insurance; (v) Workers' compensation or similar coverage; (vi) Automobile medical payment insurance; (vii...
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29 CFR 2590.732 - Special rules relating to group health plans.
Code of Federal Regulations, 2014 CFR
2014-07-01
... benefits are excepted in all circumstances— (i) Coverage only for accident (including accidental death and... insurance and automobile liability insurance; (iv) Coverage issued as a supplement to liability insurance; (v) Workers' compensation or similar coverage; (vi) Automobile medical payment insurance; (vii...
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45 CFR 148.124 - Certification and disclosure of coverage.
Code of Federal Regulations, 2011 CFR
2011-10-01
... Section 148.124 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE INDIVIDUAL HEALTH INSURANCE MARKET Requirements Relating to Access and... coverage under a group health policy, records from medical care providers indicating health coverage, third...
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45 CFR 148.124 - Certification and disclosure of coverage.
Code of Federal Regulations, 2012 CFR
2012-10-01
... Section 148.124 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE INDIVIDUAL HEALTH INSURANCE MARKET Requirements Relating to Access and... coverage under a group health policy, records from medical care providers indicating health coverage, third...
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-12-27
... for OMB Review; Comment Request; Establishing Creditable Coverage Under Group Health Plans ACTION... Administration (EBSA) sponsored information collection request (ICR) titled, ``Establishing Creditable Coverage... method of crediting coverage established by the regulations. The regulations permit a plan to adopt, as...
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Pop, T; Fleischmann, D; Effert, S
1976-09-01
Using the extrastimulus method in 100 patients, premature impulses were applied during the relative refractory period of the right atrium. Depending on the atrial response to these impulses we divided our patients in the following 3 groups: Group A: no repetitive firing (61 patients); group B: 1 to 5 additional atrial extrasystoles with a total duration of maximum 1.5 s (27 patients); group C: runs of atrial flutter or fibrilation for at least 8 s (12 patients). The statistical analysis of the following parameters: age, PA interval, absolute and corrected sinus node recovery time did not show any significant difference between the 3 groups. These results suggest that the investigated parameters are of no great importance in the genesis of the atrial vulnerability.
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Duplicate Health Insurance Coverage: Determinants of Variation Across States
Luft, Harold S.; Maerki, Susan C.
1982-01-01
Although it is recognized that many people have duplicate private health insurance coverage, either through separate purchase or as health benefits in multi-earner families, there has been little analysis of the factors determining duplicate coverage rates. A new data source, the Survey of Income and Education, offers a comparison with the only previous source of state level data, the estimates from the Health Insurance Association of America. The R2 between the two sets is only .3 and certain problems can be traced to the methodology underlying the HIAA figures. Using figures for gross and net coverage, the ratio of total policies to people with private coverage ranges from .94 in Utah to 1.53 in Illinois. Measures of industry distribution, per capita income and employment explain a large portion of the variance, but it appears that these factors operate in opposite directions for group and non-group policies. Similar sociodemographic variables also explain net coverage. These findings have substantial implications for research and the structuring of employee health benefits. PMID:10309638
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45 CFR 146.115 - Certification and disclosure of previous coverage.
Code of Federal Regulations, 2012 CFR
2012-10-01
.... 146.115 Section 146.115 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET Requirements Relating to... under a group health policy, records from medical care providers indicating health coverage, third party...
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Massat, Nathalie J; Douglas, Elaine; Waller, Jo; Wardle, Jane; Duffy, Stephen W
2015-01-01
Objectives Reducing cancer screening inequalities in England is a major focus of the 2011 Department of Health cancer outcome strategy. Screening coverage requires regular monitoring in order to implement targeted interventions where coverage is low. This study aimed to characterise districts with atypical coverage levels for cervical or breast screening. Design Observational study of district-level coverage in the English Cervical and Breast screening programmes in 2012. Setting England, UK. Participants All English women invited to participate in the cervical (age group 25–49 and 50–64) and breast (age group 50–64) screening programmes. Outcomes Risk adjustment models for coverage were developed based on district-level characteristics. Funnel plots of adjusted coverage were constructed, and atypical districts examined by correlation analysis. Results Variability in coverage was primarily explained by population factors, whereas general practice characteristics had little independent effect. Deprivation and ethnicity other than white, Asian, black or mixed were independently associated with poorer coverage in both screening programmes, with ethnicity having the strongest effect; by comparison, the influence of Asian, black or mixed ethnic minority was limited. Deprivation, ethnicity and urbanisation largely accounted for the lower cervical screening coverage in London. However, for breast screening, being located in London remained a strong negative predictor. A subset of districts was identified as having atypical coverage across programmes. Correlates of deprivation in districts with relatively low adjusted coverage were substantially different from overall correlates of deprivation. Discussion These results inform the continuing drive to reduce avoidable cancer deaths in England, and encourage implementation of targeted interventions in communities residing in districts identified as having atypically low coverage. Sequential implementation to monitor the impact of local interventions would help accrue evidence on ‘what works’. PMID:26209119
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Immunization of HIV-infected adult patients — French recommendations
Frésard, Anne; Gagneux-Brunon, Amandine; Lucht, Frédéric; Botelho-Nevers, Elisabeth; Launay, Odile
2016-01-01
ABSTRACT Human immunodeficiency virus (HIV)-infected patients remain at increased risk of infection including vaccine-preventable diseases. Vaccines are therefore critical components in the protection of HIV-infected patients from an increasing number of preventable diseases. However, missed opportunities for vaccination among HIV-infected patients persist and vaccine coverage in this population could be improved. This article presents the French recommendations regarding immunization of HIV-infected adults in the light of the evidence-based literature on the benefits and the potential risks of vaccines among this vulnerable population. PMID:27409293
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Hatch, Brigit; Bailey, Steffani R; Cowburn, Stuart; Marino, Miguel; Angier, Heather; DeVoe, Jennifer E
2016-04-01
To assess longitudinal patterns of community health center (CHC) utilization and the effect of insurance discontinuity after Oregon's 2008 Medicaid expansion (the Oregon Experiment). We conducted a retrospective cohort study with electronic health records and Medicaid data. We divided individuals who gained Medicaid in the Oregon Experiment into those who maintained (n = 788) or lost (n = 944) insurance coverage. We compared these groups with continuously insured (n = 921) and continuously uninsured (n = 5416) reference groups for community health center utilization rates over a 36-month period. Both newly insured groups increased utilization in the first 6 months. After 6 months, use among those who maintained coverage stabilized at a level consistent with the continuously insured, whereas it returned to baseline for those who lost coverage. Individuals who maintained coverage through Oregon's Medicaid expansion increased long-term utilization of CHCs, whereas those with unstable coverage did not. This study predicts long-term increase in CHC utilization following Affordable Care Act Medicaid expansion and emphasizes the need for policies that support insurance retention.
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Welch, Mary Jane; Lally, Rachel; Miller, Jennifer E; Pittman, Stephanie; Brodsky, Lynda; Caplan, Arthur L; Uhlenbrauck, Gina; Louzao, Darcy M; Fischer, James H; Wilfond, Benjamin
2015-10-01
Policies have been developed to protect vulnerable populations in clinical research, including the US federal research regulations (45 Code of Federal Regulations 46 Subparts B, C, and D). These policies generally recognize vulnerable populations to include pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. The aim has been to protect these populations from harm, often by creating regulatory and ethical checks that may limit their participation in many clinical trials. The recent increase in pragmatic clinical trials raises at least two questions about this approach. First, is exclusion itself a harm to vulnerable populations, as these groups may be denied access to understanding how health interventions work for them in clinical settings? Second, are groups considered vulnerable in traditional clinical trials also vulnerable in pragmatic clinical trials? We argue first that excluding vulnerable subjects from participation in pragmatic clinical trials can be harmful by preventing acquisition of data to meaningfully inform clinical decision-making in the future. Second, we argue that protections for vulnerable subjects in traditional clinical trial settings may not be translatable, feasible, or even ethical to apply in pragmatic clinical trials. We conclude by offering specific recommendations for appropriately protecting vulnerable research subjects in pragmatic clinical trials, focusing on pregnant women, fetuses, neonates, children, prisoners, persons with physical handicaps or mental disabilities, and disadvantaged persons. © The Author(s) 2015.
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Characterizing the Last Latrine Nonowners in Rural Malawi.
Slekiene, Jurgita; Mosler, Hans-Joachim
2018-01-01
Open defecation is a public health problem worldwide. Non-governmental organizations in developing countries use various approaches to increase latrine coverage, but for little-understood reasons, some of the population does not adopt latrine construction. The objective of our research was to uncover which of the factors predicting latrine construction are relevant to the last nonowners of latrines, termed laggards in the diffusion of innovations theory. In a cross-sectional study, quantitative face-to-face interviews were conducted in households in rural Malawi ( N = 824) to assess the behavioral determinants of latrine construction, mental health, and leadership. Around 14% of the households interviewed did not own a latrine. Study results suggest that nonowners have limited economic resources and perceive that latrine construction is expensive, that it is difficult to find money for latrine construction, and that it needs a lot of time and effort. The last nonowners of latrines live in smaller groups than latrine owners, communicate less with others about latrine construction, and are less influenced by the opinion of their leaders. They consist, in particular, of socially vulnerable households, are younger, are less educated, often have more impaired mental health, feel more vulnerable to contracting diseases, are less aware of the latrine construction of others in the village, feel less personally obliged to construct their own latrines, and are less confident in their ability to rebuild latrines damaged by flooding. The study confirmed that the assumptions of the diffusion of innovation theory are useful in combination with the risks, attitudes, norms, abilities, and self-regulation behavior change approach for developing evidence-based behavior change strategies in developing countries.
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The role of retiree health insurance in the early retirement of public sector employees.
Shoven, John B; Slavov, Sita Nataraj
2014-12-01
Most government employees have access to retiree health coverage, which provides them with group health coverage even if they retire before Medicare eligibility. We study the impact of retiree health coverage on the labor supply of public sector workers between the ages of 55 and 64. We find that retiree health coverage raises the probability of stopping full time work by 4.3 percentage points (around 38 percent) over two years among public sector workers aged 55-59, and by 6.7 percentage points (around 26 percent) over two years among public sector workers aged 60-64. In the younger age group, retiree health insurance mostly seems to facilitate transitions to part-time work rather than full retirement. However, in the older age group, it increases the probability of stopping work entirely by 4.3 percentage points (around 22 percent). Copyright © 2014 Elsevier B.V. All rights reserved.
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Thankkappan, Prasanth; Roy, Subrata; Mandlik, Vivek Bapurao
2016-01-01
Background: New technologies, instruments, and surgical techniques are necessary to help the clinician ensure the best result and satisfy the patient's expectations, and surgical microscope has been thoroughly demonstrated as a useful tool. A clinical study was carried out to compare 2 different types of root coverage procedures using periodontal microsurgical procedure. Materials and Methods: Forty patients were selected and divided into Group A and Group B. Group A subjects were treated with subepithelial connective tissue graft (CTG) whereas Group B subjects were treated using a resorbable collagen membrane. The procedures were performed with the help of an operating microscope using 250 mm objective lens and ×6 magnification. Results: A comparison between baseline, 1, 3, and 12 months have been done between groups among all parameters. It has been noticed that the root coverage was better in Group A subjects at all time. At 12 months, Group A showed 81.42% coverage where in Group B it was 70.08%. Similarly, increase in the width of keratinized gingiva and attached gingiva were more in Group A. Conclusions: The present study showed that use of microsurgical instrument helped to deliver precise incision, better visual acuity, and improved illumination which facilitate to gain a better final outcome. Root coverage was better in the patients using CTG. PMID:27143833
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Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries.
Dansereau, Emily; McNellan, Claire R; Gagnier, Marielle C; Desai, Sima S; Haakenstad, Annie; Johanns, Casey K; Palmisano, Erin B; Ríos-Zertuche, Diego; Schaefer, Alexandra; Zúñiga-Brenes, Paola; Hernandez, Bernardo; Iriarte, Emma; Mokdad, Ali H
2016-08-19
Poor women in the developing world have a heightened need for antenatal care (ANC) but are often the least likely to attend it. This study examines factors associated with the number and timing of ANC visits for poor women in Guatemala, Honduras, Mexico, Nicaragua, Panama, and El Salvador. We surveyed 8366 women regarding the ANC they attended for their most recent birth in the past two years. We conducted logistic regressions to examine demographic, household, and health characteristics associated with attending at least one skilled ANC visit, four skilled visits, and a skilled visit in the first trimester. Across countries, 78 % of women attended at least one skilled ANC visit, 62 % attended at least four skilled visits, and 56 % attended a skilled visit in the first trimester. The proportion of women attending four skilled visits was highest in Nicaragua (81 %) and lowest in Guatemala (18 %) and Panama (38 %). In multiple countries, women who were unmarried, less-educated, adolescent, indigenous, had not wanted to conceive, and lacked media exposure were less likely to meet international ANC guidelines. In countries with health insurance programs, coverage was associated with attending skilled ANC, but not the timeliness. Despite significant policy reforms and initiatives targeting the poor, many women living in the poorest regions of Mesoamérica are not meeting ANC guidelines. Both supply and demand interventions are needed to prioritize vulnerable groups, reduce unplanned pregnancies, and reach populations not exposed to common forms of media. Top performing municipalities can inform effective practices across the region.
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Douglas, Steven; Dixon, Barnali; Griffin, Dale W.
2018-01-01
With continued population growth and increasing use of fresh groundwater resources, protection of this valuable resource is critical. A cost effective means to assess risk of groundwater contamination potential will provide a useful tool to protect these resources. Integrating geospatial methods offers a means to quantify the risk of contaminant potential in cost effective and spatially explicit ways. This research was designed to compare the ability of intrinsic (DRASTIC) and specific (Attenuation Factor; AF) vulnerability models to indicate groundwater vulnerability areas by comparing model results to the presence of pesticides from groundwater sample datasets. A logistic regression was used to assess the relationship between the environmental variables and the presence or absence of pesticides within regions of varying vulnerability. According to the DRASTIC model, more than 20% of the study area is very highly vulnerable. Approximately 30% is very highly vulnerable according to the AF model. When groundwater concentrations of individual pesticides were compared to model predictions, the results were mixed. Model predictability improved when concentrations of the group of similar pesticides were compared to model results. Compared to the DRASTIC model, the AF model more accurately predicts the distribution of the number of contaminated wells within each vulnerability class.
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Validation of a social vulnerability index in context to river-floods in Germany
NASA Astrophysics Data System (ADS)
Fekete, A.
2009-03-01
Social vulnerability indices are a means for generating information about people potentially affected by disasters that are e.g. triggered by river-floods. The purpose behind such an index is in this study the development and the validation of a social vulnerability map of population characteristics towards river-floods covering all counties in Germany. This map is based on a composite index of three main indicators for social vulnerability in Germany - fragility, socio-economic conditions and region. These indicators have been identified by a factor analysis of selected demographic variables obtained from federal statistical offices. Therefore, these indicators can be updated annually based on a reliable data source. The vulnerability patterns detected by the factor analysis are verified by using an independent second data set. The interpretation of the second data set shows that vulnerability is revealed by a real extreme flood event and demonstrates that the patterns of the presumed vulnerability match the observations of a real event. It comprises a survey of flood-affected households in three federal states. By using logistic regression, it is demonstrated that the theoretically presumed indications of vulnerability are correct and that the indicators are valid. It is shown that indeed certain social groups like the elderly, the financially weak or the urban residents are higher risk groups.
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The VCOP Scale: A Measure of Overprotection in Parents of Physically Vulnerable Children.
ERIC Educational Resources Information Center
Wright, Logan; And Others
1993-01-01
Developed Vulnerable Child/Overprotecting Parent Scale to measure overprotecting versus optimal developmental stimulation tendencies for parents of physically vulnerable children. Items were administered to parents whose parenting techniques had been rated as either highly overprotective or as optimal by group of physicians and other…
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Trabulsi, Manal; Oh, Tae-Ju; Eber, Robert; Weber, Daniel; Wang, Hom-Lay
2004-11-01
Enamel matrix derivative (EMD) has been shown to promote periodontal wound healing and/or regeneration when applied to tooth root surfaces in soft tissue dehiscence models. In addition, guided tissue regeneration (GTR)-based root coverage using collagen membrane (GTRC) has shown promising results. However, limited information is available regarding how EMD may influence GTRC outcome. Twenty-six patients with Miller's Class I or II gingival recession defects of 2.5 mm were recruited for the study. Subjects were randomly assigned to receive either EMD + collagen (EMDC; test group) or collagen membrane (GTRC; control group). Clinical parameters, including plaque index (PI), gingival index (GI), relative clinical attachment levels (RCAL) to the stent, recession depth (RD), recession width (RW), probing depth (PD), gingival tissue thickness (GTT), and width of keratinized gingiva (KG) were assessed at baseline, and 3 and 6 months after surgery. A repeated measure of analysis of variance (ANOVA) was used to determine differences between treatment groups and time effect. Both treatments (GTRC and EMDC) resulted in a statistically significant decrease in RD and RW between baseline and 6 months (P <0.05). However, no difference was noted between treatment groups. The percent of root coverage after 6 months was 75% for GTRC and 63% for EMDC. Complete 100% root coverage was achieved in five patients in the GTRC group, compared to only one patient in the EMDC group. There was a statistically significant gain (P <0.05) in the clinical attachment level (CAL) between baseline and 6 months in both groups, as reflected on the RCAL data. No other significant differences were noted on other clinical parameters (PD, GTT, KG, GI, and PI). GTR-based root coverage utilizing collagen membrane, with or without enamel matrix derivative, can be successfully used in obtaining gingival recession coverage. The application of EMD during GTRC procedures did not add additional benefit to the final clinical outcome.
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NASA Astrophysics Data System (ADS)
Gemitzi, Alexandra; Petalas, Christos; Tsihrintzis, Vassilios A.; Pisinaras, Vassilios
2006-03-01
The assessment of groundwater vulnerability to pollution aims at highlighting areas at a high risk of being polluted. This study presents a methodology, to estimate the risk of an aquifer to be polluted from concentrated and/or dispersed sources, which applies an overlay and index method involving several parameters. The parameters are categorized into three factor groups: factor group 1 includes parameters relevant to the internal aquifer system’s properties, thus determining the intrinsic aquifer vulnerability to pollution; factor group 2 comprises parameters relevant to the external stresses to the system, such as human activities and rainfall effects; factor group 3 incorporates specific geological settings, such as the presence of geothermal fields or salt intrusion zones, into the computation process. Geographical information systems have been used for data acquisition and processing, coupled with a multicriteria evaluation technique enhanced with fuzzy factor standardization. Moreover, besides assigning weights to factors, a second set of weights, i.e., order weights, has been applied to factors on a pixel by pixel basis, thus allowing control of the level of risk in the vulnerability determination and the enhancement of local site characteristics. Individual analysis of each factor group resulted in three intermediate groundwater vulnerability to pollution maps, which were combined in order to produce the final composite groundwater vulnerability map for the study area. The method has been applied in the region of Eastern Macedonia and Thrace (Northern Greece), an area of approximately 14,000 km2. The methodology has been tested and calibrated against the measured nitrate concentration in wells, in the northwest part of the study area, providing results related to the aggregation and weighting procedure.
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26 CFR 54.9831-1 - Special rules relating to group health plans.
Code of Federal Regulations, 2013 CFR
2013-04-01
... excepted in all circumstances— (i) Coverage only for accident (including accidental death and dismemberment... automobile liability insurance; (iv) Coverage issued as a supplement to liability insurance; (v) Workers' compensation or similar coverage; (vi) Automobile medical payment insurance; (vii) Credit-only insurance (for...
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26 CFR 54.9831-1 - Special rules relating to group health plans.
Code of Federal Regulations, 2011 CFR
2011-04-01
... excepted in all circumstances— (i) Coverage only for accident (including accidental death and dismemberment... automobile liability insurance; (iv) Coverage issued as a supplement to liability insurance; (v) Workers' compensation or similar coverage; (vi) Automobile medical payment insurance; (vii) Credit-only insurance (for...
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26 CFR 54.9831-1 - Special rules relating to group health plans.
Code of Federal Regulations, 2014 CFR
2014-04-01
... excepted in all circumstances— (i) Coverage only for accident (including accidental death and dismemberment... automobile liability insurance; (iv) Coverage issued as a supplement to liability insurance; (v) Workers' compensation or similar coverage; (vi) Automobile medical payment insurance; (vii) Credit-only insurance (for...
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26 CFR 54.9831-1 - Special rules relating to group health plans.
Code of Federal Regulations, 2012 CFR
2012-04-01
... excepted in all circumstances— (i) Coverage only for accident (including accidental death and dismemberment... automobile liability insurance; (iv) Coverage issued as a supplement to liability insurance; (v) Workers' compensation or similar coverage; (vi) Automobile medical payment insurance; (vii) Credit-only insurance (for...
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78 FR 39869 - Coverage of Certain Preventive Services Under the Affordable Care Act
Federal Register 2010, 2011, 2012, 2013, 2014
2013-07-02
... on Birth Outcomes: Findings from Recent U.S. Studies, International Journal of Gynecology... maintained by eligible organizations (and group health insurance coverage provided in connection with such plans), as well as student health insurance coverage arranged by eligible organizations that are...
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The Agriculture Model Intercomparison and Improvement Project (AgMIP) (Invited)
NASA Astrophysics Data System (ADS)
Rosenzweig, C.
2010-12-01
The Agricultural Model Intercomparison and Improvement Project (AgMIP) is a distributed climate-scenario simulation exercise for historical model intercomparison and future climate change conditions with participation of multiple crop and world agricultural trade modeling groups around the world. The goals of AgMIP are to improve substantially the characterization of risk of hunger and world food security due to climate change and to enhance adaptation capacity in both developing and developed countries. Historical period results will spur model improvement and interaction among major modeling groups, while future period results will lead directly to tests of adaptation and mitigation strategies across a range of scales. AgMIP will consist of a multi-scale impact assessment utilizing the latest methods for climate and agricultural scenario generation. Scenarios and modeling protocols will be distributed on the web, and multi-model results will be collated and analyzed to ensure the widest possible coverage of agricultural crops and regions. AgMIP will place regional changes in agricultural production in a global context that reflects new trading opportunities, imbalances, and shortages in world markets resulting from climate change and other driving forces for food supply. Such projections are essential inputs from the Vulnerability, Impacts, and Adaptation (VIA) research community to the Intergovernmental Panel on Climate Change Fifth Assessment (AR5), now underway, and the UN Framework Convention on Climate Change. They will set the context for local-scale vulnerability and adaptation studies, supply test scenarios for national-scale development of trade policy instruments, provide critical information on changing supply and demand for water resources, and elucidate interactive effects of climate change and land use change. AgMIP will not only provide crucially-needed new global estimates of how climate change will affect food supply and hunger in the agricultural regions of the world, but it will also build the capabilities of developing countries to estimate how climate change will affect their supply and demand for food.
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45 CFR 146.150 - Guaranteed availability of coverage for employers in the small group market.
Code of Federal Regulations, 2010 CFR
2010-10-01
... SERVICES REQUIREMENTS RELATING TO HEALTH CARE ACCESS REQUIREMENTS FOR THE GROUP HEALTH INSURANCE MARKET Provisions Applicable to Only Health Insurance Issuers § 146.150 Guaranteed availability of coverage for... paragraphs (c) through (f) of this section, each health insurance issuer that offers health insurance...
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Schultz, Jon-Håkon; Langballe, Åse; Raundalen, Magne
2014-01-01
Background In the context of crisis and disasters, school-aged children are a vulnerable group with fewer coping resources than adults. The school is a key arena for preventive interventions; teachers can be given a key role in large-scale school-based interventions following a man-made or natural disaster. Objectives This paper describes a practical example of designing a school-based population-level intervention. Methods The preventive measures were delivered as a national communication strategy between teachers and pupils aged 6–19 concerning the terror attack on 22 July 2011 in Norway. The strategy is based on principles from international research. Results The presentation contributes to the discussion of defining the teacher's role in school-based crisis interventions and dealing with high-intensity media coverage of war, terror, and catastrophes. Conclusions The presentation provides educational and psychological perspectives on how teachers can take an active role in helping pupils to deal with such events through two approaches: the therapeutic approach, to restore calm and feelings of safety; and the educational approach, to foster reflection and deeper understanding. PMID:25018859
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Schultz, Jon-Håkon; Langballe, Ase; Raundalen, Magne
2014-01-01
In the context of crisis and disasters, school-aged children are a vulnerable group with fewer coping resources than adults. The school is a key arena for preventive interventions; teachers can be given a key role in large-scale school-based interventions following a man-made or natural disaster. This paper describes a practical example of designing a school-based population-level intervention. The preventive measures were delivered as a national communication strategy between teachers and pupils aged 6-19 concerning the terror attack on 22 July 2011 in Norway. The strategy is based on principles from international research. The presentation contributes to the discussion of defining the teacher's role in school-based crisis interventions and dealing with high-intensity media coverage of war, terror, and catastrophes. THE PRESENTATION PROVIDES EDUCATIONAL AND PSYCHOLOGICAL PERSPECTIVES ON HOW TEACHERS CAN TAKE AN ACTIVE ROLE IN HELPING PUPILS TO DEAL WITH SUCH EVENTS THROUGH TWO APPROACHES: the therapeutic approach, to restore calm and feelings of safety; and the educational approach, to foster reflection and deeper understanding.
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Pharmaceutical cost containment and innovation in the United States.
Kane, N M
1997-09-01
In the United States, government has played a limited role in containing the costs of pharmaceuticals. There are no price controls, no national drug formularies, no universal cost-sharing policies, and perhaps most important, no national coverage of prescription drugs. Rather, pharmaceutical cost containment was historically left to private insurers and managed care companies, while consumers paid out of pocket for close to 62% of all drug expenditures. US utilization has historically been relatively low and prices by far the highest of the four industrialized countries. The major change in pharmaceutical cost containment in the 1990s has been the consolidation of purchaser power at the level of the insurer and managed care companies. These 'whole sale' purchasers now represent 70% of direct manufacturer sales, and they are demanding and receiving deeper price discounts. Meanwhile these same players are implementing formulary policies, utilization controls, and disease management programs, the outcomes of which have not yet been systematically evaluated. Failure to pass on savings to consumers, cost shifting by manufacturers to vulnerable consumer groups, and potential under-utilization of cost-effective drugs remain of concern.
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Golden, N.H.; Rattner, B.A.
2003-01-01
The measurement of contaminant tissue concentrations or exposure-related effects in biota has been used extensively to monitor pollution and environmental health. Terrestrial vertebrates have historically been an important group of species in such evaluations, not only because many are excellent sentinels of environmental contamination, but also because they are valued natural resources in their own right that may be adversely affected by toxicant exposure. Selection of appropriate vertebrates for biomonitoring studies frequently relies on expert opinion, although a few rigorous schemes are in use for predicting vulnerability of birds to the adverse effects of petroleum crude oil. A Utility Index that ranks terrestrial vertebrate species as potential sentinels of contaminants in a region, and a Vulnerability Index that assesses the threat of specific groups of contaminants to these species, have been developed to assist decision makers in risk assessments of persistent organic pollutants, cholinesterase-inhibiting pesticides, petroleum crude oil, mercury, and lead shot. Twenty-five terrestrial vertebrate species commonly found in Atlantic Coast estuarine habitat were ranked for their utility as biomonitors of contamination and their vulnerability to pollutants in this region. No single species, taxa or class of vertebrates was found to be an ideal sentinel for all groups of contaminants. Although birds have overwhelmingly been used to monitor contaminants compared to other terrestrial vertebrate classes, the non-migratory nature and dietary habits of the snapping turtle and mink consistently resulted in ranking these species excellent sentinels as well. Vulnerability of Atlantic Coast populations of these species varied considerably among groups of contaminants. Usually a particular species was found to be at high risk to only one or two groups of contaminants, although a noteworthy exception is the bald eagle that is highly vulnerable to all five of the contaminant groups examined. This index could be further enhanced by generation of additional comparative toxicity data to facilitate interspecific extrapolations. The Utility and Vulnerability Indices have application to many types of habitat types in addition to estuaries, and are of value to natural resource and risk managers that routinely conduct local, regional or national environmental quality assessments.
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Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial.
Acera, Amelia; Manresa, Josep Maria; Rodriguez, Diego; Rodriguez, Ana; Bonet, Josep Maria; Trapero-Bertran, Marta; Hidalgo, Pablo; Sànchez, Norman; de Sanjosé, Silvia
2017-01-01
Opportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage. The CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona.A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a "rescue" visit as the screening visit resulting from the study invitation. Among the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p<0.001). However, the differences were more substantial in the age groups 50-59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women. The study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age. ClinicalTrials.gov NCT01373723.
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Health Expenditure Growth under Single-Payer Systems: Comparing South Korea and Taiwan.
Cheng, Shou-Hsia; Jin, Hyun-Hyo; Yang, Bong-Min; Blank, Robert H
2018-05-03
Achieving universal health coverage has been an important goal for many countries worldwide. However, the rapid growth of health expenditures has challenged all nations, both those with and without such universal coverage. Single-payer systems are considered more efficient for administrative affairs and may be more effective for containing costs than multipayer systems. However, South Korea, which has a typical single-payer scheme, has almost the highest growth rate in health expenditures among industrialized countries. The aim of the present study is to explicate this situation by comparing South Korea with Taiwan. This study analyzed statistical reports published by government departments in South Korea and Taiwan from 2001 to 2015, including population and economic statistics, health statistics, health expenditures, and social health insurance reports. Between 2001 and 2015, the per capita national health expenditure (NHE) in South Korea grew 292%, whereas the corresponding growth of per capita NHE in Taiwan was only 83%. We find that the national health insurance (NHI) global budget cap in Taiwan may have restricted the growth of health expenditures. Less comprehensive benefit coverage for essential diagnosis/treatment services under the South Korean NHI program may have contributed to the growth of out-of-pocket payments. The expansion of insurance coverage for vulnerable individuals may also contribute to higher growth in NHE in South Korea. Explicit regulation of health care resource distribution may also lead to more limited provisioning and utilization of health services in Taiwan. Under analogous single-payer systems, South Korea had a much higher growth in health spending than Taiwan. The annual budget cap for total reimbursement, more comprehensive coverage for essential diagnosis and treatment services, and the regulation of health care resource distribution are important factors associated with the growth of health expenditures. Copyright © 2018. Published by Elsevier Inc.
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2017-01-01
Severe and morbid obesity are associated with highly elevated risks of adverse health outcomes and the prevalence of severe obesity is increasing globally. To date, disaster literature has not considered severe and morbid obesity as a specific vulnerability, despite reports of people being left behind during disasters because of their body size, shape or weight. The complex causes of obesity are associated with the social determinants of health and one’s potential vulnerability to disasters. The absence of appropriate considerations may lead to people being exposed to disproportionate and potentially avoidable risk. The intersection of the social determinants of health, disaster vulnerability, severe and morbid obesity is explored. Previously identified vulnerable groups are also represented in severe and morbid obesity data. This poses the prospect for ‘triple jeopardy’ compounding the social determinants of health, disaster vulnerability and considerations with and for people with morbid obesity. When working to reduce disaster risk for vulnerable groups, the author proposes specific consideration is required to ensure ‘all-of-society engagement and partnership’ in an inclusive, accessible and non-discriminatory manner, to ensure no one is left behind.
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Gouda, Hebe N; Hodge, Andrew; Bermejo, Raoul; Zeck, Willibald; Jimenez-Soto, Eliana
2016-01-01
In recent years, the government of the Philippines embarked upon an ambitious Universal Health Care program, underpinned by the rapid scale-up of subsidized insurance coverage for poor and vulnerable populations. With a view of reducing the stubbornly high maternal mortality rates in the country, the program has a strong focus on maternal health services and is supported by a national policy of universal facility-based delivery (FBD). In this study, we examine the impact that recent reforms expanding health insurance coverage have had on FBD. Data from the most recent Philippines 2013 Demographic Health Survey was employed. This study applies quasi-experimental methods using propensity scores along with alternative matching techniques and weighted regression to control for self-selection and investigate the impact of health insurance on the utilization of FBD. Our findings reveal that the likelihood of FBD for women who are insured is between 5 to 10 percent higher than for those without insurance. The impact of health insurance is more pronounced amongst rural and poor women for whom insurance leads to a 9 to 11 per cent higher likelihood of FBD. We conclude that increasing health insurance coverage is likely to be an effective approach to increase women's access to FBD. Our findings suggest that when such coverage is subsidized, as it is the case in the Philippines, women from poor and rural populations are likely to benefit the most.
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Social and Contextual Influences on Mental Health Following an Episode of Mass Violence.
Felix, Erika D; Moore, Stephanie A; Meskunas, Haley; Terzieva, Antoniya
2017-11-01
Few studies explore how the recovery context following an episode of mass violence affects posttragedy mental health (MH), despite clear implications for developing posttrauma supports. Following a mass murder, this prospective, longitudinal study examined how reactions to media coverage, family reactions, and disappointment in social support influenced posttragedy MH (posttraumatic stress, depression, anxiety), above and beyond the influence of pretragedy MH, pretragedy victimization, and objective exposure. University students who participated in a study of college adjustment prior to the mass murder ( n = 593) were recontacted and provided information on their posttragedy life ( n = 142). Students ( n = 84) also responded to open-ended questions about what was the most stressful part of the tragedy and psychological effects of the mass murder. After accounting for pretragedy victimization and MH, and objective exposure to events, hierarchical regression analyses indicated that distress related to media coverage and stronger family reactions contributed to higher levels of posttraumatic stress symptoms and anxiety, but not depression. Disappointment with social support was not significantly related to posttragedy MH. Common themes in student comments include grief, feeling vulnerable/unsafe, concern for the impact on others, stress related to media coverage, proximity to the events, changes in psychosocial adjustment, and returning to daily life. Results suggest that negative reactions to media coverage and family reactions that are overprotective or distressing negatively affect survivors' MH, beyond their objective exposure to the violence, pretragedy MH, and pretragedy victimization.
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Gouda, Hebe N.; Hodge, Andrew; Bermejo, Raoul; Zeck, Willibald; Jimenez-Soto, Eliana
2016-01-01
Objectives In recent years, the government of the Philippines embarked upon an ambitious Universal Health Care program, underpinned by the rapid scale-up of subsidized insurance coverage for poor and vulnerable populations. With a view of reducing the stubbornly high maternal mortality rates in the country, the program has a strong focus on maternal health services and is supported by a national policy of universal facility-based delivery (FBD). In this study, we examine the impact that recent reforms expanding health insurance coverage have had on FBD. Results Data from the most recent Philippines 2013 Demographic Health Survey was employed. This study applies quasi-experimental methods using propensity scores along with alternative matching techniques and weighted regression to control for self-selection and investigate the impact of health insurance on the utilization of FBD. Findings Our findings reveal that the likelihood of FBD for women who are insured is between 5 to 10 percent higher than for those without insurance. The impact of health insurance is more pronounced amongst rural and poor women for whom insurance leads to a 9 to 11 per cent higher likelihood of FBD. Conclusions We conclude that increasing health insurance coverage is likely to be an effective approach to increase women’s access to FBD. Our findings suggest that when such coverage is subsidized, as it is the case in the Philippines, women from poor and rural populations are likely to benefit the most. PMID:27911935
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Sommers, Benjamin D
2014-05-01
Recent cancellations of nongroup health insurance plans generated much policy debate and raised concerns that the Affordable Care Act (ACA) may increase the number of uninsured Americans in the short term. This article provides evidence on the stability of nongroup coverage using US census data for the period 2008-11, before ACA provisions took effect. The principal findings are threefold. First, this market was characterized by high turnover: Only 42 percent of people with nongroup coverage at the outset of the study period retained that coverage after twelve months. Second, 80 percent of people experiencing coverage changes acquired other insurance within a year, most commonly from an employer. Third, turnover varied across groups, with stable coverage more common for whites and self-employed people than for other groups. Turnover was particularly high among adults ages 19-35, with only 21 percent of young adults retaining continuous nongroup coverage for two years. Given estimates from 2012 that 10.8 million people were covered in this market, these results suggest that 6.2 million people leave nongroup coverage annually. This suggests that the nongroup market was characterized by frequent disruptions in coverage before the ACA and that the effects of the recent cancellations are not necessarily out of the norm. These results can serve as a useful pre-ACA baseline with which to evaluate the law's long-term impact on the stability of nongroup coverage.
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Code of Federal Regulations, 2010 CFR
2010-01-01
... employee or eligible family member loses coverage under FEHB or another group insurance coverage including... health plan as described in § 890.301 (i)(6). (11) An employee or eligible family member gains coverage.... FEHB Program means the Federal Employees Health Benefits Program described in 5 U.S.C. 8901. Open...
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2016-01-01
Influenza vaccination is an effective strategy to reduce morbidity and mortality, particularly for those who have decreased lung functions. This study was to identify the factors that affect vaccination coverage according to the results of pulmonary function tests depending on the age. In this cross-sectional study, data were obtained from 3,224 adults over the age of 40 who participated in the fifth National Health and Nutrition Examination Survey and underwent pulmonary function testing in 2012. To identify the factors that affect vaccination rate, logistic regression analysis was conducted after dividing the subjects into two groups based on the age of 65. Influenza vaccination coverage of the entire subjects was 45.2%, and 76.8% for those aged 65 and over. The group with abnormal pulmonary function had a higher vaccination rate than the normal group, but any pulmonary dysfunction or history of COPD did not affect the vaccination coverage in the multivariate analysis. The subjects who were 40-64 years-old had higher vaccination coverage when they were less educated or with restricted activity level, received health screenings, and had chronic diseases. Those aged 65 and over had significantly higher vaccination coverage only when they received regular health screenings. Any pulmonary dysfunction or having COPD showed no significant correlation with the vaccination coverage in the Korean adult population. PMID:27134491
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Teixeira, Pedro Gr; Woo, Karen; Beck, Adam W; Scali, Salvatore T; Weaver, Fred A
2017-12-01
Objectives Investigate the impact of left subclavian artery coverage without revascularization on spinal cord ischemia development in patients undergoing thoracic endovascular aortic repair. Methods The Vascular Quality Initiative thoracic endovascular aortic repair module (April 2011-July 2014) was analyzed. Patients undergoing left subclavian artery coverage were divided into two groups according to revascularization status. The association between left subclavian artery revascularization with the primary outcome of spinal cord ischemia and the secondary outcome of stroke was assessed with multivariable analysis adjusting for between-group baseline differences. Results The left subclavian artery was covered in 508 (24.6%) of the 2063 thoracic endovascular aortic repairs performed. Among patients with left subclavian artery coverage, 58.9% underwent revascularization. Spinal cord ischemia incidence was 12.1% in the group without revascularization compared to 8.5% in the group undergoing left subclavian artery revascularization (odds ratio (95%CI): 1.48(0.82-2.68), P = 0.189). Multivariable analysis adjustment identified an independent association between left subclavian artery coverage without revascularization and the incidence of spinal cord ischemia (adjusted odds ratio (95%CI): 2.29(1.03-5.14), P = 0.043). Although the incidence of stroke was also higher for the group with a covered and nonrevascularized left subclavian artery (12.1% versus 8.5%), this difference was not statistically significant after multivariable analysis (adjusted odds ratio (95%CI): 1.55(0.74-3.26), P = 0.244). Conclusion For patients undergoing left subclavian artery coverage during thoracic endovascular aortic repair, the addition of a revascularization procedure was associated with a significantly lower incidence of spinal cord ischemia.
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Shepherd, Neal; Greenwell, Henry; Hill, Margaret; Vidal, Ricardo; Scheetz, James P
2009-03-01
The primary aim of this randomized, controlled, blinded clinical pilot study was to compare the percentage of recession defect coverage obtained with a coronally positioned tunnel (CPT) plus an acellular dermal matrix allograft (ADM) to that of a CPT plus ADM and platelet-rich plasma (CPT/PRP) 4 months post-surgically. Eighteen patients with Miller Class I or II recession >or=3 mm at one site were treated and followed for 4 months. Nine patients received a CPT plus ADM and were considered the positive control group. The test group consisted of nine patients treated with a CPT plus ADM and PRP. Patients were randomly selected by a coin toss to receive the test or positive control treatment. The mean recession at the initial examination for the CPT group was 3.6 +/- 1.0 mm, which was reduced to 1.0 +/- 1.0 mm at the 4-month examination for a gain of 2.6 +/- 1.5 mm or 70% defect coverage (P <0.05). The mean recession at the initial examination for the CPT/PRP group was 3.3 +/- 0.7 mm, which was reduced to 0.4 +/- 0.7 mm at the 4-month examination for a gain of 2.9 +/- 0.5 mm or 90% defect coverage (P <0.05). There were no statistically significant differences between the groups (P >0.05). The CPT plus ADM and PRP produced defect coverage of 90%, whereas the CPT with ADM produced only 70% defect coverage. This difference was not statistically significant, but it may be clinically significant.
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Vulnerability of Coastal Communities from Storm Surge and Flood Disasters
Bathi, Jejal Reddy; Das, Himangshu S.
2016-01-01
Disasters in the form of coastal storms and hurricanes can be very destructive. Preparing for anticipated effects of such disasters can help reduce the public health and economic burden. Identifying vulnerable population groups can help prioritize resources for the most needed communities. This paper presents a quantitative framework for vulnerability measurement that incorporates both socioeconomic and flood inundation vulnerability. The approach is demonstrated for three coastal communities in Mississippi with census tracts being the study unit. The vulnerability results are illustrated as thematic maps for easy usage by planners and emergency responders to assist in prioritizing their actions to vulnerable populations during storm surge and flood disasters. PMID:26907313
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Populations of concern: Chapter 9
Gamble, Janet; Balbus, John; Berger, Martha; Bouye, Karen; Campbell, Vince; Chief, Karletta; Conlon, K.; Crimmins, Allison; Flanagan, Barry; Gonzalez-Maddux, C.; Hallisey, E.; Hutchins, S.; Jantarasami, L.; Khoury, S.; Kiefer, M.; Kolling, J.; Lynn, K.; Manangan, A.; McDonald, M.; Morello-Frosch, R.; Hiza, Margaret; Sheffield, P.; Thigpen Tart, K.; Watson, J.; Whyte, K.P.; Wolkin, A.F.
2016-01-01
Climate change is already causing, and is expected to continue to cause, a range of health impacts that vary across different population groups in the United States. The vulnerability of any given group is a function of its sensitivity to climate change related health risks, its exposure to those risks, and its capacity for responding to or coping with climate variability and change. Vulnerable groups of people, described here as populations of concern, include those with low income, some communities of color, immigrant groups (including those with limited English proficiency), Indigenous peoples, children and pregnant women, older adults, vulnerable occupational groups, persons with disabilities, and persons with preexisting or chronic medical conditions. Planners and public health officials, politicians and physicians, scientists and social service providers are tasked with understanding and responding to the health impacts of climate change. Collectively, their characterization of vulnerability should consider how populations of concern experience disproportionate, multiple, and complex risks to their health and well-being in response to climate change. Some groups face a number of stressors related to both climate and non-climate factors. For example, people living in impoverished urban or isolated rural areas, floodplains, coastlines, and other at-risk locations are more vulnerable not only to extreme weather and persistent climate change but also to social and economic stressors. Many of these stressors can occur simultaneously or consecutively. Over time, this “accumulation” of multiple, complex stressors is expected to become more evident1 as climate impacts interact with stressors associated with existing mental and physical health conditions and with other socioeconomic and demographic factors.
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Chola, Lumbwe; Pillay, Yogan; Barron, Peter; Tugendhaft, Aviva; Kerber, Kate; Hofman, Karen
2015-01-01
Background South Africa has made substantial progress on child and maternal mortality, yet many avoidable deaths of mothers and children still occur. This analysis identifies priority interventions to be scaled up nationally and projects the potential maternal and child lives saved. Design We modelled the impact of maternal, newborn and child interventions using the Lives Saved Tools Projections to 2015 and used realistic coverage increases based on expert opinion considering recent policy change, financial and resource inputs, and observed coverage change. A scenario analysis was undertaken to test the impact of increasing intervention coverage to 95%. Results By 2015, with realistic coverage, the maternal mortality ratio (MMR) can reduce to 153 deaths per 100,000 and child mortality to 34 deaths per 1,000 live births. Fifteen interventions, including labour and delivery management, early HIV treatment in pregnancy, prevention of mother-to-child transmission and handwashing with soap, will save an additional 9,000 newborns and children and 1,000 mothers annually. An additional US$370 million (US$7 per capita) will be required annually to scale up these interventions. When intervention coverage is increased to 95%, breastfeeding promotion becomes the top intervention, the MMR reduces to 116 and the child mortality ratio to 23. Conclusions The 15 interventions identified were adopted by the National Department of Health, and the Health Minister launched a campaign to encourage Provincial Health Departments to scale up coverage. It is hoped that by focusing on implementing these 15 interventions at high quality, South Africa will reach Millennium Development Goal (MDG) 4 soon after 2015 and MDG 5 several years later. Focus on HIV and TB during early antenatal care is essential. Strategic gains could be realised by targeting vulnerable populations and districts with the worst health outcomes. The analysis demonstrates the usefulness of priority setting tools and the potential for evidence-based decision making in the health sector. PMID:25906769
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Incentives for nondiscriminatory wellness programs in group health plans. Final rule.
2013-06-03
This document contains final regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage. Specifically, these final regulations increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20 percent to 30 percent of the cost of coverage. The final regulations further increase the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use. These regulations also include other clarifications regarding the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination.
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Experiential avoidance in the vulnerability to depression among adolescent females.
Mellick, William; Vanwoerden, Salome; Sharp, Carla
2017-01-15
Although various mechanisms in the maternal transmission of Major Depressive Disorder (MDD) have been investigated, it is unknown whether experiential avoidance (EA) is a vulnerability factor in the development of depression or a consequence of the illness. The present study utilized a high-risk design to determine if EA indeed poses vulnerability to adolescent MDD. Secondly, we examined the means by which adolescent EA may come to pose vulnerability, namely that it explains the relation between maternal EA and adolescent depressive symptoms. One-hundred and forty-six biological mother/adolescent daughter dyads comprised three diagnostic groups: mothers with a history of MDD and their depressed daughters (MDD; n=21), mothers with a history of MDD and their never-depressed daughters (high-risk, HR; n=69), and healthy controls (HCs; n=56). Groups differed on daughter EA such that the MDD group reported greater EA than the HR group, which in turn reported greater EA than HCs. Daughter EA mediated the relation between maternal EA and daughter depressive symptoms after controlling for maternal depressive symptoms. Strengths aside, this study included a relatively small group of depressed mother-daughter dyads and relied on cross-sectional self-report data. EA appears to serve as a vulnerability factor for adolescent MDD, and the mechanistic role of daughter EA highlights the significance of intergenerational EA in the maternal transmission of depression. Therapeutic approaches may therefore consider reducing the transmission of EA from mothers to daughters. Copyright © 2016 Elsevier B.V. All rights reserved.
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Herens, Marion; Bakker, Evert Jan; van Ophem, Johan; Wagemakers, Annemarie; Koelen, Maria
2016-01-01
Physical inactivity is most commonly found in socially vulnerable groups. Dutch policies target these groups through community-based health-enhancing physical activity (CBHEPA) programs. As robust evidence on the effectiveness of this approach is limited, this study investigated whether CBHEPA programs contribute to an increase in and the maintenance of physical activity in socially vulnerable groups. In four successive cohorts, starting at a six-month interval, 268 participants from 19 groups were monitored for twelve months in seven CBHEPA programs. Data collection was based on repeated questionnaires. Socio-economic indicators, program participation and coping ability were measured at baseline. Physical activity, health-related quality of life and on-going program participation were measured three times. Self-efficacy and enjoyment were measured at baseline and at twelve months. Statistical analyses were based on a quasi-RCT design (independent t-tests), a comparison of participants and dropouts (Mann-Whitney test), and multilevel modelling to assess change in individual physical activity, including group level characteristics. Participants of CBHEPA programs are socially vulnerable in terms of low education (48.6%), low income (52.4%), non-Dutch origin (64.6%) and health-related quality of life outcomes. Physical activity levels were not below the Dutch average. No increase in physical activity levels over time was observed. The multilevel models showed significant positive associations between health-related quality of life, self-efficacy and enjoyment, and leisure-time physical activity over time. Short CBHEPA programs (10–13 weeks) with multiple trainers and gender-homogeneous groups were associated with lower physical activity levels over time. At twelve months, dropouts' leisure-time physical activity levels were significantly lower compared to continuing participants, as were health-related quality of life, self-efficacy and enjoyment outcomes. BMI and care consumption scored significantly higher among dropouts. In conclusion, Dutch CBHEPA programs reach socially vulnerable, but not necessarily inactive, groups in terms of socio-economic and health-related quality of life outcomes. Our findings suggest that CBHEPA programs particularly contribute to physical activity maintenance in socially vulnerable groups, rather than to an increase in physical activity behaviour over time. PMID:26909696
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Herens, Marion; Bakker, Evert Jan; van Ophem, Johan; Wagemakers, Annemarie; Koelen, Maria
2016-01-01
Physical inactivity is most commonly found in socially vulnerable groups. Dutch policies target these groups through community-based health-enhancing physical activity (CBHEPA) programs. As robust evidence on the effectiveness of this approach is limited, this study investigated whether CBHEPA programs contribute to an increase in and the maintenance of physical activity in socially vulnerable groups. In four successive cohorts, starting at a six-month interval, 268 participants from 19 groups were monitored for twelve months in seven CBHEPA programs. Data collection was based on repeated questionnaires. Socio-economic indicators, program participation and coping ability were measured at baseline. Physical activity, health-related quality of life and on-going program participation were measured three times. Self-efficacy and enjoyment were measured at baseline and at twelve months. Statistical analyses were based on a quasi-RCT design (independent t-tests), a comparison of participants and dropouts (Mann-Whitney test), and multilevel modelling to assess change in individual physical activity, including group level characteristics. Participants of CBHEPA programs are socially vulnerable in terms of low education (48.6%), low income (52.4%), non-Dutch origin (64.6%) and health-related quality of life outcomes. Physical activity levels were not below the Dutch average. No increase in physical activity levels over time was observed. The multilevel models showed significant positive associations between health-related quality of life, self-efficacy and enjoyment, and leisure-time physical activity over time. Short CBHEPA programs (10-13 weeks) with multiple trainers and gender-homogeneous groups were associated with lower physical activity levels over time. At twelve months, dropouts' leisure-time physical activity levels were significantly lower compared to continuing participants, as were health-related quality of life, self-efficacy and enjoyment outcomes. BMI and care consumption scored significantly higher among dropouts. In conclusion, Dutch CBHEPA programs reach socially vulnerable, but not necessarily inactive, groups in terms of socio-economic and health-related quality of life outcomes. Our findings suggest that CBHEPA programs particularly contribute to physical activity maintenance in socially vulnerable groups, rather than to an increase in physical activity behaviour over time.
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Spencer, Donna L; McManus, Margaret; Call, Kathleen Thiede; Turner, Joanna; Harwood, Christopher; White, Patience; Alarcon, Giovann
2018-06-01
We examine changes to health insurance coverage and access to health care among children, adolescents, and young adults since the implementation of the Affordable Care Act. Using the National Health Interview Survey, bivariate and logistic regression analyses were conducted to compare coverage and access among children, young adolescents, older adolescents, and young adults between 2010 and 2016. We show significant improvements in coverage among children, adolescents, and young adults since 2010. We also find some gains in access during this time, particularly reductions in delayed care due to cost. While we observe few age-group differences in overall trends in coverage and access, our analysis reveals an age-gradient pattern, with incrementally worse coverage and access rates for young adolescents, older adolescents, and young adults. Prior analyses often group adolescents with younger children, masking important distinctions. Future reforms should consider the increased coverage and access risks of adolescents and young adults, recognizing that approximately 40% are low income, over a third live in the South, where many states have not expanded Medicaid, and over 15% have compromised health. Copyright © 2018 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
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Spencer, Donna L.; McManus, Margaret; Call, Kathleen Thiede; Turner, Joanna; Harwood, Christopher; White, Patience; Alarcon, Giovann
2018-01-01
Purpose We examine changes to health insurance coverage and access to health care among children, adolescents, and young adults since the implementation of the Affordable Care Act. Methods Using the National Health Interview Survey, bivariate and logistic regression analyses were conducted to compare coverage and access among children, young adolescents, older adolescents, and young adults between 2010 and 2016. Results We show significant improvements in coverage among children, adolescents, and young adults since 2010. We also find some gains in access during this time, particularly reductions in delayed care due to cost. While we observe few age-group differences in overall trends in coverage and access, our analysis reveals an age-gradient pattern, with incrementally worse coverage and access rates for young adolescents, older adolescents, and young adults. Conclusions Prior analyses often group adolescents with younger children, masking important distinctions. Future reforms should consider the increased coverage and access risks of adolescents and young adults, recognizing that approximately 40% are low income, over a third live in the South, where many states have not expanded Medicaid, and over 15% have compromised health. PMID:29599046
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Vulnerability to heatwaves and implications for public health interventions - A scoping review.
Mayrhuber, Elisabeth Anne-Sophie; Dückers, Michel L A; Wallner, Peter; Arnberger, Arne; Allex, Brigitte; Wiesböck, Laura; Wanka, Anna; Kolland, Franz; Eder, Renate; Hutter, Hans-Peter; Kutalek, Ruth
2018-05-31
Heatwaves form a serious public health threat, especially for vulnerable groups. Interventions such as active outreach programs, exposure reduction measures and monitoring and mapping of at-risk groups are increasingly implemented across the world but little is known about their effect. To assess how vulnerable groups are identified and reached in heat health interventions, to understand the effectiveness and efficiency of those interventions, and to identify research gaps in existing literature. We performed a literature search in relevant scientific literature databases and searched with a four element search model for articles published from 1995 onward. We extracted data on intervention measures, target group and evaluation of effectiveness and efficiency. We identified 23 eligible studies. Patterns exist in type of interventions 1) to detect and 2) to influence extrinsic and intrinsic risk and protective factors. Results showed several intervention barriers related to the variety and intersection of these factors, as well as the self-perception of vulnerable groups, and misconceptions and unfavorable attitudes towards intervention benefits. While modest indications for the evidence on the effectiveness of interventions were found, efficiency remains unclear. Interventions entailed logical combinations of measures, subsumed as packages. Evidence for effective and efficient intervention is limited by the difficulty to determine effects and because single measures are mutually dependent. Interventions prioritized promoting behavioral change and were based on behavioral assumptions that remain untested and mechanisms not worked out explicitly. Multifaceted efforts are needed to tailor interventions, compiled in heat health warning systems and action plans for exposure reduction and protection of vulnerable populations, to fit the social, economic and geographical context. Besides adequately addressing relevant risk and protective factors, the challenge is to integrate perspectives of vulnerable groups. Future research should focus on intervention barriers and improving the methods of effectiveness and efficiency evaluation. Copyright © 2018 Elsevier Inc. All rights reserved.
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Spatial-explicit modeling of social vulnerability to malaria in East Africa
2014-01-01
Background Despite efforts in eradication and control, malaria remains a global challenge, particularly affecting vulnerable groups. Despite the recession in malaria cases, previously malaria free areas are increasingly confronted with epidemics as a result of changing environmental and socioeconomic conditions. Next to modeling transmission intensities and probabilities, integrated spatial methods targeting the complex interplay of factors that contribute to social vulnerability are required to effectively reduce malaria burden. We propose an integrative method for mapping relative levels of social vulnerability in a spatially explicit manner to support the identification of intervention measures. Methods Based on a literature review, a holistic risk and vulnerability framework has been developed to guide the assessment of social vulnerability to water-related vector-borne diseases (VBDs) in the context of changing environmental and societal conditions. Building on the framework, this paper applies spatially explicit modeling for delineating homogeneous regions of social vulnerability to malaria in eastern Africa, while taking into account expert knowledge for weighting the single vulnerability indicators. To assess the influence of the selected indicators on the final index a local sensitivity analysis is carried out. Results Results indicate that high levels of malaria vulnerability are concentrated in the highlands, where immunity within the population is currently low. Additionally, regions with a lack of access to education and health services aggravate vulnerability. Lower values can be found in regions with relatively low poverty, low population pressure, low conflict density and reduced contributions from the biological susceptibility domain. Overall, the factors characterizing vulnerability vary spatially in the region. The vulnerability index reveals a high level of robustness in regard to the final choice of input datasets, with the exception of the immunity indicator which has a marked impact on the composite vulnerability index. Conclusions We introduce a conceptual framework for modeling risk and vulnerability to VBDs. Drawing on the framework we modeled social vulnerability to malaria in the context of global change using a spatially explicit approach. The results provide decision makers with place-specific options for targeting interventions that aim at reducing the burden of the disease amongst the different vulnerable population groups. PMID:25127688
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Reino, Danilo Maeda; Maia, Luciana Prado; Fernandes, Patrícia Garani; Souza, Sergio Luis Scombatti de; Taba Junior, Mario; Palioto, Daniela Bazan; Grisi, Marcio Fermandes de Moraes; Novaes, Arthur Belém
2015-10-01
The aim of this randomized controlled clinical study was to compare the extended flap technique (EFT) with the coronally advanced flap technique (CAF) using a porcine collagen matrix (PCM) for root coverage. Twenty patients with two bilateral gingival recessions, Miller class I or II on non-molar teeth were treated with CAF+PCM (control group) or EFT+PCM (test group). Clinical measurements of probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), keratinized tissue height (KTH), keratinized mucosa thickness (KMT) were determined at baseline, 3 and 6 months post-surgery. At 6 months, the mean root coverage for test group was 81.89%, and for control group it was 62.80% (p<0.01). The change of recession depth from baseline was statistically significant between test and control groups, with an mean of 2.21 mm gained at the control sites and 2.84 mm gained at the test sites (p=0.02). There were no statistically significant differences for KTH, PPD or CAL comparing the two therapies. The extended flap technique presented better root coverage than the coronally advanced flap technique when PCM was used.
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Is endemic political corruption hampering provision of ART and PMTCT in developing countries?
Young Nicola Man, Wing; Worth, Heather; Kelly, Angela; Wilson, David P; Siba, Peter
2014-01-01
Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic. The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries. This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses. Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage. Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies.
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Is endemic political corruption hampering provision of ART and PMTCT in developing countries?
Man, Wing Young Nicola; Worth, Heather; Kelly, Angela; Wilson, David P; Siba, Peter
2014-01-01
Introduction Leadership is a key factor in the success of HIV prevention and treatment. Positive HIV-related outcomes are also affected by funding levels for HIV, health sector resources, disease burden and the socio-economic environment. Leadership on HIV as well as these other factors are affected by the quality of political governance of the country, which may be an overarching factor that influences the making of effective responses to the HIV epidemic. Aim The aim of the study was to investigate the association between quality of political governance, on one hand, and coverage of antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT), on the other, in low- to middle-income countries. Methods This investigation was carried out through a global review, online data sourcing and statistical analyses. We collected data on health burden and resources, the socio-economic environment, HIV prevalence, ART and PMTCT coverage and indicators of political governance. Outcome variables were coverage of ART (from 2004) and PMTCT (from 2007) to 2009 as a percentage of persons needing it. Potential predictors of treatment coverage were fitted with a baseline multilevel model for univariable and multivariable analyses. Results Countries with higher levels of political voice and accountability, more political stability and better control of corruption have higher levels of ART coverage but not PMTCT coverage. Control of corruption (in standard deviation units) had a strong association with ART (AOR=1.82, p=0.002) and PMTCT (AOR=1.97, p=0.01) coverage. Indicators of economic development were not significant when control of corruption was included in the multivariable regression model. Many countries in all income groups had high ART but not PMTCT coverage (e.g. Mexico, Brazil and Romania in the upper-middle-income group; Papua New Guinea and Philippines in the lower-middle-income group; and Cambodia, Laos and Comoros in the low-income group). Very few low-income countries (notably, Haiti and Kenya) had high PMTCT coverage. Conclusions Our research found a significant relationship between quality of political governance and treatment coverage. Measures and policies for improving the quality of political governance should be considered as a part of HIV programme implementation to more effectively improve the welfare of people living with HIV, particularly mothers living with HIV and their babies. PMID:24802716
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Vojt, G; Skivington, K; Sweeting, H; Campbell, M; Fenton, C; Thomson, H
2018-05-30
To review empirical evaluations of individual-level interventions intended to improve mental health or well-being for vulnerable adolescents. This is a systematic mapping review. Thirteen databases covering academic and gray literature were searched for published reviews and randomised controlled trials, and gray literature (2005-2016) and the results quality-assessed to prioritise best available evidence. We aimed to identify well-conducted systematic reviews and trials that evaluated individual-level interventions, for mental health/well-being outcomes, where the population was adolescents aged 10-24 years in any of 12 vulnerable groups at high risk of poor health outcomes (e.g. homeless, offenders, 'looked after', carers). Thirty systematic reviews and 16 additional trials were identified. There was insufficient evidence to identify promising individual-level interventions that improve the mental health/well-being of any of the vulnerable groups. Despite Western policy to promote health and well-being among vulnerable young people, the dearth of evidence suggests a lack of interest in evaluating interventions targeting these groups in respect of their mental health/well-being outcomes. Copyright © 2018 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-08-03
... Care Act) relating to coverage of preventive services without any participant cost sharing. The IRS is issuing the temporary regulations at the same time that the Employee Benefits Security Administration of... the Public Health Service Act. The temporary regulations provide guidance to employers, group health...
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26 CFR 54.4980B-6 - Electing COBRA continuation coverage.
Code of Federal Regulations, 2011 CFR
2011-04-01
... without children who is receiving employer-paid coverage under a group health plan voluntarily terminates... dependent child's ceasing to be a dependent child under the generally applicable requirements of the plan or a divorce or legal separation of a covered employee. The group health plan is not required to offer...
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26 CFR 54.4980B-6 - Electing COBRA continuation coverage.
Code of Federal Regulations, 2012 CFR
2012-04-01
... without children who is receiving employer-paid coverage under a group health plan voluntarily terminates... dependent child's ceasing to be a dependent child under the generally applicable requirements of the plan or a divorce or legal separation of a covered employee. The group health plan is not required to offer...
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26 CFR 54.4980B-6 - Electing COBRA continuation coverage.
Code of Federal Regulations, 2013 CFR
2013-04-01
... without children who is receiving employer-paid coverage under a group health plan voluntarily terminates... dependent child's ceasing to be a dependent child under the generally applicable requirements of the plan or a divorce or legal separation of a covered employee. The group health plan is not required to offer...
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20 CFR 404.1251 - Final reports-for wages paid prior to 1987.
Code of Federal Regulations, 2010 CFR
2010-04-01
... entity. The report shall include each coverage group whose existence ceases with that of the entity. It... State shall submit a statement showing the title and business address of the State official responsible... records for each coverage group whose existence is ended. The State shall also identify, as prescribed by...
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Psychosocial Vulnerability Among Patients Contacting a Norwegian Sexual Assault Center.
Vik, Bjarte Frode; Nöttestad, Jim Aage; Schei, Berit; Rasmussen, Kirsten; Hagemann, Cecilie Therese
2016-07-01
In this study, the objective was to assess the occurrence of specific vulnerability factors among adult and adolescent females attending a Norwegian sexual assault center (SAC). We also explored assault characteristics and investigated whether these characteristics differed between the group of patients with vulnerability factors compared with the group without such factors. We conducted a retrospective descriptive study of 573 women ≥ 12 years of age attending the SAC at St. Olavs Hospital, Trondheim, Norway, between July 1, 2003 and December 31, 2010. A patient was considered vulnerable if at least one of the following features was present: intellectual or physical disability; history of present/former mental health problems; history of present/former alcohol/substance abuse; or former sexual assault. At least one vulnerability factor was present in 59% of the cases. More than one vulnerability factor was present in 29%. Reporting at least one vulnerability factor was associated with a higher patient age, unemployment, a higher frequency of reported light/moderate physical violence, and the documentation of minor body injury. In contrast, those without vulnerability more often were students assaulted during night time, by a casual or stranger assailant and reporting a higher intake of alcohol prior to the assault. There are obvious patterns of differences in the nature of sexual assaults reported among victims with specific vulnerability factors compared with victims without these factors. Future research should address these differences and possible solutions for better protection of especially vulnerable individuals against sexual offenses, such as those with mental health and substance abuse difficulties.
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-11-17
...This document contains an amendment to interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding status as a grandfathered health plan; the amendment permits certain changes in policies, certificates, or contracts of insurance without loss of grandfathered status.
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NASA Astrophysics Data System (ADS)
Depsky, N. J.; Flores-Lopez, F.
2014-12-01
Earlier this year the Stockholm Environment Institute (SEI) concluded a vulnerability analysis for the Metropolitan District of Quito (DMQ) in Ecuador. Vulnerability assessments were done for five sectors in the region: water resources, public health, agriculture, ecosystems and forest fires. This abstract focuses specifically on the vulnerability of the DMQ's water resources to climatic and anthropogenic uncertainties. This analysis focused on vulnerability of potable water supply for the city of Quito, as well as industrial and agricultural water needs. Current and future vulnerability was assessed in the face of a number of scenarios of climatic and non-climatic uncertainties. The assessment used an integrated water resources model developed by Quito's National Polytechnic University for the surrounding Guayllabamba river basin. The model was built using the Water Evaluation and Planning (WEAP) software, and encompasses the urban, rural/agricultural, and industrial demands throughout the basin, linking them with existing surface and ground-water supplies. Five future scenarios were constructed in the WEAP basin model out the year 2050 in order to assess their effects: Urban population growth (~70% by 2050). Urban population growth + rising mean air temperatures (~+2°C by 2050). Urban population growth + rising temperatures + drought (recurring 3-year drought cycles built into the projection) Urban population growth + rising temperatures + conversion of 'paramo' alpine tundra ecosystem into cultivated land. (WEAP allows the user to define various types of land cover extent throughout the basin, along with their unique physical characteristics to simulate rainfall-runoff. Conversion of 'paramo' land cover to agriculture was evaluated to see potential effects it may have on the system's hydrology) Urban population growth + rising temperatures + drought + conversion of 'paramos' Coverage of demands in the model was used as the primary vulnerability metric, with urban demands experiencing supply shortages of up to 20-25% under the most stressful scenarios, a shortage which is dampened by significantly increased groundwater pumping. Rural and industrial demands suffer much more severe shortages, with nearly all demands going unmet in a number of scenarios.
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Rodriguez, Hector P; Laugesen, Miriam J; Watts, Carolyn A
2010-12-01
To assess the effect of issue framing on voter support of tax increases for health insurance expansion. During October 2008, a random sample of registered voters (n=1203) were randomized to a control and two different 'framing' groups prior to being asked about their support for tax increases. The 'framing' groups listened to one of two statements: one emphasized the externalities or negative effects of the uninsured on the insured, and the other raised racial and ethnic disparities in health insurance coverage as a problem. All groups were asked the same questions: would they support tax increases to provide adequate and reliable health insurance for three groups, (1) all American citizens, (2) all children, irrespective of citizenship, and (3) all military veterans. Support for tax increases varied substantially depending on which group benefited from the expansion. Consensus on coverage for military veterans was highest (83.3%), followed by all children, irrespective of citizenship (64.7%), and all American citizens (60.1%). There was no statistically significant difference between voter support in the 'framing' and control groups or between the two frames. In multivariable analyses, political party affiliation was the strongest predictor of support. Voters agree on the need for coverage of military veterans, but are less united on the coverage of all children and American citizens. Framing was less important than party affiliation, suggesting that voters consider coverage expansions and related tax increases in terms of the characteristics of the targeted group, and their own personal political views and values rather than the broader impact of maintaining the status quo. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
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Analysis of Environmental Vulnerability in The Landslide Areas (Case Study: Semarang Regency)
NASA Astrophysics Data System (ADS)
Hani'ah; Firdaus, H. S.; Nugraha, A. L.
2017-12-01
The Land conversion can increase the risk of landslide disaster in Semarang Regency caused by human activity. Remote sensing and geographic information system to be used in this study to mapping the landslide areas because satellite image data can represent the object on the earth surface in wide area coverage. Satellite image Landsat 8 is used to mapping land cover that processed by supervised classification method. The parameters to mapping landslide areas are based on land cover, rainfall, slope, geological factors and soil types. Semarang Regency have the minimum value of landslide is 1.6 and the maximum value is 4.3, which is dominated by landslide prone areas about 791.27 km2. The calculation of the environmental vulnerability index in the study area is based on Perka BNPB No. 2/2012. Accumulation score of environmental vulnerability index is moderate value, that means environment condition must be considered, such as vegetation as ground cover and many others aspects. The range of NDVI value shows that density level in conservation areas (0.030 - 0.844) and conservation forest (0.045 - 0.849), which rarely until high density level. The results of this study furthermore can be assessed to reduce disaster risks from landslide as an effort of disaster preventive.
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28 CFR 55.6 - Coverage under section 203(c).
Code of Federal Regulations, 2011 CFR
2011-07-01
... THE VOTING RIGHTS ACT REGARDING LANGUAGE MINORITY GROUPS Nature of Coverage § 55.6 Coverage under... subdivision approach. A political subdivision is covered if— (i) More than 5 percent of its voting age... which more than 5 percent of the voting age citizens are members of a single language minority and are...
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28 CFR 55.6 - Coverage under section 203(c).
Code of Federal Regulations, 2010 CFR
2010-07-01
... THE VOTING RIGHTS ACT REGARDING LANGUAGE MINORITY GROUPS Nature of Coverage § 55.6 Coverage under... subdivision approach. A political subdivision is covered if— (i) More than 5 percent of its voting age... which more than 5 percent of the voting age citizens are members of a single language minority and are...
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Federal Register 2010, 2011, 2012, 2013, 2014
2013-02-01
... se and those that may apply for recognition are neither group health insurance coverage nor.... 156.602) c. Requirements for Recognition as Minimum Essential Coverage for Coverage Not Otherwise... recognition that they meet the standards under section 5000A(d)(2)(B) of the Code. We also received...
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ERIC Educational Resources Information Center
David, Matthew
2016-01-01
UK media coverage of global university league tables shows systematic bias towards the Russell Group, although also highlighting tensions within its membership. Coverage positions UK "elite" institutions between US superiority and Asian ascent. Coverage claims that league table results warrant UK university funding reform. However,…
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Matos, Vanina; Barcellos, Christovam; Camargo, Luiz Octávio de Lima
2013-01-01
This article examines how a group of tourists perceives health issues related to safety, prevention and health care during their travels. Interviews were conducted with Brazilian tourists visiting the city of Rio de Janeiro, as well as local residents leaving the city on trips. The interviews were analyzed in accordance with the dimensions of vulnerability, information, prevention and health care, from which vulnerability emerged as a category of analysis. The reports of the trajectory of the tourists made it possible to identify problems and opportunities that could be used by the health sector for actions of prevention and promotion. The means of transport determines the trajectory of tourists and their security alternatives. Traveling in groups and visiting tourist attractions are seen as protective factors, which reinforces the role of information and social support networks as resources used by tourists in the absence of specific policies geared to this highly mobile and vulnerable population group.
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NASA Astrophysics Data System (ADS)
Delavar, M. R.; Moradi, M.; Moshiri, B.
2015-12-01
Nowadays, urban areas are threatened by a number of natural hazards such as flood, landslide and earthquake. They can cause huge damages to buildings and human beings which necessitates disaster mitigation and preparation. One of the most important steps in disaster management is to understand all impacts and effects of disaster on urban facilities. Given that hospitals take care of vulnerable people reaction of hospital buildings against earthquake is vital. In this research, the vulnerability of hospital buildings against earthquake is analysed. The vulnerability of buildings is related to a number of criteria including age of building, number of floors, the quality of materials and intensity of the earthquake. Therefore, the problem of seismic vulnerability assessment is a multi-criteria assessment problem and multi criteria decision making methods can be used to address the problem. In this paper a group multi criteria decision making model is applied because using only one expert's judgments can cause biased vulnerability maps. Sugeno integral which is able to take into account the interaction among criteria is employed to assess the vulnerability degree of buildings. Fuzzy capacities which are similar to layer weights in weighted linear averaging operator are calculated using particle swarm optimization. Then, calculated fuzzy capacities are included into the model to compute a vulnerability degree for each hospital.
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Characterization of Vulnerable and Resilient Spanish Adolescents in Their Developmental Contexts
Moreno, Carmen; García-Moya, Irene; Rivera, Francisco; Ramos, Pilar
2016-01-01
Research on resilience and vulnerability can offer very valuable information for optimizing design and assessment of interventions and policies aimed at fostering adolescent health. This paper used the adversity level associated with family functioning and the positive adaptation level, as measured by means of a global health score, to distinguish four groups within a representative sample of Spanish adolescents aged 13–16 years: maladaptive, resilient, competent and vulnerable. The aforementioned groups were compared in a number of demographic, school context, peer context, lifestyles, psychological and socioeconomic variables, which can facilitate or inhibit positive adaptation in each context. In addition, the degree to which each factor tended to associate with resilience and vulnerability was examined. The majority of the factors operated by increasing the likelihood of good adaptation in resilient adolescents and diminishing it in vulnerable ones. Overall, more similarities than differences were found in the factors contributing to explaining resilience or vulnerability. However, results also revealed some differential aspects: psychological variables showed a larger explicative capacity in vulnerable adolescents, whereas factors related to school and peer contexts, especially the second, showed a stronger association with resilience. In addition, perceived family wealth, satisfaction with friendships and breakfast frequency only made a significant contribution to the explanation of resilience. The current study provides a highly useful characterization of resilience and vulnerability phenomena in adolescence. PMID:27458397
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Arbyn, Marc; Simoens, Cindy; Van Oyen, Herman; Foidart, Jean-Michel; Goffin, Frédéric; Simon, Philippe; Fabri, Valérie
2009-05-01
Cervical cancer screening by surveys overestimate coverage because of selection and reporting biases. The prepared Inter-Mutualistic Agency dataset has about 13 million records from Pap smears, colposcopies, cervical biopsies and surgery, performed in Belgium between 1996 and 2000. Cervical cancer screening coverage was defined as the proportion of the target population (women of 25-64 years) that has had a Pap smear taken within the last 3 years. Proportions and incidence rates were computed using official population data of the corresponding age group, area and calendar year. Cervical cancer screening coverage, in the period 1998-2000, was 59% at national level, for the target age group 25-64 years. Differences were small between the 3 regions. Variation ranged from 39% to 71%. Coverage was 64% for 25-29 year old women, 67% for those aged 30-39 years, 56% for those aged 50-54. The modal screening interval was 1 year. In the 3-year period 1998-2000, 3 million smears were taken from the 2.7 million women in the age group 25-64. Only 1.6 million women of the target group got one or more smears in that period and 1.1 million women had no smears, corresponding to an average of 1.88 smears per woman. Coverage reached only 59%, but the number of smears used was sufficient to cover more than 100% of the target population. Structural reduction of overuse and extension of coverage is warranted.
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Breeze, J; Lewis, E A; Fryer, R
2016-09-01
Military body armour is designed to prevent the penetration of ballistic projectiles into the most vulnerable structures within the thorax and abdomen. Currently the OSPREY and VIRTUS body armour systems issued to United Kingdom (UK) Armed Forces personnel are provided with a single size front and rear ceramic plate regardless of the individual's body dimensions. Currently limited information exists to determine whether these plates overprotect some members of the military population, and no method exists to accurately size plates to an individual. Computed Tomography (CT) scans of 120 male Caucasian UK Armed Forces personnel were analysed to measure the dimensions of internal thoraco-abdominal anatomical structures that had been defined as requiring essential medical coverage. The boundaries of these structures were related to three potential anthropometric landmarks on the skin surface and statistical analysis was undertaken to validate the results. The range of heights of each individual used in this study was comparable to previous anthropometric surveys, confirming that a representative sample had been used. The vertical dimension of essential medical coverage demonstrated good correlation to torso height (suprasternal notch to iliac crest) but not to stature (r(2)=0.53 versus 0.04). Horizontal coverage did not correlate to either measure of height. Surface landmarks utilised in this study were proven to be reliable surrogate markers for the boundaries of the underlying anatomical structures potentially requiring essential protection by a plate. Providing a range of plate sizes, particularly multiple heights, should optimise the medical coverage and thus effectiveness of body armour for UK Armed Forces personnel. The results of this work provide evidence that a single width of plate if chosen correctly will provide the essential medical coverage for the entire military population, whilst recognising that it still could overprotect the smallest individuals. With regards to anthropometric measurements; it is recommended, based on this work, that torso height is used instead of stature for sizing body armour. Coverage assessments should now be undertaken for side protection as well as for other non-Caucasian populations and females, with anthropometric surveys utilising the three landmarks recommended in this study. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.
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Cognitive style, personality and vulnerability to postnatal depression.
Jones, Lisa; Scott, Jan; Cooper, Caroline; Forty, Liz; Smith, Katherine Gordon; Sham, Pak; Farmer, Anne; McGuffin, Peter; Craddock, Nick; Jones, Ian
2010-03-01
Only some women with recurrent major depressive disorder experience postnatal episodes. Personality and/or cognitive styles might increase the likelihood of experiencing postnatal depression. To establish whether personality and cognitive style predicts vulnerability to postnatal episodes over and above their known relationship to depression in general. We compared personality and cognitive style in women with recurrent major depressive disorder who had experienced one or more postnatal episodes (postnatal depression (PND) group, n=143) with healthy female controls (control group, n=173). We also examined parous women with recurrent major depressive disorder who experienced no perinatal episodes (non-postnatal depression (NPND) group, n=131). The PND group had higher levels of neuroticism and dysfunctional beliefs, and lower self-esteem than the control group. However, there were no significant differences between the PND and NPND groups. Established personality and cognitive vulnerabilities for depression were reported by women with a history of postnatal depression, but there was no evidence that any of these traits or styles confer a specific risk for the postnatal onset of episodes.
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Collecting data to evaluate the effect of health policies on vulnerable populations.
Bindman, A B; Grumbach, K; Keane, D; Lurie, N
1993-02-01
Public health policies often have disproportionate effects on the poor and other vulnerable groups. Standard survey techniques are often difficult to apply to these vulnerable populations, and many data bases systematically omit such individuals. The purpose of this paper is to review our experience in collecting primary survey data from public hospital, mentally ill, HIV-infected, and non-English-speaking patients. Important issues in conducting research on these populations include proper selection of subjects and comparison groups and difficulties involved in recruitment and enrollment of subjects. Maintaining longitudinal data on these populations is difficult and often requires tracking, secondary contacts, home visits and community outreach, and the use of organizations, institutions, and networks. Investigators must also pay careful attention to ethical issues involved in conducting research on vulnerable populations.
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Scott, Walter D; Beevers, Christopher G; Mermelstein, Robin J
2008-07-01
The present study extended previous tests of cognitive priming theories of depression by examining cognitive self-regulatory, motivational, and affective functioning of depression-vulnerable and nonvulnerable individuals after a failure experience. Participants were enrolled in a clinic-based smoking cessation program that consisted of seven group meetings. Major findings show that compared to the nonvulnerable group, depression-vulnerable individuals were less motivated to quit and experienced more negative affect, but only after a failure to quit smoking. However, after controlling for actual smoking rate, depression-vulnerable individuals did not evaluate their success any more negatively, nor did they indicate lower self-efficacy for quitting. Results are discussed in terms of cognitive self-regulatory and affect temperament models of motivation and depression.
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Meta-Synthesis of Literacy for the Empowerment of Vulnerable Groups
ERIC Educational Resources Information Center
Camilli-Trujillo, Celia; Römer-Pieretti, Max
2017-01-01
The vulnerability translates in concrete human groups that, although they know what occurs around them in a digital matter, by his own social and cultural condition they are alienated and, in this sense, away of the exercise of the information right. The aim has been to analyze the critical, media and digital literacy for the empowerment of…
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Phoummalaysith, Bounfeng; Yamamoto, Eiko; Xeuatvongsa, Anonh; Louangpradith, Viengsakhone; Keohavong, Bounxou; Saw, Yu Mon; Hamajima, Nobuyuki
2018-05-03
Routine vaccination is administered free of charge to all children under one year old in Lao People's Democratic Republic (Lao PDR) and the national goal is to achieve at least 95% coverage with all vaccines included in the national immunization program by 2025. In this study, factors related to the immunization system and characteristics of provinces and districts in Lao PDR were examined to evaluate the association with routine immunization coverage. Coverage rates for Bacillus Calmette-Guerin (BCG), Diphtheria-Tetanus-Pertussis-Hepatitis B (DTP-HepB), DTP-HepB-Hib (Haemophilus influenzae type B), polio (OPV), and measles (MCV1) vaccines from 2002 to 2014 collected through regular reporting system, were used to identify the immunization coverage trends in Lao PDR. Correlation analysis was performed using immunization coverage, characteristics of provinces or districts (population, population density, and proportion of poor villages and high-risk villages), and factors related to immunization service (including the proportions of the following: villages served by health facility levels, vaccine session types, and presence of well-functioning cold chain equipment). To determine factors associated with low coverage, provinces were categorized based on 80% of DTP-HepB-Hib3 coverage (<80% = low group; ≥80% = high group). Coverages of BCG, DTP-HepB3, OPV3 and MCV1 increased gradually from 2007 to 2014 (82.2-88.3% in 2014). However, BCG coverage showed the least improvement from 2002 to 2014. The coverage of each vaccine correlated with the coverage of the other vaccines and DTP-HepB-Hib dropout rate in provinces as well as districts. The provinces with low immunization coverage were correlated with higher proportions of poor villages. Routine immunization coverage has been improving in the last 13 years, but the national goal is not yet reached in Lao PDR. The results of this study suggest that BCG coverage and poor villages should be targeted to improve nationwide coverage. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Bailey, Steffani R.; Cowburn, Stuart; Marino, Miguel; Angier, Heather; DeVoe, Jennifer E.
2016-01-01
Objectives. To assess longitudinal patterns of community health center (CHC) utilization and the effect of insurance discontinuity after Oregon’s 2008 Medicaid expansion (the Oregon Experiment). Methods. We conducted a retrospective cohort study with electronic health records and Medicaid data. We divided individuals who gained Medicaid in the Oregon Experiment into those who maintained (n = 788) or lost (n = 944) insurance coverage. We compared these groups with continuously insured (n = 921) and continuously uninsured (n = 5416) reference groups for community health center utilization rates over a 36-month period. Results. Both newly insured groups increased utilization in the first 6 months. After 6 months, use among those who maintained coverage stabilized at a level consistent with the continuously insured, whereas it returned to baseline for those who lost coverage. Conclusions. Individuals who maintained coverage through Oregon’s Medicaid expansion increased long-term utilization of CHCs, whereas those with unstable coverage did not. Policy implications. This study predicts long-term increase in CHC utilization following Affordable Care Act Medicaid expansion and emphasizes the need for policies that support insurance retention. PMID:26890164
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Sohn, Heeju
2016-01-01
Health insurance coverage varies substantially between racial and ethnic groups in the United States. Compared to non-Hispanic whites, African Americans and people of Hispanic origin had persistently lower insurance coverage rates at all ages. This article describes age- and group-specific dynamics of insurance gain and loss that contribute to inequalities found in traditional cross-sectional studies. It uses the longitudinal 2008 Panel of the Survey of Income and Program Participation (N=114,345) to describe age-specific patterns of disparity prior to the Affordable Care Act (ACA). A formal decomposition on increment-decrement life-tables of insurance gain and loss shows that coverage disparities are predominately driven by minority groups’ greater propensity to lose the insurance that they already have. Uninsured African Americans were faster to gain insurance than non-Hispanic whites but their high rates of insurance loss more than negated this advantage. Disparities from greater rates of loss among minority groups emerge rapidly at the end of childhood and persist throughout adulthood. This is especially true for African Americans and Hispanics and their relative disadvantages again heighten in their 40s and 50s. PMID:28366968
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Sowah, Leonard Anang; Busse, Sarah; Amoroso, Anthony
2013-08-01
Tobacco use in the U.S. has declined significantly since the 1960s, but differentially by socioeconomic status. Current HIV (human immunodeficiency virus) infection rates in the United States are higher in minorities and underprivileged individuals. Effective highly active anti-retroviral therapy (HAART) has changed HIV into a chronic infection. Mortality among HIV patients is now as likely to be due to heart disease and cancers as HIV-related infections. In the current situation, one would expect public insurance plans to focus on interventions targeting lifestyle-associated behaviors such as tobacco use that have been found to be associated with increased risk for heart disease and cancers. Review of the AIDS Drug Assistance Program formularies and the Medicaid Programs of 50 states and the District of Columbia, however, revealed that coverage for smoking cessation is inadequate in most instances. To reduce health disparities, publicly funded programs that serve the nation's most vulnerable should provide coverage for effective tobacco cessation.
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Achieving Mental Health Care Parity Might Require Changes In Payments And Competition
McGuire, Thomas G.
2016-01-01
One of the most prominent features of the Affordable Care Act has been the promotion of individual health plans chosen by consumers in the Marketplaces. These plans are subject to regulation and paid by risk-adjusted capitation, a set of policies known as managed competition. Individual health insurance markets, however, are vulnerable to what economists describe as efficiency problems stemming from adverse selection, and Marketplaces are no exception. Health plans have incentives to discriminate against services used by people with certain chronic illnesses, including mental health conditions. Parity regulations, which dictate coverage for mental health benefits on par with medical and surgical benefits, can eliminate discrimination in coverage but redirect discrimination toward hard-to-regulate tactics from managed care such as restrictive network design and provider payment. This article reviews policy options to contend with ongoing selection issues. “Better enforcement” of parity has less chance of success than more fundamental but feasible changes in the way plans are paid or in the way competition among plans is structured. PMID:27269019
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The influence of performance-based payment on childhood immunisation coverage.
Merilind, Eero; Salupere, Rauno; Västra, Katrin; Kalda, Ruth
2015-06-01
Pay-for-performance, also called the quality system (QS) in Estonia, was implemented in 2006 and one indicator for achievement is the childhood immunisation coverage rate. The WHO vaccination coverage in Europe for diphtheria, tetanus and pertussis, and measles in children aged around one year old should meet or exceed 90 per cent. The study was conducted using a database from the Estonian Health Insurance Fund. The study compared childhood immunisation coverage rates of all Estonian family physicians in two groups, joined and not joined to the quality system during the observation period 2006-2012. Immunisation coverage was calculated as the percentage of persons in the target age group who received a vaccine dose by a given age. The target level of immunisations in Estonia is set at 90 per cent and higher. Immunisation coverage rates of family doctors (FD) in Estonia showed significant differences between two groups of doctors: joined to the quality system and not joined. Doctors joined to the quality system met the 90 per cent vaccination criterion more frequently compared to doctors not joined to the quality system. Doctors not joined to the quality system were below the 90 per cent vaccination criterion in all vaccinations listed in the Estonian State Immunisation Schedule. Pay-for-performance as a financial incentive encourages higher levels of childhood immunisations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Association between clean indoor air laws and voluntary smokefree rules in homes and cars.
Cheng, Kai-Wen; Okechukwu, Cassandra A; McMillen, Robert; Glantz, Stanton A
2015-03-01
This study examines the influence that smokefree workplaces, restaurants and bars have on the adoption of smokefree rules in homes and cars, and whether there is an association with adopting smokefree rules in homes and cars. Bivariate probit models were used to jointly estimate the likelihood of living in a smokefree home and having a smokefree car as a function of law coverage and other variables. Household data were obtained from the nationally representative Social Climate Survey of Tobacco Control 2001, 2002 and 2004-2009; clean indoor air law data were from the American Nonsmokers' Rights Foundation Tobacco Control Laws Database. 'Full coverage' and 'partial coverage' smokefree legislation is associated with an increased likelihood of having voluntary home and car smokefree rules compared with 'no coverage'. The association between 'full coverage' and smokefree rule in homes and cars is 5% and 4%, respectively, and the association between 'partial coverage' and smokefree rules in homes and cars is 3% and 4%, respectively. There is a positive association between the adoption of smokefree rules in homes and cars. Clean indoor air laws provide the additional benefit of encouraging voluntary adoption of smokefree rules in homes and cars. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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How Researchers Define Vulnerable Populations in HIV/AIDS Clinical Trials
Lo, Bernard; Strauss, Ronald P.; Eron, Joseph; Gifford, Allen L.
2010-01-01
In this study, we interviewed researchers, asking them to define vulnerable populations in HIV/AIDS clinical trials, and provide feedback on the federal regulations for three vulnerable populations. Interview data informed a conceptual framework, and were content analyzed to identify acceptability or disagreement with the regulations. Beginning with several characteristics of vulnerable enrollees identified by researchers, the conceptual framework illustrates possible scenarios of how enrollees could be considered vulnerable in clinical research. Content analysis identified barriers affecting HIV/AIDS researchers’ ability to conduct clinical trials with pregnant women, prisoners, and children, for which the regulations specify additional protections. This study challenges current thinking about federal regulations’ group-based approach to defining vulnerable populations. PMID:20721614
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Shrestha, Rehana; Flacke, Johannes; Martinez, Javier; van Maarseveen, Martin
2016-01-01
Differential exposure to multiple environmental burdens and benefits and their distribution across a population with varying vulnerability can contribute heavily to health inequalities. Particularly relevant are areas with high cumulative burdens and high social vulnerability termed as “hotspots”. This paper develops an index-based approach to assess these multiple burdens and benefits in combination with vulnerability factors at detailed intra-urban level. The method is applied to the city of Dortmund, Germany. Using non-spatial and spatial methods we assessed inequalities and identified “hotspot” areas in the city. We found modest inequalities burdening higher vulnerable groups in Dortmund (CI = −0.020 at p < 0.05). At the detailed intra-urban level, however, inequalities showed strong geographical patterns. Large numbers of “hotspots” exist in the northern part of the city compared to the southern part. A holistic assessment, particularly at a detailed local level, considering both environmental burdens and benefits and their distribution across the population with the different vulnerability, is essential to inform environmental justice debates and to mobilize local stakeholders. Locating “hotspot” areas at this detailed spatial level can serve as a basis to develop interventions that target vulnerable groups to ensure a health conducive equal environment. PMID:27409625
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Rich, white, and vulnerable: rethinking oppressive socialization in the euthanasia debate.
Krag, Erik
2014-08-01
Anita Silvers (1998) has criticized those who argue that members of marginalized groups are vulnerable to a special threat posed by physician-assisted suicide (PAS) and voluntary active euthanasia (VAE). She argues that paternalistic measures prohibiting PAS/VAE in order to protect these groups only serve to marginalize them further by characterizing them as belonging to a definitively weak class. I offer a new conception of vulnerability, one that demonstrates how rich, educated, white males, who are typically regarded as having their autonomy enhanced by their social status, are just as, if not more, vulnerable to threats posed by PAS/VAE as a result of the harmful social messages at work just below the surface of contemporary Western culture. I use this new conception of vulnerability to reinforce arguments for continued statutory prohibitions on PAS/VAE. © The Author 2014. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Recognizing Risk and Vulnerability in Research Ethics: Imagining the "What Ifs?"
Peter, Elizabeth; Friedland, Judith
2017-04-01
Research ethics committees (RECs) may misunderstand the vulnerability of participants, given their distance from the field. What RECs identify as the vulnerabilities that were not adequately recognized in protocols and how they attempt to protect the perceived vulnerability of participants and mitigate risks were examined using the response letters sent to researchers by three university-based RECs. Using a critical qualitative method informed by feminist ethics, we identified an overarching theme of recognizing and responding to cascading vulnerabilities and four subthemes: identifying vulnerable groups, recognizing potentially risky research, imagining the "what ifs," and mitigating perceived risks. An ethics approach that is up-close, as opposed to distant, is needed to foster closer relationships among participants, researchers, and RECs and to understand participant vulnerability and strength better.
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Lee, Su Hyun; Joh, Hee-Kyung; Kim, Soojin; Oh, Seung-Won; Lee, Cheol Min; Kwon, Hyuktae
2016-05-01
Public health insurance coverage for preventive care in young adults is incomplete in Korea. Few studies have focused on young adults' socioeconomic disparities in preventive care utilization. We aimed to explore household income disparities in the use of different types of health screening services among university students in Korea.This cross-sectional study used a web-based self-administered survey of students at a university in Korea from January to February 2013. To examine the associations between household income levels and health screening service use within the past 2 years, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression with adjustment for various covariables.Of 2479 participants, 45.5% reported using health screening services within 2 years (university-provided screening 32.9%, private sector screening 16.7%, and both 4.1%). Household income levels were not significantly associated with overall rates of health screening service use with a multivariable-adjusted OR (95% CI) in the lowest versus highest income group of 1.12 (0.87-1.45, Ptrend = 0.35). However, we found significantly different associations in specific types of utilized screening services by household income levels. The multivariable-adjusted OR (95% CI) of university-provided health screening service use in the lowest versus highest income level was 1.74 (1.30-2.34; Ptrend < 0.001), whereas the multivariable-adjusted OR (95% CI) of private sector service use in the lowest versus highest income level was 0.45 (0.31-0.66; Ptrend < 0.001).This study demonstrated significant disparities in the types of utilized health screening services by income groups among university students in Korea, although overall rates of health screening service use were similar across income levels. Low-income students were more likely to use university-provided health screening services, and less likely to use private sector screening services. To ensure appropriate preventive care delivery for young adults and to address disparities in disadvantaged groups, the expansion of medical insurance coverage for preventive health care, establishment of a usual source of care, focusing on vulnerable groups, and the development of evidence-based standardized health screening guidelines for young adults are needed.
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Income Disparities in the Use of Health Screening Services Among University Students in Korea
Lee, Su Hyun; Joh, Hee-Kyung; Kim, Soojin; Oh, Seung-Won; Lee, Cheol Min; Kwon, Hyuktae
2016-01-01
Abstract Public health insurance coverage for preventive care in young adults is incomplete in Korea. Few studies have focused on young adults’ socioeconomic disparities in preventive care utilization. We aimed to explore household income disparities in the use of different types of health screening services among university students in Korea. This cross-sectional study used a web-based self-administered survey of students at a university in Korea from January to February 2013. To examine the associations between household income levels and health screening service use within the past 2 years, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression with adjustment for various covariables. Of 2479 participants, 45.5% reported using health screening services within 2 years (university-provided screening 32.9%, private sector screening 16.7%, and both 4.1%). Household income levels were not significantly associated with overall rates of health screening service use with a multivariable-adjusted OR (95% CI) in the lowest versus highest income group of 1.12 (0.87–1.45, Ptrend = 0.35). However, we found significantly different associations in specific types of utilized screening services by household income levels. The multivariable-adjusted OR (95% CI) of university-provided health screening service use in the lowest versus highest income level was 1.74 (1.30–2.34; Ptrend < 0.001), whereas the multivariable-adjusted OR (95% CI) of private sector service use in the lowest versus highest income level was 0.45 (0.31–0.66; Ptrend < 0.001). This study demonstrated significant disparities in the types of utilized health screening services by income groups among university students in Korea, although overall rates of health screening service use were similar across income levels. Low-income students were more likely to use university-provided health screening services, and less likely to use private sector screening services. To ensure appropriate preventive care delivery for young adults and to address disparities in disadvantaged groups, the expansion of medical insurance coverage for preventive health care, establishment of a usual source of care, focusing on vulnerable groups, and the development of evidence-based standardized health screening guidelines for young adults are needed. PMID:27196475
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Reduction of racial/ethnic disparities in vaccination coverage, 1995-2011.
Walker, Allison T; Smith, Philip J; Kolasa, Maureen
2014-04-18
The Presidential Childhood Immunization Initiative was developed in 1993 to address major gaps in childhood vaccination coverage in the United States. Eliminating the cost of vaccines as a barrier to vaccination was one strategy of the Childhood Immunization Initiative; it led to Congressional legislation that authorized creation of the Vaccines for Children program (VFC) in 1994. CDC analyzed National Immunization Survey data for 1995-2011 to evaluate trends in disparities in vaccination coverage rates between non-Hispanic white children and children of other racial/ethnic groups. VFC has been effective in ireducing disparities in vaccination coverage among U.S. children. CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that has been effective in reducing childhood vaccination coverage-related disparities in the United States. At its inception in 1994, VFC was implemented in 78 Immunization Action Plan areas that covered the entire United States; within each area, concerted efforts were made to improve childhood vaccination coverage. The findings in this report demonstrate that there have been no racial/ethnic disparities in vaccine coverage for measles-mumps-rubella and poliovirus in the United States since 2005. Disparities in coverage for the diphtheria-tetanus-pertussis/diphtheria-tetanus-acellular pertussis vaccine were absent, declining, or inconsistent during this period, depending on the racial/ethnic group examined. The results in this report highlight the effectiveness of VFC.
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Palmisano, Donald J; Emmons, David W; Wozniak, Gregory D
2004-05-12
Recent reports showing an increase in the number of uninsured individuals in the United States have given heightened attention to increasing health insurance coverage. The American Medical Association (AMA) has proposed a system of tax credits for the purchase of individually owned health insurance and enhancements to individual and group health insurance markets as a means of expanding coverage. Individually owned insurance would enable people to maintain coverage without disruption to existing patient-physician relationships, regardless of changes in employers or in work status. The AMA's plan would empower individuals to choose their health plan and give patients and their physicians more control over health care choices. Employers could continue to offer employment-based coverage, but employees would not be limited to the health plans offered by their employer. With a tax credit large enough to make coverage affordable and the ability to choose their own coverage, consumers would dramatically transform the individual and group health insurance markets. Health insurers would respond to the demands of individual consumers and be more cautious about increasing premiums. Insurers would also tailor benefit packages and develop new forms of coverage to better match the preferences of individuals and families. The AMA supports the development of new health insurance markets through legislative and regulatory changes to foster a wider array of high-quality, affordable plans.
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Woodward, Robert S.; Page, Timothy F.; Soares, Ricardo; Schnitzler, Mark A.; Lentine, Krista L.; Brennan, Daniel C.
2011-01-01
Beginning January 1, 2000, Medicare extended coverage of immunosuppression medications from 3-years to lifetime based on age >65 years or disability. Using USRDS data for Medicare-insured recipients of kidney transplants between July 1995 and December 2000, we identified four Cohorts of Medicare-insured kidney transplant recipients. Patients in Cohort 1 were individuals who were both eligible and received lifetime-coverage. Patients in Cohort 2 would have been eligible, but their three-year coverage expired before lifetime-coverage was available. Patients in Cohort 3 were ineligible for lifetime-coverage because of youth or lack of disability. Patients in Cohort 4 were transplanted 1996–1996 and were ineligible for lifetime-coverage. Incomes were categorized by ZIP-code median household income from census data. Lifetime-extension of Medicare immunosuppression was associated with improved allograft survival among low-income transplant recipients in the sense that the previously existing income-related disparities in graft survival in Cohort 2 were not apparent in Cohort 1. Ineligible individuals served as a control group; the income-related disparities in graft survival observed in the early Cohort 4 persisted in more recent Cohort 3. Multivariate proportional-hazards models confirmed these findings. Future work should evaluate the cost-effectiveness of these coverage increases, as well as that of benefits extensions to broader patient groups. PMID:19032227
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-12-12
... workers who were enrolled in the employer's health plan and lost coverage as a result of termination of... had similar effects on various groups of workers, or whether it benefited some groups more than others... ability to continue employer- sponsored health coverage for a limited time after they left employment...
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29 CFR 2590.715-2713A - Accommodations in connection with coverage of preventive health services.
Code of Federal Regulations, 2014 CFR
2014-07-01
... of any contraceptive services required to be covered under § 2590.715-2713(a)(1)(iv) on account of... under section 107 of ERISA. (b) Contraceptive coverage—self-insured group health plans—(1) A group... provide contraceptive coverage if all of the requirements of this paragraph (b)(1) are satisfied: (i) The...
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26 CFR 54.9815-2713 - Coverage of preventive health services.
Code of Federal Regulations, 2014 CFR
2014-04-01
... 26 Internal Revenue 17 2014-04-01 2014-04-01 false Coverage of preventive health services. 54.9815... health services. (a) Services—(1) In general. Beginning at the time described in paragraph (b) of this section and subject to § 54.9815-2713A, a group health plan, or a health insurance issuer offering group...
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Code of Federal Regulations, 2014 CFR
2014-10-01
...) The child lost coverage due to the death or divorce of a parent. [78 FR 42313, July 15, 2013] ... SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STATE CHILDREN'S HEALTH INSURANCE PROGRAMS... from the date a child otherwise eligible for CHIP is disenrolled from coverage under a group health...
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Insurer and employer views on pediatric obesity treatment: a qualitative study.
Hampl, S E; Davis, A M; Sampilo, M L; Stephens, K L; Dean, K
2013-04-01
The effectiveness of group-based comprehensive, multidisciplinary (stage 3) pediatric weight management programs is backed by a growing body of literature, yet insurance coverage of these programs is scarce to nonexistent, limiting their reach and long-term survival. The objective of this study was to better understand the perspectives of insurers and large employers on the issue of group-based treatment coverage. The authors performed a qualitative study utilizing structured interviews with these stakeholders, following accepted techniques. Six major themes emerged: cost, program effectiveness, corporate social responsibility, secondary parental (employee) benefits, coverage options and new benefit determination. Future efforts to secure payment for group-based pediatric weight management programs should address these key themes. Copyright © 2012 The Obesity Society.
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Battin, Margaret P; van der Heide, Agnes; Ganzini, Linda; van der Wal, Gerrit; Onwuteaka-Philipsen, Bregje D
2007-10-01
Debates over legalisation of physician-assisted suicide (PAS) or euthanasia often warn of a "slippery slope", predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period. The data from Oregon (where PAS, now called death under the Oregon Death with Dignity Act, is legal) comprised all annual and cumulative Department of Human Services reports 1998-2006 and three independent studies; the data from the Netherlands (where both PAS and euthanasia are now legal) comprised all four government-commissioned nationwide studies of end-of-life decision making (1990, 1995, 2001 and 2005) and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought. Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured (inapplicable in the Netherlands, where all are insured), people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups. Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges.
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Increasing Cervical Cancer Screening Coverage: A Randomised, Community-Based Clinical Trial
Acera, Amelia; Manresa, Josep Maria; Rodriguez, Diego; Rodriguez, Ana; Bonet, Josep Maria; Trapero-Bertran, Marta; Hidalgo, Pablo; Sànchez, Norman
2017-01-01
Background Opportunistic cervical cancer screening can lead to suboptimal screening coverage. Coverage could be increased after a personalised invitation to the target population. We present a community randomized intervention study with three strategies aiming to increase screening coverage. Methods The CRICERVA study is a community-based clinical trial to improve coverage of population-based screening in the Cerdanyola SAP area in Barcelona.A total of 32,858 women residing in the study area, aged 30 to 70 years were evaluated. A total of 15,965 women were identified as having no registration of a cervical cytology in the last 3.5 years within the Public Health data base system. Eligible women were assigned to one of four community randomized intervention groups (IGs): (1) (IG1 N = 4197) personalised invitation letter, (2) (IG2 N = 3601) personalised invitation letter + informative leaflet, (3) (IG3 N = 6088) personalised invitation letter + informative leaflet + personalised phone call and (4) (Control N = 2079) based on spontaneous demand of cervical cancer screening as officially recommended. To evaluate screening coverage, we used heterogeneity tests to compare impact of the interventions and mixed logistic regression models to assess the age effect. We refer a “rescue” visit as the screening visit resulting from the study invitation. Results Among the 13,886 women in the IGs, 2,862 were evaluated as having an adequate screening history after the initial contact; 4,263 were lost to follow-up and 5,341 were identified as having insufficient screening and thus being eligible for a rescue visit. All intervention strategies significantly increased participation to screening compared to the control group. Coverage after the intervention reached 84.1% while the control group reached 64.8%. The final impact of our study was an increase of 20% in the three IGs and of 9% in the control group (p<0.001). Within the intervention arms, age was an important determinant of rescue visits showing a statistical interaction with the coverage attained in the IGs. Within the intervention groups, final screening coverage was significantly higher in IG3 (84.4%) (p<0.001). However, the differences were more substantial in the age groups 50–59 and those 60+. The highest impact of the IG3 intervention was observed among women 60+ y.o with 32.0% of them being rescued for screening. The lowest impact of the interventions was in younger women. Conclusions The study confirms that using individual contact methods and assigning a fixed screening date notably increases participation in screening. The response to the invitation is strongly dependent on age. Trial Registration ClinicalTrials.gov NCT01373723 PMID:28118410
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Dental Care Coverage and Use: Modeling Limitations and Opportunities
Moeller, John F.; Chen, Haiyan
2014-01-01
Objectives. We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage. Methods. We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use. Results. Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth. Conclusions. Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use. PMID:24328635
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Dental Care Coverage and Use: Modeling Limitations and Opportunities
Moeller, John F.; Chen, Haiyan
2014-01-01
Objectives. We examined why older US adults without dental care coverage and use would have lower use rates if offered coverage than do those who currently have coverage. Methods. We used data from the 2008 Health and Retirement Study to estimate a multinomial logistic model to analyze the influence of personal characteristics in the grouping of older US adults into those with and those without dental care coverage and dental care use. Results. Compared with persons with no coverage and no dental care use, users of dental care with coverage were more likely to be younger, female, wealthier, college graduates, married, in excellent or very good health, and not missing all their permanent teeth. Conclusions. Providing dental care coverage to uninsured older US adults without use will not necessarily result in use rates similar to those with prior coverage and use. We have offered a model using modifiable factors that may help policy planners facilitate programs to increase dental care coverage uptake and use. PMID:25343171
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Xia, Zhangyong; Yang, Hua; Yuan, Xiaochun; Wang, Jiyue; Zhang, Shigang; Zhang, Liyong; Qu, Yang; Chen, Jun; Jiao, Liqun; Wang, Le-Xin; Du, Yifeng
2017-07-01
This study aimed to utilize high-resolution magnetic resonance imaging (MRI) to investigate the characteristics of stable and vulnerable carotid arteriosclerotic plaques, with correlations to histopathological findings. High-resolution MRI was performed in 817 patients, using three-dimensional magnetic resonance angiography. Plaque composition was evaluated by measuring the areas occupied by calcification, a lipid-rich necrotic core, intra-plaque haemorrhage, and fibrous cap rupture. Plaque morphology was analysed by measuring vessel wall area, thickness, and luminal area at the bifurcation of the common carotid artery. Plaque tissues were sampled during carotid endarterectomy and examined using haematoxylin-eosin, Oil Red O, Masson trichrome staining, and immunohistochemical staining for CD68. Patients were divided into stable plaque group (n = 462) and vulnerable plaque group (n = 355), based on intraoperative observations and postoperative histopathological findings. Compared to the stable plaque group, the vulnerable plaque group exhibited increased vessel wall areas and thickness, and decreased mean luminal areas (P < 0.001). The vulnerable plaque group also had a lower collagen content, a higher lipid content, and higher CD68 expression in plaque tissues on histological examinations (P < 0.01). Incidences of lipid-rich necrotic core (38.1 % vs. 34.3 %), intra-plaque haemorrhage (26.9 % vs. 22.8 %), plaque calcification (45.2 % vs. 40.9 %), and fibrous cap rupture (36.0 % vs 39.8 %) in the plaques were concordant with MRI observations and histopathological findings (p > 0.05). Stable and vulnerable carotid plaques had different morphologies and compositions. High-resolution MRI can assess such differences qualitatively and quantitatively in vivo and provide guidance for risk stratification and management.
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Storm, Ilse; Uiters, Ellen; Busch, Mirjam C M; den Broeder, Lea; Schuit, Albertine J
2015-07-01
Learning is essential for sustainable employability. However, various factors make work-related learning more difficult for certain groups of workers, who are consequently at a disadvantage in the labour market. In the long term, that in turn can have adverse health implications and can make those groups vulnerable. With a view to encouraging workers to continue learning, the Netherlands has a policy on work-related learning, which forms part of the 'Vitality Package'. A Health Impact Assessment with equity focus (HIAef) was undertaken to determine whether the policy on work-related learning affected certain groups of workers and their health in different ways, and whether the differences were avoidable. The HIAef method involved the standard phases: screening, scoping, appraisal and recommendations. Equity was the core principle in this method. Data were collected by means of both literature searches (e.g., Scopus, Medline) and interviews with experts and stakeholders (e.g., expertise regarding work, training and/or health). The HIAef identified the following groups as potentially vulnerable in the field of work-related learning: the chronically sick, older people, less educated people, flexi-workers/the self-employed and lay carers (e.g., thresholds to learning). Published literature indicates that work-related learning may have a positive influence on health through (work-related) factors such as pay, employability, longer employment rate and training-participation. According to experts and stakeholders, work-related learning policy could be adapted to take more account of vulnerable groups through alignment with their particular needs, such as early support, informal learning and e-learning. With a view to reducing avoidable inequalities in work-related learning, it is recommended that early, low-threshold, accessible opportunities are made available to identified vulnerable groups. Making such opportunities available may have a positive effect on (continued) participation in the labour market and thus on the health of the relevant groups. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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26 CFR 1.125-4T - Permitted election changes (temporary).
Code of Federal Regulations, 2010 CFR
2010-04-01
... residence or work of the employee, spouse, or dependent. (3) Consistency rule for accident or health... employee to revoke an election for accident or health coverage during a period of coverage and make a new... accident or health coverage and group-term life—(1) In general. A cafeteria plan may permit an employee to...
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28 CFR 55.5 - Coverage under section 4(f)(4).
Code of Federal Regulations, 2010 CFR
2010-07-01
... THE VOTING RIGHTS ACT REGARDING LANGUAGE MINORITY GROUPS Nature of Coverage § 55.5 Coverage under... which (1) Over five percent of the voting-age citizens were, on November 1, 1972, members of a single... 1, 1972, and (3) Fewer than 50 percent of the voting-age citizens were registered to vote or voted...
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28 CFR 55.5 - Coverage under section 4(f)(4).
Code of Federal Regulations, 2011 CFR
2011-07-01
... THE VOTING RIGHTS ACT REGARDING LANGUAGE MINORITY GROUPS Nature of Coverage § 55.5 Coverage under... which (1) Over five percent of the voting-age citizens were, on November 1, 1972, members of a single... 1, 1972, and (3) Fewer than 50 percent of the voting-age citizens were registered to vote or voted...
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Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Hasan Farooqui, Habib; Zodpey, Sanjay P
2015-02-23
Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. 16 of 29 states in India, 2009-2012. Retrospective descriptive secondary data analysis. (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. The overall private sector Hib vaccine coverage among the 2009-2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians' prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009-2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to public sector services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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Narrowing the Gap in Outcomes for Vulnerable Groups: A Review of the Research Evidence
ERIC Educational Resources Information Center
Kendall, Sally; Straw, Suzanne; Jones, Megan; Springate, Iain; Grayson, Hilary
2008-01-01
This report presents findings from a review of the best evidence on narrowing the gap in outcomes across the five Every Child Matters (ECM) areas for vulnerable groups in the context of improving outcomes for all. The review was commissioned to prepare the ground for work on "Narrowing the Gap" with participating local authorities (LAs).…
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Impact of a website based educational program for increasing vaccination coverage among adolescents.
Esposito, Susanna; Bianchini, Sonia; Tagliabue, Claudia; Umbrello, Giulia; Madini, Barbara; Di Pietro, Giada; Principi, Nicola
2018-04-03
Data regarding the use of technology to improve adolescent knowledge on vaccines are scarce. The main aim of this study was to evaluate whether different web-based educational programmes for adolescents might increase their vaccination coverage. Overall, 917 unvaccinated adolescents (389 males, 42.4%; mean age ± standard deviation, 14.0 ± 2.2 years) were randomized 1:1:1 into the following groups: no intervention (n = 334), website educational program only (n = 281), or website plus face to face lesson (n = 302) groups. The use of the website plus the lesson significantly increased the overall knowledge of various aspects of vaccine-preventable disease and reduced the fear of vaccines (p < 0.001). A significant increase in vaccination coverage was observed for tetanus, diphtheria, acellular pertussis and conjugated meningococcal ACYW vaccines in the 2 groups using the website (p < 0.001), and better results were observed in the group that had also received the lesson; in this last group, significant results were observed in the increase in vaccination coverage for meningococcal B vaccine (p < 0.001). Overall, the majority of the participants liked the experience of the website, although they considered it important to further discuss vaccines with parents, experts and teachers. This study is the first to evaluate website based education of adolescents while considering all of the vaccines recommended for this age group. Our results demonstrate the possibility of increasing vaccination coverage by using a website based educational program with tailored information. However, to be most effective, this program should be supplemented with face-to-face discussions of vaccines at school and at home. Thus, specific education should also include teachers and parents so that they will be prepared to discuss with adolescents what is true and false in the vaccination field.
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Relationship between aneurysm occlusion and flow diverting device oversizing in a rabbit model.
Hodis, Simona; Ding, Yong-Hong; Dai, Daying; Lingineni, Ravi; Mut, Fernando; Cebral, Juan; Kallmes, David; Kadirvel, Ramanathan
2016-01-01
Implanted, actual flow diverter pore density is thought to be strongly influenced by proper matching between the device size and parent artery diameter. The objective of this study was to characterize the correlation between device sizing, metal coverage, and the resultant occlusion of aneurysms following flow diverter treatment in a rabbit model. Rabbit saccular aneurysms were treated with flow diverters (iso-sized to proximal parent artery, 0.5 mm oversized, or 1.0 mm oversized, respectively, n=6 for each group). Eight weeks after implantation, the angiographic degree of aneurysm occlusion was graded (complete, near-complete, or incomplete). The ostium of the explanted aneurysm covered with the flow diverter struts was photographed. Based on gross anatomic findings, the metal coverage and pore density at the ostium of the aneurysm were calculated and correlated with the degree of aneurysm occlusion. Angiographic results showed there were no statistically significant differences in aneurysm geometry and occlusion among groups. The mean parent artery diameter to flow diverter diameter ratio was higher in the 1.0 mm oversized group than in the other groups. Neither the percentage metal coverage nor the pore density showed statistically significant differences among groups. Aneurysm occlusion was inversely correlated with the ostium diameter, irrespective of the size of the device implanted. Device sizing alone does not predict resultant pore density or metal coverage following flow diverter implantation in the rabbit aneurysm model. Aneurysm occlusion was not impacted by either metal coverage or pore density, but was inversely correlated with the diameter of the ostium. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Determining the Financial Impact of Flood Hazards in Ungaged Basins
NASA Astrophysics Data System (ADS)
Cotterman, K. A.; Gutenson, J. L.; Pradhan, N. R.; Byrd, A.
2017-12-01
Many portions of the Earth lack adequate authoritative or in situ data that is of great value in determining natural hazard vulnerability from both anthropogenic and physical perspective. Such locations include the majority of developing nations, which do not possess adequate warning systems and protective infrastructure. The lack of warning and protection from natural hazards make these nations vulnerable to the destructive power of events such as floods. The goal of this research is to demonstrate an initial workflow with which to characterize flood financial hazards with global datasets and crowd-sourced, non-authoritative data in ungagged river basins. This workflow includes the hydrologic and hydraulic response of the watershed to precipitation, characterized by the physics-based modeling application Gridded Surface-Subsurface Hydrologic Analysis (GSSHA) model. In addition, data infrastructure and resources are available to approximate the human impact of flooding. Open source, volunteer geographic information (VGI) data can provide global coverage of elements at risk of flooding. Additional valuation mechanisms can then translate flood exposure into percentage and financial damage to each building. The combinations of these tools allow the authors to remotely assess flood hazards with minimal computational, temporal, and financial overhead. This combination of deterministic and stochastic modeling provides the means to quickly characterize watershed flood vulnerability and will allow emergency responders and planners to better understand the implications of flooding, both spatially and financially. In either a planning, real-time, or forecasting scenario, the system will assist the user in understanding basin flood vulnerability and increasing community resiliency and preparedness.
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Vulnerability and Inequality in an Increasingly Wetter World: A Namibia Case Study
NASA Astrophysics Data System (ADS)
Kelly, M.; Silva, J.; Mandl, D.; Sohlberg, R. A.
2016-12-01
Over the past two decades, Namibia has experienced increased instances of flooding that have grown in intensity and duration. Major flooding events in 2008 and 2009 displaced hundreds of thousands of people, causing thousands to remain in flood relocation camps for months at a time. Due to lack of topographic relief in the region, water tends to sit until it evaporates. Both inter-annual variability and changes in climate may lead to even greater rainfall and flooding in the future. In 2009, 29% of Namibians lived below the national poverty line (World Bank) and many make their living off of subsistence farming, as well as trading livestock. Using socio-economic data collected from the Namibia Household Income & Expenditure Survey (NHIES) reports by the Namibia Statistics Agency for the years 1993-1994, 2003-2004, and 2009-2010, and Landsat imagery for the corresponding years, we aim to characterize flood impact and flood vulnerability. Water coverage maps of Namibia were created for each time period using Landsat imagery overlain with socio-economic data to see how flooding impacts socio-variables such as income, inequality, access to livestock and grazing lands, and consumption over time. Because Namibia is not a data-rich environment, it is difficult to obtain the fine granularity of socio-data needed to put a dollar value on loss and vulnerability in flood prone areas. We hope the findings of this study will draw attention to these problems and allow us to access the data needed to more accurately characterize flood vulnerability in Namibia.
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Thomasgard, M; Metz, W P
1996-06-01
While a parental perception of child vulnerability to illness/injury is often used interchangeably with parental overprotection, research suggests that they are independent constructs. We hypothesized more frequent pediatric nonwell-child visits for perceived child vulnerability, but not for parental overprotection. The parents of 300 children, ages 2-5 years, enrolled in a health maintenance organization, were sampled. For children without medical conditions, there were no differences in nonwell-child care visits between the high perceived vulnerability and high parental protection groups (Wilcoxon Rank Sum Test, WRST, P = .31). As expected, high parental protection was not significantly associated with increased nonwell-child care visits compared with the low parental protection group (WRST, P = .14). These findings suggest that markers other than health care utilization are required to identify these forms of parent-child relationship disorders.
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Vulnerable Children's Access to Examinations at Key Stage 4. Research Report RR639
ERIC Educational Resources Information Center
Kendall, Sally; Johnson, Annie; Martin, Kerry; Kinder; Kay
2005-01-01
This research project was commissioned by the Department for Education and Skills (DfES) in 2004 to examine barriers to vulnerable children accessing examinations at the end of key stage 4 and to identify strategies employed to overcome these barriers. Key groups of vulnerable children identified by the DfES included: (1) Looked-after children;…
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Enhancing Defense Support of Civil Authorities within the National Capital Region
2011-04-04
tenorist organizations center of gravity, critical capabilities, critical requirements, and critical vulnerabilities. For example, to execute the...London Underground bombings ( critical capability), the group (center of gravity) needed money ( critical requirement! critical vulnerability). 8 Usually...the movement of large amounts of money through banks, the internet, or via credit cards creates a critical vulnerability because law enforcement
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2009-03-03
ajor vulnerabilities still exist in ... general aviation security ,”3 the commission did not further elaborate on the nature of those vulnerabilities...commercial operations may make them an attractive alternative to terrorists seeking to identify and exploit vulnerabilities in aviation security . In this...3, 2003, p. A7. 2 See Report of the Aviation Security Advisory Committee Working Group on General Aviation Airport Security (October 1, 2003); and
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Babor, Thomas F; Robaina, Katherine; Noel, Jonathan K; Ritson, E Bruce
2017-01-01
The concern that alcohol advertising can have detrimental effects on vulnerable viewers has prompted the development of codes of responsible advertising practices. This paper evaluates critically the concept of vulnerability as it applies to (1) susceptibility to alcohol-related harm and (2) susceptibility to the effects of marketing, and describes its implications for the regulation of alcohol marketing. We describe the findings of key published studies, review papers and expert reports to determine whether these two types of vulnerability apply to population groups defined by (1) age and developmental history; (2) personality characteristics; (3) family history of alcoholism; (4) female sex and pregnancy risk; and (5) history of alcohol dependence and recovery status. Developmental theory and research suggest that groups defined by younger age, incomplete neurocognitive development and a history of alcohol dependence may be particularly vulnerable because of the disproportionate harm they experience from alcohol and their increased susceptibility to alcohol marketing. Children may be more susceptible to media imagery because they do not have the ability to compensate for biases in advertising portrayals and glamorized media imagery. Young people and people with a history of alcohol dependence appear to be especially vulnerable to alcohol marketing, warranting the development of new content and exposure guidelines focused on protecting those groups to improve current self-regulation codes promoted by the alcohol industry. If adequate protections cannot be implemented through this mechanism, statutory regulations should be considered. © 2016 Society for the Study of Addiction.
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Participatory flood vulnerability assessment: a multi-criteria approach
NASA Astrophysics Data System (ADS)
Madruga de Brito, Mariana; Evers, Mariele; Delos Santos Almoradie, Adrian
2018-01-01
This paper presents a participatory multi-criteria decision-making (MCDM) approach for flood vulnerability assessment while considering the relationships between vulnerability criteria. The applicability of the proposed framework is demonstrated in the municipalities of Lajeado and Estrela, Brazil. The model was co-constructed by 101 experts from governmental organizations, universities, research institutes, NGOs, and private companies. Participatory methods such as the Delphi survey, focus groups, and workshops were applied. A participatory problem structuration, in which the modellers work closely with end users, was used to establish the structure of the vulnerability index. The preferences of each participant regarding the criteria importance were spatially modelled through the analytical hierarchy process (AHP) and analytical network process (ANP) multi-criteria methods. Experts were also involved at the end of the modelling exercise for validation. The final product is a set of individual and group flood vulnerability maps. Both AHP and ANP proved to be effective for flood vulnerability assessment; however, ANP is preferred as it considers the dependences among criteria. The participatory approach enabled experts to learn from each other and acknowledge different perspectives towards social learning. The findings highlight that to enhance the credibility and deployment of model results, multiple viewpoints should be integrated without forcing consensus.
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[Medical research and vulnerable subjects: unemployed people].
Niebrój, Lesław
2006-01-01
Although the importance of medical research for the diagnosis and treatment of human diseases is unquestionable, the use of human subjects, however, still presents a complex ethical problem. Moral difficulties occur in particular when the medical research deals with vulnerable subjects. Vulnerable individuals are defined as those who experience diminished actual autonomy. Among the groups which should be considered as being vulnerable are usually listed the following: children, pregnant women, mentally or emotionally disabled, physically disabled, homeless, and institutionalized people. This study addresses key concerns that gave rise to the question of whether unemployed people had to be recognized as vulnerable subjects. The term "vulnerability" was clarified and it was assumed that the "vulnerability" of medical research subjects' had to be understood as a form of continuum from potential, through the circumstantial, temporal, episodic, permanent to inevitable vulnerability. The conclusion was drawn that unemployed people were, at least, potentially vulnerable subjects. Research involving unemployed people presents important moral challenges to researchers and should be undertaken very carefully, following special ethical guidelines.
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Not the usual suspects: addressing layers of vulnerability.
Luna, Florencia; Vanderpoel, Sheryl
2013-07-01
This paper challenges the traditional account of vulnerability in healthcare which conceptualizes vulnerability as a list of identifiable subpopulations. This list of 'usual suspects', focusing on groups from lower resource settings, is a narrow account of vulnerability. In this article we argue that in certain circumstances middle-class individuals can be also rendered vulnerable. We propose a relational and layered account of vulnerability and explore this concept using the case study of cord blood (CB) banking. In the first section, two different approaches to 'vulnerability' are contrasted: categorical versus layered. In the second section, we describe CB banking and present a case study of CB banking in Argentina. We examine the types of pressure that middle-class pregnant women feel when considering CB collection and storage. In section three, we use the CB banking case study to critique the categorical approach to vulnerability: this model is unable to account for the ways in which these women are vulnerable. A layered account of vulnerability identifies several ways in which middle-class women are vulnerable. Finally, by utilizing the layered approach, this paper suggests how public health policies could be designed to overcome vulnerabilities. © 2013 John Wiley & Sons Ltd.
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Mochizuki, Yumi; Tomioka, Hirofumi; Tushima, Fumihiko; Shimamoto, Hiroaki; Hirai, Hideaki; Oikawa, Yuu; Harada, Hiroyuki
2016-01-01
Purpose: This study aimed to evaluate the coverage of oral wounds using either a polyglycolic acid (PGA) sheet or split-thickness skin grafting (STSG). Materials and Methods: A total of 119 cases of wound coverage using a PGA sheet and fibrin glue spray as well as 132 cases of wound coverage cases using STSG were reviewed retrospectively. The site of the excision area, perioperative conditions, and postoperative functional problems were evaluated. Results: The PGA group had significantly shorter operation time, earlier start of oral intake, and shorter hospitalization than the STSG group. If the PGA sheet over the wound with exposed bone could be protected by a surgical sprint, oral food intake could be started on the day after surgery at the earliest. When the size of the wound in the buccal excisional area was classified into two groups (<6 or ≥6 cm2), mouth opening in the STSG group was significantly larger at 3 months postoperatively. When the size of the wound in the tongue and floor of mouth was classified into two groups (<12 or ≥12 cm2), the STSG group had a significantly higher score in postoperative speech intelligibility. Conclusion: Selection of a PGA sheet or STSG based on the consideration of defect size, tumor location, patients’ local and general condition and tolerance for surgery could reduce the patients’ postsurgical dysfunctional problems. PMID:28299263
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The Role of Smoking and Gingival Crevicular Fluid Markers on Coronally Advanced Flap Outcomes
Kaval, Başak; Renaud, Diane E.; Scott, David A.; Buduneli, Nurcan
2015-01-01
Background This study evaluates possible effects of smoking on the following: 1) biochemical content in gingival crevicular fluid (GCF) samples from sites of gingival recession and saliva; and 2) clinical outcomes of coronally advanced flap (CAF) for root coverage. Methods Eighteen defects in 15 patients were included in each of the smoker and non-smoker groups. Baseline cotinine, basic fibroblast growth factor, vascular endothelial growth factor, platelet-derived growth factor, interleukin (IL)-8, IL-10, IL-12, tumor necrosis factor-α, matrix metalloproteinase (MMP)-8, MMP-9, and plasminogen activator inhibitor-1 levels were determined in GCF and saliva samples. CAF with microsurgery technique was applied. Plaque index, papilla bleeding index, recession depth (RD), recession width (RW), and root surface area were evaluated at baseline and postoperative months 1, 3, and 6. Probing depth, clinical attachment level (CAL), and keratinized gingival width (KGW) was recorded at baseline and month 6. Percentage of root coverage and complete root coverage were calculated at postoperative months 1, 3, and 6. Results All biochemical parameters were similar in the two groups apart from the definite difference in salivary cotinine concentrations (P = 0.000). Compared with the baseline values, RD, RW, CAL, and root surface area decreased, and KGW increased, with no significant difference between the study groups. CAL gain, percentage of root coverage, and complete root-coverage rates were similar in the study groups. Conclusion Similar baseline biochemical data and comparably high success rates of root coverage with CAF in systemically and periodontally healthy smokers versus non-smokers suggest lack of adverse effects of smoking on clinical outcomes. PMID:23725027
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Krashin, Jamie W; Stuart, Gretchen S; Garrett, Joanne; Spector, Hannah; Bryant, Amy G; Charm, Samantha; Morse, Jessica E
2017-07-01
To evaluate whether contraceptive insurance coverage for women who present for an abortion is associated with obtaining long-acting reversible contraception or depot medroxyprogesterone acetate (DMPA) on the day the abortion is completed. We conducted a prospective cohort study of women presenting for medical or surgical abortion at a single health center in North Carolina. Eligible women were 18 years or older and fluent in English or Spanish. Data were from participant questionnaires, medical charts, and financial records. Our main exposure was whether the woman had insurance coverage for contraception at clinic intake. Our primary outcome was receiving DMPA, an intrauterine device, or a contraceptive subdermal implant on the same day of their surgical abortion or at the visit that determined their medication abortion was complete. We used univariable, bivariable, and multivariable analysis to report our findings. Five hundred seventy-five women enrolled in our cohort between September 2015 and April 2016. One hundred twenty-eight (22%) had insurance coverage and 447 (78%) did not. In the group with insurance coverage for contraception, 38% (49/128) received a long-acting reversible contraception method or DMPA compared with 7% (33/447) in the group without insurance coverage for contraception. After adjusting for confounding, women with contraceptive coverage were more than five times as likely to receive immediate postabortion contraception with one of these methods compared with women without coverage (relative risk 5.6, 95% confidence interval 3.8-8.3). Women with contraceptive insurance coverage on the day of their abortion were more likely to leave the abortion clinic with an intrauterine device or implant in place or receive DMPA injection compared with women without coverage.
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Lee, V Y; Booy, R; Skinner, R; Edwards, K M
2018-05-31
With increased school-based vaccinations for improved coverage rates and practicality, the World Health Organization (WHO) recently endorsed research to identify possible interventions to reduce vaccine-related pain in mass clinical and school-based settings. In particular, the lack of research in adolescents indicate a particular need in this population. Acute exercise has analgesic effects and has been used as a behavioural adjuvant to vaccination. Here, we examine the effect of exercise on vaccine-related pain, anxiety and fear in adolescents, during a school-based program for HPV vaccinations. 116 students (Female: 61, Male: 55) aged 11-13 years were randomly allocated to either an Exercise (n = 60) or Control (n = 56) group. All participants completed demographic and Trait-anxiety questionnaires prior to receiving the vaccine according to usual care. The Exercise group also performed upper body exercise for 15 min prior to receiving the vaccine. Immediately after the vaccine administration, all participants reported on pain, anxiety and fear at the time of receiving the vaccine. Female adolescents in the Exercise group reported significantly less pain (3.64; 95% CI, 2.98-4.30) than Controls (4.58; 95% CI, 3.96-5.19; p = 0.04). Further, females reported greater pain and anxiety than males in the Control group but not the Exercise group. This study supports the use of exercise prior to vaccine administration, especially in female adolescents who are particularly vulnerable to negative experiences during vaccination procedures. Furthermore, the ease of application, as well as the benefit of exercise, provides support for the use of simple exercise prior to vaccination in mass vaccination settings. Clinical trial registry: ANZCTR, ACTRN12614001185651. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Pattern of susceptibility to measles in Italy. Serological Study Group.
Salmaso, S.; Gabutti, G.; Rota, M. C.; Giordano, C.; Penna, C.; Mandolini, D.; Crovari, P.
2000-01-01
On the basis of seroprevalence and incidence data we describe the distribution of individuals susceptible and immune to measles in Italy in 1996-97. In regions where vaccination coverage was at least 70%, approximately 10% of 3-year-old children were susceptible to measles, whereas 40% were in this category in regions with lower vaccination coverage. Seroprevalence among children older than 4 years was similar for the two groups of regions; in the age group 20-39 years it was approximately 95%. During 1990-96 in the regions with lower vaccination coverage the incidence was highest among children aged 4-6 years, and the median age of cases was 7 years; in the regions with higher vaccination coverage, however, the incidence remained at around 5% for the age group 4-16 years, and the overall median age was 10 years. These data confirm the partial reduction in measles incidence in Italy, although transmission has still not been interrupted. The size and geographical distribution of the current pool of susceptible individuals can be expected to present an obstacle to measles elimination if appropriate vaccination strategies, such as catch-up campaigns, are not adopted. PMID:10994277
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Sensitive Interviewing in Qualitative Research.
Dempsey, Laura; Dowling, Maura; Larkin, Philip; Murphy, Kathy
2016-12-01
In this paper we focus on important considerations when planning and conducting qualitative interviews on sensitive topics. Drawing on experiences of conducting interviews with dementia caregivers, a framework of essential elements in qualitative interviewing was developed to emphasize study participants' needs while also providing guidance for researchers. Starting with a definition of sensitive research, the framework includes preparing for interviews, interacting with gatekeepers of vulnerable groups, planning for interview timing, and location, building relationships and conducting therapeutic interactions, protecting ethically vulnerable participants, and planning for disengagement. This framework has the potential to improve the effectiveness of sensitive interviewing with vulnerable groups. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
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Voices from the Gila: health care issues for rural elders in south-western New Mexico.
Averill, Jennifer B
2002-12-01
A goal of the Healthy People 2010 initiative is to reduce or eliminate health disparities in vulnerable populations, including populations from rural and minority ethnic backgrounds. Rural communities, including elderly populations, experience lower rates of personal income, educational attainment, health-insurance coverage, access to emergency and specialty care services, and reported health status than do urban communities. A need exists to address identified research priorities, such as the perceptions of rural elders, their family members, and health care providers. The purposes of this study were to explore the health care perceptions, needs, and definitions of health for multicultural rural elders in one county of south-western New Mexico, and to consider practice implications. Informed consent procedures followed the University of New Mexico Health Sciences Center Human Research Review Committee guidelines. Research methods. This critical ethnography incorporated ethnographic interviews, ethnographic participant observation, photography, review of pertinent documents, and analysis of contextual factors. The sample consisted of 22 participants. Definitions of health varied with socioeconomic status, encompassing avoidance of contact with the health care system, obtaining needed medications, remaining independent, a sense of spiritual belonging, eating wisely, and exercising moderately. Three major concerns emerged from the analysis: the escalating cost of prescription drugs, access-to-care issues, and social isolation. The primary limitation was the small sample size. Although the researcher's position as an outsider to local communities may also have affected the outcome, it provided fresh insight to regional problems. The study addressed national research priorities for a vulnerable group of rural elders. Nursing implications include the need for expanded knowledge and educational preparation regarding elder issues and community-level services, inclusion of elders' perspectives in the planning and delivery of health services, and the need for community-level, interdisciplinary collaboration and advocacy.
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A new approach for computing a flood vulnerability index using cluster analysis
NASA Astrophysics Data System (ADS)
Fernandez, Paulo; Mourato, Sandra; Moreira, Madalena; Pereira, Luísa
2016-08-01
A Flood Vulnerability Index (FloodVI) was developed using Principal Component Analysis (PCA) and a new aggregation method based on Cluster Analysis (CA). PCA simplifies a large number of variables into a few uncorrelated factors representing the social, economic, physical and environmental dimensions of vulnerability. CA groups areas that have the same characteristics in terms of vulnerability into vulnerability classes. The grouping of the areas determines their classification contrary to other aggregation methods in which the areas' classification determines their grouping. While other aggregation methods distribute the areas into classes, in an artificial manner, by imposing a certain probability for an area to belong to a certain class, as determined by the assumption that the aggregation measure used is normally distributed, CA does not constrain the distribution of the areas by the classes. FloodVI was designed at the neighbourhood level and was applied to the Portuguese municipality of Vila Nova de Gaia where several flood events have taken place in the recent past. The FloodVI sensitivity was assessed using three different aggregation methods: the sum of component scores, the first component score and the weighted sum of component scores. The results highlight the sensitivity of the FloodVI to different aggregation methods. Both sum of component scores and weighted sum of component scores have shown similar results. The first component score aggregation method classifies almost all areas as having medium vulnerability and finally the results obtained using the CA show a distinct differentiation of the vulnerability where hot spots can be clearly identified. The information provided by records of previous flood events corroborate the results obtained with CA, because the inundated areas with greater damages are those that are identified as high and very high vulnerability areas by CA. This supports the fact that CA provides a reliable FloodVI.
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Dybdal, Kristin; Blewett, Lynn A; Pintor, Jessie Kemmick; Johnson, Kelli
2015-01-01
An evaluation of the Minnesota Community Application Agent (MNCAA) Program was conducted for the MN Minnesota Department of Human Services and funded by the Health Resources and Services Administration's State Health Access Program grant. The MNCAA evaluation assessed effectiveness in reaching disparate populations, explored overall program value, and sought lessons applicable to the Navigator programs required under the Affordable Care Act. Mixed-methods approach using quantitative analysis of tracking and payment data and interviews with key informants to elicit "lessons learned" about the MNCAA program. The MNCAA program offers incentive payments and technical assistance to community partner organizations that assist individuals in applying for public health care coverage. A total of 140 unique community organizations participated in the MNCAA program in 2008 to 2012. Outreach staff and directors from participating MNCAAs and state/local government officials were interviewed. The article highlights a strategy for targeting outreach to individuals eligible for Medicaid coverage or subsidies under the Affordable Care Act by presenting evaluation findings from a unique outreach program to increase access to care for vulnerable populations in Minnesota. Almost two-thirds of applicants were successfully enrolled but lengthy waiting periods persisted. Seventy percent of applications came from health care organizations. Only 13% of applicants assisted by MNCAAs were new to public health care programs. Most MNCAAs believed that the incentive payment-$25 per successful enrollee-was insufficient. Significant expertise in enrolling individuals in public health care programs exists within a core group of community organizations. Incentives to leverage the capacity of community organizations must be accompanied by recruiting and training. Outreach providers and navigators also need timely access to client information. More investment in financial incentives will be required.
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Coverage and Preventive Screening
Meeker, Daniella; Joyce, Geoffrey F; Malkin, Jesse; Teutsch, Steven M; Haddix, Anne C; Goldman, Dana P
2011-01-01
Context Preventive care has been shown as a high-value health care service. Many employers now offer expanded coverage of preventive care to encourage utilization. Objective To determine whether expanding coverage is an effective means to encourage utilization. Design Comparison of screening rates before and after introduction of deductible-free coverage. Setting People insured through large corporations between 2002 and 2006. Patients or Other Participants Preferred Provider Organization (PPO) enrollees from an employer introducing deductible-free coverage, and a control group enrolled in a PPO from a second employer with no policy change. Main Outcome Measures Adjusted probability of endoscopy, fecal occult blood test (FOBT), lipid screens, mammography, and Papanicolaou (pap) smears. Intervention Introduction of first-dollar coverage (FDC) of preventive services in 2003. Results After adjusting for demographics and secular trends, there were between 23 and 78 additional uses per 1,000 eligible patients of covered preventive screens (lipid screens, pap smears, mammograms, and FOBT), with no significant changes in the control group or in a service without FDC (endoscopy). Conclusions FDC improves utilization modestly among healthy individuals, particularly those in lower deductible plans. Compliance with guidelines can be encouraged by lowering out-of-pocket costs, but patients' predisposing characteristics merit attention. PMID:21029084
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Baig, Sabeeh A.; Pepper, Jessica K.; Morgan, Jennifer C.; Brewer, Noel T.
2017-01-01
Rationale Tobacco companies use advertising to target vulnerable populations, including youth, racial/ethnic minorities, and sexual minorities. Objective We sought to examine how personal identity affects support for population-specific anti-smoking advertisements that could serve as countermeasures to industry practices. Methods In 2014–2015, we surveyed probability phone samples of adults and adolescents (n = 6,139) and an online convenience sample of adults (n = 4,137) in the United States. We experimentally varied the description of tobacco industry marketing practices (no description, general, or specific to a target group). The four prevention target groups were teens; African Americans; Latinos; and gays, lesbians, and bisexuals (GLBs). Participants were either members or non-members of their prevention target group. Results Support was highest for anti-smoking advertisements targeting teens, moderate for Latinos and African Americans, and lowest for GLBs. In-group members expressed higher support than out-group members when anti-smoking advertisements targeted African Americans, Latinos, and GLBs (all p < .05). However, when teens were the target prevention group, in-group members expressed lower support than out-group members (p < .05). The description of industry marketing practices did not have an effect. Results were similar across the phone and online studies. Conclusions Our findings suggest that the public strongly supports advertisements to prevent smoking among teens, but support for similar efforts among other vulnerable populations is comparatively low. Anti-smoking campaigns for vulnerable populations may benefit from a greater understanding of the role of social identity in shaping public support for such campaigns. PMID:28427731
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HIV prevention among transgender women in Latin America: implementation, gaps and challenges.
Silva-Santisteban, Alfonso; Eng, Shirley; de la Iglesia, Gabriela; Falistocco, Carlos; Mazin, Rafael
2016-01-01
Transgender women are the population most vulnerable to HIV in Latin America, with prevalence between 18 and 38%. Although the region has improved antiretroviral coverage, there is an urgent need to strengthen HIV prevention for key populations to meet regional targets set by governments. We conducted an assessment on the state of HIV prevention among transgender women in Latin America. We conducted a desk review of Global AIDS Response Progress Reports, national strategic plans, technical reports and peer-reviewed articles from 17 Latin American countries published through January 2015. The review was preceded by 12 semi-structured interviews with UNAIDS and Pan American Health Organization officers and a discussion group with transgender women regional leaders, to guide the identification of documents. We assessed access to, implementation and coverage of programmes; legal frameworks; community participation; inclusion of new strategies; and alignment with international recommendations. Overall, prevention activities in the region focus on condom distribution, diagnosis of sexually transmitted infections and peer education, mostly delivered at health facilities, with limited community involvement. Argentina and Uruguay have implemented structural interventions to address social inclusion. Argentina, Brazil and Mexico have adopted early initiation of antiretroviral therapy and treatment as prevention strategies. The other countries do not have substantial tailored interventions and consider the trans population a sub-population of men who have sex with men in data collection and programme implementation. Limited coverage of services, discrimination and a deep-seated mistrust of the health system among transgender women are the main barriers to accessing HIV prevention services. Promising interventions include health services adapted to transgender women in Mexico; LGBT-friendly clinics in Argentina that incorporate community and health workers in mixed teams; task-shifting to community-based organizations; mobile HIV testing; and gender identity laws. Transgender women in Latin America continue to have limited access to HIV prevention services, which presents a bottleneck for reaching prevention goals and incorporating new prevention interventions. Prevention programmes should be rights-based; offer tailored, holistic interventions; and involve transgender women in their design and implementation.
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HIV prevention among transgender women in Latin America: implementation, gaps and challenges
Silva-Santisteban, Alfonso; Eng, Shirley; de la Iglesia, Gabriela; Falistocco, Carlos; Mazin, Rafael
2016-01-01
Introduction Transgender women are the population most vulnerable to HIV in Latin America, with prevalence between 18 and 38%. Although the region has improved antiretroviral coverage, there is an urgent need to strengthen HIV prevention for key populations to meet regional targets set by governments. We conducted an assessment on the state of HIV prevention among transgender women in Latin America. Methods We conducted a desk review of Global AIDS Response Progress Reports, national strategic plans, technical reports and peer-reviewed articles from 17 Latin American countries published through January 2015. The review was preceded by 12 semi-structured interviews with UNAIDS and Pan American Health Organization officers and a discussion group with transgender women regional leaders, to guide the identification of documents. We assessed access to, implementation and coverage of programmes; legal frameworks; community participation; inclusion of new strategies; and alignment with international recommendations. Results and discussion Overall, prevention activities in the region focus on condom distribution, diagnosis of sexually transmitted infections and peer education, mostly delivered at health facilities, with limited community involvement. Argentina and Uruguay have implemented structural interventions to address social inclusion. Argentina, Brazil and Mexico have adopted early initiation of antiretroviral therapy and treatment as prevention strategies. The other countries do not have substantial tailored interventions and consider the trans population a sub-population of men who have sex with men in data collection and programme implementation. Limited coverage of services, discrimination and a deep-seated mistrust of the health system among transgender women are the main barriers to accessing HIV prevention services. Promising interventions include health services adapted to transgender women in Mexico; LGBT-friendly clinics in Argentina that incorporate community and health workers in mixed teams; task-shifting to community-based organizations; mobile HIV testing; and gender identity laws. Conclusions Transgender women in Latin America continue to have limited access to HIV prevention services, which presents a bottleneck for reaching prevention goals and incorporating new prevention interventions. Prevention programmes should be rights-based; offer tailored, holistic interventions; and involve transgender women in their design and implementation. PMID:27431470
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How choices in exchange design for states could affect insurance premiums and levels of coverage.
Blavin, Fredric; Blumberg, Linda J; Buettgens, Matthew; Holahan, John; McMorrow, Stacey
2012-02-01
The Affordable Care Act gives states the option to create health insurance exchanges from which individuals and small employers can purchase health insurance. States have considerable flexibility in how they design and implement these exchanges. We analyze several key design options being considered, using the Urban Institute's Health Insurance Policy Simulation Model: creating separate versus merged small-group and nongroup markets, eliminating age rating in these markets, removing the small-employer credit, and setting the maximum number of employees for firms in the small-group market at 50 versus 100 workers. Among our findings are that merging the small-group and nongroup markets would result in 1.7 million more people nationwide participating in the exchanges and, because of greater affordability of nongroup coverage, approximately 1.0 million more people being insured than if the risk pools were not merged. The various options generate relatively small differences in overall coverage and cost, although some, such as reducing age rating bands, would result in higher costs for some people while lowering costs for others. These cost effects would be most apparent among people who purchase coverage without federal subsidies. On the whole, we conclude that states can make these design choices based on local support and preferences without dramatic repercussions for overall coverage and cost outcomes.
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O'Reilly, K. M.; Cori, A.; Durry, E.; Wadood, M. Z.; Bosan, A.; Aylward, R. B.; Grassly, N. C.
2015-01-01
Mass vaccination campaigns with the oral poliovirus vaccine targeting children aged <5 years are a critical component of the global poliomyelitis eradication effort. Monitoring the coverage of these campaigns is essential to allow corrective action, but current approaches are limited by their cross-sectional nature, nonrandom sampling, reporting biases, and accessibility issues. We describe a new Bayesian framework using data augmentation and Markov chain Monte Carlo methods to estimate variation in vaccination coverage from children's vaccination histories investigated during surveillance for acute flaccid paralysis. We tested the method using simulated data with at least 200 cases and were able to detect undervaccinated groups if they exceeded 10% of all children and temporal changes in coverage of ±10% with greater than 90% sensitivity. Application of the method to data from Pakistan for 2010–2011 identified undervaccinated groups within the Balochistan/Federally Administered Tribal Areas and Khyber Pakhtunkhwa regions, as well as temporal changes in coverage. The sizes of these groups are consistent with the multiple challenges faced by the program in these regions as a result of conflict and insecurity. Application of this new method to routinely collected data can be a useful tool for identifying poorly performing areas and assisting in eradication efforts. PMID:26568569
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ERIC Educational Resources Information Center
Kendall, Sally; Straw, Suzanne; Jones, Megan; Springate, Iain; Lord, Pippa; Stoney, Sheila
2007-01-01
In 2007, the Local Government Association (LGA) commissioned the NFER to review the best evidence on what works in narrowing the gap in outcomes for vulnerable groups across the five Every Child Matters areas. The review aimed to underpin the Narrowing the Gap Programme, a major development programme being implemented by the LGA and the DCSF. …
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ERIC Educational Resources Information Center
Pereira, Ana I. F.; Canavarro, Maria C.; Cardoso, Margarida F.; Mendonca, Denisa
2005-01-01
This study explores multiple relational contexts that promote vulnerability and protection against early pregnancy in a potential risk group of Portuguese adolescents. A comparative analysis was made between two groups of female adolescents of low socioeconomic status: pregnant adolescents (n = 57) and adolescents without a history of pregnancy (n…
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Young Adults' Selection and Use of Dependent Coverage under the Affordable Care Act.
Chen, Weiwei
2018-01-01
The dependent coverage expansion under the Affordable Care Act (ACA) required health insurance policies that cover dependents to offer coverage for policyholder' children up to age 26. It has been well documented that the provision successfully reduced the uninsured rate among the young adults. However, less is known about whether dependent coverage crowded out other insurance types and whether young adults used dependent coverage as a fill-in-the-gap short-term option. Using data from the Survey of Income and Program Participation 2008 Panel, the paper assesses dependent coverage uptake and duration before and after the ACA provision among young adults aged 19-26 versus those aged 27-30. Regressions for additional coverage outcomes were also performed to estimate the crowd-out rate. It was found that the ACA provision had a significant positive impact on dependent coverage uptake and duration. The estimated crowd-out rate ranges from 27 to 42%, depending on the definition. Most dependent coverage enrollees used the coverage for 1 or 2 years. Differences in dependent coverage uptake and duration remained among racial groups. Less healthy individuals were also less likely to make use of dependent coverage.
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Young Adults’ Selection and Use of Dependent Coverage under the Affordable Care Act
Chen, Weiwei
2018-01-01
The dependent coverage expansion under the Affordable Care Act (ACA) required health insurance policies that cover dependents to offer coverage for policyholder’ children up to age 26. It has been well documented that the provision successfully reduced the uninsured rate among the young adults. However, less is known about whether dependent coverage crowded out other insurance types and whether young adults used dependent coverage as a fill-in-the-gap short-term option. Using data from the Survey of Income and Program Participation 2008 Panel, the paper assesses dependent coverage uptake and duration before and after the ACA provision among young adults aged 19–26 versus those aged 27–30. Regressions for additional coverage outcomes were also performed to estimate the crowd-out rate. It was found that the ACA provision had a significant positive impact on dependent coverage uptake and duration. The estimated crowd-out rate ranges from 27 to 42%, depending on the definition. Most dependent coverage enrollees used the coverage for 1 or 2 years. Differences in dependent coverage uptake and duration remained among racial groups. Less healthy individuals were also less likely to make use of dependent coverage. PMID:29445721
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DNA methylation profiles of elderly individuals subjected to indentured childhood labor and trauma.
Marinova, Zoya; Maercker, Andreas; Küffer, Andreas; Robinson, Mark D; Wojdacz, Tomasz K; Walitza, Susanne; Grünblatt, Edna; Burri, Andrea
2017-02-27
Childhood trauma is associated with increased vulnerability to mental and somatic disorders later in life. Epigenetic modifications such as DNA methylation are one potential mechanism through which such long-lasting impairments/consequences can be explained. The aim of the present study was to investigate whether childhood trauma is associated with long-term DNA methylation alterations in old age. We assessed genome-wide DNA methylation profiles in a cohort of former indentured child laborers ("Verdingkinder") who suffered severe childhood adversities (N = 30; M age = 75.9 years), and compared them to control group with similar demographic characteristics (N = 15, M age = 72.8 years). DNA was isolated from epithelial buccal cells and hybridized to the Illumina Infinium 450 k DNA methylation array, which provides coverage of 485,000 methylation sites. After accounting for batch effects, age, gender and multiple testing, 71 differentially methylated CpG positions were identified between the two groups. They were annotated among others to genes involved in neuronal projections and neuronal development. Some of the identified genes with differential methylation (DLG associated protein 2, mechanistic target of rapamycin) have previously been associated with traumatic stress. The results indicate specific epigenetic alterations in elderly individuals who were subjected to childhood adversities. Psychiatric and somatic comorbidities as well as differences in buccal epithelial cells proportion may contribute to the observed epigenetic differences.
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Research should not ignore the power of elite groups.
Gregory, Robert J
2002-02-01
For a long time, public health research has focused on many and diverse types of vulnerable groups in society. Whether drug abusers, prison inmates, smokers, poverty-stricken, mentally ill, HIV positive, or any number of other ailments, the public health system and, in particular, researchers have addressed and reported on people and populations with so-called deficits. Research on these vulnerable groups has been designed, conducted, reported, discussed and analysed, but vulnerable groups continue and, in fact, appear to be increasing in number, size, and range. An alternative approach that begins with entirely different questions is possible and advisable. Public health research could, and in the author's point of view, should, examine the lifestyles and, specifically, decision-making by members of elite groups. Studying up the economic and political ladder calls for examination of how a few reap enormous benefits for themselves, leaving the rest of us to our misfortune. Such decisions as the elite groups make affects resource allocation, use of information, and results in the public health and other social, economic, military, and political sectors in society.
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Kao, Dennis
2010-04-01
This study examines the discrepancies in health insurance coverage and type across Asian American ethnic groups and the potential factors that may explain why these differences exist. Asian Americans are often considered as a homogeneous population and consequently, remain largely "invisible" in the current research literature. Recent data have highlighted discrepancies in the health insurance coverage between different Asian American ethnic groups-particularly the high uninsurance rates among Korean and Vietnamese Americans. For this study, the 2003 and 2005 California Health Interview Surveys were pooled to obtain a sample of 6,610 Asian American adults aged 18-64, including those of Chinese, Filipino, Japanese, South Asian, and Vietnamese ethnicity. Binomial and multinomial logistic regression models were used to examine the likelihood of current health coverage and insurance type (employer-based vs. private vs. public), respectively. The results showed that ethnic differences in uninsurance and insurance type were partially explained by socioeconomic and immigration-related characteristics-particularly for Vietnamese Americans and to a lesser extent, for Chinese and Korean Americans. There were also key differences in the extent to which specific ethnic groups purchased private insurance or relied on public programs (e.g., Medicaid) to offset the lack of employer-based coverage. This study reaffirms the tremendous heterogeneity in the Asian American population and the need for more targeted policy approaches. With the lack of adequate national data, more localized studies may help to improve our understanding of the health issues affecting specific Asian ethnic groups.
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Trombelli, L; Scabbia, A; Tatakis, D N; Calura, G
1998-11-01
The purpose of the present clinical study was to evaluate the effect of guided tissue regeneration (GTR) in comparison to subpedicle connective tissue graft (SCTG) in the treatment of gingival recession defects. A total of 12 patients, each contributing a pair of Miller's Class I or II buccal gingival recessions, was treated. According to a randomization list, one defect in each patient received a polyglycolide/lactide bioabsorbable membrane, while the paired defect received a SCTG. Treatment effect was evaluated 6 months postsurgery. Clinical recordings included full-mouth and defect-specific oral hygiene standards and gingival health, recession depth (RD), recession width (RW), probing depth (PD), clinical attachment level (CAL), and keratinized tissue width (KT). Mean RD significantly decreased from 3.1 mm presurgery to 1.5 mm at 6 months postsurgery for the GTR group (48% root coverage), and from 3.0 mm to 0.5 mm for the SCTG group (81% root coverage). RD reduction and root coverage were significantly greater in SCTG group compared to GTR group. Mean CAL gain amounted to 1.7 mm for the GTR group, and 2.3 mm in the SCTG group. No significant differences in PD changes were observed within and between groups. KT increased significantly from presurgery for both treatment groups, however gingival augmentation was significantly greater in the SCTG group compared to GTR group. Results indicate that: 1) treatment of human gingival recession defects by means of both GTR and SCTG procedures results in clinically and statistically significant improvement of the soft tissue conditions of the defect; and 2) treatment outcome was significantly better following SCTG compared to GTR in terms of recession depth reduction, root coverage, and keratinized tissue increase.
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Kripke, Katharine; Hatzold, Karin; Mugurungi, Owen; Ncube, Gertrude; Xaba, Sinokuthemba; Gold, Elizabeth; Ahanda, Kim Seifert; Kruse-Levy, Natalie; Njeuhmeli, Emmanuel
2016-01-01
Zimbabwe aims to increase circumcision coverage to 80% among 13- to 29-year-olds. However, implementation data suggest that high coverage among men ages 20 and older may not be achievable without efforts specifically targeted to these men, incurring additional costs per circumcision. Scale-up scenarios were created based on trends in implementation data in Zimbabwe, and the cost-effectiveness of increasing efforts to recruit clients ages 20-29 was examined. Zimbabwe voluntary medical male circumcision (VMMC) program data were used to project trends in male circumcision coverage by age into the future. The projection informed a base scenario in which, by 2018, the country achieves 80% circumcision coverage among males ages 10-19 and lower levels of coverage among men above age 20. The Zimbabwe DMPPT 2.0 model was used to project costs and impacts, assuming a US$109 VMMC unit cost in the base scenario and a 3% discount rate. Two other scenarios assumed that the program could increase coverage among clients ages 20-29 with a corresponding increase in unit cost for these age groups. When circumcision coverage among men ages 20-29 is increased compared with a base scenario reflecting current implementation trends, fewer VMMCs are required to avert one infection. If more than 50% additional effort (reflected as multiplying the unit cost by >1.5) is required to double the increase in coverage among this age group compared with the base scenario, the cost per HIV infection averted is higher than in the base scenario. Although increased investment in recruiting VMMC clients ages 20-29 may lead to greater overall impact if recruitment efforts are successful, it may also lead to lower cost-effectiveness, depending on the cost of increasing recruitment. Programs should measure the relationship between increased effort and increased ability to attract this age group.
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Universal health coverage in Turkey: enhancement of equity.
Atun, Rifat; Aydın, Sabahattin; Chakraborty, Sarbani; Sümer, Safir; Aran, Meltem; Gürol, Ipek; Nazlıoğlu, Serpil; Ozgülcü, Senay; Aydoğan, Ulger; Ayar, Banu; Dilmen, Uğur; Akdağ, Recep
2013-07-06
Turkey has successfully introduced health system changes and provided its citizens with the right to health to achieve universal health coverage, which helped to address inequities in financing, health service access, and health outcomes. We trace the trajectory of health system reforms in Turkey, with a particular emphasis on 2003-13, which coincides with the Health Transformation Program (HTP). The HTP rapidly expanded health insurance coverage and access to health-care services for all citizens, especially the poorest population groups, to achieve universal health coverage. We analyse the contextual drivers that shaped the transformations in the health system, explore the design and implementation of the HTP, identify the factors that enabled its success, and investigate its effects. Our findings suggest that the HTP was instrumental in achieving universal health coverage to enhance equity substantially, and led to quantifiable and beneficial effects on all health system goals, with an improved level and distribution of health, greater fairness in financing with better financial protection, and notably increased user satisfaction. After the HTP, five health insurance schemes were consolidated to create a unified General Health Insurance scheme with harmonised and expanded benefits. Insurance coverage for the poorest population groups in Turkey increased from 2·4 million people in 2003, to 10·2 million in 2011. Health service access increased across the country-in particular, access and use of key maternal and child health services improved to help to greatly reduce the maternal mortality ratio, and under-5, infant, and neonatal mortality, especially in socioeconomically disadvantaged groups. Several factors helped to achieve universal health coverage and improve outcomes. These factors include economic growth, political stability, a comprehensive transformation strategy led by a transformation team, rapid policy translation, flexible implementation with continuous learning, and simultaneous improvements in the health system, on both the demand side (increased health insurance coverage, expanded benefits, and reduced cost-sharing) and the supply side (expansion of infrastructure, health human resources, and health services). Copyright © 2013 Elsevier Ltd. All rights reserved.
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Protecting water quality in the watershed
DOE Office of Scientific and Technical Information (OSTI.GOV)
James, C.R.; Johnson, K.E.; Stewart, E.H.
1994-08-01
This article highlights the water quality component of a watershed management plan being developed for the San Francisco (CA) Water Department. The physical characteristics of the 63,000-acre watersheds were analyzed for source and transport vulnerability for five groups of water quality parameters--particulates, THM precursors, microorganisms (Giardia and cryptosporidium), nutrients (nitrogen and phosphorus), and synthetic organic chemicals--and vulnerability zones were mapped. Mapping was achieved through the use of an extensive geographic information system (GIS) database. Each water quality vulnerability zone map was developed based on five watershed physical characteristics--soils, slope, vegetation, wildlife concentration, and proximity to water bodies--and their relationships tomore » each of the five groups of water quality parameters. An approach to incorporate the watershed physical characteristics information into the five water quality vulnerability zone maps was defined and verified. The composite approach was based in part on information gathered from existing watershed management plans.« less
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Neville, Stephen; Adams, Jeffery; Cook, Catherine
2016-12-01
Undertaking qualitative research with vulnerable populations is a complex and challenging process for researchers. Traditional and common modes of collecting qualitative data with these groups have been via face-to-face recorded interviews. This article reports on three internet-based data collection methods; email and synchronous online interviews, as well as online qualitative survey. The key characteristics of using email, sychronous online interviews and an online qualitative survey including the strengths and limitations of each are presented. Reflections and insights on the use of these internet-based data collection methods are provided to encourage researchers to embrace technology and move away from using traditional face-to-face interviews when researching with vulnerable populations. Using the internet to collect qualitative data offers additional ways to gather qualitative data over traditional data collection methods. The use of alternative interview methods may encourage participation of vulnerable participants.
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African American adolescent perceptions of vulnerability and resilience to HIV.
Glenn, Betty L; Wilson, Kathleen P
2008-07-01
HIV/AIDS is growing at a disproportional rate among African American adolescents. This trend has occurred despite the fact that 89% of schools have educational programs on HIV/AIDS. Barriers to effective HIV prevention may be related to a failure to develop educational programs based on the cultural competencies of vulnerable populations such as adolescents who are at risk for HIV. The purpose of this qualitative study was to explore African American adolescent perceptions of vulnerability and resilience to HIV/AIDS within a cultural competency paradigm. A group of 8 adolescents at an African American church participated in a focus group to discuss vulnerability and resilience to HIV. To facilitate discussion, the adolescents developed collages from pictures in African American magazines. Content analysis was used to identify themes. The themes revealed were confidence, safe social activities, innocence, image, music/drug culture, and peer pressure.
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On Bipartite Graphs Trees and Their Partial Vertex Covers.
DOE Office of Scientific and Technical Information (OSTI.GOV)
Caskurlu, Bugra; Mkrtchyan, Vahan; Parekh, Ojas D.
2015-03-01
Graphs can be used to model risk management in various systems. Particularly, Caskurlu et al. in [7] have considered a system, which has threats, vulnerabilities and assets, and which essentially represents a tripartite graph. The goal in this model is to reduce the risk in the system below a predefined risk threshold level. One can either restricting the permissions of the users, or encapsulating the system assets. The pointed out two strategies correspond to deleting minimum number of elements corresponding to vulnerabilities and assets, such that the flow between threats and assets is reduced below the predefined threshold level. Itmore » can be shown that the main goal in this risk management system can be formulated as a Partial Vertex Cover problem on bipartite graphs. It is well-known that the Vertex Cover problem is in P on bipartite graphs, however; the computational complexity of the Partial Vertex Cover problem on bipartite graphs has remained open. In this paper, we establish that the Partial Vertex Cover problem is NP-hard on bipartite graphs, which was also recently independently demonstrated [N. Apollonio and B. Simeone, Discrete Appl. Math., 165 (2014), pp. 37–48; G. Joret and A. Vetta, preprint, arXiv:1211.4853v1 [cs.DS], 2012]. We then identify interesting special cases of bipartite graphs, for which the Partial Vertex Cover problem, the closely related Budgeted Maximum Coverage problem, and their weighted extensions can be solved in polynomial time. We also present an 8/9-approximation algorithm for the Budgeted Maximum Coverage problem in the class of bipartite graphs. We show that this matches and resolves the integrality gap of the natural LP relaxation of the problem and improves upon a recent 4/5-approximation.« less
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Turkish Compulsory Earthquake Insurance (TCIP)
NASA Astrophysics Data System (ADS)
Erdik, M.; Durukal, E.; Sesetyan, K.
2009-04-01
Through a World Bank project a government-sponsored Turkish Catastrophic Insurance Pool (TCIP) is created in 2000 with the essential aim of transferring the government's financial burden of replacing earthquake-damaged housing to international reinsurance and capital markets. Providing coverage to about 2.9 Million homeowners TCIP is the largest insurance program in the country with about 0.5 Billion USD in its own reserves and about 2.3 Billion USD in total claims paying capacity. The total payment for earthquake damage since 2000 (mostly small, 226 earthquakes) amounts to about 13 Million USD. The country-wide penetration rate is about 22%, highest in the Marmara region (30%) and lowest in the south-east Turkey (9%). TCIP is the sole-source provider of earthquake loss coverage up to 90,000 USD per house. The annual premium, categorized on the basis of earthquake zones type of structure, is about US90 for a 100 square meter reinforced concrete building in the most hazardous zone with 2% deductible. The earthquake engineering related shortcomings of the TCIP is exemplified by fact that the average rate of 0.13% (for reinforced concrete buildings) with only 2% deductible is rather low compared to countries with similar earthquake exposure. From an earthquake engineering point of view the risk underwriting (Typification of housing units to be insured, earthquake intensity zonation and the sum insured) of the TCIP needs to be overhauled. Especially for large cities, models can be developed where its expected earthquake performance (and consequently the insurance premium) can be can be assessed on the basis of the location of the unit (microzoned earthquake hazard) and basic structural attributes (earthquake vulnerability relationships). With such an approach, in the future the TCIP can contribute to the control of construction through differentiation of premia on the basis of earthquake vulnerability.