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PubMed2007

Creating a successful school-based mobile dental program.

BACKGROUND: Dental disease is one of the leading causes of school absenteeism for children. This article describes the creation and evolution of the St. David's Dental Program, a mobile school-based dental program for children. METHODS: The dental program is a collaboration of community partners in Central Texas that provides free dental care to low-income children in schools without relying on reimbursements or government funding. RESULTS: Since 1998, the program has provided 132,791 screenings for oral health treatment needs and 38,634 encounters for sealants or treatment. In 2005, the program provided $2.1 million worth of services at a cost of $1.2 million (not including donated services). Factors important to the program's success included sustained funding for general operating costs; well-compensated clinicians to deliver care and experienced human service workers to manage program operations; the devotion of resources to maximize consent form return rates; and the development of strong relationships with school district and individual school staff. CONCLUSIONS: By removing cost, time, transportation, and bureaucratic barriers, the program was able to reach more children than fixed-site clinics. The program was a merging of private and public health dentistries. This model can be useful to other communities in light of the unmet need for dental care and tighter federal, state, and local government budgets.

Adolescent↗

PubMed2006

Local immunity in Indian women with bacterial vaginosis.

OBJECTIVES: To determine the immunoglobulin (Ig) and cytokine levels and degradation of Igs in the cervico-vaginal secretions (CVS) of non-pregnant Indian women of low socio economic status (LSES), with/without bacterial vaginosis (BV) and to assess the interactions among nutritional status, BV and local immunity. METHODS: A descriptive study in non-pregnant women of LSES attending the gynecology out patient clinic at a local government hospital, Hyderabad, India. Two hundred non-pregnant women underwent clinical, anthropometrical and gynecological examination and were screened for BV. In a sub-sample of 80 with/without BV, levels of IL-10 and IL-12, IgA, IgM and IgG were determined in the CVS by ELISA and degradation of IgA and IgM by Western blotting. Statistical significance among the groups was tested using the non-parametric Mann-Whitney U-test. RESULTS: Fifty seven percent of the women tested positive for BV. Women with BMI<16.0 had the highest BV positivity and the lowest IgA levels in CVS. Higher levels of IgA were observed in women with BMI>18.5. There was significant degradation of IgA and IgM in women with BV. IL-12 was undetectable while IL-10 was detected with higher means in CVS of women with BV. CONCLUSIONS: Severe under-nutrition appears to be relevant to BV positivity and local immunity in these women. Greater degradation of IgA and IgM in BV suggests impaired local immunity.

Adult↗

PubMed1993

[Association between participation in health check and visiting medical facilities in residents in a rural town].

Participants in a community secondary prevention action sponsored by the local government were compared with non-participants with respect to utilization of medical facilities for medical examinations. The study sample consisted of 1,013 males and 1,042 females aged 40 years or over, in a rural town in Kyoto prefecture, who were members of the National Health Insurance. Data from National Health Insurance records, such as date of consultation and type of medical examinations, were analyzed. The secondary prevention action sponsored by the town consisted of a multiphasic health check for circulatory or other chronic diseases, and screenings for tuberculosis and cancers of the stomach, lung, breast and cervix. Medical examinations included urine test, blood cell count, electrocardiography, laboratory tests for serum transaminases, serum glucose, and fecal occult blood, X-ray or endoscopy of the stomach, chest X-ray, mammography, and cervical cytology. Results of the study showed that those who attended the town sponsored secondary prevention action were more likely to utilize local medical facilities, and those who did not participate were likely to visit facilities outside the town. Medical facilities, both local and outside the town, had a larger proportion of examinations corresponding to health examinations or stomach cancer screening than the town office, however, the town office had a larger proportion of lung or cervical cancer screening. The health examination and stomach cancer screening in the town office, and in the medical facilities appeared to be redundant while lung and cervical cancer screening were complemented tests at medical facilities. When these examinations are targeted as modifying factors in the natural history of diseases, consideration should be given to both the records of secondary prevention actions as well as medical records of other medical facilities that may be utilized.

Adult↗

PubMed2003

Disease impact and patient insight--a study on a local population of asthmatics.

The cornerstone of asthma management is achieving adequate symptom control and patient education. We studied in our local population of asthmatic patients how well their symptoms were controlled with currently prescribed treatment and their insight into the disease and its management. Over a 6-month period, 93 asthmatics recruited from two local government health clinics and a state hospital were interviewed using a standard questionnaire. Patients were classified into 4 groups based on the treatment they were on according to Global Initiative for Asthma (GINA) treatment guidelines. The number of patients in Step 1 (rescue medication alone), Step 2 (1 controller medication), Step 3 (2 controller medications) and Step 4 (at least 3 controller medications) were 8, 39, 34 and 12, respectively. Except for day symptoms in Step 1 group, fewer than 50% achieved minimum day or night symptoms and no restriction of daily activities. Questions on patient insight were only available for 50 patients. Weather change (74%), air pollution (66%) and physical stress (46%) were the three highest ranked common asthma triggers. More than half correctly recognized the important symptoms of a serious asthma attack but fewer than 15% were familiar with the peak flow meter and its use or with the asthma self-management plan. Most patients perceived that their treatment had helped reduce disease severity and exacerbations. We conclude that symptom control and some aspect of patient education are still lacking in our local asthmatics.

Adolescent↗

PubMed1994

Cost containment: Europe. Italy.

Through prepaid compulsory insurance managed by the central government, Italy's National Health Service (NHS) provides full coverage, free accessibility, and no or limited copayment by individuals when receiving health services. Although Italy spends less than other countries on health care (< 8% of the country's gross national product), the present NHS faces considerable difficulties, and its performance regarding quality, outcome, and spending has come under question. ICUs account for < 2% of total hospital beds, and the proportion of ICU patients is < 2.5% of all hospital patients (2.5% of all Italian hospital patients receive ICU care at some time during their hospital stay). Information from administrative databases and epidemiologic studies gives an interesting national picture of the situation in Italy regarding admission criteria case mix, and outcomes when compared with data from other countries. Important changes in the financial and institutional framework of the NHS are underway, yielding an unpredictable scenario for the future. Innovations focus mostly on cost containment and quality initiatives. These innovations will likely produce a new health service in which regions will have a more important role than in the past. Actions planned in a large Italian region by the local government are used as an example to explain the potential impact of this new trend on critical care medicine.

Aged↗

PubMed2006

Weight and place: a multilevel cross-sectional survey of area-level social disadvantage and overweight/obesity in Australia.

OBJECTIVE: To estimate variation between small areas in adult body mass index (BMI), and assess the importance of area level socioeconomic disadvantage in predicting BMI. METHODS: We identified all census collector districts (CCDs) in the 20 innermost Local Government Areas in metropolitan Melbourne, Australia, and ranked them by the percentage of low income households (< dollar 400/week). In all, 50 CCDs were randomly selected from the least, middle and most disadvantaged septiles of the ranked list and 4913 residents (61.4% participation rate) completed one of two surveys. Multilevel linear regression was used to estimate area level variance in BMI and the importance of area level socioeconomic disadvantage in predicting BMI. RESULTS: There were significant variations in BMI between CCDs for women, even after adjustment for individual and area SES (P = 0.012); significant area variation was not found for men. Living in the most versus least disadvantaged areas was associated with an average difference in BMI of 1.08 kg/m2 (95% CI: 0.48-1.68 kg/m2) for women, and of 0.93 kg/m2 (95% CI: 0.32-1.55 kg/m2) for men. Living in the mid versus least disadvantaged areas were associated with an average difference in BMI of 0.67 kg/m2 (95% CI: 0.09-1.26 kg/m2) for women, and 0.43 kg/m2 for men (95% CI: -0.16-1.01). CONCLUSION: These findings suggest that area disadvantage is an important predictor of adult BMI, and support the need to focus on improving local environments to reduce socioeconomic inequalities in overweight and obesity.

Adult↗

PubMed2005

Urban area disadvantage and physical activity: a multilevel study in Melbourne, Australia.

OBJECTIVE: To estimate variation between small areas in the levels of walking, cycling, jogging, and swimming and overall physical activity and the importance of area level socioeconomic disadvantage in predicting physical activity participation. METHODS: All census collector districts (CCDs) in the 20 innermost local government areas in metropolitan Melbourne, Australia, were identified and ranked by the percentage of low income households (<400 dollars/week) living in the CCD. Fifty CCDs were randomly selected from the least, middle, and most disadvantaged septiles of the ranked CCDs and 2349 residents (58.7% participation rate) participated in a cross sectional postal survey about physical activity. Multilevel logistic regression (adjusted for extrabinomial variation) was used to estimate area level variation in walking, cycling, jogging, and swimming and in overall physical activity participation, and the importance of area level socioeconomic disadvantage in predicting physical activity participation. RESULTS: There were significant variations between CCDs in all activities and in overall physical participation in age and sex adjusted models; however, after adjustment for individual SES (income, occupation, education) and area level socioeconomic disadvantage, significant differences remained only for walking (p = 0.004), cycling (p = 0.003), and swimming (p = 0.024). Living in the most socioeconomically disadvantaged areas was associated with a decreased likelihood of jogging and of having overall physical activity levels that were sufficiently active for health; these effects remained after adjustment for individual socioeconomic status (sufficiently active: OR 0.70, 95% CI 0.55 to 0.90 and jogging: OR = 0.69, 95% CI 0.51 to 0.94). CONCLUSION: These research findings support the need to focus on improving local environments to increase physical activity participation.

Adolescent↗

PubMed1994

The health card insurance scheme in Burundi: a social asset or a non-viable venture?

La Carte d'Assurance Maladie (CAM) is a national health card insurance scheme implemented by the government of Burundi since 1984. Focus group discussions, a household survey, and a retrospective outpatient survey were used in 1992 to assess its financial and social performance in Muyinga Province. The study showed that although the revenue from premiums was insufficient to fund even the recurrent costs of outpatient drugs consumed by participating households (the current price of the CAM card would cover approx. 34% of the outpatient drug costs), the scheme performed a valuable social equity function. Women reported that they had little access to cash and that CAM, by eliminating cash payments at the point of use, empowered them to decide the need for, and timing of health care consumption by household members without consulting male household heads. Other findings suggested that the schemes financial performance was poor because current membership was low (23% of households) and, more importantly, households with relatively high risks dominated the scheme ('adverse household selection'), making risk-sharing sub-optimal. The author concludes that improvements in the quality of care, in particular increased drug availability and higher standards of prescribing by health workers, would encourage the participation of 'lower risk' households, many of whom did not have a valid CAM because they judged the quality of care provided under the scheme to be inadequate. A policy obliging communes (local governments) to use the greater part of the scheme's revenue, initially supplemented by external 'seed money', to fund services at the health centres would facilitate these improvements. It is evisaged that improved quality would also lead to increased revenue and therefore, greater financial viability, by paving the way for moderate increases in the price of the card.

Adult↗

PubMed2025

A Digital Tool for Clinical Evidence-Driven Guideline Development by Studying Properties of Trial Eligible and Ineligible Populations: Development and Usability Study.

BACKGROUND: Clinical guideline development preferentially relies on evidence from randomized controlled trials (RCTs). RCTs are gold-standard methods to evaluate the efficacy of treatments with the highest internal validity but limited external validity, in the sense that their findings may not always be applicable to or generalizable to clinical populations or population characteristics. The external validity of RCTs for the clinical population is constrained by the lack of tailored epidemiological data analysis designed for this purpose due to data governance, consistency of disease or condition definitions, and reduplicated effort in analysis code. OBJECTIVE: This study aims to develop a digital tool that characterizes the overall population and differences between clinical trial eligible and ineligible populations from the clinical populations of a disease or condition regarding demography (eg, age, gender, ethnicity), comorbidity, coprescription, hospitalization, and mortality. Currently, the process is complex, onerous, and time-consuming, whereas a real-time tool may be used to rapidly inform a guideline developer's judgment about the applicability of evidence. METHODS: The National Institute for Health and Care Excellence-particularly the gout guideline development group-and the Scottish Intercollegiate Guidelines Network guideline developers were consulted to gather their requirements and evidential data needs when developing guidelines. An R Shiny (R Foundation for Statistical Computing) tool was designed and developed using electronic primary health care data linked with hospitalization and mortality data built upon an optimized data architecture. Disclosure control mechanisms were built into the tool to ensure data confidentiality. The tool was deployed within a Trusted Research Environment, allowing only trusted preapproved researchers to conduct analysis. RESULTS: The tool supports 128 chronic health conditions as index conditions and 161 conditions as comorbidities (33 in addition to the 128 index conditions). It enables 2 types of analyses via the graphic interface: overall population and stratified by user-defined eligibility criteria. The analyses produce an overview of statistical tables (eg, age, gender) of the index condition population and, within the overview groupings, produce details on, for example, electronic frailty index, comorbidities, and coprescriptions. The disclosure control mechanism is integral to the tool, limiting tabular counts to meet local governance needs. An exemplary result for gout as an index condition is presented to demonstrate the tool's functionality. Guideline developers from the National Institute for Health and Care Excellence and the Scottish Intercollegiate Guidelines Network provided positive feedback on the tool. CONCLUSIONS: The tool is a proof-of-concept, and the user feedback has demonstrated that this is a step toward computer-interpretable guideline development. Using the digital tool can potentially improve evidence-driven guideline development through the availability of real-world data in real time.

Humans↗

PubMed1997

Devolving authority for health care in Canada's provinces: 2. Backgrounds, resources and activities of board members.

OBJECTIVE: To obtain information from the members of the boards of devolved health care authorities and evaluate their orientations in meeting the expectations of provincial governments, local providers and community members. DESIGN: Mail survey, conducted in cooperation with the devolved authorities, in the summer of 1995. SETTING: Three provinces (Alberta, Saskatchewan and Prince Edward Island) with established boards and 2 (British Columbia and Nova Scotia) with immature boards. PARTICIPANTS: All 791 members of boards of devolved authorities in the 5 provinces, of whom 514 (65%) responded. OUTCOME MEASURES: Sociodemographic background, training, experience and activities of board members as well as their use of information. RESULTS: There were systematic differences between established and immature boards in regard to training, information use and actual and desired activities. Members spent 35 hours per month, on average, on work for their board. Members were largely middle-aged, well educated and well off. Only 36% were employed full time. Nine out of 10 had previous experience on boards, more often in health care than in social services. They were least pleased with their training in setting priorities and assessing health care needs and most pleased with their training in participating effectively in meetings and understanding their roles and responsibilities. The information for decision-making most available to them was information on service costs (68% said it was available "most of the time" or "always") and utilization (64%); the least available information was that on key informants' opinions (47%), service benefits (37%) and citizens' preferences (28%). Board activity was dominated by setting priorities and assessing needs, secondarily occupied with ensuring the effectiveness and efficiency of services and allocating funds, and least concerned with delivering services and raising revenue. The match between activities desired by members and actual activities was significantly poorer for members of immature boards than for those of established boards. CONCLUSIONS: The responses concerning these structural variables suggest that board members are most likely to meet the expectations of provincial governments. Fewer appear well equipped to accommodate the views of their providers and even fewer to incorporate the perspectives of their community.

Adult↗

PubMed1994

Which children are being operated on for recurrent acute otitis media?

OBJECTIVE: To examine at the population level which children were operated on for recurrent acute otitis media episodes, how ill they were, and what factors affected the operation rate. DESIGN: A retrospective birth cohort with an approximate 2-year follow-up. Infection data were gathered from medical records, and background information was gathered from questionnaires. SETTING: Primary health care centers, hospitals, and private practices in 10 randomly selected local government districts in the two northernmost provinces of Finland. SUBJECTS: A random sample of 2512 children from the cohort. OUTCOME MEASURES: Adenoidectomy and/or tympanostomy tube insertion. RESULTS: Only one of 10 of those with actual recurrent disease (> or = 4 episodes) had been operated on, and three of every five children operated on, in fact, had rather few episodes. The operation rate among those children with only a few episodes was increased by factors such as consulting an ear, nose, and throat specialist (risk ratio [RR], 13.0; 95% confidence interval [CI], 7.6 to 22.2); parental exaggeration of the episodes (RR, 6.7; 95% CI, 3.8 to 11.9); having the first episode under 6 months of age (RR, 4.5; 95% CI, 2.5 to 7.9); recurrent respiratory tract infections (RR, 3.3; 95% CI, 1.9 to 5.7); male sex (RR, 2.6; 95% CI, 1.4 to 4.6); urban domicile (RR, 2.4; 95% CI, 1.1 to 4.9); and day care (RR, 2.1; 95% CI, 1.1 to 3.8). The decision to operate was more or less a random phenomenon among those children with numerous episodes. CONCLUSIONS: Physicians at the primary care level should be familiar with these pitfalls concerning patient selection so that the operations are targeted at those children who are most seriously ill.

Acute Disease↗

PubMed1995

Chronic otitis media with effusion in infancy. How frequent is it? How does it develop?

OBJECTIVE: To study the occurrence and development of chronic otitis media with effusion in infancy. DESIGN: A retrospective birth cohort with a 2-year follow-up. Infection data were gathered from medical records; background information came from questionnaires. SETTING: Primary health care centers, hospitals, and private practices in 10 randomly selected local government districts in the two northernmost provinces of Finland. SUBJECTS: A random sample of 2512 children from the cohort. MAIN OUTCOME MEASURES: Chronic otitis media with effusion determined as a minimum of 2 months of asymptomatic middle ear effusion revealed by tympanocentesis and specific operative findings. RESULTS: The periodic prevalence rate of chronic otitis media with effusion up to the age of 24 months was 4.4% (95% confidence interval, 3.5 to 5.3). The maximum risk was at age 16 months. The number of acute otitis media episodes among children who developed chronic otitis media with effusion was more than double that of normal healthy children before the onset of chronic inflammation and about five times as high during prolonged mucous middle ear effusion. Inadequate treatment of prior acute otitis media was not the reason for the chronic inflammation, which was a direct continuation of an acute episode in only half of the cases and was otherwise preceded by a latent period of varying duration. CONCLUSIONS: Chronic otitis media with effusion, which may cause adverse developmental effects such as delayed language development, is a fairly common disease in infancy and is closely related to acute otitis media episodes.

Acute Disease↗

PubMed1995

Risk factors for chronic otitis media with effusion in infancy. Each acute otitis media episode induces a high but transient risk.

OBJECTIVE: To examine the effects of a history of acute otitis media and different extrinsic factors on the risk of chronic otitis media with effusion in infancy. DESIGN: A retrospective birth cohort with a 2-year follow-up. Infection data were gathered from medical records and background information came from questionnaires. The monthly risk of chronic otitis media with effusion was dynamically modeled to control the confounding effects and time-dependency of the risk factors. SETTING: Primary health care centers, hospitals, and private practices in 10 randomly selected local government districts in the two northern most provinces of Finland. SUBJECTS: A random sample of 2512 children from the cohort. MAIN OUTCOME MEASURES: Chronic otitis media with effusion, defined as a minimum of 2 months of middle-ear effusion, usually is disclosed by tympanocentesis and specific operative findings. RESULTS: Previous acute otitis media episodes were the greatest risk factor. Each acute episode induced a highly increased risk (odds ratio, 11.9; 95% confidence interval, 5.7 to 24.9) that disappeared in 3 months. Successive episodes were risky, but this risk also decreased rapidly. Other significant risk variables were attendance at a day nursery (odds ratio, 2.56; confidence interval, 1.17 to 5.57), male sex (odds ratio, 2.17; confidence interval, 1.37 to 3.44), and autumn season (odds ratio, 1.99; confidence interval, 1.11 to 3.55). CONCLUSIONS: Acute otitis media episodes constitute the greatest risk of chronic otitis media with effusion. Each episode has a high transient risk for 3 months but no further direct effect on the risk.

Acute Disease↗

PubMed2005

Financial anatomy of biomedical research.

CONTEXT: Public and private financial support of biomedical research have increased over the past decade. Few comprehensive analyses of the sources and uses of funds are available. This results in inadequate information on which to base investment decisions because not all sources allow equal latitude to explore hypotheses having scientific or clinical importance and creates a barrier to judging the value of research to society. OBJECTIVE: To quantify funding trends from 1994 to 2004 of basic, translational, and clinical biomedical research by principal sponsors based in the United States. DESIGN: Publicly available data were compiled for the federal, state, and local governments; foundations; charities; universities; and industry. Proprietary (by subscription but openly available) databases were used to supplement public sources. MAIN OUTCOME MEASURES: Total actual research spending, growth rates, and type of research with inflation adjustment. RESULTS: Biomedical research funding increased from 37.1 billion dollars in 1994 to 94.3 billion dollars in 2003 and doubled when adjusted for inflation. Principal research sponsors in 2003 were industry (57%) and the National Institutes of Health (28%). Relative proportions from all public and private sources did not change. Industry sponsorship of clinical trials increased from 4.0 dollars to 14.2 billion dollars (in real terms) while federal proportions devoted to basic and applied research were unchanged. The United States spent an estimated 5.6% of its total health expenditures on biomedical research, more than any other country, but less than 0.1% for health services research. From an economic perspective, biotechnology and medical device companies were most productive, as measured by new diagnostic and therapeutic devices per dollar of research and development cost. Productivity declined for new pharmaceuticals. CONCLUSIONS: Enhancing research productivity and evaluation of benefit are pressing challenges, requiring (1) more effective translation of basic scientific knowledge to clinical application; (2) critical appraisal of rapidly moving scientific areas to guide investment where clinical need is greatest, not only where commercial opportunity is currently perceived; and (3) more specific information about sources and uses of research funds than is generally available to allow informed investment decisions. Responsibility falls on industry, government, and foundations to bring these changes about with a longer-term view of research value.

Biomedical Research↗

PubMed1997

Living on the edge: dietary strategies of economically impoverished women in Cali, Colombia.

Economically impoverished women in Cali, Colombia, have restricted access to food in a city where food is abundant. Ethnographic observations, interviews and 2 day food records were used to better understand the coping strategies used by a group of these women (n = 85) to maintain adequate levels of energy intake. Anthropometric indicators of nutritional status were normal for the group. Interview data revealed that the ability to purchase food was a concern for 58% of the women. When faced with a restricted ability to purchase food, the women indicated they made compromises in meal composition, reduced portion sizes, and/or reduced the number of meals. They also relied on relatives, friends, neighbors, store credit, or local government programs for access to food. Changes in meal composition were identified in 17.1% of all diet records (n = 509). Low energy intake (defined as energy intake < or = 1.27 x BMR) was identified in 17.1% of all diet records. Carbohydrate consumption was significantly greater on low-energy intake days. The adequate nutritional status of this group of women suggests that their coping strategies are usually adequate to maintain energy intake, but the presence of uncertainty, the frequency of compromises in diet composition, and the frequency of low-energy intake days suggest that these women are at risk for undernutrition.

Adaptation, Psychological↗

PubMed1996

Geographical mapping of childhood diabetes in the northern English county of Yorkshire.

This study aimed to highlight geographical differences in childhood Type 1 (insulin dependent) diabetes mellitus (IDDM) by mapping incidence at 3 different geographical scales, within the northern English county of Yorkshire. Mapping techniques are applied to incident cases from a population-based regional register of childhood IDDM. The Yorkshire Children's Diabetes Register (YCDR) comprises 1310 children (0-14 years) diagnosed with IDDM from 1978-1990. Age standardized incidence rates (cases/100000/year) are given for administrative county, standardized incidence ratios (SIRs) are mapped by local government district and electoral ward. Heterogeneity between areas was assessed by a chi 2 test. At county level, incidence is 25% higher in Humberside (16.82 per 100000 per year) compared to West Yorkshire (12.21 per 100000 per year) (p < 0.001). SIRs for the 22 districts display significant heterogeneity (p < 0.001) with deficits in the urban areas of Kirklees (70 95% CI 57-85) and Bradford (81 95% CI 68-95) and significant excesses in the rural districts of Ryedale (147 95% CI 106-198), Beverley (149 95% CI 113-193), Holderness (166 95% CI 112-237) and Boothferry (186 95% CI 134-250). At the smallest scale, variation between wards is significant (p < 0.001) and low incidence in urban areas is notable. Geographical variation in the incidence of childhood IDDM may provide strong clues to its aetiology. Within Yorkshire, geographical distribution shows significant heterogeneity at three different scales. The magnitude of the variation is not explained by ethnic or genetic differences in the population and underlines the important influence of environmental factors in disease aetiology.

Adolescent↗

PubMed1975

Combining talents for the management of cancer patients.

The combination of talents required to bring to all patients the maximum benefits of combined modality treatment is examined in the following steps: devising treatment strategy, carrying out treatment, extension widely to the community, and treatment research. The devising of strategy should rest upon the theoretical principles of cell kinetics and pharmacokinetics, which in most instances combine local removal in the primary tumor and anticipatory chemotherapy of occult metastases. The delivery of treatment involves implementation of these principles for each individual patient, and its success depends upon continual consultation among the various members of the treatment team. Wide extension of best treatment to all patients with cancer in the community will involve the good will and effective liaison of many individuals in federal, state, and local government, and many professional and lay people. Many problems of treatment are still unsolved, so research must provide new knowledge. While future advances will come in unexpected ways, the three most needed are a quantitative marder for cancer cells, better drug combinations for carcinomas, and an effective was to diagnose and repair immune deficits.

Humans↗

PubMed1978

The Coopersmith Self-Esteem Inventory: analysis and partial validation of a modified adult form.

Determined the factor structure of an adult form of the Coopersmith Self-Esteem Inventory (SEI), tested several hypotheses related to its content, and assessed the utility of the five derived scores for differentiating psychiatric outpatients from normals. The modified Self-Esteem Inventory and six other scales were completed by 200 local-government employees. A principal components analysis of correlations among 58 SEI items and two marker variables revealed five factors. The rotated dimensions were labelled (1) anxiety; (2) defensiveness; (3) negative social attitude; (4) rejection of self; and (5) inadequacy of self. Fifty psychiatric outpatients were compared with 100 normals with respect to the five derived factor scores. Tests of significance indicated that the two groups differed significantly on all measures except the defensiveness or lie scale factor. It is concluded that the Coopersmith Inventory is complex and measures several characteristics in addition to self-esteem.

Adult↗