Comparison of indirect and direct approaches to measuring patient satisfaction

One indirect (PSQ) and two direct (CSQ-18B and ERS) measures of patient satisfaction were compared across a series of psychometric, acceptability, and concurrent validity criteria. None of the three measures was significantly related to health status or demographic characteristics. Each measure performed as expected from prior research on their psychometric properties. The scales contrasted, however, in regard to acceptability, with the PSQ being much less acceptable to patients than the other two. The PSQ also produced more missing data. The results on the PSQ reflected patient inconsistency on cross-check items and patients tended to be uncertain in their responses to many items. In multivariate analyses the three measures were used as predictors of patient-rated indices of global service satisfaction. The CSQ-18B and the ERS were significant predictors of patient-rated indices of global service satisfaction, whereas the PSQ was unrelated to these indices. It was concluded that the direct and indirect approaches measure different satisfaction domains. The PSQ likely assesses more generalized attitudes about health services while the CSQ-18B and the ERS efficiently reflect opinions about the specific setting in which they are administered.     

The validity of indices for rural health manpower needs assessment

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.     

Statistical estimation of socio-economic factors affecting migration in W. Europe

A statistical estimation of the relationship between socioeconomic factors and net international migration in Western Europe from 1977 to 1980 is presented using data from the Monthly Bulletin of Statistics and the Statistical Yearbooks of the United Nations and each country. It is found that the rate of change in the gross national income, the percentage of the gross national income in the tertiary sector, and the number of automobiles per 1,000 inhabitants are the major factors affecting net migration in the most industrialized countries of Western Europe.     

The management of offshore resources—Some implications of the 200-mile limit

This article examines in depth the strategic implications for those States who have recently declared 200 mile off-shore resource management zones. The authors, in a comprehensive and stimulating paper, examine the implications of so-calling a nation's offshore limit. It is an appropriate name for a nation's offshore limit since the primary reason for many nations declaring a 200 mile limit has been the abundance of resources which have often been found within those limits either in the sea or the sea bed itself. This paper reviews the current background of off-shore resource management and outlines suitable roles for adoption by the coastal States in the management of their off-shore renewable and non-renewable resources. Furthermore, it examines the contentious but nonetheless central issue of the benefits and costs which accrue through coastal state jurisdiction. The authors also examine an appropriate resource management process and the implications of resource use conflicts within the off shore limit as well as defining these conflicts on the basis of ‘stakeholder’ interests and introduces a new concept of the maximization of economic equity amongst competing stakeholders. The problem remains that the measurement of economic equity perhaps leaves the States concerned within a situation of only having defined the problem; the political process has then to deal with any reallocation measures that may be deemed appropriate.     

The Triple Agenda of Presidential Debates

The authors find little support for the view that televisedpresidential debates address the public's primary politicalconcerns. Though candidates speak directly to the public, andthe public is represented by journalists who question the candidates,the research suggests that never the "three shall meet." Basedon (I) content analysisof the Brst 1960 and 1976 presidentialdebates and (2) secondary analysis of survey data (Gallup andCPS), candidates, journalists, and public appear to have theirown separate issue agendas. Survey data in this paper were madeavailable by the Roper Center and the Inter-University Consortiumfor Political and Social Research, via the University of PennsylvaniaSocialScienceData Center. Data for 1976 were originally collected by theCenter for Political Studies of the Institute for Social Research,the University of Michigan, under a grant from the NationalScience Foundation. Neither the originalcollectors of the datanor the Consortium bear any responsibility for the analysesand interpretations presented here.     

Discrimination against women in employment

The operation of the Equal Pay Act and recent pressures to end all discrimination against women in employment makes discussion of such discrimination timely. This article begins by examining the forms which discrimination may take place and presenting evidence of the extent to which it is happening. This is followed by a summary of relevant legislation and legislative proposals and an examination of the effects to date of the Equal Pay Act. In the last part of the paper a conceptual framework is suggested for approaching some of the economic problems raised by discrimination. It is suggested that while much light could be shed by economic analysis still remaining to be done, some of the most fundamental points lie in the field of the behavioural scientist rather than the economist.     

A future for fishing?

This article outlines the potential in the fishing industry viewed from the present. The author argues that current methods are still relatively inefficient and that increases of 50–100 per cent can be expected in the next 10–20 years. Further that these larger catches can contribute markedly to world protein requirements. The article includes consideration of system fishing and concludes with a picture of the British fishing industry being among the most advanced in the world.     

Demographic crisis: The impact of the Bangladesh civil war (1971) on births and deaths in a rural area of Bangladesh

Summary In Matlab Bazaar Thana the Cholera Research Laboratory has registered the births, deaths and migrations in a population of approximately 125,000 since 1966. Although this rural area was not the scene of any significant armed encounters, striking changes in birth and death rates were registered during and after the conflict. Birth rates did not change during the relatively brief period of the civil war, but a small decline was registered for one year after the war. Fertility rates which had been declining slightly and irregularly in the pre-war baseline period may have increased slightly during the war and fell substantially in all age groups in the year following the war. The crude death rate, which rose by 37 per cent during the war, was a very sensitive reflection of the administrative and economic problems. Overall infant mortality rose by only 15 per cent over pre-war levels because all of the increase was observed in the post-neo-natal component, which traditionally accounts for less than one-third of the total infant mortality in Bangladesh. Children and older adults accounted for the majority of excess deaths which were largely attributed to acute diarrhoeas and other gastro-intestinal causes. The death rate at ages 1-4 rose by 43 per cent and at ages 5-9 soared to 208 per cent above pre-war baseline rates. All increases in age-specific mortality rates fell to baseline levels during the year following the war, except the 5-9-year age group, in which rates continued to be high largely because of deaths due to dysentery.     

Parental survival data: Some results of the application of Ledermann's model life tables

Summary Ledermann's one- and two-parameter model life tables are used in order to summarize and compare adult mortality estimates derived from parental survival data, and also to link parental survival with child survival data. The Ledermann models provide an alternative to the logit model used by Brass and Hill. Examination of life tables derived from actual child and adult mortality estimates reveals that although the two types of models yield similar overall levels of mortality, they show marked differences in the estimated patterns by sex and age. It has not been possible to disentangle completely how much of this divergence is due to the models themselves and how much to inadequacies in the data available. Finally, we question whether it is always wise to establish a full life table from child and adult mortality estimates when these are based on data which refer to different periods of exposure to the risk of dying, without allowance for possible distortions resulting from mortality change.