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PubMed2005

Ethnic variations in orthodontic treatment need in London schoolchildren.

BACKGROUND: The study was carried out to determine the prevalence of orthodontic treatment need in children from minority ethnic groups and compare the need to the white population. The second objective was to explore variations in agreement between subjective and objective treatment need in a multiethnic context using the aesthetic component of Orthodontic Treatment Need Index (IOTN AC). METHODS: A cross-sectional study in North West London, 14 schools were randomly selected from the 27 schools in the two boroughs of Harrow and Hillingdon. Comparison between objective and subjective treatment need was carried out using IOTN AC index. Clinical orthodontic treatment need was also recorded using the dental health component of Orthodontic Treatment Need Index (IOTN DHC). RESULTS: 2,788 children were examined and completed the questionnaire. 16% of the study population were already wearing appliances or had finished orthodontic treatment. Of the remaining children; 15% had definite need for treatment using the dental health component of the IOTN. There was no significant variation in the need for orthodontic treatment between different ethnic backgrounds (P > 0.05) whether using the AC or DHC components of the IOTN index. However, poor agreement was detected between professional and subjective assessment of ethnic minority of orthodontic treatment need using IOTN AC index. CONCLUSION: Orthodontic treatment need in children of ethnic minorities does not differ significantly from the vast majority of white children. However treatment need based on aesthetic index continues to vary in all ethnic groups from the professional aesthetic assessment.

Journal Article↗
PubMed2005

Information needs of wives of men following prostatectomy.

PURPOSE/OBJECTIVES: To identify and evaluate the information needs of wives of men diagnosed with prostate cancer who were treated first with radical prostatectomy and to measure the extent to which their needs were met. DESIGN: Descriptive. SETTING: Comprehensive cancer center designated by the National Cancer Institute. SAMPLE: 66 wives of men with prostate cancer. METHODS: On the second day after their husbands underwent prostatectomies, the wives of men with prostate cancer completed the Family Inventory of Needs-Wives and a demographic data form. MAIN RESEARCH VARIABLES: Information needs and the perceived degree to which they were met. FINDINGS: All needs were identified as important but were met to varying degrees. Five items were not rated "unmet" by any respondents, whereas four items were considered unmet by at least 30% of respondents. Evidence suggests that the age of the wife influences the percentage of unmet needs, with older wives having more unmet needs. P values for the relationship between needs and the age of the wife, her educational level, and the time between diagnosis and treatment were less than 0.05. CONCLUSIONS: Illness prompts a wife's need for information, which supports findings of earlier research. IMPLICATIONS FOR NURSING: Wives have a wide range of information needs. Assessing education needs and the degree to which they are met can guide nurses in restructuring education. Support and guidance regarding more difficult issues, such as fatigue and sexual activity, can decrease barriers to communication. Using a multimodality approach to education, constantly reassessing needs, and encouraging questions are imperative.

Female↗
PubMed2005

[The satisfaction of personal needs in patients with pulmonary tuberculosis].

The founder of humanistic psychology A. Maslow divided the needs of a personality into several levels--from the lowest to the highest ones. Higher-leveled needs rise when the lower-leveled needs are satisfied. A great deal of factors affect the origination and satisfaction of needs, but they are always interrelated with social values. The extent to which personality needs are satisfied in patients with pulmonary tuberculosis has not been studied. A special questionnaire has been drawn up to study the extent to which personality needs are met. Its suitability has been determined, by using a group of patients with bronchial asthma. The extent to which personality needs are satisfied in patients with pulmonary tuberculosis was studied in 178 patients with infiltrative pulmonary tuberculosis and 253 patients with fibrocavernous pulmonary tuberculosis. The results have shown that the extent to which personality needs are satisfied in patients with tuberculosis is lower than that in apparently healthy individuals of the same social status. In females with infiltrative pulmonary tuberculosis, the needs for safety are satisfied to a lesser extent. In those with fibrocavernous pulmonary tuberculosis, the extent to which the physiological, safety, and self-realization needs is decreased. In males with infiltrative pulmonary tuberculosis, the physiological, noetic, and self-realization needs are satisfied to a lesser extent. In those with fibrocavernous pulmonary tuberculosis, the extent to which the physiological, safety, group decision-making, noetic and self-realization needs is decreased.

Adult↗
PubMedDate not supplied

Psychosocial and physiologic needs of patients with arterial occlusive disease during the preoperative phase of hospitalization.

This study explored the needs experienced by 60 patients with chronic AOD during the period of hospitalization preceding reconstructive surgery. Ten physiological, psychological, and sociocultural need variables were found to relate to two major needs, a need for information and a need for support. The investigator identified a need for information related to preventive health behaviors and a need for support related to four areas. The patients expressed a need for support to overcome difficulties experienced in coping with the ramifications of chronic illness and anxiety regarding future progression of the disease. Significant differences existed between male and female and older and younger patients in several need areas. Influencing factors were primarily associated with perceived changes in self-concept and role relationships. The study indicated that difficulties experienced in adapting to chronic vascular disease exert a major influence on patients' perceptions during the preoperative period. Intervention during this period must thus meet needs related to both the chronic nature and the acute surgical phase of the disease. The study has provided an initial basis for developing interventions to meet these needs. However, further research utilizing a multivariate approach, is necessary before the complex nature of factors influencing patients' needs will be understood totally.

Adaptation, Physiological↗
PubMed2003

Assessing the unmet information, support and care delivery needs of men with prostate cancer.

This study identified the key Unmet Needs of men with localized prostate cancer. A series of Nominal Groups were used to identify needs, from which a 135-item survey was developed to assess both the Importance and Unmet Need of each item. An Importance-Weighted Unmet Need score was calculated for each item, incorporating both the Importance and the degree to which the need was unmet. Surveys (n=500) were distributed in four geographically distinct areas, with a response rate of 46%. Respondents were 90% Caucasian, 80% married, with a mean age of 66 years, and mean education of 14 years. Care delivery needs were most important and least unmet, while Support needs were least important and most unmet. However, when degree to which needs were unmet was weighted by Importance, information needs had the highest Importance-Weighted Unmet Need scores. The greatest Unmet Needs for information were in knowledge of recurrence issues and in side effects of the illness and its treatment.

Aged↗
PubMed2000

Disabled people and professionals differ in their perceptions of rehabilitation needs.

BACKGROUND: This study set out to explore whether there are systematic differences in unmet needs for rehabilitation services and resources as identified by disabled people and nominated key professionals. METHODS: A cross-sectional interview survey of 87 pairs of community-dwelling disabled people (aged 16-65) and their nominated key professionals was conducted in southern England. The Southampton Needs Assessment Questionnaire (SNAQ) was used to examine unmet needs and the Office of Population Censuses and Surveys (OPCS) Disability and Severity Scale to examine level of disability. RESULTS: Eighty-seven pairs of disabled people and their nominated key professionals participated. People were severely disabled (median OPCS score 8; interquartile range 6-9). Disabled participants reported significantly more unmet needs than did professionals. There was zero concordance on identified unmet needs between disabled participants and professionals in 56 per cent of cases. Concordance between disabled participants and professionals was significantly better if the disabled participant had reported more unmet needs. There was a trend for general practitioners to be poorer at reporting disabled participants' needs than other professionals. There was fair agreement between disabled participants and professionals in five areas of unmet need only (in descending order): adaptations, physiotherapy, equipment, assistance with 'non-care' activities and the use of a day centre. In all the other areas of unmet need the agreement was poor. CONCLUSIONS: Needs for rehabilitation services and resources (for disabled people) are perceived differently by disabled people and professionals. Until we know who is right about rehabilitation needs, it is important to determine both users' and providers' views when planning and commissioning services.

Adolescent↗
PubMed2000

Assessment of the need for palliative care as perceived by individual cancer patients and their families: a review of instruments for improving patient participation in palliative care.

BACKGROUND: Palliative care should fit the needs of individual cancer patients and their families. Instruments can help to improve needs assessment. This review evaluates questionnaires for the systematic assessment of needs experienced by individual cancer patients for help, care, or support, as well as the needs of their family members. METHODS: The MEDLINE and PsycLIT data bases were searched systematically. Questionnaires were evaluated by reviewing their contents and estimating their validity, reliability, and feasibility for use in caregiving practice. RESULTS: Analysis of the 471 articles identified from the searches yielded 9 questionnaires for the assessment of patients' needs and 6 questionnaires for the assessment of family members' needs. Most of these instruments were carefully constructed; their validity and reliability were satisfactory and well documented. However, in most questionnaires the needs for care were confounded by satisfaction with care, and the problems experienced by patients. Only one questionnaire for patients specifically addressed the need for help; none for family members was so specific. Data on the feasibility of questionnaires for use in regular care were scarce. Issues frequently omitted were spiritual issues, the personal needs of family members, and the continuity of care. CONCLUSIONS: None of the instruments the authors found was complete for all dimensions of palliative care. Most instruments were constructed for research purposes and had not been tested for use in practical care. Further development of practical instruments based on a theoretical concept of needs assessment seems necessary. The feasibility of instruments for use in practical caregiving and their effects on the quality of care needs further research.

Family↗
PubMed2002

The effect of education and income on need and willingness to undergo total joint arthroplasty.

OBJECTIVE: Individuals with lower socioeconomic status (SES) receive less arthritis care, including joint arthroplasty. However, no studies have considered the expectations or needs of the patients. Our objective was to assess the effect of education and income on the potential need for, and the willingness to consider hip and knee arthroplasty. METHODS: Through a mail/telephone survey of 48,218 persons ages 55 years or older residing in 2 areas of Ontario, Canada, 3,307 individuals with moderate-to-severe hip/knee problems were identified. These individuals received a questionnaire to assess education, income, arthritis severity, and comorbidity. In a subset of these subjects, we conducted interviews to evaluate the willingness to consider arthroplasty, and we also performed clinical and radiographic examinations of the joints to validate self-reports of arthritis. The potential need for arthroplasty was defined as the presence of severe arthritis (as scored by the Western Ontario and McMaster Universities Osteoarthritis Index), with no absolute contraindications to surgery. Separate logistic regression models examined the independent effects of education and income on the potential need for, and definite willingness to consider arthroplasty, after controlling for age, sex, and region of residence. Potential unmet need was estimated as the proportion of subjects with the need for arthroplasty who were not already on a surgery waiting list, who were definitely willing to consider arthroplasty, and who had evidence of arthritis by examination and radiography. RESULTS: Response rates were at least 72% for all questionnaires and interviews. Less education (adjusted odds ratio [OR] 1.57 for less than high school versus postsecondary education, 95% confidence interval [95% CI] 1.17-2.11) and lower income (adjusted OR 1.83 for </=$20,000 versus >$40,000, 95% CI 1.24-2.70) were independently associated with a greater likelihood of having the potential need for arthroplasty. Among the subjects with potential need, neither education nor income was independently associated with a definite willingness to consider arthroplasty. Thus, taking willingness into consideration, individuals with less education and/or lower income were more likely to have potential unmet need for arthroplasty. CONCLUSION: Persons with lower SES had a greater need for, and were equally willing to consider arthroplasty, compared with those with higher SES. Thus, observed SES disparities in the rates of performed arthroplasties cannot be explained by a lower need or less willingness to undergo arthroplasty in those with lower SES.

Aged↗
PubMed2005

Needs assessment in dementia.

BACKGROUND: Resource allocation and service development traditionally focuses on diagnostic categories and consequent perceived need. Identification of the actual level of need in the elderly with dementia, and the degree to which it is unmet is necessary to plan services both individually and as a group. The aim of this study was to characterise the needs of a sample of community dwelling elderly patients with dementia who were referred to an old age psychiatry service in Ireland between July 2002 and July 2003. METHODOLOGY: Eighty-two consecutively referred community dwelling patients with ICD-10 diagnosis of dementia were assessed on The Care Needs Assessment Pack for Dementia (CareNap-D). Data on needs across seven domains (health and mobility, self-care and toileting, social interaction, thinking and memory, behaviour and mental state, housecare, community living) is presented (Reynolds T et al., 1998). RESULTS: Subjects had a mean of 33 (range: 13-56) identified needs. Approximately 1/3 of these were unmet with a mean of 13 (range: 0-37) and a mean of 20 (range: 4-39) were met. High levels of unmet need was identified in the domains of behaviour and mental state (84% of those with agitation) and of social interaction (79% of those with 'partaking in activities' need). The specific item of repetitive questioning occurred in 68 individuals and was unmet in 88% of these cases. Increasing age, lower MMSE score, and living alone were associated with greater total levels of unmet need. CONCLUSION: This data underlines the degree of unmet need in the community dwelling elderly with dementia and the importance of developing a spectrum of services on the basis of the actual needs identified.

Activities of Daily Living↗
PubMed2001

Needs and demands for dental care in patients attending the University Dental Hospital in Sri Lanka.

AIMS: To determine the needs and demands for dental care in patients visiting a university dental hospital. DESIGN: A cross-sectional study of first visit patients. SETTING: The University Dental Hospital in Peradeniya, Sri Lanka. PARTICIPANTS: A total of 849 first visit patients. METHODS: The main complaint of each patient was recorded and was considered as a measure of demand for dental care. Tooth based and orthodontic treatment needs were assessed using the WHO basic methods. Periodontal treatment need was assessed by the periodontal treatment needs system. Need for prosthetic care was also assessed. RESULTS: Thirty per cent and 23% of patients demanded treatment for decayed teeth and toothache respectively. Nearly 34%, 27% and 17% of patients needed surgical, restorative and periodontal care respectively for the main complaint. Of those seeking care, 94% needed treatment other than what was required for the main complaint. The predominant normative treatment need was for periodontal care (77%) whilst 47% needed restorations or extractions. CONCLUSION: Normative needs of patients demanding treatment were high and many had demanded treatment before acute symptoms had developed. However, delays in seeking care were evident. Further studies are needed to identify factors for delay in obtaining care.

Adolescent↗
PubMed2006

Supportive care needs: are patients with lung cancer a neglected population?

While the unmet supportive care needs are well documented for some groups of cancer patients, relatively little is known about the levels and types of needs of lung cancer patients. The study aims to compare the levels of lung cancer patients' psychosocial needs with those of other cancer patients. A total of 1,492 consecutive patients in nine major public cancer treatment centres in New South Wales, Australia, were invited to participate in the Supportive Care Needs Study; 888 completed surveys were received. The mean number of unmet needs (out of a maximum of 59) reported by lung cancer patients was 15.6 (95% CI 12.1-19.1), compared to 10.9 (95% CI 10.0-11.8) in other cancer patients. The differences were mainly due to the fact that lung cancer patients reported a higher mean number of unmet psychological needs (7.6 versus 5.0) and physical and daily living unmet needs (2.8 versus 1.4), compared to the other cancer patients. Having a lung cancer diagnosis was an independent predictor of having a high level of psychological need (RR 2.00, 95%CI 1.13-3.56) and daily living need (RR 2.81, 95%CI 1.60-4.95), together with not being in remission, and receiving the cancer diagnosis more than two years previously. The results suggest that priority needs to be given to addressing the specific needs of this sub-group of cancer survivors.

Adolescent↗
PubMed1997

Epidemiologic assessment of overmet need in mental health care.

The traditional purpose of psychiatric epidemiologic surveys has been the assessment of mental illness and, by implication, the need for care. Previous research has focused on unmet need, defined as those who meet "caseness" but do not receive care, but has rarely examined the converse. Since survey respondents receiving care but not meeting caseness have been found to represent up to one-half of mental health service users, this is a significant service delivery issue. The data are drawn from the Mental Health Supplement to the Ontario Health Survey (the Supplement), a household survey of 9,953 respondents, which used the University of Michigan's version of the Composite International Diagnostic Interview (UM-CIDI) as its diagnostic instrument. Community residents who used formal mental health services in the past year but who did not have a concurrent UM-CIDI/DSM-III-R (Diagnostic and Statistical Manual 3, revised) diagnosis were defined as "treated without CIDI disorder". Their need for care was evaluated by comparing them to "treated depressed" and "healthy" respondents, using indicators of functional impairment, vulnerability to developing disorder, and risk of relapse. The match between need and care levels was examined by comparing their type and intensity of use with those of the treated depressed. Results present strong evidence for conceptualizing need as continuous, rather than discrete. The results for the group defined as "treated without CIDI disorder" were consistently between those for the other two groups (with the "treated depressed" always showing the highest need) on all indicators as well as on a summary need index. However, their type and intensity of service use appeared to be unrelated to their level of need. Although some of the "treated without CIDI disorder" group may require preventive or follow-up treatment, the need for service for others is not as convincingly demonstrated. Outcome studies are needed to provide comparative data to describe more fully the problems experienced by this group and indicate whether treatment is helpful. In an age of fiscal restraint, when resource reallocation (rather than generation of new resources) is the likely scenario, such close examination of the fit between need and care is critical if services are to be targeted appropriately.

Adolescent↗
PubMed2005

CSHCN in Texas: meeting the need for specialist care.

OBJECTIVE: Assuring the sufficiency and suitability of systems of care and services for children with special health care needs (CSHCN) presents a challenge to Texas providers, agencies, and state Title V programs. To meet the need for specialist care, referrals from primary care doctors are often necessary. The objective of this study was to describe the factors associated with the need for specialist care and problems associated with obtaining referrals in Texas. METHODS: Bivariate and multivariate analyses were performed using the National Survey of Children with Special Health Care Needs (NS-CSHCN) weighted sample for Texas (n = 719,014) to identify variables associated with the need for specialist care and problems obtaining referrals for specialist care. RESULTS: Medical need of the CSHCN and sensitivity to family values/customs was associated with greater need for specialist care, and Hispanic ethnicity and lower maternal education were associated with less need. Medical need, amount of time spent with doctors and sensitivity to values/customs, living in a large metropolitan statistical area, and lack of medical information were associated with problems obtaining a specialist care referral. CONCLUSIONS: Findings revealed some similarities and differences with meeting the need for specialist care when comparing Texas results to other studies. In Texas, aspects of customer satisfaction variables, especially doctors' sensitivity to family values/customs and parents' not receiving enough information on medical problems, were significantly associated with problems obtaining specialist referrals. Findings indicate a need to further research relationships and communication among doctors, CSHCN, and their families.

Child↗
PubMed2004

Association between normative and self-perceived orthodontic treatment need among Arab high school students.

The aim of this study was to investigate whether there was an association between normative and self-perceived orthodontic treatment need, and to evaluate the influence of sex and socioeconomic background on treatment need. A total of 139 high school students, aged 14 to 18 years, from 2 districts in Kuwait were included. The study consisted of a questionnaire and a clinical examination. Normative need for treatment was assessed clinically by using the index of orthodontic treatment need (IOTN). Both the dental health component (DHC) and the aesthetic component (AC) of the IOTN correlated positively with self-perceived treatment need. In 53% of the subjects, there was agreement between self-perceived treatment need and the DHC score. Between the AC component and self-perceived need, the agreement was 77%. The odds of self-perceived treatment need were 10-fold for subjects having AC scores higher than 4, indicating moderate or definite need. Sex and socioeconomic factors did not significantly affect the normative treatment need. These results suggest that the AC component of the IOTN clearly reflects the self-perceived need for treatment.

Adolescent↗
PubMed2005

Patient- and clinician-perceived need for orthognathic surgery.

INTRODUCTION: To better understand why patients believe they need orthognathic treatment, a study was undertaken to examine perceived need for treatment by patients and clinicians. This questionnaire-based study was undertaken at The John Radcliffe Hospital, Oxford, United Kingdom. SUBJECTS AND METHODS: Forty patients were recruited from combined orthodontic-surgical clinics. They were asked to rate their perceived need for treatment based on facial appearance, dental appearance, function, and overall need. Twenty orthodontists and 20 maxillofacial surgeons were asked to rate perceived need for treatment based on the same parameters, using study models and clinical photographs. Ratings were marked on visual analog scales. RESULTS: Significant differences were found between patients and clinicians in perceived need for treatment based on facial appearance (orthodontists compared with patients, P = .023; surgeons compared with patients, P = .001). In addition, maxillofacial surgeons rated a significantly greater overall need for treatment than patients (P = .027), and they rated treatment need based on facial appearance (P = .005) and function (P < .001) significantly higher than orthodontists. CONCLUSIONS: Clinicians rated greater need for orthognathic treatment based on facial appearance than did patients. Surgeons also rated greater overall need for treatment than patients. In addition, surgeons rated treatment need based on facial appearance and function significantly higher than orthodontists, but large variations existed in both clinician groups.

Adolescent↗
PubMed2000

A needs assessment for a palliative care curriculum.

To ensure the success of a new curriculum at an institution, information about the educational needs of learners, available resources, and potential obstacles needs to be systematically collected and analyzed prior to the development and implementation of the actual curriculum. This process, known as needs assessment, is important in the development of palliative care training for internal medicine residents, because internal medicine has only recently begun to address these issues in a formalized way and palliative care is a relatively new topic in medical education and clinical medicine. Therefore, institutional issues and resistance, lack of knowledge and appropriate attitudes among trainees and faculty, and a paucity of educational models for individual internal medicine training programs present potential obstacles. Although curricula that have been developed by national organizations can serve as "guideposts, " these documents are unable to address the specific needs and culture of an individual institution. This paper outlines a systematic methodology of needs assessment for palliative care curricula at individual institutions that could be applied to the development and implementation of palliative care training for different groups of learners. An institution-specific needs assessment was developed based upon the findings of a systematic literature review and interviews with experts in palliative medicine and medical education. The following methods were utilized: 1) an anonymous survey; 2) focus groups; 3) topic rankings; and 4) individual interviews. The needs assessment revealed the following educational, clinical, and institutional information: 1) interns had very little exposure to palliative care in medical school; 2) there was no formalized system formal education and clinical exposure; 3) tremendous interest in palliative care education existed; 4) patients, families, physicians, and nurses perceived a need to improve the quality of palliative care; and 5) there are several political, logistical, and resource (time and financial) obstacles that needed to be addressed. An institution-specific needs assessment is an important part of the successful development and implementation of any new curriculum for medical residents and was specifically necessary for our palliative care program. As a result of the needs assessment process, a curriculum consisting of ten units of case-based and problem-based teaching was successfully implemented.

Curriculum↗
PubMed1994

Orthodontic treatment demand and need in third and fourth grade schoolchildren.

There have been few reports worldwide addressing orthodontic need and demand in children and no recent reports in the United States. The purpose of this study was to examine the orthodontic need and demand in third and fourth grade children (n = 3696). Data including age, sex, race, orthodontic status, socioeconomic status, availability of specialist treatment services, as well as thorough occlusal data, were collected. Orthodontic demand was significantly higher in girls (9.5%) than boys (6.8%), whereas need had the inverse relationship (41.8%, 44.2%, respectively). There were no meaningful differences in age among the demand, need, and no need groups. Demand was greater in white than in black children (11.8% versus 1.2%); however, need was observed to be less in black (35.3%) than in white children (47.2%). Demand was greater in the urban schools (8.9%) than in the rural schools (6.3%), whereas need was found to be similar. There was more demand in the higher socioeconomic groups (11.7%) than in the lower groups (1.8%), whereas need was similar in all the groups. The demand group had a significantly greater number of orthodontists within a radius of up to 5 miles of the school than the need and no need groups. Logistic regression models to examine factors that distinguish the groups show that when demand versus need/no need groups are compared, those students with an increased "risk" of previous treatment are more likely to have more orthodontists nearby, to be in higher socioeconomic groups, and to be female students.

Black or African American↗
PubMed1998

Contextualizing critical care family needs through triangulation: an Australian study.

Family needs and concerns within the critical care context have been thoroughly explored from the quantitative perspective utilizing the Critical Care Family Needs Inventory (CCFNI). Nursing interventions have been designed on the basis of the findings from these studies. However, while the CCFNI would seem to encompass all the possible needs of families with a critically ill loved one, at no time were the family members themselves consulted at length in regard to the development of the instrument, or in any subsequent validation studies. Individual reality generates the variables that are measured in a needs analysis, and the family member experiences encompass dimensions that are not easily assessed by quantification. In fact the unique experiences of family members underpin their perception of need. Methodological triangulation formed the basis for this study to determine the degree of confirmation (or otherwise) between family member respondents to the CCFNI (n = 105) and those participating in an interview (n = 26) designed to explore needs and experiences. The qualitative data served the purpose of completeness by providing a more contextual representation of needs and therefore greater depth of understanding of the whole construct. The results indicate that, while there were many areas of convergence between the two samples, there were also areas of diveregence. Two major needs emerged from the interviews that are not represented on the CCFNI: the need of family members to provide reassurance and support to the patient; and their need to protect (others as well as the patient). A more complete understanding of family needs was obtained through the contextualization of their experiences.

Adolescent↗