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PubMed1993

[To be born or not to be. Epidemiologic, judicial and psychological aspects].

The requisites for filling up birth certificates in France (> or = 180 days of pregnancy and vitality at the registration of birth) are different from the criteria recommended by the World Health Organisation (WHO) (at least 500 g) for national statistics. The number of stillborn babies and neonatal deaths known from two different sources in the Nord-Pas de Calais Region in 1988-1989 have been compared ie: the vital statistics published by INSEE and the data of a survey carried out in hospitals according to the WHO criteria. Among the 808 known perinatal deaths in the survey, 305 (37.7%) were ignored or were not classified in the same categories by the registration services for vital statistics. 230 children including 29 born alive had not been registered and 75 children born alive had been registered as still born. The disparity in these definitions between INSEE and the WHO has serious consequences: the perinatal mortality measured by INSEE is underestimated by 28%, in comparison with mortality registered according to the WHO criteria. The 180 day threshold of viability reduces the social rights of employed women and makes it more difficult for them to have the money they spent on medical care refunded. Finally, as it is impossible to find a trace of these children who were not legally registered since they were under the threshold of viability, the mourning response of parents to perinatal deaths is all the more difficult. Current evolution in the threshold of viability observed in maternity units, makes it necessary to change the criteria which are applied for the legal registration of births.

Attitude to Death↗
PubMed2006

Doctor-patient relationship as motivation and outcome: examining uses of an Interactive Cancer Communication System.

OBJECTIVE: To examine how the pre-existing doctor-patient relationship predicts conceptually distinct service use within an Interactive Cancer Communication System (ICCS) for underserved women with breast cancer and in turn how service utilization influences the doctor-patient relationship. METHODS: Study sample included 231 recently diagnosed, lower income breast cancer patients. Participants were provided a free computer, Internet access and training in how to use an ICCS called the Comprehensive Health Enhancement Support System (CHESS) "Living with Breast Cancer" program. Survey data was collected at pre-test and 4-months after using the system, and use data about how women used the system was also collected. RESULTS: The only statistically significant predictor of service use was that patients with a more negative appraisal about the doctor-patient relationship used the Ask an Expert service more frequently, and there were trends toward a more negative appraisal of the doctor-patient relationship being associated with higher use of Information and Interactive services. Conversely, there was a trend toward a more positive appraisal predicting higher use of the Discussion Group service. In terms of statistically significant effects, more frequent utilization of Information services was associated with a more positive appraisal of the doctor relationship. CONCLUSION: While a more negative perception of the doctor-patient relationships at pre-test was associated with higher use of most of the conceptually distinct services within this ICCS, use of the Information services was associated with having a more positive appraisal of the doctor-patient relationship at post-test suggesting that high-quality information on the Internet can serve to improve patients' satisfaction with their doctor.

Adult↗
PubMed2002

The integrity of bonded amalgam restorations: a clinical evaluation after five years.

BACKGROUND: Bonded amalgam restorations have been studied extensively in vitro, but few long term clinical studies exist. The authors examined the clinical performance of bonded amalgam restorations after five years of clinical service an compared it with that of nonbonded amalgam restorations. METHODS: The authors placed 75 bonded and 62 nonbonded amalgam restorations in patients needing restorations. Most of the restorations were placed in conventional preparations; six bonded restorations were placed in nonretentive cavities. They were evaluated after a five-year period of clinical service by two trained dentists using a mirror and explorer and following modified U.S. Public Health Service criteria. RESULTS: Statistical analysis (via Fisher exact test) showed no significant differences between the two techniques when conventional preparations were used. Restorations in nonretentive preparations were successful during this period. CONCLUSIONS: Bonded and nonbonded amalgam restorations yielded similar results in conventional preparations after five years of clinical service. Bonded amalgam restorations were clinically successful in a limited number of nonretentive preparations over a five-year period. CLINICAL IMPLICATIONS: Bonded amalgam restorations can be used successfully in conventional preparations and possibly in nonretentive preparations as well, and can be expected to last at least five years.

Dental Amalgam↗
PubMed1988

The relationship of work satisfaction and organizational commitment to retirement intention.

The relationship between attitudes, job satisfaction, and organizational commitment has been shown to influence turnover/retirement. This relationship is important because of changing demographic patterns in the U.S. that are contributing to present and future foodservice labor shortages. The labor shortage has potential for retarding the long-term growth of the foodservice industry. However, recruitment and retention of older workers could be a factor in controlling the problem. Therefore, the major purpose of this research was to obtain information from current older foodservice employees to permit the determination of how various aspects of their jobs affect job satisfaction and organizational commitment and, thus, intention to remain on the job by delaying retirement. Non-management-level hospital and college/university foodservice workers aged 55 years and older (no. = 243) were surveyed. Hospital employees were selected from corporate rosters provided by a major contract foodservice company. College and university employees were selected from the roster of the National Association of College and University Food Services (NACUFS). No statistically meaningful relationship (r greater than or equal to .30) between work satisfaction (measured by the Minnesota Satisfaction Questionnaire) and organizational commitment (measured by the Organizational Commitment Questionnaire), as correlated with retirement intention, was found. Although not considered meaningful, a slight statistical relationship was found (r = .15, p less than .02) between intrinsic satisfaction and the desire to delay retirement (work intention).

Aged↗
PubMed1989

How Chinese clinicians contribute to the improvement of maternity care.

Clinicians in China are deeply involved in efforts to improve maternity care throughout the country. A Women's Health section has been established in the Chinese Society of Obstetrics and Gynecology. Staff of tertiary hospitals participate in perinatal surveillance of cities, including regular maternal and perinatal mortality meetings and comparative inter-hospital evaluations of service and clinical statistics. Clinicians from larger urban centers visit rural hospitals to provide guidance in management of high risk patients.

China↗
PubMed2003

Gap analysis of patient meal service perceptions.

The provision of food and drinks to patients remains a largely unexplored, multidimensional phenomenon. In an attempt to ameliorate this lack of understanding, a survey utilising a modified SERVQUAL instrument measured on a seven-point Likert scale was carried out on-site at four NHS acute trusts for the purpose of assessing the perceptions and expectations of meal attributes and their importance in determining patient satisfaction. The results of factor analysis found three dimensions: food properties, interpersonal service, and environmental presentation, with a high reliability (Cronbach's alpha from 0.9191 to 0.7836). Path analysis further established sophisticated causal relations with patient satisfaction. The food dimension was found to be the best predictor of patient satisfaction among the three dimensions, while the interpersonal service dimension was not found to have any correlation with satisfaction. Bridging the gaps that exist between perceptions and expectations can improve the quality of meal services for the purpose of maximising patient satisfaction and ultimately aiding in patient recovery.

Adolescent↗
PubMed2005

Utilization of health care services among the near-elderly: a comparison of managed care and fee-for-service enrollees.

This article compares and contrasts the use of health care services among near-elderly adults (55-64 yr) across HMOs, PPOs, and fee-for-service (FFS) plans. Statistical tests are used to examine possible selection bias by type of plan [corrected] Multistage regression methods are implemented whenever the test results indicate the presence of selection bias. The findings show that compared with FFS plans, HMOs and PPOs are associated with a greater use of outpatient services and preventive services among adults in this age range. The rate of hospital admissions and the length of hospital stay are found to be similar across these types of plans.

Fee-for-Service Plans↗
PubMed2000

Using DSM diagnoses for clinical, research, and administrative purposes.

DSM data are often used to build statistics on the types of patients to whom mental health services are offered. These statistics are normally based on broad categories that cluster finer subcategories for specific diagnoses. These broad categories can be built in a number of ways. The purpose of this study is to determine the effect of the choices made in forming broad DSM categories, by observing the resulting differences in clinical health statistics. Results based on 3496 clinical cases show that DSM-III-(R) classifications can be presented in different formats, leading to different outcomes. To avoid wrong conclusions based on one format, DSM statistics should always be presented in varying formats.

Adolescent↗
PubMedDate not supplied

Post-war Kosovo: Part 2. Assessment of emergency medicine leadership development strategy.

Since the return of the refugee population to Kosovo, attempts at development of an emergency medical system in Kosovo have met with varied success, and have been hampered by unforeseen barriers. These barriers have been exacerbated by the lack of detailed health system assessments. A multimodal approach of data collection and analysis was used to identify potential barriers, and determine the appropriate level of intervention for emergency medicine (EM) development in Kosovo. The four step, multi-modal, data collection tool utilized: 1) demographic and health systems data; 2) focus group discussions with health-care workers; 3) individual interviews with key individuals in EM development; and 4) Q-Analysis of the attitudes and opinions of EM leaders. Results indicated that Emergency Medicine in Kosovo is under-developed. This method of combined quantitative and qualitative analysis identified a number of developmental needs in the Kosovar health system. There has been little formal training, the EMS system lacks organization, equipment, and a reliable communication system, and centralized emergency centers, other than the center at Prishtina Hospital, are inadequate. Group discussions and interviews support the desire by Kosovar health-care workers to establish EM, and highlight a number of concerns. A Q-methodology analysis of the attitudes of potential leaders in the field, supported these concerns and identified two attitudinal groups with deeper insights into their opinions on the development of such a system. This study suggests that a multi-modal assessment of health systems can provide important information about the need for emergency health system improvements in Kosovo. This methodology may serve as a model for future, system-wide assessments in post-conflict health system reconstruction.

Data Collection↗