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PubMed2000

Work ability assessed by patients and their GPs in new episodes of sickness certification.

BACKGROUND: Sickness certification legislation demands that work ability is reduced due to disease or injury. Most sickness certificates are issued by GPs. Assessment of work ability might introduce conflict in the doctor-patient relationship. OBJECTIVES: The aim of this study was to compare the level of work ability assessments by patients and their GPs in new episodes of sickness certification, and to explore how medical conditions and work demands are associated with the assessments. METHODS: Forty nine GPs supplied data about 408 patients certified sick <8 days before questionnaires were filled in. A total of 268 (66%) patients completed corresponding questionnaires. Patients and GPs independently answered the following question using a five-point scale: "To what degree is your (the patient's) ability to perform your (his or her) ordinary, remunerative work reduced today?" RESULTS: Work ability was assessed by patients as very much or much reduced in 66%, moderately reduced in 23% and not much or hardly reduced at all in 11% of the cases. Corresponding assessments made by GPs were 71, 27 and 2%. Patients and GPs agreed well on their assessments (+/- 1 answer category) in 81% (216/266) of the cases. The patients assessed work ability as more reduced the more stressful or physically strenuous their jobs were, and the older their GPs were. The GPs assessed work ability as more reduced the more their assessments were based on clinical findings. CONCLUSIONS: The agreement between work ability assessments made by patients and GPs was high, despite patients' assessments being associated with work demands and GPs' with medical conditions.

Adolescent↗
PubMed1995

Certification in postgraduate medical education.

This paper sets out some of the issues relating to certification of specialists. It first defines the purpose of certification as assuring the public of the level of competence of specialist practice. It then describes some of the issues involved, which include the assessment of competence, the need for public involvement, the issue of re-certification, and the problem of dealing with poor doctors. It concludes with a challenge to doctors to seize the opportunities and to enhance the quality of teaching and research in medical education.

Education, Medical↗
PubMed2001

School immunisation certificates--a review over time in a disadvantaged community.

OBJECTIVES: To compare proportions of kindergarten children in Auburn presenting School Immunisation Certificates (SIC) or other school-entry immunisation documentation over time, and to examine the immunisation status of these children. METHODS: Immunisation records of kindergarten children enrolled in all primary schools in the Auburn local government area were reviewed in 1994 and 1998. RESULTS: Eight hundred and thirty-three and 737 school entry records of children enrolled in kindergarten were reviewed in 1998 and 1994 respectively. There was no change in the overall proportion of children with immunisation documentation and SICs. Sixty-nine per cent (571/833) of children had SICs in 1998, compared with 72% (531/737) in 1994. Thirteen per cent of children had other immunisation documentation in 1998, compared with 11% in 1994. The proportion of invalid certificates fell from 39.2% in 1994 to 12.6% in 1998 (p<0.001). The 1998 survey indicated that 80.2% of children provided a certificate indicating they were completely immunised compared with 56.7% in 1994 (p<0.001). IMPLICATIONS: Although SICs play an important role in promoting the importance of immunisation among parents and in the school community, there continues to be a substantial number of children whose immunisation status is unknown. In the event of an outbreak, an effective public health response may need to incorporate the use of additional objective measures, such as the Australian Childhood Immunisation Register or personal health records.

Child, Preschool↗
PubMed1994

Legislation for school entry immunisation certificates in Victoria.

In 1982 the National Health and Medical Research Council recommended that every state introduce legislation requiring immunisation certificates at school entry. Victoria was the first state to enact such legislation. This paper explores the process and difficulties encountered in achieving this legal requirement, describes the requirements under the legislation as it was finally introduced, and examines the early data available to the state health department regarding its implementation. Compliance with the legislation and immunisation status of children enrolling in government primary schools were ascertained from mid-year census data. In 1992 almost 90 per cent of children complied with the legislation, but because 10.2 per cent of children did not present a certificate it was possible to estimate only the lower limit of statewide coverage at 85 per cent against the prescribed diseases. School entry immunisation legislation may provide an important safety net to identify children with incomplete immunisation. However, the effectiveness of the legislation in Victoria remains unproven, and the requirements of the legislation are demanding for parents, local councils, and schools. The failure to document immunisation status in over 10 per cent of children indicates that further efforts to increase compliance are needed. This will require information on the vaccination status of those without certificates and the reasons they have not complied. The impact of the legislation needs further evaluation, although it may be years before its effectiveness can be gauged. Its effectiveness may depend upon enforcement of the requirement to exclude unimmunised children in disease outbreaks.

Child↗
PubMed2003

Occupational silica exposure and risk of various diseases: an analysis using death certificates from 27 states of the United States.

BACKGROUND: Although crystalline silica exposure is associated with silicosis, lung cancer, pulmonary tuberculosis, and chronic obstructive pulmonary disease (COPD), there is less support for an association with autoimmune disease, and renal disease. METHODS: Using data from the US National Occupational Mortality Surveillance (NOMS) system, a matched case-control design was employed to examine each of several diseases (including silicosis, lung cancer, stomach cancer, oesophageal cancer, COPD, pulmonary tuberculosis, sarcoidosis, systemic lupus erythematosus, systemic sclerosis, rheumatoid arthritis, and various types of renal disease). Cases were subjects whose death certificate mentioned the disease of interest. A separate control group for each of the diseases of interest was selected from among subjects whose death certificate did not mention the disease of interest or any of several diseases reported to be associated with crystalline silica exposure. Subjects were assigned into a qualitative crystalline silica exposure category based on the industry/occupation pairing found on their death certificate. We also investigated whether silicotics had a higher risk of disease compared to those without silicosis. RESULTS: Those postulated to have had detectable crystalline silica exposure had a significantly increased risk for silicosis, COPD, pulmonary tuberculosis, and rheumatoid arthritis. In addition, a significant trend of increasing risk with increasing silica exposure was observed for these same conditions and for lung cancer. Those postulated to have had the greatest crystalline silica exposure had a significantly increased risk for silicosis, lung cancer, COPD, and pulmonary tuberculosis only. Finally, those with silicosis had a significantly increased risk for COPD, pulmonary tuberculosis, and rheumatoid arthritis. CONCLUSIONS: This study corroborates the association between crystalline silica exposure and silicosis, lung cancer, COPD, and pulmonary tuberculosis. In addition, support is provided for an association between crystalline silica exposure and rheumatoid arthritis.

Adult↗
PubMed2004

Preparing psychiatry residents for the certification exam: a survey of residency and exam experiences.

OBJECTIVE: To determine which methods best prepare psychiatry residents for the certification exam, and ultimately for practice, to facilitate appropriate residency program curriculum changes. METHOD: We sent an anonymous survey to all final year (that is, PGY5) Canadian university-affiliated psychiatry residents, regarding frequency and diversity of observed interviews, form of feedback delivery, research and other training experiences, self-perception of preparedness and knowledge base, and management strategies for exam anxiety 6 months before and immediately after the certification exam. RESULTS: There was a 52% response rate. Residents from across Canada identified the following factors as enabling successful exam completion: regular mock orals supervised by Royal College examiners, clinical experience with exposure to a wide spectrum of pathologies, individual and group study time, and appropriate anxiety management. Preparation for the oral exam involving sample case vignettes with presentation and formulation skills training was considered to be essential but was identified as an area of educational and experiential weakness in some programs. CONCLUSIONS: To prepare psychiatry residents for successful completion of their certification exam, programs should incorporate regular mock orals observed by Royal College examiners throughout residency training (not just in PGY2 and PGY5). Programs should also incorporate training in case vignettes, training in oral exam skills, and teaching of anxiety-management strategies.

Adult↗
PubMed1988

[The physician and disability certificates: preconceived attitudes and behaviors].

Five attitudes and predicted behaviors characterize the physicians' responses (strategies) to invalidity certificates. These are: 1- scientific objectivation; 2- complicity (meaning: always completing the certificates without objective preoccupations of any kind); 3- socio political (meaning: influenced by the physician's ideas concerning ways the society should consider the non-working people: permissive or repressive); 4- negotiation (implicating a psychobiosocial approach to the patient and the problem); 5- indifference (never completing certificates, referring this role to someone else). Our recent survey (September 1986) including 92 physicians of a General Hospital (Cité de la Santé) in Laval demonstrates a preponderant attitude, the "socio political" one (A3). But, it has no relation to the preponderant predicted behavior which is the negotiation (C4), characterizing a psychobiosocial approach to the patient and the problem. This behavior has been chosen in a statistically significant way. Nevertheless, there is a relation between the attitude A1: scientific objectivation and the corresponding predicted behavior C1: scientific objectivation. Notions of rationability, professionalism and sociable desirability are evoked as explanations of these results.

Attitude of Health Personnel↗
PubMed1990

The validity of commitment certificates in British Columbia.

This study surveyed the content of committal forms completed at two B.C. hospitals. A profile of 50 patients at a provincial mental hospital and 50 patients on the ward of a general hospital was obtained by comparing the two groups on a number of demographic and psychiatric history variables. The medical certificates of the patients were then assessed for the inclusion of information required by the B.C. Mental Health Act. Of the 198 forms rated (two per patient), 137 (69.2%) were in compliance with the requirements of the B.C. Mental Health Act. Although a larger number of valid forms was scored for the psychiatric hospital, this difference was not significant. A total of 50 patients had a legally valid combination of medical certificates. Much of the problem associated with the invalid forms was related to the vague and confused wording of the Mental Health Act. It is suggested that a clearer definition of committal criteria and a rewording of the medical certificate may aid physicians in completing commitment documentation.

Adult↗
PubMed1975

Arteriosclerotic and other degenerative heart diseases in Finland. I. A death certificate study of the frequency of degenerative heart diseases among males and females.

All available information recorded on the death certificates of 12973 Finnish persons who, according to the official Finnish mortality statistics, died in 1968 from arteriosclerotic and other degenerative heart diseases (ADHD, rubrics 420-422 in ICD) comprised the material of the present study. The mortality of males from ADHD analysed by age and place of residence was very high when compared with various national rates of international WHO statistics. The degree of urbanization of the domicile did not have any statistically significant effect on the mortality from ADHD. Significant differences between various provinces were found in the mortality of males from ADHD. The male population living in the eastern provinces of Finland showed a highly significantly higher mortality from degenerative heart diseases than the male population living on the west coast. A highly significant difference was found in mortality between various subgroups of the Finnish male and female populations analysed by age, place of residence, and type of community. The uniform difference between the mortality of various male and female subgroups of the Finnish population, which was obtained using the present statistical survey of death certificates, and the fairly uniform distribution of high rate of mortality of males from degenerative heart diseases in most regions of the country lend further support to the reliability of cause-of-death statistics, since certification of deaths can then be regarded to occur uniformly and with about the same accuracy in different parts of the country.

Adult↗
PubMed2000

Lymphatic filariasis in the Caribbean region: the opportunity for its elimination and certification.

In order to support the case for a certification of elimination of lymphatic filariasis (LF) in some Caribbean countries, we compared the prevalence of circulating Wuchereria bancrofti antigen in communities in Guyana, Suriname, and Trinidad. For the study, we assayed school children in six communities in Guyana, five communities in Suriname, and three communities in Trinidad for the prevalence of circulating W. bancrofti antigen, using a new immunochromatographic test for LF. We also assayed adults in these three countries, with a special focus on Blanchisseuse, Trinidad, where mass treatment for LF elimination had been carried out in 1981. The prevalences of W. bancrofti circulating antigen found in the school children populations ranged from 1.7% to 33.2% in Guyana and were 0.22% overall in Suriname and 0.0% in Trinidad. Among adults in two Guyana communities the prevalences were 16.7% and 32.1%. The results were all negative from 211 adults in communities in the north, center, and south of Trinidad, as well as from 29 adults in Suriname. The data suggest that contrary to reports of LF endemicity from the World Health Organization, LF may no longer be present in Trinidad and may be of very low prevalence in Suriname. Trinidad and Tobago and other Caribbean nations proven negative could seek to be awarded a certificate of LF elimination. In Suriname the small localized pocket of infected persons who may serve as a reservoir of LF infection could be tested and appropriately treated to achieve LF elimination. Such LF-positive countries as Guyana should access new international resources being made available for LF elimination efforts. An adequate certification program would help identify which countries should seek the new LF elimination resources.

Adult↗
PubMed2006

Investigating the potential influence of established multiple-choice test-taking cues on item response in a pharmacotherapy board certification examination preparatory manual: a pilot study.

OBJECTIVE: To determine the prevalence of established multiple-choice test-taking correct and incorrect answer cues in the American College of Clinical Pharmacy's Updates in Therapeutics: The Pharmacotherapy Preparatory Course, 2005 Edition, as an equal or lesser surrogate indication of the prevalence of such cues in the Pharmacotherapy board certification examination. METHODS: All self-assessment and patient case question-and-answer sets were assessed individually to determine if they were subject to selected correct and incorrect answer cues commonly seen in multiple-choice question writing. If the question was considered evaluable, correct answer cues-longest answer, mid-range number, one of two similar choices, and one of two opposite choices-were tallied. In addition, incorrect answer cues- inclusionary language and grammatical mismatch-were also tallied. Each cue was counted if it did what was expected or did the opposite of what was expected. Multiple cues could be identified in each question. RESULTS: A total of 237 (47.7%) of 497 questions in the manual were deemed evaluable. A total of 325 correct answer cues and 35 incorrect answer cues were identified in the 237 evaluable questions. Most evaluable questions contained one to two correct and/or incorrect answer cue(s). Longest answer was the most frequently identified correct answer cue; however, it was the least likely to identify the correct answer. Inclusionary language was the most frequently identified incorrect answer cue. Incorrect answer cues were considerably more likely to identify incorrect answer choices than correct answer cues were able to identify correct answer choices. CONCLUSIONS: The use of established multiple-choice test-taking cues is unlikely to be of significant help when taking the Pharmacotherapy board certification examination, primarily because of the lack of questions subject to such cues and the inability of correct answer cues to accurately identify correct answers. Incorrect answer cues, especially the use of inclusionary language, almost always will accurately identify an incorrect answer choice. Assuming that questions in the preparatory course manual were equal or lesser surrogates of those in the board certification examination, it is unlikely that intuition alone can replace adequate preparation and studying as the sole determinant of examination success.

Clinical Competence↗
PubMedDate not supplied

Distributed certification application via a trusted dealer.

Distributed certification via threshold cryptography is much more secure than other ways to protect certification authority (CA)'s private key, and can tolerate some intrusions. As the original system such as ITTC, etc., is unsafe, inefficient and impractical in actual network environment, this paper brings up a new distributed certification scheme, which although it generates key shares concentratively, it updates key shares distributedly, and so, avoids single-point failure like ITTC. It not only enhances robustness with Feldman verification and SSL protocol, but can also change the threshold (t, k) flexibly and robustly, and so, is much more practical. In this work, the authors implement the prototype system of the new scheme and test and analyze its performance.

Algorithms↗
PubMed1998

MicroVal: a European approach to the certification of new microbiological methods.

In recent years, food microbiologists have seen the development of a range of nonstandard methods designed to enumerate or determine the presence of various microorganisms in food products. Generally the new methods are designed to give the microbiologist advantages, such as greater automation or faster results, over standard conventional methods. The new methods, however, have often not been thoroughly tested to give the end user confidence in the results. In order to generate data to show that new methods give results that are comparable with standard methods, they must be validated. A number of validation schemes have been developed in various countries throughout the world. There has not, however, been an acceptable scheme recognized throughout Europe. The MicroVal project has been involved in the development of a European microbiological method validation and certification scheme; it involves 21 partners from 7 EU member states. New methods that are tested by the MicroVal system will undergo initial testing in a single expert laboratory, to establish the test's specificity, limit of detection, relative accuracy, sensitivity, and linearity. This testing will be followed by a collaborative study in a minimum of eight laboratories, which will be used to determine the test precision, repeatability, and reproducibility. All results will be assessed by two expert reviewers who will recommend or reject the test. Tests that are recommended will be finally accepted by a MicroVal committee. The committee will pass its comments to one of several certification bodies (working together through a memorandum of understanding) who will certify that the new method gives results that are equivalent to the reference method used throughout the validation work. The technical rules that describe the work required to certify a method are currently being considered by the European Committee for Standardisation (CEN), with the objective that the rules will become a CEN standard for the certification of new test methods. When this objective has been achieved the rules will become an International Standards Organisation (ISO) standard for new test method validation.

European Union↗
PubMedDate not supplied

Formative evaluation of an Inspection Certificate Program (ICP) pilot in Toronto.

The inspection certificate program consists of food establishments voluntarily posting a certificate to inform patrons that inspection reports can be accessed from operators or the public health department. A three-month pilot program was evaluated for program improvement purposes. Only 65% of the selected operators were willing to participate, which suggests a challenge to fully implementing the program. Thirty-nine randomly selected restaurant operators participated. Most operators posted the certificate at the front entrance, and patrons indicated that reports were clear. Operators were supportive of the program. Some operators reported that the program was good for business and offered suggestions to improve it. A total of 583 requests for reports were made which suggests that the program empowered patrons to request reports, mostly from operators. Most patron evaluation forms came from a few operators that had no deficiencies, which limits generalizability.

Accreditation↗
PubMed1999

Education and certification of genetic counselors.

Genetic counseling is defined by the American Society of Human Genetics as a communication process which deals with the human problems associated with the occurrence, or risk of occurrence, of a genetic disorder in a family. The first graduate program (Master's degree) in genetic counseling started in 1969 at Sarah Lawrence College, NY, USA, while in 1979 the National Society of Genetic Counseling (NSGC) was established. Today, there are 29 programs in U.S.A. offering a Master's degree in Genetic Counseling, five programs in Canada, one in Mexico, one in England and one in S. Africa. Most of these graduate programs offer two year training, consisting of graduate courses, seminars, research and practical training. Emphasis is given in human physiology, biochemistry, clinical genetics, cytogenetics, molecular and biochemical genetics, population genetics and statistics, prenatal diagnosis, teratology and genetic counseling in relation to psychosocial and ethical issues. Certification for eligible candidates is available through the American Board of Medical Genetics (ABMG). Requirements for certification include a master's degree in human genetics, training at sites accredited by the ABMG, documentation of genetic counseling experience, evidence of continuing education and successful completion of a comprehensive ABMG certification examination. As professionals, genetic counselors should maintain expertise, should insure mechanisms for professional advancement and should always maintain the ability to approach their patients.

Counseling↗
PubMed1999

[Cooperation between regional occupational health centers and the clinic of occupational diseases in the Nofer Institute of Occupational Medicine in the area of diagnosis and certification of occupational pathology].

Diagnosis and certification of occupational diseases is a statutory responsibility of all regional occupational health centres. An increasing number of certificates issued by these centres has been questioned over last recent years by employees concerned. The Nofer Institute of Occupational Medicine co-operates with these centres, particularly if some doubts are reported. Some shortcomings in diagnosis and certification become the subject of thorough analysis and steps are taken to identify the causes of miscertification.

Diagnostic Services↗
PubMedDate not supplied

Pre-certification: lessons from diagnostic imaging.

Recently, managed care has received a great deal of criticism from the public and press, some of it richly deserved. One of the areas of greatest concern is pre-certification requirements and possible denial of services. Experience with programs of this sort in diagnostic imaging suggests that, implemented correctly, the consultative interface created by a pre-certification program can be of tremendous value in physician education. Appropriate behavior modification programs need to be crafted with an educational rather than economic bias and the methodology not be totally abandoned simply because it has been misused by some. The pre-certification process can be used as a vehicle to disseminate information about rapidly emerging new therapies and technologies.

Cost Control↗
PubMed2001

[Molecular-genetic identification and certification of soybean (Glycine max L.) cultivars].

An approach to certification of soybean genotypes has been developed. The procedure employs three methods of DNA analysis based on polymerase chain reaction (PCR): PCR with arbitrary primers (AP PCR), simple sequence repeat polymorphism (SSRP) analysis, and inter-simple sequence repeat (ISSR) analysis. The approach to certification proposed may be used in both genetic and breeding research and seed production. A "certificate" form that reflects the unique characteristics of each cultivar studied is proposed. The results of molecular genetic analysis of allele distribution in genotypes of soybean from different ecological geographic zones permit estimation of the adaptive significance of individual alleles.

Alleles↗