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PubMed2003

Trends and variations in smoking during pregnancy and low birth weight: evidence from the birth certificate, 1990-2000.

OBJECTIVE: This study compares patterns of tobacco use during pregnancy over time and across population subgroups and examines the impact of maternal smoking on the incidence of low birth weight (LBW). The study also evaluates the use of birth certificates to monitor prenatal smoking. METHODS: The birth certificates of all states (except California) and the District of Columbia for 2000 provided to Centers for Disease Control and Prevention's National Center for Health Statistics were analyzed. Trends in maternal smoking were examined with data from birth certificates and other relevant sources. RESULTS: Smoking during pregnancy was reported for 12.2% of women who gave birth in 2000, down 37% from 1989 (19.5%), when this information was first collected on birth certificates. Throughout the 1990s, prenatal smoking rates were highest for older teenagers and women in their early 20s. Among population subgroups, the highest rates were reported for non-Hispanic white women who attended but did not complete high school. The incidence of LBW among singleton infants who were born to smokers was double that for nonsmokers. This relationship was observed in all age groups, for births to Hispanic and non-Hispanic white and black women, and within educational attainment subgroups. Even light smoking (<5 cigarettes daily) was associated with elevated rates of LBW. CONCLUSION: Although prenatal smoking may be underreported on the birth certificate, the trends and variations in smoking based on birth certificate data have been confirmed with data from other sources. Birth certificate data can be useful in monitoring prenatal smoking patterns. Changes in the birth certificate questions that are to be implemented beginning in 2003 will help to clarify the levels and changes in smoking behavior during pregnancy so that smoking cessation programs can be more effectively designed to meet the needs of the populations at risk.

Adolescent↗
PubMed1992

Death certification in Auckland.

AIMS: to investigate the reasons behind general practitioner referral of cases of natural death to the coroner, and also the understanding of general practitioners of the relevant legislation. METHODS: as cases of natural death were referred to the coroner over a seven month period, the deceased's general practitioner was contacted by telephone and questioned regarding his/her knowledge of the death and willingness to sign a cause of death certificate. Based upon this interview, cases were divided according to whether their general practitioner could have signed the death certificate or not. RESULTS: there were 314 cases where there was a contactable general practitioner. In 257 instances, the general practitioner would not have signed the death certificate: 183 found the death unexpected, and 74 had not seen the patient recently enough. In 57 instances the general practitioner would have signed the death certificate, but did not because: 23 were unaware of the death, 13 could not be contacted, 14 did sign a death certificate but this was rejected by the medical referee, and seven would have signed but did not for miscellaneous reasons. CONCLUSION: a disturbing finding was the general lack of understanding of certification legislation in particular the concept that the patient must have been seen in their last illness to be able to sign the death certificate. When signing death certificates, doctors should be thinking in terms of last illness rather than a vague period of time between two weeks and three months.

Cause of Death↗
PubMed1990

State boards of optometry requirements of CPR certification for optometric licensure.

Cardiopulmonary resuscitation (CPR) certification requirements for optometric licensure were obtained from 49 states, the District of Columbia and Puerto Rico. It was found that 17 percent of the states required CPR certification for optometric licensure while 11 percent required certification to maintain licensure. For initial Diagnostic Pharmaceutical Agents (DPA) licensing 44 percent of the boards required CPR certification while less than 25 percent required maintaining that certification to sustain DPA licensure. Of those states having Therapeutic Pharmaceutical Agents (TPA) legislation, 36 percent required CPR certification for initial licensure but only 8 percent of them required maintenance of certification for license renewal. Optometry can take the lead in health care by requiring CPR certification for all forms of licensure and license renewal.

Certification↗
PubMed2005

Sickness certificates as a basis for decisions regarding entitlement to sickness insurance benefits.

BACKGROUND: The sickness certificate is a major instrument for establishing contact and conveying information between two authorities that have a substantial impact on the life situation and work situation of the patients, as well as on the economic costs of the society. AIM: A study was undertaken to assess the quality of physicians' sickness certificates as a basis for social insurance officers' decisions regarding entitlement to sickness benefits. METHOD: Information on all 2,449 sickness certificates for sick-leave periods exceeding 28 days' sick leave period received at the social insurance offices in one Swedish county during one week in 2002 was coded and analysed. RESULTS: Information provided in the certificates was often not sufficient to allow social insurance officers to determine eligibility for sickness benefits. Qualitative analyses of certificates from general practitioners (GPs) revealed that 21% contained ambiguous statements about the medical disorder, 30% were unclear regarding the assessment of functional capacity, and 22% required additional information on both those aspects. Sickness certificates issued by GPs and physicians under specialist training, as compared with other categories of physicians, more often provided essential data, for example concerning the patient's occupational tasks and type of employment. CONCLUSIONS: Physicians often fail to contribute required information concerning functional capacity and other important aspects when issuing sickness certificates. This limits the use of these documents as a basis for decisions regarding sickness insurance benefits. The practical consequences of incomplete certificates might be delayed payment of benefits and delayed initiation of return to work measures.

Decision Making↗
PubMed1996

An evaluation of 1994 school entry immunization certificates on the Central Coast of New South Wales.

OBJECTIVE: To evaluate school entry immunization certificates and document the immunization status of children enrolled during 1994 in kindergartens on the NSW Central Coast. METHODOLOGY: Immunization certificates and non-statutory documentation of immunization for school entry presented by parents were evaluated during visits to 68 NSW Central Coast schools in May and June 1994. RESULTS: Immunization information for 3741 kindergarten enrollments was reviewed. Of these enrollments, 79% presented immunization certificates of which 10% were incomplete, 14% presented non-statutory documentation and 7% had no certificate or non-statutory documentation. It was considered that 19% of children were incompletely immunized; 8% of certificates presented were incorrectly completed. CONCLUSIONS: The study found that about 80% of Central Coast school entrants were fully immunized. Reliance on immunization certificates as evidence of immunization may overestimate vaccination completion rates, as some certificates may be incorrectly completed. Education of parents, school staff and certificate providers should help to improve both immunization completion and documentation.

Child Welfare↗
PubMed1994

Clinical and treatment correlates of access to Section 8 certificates for homeless mentally ill persons.

OBJECTIVE: The study assessed how clients' housing preference and other variables were related to the acquisition of Section 8 certificates, facilitating independent living, for homeless persons with severe mental illness who were being served by an experimental assertive community treatment team. METHODS: For 77 clients, demographic and clinical differences between receivers and nonreceivers of certificates were examined, and correlates of time from referral to the team to completion of the Section 8 application were analyzed. Reasons clients did not receive certificates and housing outcomes were summarized in relation to client preference. RESULTS: The 34 clients who received certificates (44 percent) had significantly less psychopathology after three months than did nonreceivers and tended to have affective disorders rather than schizophrenia. Of the 43 nonreceivers, the two largest groups were 19 clients who did not want certificates and ten clients who wanted certificates but whom staff considered unable to live safely in an unsupervised apartment. The mean +/- SD length of time for application for a certificate was 5.7 +/- 5.8 months. Longer time to apply was significantly associated with having schizophrenia, having the team as a representative payee, and showing increased psychotic symptoms at referral and at three months. CONCLUSIONS: The study suggests that it is possible to honor the housing preferences of the majority of homeless persons with severe mental illness if adequate resources are provided. However, staff may view persons who have schizophrenia and more symptoms as needing more supervision than those clients prefer. Homeless mentally ill persons may also take longer than more symptomatic persons to pursue independent living through a Section 8 certificate.

Adult↗
PubMed1989

Epidemiology of sickness certification--a methodological approach based on a study from Buskerud County in Norway.

This paper is part of a broader study of doctors' "sickness certification" practice, which is correlated with, but not the same as, "sickness absence" or "sickness benefits". In order to obtain a total picture, information on sickness certification must be related to the population at risk, i.e. the epidemiology of sickness certification in a total population defined geographically. There is no routine registration system that provides statistics of sickness certification in Norway. Neither is there current information about those of the population who at any one time are entitled to sickness benefits, i.e. the population at risk. The aim of the present paper is to discuss the problems of estimating annual incidences of sickness certification, and to describe the results according to patients' sex, age, and place of residence. The study is based on all "initial certificates" received at the National Insurance Offices in Buskerud county during a period of four weeks in 1985. The population at risk was estimated at 106,019 employed persons aged 16-69 years, and the annual incidence of sickness certification at 580 per 1,000 employed persons per year (females 596, males 568). The highest incidence was found in the age group 20-29 years (females 739, males 741). In the age groups 30-39 and 40-49 years, incidences were significantly higher in females than males. The standardized incidence ratio was significantly lower than average for both females and males in agricultural municipalities, while it was significantly higher than average for females 30-39 years old in urban municipalities. The basis of epidemiological studies of sickness certification used in health services planning and in community medicine is in need of improvement. This challenge is being addressed by the National Insurance Administration in association with the Central Bureau of Statistics in Norway.

Absenteeism↗
PubMed2001

[Medical certificate in psychiatry: practical aspects].

Among certificates written in psychiatry, some are obligatory, admission certificate, in case of automatically hospitalization or that asked by a third party, certificate of 48 hours: in which the psychiatrist of the admission' service describes the state of the patient and indicates the necessity or not to continue the hospitalization, monthly certificate: to justify the maintenance of hospitalization or to ask its end and certificate of situation be written in some particular circumstances. Others concern the cases of expert appraisement (in civilian or penal rights) or in the framework of medical controls asked by the employer. Other certificates are optional or customary. They could be delivered if asked by the patient. These considerations incite to follow scrupulously ethical rules and common sense when doing these certificates. Finally, The certificate has always to be given to the patient personally. That will be mentioned down of the document.

Commitment of Persons with Psychiatric Disorders↗
PubMed2001

Predicting Performance on the National Athletic Trainers' Association Board of Certification Examination From Grade Point Average and Number of Clinical Hours.

OBJECTIVE: To determine whether grade point average, hours of clinical education, or both are significant predictors of performance on the National Athletic Trainers' Association Board of Certification examination and whether curriculum and internship candidates' scores on the certification examination can be differentially predicted. DESIGN AND SETTING: Data collection forms and consent forms were mailed to the subjects to collect data for predictor variables. Subject scores on the certification examination were obtained from Columbia Assessment Services. SUBJECTS: A total of 270 first-time candidates for the April and June 1998 certification examinations. MEASUREMENTS: Grade point average, number of clinical hours completed, sex, route to certification eligibility (curriculum or internship), scores on each section of the certification examination, and pass/fail criteria for each section. RESULTS: We found no significant difference between the scores of men and women on any section of the examination. Scores for curriculum and internship candidates differed significantly on the written and practical sections of the examination but not on the simulation section. Grade point average was a significant predictor of scores on each section of the examination and the examination as a whole. Clinical hours completed did not add a significant increment for any section but did add a significant increment for the examination overall. Although no significant difference was noted between curriculum and internship candidates in predicting scores on sections of the examination, a significant difference by route was found in predicting whether candidates would pass the examination as a whole (P =.047). Proportion of variance accounted for was less than R(2) = 0.0723 for any section of the examination and R(2) = 0.057 for the examination as a whole. CONCLUSIONS: Potential predictors of performance on the certification examination can be useful to athletic training educators in assisting students. These findings must be used cautiously because of the low proportion of explained variance. Low R(2) values suggest that the largest contributors to performance on the examination were not identified in this study. Although the results of this study support the decision to discontinue the internship route to certification, continued research focusing on identification and investigation of the constructs that contribute to examination success is needed.

Journal Article↗
PubMedDate not supplied

Analysis of unlinked infant death certificates from the NIMS project.

The National Infant Mortality Surveillance (NIMS) project used linked birth and infant death certificates to calculate birth weight-specific infant mortality risks for the 1980 U.S. birth cohort. Record linkage depends on complete registration of vital events, interstate exchange of vital records, accurate information on certificates, and a comprehensive linkage system. States reported 2,604 unlinked infant death certificates for 1980, ranging from 0 to 397 per State. Age at death for these infants ranged from 1 minute to 11 months. More than 41 percent of the unlinked death certificates were for postneonates, compared with 32.5 percent found in the cohort's total infant death experience. Only 38.2 percent of the unlinked infant death certificates showed strictly intrastate events (birth and death occurrence, and residence at death all in one State), compared with 92.9 percent in the cohort's total infant death experience. Estimates of the percentage successfully linked by State ranged from 86.0 to 100.0. After adjusting for the certainly unlinked infant death certificates, nine States' infant mortality risks increased by more than 0.2 per 1,000 live births. Improvements are needed both within and between States to ensure more complete birth and infant death certificate linkage.

Birth Certificates↗
PubMed1991

Certification and recertification.

The American Board of Psychiatry and Neurology issues certificates for psychiatrists in general psychiatry, child and adolescent psychiatry, and added qualification in geriatric psychiatry. It will issue a certificate in added qualification in clinical neurophysiology in 1992. An application for a certificate in added qualification in addiction psychiatry is currently under review by the American Board of Medical Specialties. The American Psychiatric Association has requested that the ABPN consider forensic psychiatry for an added qualification. All new subspecialty certificates will have a ten year time limit. Beginning on October 1, 1994, all certificates will be time-limited. Time-limited certificates will lead to the requirement for recertification. Current requirements for certification are reviewed and strategies for planing for recertification are discussed.

Adolescent Psychiatry↗
PubMed1985

The causal sequence on death certificates: errors affecting the reliability of mortality statistics for rheumatoid arthritis.

Physicians' amount of diagnostic information and the adequacy of the causal sequence(s) on death certificates involving rheumatoid arthritis (RA) were investigated. Physicians' reporting was compared with the Swedish National Central Bureau of Statistics' (NCBS) registration of the causal conditions, particularly the underlying cause of death. All Swedish RA death certificates for the years 1971 and 1975 were studied. A total of 1224 such certificates were identified. The causal sequences were inadequate in 35% of the certificates, 37% in 1971 and 33% in 1975. Ten types of inadequate sequences were identified. The NCBS rejected the underlying cause of death in 56% of the inadequate sequences and in 52% of the adequate sequences. When the whole sequence leading directly to death was described by only a single diagnosis, 374 (31%) of the cases, this diagnosis was rejected by the NCBS in 54% of the certificates from 1971 and 75% from 1975. More than one diagnosis on each line of the causal-sequence-description appeared on 28% of the certificates. The total number of diagnoses on each certificate did not, however, exceed the NCBS' registration capacity (up to seven diagnoses) in more than 1.6% of the 1224 cases. Thus, the major problem in the NCBS' data collecting process was not how to sort out excessive diagnostic information, but to record properly the causal classification of the conditions, and to interpret the physicians' account of the underlying cause of death.

Arthritis, Rheumatoid↗
PubMed1985

In what sense is rheumatoid arthritis the principal cause of death? A study of the National Statistics Office's way of reasoning based on 1224 death certificates.

Physicians' inadequacies in making out death certificates involving rheumatoid arthritis (RA) and the coders' reasons for not registering physicians' stated underlying cause as the underlying cause of death were investigated. The starting point of the study was a disagreement between physicians' reporting of RA on death certificates and the Swedish National Central Bureau of Statistics' (NCBS) registration of this condition, to the effect that the NCBS registered a 3.0-fold increase in mortality for women and a 2.7-fold increase for men attributed to RA between 1971 and 1975, whereas the physicians had reported practically no change at all for women and a slight decrease for men between the years. All Swedish RA death certificates for the years 1971 and 1975 were studied. A total of 1224 such certificates were identified. Four major qualifications for the coders to reject physicians' non-RA underlying cause, and for giving preference to RA in the registration of the underlying cause of death were discerned: RA appeared to have been favoured to the greatest extent by the NCBS (i) when RA was likely to have caused the reported underlying condition; (ii) when there is only one, non-RA, diagnosis reported in Part I of the certificate, and this diagnosis does not completely describe the train of events leading to death; (iii) when the diagnosis for the non-RA underlying condition provides less precise information about the site or nature of the underlying condition, compared with another diagnosis for another condition, RA, stated on the certificate; or (iv) when the reported non-RA underlying condition was unlikely itself to cause death, and was not reported as a cause of a more serious condition. The NCBS' increased registration of RA as the underlying cause of death between 1971 and 1975 could be explained neither by physicians' inadequacies in making out death certificates nor by a strict application of the international coding rules for registration of the underlying cause of death.

Arthritis, Rheumatoid↗
PubMed2005

The reporting of pre-existing maternal medical conditions and complications of pregnancy on birth certificates and in hospital discharge data.

OBJECTIVE: The purpose of this study was to determine the accuracy of live-birth certificates and hospital discharge data that reported of pre-existing maternal medical conditions and complications of pregnancy. STUDY DESIGN: We conducted a population-based validation study in 19 non-federal short-stay hospitals in Washington state with a stratified random sample of 4541 women who had live births between January 1, 2000, and December 31, 2000. True- and false-positive fractions were calculated. RESULTS: Birth certificate and hospital discharge data combined had substantially higher true-positive fractions than did birth certificate data alone for cardiac disease (54% vs 29%), acute or chronic lung disease (24% vs 10%), gestational diabetes mellitus (93% vs 64%), established diabetes mellitus (97% vs 52%), active genital herpes (77% vs 38%), chronic hypertension (70% vs 47%), pregnancy-induced hypertension (74% vs 49%), renal disease (13% vs 2%), and placenta previa (70% vs 33%). For the 2 medical risk factors that are available only on birth certificates, true-positive fractions were 37% for established genital herpes and 68% for being seropositive for hepatitis B surface antigen. CONCLUSION: In Washington, most medical conditions and complications of pregnancy that affect mothers are substantially underreported on birth certificates, but hospital discharge data are accurate in the reporting of gestational and established diabetes mellitus and placenta previa. Together, birth certificate and hospital discharge data are much superior to birth certificates alone in the reporting of gestational diabetes mellitus, active genital herpes, and chronic hypertension.

Birth Certificates↗
PubMed2005

Maintenance of certification for radiation oncology.

Maintenance of Certification (MOC) recognizes that in addition to medical knowledge, several essential elements involved in delivering quality care must be developed and maintained throughout one's career. The MOC process is designed to facilitate and document professional development of American Board of Radiology (ABR) diplomates in the essential elements of quality care in Radiation Oncology and Radiologic Physics. ABR MOC has been developed in accord with guidelines of the American Board of Medical Specialties. All Radiation Oncology certificates issued since 1995 are 10-year, time-limited certificates; diplomates with time-limited certificates who wish to maintain specialty certification must complete specific requirements of the American Board of Radiology MOC program. Diplomates with lifelong certificates are not required to participate but are strongly encouraged to do so. Maintenance of Certification is based on documentation of participation in the four components of MOC: (1) professional standing, (2) lifelong learning and self-assessment, (3) cognitive expertise, and (4) performance in practice. Through these components, MOC addresses six competencies-medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice. Details of requirements for components 1, 2, and 3 of MOC are outlined along with aspects of the fourth component currently under development.

Certification↗
PubMed2005

The Automated Classification of Medical Entities (ACME) system objectively assessed the appropriateness of underlying cause-of-death certification and assignment.

BACKGROUND AND OBJECTIVES: To assess the feasibility of using the Automated Classification of Medical Entities (ACME) system to objectively define the appropriateness of tuberculosis (TB) related underlying cause of death (UCD) certification and the accuracy of UCD assignment. METHODS: All death certificates issued in 2002 in Taiwan in which TB was mentioned were extracted for analysis. Certification of the UCD was defined as inappropriate when ACME used Rule 1 or Rule 2 in assigning the UCD. The assignment of the UCD was defined as inaccurate when the UCD selected by coders was discordant with the UCD selected by ACME. RESULTS: Of the 2,129 death certificates mentioned TB, half (1,067 of 2,129) were inappropriately certified by physicians and 16.5% (351 of 2129) had an inaccurately assigned UCD by coders. The discrepancy rate in UCD assignment between coders and ACME increased when the number of diagnoses increased, TB was listed in Part II, and the certification of UCD was inappropriate. CONCLUSIONS: It is feasible to use the process information in ACME to objectively define the appropriateness of UCD certification and the accuracy of UCD assignment. Inappropriate certification of the UCD and TB being listed in Part II were the two most important factors associated incorrect interpretation of the World Health Organization Selection Rules by coders.

Cause of Death↗
PubMedDate not supplied

Perceived value of certification among certified, noncertified, and administrative perioperative nurses.

This study was designed to determine similarities and differences in perceived value of certification among three groups of perioperative nurses. Responses to the Perceived Value of Certification Tool (PVCT), demographic questions, and certification experience questions were requested from 1,250 certificants, 2,000 noncertificants, and 1,250 administrators, with an overall response rate of 55.5%. Respondents agreed with 16 of 18 PVCT statements. Agreement was highest for intrinsic items. Respondents were less likely to agree with extrinsic items and did not agree that certification increases salary. All samples were significantly different from each other on the intrinsic construct. Noncertificants were significantly different from certificants and administrators on the extrinsic construct and the total PVCT score; certificants and administrators were not significantly different from each other. Age and experience variables were not related to PVCT constructs or total score. Certificants in administration/management work roles had significantly higher PVCT constructs and total scores than did certified staff nurses but noncertified administrators and staff nurses were not significantly different from each other. Barriers to certification listed most often related to lack of extrinsic rewards. Certification and health care organizations will need to find ways to provide extrinsic rewards if the goals of certification are to be achieved.

Adult↗
PubMed2002

DPD directors' attitudes are more favorable toward food-safety education than certification.

OBJECTIVE: To determine the prevalence of food-safety education in didactic programs in dietetics (DPDs) across the United States and factors associated with the provision of this education and to explore DPD directors' attitudes toward food safety. SUBJECTS: The population consisted of 230 DPD directors listed in The American Dietetic Association's 1998-1999 Directory of Dietetics Programs. Overall, 146 directors participated in the study, yielding a 64% response rate. DESIGN: The nature and prevalence of food-safety education and certification, as well as DPD directors' attitudes toward food safety, were assessed by means of a survey instrument. Statistical analyses Descriptive statistics were calculated. Analysis of variance, t test, and chi2 were used to assess differences in DPD directors' attitudes toward food-safety education and certification on the basis of demographic variables. RESULTS: Among dietetics programs, 40% had dietetics majors receive 16 or more hours of food-safety education; 38% (n=54) of DPDs had dietetics majors complete a food-safety certification examination. DPD directors agreed that food safety is an important concept within dietetics education; however, they held differing views regarding certification. APPLICATIONS/CONCLUSIONS: Dietetics educators need to familiarize themselves with food-safety certification, weigh the pros and cons, and determine whether or not certification should be an academic goal. Partnering with associations and the foodservice industry to offer cost-effective food-safety training and certification opportunities is suggested.

Attitude↗