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PubMed2001

Disability certifications in adult workers: a practical approach.

Family physicians are frequently asked to complete disability certification forms for workers. The certification process can be contentious because of the number of stakeholders, the varying definitions of disability and the nature of the administrative systems. Insufficient training on disability during medical school and residency complicates this process. Disability systems discussed include workers' compensation, private disability insurance, the Americans with Disabilities Act and the Family and Medical Leave Act. Strategies that help the physician complete disability certification forms effectively include identification of disability type, ascertainment of the definition of disability being applied, evaluation of workplace demands and essential job functions, assessment of worker capacity, and accurate and timely completion of the forms in their entirety.

Adult↗

PubMed1975

Antibiotic batch certification and bioequivalence.

All antibiotics marketed in the United States must undergo batch certification by the Food and Drug Administration. It is often assumed that the different brands of a particular antibiotic that pass in vitro batch certification tests have equal in vivo bioavailability. The fallacy of this assumption is clearly supported for commercially available lots of tetracycline hydrochloride that had passed batch certification tests yet had different serial serum concentrations.

Administration, Oral↗

PubMed1993

Does the gender of the child affect acceptance of the one-child certificate? The case of Shaanxi province, China.

The author investigates the impact of gender on both acceptance of the one-child certificate and contraceptive use in Shaanxi province, China. "We found a weak association...in both the cross-classification and multiple classification analyses of the 1988 Two-per-Thousand Survey data. However,...[son preference] remains a clear tendency in rural areas, but the low proportion of the one-child certificate acceptors reflects the existence of stronger preferences for larger family size and specific sex composition.... By contrast, the high percentage of urban acceptors of the one-child certificate, regardless of the gender of the child, implies that son preference has decreased in urban areas of Shaanxi Province."

Asia↗

PubMed1975

Certificate of need: the Massachusetts experience.

Certificate of Need legislation is one of several regulatory programs designed to control the allocation of health care delivery resources. This paper examines the Massachusetts experience with Certificate of Need, focusing on two major administrative law controversies--the extent of the regulatory agency's power to participate actively in the planning process, and the scope of review of agency decisions permitted under a non-judicial appeals mechanism. The study concludes that any Certificate of Need program may be strengthened by accurately defining the roles of the participants and by providing for safeguards within the system itself.

Decision Making↗

PubMed2002

Thermodynamic indicators for environmental certification.

The Earth is an open thermodynamic system, that remains in a steady state far from the equilibrium, through energy and matter exchanges with the surrounding environment. These natural constraints, which prevent the system from maximizing its entropy, are threatened by human action and our ecosystem needs urgent protection. In this viewpoint the environmental certification was born, according to international standards ISO 14001, ISO 14040, and European Regulation EMAS. These are voluntary adhesions to a program of environmental protection by companies, administrations and organizations which, starting from the respect of the existing environmental laws and regulations, decide to further improve their environmental performance. To obtain and maintain certification of a system is necessary to apply some indicators to evaluate its environmental performance and to demonstrate its progressive improvement. Here we propose to use for this purpose the thermodynamic indicators produced from energy analysis by Odum. The case study is Montalcino city (Italy) and energy indicators are used to evaluate environmental performance of this system where exist different activities, from agricultural productions, to tourism. Results show that energy analysis could become a valid standard monitoring method for environmental certification, especially in consideration of its wide application field.

Conservation of Natural Resources↗

PubMed2003

Development and some problems in postgraduate psychiatric education and certification system in Korea.

This article provided the information concerning the developmental process and the present situation of postgraduate psychiatric education and certification system in Korea, and summarized some of the problems in the system. Korea, first in Asia, by adapting the American psychiatric residency program and their specialty board certification system since 1959, has achieved modern psychiatry faster than any others in Asia. The government proclaimed a law of specialty board certification system and the regulations of the residency training system as well as the curriculum and the supervisory functions in detail. Author presented the curriculum and the regulations step by step. In a brief survey of the 8 training hospitals, majority of the supervising psychiatrists expressed opinions that the present system has many problems to restructure or to reconsider because it is too rigid, too much to teach, old fashioned, neglected Korea's culture specific factors, stereotyped, too many training hospitals, too many residents, and The Korean Neuropsychiatric Association should take over the main role. However it showed that the current situation of the training has very well standardized.

Curriculum↗

PubMed2003

Policy decision options during the first 5 years following certification of polio eradication.

Policy makers face a number of difficult choices as they develop policies to ensure maintenance of a polio-free world following global eradication and certification. These policy decisions include choices about immunization, outbreak response (including whether to create a vaccine stockpile), surveillance, containment, management of chronic excretors, and investment in future research. This paper focuses on identifying the categories of decisions and characterizing the actual factors that country-level policy makers must weigh to manage polio risks during the first 5 years after certification. Building on a comprehensive literature review, we report the results of the first qualitative analysis to: (1) systematically characterize each type of decision and the relevant options during the first 5 years after certification, (2) clearly identify critical factors that influence the choices, and (3) specifically demonstrate the interdependence among the decisions to produce a reduced set of decision options. This paper explicitly focuses on the different perspectives of developed and developing countries in characterizing the options. While the management of polio risk in the postcertification period presents important challenges, this comprehensive approach helps simplify the process by focusing on critical decisions.

Developed Countries↗

PubMed1991

Training experience of doctors certificated for general practice in 1985-90.

The computerized records held by the Joint Committee on Postgraduate Training for General Practice have been reviewed to determine the post-registration experience offered by doctors who were issued with a joint committee certificate during the years 1985-90, inclusive. The percentage of certificates issued on the basis of experience prescribed in the vocational training regulations rose from 74.4% in 1985 to 89.7% in 1990. Since 1985 obstetrics/gynaecology has been the specialty in which the greatest number of successful applicants have offered experience, increasing from 86.4% in 1985 to 93.8% in 1990. The next most popular specialty was accident and emergency/general surgery (offered by 65.5% of successful applicants in 1985 and 73.6% in 1990) followed by paediatrics (56.7% in 1985 and 62.2% in 1990). The percentage of certificates issued on the basis of experience in geriatric medicine rose slowly from 35.6% in 1985 to 41.7% in 1990, for psychiatry the figures were similar (36.4% in 1985 and 40.7% in 1990), and for general medicine there was a slight decrease (46.2% in 1985 and 44.7% in 1990). There is a need for more doctors to acquire experience in general medicine, geriatric medicine and psychiatry. Since 1985, the trend has been for applicants to offer a more broadly based range of experience. In 1985, 48.5% of successful applicants offered experience in four hospital specialties and this rose to 63.6% in 1990. Although the vocational training regulations offer a degree of flexibility only a small number of successful applicants have taken advantage of this.(ABSTRACT TRUNCATED AT 250 WORDS)

Education, Medical, Continuing↗

PubMed1988

Absenteeism certification: the physician's role.

Two hundred five family physicians and 135 personnel managers were surveyed to determine the physician's role in certifying absenteeism. Fifty-four percent of the managers returned the questionnaire and indicated that the physician's certificate reduced absenteeism. Even though they expressed dissatisfaction with the certificate's content, the personnel managers usually did not request additional information. Sixty-six percent of the physicians returned questionnaires, with 80 percent reporting one or more requests for certification per week, and 41 percent feeling pressured to write unwarranted excuses. The primary factor the physicians considered when writing an excuse was whether the illness could be verified. Requests for excuses when conditions lacked objective findings produced physician feelings of reluctance, of suspicion, and of being manipulated.

Absenteeism↗

PubMed1993

[Strategies for the certification of the eradication of wild poliovirus transmission in the Americas].

Because it appears that the last case of poliomyelitis caused by transmission of indigenous wild poliovirus occurred 2 years ago on 23 August 1991 in Peru, the challenge for PAHO is to develop a methodology of certification that will convince the rest of the world that the eradication of poliomyelitis in the Americas has been achieved. To that end, the guidelines set forth here allow for a rigorous and standardized evaluation of the certification process by objective experts. As it was during the campaign to eradicate smallpox, epidemiologic surveillance (of acute flaccid paralysis [AFP] in the case of polio) will be the most important component of the certification process. It must be demonstrated that when cases of AFP occur, they will be identified, reported, and investigated in a timely manner to insure that if wild poliovirus is present, it will be identified.

Americas↗

PubMed1993

Strategies for the certification of the eradication of wild poliovirus transmission in the Americas. Expanded Program on Immunization, Pan American Health Organization.

Central America↗

PubMed2005

Identifying multiple gestation groups using state-level birth and fetal death certificate data.

PURPOSE: Birth and fetal death certificates classify individuals as twins or higher order multiples, but do not identify multiple gestation groups. As a result, multiple gestations are consistently excluded from maternal and child health research studies despite the surge in multiple births since the early 1980s and the health risks associated with them. A standardized methodology for states to identify multiple gestation groups is proposed to allow researchers to account for multiple gestations in analyses, improve the accuracy of the incidence of multiple gestations and further knowledge of the impact of multiple gestations on birth outcomes. METHODS: Using 3 years of Massachusetts birth and fetal death certificate data from 1998 to 2000 (247,959 births and 1358 fetal deaths), we assigned matching multiple gestation group numbers to records with identical combinations of mother's first name, last name, date of birth, and month of delivery. To validate our methodology, we calculated plurality and compared it to plurality reported on the existing birth and fetal death data. RESULTS: This method correctly identified 10,765 records out of 10,795 validated multiple gestation deliveries (99.8%). Our method identified 71 additional multiple gestation deliveries, which were not identified by the birth and fetal death files. This method resulted in only 4 false positives and 51 false negatives over 3 years. CONCLUSIONS: This algorithm provides much needed information on multiple gestation groupings, and as an additional benefit, improves the identification of multiple gestation deliveries. This method has proven easy to use, employs state-level data, and offers numerous new analytic opportunities.

Birth Certificates↗

PubMed1999

Effect of prenatal care on infant mortality rates according to birth-death certificate files.

Infant mortality has decreased nationwide; however, our national rates still log behind those of other industrialized countries, especially the rates for minority groups. This study evaluates the effect of prenatal care and risk factors on infant mortality rates in Chicago. Using linked infant birth and death certificates of Chicago residents for 1989-1995, a total of 5838 deaths occurring during the first year of life were identified. Birth certificate variables, especially prenatal care, were reviewed. Variables were compared by stratified analysis. Pearson chi 2 analysis and odd ratios (ORs) were computed. Infant mortality rate (IMR) in Chicago decreased from 17 in 1989 to 12.6 in 1995 (P < .0001). Some factors increased IMR several fold: prematurity (OR 17.43), no prenatal care (OR 4.07), inadequate weight gain (OR 2.95), African-American ethnicity (OR 2.55), and inadequate prenatal care (OR 2.03). Compared with no care, prenatal care was associated with lower IMR; however, early care was associated with higher IMR and ORs than later care. These results demonstrate prenatal care is associated with lower IMR; however, compared with late prenatal care, early care does not improve IMR. Further studies should evaluate whether improving the quality of care improves IMRs.

Adolescent↗

PubMed1993

Classification of American Indian race on birth and infant death certificates--California and Montana.

The accuracy of infant mortality rates and other indices of the health of populations depends on the consistency of information collected from separate sources (e.g., birth and death certificates). Inconsistent recording of basic information such as race and ethnicity has resulted in underestimation of mortality among minority populations, particularly minority populations other than blacks. This report summarizes studies in California and Montana that describe and measure the magnitude of differences in the recording of race for American Indians/Alaskan Natives (AI/ANs) on birth and infant death certificates.

Birth Certificates↗

PubMed1998

Pediatric death certification.

OBJECTIVE: To determine location, manner, and physician certifier of pediatric deaths. DESIGN: A descriptive study of death certificate information for all child deaths (aged birth through 17 years) for the years 1995 and 1996. SETTING: Urban county of more than 780,000 population. MAIN OUTCOME MEASURES: Field of specialty of physician certifiers, location of death, and category of deaths certified by the medical examiner. RESULTS: Of 361 child deaths, 42.6% were certified by the medical examiner, 24.1% by neonatologists, 10.0% by obstetricians, 8.0% by pediatric critical care specialists, and 5.3% by general pediatricians. The remaining deaths were certified by pediatric subspecialists, surgeons, family practitioners, emergency medicine specialists, hospital pathologists, and law enforcement officials. The medical examiner certified deaths due to trauma (64.5%), sudden infant death syndrome (13.5%), unexplained or suspicious causes (9.7%), medical or surgical complications (3.9%), or because no other physician certifier was available (5.8%). Most children were pronounced dead at hospitals, but 10.0% died at home, 4.4% on roads, and 2.5% on public or private lands. CONCLUSIONS: General pediatricians are unlikely to be directly involved in the care of most children who die and are therefore unlikely to sign the death certificate. Education about death and dying issues should be available for all pediatricians but should be directed at those specialists most likely to provide care during critical events. Support services for families need to be community based and accessible to survivors.

Adolescent↗

PubMed1985

Where have all the students gone? An epidemiologic study of US nationals applying for certification by the Educational Commission for Foreign Medical Graduates, 1969 through 1982.

Larger and larger numbers of US nationals are studying medicine abroad and they now comprise the foremost national group of foreign medical graduates (FMGs) seeking to enter the US health care system. The Educational Commission for Foreign Medical Graduates (ECFMG) is currently conducting a comprehensive study of 205,542 graduates of foreign medical schools who, during a 14-year study period, 1969 through 1982, have sought its certification, an established prerequisite for FMGs applying for training in an accredited hospital residency program and/or licensure within the United States. This report summarizes preliminary data on the 17,642 US citizens included in the study who attended 431 different medical schools in 79 foreign countries. Particular attention is given to their performance on the combined medical knowledge-English language competence examinations requisite to the awarding of ECFMG certification.

Certification↗

PubMed1988

A death-certificate case-control study of non-Hodgkin's lymphoma and occupation in men in North Carolina.

A death certificate-based case-control study was performed to investigate associations between occupation and non-Hodgkin's lymphoma (NHL) in North Carolina. Cases consisted of 501 men who died of NHL (International Classification of Diseases codes 200 and 202) during the years 1968-1970, 1975-1977, and 1980-1982. Controls were selected from other noncancer deaths, and were frequency matched for age, year of death, and race. Occupation and industry were obtained from the death certificates and coded without knowledge of case-control status. An increased risk for men in professional, technical, and managerial occupations, compared with all others, was detected among whites (OR = 2.69, 1.95-3.72). Black men classified as having "low exposures" by an occupational exposure linkage system had an odds ratio of 1.74 (0.84-3.60). Because of this finding, the occupations were ranked by social class and a statistically significant linear relationship was noted in whites, with risk increasing from lower social class to upper social class. An increased risk was also detected among whites in the rubber, plastics, and synthetics industries (p = .03), and among blacks employed in machine trades occupations (OR = 3.63, 1.32-9.97) and structural work occupations (OR = 2.38, 0.93-6.05). An increased risk was also detected for black painters (p = .02), but not for whites. There was no association found between NHL and employment in the following areas: textile industry; farming; laborers; or occupations with exposures to asbestos or benzene. The association with farming was further examined in counties with high use of pesticides and herbicides, and no increased risk of NHL was detected. Cases were more likely to live in the western part of the state than the eastern. However, NHL mortality rates provided by the North Carolina State Center for Health Statistics did not confirm the relationship.

Adult↗

PubMed2004

Maintenance of certification in the United States: a progress report.

The American Board of Medical Specialties (ABMS) is working closely with its 24 member boards to implement the four components of a Maintenance of Certification (MOC) program. Those components include evidence of professional standing, lifelong learning and self-assessment, cognitive expertise, and evaluation of performance in practice. The new MOC program of the ABMS represents a dramatic shift from how graduate medical education, initial certification in the medical specialties, and recertification in the medical specialties are being conducted. This article updates how specialty boards are implementing the four components.

Certification↗