Self-assessed Need Research Articles

Race/Ethnicity and Nonadherence to Prescription Medications Among Seniors: Results of a National Study

Nonadherence to prescription drugs results in poorer control of chronic health conditions. Because of significant racial/ethnic disparities in the control of many chronic diseases, differences in the rates of and reasons for medication nonadherence should be studied. 1) To determine whether rates of and reasons for medication nonadherence vary by race/ethnicity among seniors; and 2) to evaluate whether any association between race/ethnicity and nonadherence is moderated by prescription coverage and income. Cross-sectional national survey, 2003. Medicare beneficiaries > or = 65 years of age, who reported their race/ethnicity as white, black, or Hispanic, and who reported taking at least 1 medication (n = 14,829). Self-reported nonadherence (caused by cost, self-assessed need, or experiences/side effects) during the last 12 months. Blacks and Hispanics were more likely than whites to report cost-related nonadherence (35.1%, 36.5%, and 26.7%, respectively, p < .001). There were no racial/ethnic differences in nonadherence caused by experiences or self-assessed need. In analyses controlling for age, gender, number of chronic conditions and medications, education, and presence and type of prescription drug coverage, blacks (odds ratio [OR] 1.38; 95% confidence interval [CI] 1.08-1.78) and Hispanics (1.35; 1.02-1.78) remained more likely to report cost-related nonadherence compared to whites. When income was added to the model, the relationship between cost-related nonadherence and race/ethnicity was no longer statistically significant (p = .12). Racial/ethnic disparities in medication nonadherence exist among seniors, and are related to cost concerns, and not to differences in experiences or self-assessed need. Considering the importance of medication adherence in controlling chronic diseases, affordability of prescriptions should be explicitly addressed to reduce racial/ethnic disparities.

Malocclusion frequency in Swedish and immigrant adolescents--influence of origin on orthodontic treatment need

Sweden has become increasingly multicultural. In the year 2000, almost 25 per cent of the child and adolescent population was of foreign origin. Such a major change in demographics may lead to altered orthodontic treatment need in the community, with implications for planning appropriate levels of orthodontic resources. The aim of this study was to compare the frequency of malocclusion and orthodontic treatment need in 12- and 13-year olds of Swedish and immigrant background. The subjects, n = 493, were stratified into four groups according to family origin: (A) subject and both parents born in Sweden, and subject or at least one parent born in (B) Eastern Europe, (C) Asia, or (D) other countries. Registrations were based on available radiographs, patient records, and a clinical examination. Normative treatment need was based on a number of variables. Treatment need was expressed according to the dental health component (DHC) and aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN). Group A exhibited the greatest space deficiencies and irregularities in the maxillary and mandibular anterior segments and also the greatest overjet. More primary molars had been extracted in groups B and C, with a positive correlation between early extraction of primary molars and retention of permanent successors. Self-assessed orthodontic treatment need, IOTN-AC, was highest in group A. For all four groups, the orthodontist's estimate of treatment need was significantly higher than the subjects' self-assessed need. This study confirms that, despite the change in demographics, variations in frequencies of malocclusion and treatment need among children of different cultural background are only minor and the overall orthodontic treatment need remains unchanged.

Occlusal perceptions of children seeking orthodontic treatment: Impact of ethnicity and socioeconomic status

With the growth of orthodontic intervention at younger ages and increased interest in improving dentofacial appearance among the general public, it is important to assess whether demand for treatment is uniform across ethnic and socioeconomic groups. This study compared 3 groups of children who varied by location, payment source, and ethnicity. The sample consisted of 150 children in the Bronx, NY, and 100 in Seattle, Wash, who were undergoing or anticipating orthodontic treatment in publicly funded dental clinics. Ethnic minorities comprised 69% and 92%, respectively, of these groups. The third group consisted of 84 children in Seattle, Anchorage (Alaska), and Chicago who had sought treatment by private practitioners; ethnic minorities comprised 22% of this group. Data were collected from children and parents or guardians by questionnaires. Desire for treatment was higher among children in the publicly funded clinics and among black children than whites or Asian Americans. Children in publicly funded clinics rated themselves as having worse occlusions as determined by anterior crowding, overbite, overjet, diastema, and open bite. Children in the Bronx clinic accepted a wider range of occlusion as attractive. Stage of treatment affected judgments of attractiveness. Vicarious experience with orthodontics through parents or siblings made children more tolerant of dentofacial disharmony, with more favorable ratings of malocclusion in this group than among children who had no family experience with orthodontics. Hispanic and mixed-ethnicity children rated themselves more negatively on all dimensions. These results suggest that both socioeconomic status and ethnicity play roles in children's desire for treatment, self-assessed need, and judgments of esthetics. A clinician's sensitivity to such differences can improve patient cooperation with treatment.

Self-Assessment in the Measurement of Public Health Workforce Preparedness for Bioterrorism or other Public Health Disasters

The purpose of this study was to examine effective ways to evaluate public health workers' competence for preparedness. The Public Health Ready project, developed by the National Association of County and City Public Health Officials and the Centers for Disease Control and Prevention, is a pilot program designed to prepare local public health agencies to respond to emergency events. Workers at a Public Health Ready site (N=265) rated their need for training and their competence in meeting generic emergency response goals. Cluster analysis of cases was conducted on the self-assessed need for training. Three groups of workers emerged, differing in their overall ratings of need for training. A given worker tended to report similar needs for training across all training goals. In this study, workers' ratings of need for training may reflect an overall interest in training rather than need for training in a particular area. Caution should be exercised in interpretation when generic goals and self-assessment are used to measure need for training. Future assessments of training needs may be more effective if they use objective measures of specific local plans.

Current approaches to assessing the quality of life in children and adolescents.

Urologists are well aware of the importance of the quality of life (QoL) in determining the success of their treatments. The public are increasingly aware of this aspect of medicine. The advent of fetal ultrasonography has made knowledge of QoL in long-term survivors of congenital anomalies essential in counselling about pregnancy termination. It is becoming mandatory that clinical trials involving adults include an assessment of QoL. For children, measuring QoL has been restricted to life-threatening conditions such as cancer or transplantation medicine. Measuring QoL is difficult in children and adolescents, and this is reflected in the few suitable instruments available. The development of sexuality contributes a further difficulty as many anxieties typical of those with genital anomalies may be common to all teenagers. Several instruments rely on the opinions of a proxy (parent or carer) but self-assessment by the child is preferable where possible. The need for child self-assessment is supported by finding little concordance between child and proxy assessments. While measuring QoL is challenging, we provide a substantial case for greater consideration of QoL in paediatric urology.

Choices for Lexical Semantics

The modern computational lexical semantics reached a point in its development when it has become useful to compare the goals and methods of the various approaches to it. This article proposes several choices in terms of which these goals and methods can be discussed. It is argued that the central questions include the use of lexical rules for generating word senses; the role of syntax and formal semantics in the specification of lexical meaning; the use of a world model, or ontology, as the organizing principle for lexical‐semantic descriptions; the relation between static and dynamic resources; the commitment to descriptive coverage; the tradeoff between generalization and idiosyncracy; and finally, the adherence to the “supply side” (method‐oriented) or “demand side” (task‐oriented) ideology of research. The discussion is inspired by, but not limited to, the comparison between the generative lexicon approach and the ontologic semantic approach to lexical semantics.

Delayed Subarachnoid Migration of an Epidural Catheter

Department of Anesthesiology; University of Virginia Health Sciences Center; Charlottesville, Virginia.In Reply:-I thank Drs. Bromage, Launcelott, and Visser for taking the time to raise issues about this case that we were unable to include in our original letter because of word limitations. First, both are correct that the concentration of hydromorphone in the epidural infusate was 6 micrograms per milliliter and not milligrams as erroneously published. The size of the Tuohy needle in the Arrow epidural kit is 17 gauge.Drs. Bromage and Launcelott assert that it is possible that all, or at least a significant fraction, of the epidural infusate (1.25 mg bupivacaine and 6 micro gram hydromorphone per ml and given at a rate of 14 ml/h) passed through the dural rent created during placement one vertebral interspace below the final epidural insertion at T10–11. I could not refute that notion without assaying cerebral spinal fluid. However, on clinical grounds, one would expect to see a significant and persistent cephalad migration of paralysis or at least noticeable paresis. Serial evaluations by the Anesthesia Pain Service and the nursing staff failed to reveal any extraordinary abnormalities in this patient who was ambulatory and receiving chest physiotherapy. Specifically, her neurologic examination at 5:00 PM the first postoperative day (30 h post-insertion) revealed a decreased sensation to cold but intact crude touch from T4 to L1 and intact motor. Reportedly, the patient was able to feed herself dinner without difficulty. After the incident, the patient's husband offered his impression that perhaps later that evening she appeared more somnolent and weaker, however, not sufficiently to be alarming. We had no other documentation of her condition before her nurse's discovery at 2:00 AM the next morning. I am compelled to assume that the epidural catheter was functioning as expected until sometime later that evening when there was a relatively abrupt transition to a subarachnoid block, with a dense motor block of lower and upper extremities with a sensorium responsive only to intense stimulation.Despite her dismal diagnosis of mesothelioma, the patient was relatively robust and should have been capable of normal absorption and metabolism of bupivacaine and hydromorphone. Accumulation of drug can occur and must be monitored clinically, which is the purpose of APS rounds and vigilant observation as per our nursing protocol. Nonetheless, I do not believe that it is an appropriate comparison to equate the effects of 2.35–2.73 mg of hydromorphone given as an infusion over approximately 30 h with Dr. Bromage's experience with a single 1-mg epidural bolus. Finally, if a large portion of an epidural infusate or the migration of a catheter can occur through a previous accidental dural puncture, then perhaps we ought to reconsider the wisdom of the widespread practice of placing epidural catheters a level of two above such sites.With regards to Dr. Launcelott's concerns regarding the quality of our care for this patient, I would like to state that our APS system provides the close and responsive service that he recommends. Our APS rounds bis in die include the completion of a standard daily progress note, which details drug dose and technique, catheter site assessment, patient sensory and motor levels, side effects, and patient satisfaction with the therapy. The nurses are instructed to contact the APS liberally for consultation (available 24 h) regarding changes in the patient's state or comfort level, and standing orders exist for the cessation of epidural infusions and the administration of naloxone should events such as the one we present occur. These steps were followed as our case illustrates. In addition, I echo the concerns of Dr. Launcelott regarding the monitoring of patients using epidural analgesia outside the operating suite. With the present economic pressures to explore new avenues by which to ply our trade outside of the operating room, anesthesiologists are finding themselves using drugs and techniques under conditions that are frequently suboptimal as compared with those in a conventional OR. It is neither feasible to place all patients in intensive care units for the sole purpose of postoperative pain management nor is it possible for the anesthesiologist to remain continuously at the bedside. Attempts at using pulse oximetry on a large scale on the wards often lead to non-compliance because of restriction to patient movement, frequent false alarms, and inattentiveness by nursing staff because of current workloads. Because I suspect that the patient may ultimately be our best “monitor,” more time spent educating the patient and family as to the need for continuous self-assessment and recognition of early warning signs of undesired levels of weakness or sedation before the placement of epidural catheters could prove useful.James Michael Jaeger, M.D., Ph.D.Department of Anesthesiology; University of Virginia Health Sciences Center; Charlottesville, Virginia(Accepted for publication January 20, 1998.)

Older Dogs and New Tricks: Career Stage and Self-Assessed Need for Training

Self-assessed training needs, increasingly used in designing, delivering, and targeting training, can be systematically affected by factors other than actual need. Using a sample of public sector employees, this research investigated the influence of career stage on perceptions of managerial support, training self-efficacy, utility and self-reported training needs. Those in later career stages reported lower training self-efficacy, lower training utility, and less need for management training. Implications for organizations and this growing segment of the work force are discussed.

Equity in health care: methodological contributions to the analysis of hospital utilization within Canada.

The main objective of this paper is to determine whether the distribution of hospital service utilization corresponds to the distribution of needs within Canada. This is accomplished by identifying the factors affecting the relationship between the incidence and quantity of hospital services and self-assessed need for such care in Canada. The data were derived from the General Social Survey (Statistics Canada, 1987) which is a weighted random sample of the Canadian population aged 15 and over. Employing methodological extensions over previous studies, the results indicate that although variation in quantity of hospital use is largely independent of income, household income has a significant positive effect on the incidence of hospital utilization. Additionally, variations in both incidence and quantity of use of hospital services are associated with variations in need and other factors within the model.

Total quality management and the need for organizational self-assessment: Some empirical evidence

This paper addresses the shortage of empirical data on the implementation of total quality management (TQM), particularly in small and medium-sized organizations. Evidence from a postal survey of 113 organizations practising TQM suggests that many are lacking the necessary perspectives to sustain this activity in the longer term. Internally focused, operations level TQM, with poor understanding and lack of measurement, combined with ineffective consultancy interventions, underlines the need for rigorous, systematic, organizational self-assessment to be practiced much more widely.

Self-Assessed Need for Mental Health Services Among Homeless Adults

Back to table of contents Previous article Next article ArticleNo AccessSelf-Assessed Need for Mental Health Services Among Homeless AdultsDaniel B. Herman, Elmer L. Struening, and Susan M. BarrowDaniel B. HermanSearch for more papers by this author, Elmer L. StrueningSearch for more papers by this author, and Susan M. BarrowSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.44.12.1181AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail PDFThis content is only available as a PDF. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byMental Healthcare Utilization among Homeless People in the Greater Paris Area4 November 2020 | International Journal of Environmental Research and Public Health, Vol. 17, No. 21 Volume 44Issue 12 December 1993Pages 1181-1183 Metrics PDF download History Published online 1 April 2006 Published in print 1 December 1993

Self-assessment of need, relevance and motivation to learn as indicators of participation in continuing medical education.

This study examined the validity of using physicians' self-assessed needs, relevance and motivation to learn about clinical topics as a means for setting objectives and priorities for continuing medical education (CME) programmes. In an initial survey family doctors were asked to rate their need, relevance and motivation to learn about 120 different clinical topics. Eight months later, the same population was sent a second mail survey asking respondents to indicate if they had learned about a set of sixteen topics taken from the initial survey and, if so, in what kind of learning activities. Eight of the sixteen topics were highly rated and eight were low rated in the initial survey. In terms of actual participation of family doctors, self-assessed motivation to learn exhibited a strong positive relationship with actual participation. Both self-assessed need and relevance were negative to only moderately positive in their association with actual participation. This evidence contributed to the value of using self-assessed motivation as an indicator of future participation of family doctors in CME and questioned the value of using self-assessed need and relevance as indicators of future patterns of participation.

Utilization of dental care in a Finnish industrial population

Ninety-three percent of the 300 employees of a paper mill in central-eastern Finland answered a questionnaire in the context of a clinical dental survey. One third had visited the dentist annually, 22% once in 2 years and the rest irregularly. Dental visit frequency of females was somewhat higher than that of males. People in younger age groups and higher income groups used more dental services, whereas those who had dentures used clearly less dental services than others. Subjective assessment of treatment need was the main reason for dental visits, more than half of the subjects had attended the dentist the last time because of self-assessed need. Thirty-eight percent went to the dentist because of toothache and only 9% for regular check-up. Although more than one third had gone to the dentist because of toothache only one third of those who had toothache during the preceding year had visited the dentist during that period. People without toothache, in fact, used more dental services than those who had had it.