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Consistent with cognitive models of social anxiety, socially anxious individuals show cognitive biases that magnify their perceived level of threat in the environment. OBJECTIVES: The first objective was to determine whether attentional bias for socially threatening stimuli occurs after concomitant depression has been controlled. The second objective was to test the effectiveness of the Attention Control Training Program for Social Anxiety (ACTP-SA) for reducing social anxiety attentional bias and improving therapeutic indices in people with social anxiety. METHOD: In the first study, socially anxious (N = 30) and non-anxious individuals (N = 30) completed the Beck Depression Inventory-II, Spielberger's State-Trait Anxiety Inventory, Conner's Social Phobia Inventory, a social-anxiety Stroop test, and a clinical interview. In the second study, individuals with social anxiety (N = 30) were randomly assigned to an experimental group that received 4 sessions of ACTP-SA, or to a sham-intervention control condition. At the post-test and a 3-month follow-up, both groups completed the same measures as in Study 1. RESULTS: In Study 1, socially anxious individuals showed higher attentional bias for threatening stimuli than the controls, after depression had been controlled for. In Study 2, participants in the experimental group, compared with the controls, showed greater reductions in attentional bias, social anxiety, and trait anxiety at post-test and follow-up. CONCLUSIONS: The results underscore the importance of information processing biases in social anxiety and the benefits of attentional bias training as a complementary intervention for modifying symptoms of social anxiety.
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Viés de Atenção , Humanos , Medo/psicologia , Atenção , Ansiedade/psicologiaRESUMO
Becoming committed to a new health-related goal and pursuing it is difficult for many people. The present study (a) developed and tested the psychometric properties of a brief Goal Ambivalence Scale (GAS) in a sample of dieters and (b) tested the effectiveness of providing dieters with feedback on their scores on the GAS. In Study 1, dieters (n = 334, 74% females) completed the GAS and a measure of Health-Related Concerns and Actions (HRCA). The standardization of the GAS was supported by CVR and CVI, the results of a PCA, and strong reliability and validity statistics. In Study 2, the experimental group of dieters (n = 107; 67.50% female) received feedback on their GAS scores, but the control group did not (n = 111; 62.30% female). Compared with the control group, the experimental group reported a greater need for information, greater readiness to change, and higher perceived situational confidence in resisting food that was inconsistent with their dieting goals. To conclude, the GAS could be used in health settings to provide clients and providers with an objective, fast measure of commitment to achieving health-related goals. Moreover, immediate feedback on health-related goals may improve change motivation.
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Cadmium (Cd) toxicity reduces growth and yield of crops grown in metal-polluted sites. Research was conducted to estimate the potential of hydrogen sulphide (H2 S) to mitigate toxicity caused by Cd in fenugreek seedlings (Trigonella foenum-graecum L.). Different concentrations of CdCl2 (Cd1-1 mM, Cd2-1.5 mM, Cd3-2mM) and H2 S (HS1-100 µM, HS2-150 µM, HS3-200 µM) were assessed. Seeds of fenugreek were primed with sodium hydrosulphide (NaHS), as H2 S donor. Seedlings growing in Cd-spiked media treated with H2 S were harvested after 2 weeks. Cd stress affected growth of fenugreek seedlings. Cd toxicity decreased leaf relative water content (LRWC), intercellular CO2 concentration, net photosynthesis, stomatal conductance and transpiration. However, application of H2 S significantly improved seedling morphological attributes by increasing the activity of antioxidant enzymes, i.e. APX, CAT and SOD, in Cd-contaminated soil. H2 S treatment also regulated phenolic and flavonoid content. H2 S-induced biosynthesis of spermidine (Spd) and putrescine (Put) could account for the enhancement of growth and physiological performance of fenugreek seedlings under Cd stress. H2 S treatment also reduced H2 O2 production (38%) and electrolyte leakage (EL, 51%) in seedlings grown in different concentrations of Cd. It is recommended to evaluate the efficacy of H2 S in alleviating Cd toxicity in other crop plants.
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Sulfeto de Hidrogênio , Trigonella , Antioxidantes/metabolismo , Cádmio/toxicidade , Peróxido de Hidrogênio , Sulfeto de Hidrogênio/farmacologia , Estresse Oxidativo , Poliaminas , Plântula , Trigonella/metabolismoRESUMO
Background: There is consistent evidence that community and clinical samples of individuals with an alcohol use disorder (AUD) have attentional biases toward alcohol cues. The alcohol attentional control training program (AACTP) has shown promise for retraining these biases and decreasing alcohol consumption in community samples of excessive drinkers. However, there is a lack of evidence regarding the effectiveness of ACTP in clinical AUD samples. The main aim of the present study is to investigate whether primary pharmacological and psychological, evidence-based alcohol treatment can be enhanced by the addition of a gamified AACTP smartphone application for patients with an AUD. Design and Methods: The study will be implemented as a randomized controlled trial. A total of 317 consecutively enrolled patients with AUD will be recruited from alcohol outpatient clinics in Denmark. Patients will be randomized to one of three groups upon initiation of primary alcohol treatment: Group A: a gamified AACTP smartphone application + treatment as usual (TAU); Group B: a gamified AACTP sham-control application + TAU; or Group C: only TAU. Treatment outcomes will be assessed at baseline, post-treatment, and at 3- and 6-month follow-ups. Repeated measures MANOVA will be used to compare the trajectories of the groups over time on alcohol attentional bias, alcohol craving, and drinking reductions. It is hypothesized that Group A will achieve better treatment outcomes than either Group B or Group C. Perspectives: Because attentional bias for alcohol cues is proportional to the amount of alcohol consumed, and these biases are not addressed within current evidence-based treatment programs, this study is expected to provide new evidence regarding the effectiveness of the gamified AACTP in a clinical population. Furthermore, due to promising results found using AACTP in community samples of excessive drinkers, there is a high probability that the AACTP treatment in this study will also be effective, thereby allowing AACTP to be readily implemented in clinical settings. Finally, we expect that this study will increase the effectiveness of evidence-based AUD treatment and introduce a new, low-cost gamified treatment targeting patients with an AUD. Overall, this study is likely to have an impact at the scientific, clinical, and societal levels. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05102942?term=NCT05102942&draw=2&rank=1, identifier: NCT05102942.
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BACKGROUND: In obese patients (OP), the best intraoperative ventilation strategy remains to be defined. Dynamic lung compliance (Cdyn) and dead space fraction are indicators of efficient ventilation at an optimal positive end-expiratory pressure (PEEP). Herein, we investigated whether intraoperative dynamic lung compliance optimization through PEEP manipulations affects the incidence of postoperative hypoxemia (SpO2 < 90%) in OP undergoing laparoscopic bariatric surgery (LBS). METHODS: This was a single-center, prospective, randomized controlled study conducted from July 2013 to December 2015. After obtaining institutional review board approval and informed consent, 100 OP undergoing LBS under volume-controlled ventilation (tidal volume 8 mL/kg of ideal body weight) were randomized according to the PEEP level maintained during the surgery. In the control group, a PEEP of 10 cm H2O was maintained, while in the intervention group, the PEEP was adapted to achieve the best dynamic lung compliance. Anesthesia and analgesia were standardized. The patients received supplemental nasal oxygen on the first postoperative day and were monitored up to the second postoperative day with a portable pulse oximeter. RESULTS: Demographics were similar between groups. There was no difference in the incidence of hypoxemia during the first 2 postoperative days (control: 1.3%; intervention: 2.1%; p = 0.264). CONCLUSIONS: The incidence of postoperative hypoxemia was not reduced by an open-lung approach with protective ventilation strategy in obese patients undergoing LBS. A pragmatic application of a PEEP level of 10 cm H2O was comparable to individual PEEP titration in these patients. TRIAL REGISTRATION: Clinicaltrials.gov identifier, NCT02579798; https://clinicaltrials.gov/ct2/show/NCT02579798.
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Cirurgia Bariátrica/efeitos adversos , Hipóxia/epidemiologia , Hipóxia/prevenção & controle , Complacência Pulmonar/fisiologia , Obesidade Mórbida/cirurgia , Respiração com Pressão Positiva , Adulto , Cirurgia Bariátrica/métodos , Feminino , Humanos , Hipóxia/etiologia , Incidência , Laparoscopia/efeitos adversos , Pulmão/fisiologia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/fisiopatologia , Respiração com Pressão Positiva/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , Respiração , Volume de Ventilação PulmonarRESUMO
We aimed to test the relationships between Trust-in-God, positive and negative affect, and feelings of hope. A sample of university students (N = 282, 50 % female) completed the Positive and Negative Affect Schedule, the Adult Dispositional Hope Scale, and a Persian measure of Trust-in-God for Muslims. The results of a series of hierarchical regression analyses indicated that Trust-in-God was positively associated with participants' scores for hope and positive affect but was negatively associated with their scores for negative affect. The results support the relationship between Trust-in-God and indices of mental health.
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Afeto , Esperança , Islamismo/psicologia , Religião e Psicologia , Estudantes/psicologia , Confiança/psicologia , Adulto , Feminino , Humanos , Masculino , Estudantes/estatística & dados numéricos , Universidades , Adulto JovemRESUMO
Two cognitive-motivational variables that help to solidify drinkers' intentions to drink are their alcohol attentional bias and their maladaptive motivation. The Alcohol Attention Control Training Programme (AACTP) was designed to rectify the former, and the Life Enhancement and Advancement Programme (LEAP) was designed to rectify the latter. The present study used a factorial design to compare the individual and combined effects of the 2 interventions on mean weekly drinking and atypical weekly drinking of 148 harmful drinkers (49% males, mean age = 28.8 years). A variety of other cognitive-motivational and demographic measures were also taken at baseline, and the drinking measures were reassessed at posttreatment and 3 and 6 months later. In comparison with LEAP, the effects of AACTP were less enduring. Combining AACTP and LEAP had few incremental benefits. These results suggest that AACTP would be more effective for achieving short-term reductions in drinking, whereas LEAP would be more effective for alleviating problematic drinking.
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Alcoolismo/terapia , Atenção/fisiologia , Terapia Cognitivo-Comportamental/métodos , Motivação/fisiologia , Adolescente , Adulto , Alcoolismo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The nasal tip is an important esthetic feature of the face and surgery on it is the most challenging part of a rhinoplasty. In the present study, we evaluated the effects of modification of the depressor septi nasi muscle on nasal tip rotation and projection. METHODS: Eighty primary rhinoplasty patients who required nasal tip modifications were enrolled in a randomized clinical trial from October 2008 to March 2012. A study group composed of 40 patients underwent rhinoplasty including cutting and repositioning of the depressor septi nasi muscle and another group of 40 patients (control) underwent rhinoplasty without manipulation of the depressor septi nasi muscle. Nasal tip rotation and projection, and patient satisfaction were evaluated before and 6 months after the operation. RESULTS: Following rhinoplasty including cutting of the depressor septi nasi muscle, nasal tip rotation and projection, and patient satisfaction were improved in 70, 57.5, and 85 % of the patients, respectively; and in the control group, they were improved in 82.5, 55, and 67.5 %, respectively (P = 0.089, 0.607, and 0.069). CONCLUSION: Cutting and repositioning of the depressor septi nasi muscle as an adjunct to rhinoplasty is not associated with any additional advantage in terms of nasal tip rotation and projection, or patient satisfaction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Músculos Faciais/cirurgia , Septo Nasal/cirurgia , Rinoplastia/métodos , Adolescente , Adulto , Estética , Feminino , Seguimentos , Humanos , Masculino , Variações Dependentes do Observador , Satisfação do Paciente , Estudos Prospectivos , Rotação , Resultado do Tratamento , Adulto JovemRESUMO
Following successful outcomes of cognitive bias modification (CBM) programs for alcoholism in clinical and community samples, the present study investigated whether different varieties of CBM (attention control training and approach-bias re-training) could be delivered successfully in a fully automated web-based way and whether these interventions would help self-selected problem drinkers to reduce their drinking. Participants were recruited through online advertising, which resulted in 697 interested participants, of whom 615 were screened in. Of the 314 who initiated training, 136 completed a pretest, four sessions of computerized training and a posttest. Participants were randomly assigned to one of four experimental conditions (attention control or one of three varieties of approach-bias re-training) or a sham-training control condition. The general pattern of findings was that participants in all conditions (including participants in the control-training condition) reduced their drinking. It is suggested that integrating CBM with online cognitive and motivational interventions could improve results.
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Alcoolismo/reabilitação , Atenção , Terapia Cognitivo-Comportamental/métodos , Internet , Terapia Assistida por Computador/métodos , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/psicologia , Cognição , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Resultado do TratamentoRESUMO
If a person expects that (a) drinking alcohol or using another addictive substance will enhance positive affect or reduce negative affect, and (b) there is a strong likelihood that these desirable consequences will occur if the substance is used, that person is likely to form a goal of using the substance. The theoretical framework presented here predicts that when that happens, the person will have a current concern for using the substance, with the person thereby sensitized to environmental stimuli related to procuring and using the substance. One indication of the sensitization is selective attention to substance-related stimuli, which is correlated with urges to use and actual use of the substance. Accordingly, interventions have been developed for helping substance users to overcome substance-related attentional bias. The results are promising for reducing both the attentional bias and the substance use. Finally, we discuss other cognitive-modification and motivational techniques that have been evaluated with promising results.
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Comportamento Aditivo/psicologia , Cognição , Motivação , Transtornos Relacionados ao Uso de Substâncias/psicologia , HumanosRESUMO
When a person has a goal of drinking alcohol or using another addictive substance, the person appears to be automatically distracted by stimuli related to the goal. Because the attentional bias might propel the person to use the substance, an intervention might help modify it. In this article, we discuss techniques that have been developed to help people overcome their attentional bias for alcohol, smoking-related stimuli, drugs, or unhealthy food. We also discuss how these techniques are being adapted for use on mobile devices. The latter would allow people with an addictive behavior to use the attentional training in privacy and as frequently as needed. The attentional training techniques discussed here appear to have several advantages. They are inexpensive, can be fun to use, and have flexibility in when, where, and how often they are used. The evidence so far also suggests that they are effective.
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Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Comportamento Aditivo/complicações , Comportamento Aditivo/psicologia , Viés , Transtorno do Deficit de Atenção com Hiperatividade/reabilitação , HumanosRESUMO
BACKGROUND: Anaphylaxis is an acute, potentially fatal, multi-organ system, allergic reaction caused by the release of chemical mediators from mast cells and basophils. Uncertainty exists around epidemiological measures of incidence and prevalence, risk factors, risk of recurrence, and death due to anaphylaxis. This systematic review aimed to (1) understand and describe the epidemiology of anaphylaxis and (2) describe how these characteristics vary by person, place, and time. METHODS: Using a highly sensitive search strategy, we identified systematic reviews of epidemiological studies, descriptive and analytical epidemiological investigations, and studies involving analysis of routine data. RESULTS: Our searches identified a total of 5,843 potentially eligible studies, of which 49 satisfied our inclusion criteria. Of these, three were suitable for pooled estimates of prevalence. The incidence rates for all-cause anaphylaxis ranged from 1.5 to 7.9 per 100,000 person-years. These data indicated that an estimated 0.3% (95% CI 0.1-0.5) of the population experience anaphylaxis at some point in their lives. Food, drugs, stinging insects, and latex were the most commonly identified triggers. CONCLUSIONS: Anaphylaxis is a common problem, affecting an estimated 1 in 300 of the European population at some time in their lives. Future research needs to focus on better understanding of the trends across Europe and identifying those most likely to experience fatal reactions.
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Anafilaxia/epidemiologia , Anafilaxia/diagnóstico , Anafilaxia/imunologia , Animais , Europa (Continente)/epidemiologia , Humanos , Incidência , Prevalência , Fatores de Risco , Síndrome , Fatores de TempoRESUMO
OBJECTIVE: This investigation aims to evaluate the validity of a Persian Tanner Stages Self-Assessment Questionnaire. METHODS: In this cross sectional study, 190 male students aged 8-16 years selected from three layers of different regions of Tehran (North, Central and South) were enrolled. A Persian questionnaire illustrated with Tanner stages of puberty (genital development and pubic hair distribution) was prepared. Children were asked to select the illustration that best described their pubertal development. Tanner status of the children was also estimated by an independent physician using physical examination. The degree of agreement between subjects' judgments with assessments made by the rater was compared through the calculation of the weighted kappa statistic coefficient. FINDINGS: We found a substantial agreement between self-assessment of pubertal development made by the children and doctor's assessment of genital development (kappa=0.63, P<0.0001) and also the pubic hair distribution (kappa= 0.74, P<0.0001). Although a large proportion of subjects in G4 (89.2%) and G5 (85.7%) were capable of accurately or almost accurately identifying their own Tanner sexual stages, some degree of disagreement was observed in G3 Tanner stage (%46.9). CONCLUSION: Self-assessment of puberty should be used very cautiously and may not be a substitute method for routine evaluation of pubertal state especially for early and mid pubertal groups.
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BACKGROUND: The nasal tip is one of the most important features of facial aesthetics and its modification is still a great challenge in rhinoplasty. The aim of this study was to evaluate outcomes of the Goldman tip procedure and suture technique on the shape of the nasal tip. PATIENTS AND METHODS: In a randomised clinical trial, 100 primary rhinoplasty patients were enrolled in two groups. One group underwent tip rhinoplasty by the Goldman tip procedure and the other one by suturing of cartilages. Rhinoplasty outcomes were evaluated after 12 months. RESULTS: On a 0-100 scale, postoperative patient satisfaction in the Goldman and suture groups improved, on average, by 49.16 and 23.12, respectively (P < 0.001). In objective assessments on a -8 to +8 scale, the mean of changes for the Goldman technique was +3.30 and for the suture technique, +1.18 (P < 0.001). There was no difference between the two techniques in terms of complications. There was a correlation between subjective and objective assessments in the suture technique group (P < 0.001, rho = 0.519). CONCLUSION: This study has shown that despite the efficacy of both techniques, the Goldman tip technique was associated with better results in terms of patient satisfaction and objective evaluations.
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Rinoplastia/métodos , Técnicas de Sutura , Adolescente , Adulto , Feminino , Humanos , Masculino , Cartilagens Nasais/cirurgia , Satisfação do Paciente , Adulto JovemRESUMO
The present study was conducted to find out whether combined treatment of intravenous urografin and corticosteroid has a therapeutic advantage over oral corticosteroid therapy in the treatment of Sudden Sensorineural Hearing Loss (SSNHL). The design of the study was an interventional and controlled clinical trial. Between 2003 and 2005, patients with SSNHL were treated in our center in Tabriz, Iran. Patients were selected if they had a hearing loss of at least 30 dB in at least 3 frequencies on audiometric testing. Audiograms were performed before admission, 1 and 2 weeks and 1 and 2 months after treatment. Patients who were put on bed rest and received intravenous urografin and hydrocortisone were compared with outpatients treated with oral steroid alone. Various descriptive analytical calculations and both Chi-square and t-test were used to analyze the data. Sixty patients were included in this study. Fifty-one patients referred to the otological clinics for the appropriate treatment within the first two weeks after the onset of hearing loss. The overall improvement of both groups was 53.3%. Seventeen (56.6%) of 30 patients treated in the inpatient group who received intravenous urografin and intravenous corticosteroid had hearing improvement, while half of the outpatient group received oral corticosteroid responded positively to the treatment (p > 0.05). This study revealed no significant difference in hearing improvement between the hospitalized patients who received intravenous urografin and corticosteroid and the patients who received oral corticosteroid alone.
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Diatrizoato de Meglumina/uso terapêutico , Perda Auditiva Neurossensorial/tratamento farmacológico , Perda Auditiva Súbita/tratamento farmacológico , Adolescente , Adulto , Idoso , Feminino , Perda Auditiva Neurossensorial/patologia , Perda Auditiva Súbita/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
This study examined associations between restraint, disinhibition and food-related processing bias (FPB, assessed by the emotional Stroop task) in males and females in the UK, Greece and Iran. Results showed high restraint was associated with higher FPB. However, high restrained current dieters showed lower FPB that high restrained non-dieters. There was no significant difference in FPB for those showing high versus low disinhibition. Results are discussed in relation to theories of incentive salience and current concerns.
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Dieta Redutora/psicologia , Ingestão de Alimentos/psicologia , Comportamento Alimentar/psicologia , Inibição Psicológica , Estudantes/psicologia , Adolescente , Adulto , Análise de Variância , Ingestão de Alimentos/fisiologia , Comportamento Alimentar/fisiologia , Feminino , Grécia , Humanos , Controle Interno-Externo , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Tempo de Reação , Leitura , Reino UnidoRESUMO
OBJECTIVE: The Muller-Lyer illusion is a visual illusion in which a horizontal shaft with an inward-pointing chevron (fins-out) affixed to each end is perceived longer than a shaft with outward-pointing chevrons (fins-in). The goal of this study was to compare the effects of experience and knowledge about the Muller-Lyer illusion on participants' perceptual precision. METHODS: Participants were undergraduate students (n = 108) who were not familiar with the Muller-Lyer illusion prior to the experiment. The task of participants was to adjust one movable line to make it equal to the other in Muller-Lyer figure. They received ascending and descending Muller-Lyer trials in three blocks with 20 trials each. The Experimental Group received information about the Muller-Lyer illusion prior to the third block. RESULTS: For the Experimental Group, the amount of departure in Block 3 was reduced significantly compared with previous blocks. CONCLUSION: Knowledge about the mechanisms underlying visual illusions may play an important role in helping individuals overcome them.
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Cognição/fisiologia , Ilusões/fisiologia , Aprendizagem/fisiologia , Percepção Visual/fisiologia , Adulto , Encéfalo/fisiologia , Feminino , Humanos , Masculino , Modelos Neurológicos , Testes Neuropsicológicos , Orientação/fisiologia , Reconhecimento Visual de Modelos/fisiologia , Estimulação Luminosa , Caracteres SexuaisRESUMO
This article summarizes a symposium on new ways to change implicit alcohol-related cognitions, presented at the 2005 Annual Meeting of the Research Society on Alcoholism in Santa Barbara, California, organized by Wiers and Cox. During the past few years, research has demonstrated that implicit cognitions predict unique variance in prospective alcohol use and preliminary results indicate that they also predict treatment outcomes. The central question in this symposium was how implicit cognitions can be changed and how the changes will influence behavior. Field presented data showing that an attentional bias for alcohol can be altered by attentional training: heavy drinkers who were trained not to attend to alcohol stimuli reported less craving and drank less beer than those trained to attend to alcohol stimuli. Schoenmakers used a similar, clinically relevant attentional retraining (AR) procedure, heavy drinkers were trained not to attend to alcohol pictures or received no training. After the training, the AR group attended less to the alcohol pictures than the control group. Fadardi described the Alcohol Attentional Control Training Program (AACTP), which makes alcohol drinkers aware of the automatic, cognitive determinants of their drinking and aims to help them to gain control over these processes. Data were presented to support the effectiveness of the AACTP. Palfai presented data showing that alcohol drinkers can be taught to use implementation intentions to gain control over their drinking, which may be used to automatically activate self-control skills in the presence of alcohol cues. In his discussion, Stacy pointed out the importance of recent cognitive theories that integrate attention and memory processes-theories that can help us better understand the mechanisms involved in AR. Together, the studies presented demonstrate that there are promising new ways in which implicit alcohol-related cognitions and their effects on drinking can be changed. After further refinement, these procedures might be used in clinical interventions that have not previously addressed implicit cognitive processes.
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Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/reabilitação , Atenção , Conscientização , Terapia Cognitivo-Comportamental , Enquadramento Psicológico , Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/psicologia , Condicionamento Clássico , Sinais (Psicologia) , Humanos , Controle Interno-Externo , Motivação , Resultado do TratamentoRESUMO
This paper discusses an Index developed and used to measure accessibility to health services provided on an outpatient basis at the Kaiser Community Health Foundation, Cleveland, Ohio. The Index is based on four levels of urgency or severity of illness and on the waiting times to get entry into the system. The parameters of the Index, initially established by task force members, were tested on a sample basis against the judgments of Kaiser outpatient facility users and finally refined through the consensus-seeking Delphi technique using a panel representing Kaiser members, gatekeepers, physicians and administrators. The actual times required to gain accessibility in the various process stages and in the various departments were obtained through simulated requests for appointments, by monitoring telephone calls to the various gate-keeping stations, by direct observations, and by the use of a telephone traffic computer. The paper discusses the Index developed, the data collection methodologies, and the data analyses performed.