Survival characteristics of 771 resin-retained bridges provided at a UK dental teaching hospital.

OBJECTIVE: To analyse the factors affecting the clinical performance and those influencing the survival of resin-retained bridgework provided at a UK dental teaching hospital between 1994 and 2001. DESIGN: A prospective analysis of restorations provided at a single centre using case notes with all patients invited for review to corroborate findings. SETTING: Department of Restorative Dentistry, University of Bristol Dental Hospital and School, Bristol, United Kingdom. SUBJECTS AND METHODS: Between January 1994 and December 2001, data regarding 1,000 consecutive resin-retained bridges provided at Bristol Dental Hospital and School were recorded. Data was available for 805 patients at the time of the study. Following invitation, 621 patients attended for a review appointment. Life table and Kaplan-Meir survival analysis were carried out for all restorations provided. RESULTS: The five-year and ten-year survival rates estimated by the life-table method are 80.8% (95% confidence interval 78.0-83.6%) and 80.4% (95% confidence interval 77.6-83.2%) respectively. The median survival cannot be estimated for this study as the survival probability remains above 80% even at the longest follow-up. Analysis of clinical variables influencing survival revealed that design of the restoration and experience of the operator providing the restoration were significant factors. Resin-retained bridges made with minimal tooth preparation are shown to be superior in terms of longevity than those for which other types of tooth preparation is made. Patient satisfaction with their treatment was high.

Impact of child health centre organization on parental satisfaction.

The aim of this study is to describe differences in parental satisfaction with child health services under different organizational arrangements. The study had a cross-sectional design and was based on 3 largely identical surveys, involving 60 questions, performed in 1970, 1988 and 1993. The original questionnaire was developed by one of the authors in 1970. The present study analyses responses to 5 demographic questions and 12 questions regarding the content of child health services, evaluating parental satisfaction with these services. The study population in 1970 consisted of 443 parents (93% of those invited to participate) with children 6-18 months old, 1008 (82%) in 1988 and 1071 (80%) in 1993. Parents expressed more satisfaction with child health services in 1970 and 1993 compared to 1988. This pattern is not attributable to macro-level societal changes, but corresponds to changes in the organization of child health care services over the study period. The results highlight the vital question of how child health care should be organized in order to satisfy parents. The quality of child health care and parental satisfaction depend in part on the style of organization, including how much nurses with 'first-line' contacts focus on paediatric services.

Child health service's response to early feeding and behaviour problems: changes in parental perceptions 1970-93.

OBJECTIVE: This health systems study was done to measure changes over time concerning parents' perceptions of feeding and behavioural problems in children 6-18 mo of age, parents' willingness to use child health services and their evaluation of the advice received. METHOD: The study had a repetitive cross-sectional design. Three largely identical surveys were performed in 1970, 1988 and 1993. Questionnaires were sent to a random sample of all parents of children 6-18 mo living in Uppsala, Sweden. RESULTS AND CONCLUSIONS: The frequency of different perceived feeding and/or behavioural problems was stable or declined between 1970 and 1988, but increased in 1993. For most problems, inclination to seek help and perceived benefit of advice decreased between 1970 and 1988, but increased again in 1993. The parents sought more help and perceived the advice they received as more beneficial when the service was in the hands of paediatric nurses (1970) or of district nurses focusing on the care of infants and preschool children (1993) than when the district nurses also had responsibilities for adults and the elderly (1988). No correlation was seen with societal and sociodemographic trends. Although the cross-sectional (hence non-experimental) design of the study makes it impossible to prove causality, the findings suggest that parents' willingness to use the child health service and their evaluation of that service may depend in part on organization, including the degree to which nurses with "first-line" contacts are focused on paediatric services.

Application of 'futures' in the community-level health promotion with special reference to Latin America.

Health promotion strategies are built upon the notion of creating healthy communities who are participating in taking a greater control over their own destinies. Social participation has a long tradition in Latin America and current movements to strengthen this are represented in the municipios saludables. Innovative frameworks for community involvement draw on the work developed in the 'futures' field, harnessing collaboration between communities and policy makers in order to formulate visions of health which empower communities. This article explores the methodologies used by futurists and their potential and application in the Latin American context, and in particular, it illustrates the work by the Pan American Health Organization aimed at improving the health condition of the various communities in the region.

An introduction to national futures studies for policymakers in the health sector.

Health futures studies have been carried out in only a few countries, but as interest grows in both national long-term perspective studies and health futures, this pattern is likely to change. Policymakers who decide to launch a national study within the health sector should begin by learning about the alternative purposes for which such a study can be done, the different designs and methodologies it can employ, and the various funding and sponsorship arrangements under which it can be carried out. Newcomers to the futures field often make false assumptions about these four aspects and underestimate the range within each. If those responsible for a study become fully aware of the diverse approaches that are possible and make well-considered choices among them, they are more likely to produce a study that has a clearly defined purpose, combines appropriate components in a design which serves the purpose, employs methodologies suited to the components, and is funded and sponsored under an arrangement which supports the study's integrity and implementation.

Regimen compliance two years after myocardial infarction.

Two-years postinfarction, the effect of a nursing intervention at 30 days postinfarction, and intentions, attitudes, and perceived beliefs of others on regimen compliance of myocardial infarction patients was investigated. The sample was comprised of 51 patients (E = 29, C = 22) who participated in a five-phase study over 2 years. No differences were found between experimental and control groups for regimen compliance to activity, stress, and medication prescriptions. The experimental group was significantly more compliant to the diet prescription than the control group. The control group was significantly more compliant than the experimental group with cessation from smoking. Perceived beliefs of others were predictive of compliance for all regimen prescriptions at 2 years. Attitude was also predictive of compliance with the diet, smoking, and stress regimens.

Stressors and stress management--1 month after myocardial infarction.

Stressors and stress management behaviors reported by 52 myocardial infarction (MI) patients were identified from a content analysis of transcriptions of nurse/patient/spouse interactions that took place 30 days postinfarction. Subjects defined stress primarily in terms of distress related to appraisals of harm, loss, or threat. Stressors and stress management behaviors varied, although subjects were similar in age and occupation and were in the same phase of recovery. Most stressors related to recent myocardial infarction and pertained to thoughts and feelings more than to external events. Others, related to family and/or work, were ongoing before the MI. Stress management behaviors comprised a continuum of physical, cognitive, and verbal behaviors ranging from active to passive. Avoidance of situations, ignoring situations, expressing feelings, and thinking things through were the four major modes of stress management behaviors. Implications for rehabilitation nursing practice are identified.

Marital functioning after cardiac surgery.

Using Barnhill's components of family health functioning, we examined the relationships of spouse anxiety, coping methods, couple responsibility for compliance, and reported compliance with marital couple functioning. Five psychosocial scales were returned by mail by 136 Mended Heart members and spouses from five geographic regions. By multiple regression analysis, confrontive coping strategies and spouse trait anxiety were the two factors predictive of couple marital functioning. When marital functioning scores were examined separately, spouses' confrontive behaviors and patient reported compliance for diet, stress, and smoking prescriptions were predictive of both spouse and patient marital functioning. In addition, spouse marital functioning was predicted by state anxiety and patient compliance, and patient marital functioning by compliance and shared responsibility for compliance. Further studies should evaluate spouse inclusion in rehabilitation programs during hospitalization and convalescence and examine interactional strategies that facilitate confrontive behaviors and patient compliance to promote couple marital functioning after the cardiac event.

Personal adjustments and regimen compliance 1 year after myocardial infarction.

The relationship of attitudes and perceived beliefs of others to regimen compliance and personal psychologic and social adjustments of patients with myocardial infarction was investigated 1 year after the infarction. Eighty-one patients (39 in the experimental group, 42 in the control group) who participated in a prior study on the effect of a nursing intervention on regimen compliance, completed scales that assessed attitudes toward regimen prescriptions (diet, medications, activity, smoking, and stress response), perceived beliefs of others concerning compliance, personal adjustments, and regimen compliance. At 1 year, no differences were found between experimental and control groups for regimen compliance or personal adjustments. There was a significant decrease in mean scores for all variables from the time the patient was in the hospital to 30 days afterward, but no change at 1 year from the 30- or 60-day visit. At 1 year, attitudes were predictive of compliance for all regimen prescriptions. Perceived beliefs of others were predictive of diet, activity, and medication prescriptions.

Influence of a nursing intervention on regimen adherence and societal adjustments postmyocardial infarction.

One hundred three first-time myocardial infarction (MI) patients were randomly assigned to either an experimental or a control condition. Patients completed a cardiac rehabilitation program during hospitalization and were interviewed to assess intentions to follow regimen prescriptions, attitudes toward the prescriptions, coping methods, and the perceived beliefs of others concerning their intentions. Patients were visited at home 30 days after discharge and reassessed on each of the above variables except that their behavior was substituted for intentions and societal adjustment was assessed. The experimental group was given an intervention program which included a discussion of assessment data, identification of problems, and establishment of goals. The assessment was repeated 60 days after discharge. No differences were found between experimental and control groups for either medical regimen adherence or societal adjustment. There was a significant decrease in mean scores for all variables from hospital to 30 days for both groups, but no change from 30 to 60 days. Attitudes and perceived beliefs of others were predictive of adherence, and it was concluded that these variables need to be included in any rehabilitation program.

Life situations, health beliefs, and medical regimen adherence of patients with myocardial infarction.

One hundred twelve patients with MI were followed over a 6- to 9-month period to investigate their intentions and adherence behavior to a prescribed medical regimen in four life situations. The subjects with MI had strong intentions in the hospital to follow their prescription in all four situations, with the strongest for the home situation and the weakest for work. However, the actual adherence behaviors were less than the original intentions. The findings indicate the need for a review of the content of rehabilitation programs and consideration of the stage of recovery at which instructions are presented to patients rehabilitating from a MI. The intentions and adherence behaviors of subjects with MI were closely related to their perceptions of significant others' expectations. For the health team, this emphasizes the need to include significant others in patient rehabilitation.

Indicators of medical regimen adherence for myocardial infarction patients.

This study investigated relationships between demographic and medical variables, attitudes, perceived beliefs of others, and intentions toward medical regimen adherence and actual posthospitalization regimen adherence. During hospitalization, attitudes, perceived beliefs of others, and intentions toward prescribed medical regimen were elicited from 112 persons recovering from a first time myocardial infarction (MI). Six to 9 months posthospitalization, attitudes, perceived beliefs of others, and adherence behaviors were assessed. Multiple regression analysis indicated that, during hospitalization, attitudes and perceived beliefs of others were strong indicators of intentions to adhere to the medical regimen, but they were not indicators of actual adherence posthospitalization. Posthospitalization, attitudes and perceived beliefs of others were strong indicators of actual regimen adherence. Findings indicate rehabilitation plans for the MI patient should be individualized for hospital and home and should include data on health belief variables.

Half body radiation in plasma cell myeloma.

Sequential hemi-body irradiation can achieve useful responses in the treatment of myeloma. It is less toxic than many widely used drugs and its use in multimodality treatment schedules deserves further attention. The ideal fractionation has also to be determined.

Development of a health attitude scale.

A tool was developed to assess attitudes of patients with cardiac disease toward performing prescribed behaviors of their medical regimen. Two groups of subjects with heart disease were used to examine validity and reliability of the Miller Attitude Scale. One group included 480 members of Mended Hearts, Inc., and the second group consisted of 35 patients diagnosed with a first myocardial infarction. The second group repeated the attitude scale six months post-hospitalization. Performance of the medical regimen by this group was verified at the six-month follow-up period. Using Spearman Rank Correlation, there was a significant relationship between attitudes and adherence behaviors for three of the five subscales. Alpha reliabilities revealed a high degree of internal consistency of scale items for all five subscales when testing both groups. A factor analysis resulted in eight factors accounting for the majority of the variance. Each of the five behaviors of the medical regimen clearly defined a factor supporting used of the Miller Attitude Scale for assessing attitudes of heart patients toward behaviors of their medical regimen.