Basic Minimum Research Articles

Characteristics and outcome in nonagenarians admitted in general internal medicine and other specialties

SummaryTo describe the characteristics of nonagenarians admitted to the surgical and medical divisions at a tertiary hospital and compare them with nonagenarians admitted to other hospital care services. MethodsA retrospective study of all hospital discharge episodes via the registry of the Basic Minimum Data Set at the Hospital General Universitario de Alicante from January 2007 until December 2011. ResultsOf the 165,870 hospitalizations, 2461 (1.5%) were nonagenarians. The highest number of admitted nonagenarians was in the Division of General Internal Medicine (DGIM) (n=751), followed by the short stay unit (SSU) (n=633). The rate of nonagenarians per 100 admissions to the DGIM was 10.2, significantly higher than that of those admitted to the SSU (6.2) (p<0.001), the service of orthopedic and trauma surgery (2.2) (p<0.001), and other specialties. Females comprised 64.8% of the nonagenarians. Mortality was 17% for the nonagenarians admitted, while for those admitted to the DGIM it was 27.7%. Those hospitalized in the SSU had a lower risk of death during hospitalization (8.1%) (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.16–0.32) and a greater risk of being admitted for diseases and disorders of the circulatory system (OR: 1.58, 95% CI: 1.22–2.05), particularly for heart failure and shock (OR: 1.82, 95% CI: 1.30–2.53), and being discharged with home hospitalization (OR: 8.05, 95% CI: 5.5–11.8). ConclusionsNonagenarian patients represent a tenth of those admitted to the DGIM. The profile of nonagenarians admitted to the DGIM is different from other hospital services. Hospital mortality for nonagenarians admitted to the DGIM is high and superior to other hospital services.

Hospitalizaciones por hipoglucemia grave en pacientes con diabetes mellitus en España

Background and objectives One of the most important therapeutic complications in patients with diabetes mellitus (DM) is hypoglycemia. This study has estimated the number of hospitalizations due to severe hypoglycemia in patients with type DM1 and DM2. Patients and methodsThe study hospital population was defined using the National Catalogue of Hospitals (CNH) 2007 (last available data), and has included 260 general hospitals of the National Health System. The number of hospitalizations due to severe hypoglycemia was obtained from the Basic Minimum Data Set (BMDS) for the 183 hospitals. For the remaining 77 hospitals, this number was estimated based on the available information. ResultsIn 2007, there were 26,701 (0.82%) hospitalizations with hypoglycemia. In DM2 patients, 8,242 (0.25%) episodes were reported as primary diagnosis and 16,649 (0.51%) as secondary. In DM1 patients, 1,157 (0.04%) and 653 (0.02%) episodes were reported as primary and secondary diagnosis, respectively. Overall incidence in DM2 was 1.82 episodes/10,000 inhabitants-year, this ranging between 1.10 episodes/10,000 inhabitants-year in the Islas Canarias to 3.37 in Castilla y León. ConclusionsSevere hypoglycemia is an important reason for hospitalization of patients with DM in Spain, there being great variability according to the Autonomous Regions.

Nonagenarios en los servicios de Medicina Interna españoles

ObjetiveTo describe the demographic and clinical profile of nonagenarian patients admitted to Internal Medicine departments in Spanish hospitals, and to compare it with younger patients. MethodsWe identified, through the MBDS (Basic Minimum Data Set), every patient older than 90 years admitted to Internal Medicine Departments of the Spanish National Health Service public hospitals between 2005- 2008. Hospital discharge data were obtained from the MBDS. A diagnosis-related group (DRG) was identified for every patient. The DRG 21.0 version was used. We compared this nonagenarian group with data of younger adult people. All centres submit this information to the Spanish Health Ministry. The Charlson Index (CCI) was used to determine comorbidity. All statistical analyses were performed using SPSS 14.0. ResultsThe sample included 131,434 patients over 90 years (6% of total patients admitted), with 2,222 patients being over 100 years. There were 45.3% female patients under 90 years, compared to 67.3% over 90 years (P<.001). The top ten DRGs listed in the older group included three new conditions not present in the younger one: pulmonary oedema (DRG: 87), severe urinary tract infection (DRG: 320), and severe respiratory tract infection (DRG: 540). The first 5 DRG were: pneumonia/bronchitis (541): 11.9%, heart failure (127): 8.9%, rhythm disorders (544): 7.5%, pulmonary oedema (87): 3.8%, and other respiratory diseases (89): 3.24%. In any case the incidence of these conditions was higher than those found in younger patients. Among this top ten, only COPD and angina had a higher rate in the younger group. The incidence of hospital deaths were 9.1% among the younger group, and 21.8% among the nonagenarians (P<.001). If only the first 48hours after admission are taken into account, the rates were 2.2% vs 6% (P<.001). The majority (78.2%) of nonagenarian patients return home after discharge Conclusions1) There are a high number of nonagenarians patients admitted in hospital Internal Medicine Departments; 2) The number of women increases with age; 3) List of diagnosis varies according with age; 4) Hospital death rates increase with age, both in first two days and total stay, and 5) The majority of these patients are able to return home after discharge.

Comparisons of Redistribution Effects between Basic Income Policy and Minimum Income Guarantee Policy in Korea

Comparisons of Redistribution Effects between Basic Income Policy and Minimum Income Guarantee Policy in Korea

The Cultural Moral Right to a Basic Minimum of Accessible Health Care

(1) The conception of a cultural moral right is useful in capturing the social-moral realities that underlie debate about universal health care. In asserting such rights, individuals make claims above and beyond their legal rights, but those claims are based on the society's existing commitments and moral culture. In the United States such a right to accessible basic health care is generated by various empirical social facts, primarily the conjunction of the legal requirement of access to emergency care with widely held principles about unfair free riding and just sharing of costs between well and ill. The right can get expressed in social policy through either single-payer or mandated insurance. (2) The same elements that generate this right provide modest assistance in determining its content, the structure and scope of a basic minimum of care. They justify limits on patient cost sharing, require comparative effectiveness, and make cost considerations relevant. They shed light on the status of expensive, marginally life extending, last-chance therapies, as well as life support for PVS patients. They are of less assistance in settling contentious debates about screening for breast and prostate cancer and treatments for infertility and erectile dysfunction, but even there they establish a useful framework for discussion. Scarcity of resources need not be a leading conceptual consideration in discerning a basic minimum. More important are the societal elements that generate the cultural moral right to a basic minimum.

Admission of Nursing Home Residents to a Hospital Internal Medicine Department

Hospitalization of nursing home residents is costly and potentially exposes residents to iatrogenic disease and psychological harm. In this study, we analyzed the data from the Basic Minimum Data Set of patients hospitalized from the nursing home who were discharged from all the internal medicine departments at the National Health Service hospitals in Spain between 2005 and 2008, according to the data provided by the Ministry of Health and Consumer Affairs. Between January 2005 and December 2008, 2,134,363 patients were admitted to internal medicine departments in Spain, of whom 45,757 (2.1%) were nursing home residents. Overall, 7898 (17.3%) patients died during hospitalization, 2442 (30.91%) of them in the first 48 hours. The following variables were the significant predictors of in-hospital mortality in multivariate analysis: age (odds ratio [OR] 1.02, 95% confidence intervals [CI] 1.02-1.03), female gender (OR 1.13, 95% CI 1.13-1.17), dementia (OR 1.09, 95% CI 1.03-1.16), previous feeding tube (OR 1.34, 95% CI 1.09-1.79), malignant disease (OR 2.03, 95% CI 1.86-2.23), acute infectious disease (OR 1.18, 95% CI 1.12-1.25), pressure sores (OR 1.88, 95% CI 1.62-1.95), acute respiratory failure (OR 2.00, 95% CI 1.90-2.10), and nosocomial pneumonia (OR 2.5, 95% CI 2.23-2.72). Two of every 100 patients admitted to internal medicine departments came from nursing homes. The rate of mortality is very high in these patients, with almost one third of patients dying in the first 48 hours, which suggests that many of these transfers were unnecessary. The cost of these admissions for 1 year was equivalent to the annual budget of a 300- to 400-bed public hospital in Spain. The mechanism of coordination between nursing homes and public hospitals must be reviewed with the aim of containing costs and facilitating the care of patients in the last days of life.

P03-74 Prediction of diagnostic evolution of Borderline Personality Disorder in Andalusia (Spain)

Introduction:Along last years psychiatric literature has shown an increased interest about Borderline Personality Disorder (BPD) diagnosis. Nevertheless, few studies in large samples has been developed in our country. This study is a part of a main research: Personality Disorders in Andalusian Community. Diagnostic evolution and its link with use of health services.Objectives:•To study BPD diagnosis in Andalusian inpatients throughout the last 10 years.•To establish a predictive model analyzing the BPD diagnostic evolution.Method:The information has been obtained from the Basic Information Minimum Set: A record of admissions (with clinical and demographic variables) registered in the Andalusian population. We made an observational naturalistic study about the number of inpatients with BPD diagnosis, and an analytical study (Linear Regression) to determine the trend marked in the last years about evolution in the diagnosis of inpatients with Personality Disorders (PD).Results:The number of total psychiatric admissions was 99444 (64968 inpatients): 10755 records had a Personality Disorder (PD) diagnosis.The number of patients with BPD diagnosis has increased from 75 in 1995 to 340 in 2004 (11,8% to 26,13% over percentage of PD). the linear regression had a thread of 0,95, with a determination coefficient of 91,6% (standard error 0,34), with statistical significance (p = 0,00), establishing a prediction linear model about the increase of inpatients with BPD diagnosis.Conclusions:1.The number of inpatients with BPD diagnosis in Andalusia is increasing over last years.2.The model predicts a growing of BPD diagnosis along next years.

Toward a theory of the basic minimum

Many have thought that an important feature of any just society is the establishment and maintenance of a suitable basic minimum: some set of welfare achievements, resources, capabilities, and so on that are guaranteed to all. However, if a basic minimum is a plausible requirement of justice, we must have a theory — a theory of what, precisely, the state owes in terms of these basic needs or achievements and what, precisely, is the proper structure of the obligation to provide them. In Section 1, I will critically examine one recent influential account of the basic minimum: Martha Nussbaum's `human capabilities approach'. I argue that Nussbaum's account has several structural features, few of which are independently plausible, and which create insuperable difficulties when viewed in combination. The failure of Nussbaum's account is instructive, however. It provides motivation for the positive account I sketch in Section 2.

Linguistic summarization of time series using a fuzzy quantifier driven aggregation

We propose new types of linguistic summaries of time-series data that extend those proposed in our previous papers. The proposed summaries of time series refer to the summaries of trends identified here with straight line segments of a piecewise linear approximation of time series. We first show how to construct such an approximation. Then we employ a set of features (attributes) to characterize the trends such as the slope of the line segment, the goodness of approximation and the length of the trend. The derivation of a linguistic summary of a time series is then related to a linguistic quantifier driven aggregation of trends. For this purpose we employ the classic Zadeh's calculus of linguistically quantified propositions but, extending our previous works, with different t-norms in addition to the basic minimum. We show an application to the analysis of time-series data on daily quotations of an investment fund over an eight year period, present some interesting linguistic summaries obtained, and show results for different t-norms. The results are very promising.

Importancia de la hepatología en el entorno sanitario, español, actual

To find out the impact of hepatic diseases on care activity at national and autonomous region level, and in a tertiary hospital with a Hepatology Department. An analysis was carried out on BMDS data (Basic Minimum Data Set) from 1999 to 2003. In the study of cases from the Gregorio Marañón Hospital, Madrid, data bases from the years 2000-2004 were used, and indicators were calculated, such as the percentages of digestive diseases of the total hospital discharges, of digestive diseases that were admitted into the Digestive Diseases Department, and of the total discharges form this Department that originated from hepatic diseases. Hepatic diseases represented around 23% of the hospital discharges generated by gastroenterology at national level and about the same at autonomous regional level. Hepatocellular carcinoma shows a slow and sustained increase, reaching 22.7% of discharges, due to hepatic disease, in 2003. The mortality specifically due to hepatic disease was around 12% in the year 2003. In the study carried out in a tertiary hospital, 21.2% of the total hospital discharges were due to digestive diseases, in the last year analysed. Only 12.48% of these had been admitted to the Digestive Diseases Department and more than 50% were attributed to Hepatology. Hepatology is a very important area of health care within Gastroenterology, showing a sustained growth in the last few years.

On Achieving Access and Equity in Health Care

This paper addresses some of the issues related to health care in the United States. In so doing, I give primary emphasis to questions involving access to health care. Even so, I limit the discussion of any particular topic to its most important facets. The principle of selection involves various criteria: insofar as possible, I discuss those issues that are important at a system level (particularly as they impinge on the allocation of resources), that involve economic arrangements influencing behavior and performance, and that can be illuminated by the economist's perspective. I attempt to give primary emphasis to those variables whose influence is far ranging. In so doing, of course, we cannot examine every network of interrelations. Although this simplifies the discussion, we pay a price for incompleteness. There is little choice, however. One of the difficulties with the health field stems from the fact that everything is interrelated: that intervention on one front has “side effects” on other fronts; that intervention designed to accomplish one purpose sometimes fails to do so because other factors that appear unrelated are not changed. To discuss everything is impossible. On the other hand, to say nothing because we cannot discuss everything is irresponsible. Finally, we will have to reach judgments even in spite of the relative weakness of the data available for analysis. We know far less, for example, about the availability of services (particularly if corrected for quality differentials) than we would like to. So, too, with the impact of differences in utilization on levels of health. The current refrain often seems to be, “But we have no output measures.” That, regrettably, is frequently the case. Nevertheless, just as we cannot be silent because of the complexity of intertwined relations, neither can we be silent because of insufficiency of data. We can use experience and judgment to arrive at (tentative) conclusions. Not knowing everything does not mean we know nothing.

Searching for Balance: Water Rights, Human Rights and Water Ethics

Worldwide, the many debates over water management emphasise the importance of establishing secure rights systems as the foundation for the efficient and equitable allocation of scarce freshwater resources. This perspective follows from global statements recognising water as an economic good and from pragmatic considerations regarding the incentives individuals have to waste resources in the absence of clear ownership rules. Private, tradable rights are the foundation for water allocation systems based on market mechanisms. According to economic theory, private rights and the presence of a market should also provide strong incentives for individuals to use water as efficiently as possible. The above pragmatic perspective has formed the basis for many efforts in many countries to reform water rights systems. There is, however, increasing dissonance between this perspective and a broad array of values or perspectives held by local water users and others who may lack formal legal rights but whose interests are affected either directly or indirectly by water allocation decisions. When rights to any resource are allocated or claimed by any one group of individuals, other individuals will lose their right to that resource and also to the values it supports. This raises questions concerning the legitimacy of the initial allocation system and whether or not those losing rights did so willingly and in an informed manner. It also raises questions regarding the authority of those who allocate rights to make such an allocation. This issue is particularly fundamental when, as in the case of water, the resource being allocated is essential for life. Access to water is essential for human survival and the right to life is recognised as fundamental in many religions, national constitutions and international agreements. Should, then, access to a basic minimum of water be classified as a human right? Taking it a step further, is a human right being violated when water is privatised or private rights to water are issued? Classifying access to water as a human right would pull the chords of emotive and legally powerful global institutions. This said, however, arguments about the denial of human rights are most often associated with acts of commission – such as murder, torture and genocide – as opposed to acts of omission – such as the failure of a government to provide for the basic needs of its people. In general, questions about access to water for fundamental needs are more acts of omission or at most diffused commission (such as the depletion of groundwater aquifers by thousands of individual users) rather than the direct violations associated with what are commonly perceived as human rights abuses. Furthermore, looking at water through a human rights lens may obscure many of the basic ethical issues inherent in the growing effort to develop private rights systems. My perspective, articulated in this paper, is that it may be more appropriate to recognise a new category of basic rights or entitlements which differs from – but which complements – those rights commonly falling in the human rights category. This new category would not carry the sets of associations already embedded in debates over human rights. Instead it would capture and give voice to many of the fundamental ethical issues inherent in different approaches to the allocation and management systems water and other natural resources. Drawing on examples from the western US, South Asia and the Islamic world, this paper explores themes in the growing debate over water rights systems. The economic logic underlying current efforts to reform rights systems is discussed first. A discussion of the social and historical roots of concepts emphasising the public ownership of water and providing for the role of the state owner or trustee of water resources follows. Private rights approaches, the counterpart of public ownership, are discussed next, followed by an exploration of ethical issues inherent in different rights systems. Particular attention is given to the ethical foundations of other rights systems such as those evolving for intellectual property. The subsequent section focuses on links to debates over human rights and the utility of using a human rights lens for looking at water issues. The final section explores potential alternatives and introduces notions of a ‘basic ethics’ framework. Water Nepal Vol. Vol.9-10, No.1-2, 2003, pp.165-183

PARALLEL ALGORITHMS FOR ROBUST BROADBAND MVDR BEAMFORMING

Rapid advancements in adaptive sonar beamforming algorithms have greatly increased the computation and communication demands on beamforming arrays, particularly for applications that require in-array autonomous operation. By coupling each transducer node in a distributed array with a microprocessor, and networking them together, embedded parallel processing for adaptive beamformers can significantly reduce execution time, power consumption and cost, and increase scalability and dependability. In this paper, the basic narrowband Minimum Variance Distortionless Response (MVDR) beamformer is enhanced by incorporating broadband processing, a technique to enhance the robustness of the algorithm, and speedup of the matrix inversion task using sequential regression. Using this Robust Broadband MVDR (RB-MVDR) algorithm as a sequential baseline, two novel parallel algorithms are developed and analyzed. Performance results are included, among them execution time, scaled speedup, parallel efficiency, result latency and memory utilization. The testbed used is a distributed system comprised of a cluster of personal computers connected by a conventional network.

‘Giving midwifery care’: student midwives' views of their working role

Objective: to explore the opinions, feelings and views of student midwives of their education as they progressed through their two-year programme in Ireland, with the intention of interpreting and understanding the working and learning world of the participants so that future students might be assisted to improve their educational experiences. Design: using quantitative and qualitative methods. A phenomenological approach was used to guide the qualitative section of the study reported here. Setting: all seven midwifery schools in Southern Ireland. Participants: all students in the first intake of 1995 in every midwifery school in Ireland (n=125). Data collection: individual and group interviews, diary-keeping and questionnaires. Key conclusions: the findings presented here illustrate the students' views of their working role. The environment appeared to be one of work, rather than learning, and the students' status that of junior employee rather than ‘learner’. They perceived themselves as ‘thrown in the deep end’ without much support or guidance from qualified staff. They were frightened, unsure of themselves and suffered from role conflict and loss of status. There appeared to be an acute shortage of staff and the care given was seen to be the basic minimum, fulfilling women's physical needs but ignoring their emotional ones. The care given appeared to be planned according to routine and economic necessity rather than for sound midwifery, medical or social reasons. Implications for practice: the education of students needs to focus on the development of autonomous practice and the use of routines and non-research based care should be phased out. Students need to be assisted, with support from educated mentors, to plan care in a holistic way that will enable them to develop their midwifery skills in the future.

Modelos probabilísticos de mortalidad para pacientes hospitalizados en unidades convencionales

We have developed a tool to measure disease severity of patients hospitalized in conventional units in order to evaluate and compare the effectiveness and quality of health care in our setting. A total of 2,274 adult patients admitted consecutively to inpatient units from the Medicine, Surgery and Orthopaedic Surgery, and Trauma Departments of the Corporació Sanitària Parc Taulí of Sabadell, Spain, between November 1, 1997 and September 30, 1998 were included. The following variables were collected: demographic data, previous health state, substance abuse, comorbidity prior to admission, characteristics of the admission, clinical parameters within the first 24 hours of admission, laboratory results and data from the Basic Minimum Data Set of hospital discharges. Multiple logistic regression analysis was used to develop mortality probability models during the hospital stay. The mortality probability model at admission (MPMHOS-0) contained 7 variables associated with mortality during hospital stay: age, urgent admission, chronic cardiac insufficiency, chronic respiratory insufficiency, chronic liver disease, neoplasm, and dementia syndrome. The mortality probability model at 24-48 hours from admission (MPMHOS-24) contained 9 variables: those included in the MPMHOS-0 plus two statistically significant laboratory variables: hemoglobin and creatinine. Severity measures, in particular those presented in this study, can be helpful for the interpretation of hospital mortality rates and can guide mortality or quality committees at the time of investigating health care-related problems.

Deaths on the Table: Proposal for an International Convention on the Investigation and Prevention of Anaesthetic Mortality

National and international variations in clinical practice, study methodologies, and data collection make the estimation of patient deaths attributable in some measure to anaesthesia a difficult task. Such rates have undoubtedly significantly declined, a tribute, in large part, to the work of groups such as the International Committee for the Prevention of Anaesthetic Mortality and Morbidity, the Anesthesia Patient Safety Foundation and the Australian Patient Safety Foundation. There is, however, internationally, still a significant risk of mortality associated with anaesthesia which is distinct from that related to any relevant surgery or intercurrent disease. As a matter of pure logic, patients worldwide should be entitled to expect a basic minimum of knowledge and skills from an anaesthetist, as well as his or her use of standard monitoring equipment. In an age where the global provision of health services and equipment may be increasingly dominated, under trade-promoting international agreements, by a few trans-national corporations, and where technology facilitates dissemination of medical data, a unified, worldwide approach to the investigation and prevention of anaesthetic mortality appears both rational and urgent. The benefits of an investigatory system, focused on subsequent safety rather than present liability and standardized through International Conventions, are well established in the air transport industry. We urge the involvement of persons with political and legal expertise in the development of an International Convention for the Investigation and Prevention of Anaesthetic Mortality.

Rawls, Human Rights, and Cultural Pluralism: A Critique

In his 1993 Oxford Amnesty Lecture, John Rawls attempts to respond to some of the criticisms his theory of justice has received from those concerned with the international aspects of social justice, and in particular with universal human rights. Rawls takes what he refers to as the ‘law of peoples’ as the focus for his discussion. He claims that a general liberal theory of justice may be extended internationally and form the basis for a universally recognised basic human rights minimum. Additionally, Rawls suggests that this scheme of international justice is an improvement on other liberal theories dealing with human rights because, he concludes, it would be acceptable to nonliberal, non-Western societies as well as to liberal, Western societies.

In pursuit of a better quality of life through the Basic Minimum Needs Programme: the Afghan experience.

This paper reports the outcome of work on integrated community development carried out in two villages in the Behsood district of Nangarhar province, Afghanistan, where the Basic Development Needs (BMN) model of community development was introduced in the last quarter of 1995. It describes the conceptual framework and the socio-political constraint under which the BMN development process evolved and was pursued. It also provides a detailed account of the methodology adopted, the results of the BMN survey, the socio-economic profile of the villages and the underlying causes of the problems. The paper gives an exposé of the set of potential interventions and solutions chosen by the community to solve their problems.

In pursuit of a better quality of life through the Basic Minimum Needs Programme: the Afghan experience

This paper reports the outcome of work on integrated community development carried out in two villages in the Behsood district of Nangarhar province, Afghanistan, where the Basic Development Needs (BMN) model of community development was introduced in the last quarter of 1995. It describes the conceptual framework and the socio-political constraint under which the BMN development process evolved and was pursued. It also provides a detailed account of the methodology adopted, the results of the BMN survey, the socio-economic profile of the villages and the underlying causes of the problems. The paper gives an expose of the set of potential interventions and solutions chosen by the community to solve their problems.

Basic minimum needs, quality of life and selected correlates : Explorations in villages in northern India

For those involved in international development, one of the major goals is an improvement in the quality of life of the poor. Bhargava and Chakrabati (1992: 133) see the “primary objective of development at any given time is to improve the quality of life”. Indeed, the mission statement for an international development organization explicitly commits itself to the improvement of the quality of life for the “poorest of the poor” (DID, 1994). Social indicators, as “transeconomic” measures of quality of life, have “become an integral part of 'development indicators”' (Kao and Liu, 1984: 400; see, also Kahn, 1991). The connection between quality of life and development extends beyond the Third World. For example, in the U.S. Myers (1987) found quality of life influenced inmigration to Austin, Texas, thus affecting its economic development. Undoubtedly the majority of the connections between social indicators and development has been examined at the macro, or national levels using economic, health, education and other objective, comparative indices. Recognizing that such measures as GNP are oftentimes inadequate, assorted indices have been derived to gauge the changes in social development over time, e.g., the well-known Physical Quality of Life Index (PQLI) constructed by the Overseas Development Council (Morris, 1976). Many of these tend to focus on objective, material indicators (commodity possessions) as opposed to the more subjective ones (Anand and Ravallion, 1993). It is not the purpose of this paper to examine the various critics' arguments about the strengths and weaknesses of extant macro versus micro indices, but rather to lend support for the general need to assess development and social change through social indicators, whether macro or micro, objective or subjective. Ultimately, the purpose of the assessment should guide which social indicators are selected. The purpose of this paper is to examine several issues arising from the linkages between development efforts and quality of life (QOL). Using empirical data which were gathered to evaluate a community development project in the Garhwal region of Northern India, several issues, germane to both social indicators and development, will be investigated. These include: (1) the relationship between “Basic Minimum Needs” (BMNs) and QOL, (2) some methodological innovations for measuring both BMNs and QOL, and (3) selected correlates of BMNs and social indicators of QOL for Garhwali villagers. Before describing the project and its findings, we will first place it in the overall development context.