PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “provisioning behaviour”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources

The identification of supplier-inducement in a fixed price system of health care provision. The case of dentistry in the United Kingdom.

The analysis in this paper extends the existing research on supplier-inducement by introducing a fixed price constraint on supplier behaviour and analysing output by treatment episode. Testable predictions are generated which distinguish between the inducement and traditional approaches to explaining supplier behaviour. Using data on dental care provision under the U.K. National Health Service support is found for the presence of supplier-inducement. The implications of the findings for the organisation of dental care in the U.K. are considered.

Demography↗

The Community Study Stuttgart.

A basic objective of the "Community Study Stuttgart", a part of the German Cardiovascular Prevention Study (GCP), which began in April 1984 and will end in December 1991, is to develop and utilize globally applicable intervention measures through which cardiovascular risk factors can be reduced effectively under the population's living conditions in the Federal Republic of Germany. Vital elements of intervention include exerting influence on individual health behaviour as well as creating and developing community structures and provisions to foster health. The intervention is directed towards behaviour in the sectors of nutrition, physical activity and (non-)smoking, but psychosocial constellations will also be taken into consideration. The long-range goal of the study is a reduction in the incidence of ischaemic heart diseases and cerebrovascular diseases (as well as the ensuring reduction in total mortality) among the community populations as compared to the average population of the same age in the Federal Republic of Germany. The intervention concept is based on a broadened pathogenetic chain in which the so-called classic somatic risk factors for cardiovascular diseases have been supplemented by behaviour-related psychosocial factors and living conditions which influence health behaviour. Each of the target variables is significant in itself within the intervention concept. In the study, it is assumed that the community framework is of essential relevance to daily life and affects community members' knowledge, attitudes and opportunities for realization. On the basis of scientific studies on the lifestyle concept, an intervention concept was developed which centres on the population of defined communities.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiovascular Diseases↗

Determinants of quality in a long-lived colonial species.

1. In many animal populations a small proportion of individuals produce the majority of surviving offspring, but the underlying mechanisms are unclear. Behaviour may be an important determinant of variation in fitness: 'high-quality' individuals may have enhanced abilities in foraging or predator and parasite avoidance. 2. The role of behaviour in determining variation in quality was examined using the common guillemot Uria aalge, a monogamous seabird with biparental care. Using a novel mixed model approach, we analysed binary data on breeding success of each pair attempting to breed in each year with variables critical to breeding success (timing of breeding; inferred age; breeding experience and success; number of nest sites and partners) as fixed effects. Random effects for year, male, female and each distinct pairing of a male and a female were included in the model, allowing a quality estimate to be derived for each individual and pair. A range of behaviours associated with breeding were examined in relation to these quality estimates. 3. Breeding success declined with timing of breeding, and increased initially with age before declining in old age. It increased with previous successful experience, not breeding experience per se, until senescence effects became apparent. For males, breeding success declined with increasing numbers of mates. 4. The most important behavioural determinants of quality operated at the level of the pair, with the time mates spent together at the site and chick feeding rates both positively related to quality. At the individual level, trip durations and feeding rates were associated with female but not male quality, suggesting that pair quality was operating principally through the female. However, removal of laying date, the most important component in the binomial model, confirmed that the pair effect was much larger than the female effect. 5. This study demonstrates the potential of mixed modelling to determine quality estimates based on long-term breeding histories. The probability of a successful reproductive attempt was explained by the timing of breeding, age, successful breeding experience and number of mates. Behaviour was an important proximate mechanism underlying quality, in particular the foraging abilities of the pair, and the female's contribution to offspring provisioning. In species with biparental care, behavioural correlates of quality operate most strongly at the scale of the breeding pair, because contributions from both individuals are required for a successful outcome.

Animals↗

An evaluation of specialized community-based residential supports for people with challenging behaviour.

This study explored the effects of relocation from institutional to specialized community-based residential provision for six men with mild to moderate intellectual disabilities and challenging behaviour and for a comparison group of six men with mild to moderate intellectual disabilities and challenging behaviour who were already living in specialized community-based residential provision. Relocation was associated with: (1) a significant increase in participants' domestic activity skills; (2) a decrease in the observed occurrence of some problem behaviours; (3) an increase in quality of life; and (4) an increase in engagement and staff contact. The community group, however, also showed some improvements over time, most notably in their levels of engagement in meaningful activity and staff contact. The implications of these results for service provision and suggestions for future research are discussed.

Adult↗

Behaviour modification and gentle teaching workshops: management of children with learning disabilities exhibiting challenging behaviour and implications for learning disability nursing.

BACKGROUND: Challenging behaviours (behaviour difficulties) represent a problem of considerable clinical significance for learning disability nurses, and a source of much human distress. Gentle teaching is a relatively new approach to dealing with behavioural difficulties, and has been received with enthusiasm by clinicians, but has so far received little empirical support. The current study attempted to compare gentle teaching with a well-established alternative (behaviour modification) and a control group. OBJECTIVES: To examine the comparative effectiveness of gentle teaching, behaviour modification and control interventions for challenging behaviour amongst children with learning disabilities. DESIGN: Nonrandomized controlled trial. SETTING: Service users' homes in East Yorkshire. PARTICIPANTS: Seventy-seven children who presented with learning disabilities and challenging behaviour (behaviour difficulties) and their parents. PROCEDURE: One-day workshops in were offered by recognized authorities in either behaviour modification or gentle teaching that were not otherwise involved with the research project. Forty-one participants were recruited to the gentle teaching condition; 36 to behaviour modification; 26 to the control group. Random allocation was not possible, because of the slow uptake by interested parents. Measures was preintervention, and at assessment points up until 12 months following intervention. ANALYSIS: Quantitative analysis of pre-post differences between the groups, using t-test. RESULTS: In general, no significant differences were found between the treatment groups and controls. Significant improvements were found for both gentle teachingand behaviour modification children over controls on the AAMR ABS XVII (social engagement) subscale. Controls had more contact with medical practitioner (GP) services than behaviour modification children and less than gentle teaching children. CONCLUSION: Although very few differences were found between the three groups, those that did exist generally favoured behaviour modification. Implications for service provision and learning disability nursing practice are described.

Adolescent↗

Aggressive behaviour in the high-secure forensic setting: the perceptions of patients.

Twenty-seven patients undergoing treatment in a high-secure forensic facility participated in focus group interviews to elicit their perceptions of (1) the factors leading to aggressive behaviour; and (2) strategies to reduce the risk of such behaviour. The focus group interviews were audiotaped, transcribed and analysed using content analysis. The participants identified that a combination of patient, staff and environmental factors contributed to violence in the study wards. The cause of aggressive behaviour centred around five major themes: the environment; empty days; staff interactions; medication issues; and patient-centred factors. Potential strategies identified by patients to reduce aggressive behaviour included: early intervention; the provision of meaningful activities to reduce boredom; separation of acutely disturbed patients; improved staff attitudes; implementation of effective justice procedures; and a patient advocate to mediate during times of conflict. Findings suggested that social and organizational factors need to be addressed to change the punitive subculture inherent in forensic psychiatric facilities, and to ensure a balance between security and effective therapy.

Aggression↗

Dangerousness and dentistry: an explanation of dentists' reactions and responses to the treatment of HIV-seropositive patients.

Factors which influence health professional's willingness to treat HIV seropositive patients have been explained in terms of the concept of dangerousness. Can this concept be used as a vehicle to explain dentists' responses? All dentists currently in practice in Northern Ireland (n = 664) were invited to take part in the study. A final valid response rate of 73.3% was achieved. Attitudes and behavioural aspects of dental practice were examined in relation to whether they had or had not treated and HIV seropositive patients. In addition correlation and factor analyses were conducted. The results indicated that the concept of "dangerousness' provides a useful framework to explain dentists' attitudes and behaviours with respect to the provision of dental care for this patient group.

Attitude of Health Personnel↗

The effect of deprivation on variations in general practitioners' referral rates: a cross sectional study of computerised data on new medical and surgical outpatient referrals in Nottinghamshire.

OBJECTIVE: To determine the effect of deprivation on variations in general practitioners' referral rates using the Jarman underprivileged area (UPA(8)) score as a proxy measure. DESIGN: Cross sectional survey of new medical and surgical referrals from general practices to hospitals (determined from hospital activity data). SETTING: All of the 183 general practices in Nottinghamshire and all of the 19 hospitals in Trent region. MAIN OUTCOME MEASURES: The relation between the referral rates per 1000 registered patients and the practice population's UPA(8) score (calculated on the basis of electoral ward), with adjustment for the number of partners, percentage of patients aged over 65 years, and fundholding status of each practice. RESULTS: There was a significant independent association between deprivation, as measured by the UPA(8) score, and high total referral rates and high medical referral rates (P < 0.0001). The UPA(8) score alone explained 23% of the total variation in total referral rates and 32% of the variation in medical referral rates. On multivariate analysis, where partnership size, fundholding status, and percentage of men and women aged over 65 years were included, the UPA(8) score explained 29% and 35% of the variation in total and medical referral rates respectively. CONCLUSION: Of the variables studied, the UPA(8) score was the strongest predictor of variations in referral rates. This association is most likely to be through a link with morbidity, although it could reflect differences in patients' perceptions, doctors' behaviour, or the use and provision of services.

England↗

The quality and management of written information presented to women undergoing hysterectomy.

A study of a random sample of hospitals in England that provide information leaflets for women undergoing hysterectomy indicates a large variation in quality. In general, the findings reveal that written information for patients is given a relatively low priority. Production and dissemination of information for hysterectomy patients is somewhat ad hoc. It is not clear that any evaluation of the leaflets has been conducted to prove the efficacy of the available literature. While the majority of leaflets include information deemed essential by past hysterectomy patients, the presentation of the recovery process often implies no control for the patient, and conceives normality with a narrow perspective about what healthy behaviour means for women. The provision of a specific timetable for resumption of housework duties in 65% of the leaflets is a case in point. On the basis of the results of the survey, recommendations are made concerning the improvement of the standard of patient information leaflets.

England↗

Patient education about cough: effect on the consulting behaviour of general practice patients.

The aim of this general practice study was to examine how the consulting behaviour of patients with a cough was affected when the tasks and responsibilities of patients, practice nurses and general practitioners were reorganized. In four 'average' single-handed general practices the effects on the consulting behaviour of patients of a rational practice policy on cough and the provision of systematic patient education on cough were compared with patient behaviour in four matched control practices. Changes of behaviour were measured in 548 patients who consulted for cough at least twice, in two successive autumn-winter periods. Significantly more patients in the experimental practice changed their behaviour to follow the practice guidelines than did patients in the control practices (56% versus 30%, P less than 0.001). The proportion of patients who continued to consult in the approved manner was greater among patients receiving intervention (66% versus 29%, P less than 0.001). This was equally true for patients who had suffered less than four episodes of cough or more than four episodes. The more often the patients received the education, the more effective it was. All patients who consulted the general practitioner for cough during the first autumn-winter period filled in a cough diary during the second period. From this it appeared that the intervention did not result in patients delaying consultation when they had a cough lasting longer than three weeks or one with 'serious' symptoms. It would appear that a rational practice policy and the provision of patient education can stimulate patients to modify their consulting behaviour. This could result in a reduction in the costs of health care.

Adolescent↗

An evaluation of hospital-based specialized staffed housing for people with seriously challenging behaviours.

Resident and staff activity was observed in two hospital-based staffed houses for adults with severe or profound mental handicap, and seriously challenging behaviours. The results indicated that: (1) staffing resources were inefficiently deployed, leading to low levels of support being provided to service users; (2) staff attention was inequitably distributed across users, individuals showing the highest levels of seriously challenging behaviours received disproportionately more staff attention; (3) users spent little of the time they were observed engaged in constructive activities. Comparisons with data collected previously on four of the users in institutional settings indicated that: (4) no overall changes occurred in either user participation in constructive activities or (5) duration of challenging behaviours; and (6) overall, more staff contact was provided in the specialized housing projects compared to previous institutional settings. The results are discussed in terms of the determinants of quality in residential provision for people with seriously challenging behaviour.

Activities of Daily Living↗

Risk and the welfare state.

The British welfare state developed as a state-centred response to the problem of handling the risks encountered in a typical life-course. The influential work of Giddens and others implies that the traditional welfare state is under attack from two directions: a changing international politico-economic environment limits the freedom of national governments to pursue independent policies involving relatively high taxation to finance social spending. At the same time, changes in the experience of risk and declining confidence in the expertise of welfare state planners and professionals undermine support for state-centred solutions. This approach fails to acknowledge that available non-state services are often inadequate to meet many everyday life risks and that the authority of private sector advisers, insurers and professionals is also increasingly open to question. This article discusses whether people reject welfare state solutions to problems of risk in the context of research on the perceptions and behaviour of people buying or selling their homes, considering provision for long-term care needs and defrauding social security carried out by the ESRC's Economic Beliefs and Behaviour programme. Individual responses endorse the continued provision of state welfare in order to meet unprovided risks alongside disenchantment with the record of both state and private professionals and planners and awareness that state retrenchment requires greater individual responsibility for meeting one's own needs. The theory of risk society requires development to recognize that citizens are not necessarily alienated from state welfare.

Attitude to Health↗

Modern concepts of socialisation for dogs: implications for their behaviour, welfare and use in scientific procedures.

The provision of a socialisation and training programme for dogs can lead to an improvement in the quality of the data that are produced from scientific procedures, and also to an improvement in animal welfare. A reduction in the number of animals needed to produce statistically significant data can result from decreasing the variability of the experimental data. The effects of a dog's behaviour can be a major source of random variability. A well socialised, habituated and trained dog should be calm during experimental procedures and, for example, during an ECG measurement, thus providing good quality data. A fearful, poorly socialised dog may also appear to be well-behaved on an examination table, and during an ECG measurement, because of the freezing response. However, there is likely to be a difference in the level of stress that these two individuals experience during the procedures. The stress response can have an impact on vital physiological parameters, such as heart rate. The variability in these parameters and the behaviour exhibited within a group of socialised, habituated and trained dogs that have been well prepared for experimental procedures, should be less than the variability present within a similar group of dogs that have not been prepared for these procedures. This paper describes two socialisation programmes, which were designed in order to compare the heart rates and behaviour of dogs which had received different degrees of socialisation, habituation and training. The behaviour of small groups of dogs from this study was compared with that of dogs on a standard socialisation programme, by using a simple, reproducible behavioural score scheme. The heart rate of the dogs was also measured. The results showed that there was little difference in heart rate between the groups, but that there were significant differences in the scores for key behaviours. There was evidence of a decrease in the variability of the behavioural scores for the groups of dogs that had undergone an intensive socialisation programme. Therefore, a socialisation programme can have a significant effect on behaviour and welfare, and has the potential to improve the quality of the data that are recorded.

Animal Welfare↗

Cognitive behavioural interventions for sleep problems in adults aged 60+.

BACKGROUND: The prevalence of sleep problems in adulthood increases with age. While not all sleep changes are pathological in later life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for carers and increased healthcare costs. The most common treatment for sleep disorders (particularly insomnia) is pharmacological. The efficacy of non-drug interventions has been suggested to be slower than pharmacological methods, but with no risk of drug-related tolerance or dependency. Cognitive and behavioural treatments for sleep problems aim to improve sleep by changing poor sleep habits, promoting better sleep hygiene practices and by challenging negative thoughts, attitudes and beliefs about sleep. OBJECTIVES: To assess the efficacy of cognitive-behavioural interventions in improving sleep quality, duration and efficiency amongst older adults (aged 60 and above). SEARCH STRATEGY: The following databases were searched: MEDLINE (1966 - October 2001); EMBASE (1980 - January 2002), CINAHL ( 1982 - January 2002; PsychINFO 1887 to 2002; The Cochrane Library (Issue 1, 2002); National Research Register (NRR [2002]). Bibliographies of existing reviews in the area, as well as of all trial reports obtained, were searched. Experts in the field were consulted. SELECTION CRITERIA: Randomised controlled trials of cognitive behavioural treatments for primary insomnia where 80% or more of participants were over 60. Participants must have been screened to exclude those with dementia and/or depression. DATA COLLECTION AND ANALYSIS: Abstracts of studies identified in searches of electronic databases were read and assessed to determine whether they might meet the inclusion criteria. Data were analysed separately depending on whether results had been obtained subjectively or objectively. MAIN RESULTS: Six trials, including 282 participants with insomnia, examined the effectiveness of cognitive-behavioural treatments (CBT) for sleep problems in this population. The final total of participants included in the meta-analysis was 224. The data suggest a mild effect of CBT for sleep problems in older adults, best demonstrated for sleep maintenance insomnia. REVIEWER'S CONCLUSIONS: When the possible side-effects of standard treatment (hypnotics) are considered, there is an argument to be made for clinical use of cognitive-behavioural treatments. Research is needed to establish the likely predictors of success with such treatments. As it may well be the case that the treatment efficacy of cognitive-behavioural therapy itself is not durable, the provision of "top-up" sessions of CBT training to improve durability of effect are worthy of investigation.

Age Factors↗

Epidemics of syphilis in the Russian Federation: trends, origins, and priorities for control.

After continuous decline throughout the 1980s, surveillance-defined estimates of the incidence of syphilis in Russia have shown a rapid and substantial increase during the 1990s. The reasons for this epidemic are unclear, but must be sought among changes both in sexual behaviour and in the patterns of provision, use, and effectiveness of diagnostic, treatment, and contact tracing services. High incidence of sexually transmitted disease causes correspondingly high levels of morbidity and suffering as well as significant health-care and other economic costs. Our current understanding suggests that the transmissibility of HIV is increased by infection with sexually transmitted disease. The syphilis epidemic together with changes in sexual behaviour, increased travel and migration, and rapid increases in injecting drug use may create the conditions for an epidemic of sexually acquired HIV infection in Russia that substantially outstrips those encountered in most Western European countries.

Adolescent↗

Behavioural disturbance in people with Down's syndrome and dementia.

Behavioural disturbance associated with dementia in people with Down's syndrome has not been fully researched. This study investigated such problems in demented Down's syndrome subjects and nondemented Down's syndrome controls. Changes in mood, difficulty with communication, gait deterioration, loss of self-care skills, sleep disturbance, day-time wandering and urinary incontinence were found to be associated with dementia. Problems giving the greatest cause for concern to carers were restlessness, loss of communication skills, urinary incontinence and wandering. Care provision specifically focused on management of behavioural disturbance in individuals who develop dementia is recommended.

Activities of Daily Living↗

Attitudes and intentions of homeless people towards service provision in South Wales.

The theory of planned behaviour (TPB: Ajzen, 1988, 1991) was used as a framework to investigate homeless people's participation in outreach service programmes. In total, 104 homeless people from South Wales were interviewed using a schedule based on the TPB. Congruent with previous research on the TPB, attitude was the dominant predictor of behavioural intentions, and intention and perceived behavioural control were predictive of behaviour. Contrary to predictions, subjective norms also exerted a direct effect on behaviour. The discussion focuses on two issues: first, the utility of social cognition models in explaining the relationship between demographic variables and behaviour in homelessness research; second, the direct effects of norms on behaviour and the extent to which work on social groups might usefully extend research on models such as the TPB to aid understanding of behaviour amongst stigmatized populations.

Adolescent↗

Behavioural management of antipsychotic-induced weight gain: a review.

OBJECTIVE: Although psychiatrists are aware of weight gain induced by atypical antipsychotics, only few studies on behavioural interventions in this patient group are published. This review aims to summarize the evidence on effectiveness of behavioural interventions for weight gain in the general population and in-patients treated with atypical antipsychotics. METHOD: Medline and Cochrane databases search for evidence on effectiveness of behavioural interventions. RESULTS: In general, behavioural approaches including, diet, exercise and drug treatments may be effective. There were only 13 studies of behavioural interventions for patients taking antipsychotic medication. No study met the criteria for a RCT. Calorie restriction in a controlled ward environment, structured counselling combined with cognitive behavioural therapy and counselling on life style and provision of rewards may potentially lead to weight loss. CONCLUSION: Currently only limited, methodologically flawed, evidence is available that behavioural interventions in overweight patients treated with antipsychotics, although intuitively appealing, actually work.

Antipsychotic Agents↗