摘要:

On August 23,1988, a fire broke out in a warehouse storing PCBs, forcing the evacuation of 5,500 citizens. Three days later, a specialized clinic was opened to examine and reassure the population. Seventy percent of the evacuated people showed up at the clinic. The aim of this case-control study was to identify the determinants of utilization of this clinic among the evacuated population. Cases and controls were sampled from the cohort of the evacuated adults. Both cases and controls were randomly selected among those who consulted and those who did not consult at the clinic. A logistic regression identified nine predictors of utilization: age, family type of household, annual income less than $40,000, objective and perceived exposure to the toxic smoke, reaction to the risk, perceived scale of the evacuation, number of moves during the evacuation period and consultation elsewhere with a physician. Results showed that the fear resulting from exposure created a stronger motive to consult the clinic than physical symptoms and needs.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The purpose of this analysis was to compare depressed patients receiving care in the general medical setting with depressed patients receiving care in specialty mental health settings. The analysis was limited to 559 respondents from the NIMH Epidemiologic Catchment Area (ECA) study who met criteria for the diagnosis of major depression sometime in the year before the interview as defined by the Diagnostic Interview Schedule. Patients who received care in the general medical sector were more likely to be black, older than age 65, have a high school education or less, and to be women, and less likely to be in the highest socioeconomic quartile. A higher proportion of specialty mental health patients reported a lifetime history of delusions, met criteria for the diagnosis of panic disorder, obsessive-compulsive disorder, or schizophrenia, and had a lifetime history of psychiatric hospitalization. Depressed patients seen in the general medical sector had a lower chance of meeting criteria for major depression one year later than those seen in the specialty mental health sector. A multivariate analysis limited to an investigation of the relative importance of sociodemographic factors indicated that the following factors were significantly associated with receiving care in the specialty mental health care sector: age groups 31-50 and 51-65, and single marital status. Black race was inversely correlated with use of specialty mental health care. These results suggest that data generated from the specialty mental health sector can be generalized to the general medical sector only after assessing demographic differences between the two groups. Demographic differences could be associated with differences in knowledge, attitudes, interpretation of symptoms, and treatment preferences related to depression.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The Resource-Based Relative Value Scale (RBRVS) was developed by surveying panels of physicians from single specialties, then merging the specialtyspecific results into a common work scale. The merging process involved two steps: 1) specification of links or equivalent services across specialties: and 2) use of links to align work values from each specialty onto a common scale. This study examines the sensitivity of physician relative values of work (RVWs) to changes in both the specification of links and in the method for aligning specialties. Using the same survey data employed in developing the RBRVS, we calculated new RVWs based on an alternative specification of links and an alternative method for aligning specialties. Total RVWs declined by almost 50% for anesthesiology, and increased by more than 20% for allergists, neurologists, and thoracic surgeons. Most of this change was attributable to our specification of links. We conclude that future use of the linkage procedure employed in developing the RBRVS is not warranted without further research. Instead, efforts to update and revise work values could be based on a common scale of work developed by cross-specialty panels, thus eliminating the need for a linkage procedure.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The widespread use of standardized health surveys is predicated on the largely untested assumption that scales constructed from those surveys will satisfy minimum psychometric requirements across diverse population groups. Data from the Medical Outcomes Study (MOS) were used to evaluate data completeness and quality, test scaling assumptions, and estimate internal-consistency reliability for the eight scales constructed from the MOS SF-36 Health Survey. Analyses were conducted among 3,445 patients and were replicated across 24 subgroups differing in sociodemographic characteristics, diagnosis, and disease severity. For each scale, item-completion rates were high across all groups (88% to 95%), but tended to be somewhat lower among the elderly, those with less than a high school education, and those in poverty. On average, surveys were complete enough to compute scale scores for more than 96% of the sample. Across patient groups, all scales passed tests for item-internal consistency (97% passed) and item-discriminant validity (92% passed). Reliability coefficients ranged from a low of 0.65 to a high of 0.94 across scales (median=0.85) and varied somewhat across patient subgroups. Floor effects were negligible except for the two role disability scales. Noteworthy ceiling effects were observed for both role disability scales and the social functioning scale. These findings support the use of the SF-36 survey across the diverse populations studied and identify population groups in which use of standardized health status measures may or may not be problematic.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Chronic shortages of registered nurses (RNs) have stimulated interest in locating non-traditional sources of RNs. A statewide survey of 2,315 newly graduated RNs compared three non-traditional groups in nursing with their traditional counterparts, identifying differences that have implications for successful recruitment and retention. Second career nurses, former LPNs and minorities comprised 41.9% of the population. Compared to the traditional groups, more second career nurses, former LPNs and some minority groups were older, married and had children. Second career vs. first career nurses placed less emphasis on selecting schools at the highest levels of academic quality, holding out for the most lucrative jobs or working with the most “interesting” patients (i.e., the acutely ill). Former LPNs, compared to other RNs, placed greater value on easy access to schools and jobs. Compared to whites, minority RNs were more inclined to value nursing's socioeconomic rewards. However, compared to non-Asian minorities in nursing, Asian RNs had higher expectations for professional advancement and were less altruistic. Our results indicate that several of the new groups view nursing less as a “calling,” finding the field appealing for practical socioeconomic reasons and accessibility.

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0025-7079    

出版商:OVID    

年代:1994

数据来源: OVID