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PubMed2005

The reliability and validity of the Index of Complexity, Outcome and Need for determining treatment need in Dutch orthodontic practice.

The Index of Complexity, Outcome and Need (ICON), based on international opinion, has been proposed as a multipurpose occlusal index. The aim of this study was to validate the ICON for treatment need in the Netherlands by relating it to Dutch orthodontic opinion. Furthermore, the reliability of this index was explored, for both a calibrated orthodontist and non-calibrated orthodontists. A sample of 102 patients was chosen which represented the actual distribution of severity of malocclusion experienced by orthodontists in every day practice. The ICON was scored, based on complete patients records of those 102 patients, by an examiner calibrated in the use of this index. The results were compared with the opinion about treatment need of seven Dutch orthodontists - the 'gold standard'. Nine non-calibrated orthodontists also scored the ICON for 49 patients. The intra-examiner agreement of both the non-calibrated and the calibrated orthodontists was moderate to high [0.52-0.86 and 0.89, respectively, measured with the Intraclass Correlation Coefficient (ICC)]. The inter-examiner agreement of the ICON score of the nine orthodontists was moderate measured with the single estimate of the ICC (0.60), and high measured with the average estimate (0.93). Spearman's correlation coefficient between the ICON score (calibrated) and the gold standard was sufficient: 0.78. The sensitivity and specificity were 1 and 0.36, respectively. The best compromise between sensitivity and specificity was at a cut-off point of 52, instead of the international ICON cut-off point of 43. There was a significant difference in ICON score between the non-calibrated orthodontists and the calibrated orthodontist, mainly based on the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). It can be concluded that the ICON needs to be adjusted when used to determine treatment need in the Dutch orthodontic population.

Dental Health Surveys↗
PubMed2004

Assessing the needs of people with learning disabilities and mental illness: development of the Learning Disability version of the Cardinal Needs Schedule.

BACKGROUND: People with learning disability (LD) experience a range of mental health problems. They are a complex population, whose needs are not well understood. This study focuses on the development of a systematic process of needs assessment for this population. METHODS: The Cardinal Needs Schedule used in general psychiatry was adapted for people with learning disabilities (LD). The Learning Disability version of the Cardinal Needs Schedule (LDCNS) was tested on a sample of 35 people with LD and mental illness for its inter-rater reliability. RESULTS: The inter-rater reliability (Kappa) was calculated for 22 areas of functioning assessed by the LDCNS. Overall, there was very good agreement in seven areas, moderate agreement in six areas, fair agreement in three areas and poor agreement in one area. In four areas of functioning, Kappa could not be calculated. More needs were found in the social domain than in the clinical domain. CONCLUSION: A systematic needs assessment schedule (LDCNS) was developed for people with LD and mental illness. The inter-rater reliability is generally acceptable, but requires further examination.

Adult↗
PubMed1993

Measurement of problem-oriented need for the primary health care services: need for exercise counseling as an example.

Based on several previous approaches, a new model for the measurement of needs for primary health care services is constructed and demonstrated. This fourfold model includes the concepts of diagnostic need, perceived need, client dependent demand and provider dependent demand. The empirical results concerning the need for exercise counseling in the primary health care indicated that the present approach is feasible and comprehensive enough to obtain valuable information about the health needs and how they are supplied. The model makes it possible to identify discrepancies, for example, between the experts' and clients' priority ratings and between the criterion-based prevalence of a problem and the practice of the care providers. It may also reveal barriers and inequalities in the use of services. For health administrators and decisionmakers the present problem-oriented model provides a systematic approach to assess needs for health care services and to develop the services provided.

Adult↗
PubMedDate not supplied

[Need for psycho-oncologic management in Germany--a comparison of present status and future needs].

A comparison of acute care, inpatient rehabilitation and outpatient aftercare in Germany reveals significant differences in the quality and spreading of psychosocial services for cancer patients. Planning psychosocial care for cancer patients, we have to consider patients' need for psychosocial care as well as the health professionals' estimation of patients' needs and the demand for health care services. Analyses of patients' requirements have shown that the needs which patients defined themselves differ from the needs estimated by experts. Therefore, decisions made in health care must be based on systematic data acquired by various approaches. Within the frame of evaluation performed in the research program "Rehabilitation of Cancer Patients" funded by the German Ministry of Research (the former BMFT), data from two studies are presented investigating the need for psychosocial care in oncology using two different approaches. In one study we investigated the status quo of psychosocial care for cancer patients in acute hospitals (n = 585) and rehabilitation centers (n = 42). By use of the Delphi technique, the second study focuses on an analysis of patients' need estimated by health professionals (n = 34). Comparing both studies, deficits in psychosocial care for cancer patients were found especially in acute hospitals and outpatient aftercare services. Methodological problems of the two approaches are discussed and further research strategies are suggested.

Adaptation, Psychological↗
PubMed1996

[What needs following treatment have long-term schizophrenic patients? The problem of self- and external assessment of "needs"].

Needs for help and support were examined in 153 schizophrenic patients who had been being hospitalized for more than 6 months. In an operationalized and systematic way, needs as viewed by patients and their therapists were assessed using the Berliner Bedürfnis Inventar. In general as well as regarding single domains of life therapists stated significantly more needs than the patients; the agreement between patients' and therapists' views was very low. Frequency of needs as expressed by the patients was correlated with self-rated complaints, but not with observer ratings of psychopathology. Needs were mostly met by medical and social institutions according to the patients' statements. Patients reported more often than their therapists that adequate help and support was not provided in some areas despite an existing need. Clinical and research implications of the findings are discussed.

Female↗
PubMed2004

Palatability: response to nutritional need or need-free stimulation of appetite?

The traditional view of palatability was that it reflected some underlying nutritional deficit and was part of a homeostatically driven motivational system. However, this idea does not fit with the common observation that palatability can lead to short-term overconsumption. Here, we attempt to re-evaluate the basis of palatability, first by reviewing the role of salt-need both in the expression of liking for salty tastes, and paradoxically, in dissociating need from palatability, and second by examining the role of palatability in short-term control of appetite. Despite the clarity of this system in animals, however, most salt (NaCl) intake in man occurs in a need-free state. Similar conclusions can be drawn in relation to the palatability of food in general. Importantly, the neural systems underlying the hedonic system relating to palatability and homeostatic controls of eating are separate, involving distinct brain structures and neurochemicals. If palatability was a component of homeostatic control, reducing need-state should reduce palatability. However, this is not so, and if anything palatability exerts a stronger stimulatory effect on eating when sated, and over-consumption induced by palatability may contribute to obesity. Differential responsivity to palatability may be a component of the obese phenotype, perhaps through sensitisation of the neural structures related to hedonic aspects of eating. Together, these disparate data clearly indicate that palatability is not a simple reflection of need state, but acts to promote intake through a distinct hedonic system, which has inputs from a variety of other systems, including those regulating need. This conclusion leads to the possibility of novel therapies for obesity based on modulation of hedonic rather than homeostatic controls. Potential developments are discussed.

Appetite Regulation↗
PubMed2004

The individual within the group: balancing the need to belong with the need to be different.

Many theorists have wrestled with the notion of how people balance their need to be included in social groups with their need to be different and distinctive. This question is particularly salient to researchers from the social identity perspective, who have traditionally viewed individual differentiation within groups as being inimical to group identification. In this article we present a number of strategies that people can use to balance their need to belong and their need to be different, without violating social identity principles. First, drawing from optimal distinctiveness theory, we discuss 4 ways in which the need for belonging and the need to be different can be resolved by maximizing group distinctiveness. We then discuss 4 ways in which it is possible to achieve individual differentiation within a group at the same time demonstrating group identification. These strategies are discussed and integrated with reference to recent empirical research and to the social identity perspective.

Group Processes↗
PubMed1997

[Extensive rehabilitation needed in epilepsy. Different models for varying needs].

Many people with epilepsy experience the need for more information concerning their condition and some people require, at times, greater access to rehabilitation services than has previously been available. Information and support may also be required by the family, friends and work colleagues of the patient. Research indicates that rehabilitation needs, for the patient, can arise in relation to poor self-esteem, overprotection as a child, low expectations, reduced cognitive abilities and stigma perceived or experienced in the family, in society, and at work. Successful rehabilitation is individualistic and should therefore be based on an assessment of the individual's needs. Only on the basis of this can realistic goals be identified. In the cases where intensive multidisciplinary rehabilitation is required a thorough medical assessment will also be needed in order to formulate realistic goals. Achievement of these goals may involve input from psychological, neuropsychological, pedagogical, social, employment and family orientated perspectives. Specialists in these areas must be included within, or co-ordinated by, the epilepsy team or rehabilitation service. In Sweden hospital based epilepsy-teams have added psycho-social rehabilitation aspects in their responsibilities and other rehabilitation services have recently begun to focus on the needs of people with epilepsy. This has led to a range of different rehabilitation models being available. The need to develop improved epilepsy rehabilitation services was identified in the 1970s and has recently received short-term funding support to develop new services and build up expertise. It is hoped that in the future these services will continue to find support at both the county and national levels.

Epilepsy↗
PubMed2007

The development and evaluation of a measure to assess cancer survivors' unmet supportive care needs: the CaSUN (Cancer Survivors' Unmet Needs measure).

BACKGROUND: Many cancer survivors experience ongoing morbidity over the survivorship continuum and their supportive care needs have yet to be comprehensively assessed. METHODS: This study aimed to develop and empirically evaluate a self-report measure of cancer survivors' supportive care needs. In Phase I, questionnaire items were generated based upon previous qualitative research that identified both unique and shared needs in survivors and their partners; items were constructed into the Cancer Survivors' Unmet Needs measure (CaSUN). In Phase 2, the CaSUN was completed by 353 cancer survivors who had been diagnosed with cancer between 1 and 15 years earlier and were currently disease-free. RESULTS: After modification, the CaSUN included 35 unmet need items, 6 positive change items and an open-ended question. Good acceptability, internal consistency and validity were demonstrated, although test-retest reliability was low. Maximum likelihood factor analysis identified five discrete factors: Existential Survivorship, Comprehensive Care, Information, Quality of Life and Relationships. CONCLUSIONS: Preliminary data indicates that the CaSUN meets the majority of psychometric criteria for assessment measures, although its low test-retest reliability awaits further investigation. The CaSUN will facilitate the evaluation of supportive care services and generation of service delivery recommendations for cancer survivors.

Adult↗
PubMed2006

The Mental Health Needs Council of Harris County: a case report on community collaboration and adult mental illness prevalence assessment and service need analysis.

Accurate mental illness prevalence and service needs assessment are critical to the development and delivery of effective mental health programs. Assessment precision and efficient service development and delivery are best facilitated by a close collaboration of all relevant major stakeholders. This report examines the history, mission, and composition of the Mental Health Needs Council of Harris County, Texas. This Council, located in Houston, has for the past 25 years investigated mental health service problems and recommended strategies for their solution. This Council consists of all of Harris County's major public service providers, professional groups and advocacy organizations. This report traces the evolution of the Council's prevalence and needs assessment methodologies. Its current methodologies are examined. These assessment strategies are applicable to other metropolitan areas. The Mental Health Needs Council is a model for effective community collaboration on the needs and problems of persons with mental illness.

Adult↗
PubMed2005

Whose informational needs are considered? A comparison between cancer patients and their spouses' perceptions of their own and their partners' knowledge and informational needs.

The present study examines information exchange patterns between 98 married couples in Israel where one is a cancer patient and the other is the main caregiver. Specifically, the accuracy of each spouse's perception of the extent of knowledge and the need to receive more disease-related information is examined as a function of the role (patient-caregiver) and gender of the participants. The results showed that women, regardless of their role, were inaccurate in their perception of their husbands' knowledge and motivation to know more. For men, a difference between the roles was found for the perception of their wives' knowledge. As caregivers, they were inaccurate while as patients they were accurate in this estimation. Their perception of their wives' needs to know more was accurate. Moreover, female patients, more than male, relied on their perception of themselves when assessing their spouse's knowledge and informational needs. Thus, it is concluded that female patients were more egocentric and their perception of their spouse's preferences was influenced by their own needs. The results demonstrated that in the context of cancer patients and their spouse as caregivers, neither partner considered the informational needs of his or her spouse.

Adult↗
PubMed1987

Principles and practice of measuring needs in the long-term mentally ill: the MRC needs for care assessment.

We report the development of a new procedure for assessing the needs for treatment and care of the long-term mentally ill. This procedure covers 21 areas of clinical and social functioning, and in each of these specifies appropriate interventions. Decision rules are described which permit problems in functioning to be primarily classified as a met need, an unmet need, or as involving no need, and which allow the identification of various secondary needs. We report preliminary data on the reliability and validity of this procedure and discuss its potential applications in the care of the long-term mentally ill.

Activities of Daily Living↗
PubMed1992

Can we measure need in the homeless mentally ill? Using the MRC Needs for Care Assessment in hostels for the homeless.

Hostels for the homeless contain many who are disabled by chronic mental illness but have little access to rehabilitation services. One approach to solving this problem might be to measure the needs of hostel residents in a standardized way and use this information as a basis for planning interventions. This study attempted to use the MRC Needs for Care Assessment Schedule to measure the needs of 46 mentally ill residents of Oxford hostels. It aimed to determine if a standardized assessment could be used in these difficult settings and if the needs it identified could form a useful basis for planning future interventions. Although it was possible to use the schedule, and although the pattern of need identified appeared broadly to reflect conditions in the hostels, it was not felt that the information produced was of sufficient quality to assist in planning services. The authors postulate that underlying this deficiency is the failure of the schedule to take sufficient account of the views of staff and residents.

Adaptation, Psychological↗
PubMed1997

The need for psychiatric treatment in the general population: the Camberwell Needs for Care Survey.

BACKGROUND: This paper presents the first results of a two-stage psychiatric population survey, which uses a new method of directly evaluating needs for specific psychiatric treatment and the extent to which they have been met. METHOD: The sample was drawn at random from the population of an area of inner south London with high levels of deprivation. Seven hundred and sixty subjects aged 18-65 completed the GHQ-28. All those scoring > 5 and half of the rest were invited to take part in the second stage, comprising measures of mental state (SCAN), social role performance (SRPS), life events and difficulties (LEDS) and a Treatment Inventory. This information was used to rate the community version of the Needs for Care Assessment (NFCAS-C). RESULTS: In all, 408 subjects were interviewed in the second stage. The weighted 1 month prevalence of hierarchically ordered ICD-10 psychiatric disorders was 9.8%, the 1 year prevalence 12.3%. The equivalent prevalences for depressive episode were 3.1% and 5.3% respectively, while those for anxiety states were both 2.8%. At interview nearly 10% of the population were identified as having a need for the treatment of a psychiatric condition. This rose to 10.4% if the whole of the preceding year was assessed. Less than half of all potentially meetable needs were met. There was only partial overlap between diagnosis and an adjudged need for treatment. CONCLUSION: A majority of people with mental health problems do not have proper treatment; given more resources and greater public and medical awareness, most could be treated by family doctors.

Adolescent↗
PubMed1989

Linking level of care to level of need. Assessing the need for mental health care for nursing home residents.

What are the mental health status and active treatment needs of nursing home residents? A stratified random sample of 828 residents in 25 facilities serving Medicaid recipients was assessed for levels of physical and psychosocial functioning. Although 91.2% had sufficiently high levels of medical and physical care needs to justify nursing home placement, 79.6% also had moderate to intense needs for mental health care. Older residents, relative to their younger counterparts, had more intense medical and mental health care needs. It was also found that psychiatric diagnosis was a poor indicator of mental health service needs, particularly among elderly individuals.

Adult↗
PubMedDate not supplied

Meeting the needs of rural breast cancer survivors: what still needs to be done?

As screening and treatment for breast cancer improve, learning about survivors' post-treatment needs becomes increasingly important. Focus groups (n = 23) were conducted with breast cancer survivors (n = 128) in rural Washington communities during a 5-month period in 1996 to explore ways to improve the lives of rural breast cancer survivors and to expand existing knowledge of breast cancer survivorship. Survivors reported positive and negative outcomes of their cancer experience. Results indicate that the needs of many women with breast cancer, particularly women diagnosed with late-stage disease, are not being met. Participants diagnosed with late-stage cancer were more likely than participants diagnosed with early-stage cancer to comment about being treated poorly by the medical system and to voice a need for increased support and educational services for breast cancer patients. Rural survivors, regardless of stage at diagnosis, reported needing more education about breast cancer and more emotional support after diagnosis. Further efforts to facilitate support and education within the context of medical care and to improve patient-clinician relationships are needed.

Adult↗