Linking customer satisfaction, quality, and strategic planning

By acknowledging and dissecting the interconnected roles of customer satisfaction, quality, and strategic planning, this paper provides an analytical framework for creating a customer-driven organization and culture. It shows how quality starts and ends with the customer. Companies that are achieving long-term continuous improvement in quality tailored to customer satisfaction possess lasting characteristics such as customer orientation, customer consciousness, and customer responsiveness. In doing so, they liberate the quality concept from the narrow product or service focus to encompass total conformance to customer requirements in spite of the existing functionalization and departmentalization of modern complex structures. In addition to these key components, a customer-driven organization demands building and nurturing a customer satisfaction culture and value system that makes quality improvement and heightened concern for customer satisfaction a permanent aspect of organizational life.

The role of discriminant analysis in the refinement of customer satisfaction assessment

OBJECTIVE: To test discriminant analysis as a method of turning the information of a routine customer satisfaction survey (CSS) into a more accurate decision-making tool. METHODS: A 7-question, 10-multiple choice, self-applied questionnaire was used to study a sample of patients seen in two outpatient care units in Valparaíso, Chile, one of primary care (n=100) and the other of secondary care (n=249). Two cutting points were considered in the dependent variable (final satisfaction score): satisfied versus unsatisfied, and very satisfied versus all others. Results were compared with empirical measures (proportion of satisfied individuals, proportion of unsatisfied individuals and size of the median). RESULTS: The response rate was very high, over 97.0% in both units. A new variable, medical attention, was revealed, as explaining satisfaction at the primary care unit. The proportion of the total variability explained by the model was very high (over 99.4%) in both units, when comparing satisfied with unsatisfied customers. In the analysis of very satisfied versus all other customers, significant relationship was identified only in the case of the primary care unit, which explained a small proportion of the variability (41.9%). CONCLUSIONS: Discriminant analysis identified relationships not revealed by the previous analysis. It provided information about the proportion of the variability explained by the model. It identified non-significant relationships suggested by empirical analysis (e.g. the case of the relation very satisfied versus others in the secondary care unit). It measured the contribution of each independent variable to the explanation of the variation of the dependent one.

Are severe occlusal problems more frequent in permanent than deciduous dentition?

OBJECTIVE: To determine the prevalence and severity of occlusal problems in populations at the ages of deciduous and permanent dentition and to carry out a meta-analysis to estimate the weighted odds ratio for occlusal problems comparing both groups. METHODS: Data of a probabilistic sample (n=985) of schoolchildren aged 5 and 12 from an epidemiological study in the municipality of São Paulo, Brazil, were analyzed using univariate logistic regression (MLR). Results of cross-sectional study data published in the last 70 years were examined in the meta-analysis. RESULTS: The prevalence of occlusal problems increased from 49.0% (95% CI =47.4%-50.6%) in the deciduous dentition to 71.3% (95% CI =70.3%-72.3%) in the permanent dentition (p<0.001). Dentition was the only variable significantly associated to the severity of malocclusion (OR=1.87; 95% CI =1.43-2.45; p<0.001). The variables sex, type of school and ethnic group were not significant. The meta-analysis showed that a weighted OR of 1.95 (1.91; 1.98) when compared the second dentition period with deciduous and mixed dentition. CONCLUSIONS: In planning oral health services, some activities are indicated to reduce the proportion of moderate/severe malocclusion to levels that are socially more acceptable and economically sustainable.

Cutaneous leishmaniasis in frequent in equines from an endemic area in Rio de Janeiro, Brazil

In an endemic area of cutaneous leishmaniasis in Rio de Janeiro State where a mule had been found infected, a systematic search among equines was performed, resulting in the detection of Leishmania parasites in skin lesions of 30.8% of the animals, which included horses and mules. The eventual role of equines in the epidemiology of the human disease is being investigated.

Frequent occurrence of nicotinic acetylcholine receptors in GABAergic neurons of the chick visual system

Double-labeling immunohistochemical methods were used to investigate the occurrence of the alpha8 and alpha5 nicotinic receptor subunits in presumptive GABAergic neurons of the chick nervous system. Nicotinic receptor immunoreactivity was often found in cells exhibiting GABA-like immunoreactivity, especially in the visual system. The alpha8 subunit appeared to be present in presumptive GABAergic cells of the ventral lateral geniculate nucleus, nucleus of the basal optic root of the accessory optic system, and the optic tectum, among several other structures. The alpha5 subunit was also found in GABA-positive neurons, as observed in the lentiform nucleus of the mesencephalon and other pretectal nuclei. The numbers of alpha8- and alpha5-positive neurons that were also GABA-positive represented high percentages of the total number of neurons containing nicotinic receptor labeling in several brain areas, which indicates that most of the alpha8 and alpha5 nicotinic receptor subunits are present in GABAergic cells. Taken together with data from other studies, our results indicate an important role of the nicotinic acetylcholine receptors in the functional organization of GABAergic circuits in the visual system.

Do socioeconomic factors explain why maternal smoking during pregnancy is more frequent in a more developed city of Brazil?

The prevalence of smoking during pregnancy in Ribeirão Preto, a rich Brazilian city, was significantly higher (21.4%) than in São Luís (5.9%), a less developed city. To assess which variables explain the difference in prevalence of smoking during pregnancy, data from two birth cohorts were used, including 2846 puerperae from Ribeirão Preto, in 1994, and 2443 puerperae from São Luís, in 1997/98. In multivariable analysis, risk of maternal smoking during pregnancy was higher in São Luís for mothers living in a household with five or more persons (OR = 1.72, 95%CI = 1.12-2.64), aged 35 years or older (OR = 1.98, 95%CI = 0.99-3.96), who had five or more children (OR = 2.10, 95%CI = 1.16-3.81), and whose companion smoked (OR = 2.20, 95%CI = 1.52-3.18). Age of less than 20 years was a protective factor (OR = 0.55, 95%CI = 0.33-0.92). In Ribeirão Preto there was association with maternal low educational level (OR = 2.18, 95%CI = 1.30-3.65) and with a smoking companion (OR = 3.25, 95%CI = 2.52-4.18). Receiving prenatal care was a protective factor (OR = 0.24, 95%CI = 0.11-0.49). Mothers from Ribeirão Preto who worked outside the home were at a higher risk and those aged 35 years or older or who attended five or more prenatal care visits were at lower risk of smoking during pregnancy as compared to mothers from São Luís. Smoking by the companion reduced the difference between smoking rates in the two cities by 10%. The socioeconomic variables in the model did not explain the higher prevalence of smoking during pregnancy in the more developed city.

Hepatitis B virus genotype E detected in Brazil in an African patient who is a frequent traveler

Genotype E of hepatitis B virus (HBV) has not been described in Brazil and is found mainly in Africa. Genotype A is the most prevalent in Brazil, and genotypes B, C, D, and F have already been reported. We report here an HBV genotype E-infected patient and some characterization of surface (S) protein, DNA polymerase (P) and precore/core (preC/C) coding regions based on the viral genome. The patient is a 31-year-old black man with chronic hepatitis B who was born and raised in Angola. He has been followed by a hepatologist in São Paulo, Brazil, since November 2003, and he is a frequent traveler to Latin America, Africa, and Europe. In 2003, he was diagnosed with HBV infection and started treatment with lamivudine with the later addition of adefovir dipivoxil. No known risk factor was identified. Serologically, he is HBsAg and anti-HBe positive, but HBeAg and anti-HBs negative. DNA sequence analysis of the S/P region confirmed that this patient is infected with genotype E, subtype ayw4. The preC/C region showed G1896A and G1899A mutations but no mutations in the basal core promoter. Nucleotide substitutions common in genotype E were also observed (C1772, T1858 and A1757). Although this is not an autochthonous case and there is no evidence of further spread, the description of this case in Brazil highlights the current risk of viral genotypes spreading with unprecedented speed due to constant travel around the world.