Factors influencing immunisation coverage among children under five years of age in Khartoum State, Sudan

Background This article explores the hypothesis that predisposing and enabling factors of households influence the vaccination status of the children under the age of five in Khartoum State, Sudan. Method The study was a cross-sectional survey among a representative sample of 410 male and female children under five years of age from households with varying socio-economic status and mothers with varying levels of education, from both urban and rural localities in the state. Results The correct vaccination coverage rate for children was found to be high. Children in urban and rural areas differed substantially in their correct vaccination rates and their receipt of each vaccine separately. Walking or travelling time to the place of vaccination was found to be longer in rural areas when compared with urban areas. The vaccination rate increased with an increase in the age of the children and the education level of the mother. Children of older mothers were more likely to have had the correct vaccinations. The mothers\' knowledge of and attitudes to vaccination showed a strong relationship with the vaccination status of their children. When the coverage rate for each vaccine was taken separately, the economic level of the households significantly affected only the BCG vaccine coverage. Most vaccinations occurred in public outlet agencies. Conclusion The large differences found in vaccination coverage by place of residence and level of mother\'s education suggest that much greater efforts are required by the government if better rates of correct vaccination are to be achieved in rural areas. South African Family Practice Vol. 49 (8) 2007: pp. 1

Tooth loss in Sjögren?s syndrome patients compared to age and gender matched controls

To analyze the prevalence and location of tooth loss in Sjögren?s syndrome (SS) patients and compare them with an age- and gender-matched control group. Dental charts and x-rays of 108 (SS) patients were retrieved from an academic dental center and special care dentistry department. For each SS patient, an age- and gender-matched non-SS patient was randomly selected. Medication, number of extractions and date and location of extractions were assessed. Differences between SS and non-SS patients were analyzed using Mann-Whitney U tests, Chi-square tests and Fisher?s exact tests. Significantly more SS patients were edentulous compared to the non-SS group (14.8% versus 1.9%, p = 0.001). SS patients had a 61% higher risk to have experienced one or more extractions than control patients. In the SS group, there was a non-significant tendency for more maxillary teeth to have been extracted than mandibular teeth (42:34). In the control group, the number of extractions in the maxilla and mandible were comparable (21:20). When divided into sextants, the number of SS patients with one or more extractions was significantly higher than for non-SS patients for each sextant (p = 0.001 to p = 0.032). The largest difference in the proportion of patients with one or more extractions between the SS and non-SS patients occurred in the upper anterior sextant (3.4 times more frequent). SS patients are more prone to experience dental extractions compared to patients without SS. It could be speculated that this is related to a decreased salivary secretion

The Role of Negative-Pressure Wound Therapy in Patients with Fracture-Related Infection:A Systematic Review and Critical Appraisal

INTRODUCTION: Fracture-related infection (FRI) is a severe musculoskeletal complication in orthopedic trauma surgery, causing challenges in bony and soft tissue management. Currently, negative-pressure wound therapy (NPWT) is often used as temporary coverage for traumatic and surgical wounds, also in cases of FRI. However, controversy exists about the impact of NPWT on the outcome in FRI, specifically on infection recurrence. Therefore, this systematic review qualitatively assesses the literature on the role of NPWT in the management of FRI. METHODS: A literature search of the PubMed, Embase, and Web of Science database was performed. Studies that reported on infection recurrence related to FRI management combined with NPWT were eligible for inclusion. Quality assessment was done using the PRISMA statement and the Newcastle-Ottawa Quality Assessment Scale. RESULTS: After screening and quality assessment of 775 unique identified records, eight articles could be included for qualitative synthesis. All eight studies reported on infection recurrence, which ranged from 2.8% to 34.9%. Six studies described wound healing time, varying from two to seven weeks. Four studies took repeated microbial swabs during subsequent vacuum dressing changes. One study reported newly detected pathogens in 23% of the included patients, and three studies did not find new pathogens. CONCLUSION: This review provides an assessment of current literature on the role of NPWT in the management of soft tissue defects in patients with FRI. Due to the lack of uniformity in included studies, conclusions should be drawn with caution. Currently, there is no clear scientific evidence to support the use of NPWT as definitive treatment in FRI. At this stage, we can only recommend early soft tissue coverage (within days) with a local or free flap. NPWT may be safe for a few days as temporarily soft tissue coverage until definitive soft tissue management could be performed. However, comparative studies between NPWT and early wound closure in FRI patients are needed

Is there a difference in venous thrombosis rate in free flap anastomoses based on coupler diameter?: A systematic review. Does Size Really Matter?

Background: The adage is to use the largest anastomotic coupler device (coupler) size possible, since smaller an anastomosis might be more susceptible to thrombosis. It is unclear if this wisdom is supported by data. This study tests the hypothesis that there is no difference in the reported literature in thrombosis rate between different coupler sizes. Methods: We searched PubMed, Embase, and the Cochrane Library. After screening 235 studies, we included 11 retrospective case-series. According to the criteria of Newcastle-Ottowa Scale, quality score ranged from 2 to 4 (out of 5) and funnel plots indicated publication bias. We included a total of 5930 coupled anastomoses. We calculated thrombosis rate per coupler diameter with exact confidence intervals (CIs). We regard non-overlapping CIs as a significant difference. Results: Nine studies reported no difference in thrombosis rate based on coupler size. Two studies report a potentially greater thrombosis rates in smaller sizes: (1) 2.0 mm 27% (95% CI 17%-40%, 17/62 cases) vs. 3.0 mm 6.3% (95% CI 2.8%-12%, 8/126 cases) and (2) 1.5 mm 6.9% (95% CI 2.8%-14%, 7/101 cases) vs. 3.0 mm group 1.2% (95% CI 0.64%-2.1%, 13/1079). Conclusion: There is some evidence that suggests that smaller coupler sizes are associated with greater thrombosis rate, but the current available evidence has limitations. Performing a second anastomosis, in case, the first anastomosis is performed with a coupler size of 1.0, 1.5, or even 2.0 mm, can potentially reduce this rate, however, this remains to be determined

Sialendoscopy increases saliva secretion and reduces xerostomia up to 60 weeks in Sjogren's syndrome patients:a randomized controlled study

OBJECTIVE: To assess the effect of sialendoscopy of the major salivary glands on salivary flow and xerostomia in patients with Sjögren's syndrome (SS). METHODS: Forty-five patients with SS were randomly assigned to a control group (no irrigation, control, n = 15), to irrigation of the major salivary glands with saline (saline, n = 15) or to irrigation with saline followed by corticosteroid application (triamcinolone acetonide in saline, saline/TA, n = 15). Unstimulated whole saliva flow (UWSF), chewing-stimulated whole saliva flow (SWSF), citric acid-stimulated parotid flow, Clinical Oral Dryness Score (CODS), Xerostomia Inventory (XI) and EULAR SS Patient Reported Index (ESSPRI) scores were obtained 1 week before (T0), and 1, 8, 16, 24, 36, 48 and 60 weeks after sialendoscopy. Data were analysed using linear mixed models. RESULTS: Irrespective of the irrigation protocol used, sialendoscopy resulted in an increased salivary flow during follow-up up to 60 weeks. Significant between-group differences in the longitudinal course of outcomes were found for UWSF, SWSF, XI and ESSPRI scores (P = 0.028, P = 0.001, P = 0.03, P = 0.021, respectively). UWSF at 60 weeks was higher compared with T0 in the saline group (median: 0.14 vs median: 0.10, P = 0.02) and in the saline/TA group (median: 0.20, vs 0.13, P = 0.035). In the saline/TA group SWSF at 48 weeks was higher compared with T0 (median: 0.74 vs 0.38, P = 0.004). Increase in unstimulated salivary flow was also reflected in improved CODS, XI and ESSPRI scores compared with baseline. CONCLUSION: Irrigation of the major salivary glands in patients with SS increases salivary flow and reduces xerostomia

Dutch healthcare reform: did it result in performance improvement of health plans? A comparison of consumer experiences over time

<p>Abstract</p> <p>Background</p> <p>Many countries have introduced elements of managed competition in their healthcare system with the aim to accomplish more efficient and demand-driven health care. Simultaneously, generating and reporting of comparative healthcare information has become an important quality-improvement instrument. We examined whether the introduction of managed competition in the Dutch healthcare system along with public reporting of quality information was associated with performance improvement in health plans.</p> <p>Methods</p> <p>Experiences of consumers with their health plan were measured in four consecutive years (2005-2008) using the CQI^®health plan instrument 'Experiences with Healthcare and Health Insurer'. Data were available of 13,819 respondents (response = 45%) of 30 health plans in 2005, of 8,266 respondents (response = 39%) of 32 health plans in 2006, of 8,088 respondents (response = 34%) of 32 health plans in 2007, and of 7,183 respondents (response = 31%) of 32 health plans in 2008. We performed multilevel regression analyses with three levels: respondent, health plan and year of measurement. Per year and per quality aspect, we estimated health plan means while adjusting for consumers' age, education and self-reported health status. We tested for linear and quadratic time effects using chi-squares.</p> <p>Results</p> <p>The overall performance of health plans increased significantly from 2005 to 2008 on four quality aspects. For three other aspects, we found that the overall performance first declined and then increased from 2006 to 2008, but the performance in 2008 was not better than in 2005. The overall performance of health plans did not improve more often for quality aspects that were identified as important areas of improvement in the first year of measurement. On six out of seven aspects, the performance of health plans that scored below average in 2005 increased more than the performance of health plans that scored average and/or above average in that year.</p> <p>Conclusion</p> <p>We found mixed results concerning the effects of managed competition on the performance of health plans. To determine whether managed competition in the healthcare system leads to quality improvement in health plans, it is important to examine whether and for what reasons health plans initiate improvement efforts.</p

The Dutch health insurance reform: switching between insurers, a comparison between the general population and the chronically ill and disabled

Background: On 1 January 2006 a number of far-reaching changes in the Dutch health insurance system came into effect. In the new system of managed competition consumer mobility plays an important role. Consumers are free to change their insurer and insurance plan every year. The idea is that consumers who are not satisfied with the premium or quality of care provided will opt for a different insurer. This would force insurers to strive for good prices and quality of care. Internationally, the Dutch changes are under the attention of both policy makers and researchers. Questions answered in this article relate to switching behaviour, reasons for switching, and differences between population categories. Methods: Postal questionnaires were sent to 1516 members of the Dutch Health Care Consumer Panel and to 3757 members of the National Panel of the Chronically ill and Disabled (NPCD) in April 2006. The questionnaire was returned by 1198 members of the Consumer Panel (response 79%) and by 3211 members of the NPCD (response 86%). Among other things, questions were asked about choices for a health insurer and insurance plan and the reasons for this choice. Results: Young and healthy people switch insurer more often than elderly or people in bad health. The chronically ill and disabled do not switch less often than the general population when both populations are comparable on age, sex and education. For the general population, premium is more important than content, while the chronically ill and disabled value content of the insurance package as well. However, quality of care is not important for either group as a reason for switching. Conclusion: There is increased mobility in the new system for both the general population and the chronically ill and disabled. This however is not based on quality of care. If reasons for switching are unrelated to the quality of care, it is hard to believe that switching influences the quality of care. As yet there are no signs of barriers to switch insurer for the chronically ill and disabled. This however could change in the future and it is therefore important to monitor changes.