Patient satisfaction with mental health services: a meta-analysis to establish norms

Patients typically express high rates of satisfaction with their mental health care. This finding and the lack of well controlled studies on patient satisfaction in the literature underscore the need for meaningful guidelines for clinicians and program evaluators in interpreting patient satisfaction data. To address this problem a meta-analysis was undertaken to establish norms on patient satisfaction for various types of mental health programs. Programs were categorized according to three dimensions: inpatient vs. outpatient vs. residential care; chronic vs. non-chronic; and conventional vs. innovative. Meta-analysis procedures were modified to accommodate the single-group study designs that dominate the literature. The analysis revealed that chronic patients express less satisfaction with their treatment compared to non-chronic patients. Innovative programs are viewed more positively than conventional ones. No differences were found in rates of patient satisfaction between inpatient and outpatient programs. Acceptably reliable norms and confidence intervals of patient satisfaction were established for conventional inpatient programs serving either chronic or non-chronic patients; conventional outpatient programs for non-chronic patients; and for all programs combined according to chronic vs. non-chronic, inpatient vs. outpatient, and conventional vs. innovative. However, data were insufficient to compute norms for other program types. The norms thus established can be used for comparative purposes by program evaluators. A cumulative, national data base on patient satisfaction is recommended to further refine these norms.     

Analysis of social pathologies in a policy context: A paradigm for action

Prevention continues to gain importance among the strategies open for governmental development of social policy. This paper offers two exploratory conceptual discussions related to prevention in social policy. The first is a representation of the policy making environment with special reference to the informational requirements for the development of policy. The second is a discussion of social pathologies, broadly defined as patterns of behavior with important negative repercussions on individuals whom we refer to as victims, and of possible strategies toward the development of (at least partial) preventive measures. The two discussions are interrelated as the shape of the second is dictated by the desiderata outlined in the first. The paper is divided into five parts:

1. Introduction: the conundrum of prevention.
2. The Development of a paradigm of the policy context.
3. Dependent variables: social pathologies.
4. Independent variables: a focus on structural determinants.
5. Conclusion: information requirements for preventive action.

     

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.     

The Determinants of Trust and Credibility in Environmental Risk Communication: An Empirical Study

This study examines a key component of environmental risk communication; trust and credibility. The study was conducted in two parts. In the first part, six hypotheses regarding the perceptions and determinants of trust and credibility were tested against survey data. The hypotheses were supported by the data. The most important hypothesis was that perceptions of trust and credibility are dependent on three factors: perceptions of knowledge and expertise; perceptions of openness and honesty; and perceptions of concern and care. In the second part, models were constructed with perceptions of trust and credibility as the dependent variable. The goal was to examine the data for findings with direct policy implications. One such finding was that defying a negative stereotype is key to improving perceptions of trust and credibility.     

Estimation from Zero-Failure Data

When performing quantitative (or probabilistic) risk assessments, it is often the case that data for many of the potential events in question are sparse or nonexistent. Some of these events may be well-represented by the binomial probability distribution. In this paper, a model for predicting the binomial failure probability, P , from data that include no failures is examined. A review of the literature indicates that the use of this model is currently limited to risk analysis of energetic initiation in the explosives testing field. The basis for the model is discussed, and the behavior of the model relative to other models developed for the same purpose is investigated. It is found that the qualitative behavior of the model is very similar to that of the other models, and for larger values of n (the number of trials), the predicted P values varied by a factor of about eight among the five models examined. Analysis revealed that the estimator is nearly identical to the median of a Bayesian posterior distribution, derived using a uniform prior. An explanation of the application of the estimator in explosives testing is provided, and comments are offered regarding the use of the estimator versus other possible techniques.     

The impact of supply chain management practices on competitive advantage and organizational performance

Effective supply chain management (SCM) has become a potentially valuable way of securing competitive advantage and improving organizational performance since competition is no longer between organizations, but among supply chains. This research conceptualizes and develops five dimensions of SCM practice (strategic supplier partnership, customer relationship, level of information sharing, quality of information sharing, and postponement) and tests the relationships between SCM practices, competitive advantage, and organizational performance. Data for the study were collected from 196 organizations and the relationships proposed in the framework were tested using structural equation modeling. The results indicate that higher levels of SCM practice can lead to enhanced competitive advantage and improved organizational performance. Also, competitive advantage can have a direct, positive impact on organizational performance.