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PubMed2006

A sociodental approach to assessing dental needs of children: concept and models.

OBJECTIVES: Traditional normative methods of assessing dental needs do not correspond to current concepts of 'health' and 'need'. Although there is dental research on quality of life, evidence-based practice, and oral behaviours, those concepts are rarely applied to dental needs estimation. Dental needs are usually calculated mainly from clinical data and are likely to be inaccurate. A structured comprehensive method for assessing dental needs is required. The objectives of this study are to develop and test a new sociodental system of needs assessment for overall dental needs of primary schoolchildren. Furthermore, normative and sociodental estimates of need are compared. DESIGN: The study developed a theoretical framework and pathway algorithms of sociodental needs assessment and applied them to assessing overall dental needs. Normative dental needs were assessed using standard normative criteria. The child oral impacts on daily performances (Child-OIDP) was used to assess oral impacts, and a self-administered questionnaire was used to obtain information on demographic variables and oral behaviours. Data were analysed according to the developed algorithms. SETTING: A cross-sectional survey in Suphanburi Province, Thailand. PARTICIPANTS: All 1,126 children aged 11-12 years in a town. MAIN RESULTS: The sociodental approach was acceptable and not costly. In all, 54.4% had normative need under the dental needs model for life-threatening and progressive conditions, but only 16.6% had high propensity-related need; the remaining 37.8% would require dental health education or oral health promotion (DHE/OHP) or both and appropriately adjusted clinical interventions. Under the basic model of dental needs, 45.1% had normative need. Two-thirds of them (30.9%) had impact-related need and the remaining 14.2% did not have oral impacts and therefore should only receive dental health education. Only one-third of those with impact-related need had high propensity and were suitable for evidence-based conventional treatments; the remaining two-thirds should receive DHE/OHP and alternative clinical interventions. CONCLUSIONS: A sociodental system of dental needs assessment was developed and tested on school children. It decreased the estimates of conventionally assessed dental treatment needs and introduced a broader approach to care.

Algorithms↗
PubMed2000

Prevalence and predictors of unmet need for supportive services among HIV-infected persons: impact of case management.

BACKGROUND: Previous research has indicated that the needs of persons infected with human immunodeficiency virus (HIV) for supportive services often go unmet. Although case management has been advocated as a method of decreasing unmet needs for supportive services, its effectiveness is poorly understood. OBJECTIVES: To assess the prevalence of need and unmet need for supportive services and the impact of case managers on unmet need among HIV-infected persons. RESEARCH DESIGN: National probability sample. PARTICIPANTS: A total of 2,832 HIV-infected adults receiving care. MEASURES: Need and unmet need for benefits advocacy, housing, home health, emotional counseling, and substance abuse treatment services. RESULTS: Sixty-seven percent of the sample had a need for at least one supportive service, and 26.6% had an unmet need for at least one service in the previous 6 months. Contingent unmet need (unmet need among persons who needed the service) was greatest for benefits advocacy (34.6%) and substance abuse treatment (27.6%). Fifty-seven percent of the sample had had contact with their case manager in the previous 6 months. In multiple logistic regression analysis, with adjustment for covariates, having a case manager was associated with decreased unmet need for home healthcare (OR =0.39; 95% CI = 0.25-0.60), emotional counseling (OR = 0.54; 95% CI = 0.38-0.78), and any unmet need (OR = 0.70; 95% CI = 0.54-0.91). An increased number of contacts with a case manager was significantly associated with lower unmet need for home health care, emotional counseling, and any unmet need. CONCLUSIONS: Need and unmet need for supportive services among HIV-infected persons is high. Case management programs appear to lower unmet need for supportive services.

Adult↗
PubMed2005

Health Needs Instrument for hospitalized single-living Taiwanese elders with heart disease: triangulation research design.

AIM: The aims of this study were (a) to explore the health needs of hospitalized Taiwanese older people with heart disease who live alone in the community; (b) to develop an instrument to assess their health needs and (c) to examine relationships among their health needs. DESIGN: Three phases were involved in this between-method triangulation design. METHODS: The first phase explored the contextual content of the health needs from the perspectives of a purposive sampling of 34 subjects by the use of an explorative qualitative method. The second phase developed the Health Needs Instrument (HNI) and established its reliability and validity. The last phase implemented the instrument in a cohort and examined their appraisals of each type of health need as well as the relationships among different types of health needs. RESULTS: The HNI encompasses the following five types of health needs: help in managing tangible things, psychological support, medical support, obtaining health information and participation in decision-making. In the last phase, a purposive sample of 54 subjects (48 men and 6 women) with an average age of 75.3 years was obtained. Subjects' health needs were ranked as obtaining health information (100%), participation in decision-making (96%), managing tangible issues (87%), medical support (86%) and psychological support (67%). Detailed items for each type of health need were revealed. By examining the relationship between their health needs, the psychological needs in confronting the subjects' physical discomfort had a significant correlation with medical support (r = 0.469, P < 0.01), with tangible needs after surgery or an invasive examination (r = 0.460, P < 0.01), with informational needs (r = 0.393, P = 0.034) and with tangible needs of maintaining daily living activities during the hospitalization period (r = 0.290, P = 0.034). The need for tangible help in maintaining daily living activities during the hospitalization period was significantly correlated with the need for medical support (r = 0.341, P = 0.012), with help in managing admissions and discharge procedures (r = 0.374, P = 0.05) and with help after an invasive examination or in the postsurgery period (r = 0.334, P = 0.013). CONCLUSION: Finally, a conceptual framework was developed to depict this phenomenon. With the help of this HNI, both Eastern and Western health care providers can be empowered to detect the complex health needs of this particular population earlier and more accurately in order to promote their well-being as well as their health-related quality of life. RELEVANCE TO CLINICAL PRACTICE: Empowering nurse clinicians to assess health needs of hospitalized single-living Taiwanese elders with heart disease.

Aged↗
PubMed2007

Subjective needs of people with dementia: a review of the literature.

OBJECTIVE: Insight into the individual care needs of the growing number of people with dementia is necessary to deliver more customized care. Our study aims to provide an overview of the literature on the subjective needs of people with dementia. METHOD: Electronic databases were searched for publications on subjective needs between January 1985 and July 2005, and reference lists were cross-referenced. Extracts of needs were classified within problem areas of the (Dutch) National Dementia Program and quality of life domains, and the extracts were classified as a "need" (an implicitly communicated felt state of deprivation), "want" (expression of a need) or "demand" (suitable solution to fulfill a need). RESULTS: Subjective needs were found in 34 studies with various research aims, such as awareness and coping. Few studies aimed to measure needs of people with dementia. The most frequently reported needs of people with dementia were the need to be accepted and respected as they are, the need to find adequate strategies to cope with disabilities, and the need to come to terms with their situation. Explicit wants or demands were reported less frequently than needs. CONCLUSION: The high number of reported needs and the limited number of wants and demands show that people with dementia do not frequently mention how they want their needs to be met. Most reported needs are not instrumental, but are related to well-being and coping. Further research to inventory these needs could help achieve more demand-directed and better attuned care in the future.

Activities of Daily Living↗
PubMed2002

Prosthetic dental treatment needs in Eastern [corrected] Saudi Arabia.

OBJECTIVE: The objective of this study was to determine the prosthetic treatment needs of an adult population in Al-Ahsa Area, Kingdom of Saudi Arabia. METHODS: A sample of adults attending the King Fahad Hospital Dental Center, Al-Ahsa, Kingdom of Saudi Arabia were examined for prosthetic treatment needs utilizing the World Health Organization criteria during 1999. Statistical analysis system was utilized to generate frequencies, means and standard deviations, and various statistical tests were carried out. RESULTS: A total of 435 adults, 192 (44.1%) males and 243 (55.9%) females with a mean age of 47.7 (standard deviation 15.4) years were examined for prosthetic treatment needs. About two-thirds (64.8%) of the sample were in need of an upper denture. A significantly higher number of males (68.8%) needed an upper denture as compared to the females (61.7%). About three-quarters (73.8%) of the sample were in need of a lower denture. The need for lower denture was similar among the males (75.0%) and females (72.8%). About one-sixth (17.2%) of the sample was in need of an upper bridge. A higher number of females (18.9%) needed an upper bridge as compared to the males (15.1%). About one-quarter (22.5%) of the sample was in need of a lower bridge. A higher number of females (25.5%) needed lower bridge as compared to the males (18.8%). The need for upper denture was similar in both urban (64.7%) and rural (65.1%) dwellers. The need for lower denture was also similar in both urban (73.2%) and rural (75.2%) dwellers. A higher number of rural dwellers needed an upper (20.2%) and lower (26.4%) bridge as compared to the upper (16%) and lower (20.9%) bridge in urban dwellers. CONCLUSION: The results indicate that more than one- quarter of the sample needs a denture. A significantly higher number of males needed dentures than females. More females were in need of a bridge as compared with males. A significantly higher percentage of urban population needed full dentures as compared with rural population.

Aged↗
PubMedDate not supplied

The needs of patients with cancer and their caregivers in rural areas.

PURPOSE/OBJECTIVES: To describe physical and psychological needs, rank their importance, and identify needs that were not met of patients with cancer and their caregivers living in rural settings. DESIGN: Exploratory descriptive. SETTING: Rural Vermont. SAMPLE: 30 patients with cancer and 30 caregivers. METHODS: Patients completed the self-administered. 104-item Patient Needs Scale; caregivers completed the self-administered, 90-item Caregiver Needs Scale. Respondents were asked to rate the importance of an item on a scale of 1-10 if they considered if a need. If a numbered item was scored, respondents identified whether the need was met. FINDINGS: The patient group identified 49% of scale items as needs; the caregiver group identified 41% of scale items as needs. Greater than 50% of the patient and caregiver respondents identified needs in areas of personal care. Involvement with health care, and interpersonal Interaction as very important. The patient group reported that 5% of identified needs were unmet, whereas the caregiver group reported that 14% of identified needs were unmet. CONCLUSIONS: In rural settings, caregiver needs, while fewer in number, are not met three times more frequently than patient needs. IMPLICATIONS FOR NURSING PRACTICE: The needs identified by more than 50% of both groups should be included in assessment and care plans. The variability of patient and caregiver needs reinforces the importance of individual assessment and planning rather than making assumptions about needs. Future research may include identifying questions to elicit current needs and determining how often these questions should be asked to meet changing needs.

Aged↗
PubMedDate not supplied

Information needs and coping styles of primary family caregivers of women following breast cancer surgery.

PURPOSE/OBJECTIVES: To determine the information needs and unmet needs of primary family caregivers of women with breast cancer, their informational coping styles, and the relationships among needs, coping styles, and caregiver and patient variables in the first three weeks after surgery. DESIGN: Descriptive, correlational survey. SETTING: Three surgical inpatient units at one private and two public hospitals in Perth, Western Australia. SAMPLE: 141 primary family caregivers of women having surgery for breast cancer. METHODS: Modified Family Inventory of Needs-Husbands and the Miller Behavioral Style Scale administered within one week after surgery and repeated one to two weeks later, after the postoperative visit with the surgeon. MAIN RESEARCH VARIABLES: Information needs, unmet needs, informational coping styles. FINDINGS: All 30 needs were rated as important by the majority of participants. A reduction in the median percentage of unmet needs occurred between time 1 (22%) and time 2 (10%) (p = 0.00004). Caregivers with children younger than 20 had a greater number of needs than the remaining sample (p = 0.001). Caregivers who received information from the breast nurse counselor and medical staff had the lowest percentage of unmet needs compared with those reporting any other source of information (p = 0.007). Caregivers of private patients had more unmet needs compared with public patients' caregivers (p = 0.035). Most caregivers displayed a high monitoring coping style, but further analysis of composite monitoring and blunting profiles revealed that 11%-16% were low monitors as well as low blunters and another 22%-26% displayed an apparently conflicting style of both high monitoring and high blunting. CONCLUSIONS: Western Australian caregivers have a similar range and priority of needs as those previously reported internationally. Caregivers in the private system, where breast centers are not established, are at risk for not having their needs met. Further studies are needed to determine how informational coping styles may affect family caregivers' need for and response to education given by nurses. IMPLICATIONS FOR NURSING: Breast nurse counselors and other nursing staff play an important role in caregiver support. Caregivers with young children need additional support. Caregivers' coping styles indicate the need for high levels of information, which, paradoxically, may lead to increased distress. Therefore, nurses should consider assessing caregivers' informational coping styles to balance the amount of information given with appropriate strategies for assisting caregivers to cope with stressful information.

Adaptation, Psychological↗
PubMed2002

Patients' needs during the year after a suicide attempt. A secondary analysis of a randomised controlled intervention study.

OBJECTIVE: We first studied whether changes of needs were influenced by randomly allocated telephone interventions between 1 and 12 months after a suicide attempt in addition to treatment as usual. These were aimed at improving motivation for professional treatment. As a secondary analysis we investigated the frequency and changes of needs during this period and if changes were related to other outcome measures. METHOD: One month after a suicide attempt 216 patients were randomised to two telephone interventions or to no such interventions within 1 year. The Camberwell Assessment of Need (CAN) was used to evaluate 22 different need areas at 1 and 12 months. Other outcome measurements used were Global functioning axis V (GAF), psychological symptoms (SCL-90, GSI) and scale of suicide ideation (SSI). RESULTS: Of 178 patients who were followed up, 140 had been rated by CAN at both 1 and 12 months. Changes of needs did not differ between the randomised groups. At 1 month the patients had a mean number of 5.1 +/- 2.4 needs and 2.4 +/- 1.5 of these were considered as unmet. The most frequently reported needs concerned health aspects, basic needs and social needs. At 12 months needs concerning health aspects were significantly reduced, while basic needs and social needs were not. Changes of GAF explained 21 % and changes of GSI 4 % of the variance of the reduction of needs. CONCLUSIONS: After 12 months, needs in health aspects, basic needs and social needs were still common. A structured evaluation of the patient's needs seems to be helpful when planning treatment after a suicide attempt.

Aftercare↗
PubMed2005

The assessment of need for mental health services.

BACKGROUND: The field of psychiatric epidemiology has yielded several large and important studies of the prevalence of psychiatric disorders. These surveys have been enhanced by the inclusion of methodologies that reflect the needs for care of the population in question. Clinical studies of psychiatric disorders and unmet needs have focussed on identifying needs and correlating them with service evaluation and satisfaction measures. The association between prevalence, service use and unmet need requires review in order to establish whether there are trends and consistent findings. METHOD: Peer-reviewed studies involving the assessment of need up to the present were included. These were of two broad groups: population-based studies and clinical studies. Studies based on outcome measures, review articles, and child psychiatry, old age, and intellectual disability samples were excluded. We conducted a search of MEDLINE and PSYCHINFO using the key words, "mental health needs","assessment of need", and "needs assessment". In addition, we hand-searched key journals and sought personal communication with researchers in the field. RESULTS: A total of 14 population studies and 19 clinical studies were retrieved. The percentage of the general population who reported at least one need for care ranged from 9.5% to 13.8%. The numbers of needs in psychiatric patients ranged from 3.3 to 8.6. Correlates of unmet need include: unemployment, single status, low quality of life and high disability scores, and the presence of certain psychiatric diagnoses, such as affective psychosis and personality disorders. Higher rates of met need and service satisfaction are correlated with a longer duration of service contact. CONCLUSION: The assessment of need to date has been established either by service use data to make inferences about unmet need, by asking limited guided questions about needs, or by using established needs assessment instruments. The high prevalence of psychiatric disorders and the weak correlation between disorder and unmet need require a combined approach towards service development.

Cross-Cultural Comparison↗
PubMed2001

Assessing the difference between sociodental and normative approaches to assessing prosthetic dental treatment needs in dentate older people.

OBJECTIVE: To illustrate differences in assessed need using normative and sociodental approaches to assess prosthetic treatment needs of dentate older people. DESIGN: A cross-sectional study using non-random sample. SETTING: Metropolitan area of Chiang Mai, Thailand. SUBJECTS: 707 older individuals, 549 of the total sample were dentate, living independently, aged 60 to 74 years. RESULTS: The dentate population examined consisted of 289 classified as 'normal health' and 44 with a nutritional problem. Of the total population, 60% (333) had a normative need for partial dentures. Excluding the 44 with a nutritional problem, 50% (146) of the NTM group had 'impact-related treatment need' and of the latter 146, 69% (102) had a high propensity for health behaviour. 41% of the 102 who had 'impact-related' and 'propensity related treatment need' had 'accessible treatment need'. That is 14.5 per 100 of those with normative need. The gap between normative and 'accessible need' was greater among those with 'general health related treatment need' due to underweight. Of the 44 with a NTM and had a health problem, 45% (20) had a 'propensity related treatment need'. 40% of the group with a 'propensity related treatment need' had 'accessible treatment need'. Overall of the 44 older people with a normative need for a prosthesis and who had a health problem, only 2.4% had 'accessible treatment need' mainly due to lack of finance. If the treatment were subsidised then 45% of those with 'propensity related treatment need' would be eligible for treatment. CONCLUSION: Large differences of estimated treatment need were found between a sociodental and a normative approach to assess prosthetic dental treatment needs of older Thai people.

Activities of Daily Living↗
PubMed1999

The distinction between needs and wishes: implications for psychoanalytic theory and technique.

After a comprehensive survey of the literature is presented and some caveats entered, this paper delineates the concept of a psychological "need," noting that it bears a complex relation to the concept of a "wish." Need is universal, wish experience-bound. A need, unlike a wish, is not subject to repression. In addition, although a wish can be replaced by another wish, a need cannot be replaced by another need. Whereas the frustration of a wish causes dynamic shifts, the frustration of a need leads to structural disintegration. Needs and wishes can be in harmony or in opposition. The paper also identifies six basic psychological needs, which would seem to be ubiquitous, though the degree to which they are overt and the ways in which they are met vary across cultures. Their gratification seems necessary for healthy psychic development to occur, for relationships to survive, and for psychoanalytic work to take hold and to continue optimally. These needs are (1) the need for one's physical needs to be deemed legitimate; (2) the need for identity, recognition, and affirmation; (3) the need for interpersonal and intrapsychic boundaries; (4) the need for understanding the causes of events; (5) the need for optimal emotional availability of a love object; and (6) the need for a resilient responsiveness by one's love objects under special circumstances. Ordinarily these needs are met during the course of treatment with no deliberate effort by the analyst. In the treatment of some patients, however, they require more direct attention. A number of clinical vignettes are presented to elucidate these ideas.

Adult↗
PubMed2005

Health status and access to care for children with special health care needs.

BACKGROUND: About 11-14% of children with special health care needs (CSHCN) have unmet needs during a given year. Little is known about the determinants of unmet health care needs for CSHCN. AIMS OF THE STUDY: The objective of this study was to explore the association between access to care (unmet needs) among CSHCN and their caregivers' mental health status as well as children's mental health status. METHODS: We surveyed a random sample of 1,088 caregivers of CSHCN who resided in the District of Columbia during the summer and fall of 2002. In the survey, we collected information on children's unmet needs mental health status (PARS) and their caregivers' mental health status (CES-D). We estimated the association between mental health status determinants of unmet needs adjusting for selection bias associated with plan choice (partially capitated managed care versus FFS) with an instrumental variables probit estimation technique. We used caregivers' preferences about physicians and hospitals networks, and whether the caregiver and child had the same last name to identify the plan choice equation. RESULTS: We found that caregivers with symptoms of depression were 26.3% more likely to report any unmet need, 67.6% more likely to report unmet hospital and physician need, 66.1% more likely to report unmet mental health care need and 38.8% more likely to report unmet need for other health care services. Caregivers of children with poor psychological adjustment were 26.3% more likely to report their child had an unmet need and 92.3% more likely to report an unmet mental health care need. DISCUSSION: Our analyses show that children whose caregivers experience symptoms of depression are significantly more likely to encounter difficulties obtaining needed medical and mental health care services. Furthermore, the findings reported here indicate that children with poor psychological adjustment are significantly more likely to experience unmet needs for medical and mental health care services. Our study has some limitations. First, most of the children in our sample are African-American, so these findings may differ for children of other races. Second, these findings may not be applicable to CSHCN who reside in rural areas. Third, we recognize the possibility that child and caregiver mental health is potentially endogenous. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The mental health status of CSHCN and their caregivers are barriers to care. IMPLICATIONS FOR HEALTH POLICIES: Policymakers should be concerned about the mental health status of children with special health care needs and their caregivers as such problems appear to be barriers to obtaining care. Therefore, to adequately address the access problems of children with special health care needs, policy must address the mental health problems of children and their caregivers. Providing mental health care for caregivers and children has the potential for improving overall access for CSHCN. IMPLICATION FOR FURTHER RESEARCH: Future research should determine the causal relationship between mental health problems of CSHCN and their caregivers and the level unmet health care needs.

Adolescent↗
PubMed1989

A description of the needs of noninstitutionalized cancer patients and their primary care givers.

The purpose of this descriptive study was twofold: to identify the needs of the noninstitutionalized patient with cancer as defined by patients, primary care givers, and nurses, and to identify the needs of the primary care giver as defined by the same three groups of subjects. Each subject completed two forms of the Objects Content Test, an open-ended questionnaire on which subjects were asked to list the needs of patients and care givers. Content analysis was applied to the two sets of data to formulate categories of need responses; each set of data with category labels and definitions was submitted for q-sort by two successive groups of nurse experts to establish the validity of need item responses in categories. Findings revealed that patient needs were represented by six categories and caregivers' needs by seven categories. For both sets of data, the largest number of needs were in the psychological needs category. For patients, physical needs and information needs were the next largest categories; for care givers, the categories of household management needs (which encompassed patient care) and information needs were the second and third largest. Some disparity between perceived needs as generated by the three groups of subjects was noted. Further research utilizing quantitative methods is needed to determine whether suggested trends (such as nurse subjects' emphasis on informational needs for care givers and patients' infrequent listing of informational needs for themselves) have validity.

Adult↗
PubMedDate not supplied

[Comparative study of the needs of patients with schizophrenia by gender].

OBJECTIVES: To evaluate the gender differences in the needs of the people with schizophrenia who live in the community. METHOD: We randomly selected 231 patients with schizophrenia who were receiving treatment in one of the five mental health care centres that participated in the study. Patients were evaluated with a socio-demographic questionnaire, the Positive and Negative Syndromes Scale (PANSS) and Camberwell Assessment of Need (CAN) questionnaire. The CAN evaluate 22 needs, that we could be grouped into five subscales: service needs, basic needs, functioning need, health needs and social needs. All needs were evaluated by the professional and the user independently. RESULTS: Professionals detected more needs in men than in women, but users did not report such difference. Both professionals and users detected more service needs for women (p< 0.005) and more basic needs for men (p< 0,01-0.005). Only professionals detected more functioning needs in men (p< 0.05). CONCLUSIONS: Professionals detect more needs than users and detect more needs for men than for women. Women have less needs in food, personal care, home care, and daily activities. These gender differences should be taken into account when designing treatment programs for schizophrenia.

Adolescent↗
PubMed2004

[Evaluation of indices indicating elderly long-term care need in municipalities].

OBJECTIVE: To establish a way to evaluate preventive care programs using indices that indicate the status of long-term care need for elderly in municipalities. METHOD: Based on the number of people certified as subject to long-term care need and the number of deaths in Taihaku Ward in Sendai City, 3 indices in 14 junior high school districts in the ward were derived; Healthy Life Expectancy for 65 year old men and women (the period in which certification for long-term care need is not made), Hours of Care Need (age-adjusted standard hours for care need) and the Odds Ratio (age-adjusted relative risk) for the elderly aged 65 years or older. Yearly comparisons of the indices were made for 2000 vs 2001, 2001 vs 2002 and 2000 vs 2002. The relationships between the three indices were further analyzed for 2000, 2001 and 2002. Care Compensation by district (age-adjusted care compensation by district was derived for 2001) and its relationships to Healthy Life Expectancy, Hours of Care Need and the Odds Ratio were analyzed by school district for 2001. RESULTS: 1) The Hours of Care Need by district significantly correlated with the Odds Ratios by district for 2000, 2001 and 2002. Both the Hours of Care Need and the Odds Ratio by district also significantly correlated between 2000 and 2001, between 2001 and 2002 and between 2000 and 2002. Healthy Life Expectancy did not show a significant correlation between 2000 and 2001, between 2001 and 2002 and between 2000 and 2002, for men and women. 2) The 2001 Care Compensation by district was obviously proportional to both Hours of Care Need by district and the Odds Ratio by district but did not correlate with Healthy Life Expectancy by district for men and women. 3) Using the co-relationship of the Hours of Care Need between the years, the percentage of applications for certification for care need by people needing care was estimated at 65% for 2000, 87.5% for 2001 and 101% for 2002. This implies that in 2002 almost all the people who needed care applied for the certification. The 2001 Odds Ratio by district was significantly low in district D and significantly high in district H. CONCLUSIONS: Hours of Care Need correlate well with the Odds Ratio and also with Care Compensation which represents long-term care insurance service expenses. The results clearly indicate that the 3 indices represent the status of care need of the elderly in these districts, even with conservative estimates, after 2002. It is suggested that Hours of Care Need and the Odds Ratio are appropriate as indices to evaluate preventive care programs in municipalities.

Aged↗
PubMed2004

[Orthodontic treatment needs and indications assessed with IONT].

The aim of this work was to determine the usefulness of the Index of Orthodontic Treatment Need (IOTN) in epidemiological studies undertaken to assess orthodontic treatment need of a given population, as well as in the process of defining indications to orthodontic treatment in individual cases with regard to objective treatment need and expressed demand for treatment. The correlation of the Aesthetic Component of IOTN (AC degree) with demand for treatment, usefulness of IOTN for screening studies, necessary modifications to make IOTN more acceptable to Polish orthodontists, and value of IOTN as a diagnostic and measuring tool for the assessment of orthodontic treatment need were addressed. The correlation between AC and demand for treatment, as well as the usefulness of IOTN in epidemiological studies were investigated with questionnaires and clinical examination using both components of IOTN (Figs. 1, 2, 3). The study group consisted of 264 schoolchildren aged 12 years. The results show that poor dental aesthetics is the main motivating factor to undertake orthodontic treatment (Tab. 1) and that demand for orthodontic treatment exceeds treatment need determined by IOTN (Tab. 2, 3). A regular distribution of AC degrees relative to the demand for treatment was obtained (Fig. 4) revealing the necessity to modify treatment need categories of this component in order to identify individuals with significant subjective treatment need. The modified aesthetic component would comprise the following treatment need categories: Grades (photographs) 1-2--"no demand for treatment"; 3-4--"borderline demand for treatment"; 5-10--"great demand for treatment". Excellent reproducibility of the Index (high values according to Kappa statistics), its universality, usefulness for various purposes, and simplicity in practice make the Index valuable for screening studies and assessment of treatment need in a given population. In order to test the reliability of the Dental Health Component of IOTN (the degree of conformity of this component with treatment tendencies among orthodontists), DHC criteria and subjective evaluation of treatment need were compared. This part of the study was carried out in a group of six orthodontists. 50 pairs of plaster casts covering a wide range of occlusal anomalies were analyzed. The subjective need for orthodontic treatment was stated for each case taking into account treatment priority and occlusal features determining treatment need. The results reveal a moderate conformity of DHC criteria with the orthodontist's opinion (Tab. 4 A, B) and a tendency among orthodontists to qualify for treatment also cases without treatment need according to IOTN recommendations. The discrepancy between the orthodontist's assessment of treatment need and DHC criteria applies mainly to cases with reverse overjet, front open bite, front or total crossbite and crowding in buccal segments of dental arches (Tab. 4 A, B). Matching the dental health component with opinions of Polish orthodontists requires shifting of some criteria from the moderate treatment need to the great treatment need category (Fig. 5).

Age Factors↗
PubMed2001

The Nordic Study on schizophrenic patients living in the community. Subjective needs and perceived help.

In a community sample of 418 persons diagnosed with schizophrenia, subjective needs and perceived help was measured by the Camberwell Assessment of Need (CAN). The mean number of reported needs was 6.2 and the mean number of unmet needs 2.6. The prevalence of needs varied substantially between the need areas from 3.6% ('telephone') to 84.0% ('psychotic symptoms'). The rate of satisfaction estimated as the percentage of persons satisfied with the help provided within an area varied between 20.0% ('telephone') and 80.6% ('food'). The need areas concerning social and interpersonal functioning demonstrated the highest proportion of unmet to total needs. In a majority of need areas the patients received more help from services than from relatives, but in the areas of social relations the informal network provided substantial help. In general the patients reported a need for help from services clearly exceeding the actual amount of help received. In a linear regression model symptom load (BPRS) and impaired functioning (GAF) were significant predictors of the need status, explaining 30% of the variance in total needs and 20% of the variance in unmet needs. It is concluded that the mental health system fails to detect and alleviate needs in several areas of major importance to schizophrenic patients. Enhanced collaboration between the care system and the informal network to systematically map the need profile of the patients seems necessary to minimise the gap between perceived needs and received help.

Activities of Daily Living↗
PubMed2001

Increasing understanding of patient needs during and after hospitalization.

BACKGROUND: The value of patient satisfaction surveys in health care improvement remains controversial. This study examined the value of alternative ways of identifying patient needs and estimating importance of those needs in improving the impact of satisfaction surveys. METHODS: Ninety-one acute myocardial infarction (AMI) patients from three southeast U.S. community hospitals were surveyed in 1992. Critical incident and person-focused interviews were used to identify patient needs. Besides overall/global satisfaction with care, patients rated satisfaction with and importance of 12 care delivery and 18 information and support needs. Unmet need scores (importance minus satisfaction) were estimated. Derived importance scores were assessed by correlating global satisfaction with individual need satisfaction scores. A two-step process for identifying priority areas for improvement was proposed. RESULTS: Patients identified and assigned greater scores to unmet needs for information and support needs (not included in typical satisfaction surveys) compared to typically assessed care delivery needs (p < 0.0001). Direct importance ratings differed substantially from those derived through correlation analyses (r = 0.28, p > 0.3 for care delivery needs and r = -0.17, p > 0.4 for information and support needs). Needs that received high importance and low satisfaction scores were all information and support needs. DISCUSSION: Needs that patients consider very important are usually ignored in typical patient surveys. Derived approaches typically used to assess importance of need from satisfaction data may provide misleading results. If satisfaction surveys are to result in real performance improvement, a fresh examination of the content and importance assessment strategies, as proposed, is needed.

Adult↗