CHAPTER 35	INDEXING PRINCIPLES FOR CATEGORY N 
	(HEALTH CARE) 
 

35.1		Category N was designed to describe the literature of the expanding  
field of health care throughout the world, especially in the United States and  
the industrialized world.  It provides terminology that is designed to answer a  
variety of questions with cohesive groups of headings in these subcategories: 
 
N1  - Population Characteristics 
What kinds of people use health care? 
(Demography, vital statistics, health and disease, socioeconomic factors) 
 
N2  - Facilities, Manpower and Services 
Where is care given?  Who gives the care?  What are the types of health care? 
(Health facilities, health personnel, health services, patient care  
characteristics) 
 
N3  - Economics, Organizations and Social Controls 
How is society involved? 
(Economics, costs and fees, financial management, financing, insurance, health  
planning, organizations, formal social control, policy) 
 
N4  - Health Services Administration 
How are services and facilities organized and administered? 
(Health facility administration, management information systems, personnel  
management, professional practice, public relations, records, patient care  
management, quality) 
 
N5  - Quality, Access, Evaluation 
How can the appropriateness, accessibility, efficacy, efficiency, and quality of  
health care be evaluated? 
(Delivery of health care, ethics, quality, evaluation mechanisms, statistics,  
study characteristics, study design) 
 
Except for a few terms in Categories N1 through N4 serving as NIM parameters,  
most terms in these four categories are IM.  However, many of the terms in N5  
indented under STATISTICS, under STUDY CHARACTERISTICS (NON MESH), and under  
STUDY DESIGN (NON MESH), are research parameters and are usually NIM, except  
when they are discussed in general as subjects.  Consult ANNOTATED MESH for  
suggestions and restrictions on making individual terms IM or NIM. 
 
All of the terms in Category N5 also appear in other categories, except for the  
following two NON MESH leading hierarchical terms: QUALITY, ACCESS, EVALUATION  
and EVALUATION MECHANISMS, HEALTH CARE.  This Category was designed to group  
together terms that involve health services research, technology assessment, and  
the evaluation of diagnostic/therapeutic procedures in order to make online  
searching easier for health service researchers.  For indexers, it provides the  
convenience of one category to locate these terms. 
 

35.2		The subheadings available for use with trees in N Category are: 
 
	N1 List - Population Characteristics 
 
	CL /class	HI /hist	SN /statist 
		 
	N2 List - Facilities, Manpower and Services  
 
	CL /class	LJ /legis	OG /organ		SD /supply 
	EC /econ	MA /man	ST /stand		TD /trends 
	HI /hist	MT /methods	SN /statist		UT /util 
 
	N3 - Economics, Organizations, Control 
 
	CL /class	LJ /legis	ST /stand		TD /trends 
	EC /econ	OG /organ	SN /statist		UT /util 
	HI /hist 
 
	N4 - Health Services Administration 
 
	CL /class	LJ /legis	ST /stand		TD /trends 
	EC /econ	OG /organ	SN /statist		UT /util 
	HI /hist 
 
	N5 - Quality, Access, Evaluation 
 
	CL /class	LJ /legis	ST /stand		TD /trends 
	EC /econ	OG /organ	SN /statist		UT /util 
	HI /hist 
 
The array above represents a general assignment of subheadings by subcategory.   
In addition, every MeSH heading is assigned either a listing of allowed  
subheadings specific to that term or is allowed no subheadings at all.   
Naturally, every assigned subheading does not fit with every term in the  
subcategories above, and even specifically allowed main heading/subheading  
combinations should be given some thought. 
 
For example, although HOSPITAL ADMINISTRATION is in Categories N2, N4, and G2 to  
which /organization & administration has been assigned, the combination HOSPITAL  
ADMINISTRATION/organization & administration is redundant and is not allowed.   
Similarly, although COSTS AND COST ANALYSIS is in the N3 Tree to which  
/economics has been assigned, the combination COSTS AND COST ANALYSIS/economics  
is questionable, even though it is allowed.  Use common sense in applying  
allowed subheadings. 
 
N Category specialty terms that are also in Category G2 allow the assignment of  
subheadings from the Specialties List, as well as those from applicable N  
Category lists.  The subheadings available for use with the G2 Category are: 
 
	Specialties List (G2 - Health Occupations)   
 
	CL /class	HI /hist		MA /man		ST /stand 
	EC /econ	IS /instrum	MT /methods			SN /statist 
	ED /educ	LJ / legis	OG /organ			TD /trends 
 
		See Manual Chapter 28 for more information on Category G2. 
 

35.2.1	Administrative subheadings are not as specific as clinical  
subheadings--they overlap greatly.  Therefore, it is preferable not to add  
strings of administrative subheadings to one term.  Identify any prevailing  
subheading, make it IM, and assign few other subheadings.  In assigning  
administrative subheadings, remember the following subheading hierarchy: 
 
			organization & administration 
				economics 
				legislation & jurisprudence 
				manpower 
				standards 
				supply & distribution 
				trends 
				utilization 
 

35.2.2	When assigning the subheading /economics, consult the N3 Category  
for specific economic terms in order to coordinate main headings. 
 
Financial audit in nursing homes: 
	NURSING HOMES / * econ 
	*FINANCIAL AUDIT  (N3) 
 
Watch for pre-coordinated economics terms in N3. 
 
			ECONOMIC COMPETITION 
			ECONOMIC VALUE OF LIFE 
			ECONOMICS, DENTAL 
			ECONOMICS, HOSPITAL 
			ECONOMICS, MEDICAL 
			ECONOMICS, NURSING 
			ECONOMICS, PHARMACEUTICAL 
			INFLATION, ECONOMIC 
			MODELS, ECONOMETRIC 
			MODELS, ECONOMIC 
See also Section 19.8.27 (/economics) for illustrations. 
 

35.2.2.3	Index MODELS, ECONOMETRIC (IM) for models that apply mathematical  
formulas and statistical techniques in the testing and quantifying of broad  
economic theories or the solution of broad economic problems.  Do not use it for  
the application of statistical formulas to very specific economic or financial  
subjects, such as cost benefit analysis, for which MODELS< ECONOMICis correct  
term.  Note that MODELS ECON is the short form for MODELS, ECONOMIC. 
 
Economic theories of competition in health care delivery: 
DELIVERY OF HEALTH CARE / * econ 
	*MODELS, ECONOMETRIC			 
	*ECONOMIC COMPETITION  
 
Economic formulas used to calculate statistically the cost effectiveness of  
magnetic resonance imaging: 
	MAGNETIC RESONANCE IMAGING / * econ 
	COST BENEFIT ANALYSIS / methods 
	MODELS, ECONOMIC 
 

35.2.2.4	Index the broad, pre-coordinated economic subject field or specialty  
terms (IM) for general articles only.  These articles usually cover an entire  
geographic area or time period. 
 
Trends in hospital economics under the Medicare prospective reimbursement  
system: 
	ECONOMICS, HOSPITAL / * trends 
	MEDICARE A / * econ 
	PROSPECTIVE PAYMENT SYSTEM  / * econ 
	UNITED STATES 
 
Assign the subheading /economics to index articles about particular health  
facilities, their departments or units, and coordinate with the term for that  
specific economic aspect discussed.  Do not also index the broad, pre- 
coordinated economic subject field or specialty term. 
 
Financial management in pediatric hospitals: 
	HOSPITALS, PEDIATRIC / * econ 
	*FINANCIAL MANAGEMENT, HOSPITAL 
	(Do not also index ECONOMICS, HOSPITAL)  
 

35.2.3	Although /education is not available to Category N, it is available  
to N Category headings indented under HEALTH PERSONNEL that are also in Category  
M and to N Category specialty terms that are also in Category G2.  For example,  
the following combinations are permitted: 
 
			HOSPITAL ADMINISTRATION / educ	(specialty) 
			GERIATRIC NURSING / educ		(specialty) 
			PUBLIC HEALTH / educ			(specialty) 
			NURSE CLINICIANS / educ			(personnel) 
			PERSONNEL, HOSPITAL / educ		(personnel) 
			MEDICAL STAFF, HOSPITAL / educ	(personnel) 
 
Do not use /education with the following personnel headings: DENTISTS, NURSES,  
PHARMACISTS, and PHYSICIANS.  These are correctly indexed instead as EDUCATION,  
DENTAL; EDUCATION, NURSING; EDUCATION, PHARMACY; EDUCATION, MEDICAL  
respectively.  The specific type of education indented under each may be  
substituted. 
 
However, /education is available with all remaining personnel headings in  
Category N2 indented under HEALTH PERSONNEL except for FACULTY, DENTAL; FACULTY,  
MEDICAL; and FACULTY, NURSING. 
 
When assigning /education, consult the I2 Category (Education--Professional and  
Nonprofessional) for specific education terms in order to coordinate main  
headings. 
 
Graduate education in hospital administration: 
	HOSPITAL ADMINISTRATION / * educ 
	*EDUCATION, GRADUATE  (I2) 
 
Watch for pre-coordinated education terms in I2. 
 
See also Section 19.8.28 (/education) for illustrations. 
 

35.2.4	When assigning the subheading /legislation & jurisprudence, consult  
the N3 Category under SOCIAL CONTROL, FORMAL for specific terms implying  
legislative, regulatory, or private sector control in order to coordinate main  
headings. 
 
Legal liability in failing to implement the Americans with Disabilities Act: 
	DISABLED / * legis 
	*LIABILITY, LEGAL  (N3) 
	UNITED STATES 
 
Watch for pre-coordinated legislative terms in N3. 
 
			ANTITRUST LAWS 
			LIABILITY, LEGAL 
			LEGISLATION, DENTAL 
			LEGISLATION, DRUG 
			LEGISLATION, FOOD 
			LEGISLATION, HOSPITAL 
			LEGISLATION, MEDICAL 
			LEGISLATION, NURSING 
			LEGISLATION, PHARMACY 
			LEGISLATION, VETERINARY 
 
See also Section 19.8.42 (/legislation & jurisprudence) for illustrations.	 
		 
 

35.2.4.1	MeSH contains the following see reference: HEALTH LEGISLATION see  
LEGISLATION.  However, prefer a health service, facility, personnel, or planning  
term with the subheading /legislation & jurisprudence to express this concept.   
In its broadest application, this could be one of the following: 
 
			HEALTH SERVICES / * legis 
			DELIVERY OF HEALTH CARE / * legis 
 

35.2.4.2	Index the broad, pre-coordinated legal subject field or specialty  
terms (IM) for general articles only. 
 
Hospital antitrust legislation in the United States: 
	*LEGISLATION, HOSPITAL 
	*ANTITRUST LAWS 
	UNITED STATES 
 
Assign the subheading /legislation & jurisprudence to index articles about  
particular health facilities, their departments or units, and coordinate with  
the term for that specific legal or judicial aspect discussed.  Do not also  
index the broad, pre-coordinated legal subject field or specialty term. 
 
Legality of emergency room patient transfer in Texas: 
	EMERGENCY SERVICE, HOSPITAL / * legis 
	PATIENT TRANSFER / * legis 
	TEXAS 
(Do not also index LEGISLATION, HOSPITAL) 
 

35.2.5	The subheadings /manpower and /supply & distribution are two  
commonly applicable Category N2-N4 subheadings.  When they are used to indicate  
personnel in the field, they should be applied as follows:  
 
/manpower		Who is available?  What type of person is available?  Use with  
specialties, services, and facilities.  Do not use with personnel headings. 
 
/supply & distribution			How many of these people are there?  Where  
are they?  Use with 							personnel headings. 
 
		Consider the following examples. 
 
Availability of physicians: 
	PHYSICIANS / supply 
 
Availability of internists: 
	INTERNAL MEDICINE / man 
 
When assigning /manpower, consult the HEALTH PERSONNEL terms listed in N2 in  
order to coordinate main headings. 
 
Using nurse clinicians in skilled nursing facilities: 
	SKILLED NURSING FACILITIES / * man 
	NURSE CLINICIANS / * util  
 
See also Sections 19.8.43 (/manpower) and 19.8.69 (/supply & distribution) for  
illustrations. 
 

35.2.6	When assigning /organization & administration, consult the N4  
Category for organizational terms in order to coordinate main headings. 
 
Governance in university hospitals: 
	HOSPITALS, UNIVERSITY / * organ 
* GOVERNING BOARD (N4) 
 
Watch for numerous pre-coordinated organizational, management, and  
administration terms. 
 
Remember, this subheading is at the top of a hierarchy of subheadings--it  
includes economics, legislation & jurisprudence, manpower, standards, supply &  
distribution, trends, and utilization aspects. 
 
Assign the subheading /organization & administration to index articles about  
particular health facilities, their departments or units, and coordinate with  
the term for that specific administrative aspect discussed.  Do not also index  
the broad, pre-coordinated administrative subject field or specialty term. 
 
Management innovation in community hospitals: 
	HOSPITALS, COMMUNITY / * organ 
	*ORGANIZATIONAL INNOVATION 
(Do not also index HOSPITAL ADMINISTRATION) 
 
See Section 19.8.49 (/organization & administration) for illustrations. 
 

35.2.7	When assigning /standards as an aspect of quality, consult the N4  
Category for specific terms under QUALITY OF HEALTH CARE in order to coordinate  
main headings.  
 
Quality assurance in hospital nursing: 
	NURSING SERVICE, HOSPITAL / * stand 
	*QUALITY ASSURANCE, HEALTH CARE 
 
Look for the following words as indications for using /standards: adequacy,  
appraisal, assessment, audit, competence, criteria, evaluation, guideline,  
improvement, quality. 
 
See also Section 19.8.67 (/standards) for illustrations. 
 

35.2.8	The subheading /statistics & numerical data is used frequently with  
N Category terms for the expression of numerical values which describe  
particular sets or groups of data.  Although /statist is an allowed qualifier  
for most N Category terms, prefer a more specific subheading.  Statistics on  
economics, manpower, supply and distribution, and utilization are indexed as  
/econ, /man, /supply, and /util, respectively.  /statist may be added as a  
second (NIM) subheading if significant statistical or numerical data is present.   
 
Statistical analysis of the hospital economy in California: 
	ECONOMICS, HOSPITAL / * statist 
	CALIFORNIA 
 
Statistical data on personnel turnover in urban emergency departments: 
EMERGENCY SERVICE, HOSPITAL / * man / statist 
	HOSPITALS, URBAN / * man / statist 
	PERSONNEL TURNOVER / * statist 
 
Numerical data on the distribution of physicians in the United States: 
	PHYSICIANS / * supply / statist 
	UNITED STATES 
 
Statistical analysis of community hospital patient admission rates: 
	HOSPITALS, COMMUNITY / * util / statist 
	PATIENT ADMISSION / * statist 
 
When using /statistics & numerical data, consult the N5 Category under  
STATISTICS for specific statistical techniques.  MODELS, STATISTICAL is also  
available. 
 
See also Section 19.8.68 (/statistics & numerical data) for illustrations. 
 

35.2.9	The subheading /trends expresses aspects of change over time.  It  
may be coordinated with FORECASTING for future trends.  Look for the following  
words as indications for using /trends: changing, emerging, forecast, future,  
outlook, projecting, shifting, transition. 
 
Although /trends is allowed with most N Category terms, prefer a more specific  
subheading.  Trends in economics, manpower, supply and distribution, and  
utilization are indexed as /econ, /man, /supply, and /util, respectively. 
 
Trends in health manpower: 
	HEALTH MANPOWER / * trends 
 
New developments in positron emission tomography: 
TOMOGRAPHY, EMISSION-COMPUTED / * trends 
 
Trends in staffing home care services: 
	HOME CARE SERVICES / * man 
PERSONNEL STAFFING AND SCHEDULING / * trends 
 
Forecasting trends in the utilization and need for heart catheterization: 
	HEART CATHETERIZATION / * util 
HEALTH SERVICES NEEDS AND DEMAND / * trends 
	FORECASTING 
 
See also Section 19.8.76 (/trends) for illustrations. 
 

35.2.10	The subheading /utilization is used with personnel, services,  
facilities, and diagnostic and therapeutic procedures and techniques to answer  
the following types of quantitative questions and also to express overuse and  
underuse: 
 
Personnel		How are the people used?  Where are they used?  How often are  
they used? 
 
Services		How often are the services used?  Who uses the services? 
 
Facilities		How often are the facilities used?  Who uses the facilities? 
 
Procedures & techniques		How often are the procedures  and techniques used? 
					What are the rates of use?  Who uses them?  
Do not use /utilization for discussions of how they are used. 
 
Consider the following examples: 
 
How often are physicians' assistants used in family practice?: 
	PHYSICIANS' ASSISTANTS / * util 
	FAMILY PRACTICE / * man 
 
What types of patients use preventive health services?: 
	PREVENTIVE HEALTH SERVICES / * util 
	PATIENTS / * class 
 
Use of hospital emergency rooms for primary care: 
	EMERGENCY SERVICE, HOSPITAL / * util 
	*PRIMARY HEALTH CARE 
 
Utilization review of cesarean section: 
	CESAREAN SECTION / * util 
	*UTILIZATION REVIEW 
			 
Watch for pre-coordinated terms that imply utilization.  Among them are the  
following terms: 
 
			CONCURRENT REVIEW 
			DIAGNOSTIC TESTS, ROUTINE 
			DRUG UTILIZATION 
			DRUG UTILIZATION REVIEW 
			HEALTH SERVICES MISUSE 
			INSURANCE CLAIM REVIEW 
			UTILIZATION REVIEW 
 
Such pre-coordinated terms are often assigned together with the specific  
service, personnel, or facility term, as follows: 
 
Overuse of ultrasonography: 
	ULTRASONOGRAPHY / * util 
	*HEALTH SERVICES MISUSE  
 
See also Section 19.8.80 (/utilization) for illustrations. 
 

35.3		If Category N main headings are central concepts (IM), and the  
geographic location is known, always add the given geographic location from  
Category Z (NIM).  (Note: Z Category terms are always NIM.)  It is important to  
health administrators, planners, policy makers, and researchers to know the  
specific geographic location of the study, facility, or service. 
 
Health policy reform in Canada: 
	*HEALTH CARE REFORM 
	CANADA  (NIM) 
 
Hospital restructuring in Guy's Hospital, London: 
	*HOSPITAL RESTRUCTURING 
	LONDON  (NIM) 
 
In some cases, N Category main headings are unique to the United States.  In  
such cases, while ANNOTATED MESH so instructs the indexer and the AIMS system  
adds UNITED STATES automatically, the indexer must add a state or city name when  
substantially discussed. 
 
The Medicaid program in Oregon: 
	*MEDICAID 
	OREGON  (NIM) 
	UNITED STATES  (NIM)  (AIMS validation) 
 

35.4		Most clinical disease studies take place within health facility  
populations.  If the essence of this type of article is clinical, rather than  
administrative, use the terms HOSPITALIZATION (NIM), INSTITUTIONALIZATION (NIM),  
or the health facility term (NIM) to express where the therapeutic or diagnostic  
procedures under study took place, if this is significant.  Do not add an IM  
health facility term unless it is highly relevant to the substance of the  
article that the study took place in a certain type of health facility or health  
facility department or unit. 
 
Clinical study on treating asthma in an emergency room population: 
	ASTHMA / * ther 
	EMERGENCY SERVICE, HOSPITAL  (NIM) 
 
Organizing the emergency room to treat asthma patients efficiently: 
	ASTHMA / * ther 
	EMERGENCY SERVICE, HOSPITAL / * organ 
 

35.5		Index AGE FACTORS or AGE DISTRIBUTION generally as NIM coordinates  
when used with specific diseases, physiological processes, social, cultural,  
sociological, psychological, and demographic concepts.  They will usually appear  
in articles discussing a specific subject from various viewpoints, such as age,  
sex, economics, marital status, educational background, etc.  In AGE FACTORS the  
emphasis is usually on age and other factors with cause and effect implications.   
In age factor articles the aging process (AGING, see below) is not at issue. In  
AGE DISTRIBUTION the emphasis is largely statistical and concerns the frequency  
of different ages or age groups in a given population.  Indexed as one of the  
parameters for depth indexing, AGE FACTORS and AGE DISTRIBUTION are NIM. 
 
The relative percentages of different age groups in the homeless population: 
	HOMELESS PERSONS / * statist 
	AGE DISTRIBUTION  (NIM) 
 
Age is one of several factors in health services accessibility: 
	*HEALTH SERVICES ACCESSIBILITY 
	AGE FACTORS  (NIM) 
 
In occasional articles where age is the sole factor and is the main point, AGE  
FACTORS is IM. 
 
Cancer treatment as affected by age: 
	NEOPLASMS / * ther 
	*AGE FACTORS 
 

35.5.1	When indexing AGE FACTORS and AGE DISTRIBUTION, check the age groups  
if given (MeSH age groups are human age groups).  If no specific age groups are  
given, check ANIMAL or HUMAN.  These concepts are not restricted to humans or to  
medicine. 
 

35.5.2	Do not confuse AGE FACTORS with AGING (Category G), a physiological  
concept.  Articles discussing aging will deal usually with the aging process and  
should be indexed under AGING.  In articles on AGING the author sometimes  
illustrates with subjects whose ages are specified.  In these cases check the  
age tags required, but do not add AGE FACTORS. 
 

35.5.3	Do not confuse AGE FACTORS with TIME FACTORS.  The response of lower  
organisms with the passage of time is sometimes referred to in titles and text  
as "aging" or "age-dependent", for example with regard to cultures.  This is not  
to be indexed as AGE FACTORS despite the wording. 
 
Demographic factors, including age, in per capita income of physicians: 
	*INCOME 
	PHYSICIANS / * econ 
	*DEMOGRAPHY  
	AGE FACTORS 
 
Age factor in kidney function during acclimatization to cold: 
	KIDNEY / * physiol 
	*COLD 
	*ACCLIMATIZATION 
	AGING / * physiol 
(Do not add AGE FACTORS despite wording of example) 
 
Techniques for synchronization and aging of large-scale bacterial cultures: 
	*BACTERIOLOGICAL TECHNIQUES 
	TIME FACTORS 
	(Do not add AGE FACTORS or AGING) 
 

35.5.4	There are many additional age-related terms in N Category and other  
MeSH Categories that are alternatives to or more specific than AGE FACTORS and  
AGE DISTRIBUTION.  These include, for example:  
 
			ADOLESCENT, HOSPITALIZED 
			ADOLESCENT HEALTH SERVICES 
			AGE OF ONSET 
			CHILD, HOSPITALIZED 
			CHILD CARE 
			CHILD HEALTH SERVICES 
			DENTAL CARE FOR AGED 
			GESTATIONAL AGE 
			HEALTH SERVICES FOR THE AGED 
			HOMES FOR THE AGED 
			INFANT CARE 
			INTERGENERATIONAL RELATIONS 
			MATERNAL AGE 
			OLD AGE ASSISTANCE 
			PATERNAL AGE 
 
Consider these in preference to AGE FACTORS or AGE DISTRIBUTION when applicable. 
 

35.6		Index SEX FACTORS and SEX DISTRIBUTION generally as NIM coordinates  
when used with specific diseases, physiological processes, social, cultural,  
sociological, psychological, and demographic concepts.  They will usually appear  
in articles discussing a specific subject from various viewpoints, such as sex,  
age, economics, marital status, educational background, etc.  In SEX FACTORS the  
emphasis is usually on sex and other factors with cause and effect implications.   
In SEX DISTRIBUTION, the concept is largely statistical with emphasis on the  
number of males and females in a given population.  Indexed as one of the  
parameters for depth indexing, SEX FACTORS and SEX DISTRIBUTION are NIM. 
 
Relative percentages of males and females in Canadian intermediate care  
facilities: 
	INTERMEDIATE CARE FACILITIES / * util 
	SEX DISTRIBUTION  (NIM) 
	CANADA 
 
Sex factors are one of several factors in overuse of health services: 
	*HEALTH SERVICES MISUSE 
	SEX FACTORS  (NIM) 
 
In occasional articles where sex is the sole factor and is the main point, SEX  
FACTORS is IM. 
 
Utilization of life support care as affected by sex: 
	LIFE SUPPORT CARE / * util 
	*SEX FACTORS 
 
Comparing physician responsiveness to womens' and mens' health complaints: 
	*PHYSICIAN-PATIENT RELATIONS 
	*SEX FACTORS 
 

35.6.1	When indexing SEX FACTORS and SEX DISTRIBUTION, also check MALE,  
FEMALE, or both, along with ANIMAL or HUMAN.  These concepts are not restricted  
to humans or to medicine. 
 

35.6.2	Do not index with SEX FACTORS at all for straightforward  
epidemiological material, but consider SEX DISTRIBUTION.  The occurrence of  
disease in women is indexed under the name of the disease with the subheading  
/epidemiology (IM) and the check tags FEMALE and HUMAN.  The same policy is true  
of the incidence of a disease in men: the name of the disease with the  
subheading /epidemiology (IM) and the check tags MALE and HUMAN.  However, an  
article on the relative occurrence of a disease in male and female populations  
is indexed with the name of the disease with the subheading /epidemiology, the  
check tags MALE, FEMALE, and HUMAN, and SEX DISTRIBUTION.  SEX FACTORS is  
indexed only if the author discusses sex as a determining factor in disease  
incidence.  
 
Incidence of tuberculosis in male and female populations in New York City: 
	TUBERCULOSIS / * epidemiol 
	SEX DISTRIBUTION  (NIM)  
	NEW YORK CITY / epidemiol 
 

35.6.3	There are many additional sex-related terms in N Category and other  
MeSH Categories that are alternatives to or more specific than SEX FACTORS and  
SEX DISTRIBUTION.  These include, for example:  
 
			FATHERS 
			MEN 
			MOTHERS 
			MATERNAL HEALTH SERVICES 
			PHYSICIANS, WOMEN 
			SEX BEHAVIOR 
			SEX CHARACTERISTICS 
			SEX DETERMINATION 
			SEX DIFFERENTIATION 
			SEX RATIO 
			SEXUAL HARASSMENT 
			WOMEN 
			WOMEN, WORKING 
			WOMEN'S HEALTH 
			WOMEN'S HEALTH SERVICES 
			WOMEN'S RIGHTS 
 
Consider these in preference to SEX FACTORS and SEX DISTRIBUTION when  
applicable. 
 

35.7		SOCIOECONOMIC FACTORS in general, like AGE FACTORS and SEX FACTORS,  
will usually be NIM as a coordinate to an IM disease or other subject discussed.   
Read the instructions in 35.5 and 35.6 above to get the general tenor of our  
approach. 
 
Occurrence of AIDS within certain groups defined by income, social class,  
unemployment, and educational status: 
ACQUIRED IMMUNODEFICIENCY SYNDROME / * epidemiol 
	SOCIOECONOMIC FACTORS  (NIM) 
 
SOCIOECONOMIC FACTORS is IM when it is the point of the article, as shown in the  
following example: 
 
Homelessness is determined by socioeconomic factors: 
	*HOMELESS PERSONS 
	*SOCIOECONOMIC FACTORS 
 
The specific terms indented under SOCIOECONOMIC FACTORS in N1 Category are  
frequently IM. 
 
As with AGE FACTORS and SEX FACTORS, check all relevant age and sex check tags.   
While the SOCIOECONOMIC FACTORS tree hierarchy is inherently human, the indexing  
of MALE or FEMALE requires HUMAN also. 
 
Consider also Category N3 for more specific economic terms. 
 

35.8		CONGRESSES is used for general articles about congresses,  
conferences, or meetings as a means of communication.  It is not to be used for  
announcements of individual congresses. 
 
The value of congresses in promoting cooperation between the United States and  
China: 
	*CONGRESSES 
	*INTERNATIONAL COOPERATION 
	UNITED STATES  (NIM) 
	CHINA  (NIM) 
 
How to organize a successful conference: 
	CONGRESSES / * organ 
 
While announcements of individual congresses are not selected for indexing, a  
publisher sometimes presents as an article a list of national or international  
congresses on a specific subject area.  Since this information is useful to  
reference librarians, the indexer will index this article, if it appears to have  
reference value.  Index under the specific subject (IM), CONGRESSES (IM), and  
DIRECTORY (PT) (see Section 17.30), adding a geographic heading if congress  
locations are given and relevant. 
 
Family practice conferences in the U.S. and Canada: 
	*FAMILY PRACTICE 
	*CONGRESSES 
	UNITED STATES  (NIM) 
	CANADA  (NIM) 
	DIRECTORY (PT) 
 
A calendar of hematology congresses for the next five years: 
	*HEMATOLOGY 
	*CONGRESSES 
	DIRECTORY (PT) 
 

35.8.1	Do not confuse CONGRESSES, the main heading, with MEETING REPORT  
(PT), the publication type.  The former is about congresses or conferences,  
while the latter is used for collections of reports, papers, or abstracts that  
are presented at congresses, conferences, or meetings. 
 
The report of the scientific or administrative material presented at a  
conference or congress is indexed as if it were an independent article, with the  
addition of MEETING REPORT (PT) (see Section 17.51). 
 
Selection of reports of material presented at congresses is detailed in Section  
4.6.4.  
 

35.8.2	Specific types of congresses are indented under CONGRESSES in  
Category N3:  CONSENSUS DEVELOPMENT CONFERENCES and CONSENSUS DEVELOPMENT  
CONFERENCES, NIH.  Again, do not confuse these main headings which are about  
these types of conferences, with the publication types which are the reports of  
the scientific materials presented at these conferences.  See CONSENSUS  
DEVELOPMENT CONFERENCE (PT), Section 17.24, and CONSENSUS DEVELOPMENT  
CONFERENCE, NIH (PT), Section 17.25, for instructions on the use of these  
publication types. 
 

35.9		The terms in Category N referring to organized bodies (FOUNDATIONS;   
ORGANIZATIONS; ACADEMIES AND INSTITUTES; SOCIETIES; SOCIETIES, MEDICAL; etc.)  
overlap in the dictionary definition of these words, in the MeSH definition or  
intent, in the corporate structure of the bodies, and in the names adopted by  
the bodies themselves.  Index under the term closest to that used by the  
organization or association in its corporate name.  The least frequently used of  
these MeSH headings is ORGANIZATIONS: avoid it as a generic designation and as  
of little meaning. 
 

35.9.1	SOCIETIES will be used as a synonym for "Association" and applies to  
those bodies left over after the indexer has considered more specific terms,  
such as: AMERICAN HOSPITAL ASSOCIATION; SOCIETIES, DENTAL; SOCIETIES, HOSPITAL;  
SOCIETIES, MEDICAL; SOCIETIES, NURSING; SOCIETIES, PHARMACEUTICAL; and  
SOCIETIES, SCIENTIFIC.  SOCIETIES will be used for physical therapy  
associations, sociological associations, and similar organizations for which  
there are no specific terms. 
 
SOCIETIES, SCIENTIFIC should be reserved for such bodies as the American  
Association for the Advancement of Science or the members of Federation of  
American Societies for Experimental Biology (FASEB). 
 
Index articles on the various organized bodies in MeSH under the name of the  
subject field or specialty to which the members are dedicated (IM), the correct  
society or other organizational heading (IM), and the geographic location of the  
society (NIM).  If no MeSH subject field or specialty term is available, index  
under an applicable personnel term (IM). 
 
American Association for Respiratory Therapy: 
	*SOCIETIES 
	*RESPIRATORY THERAPY  (subject field) 
	UNITED STATES 
 
American Society for Hospital Materials Management: 
	*SOCIETIES, HOSPITAL 
*MATERIALS MANAGEMENT, HOSPITAL  (subject field) 
	UNITED STATES 
 
American College of Hospital Administrators: 
	*SOCIETIES, HOSPITAL 
	*HOSPITAL ADMINISTRATION  (specialty) 
	UNITED STATES 
 
American Health Information Management Association 
	*SOCIETIES 
*MEDICAL RECORD ADMINISTRATORS  (personnel) 
	UNITED STATES 
 
Index state hospital or medical societies under SOCIETIES, HOSPITAL (IM) or  
SOCIETIES, MEDICAL (IM) and the state (NIM). 
 
Maryland Hospital Association: 
	*SOCIETIES, HOSPITAL 
	MARYLAND 
 

35.9.2	Membership lists and directories of societies and other  
organizations are indexed under the society heading (IM), the specialty heading  
(IM), the geographical term (NIM), and DIRECTORY (PT). 
 
See Sections 36.15, 36.16, and 36.17 for societies in relation to geographics. 
 

35.10		Addresses given by presidents of societies appear most frequently in  
state hospital and medical journals, but are published in other types of  
journals too. 
 
These are to be indexed, but since they are usually nostalgic, philosophical,  
organizational, of immediate interest, and sometimes querulous in tone, they are  
hard to index.  Often American ones speak of the status of medical care in this  
country and of the impact of Medicare and other governmental enterprises on  
physicians.  Many are quite editorial in nature.  Presidential addresses,  
however, are indexable. 
 
The marking of titles of presidential addresses is discussed in 14.5.2.  If the  
presidential address is substantive and on a specific indexable subject, index  
under the subject (IM) as you do with any article, assigning all required main  
headings, subheadings, and check tags.  Make no mention, however, about its  
nature as a presidential address.  Do not index under any society term and do  
not supply a geographical heading for the society. 
 
If little is said beyond the general words of an incoming or outgoing figure in  
any office, index under the society heading (IM), under the specialty heading  
(IM), and under the geographical location of the society. 
 

35.11		Distinguishing between the main headings HEALTH OCCUPATIONS, HEALTH  
MANPOWER, HEALTH PERSONNEL, and CAREGIVERS. 
 
HEALTH OCCUPATIONS is listed in the G2 Category (Health Occupations) at the head  
of the category.  It is indexed in very general articles about the health  
specialties.  Specific specialty or personnel terms are almost always assigned,  
rather than HEALTH OCCUPATIONS.  Health occupations manpower is indexed as  
HEALTH MANPOWER. 
 
Trends in career choice in the health occupations: 
	HEALTH OCCUPATIONS / * trends 
	*CAREER CHOICE 
 
HEALTH MANPOWER is listed in the N2 and N5 Categories with no terms indented  
under it.  It is indexed (IM) in general articles about manpower availability-- 
policy, planning, distribution, and trends.  HEALTH MANPOWER is also indexed  
(NIM) in coordination with a specialty/manpower or personnel/supply &  
distribution combination when a specific aspect of manpower in that specialty or  
regarding those personnel is discussed. 
 
Trends in health manpower in Great Britain: 
	HEALTH MANPOWER / * trends 
	GREAT BRITAIN 
 
The availability of nurse practitioners in 2020: 
	NURSE PRACTITIONERS / * supply 
	HEALTH MANPOWER / trends  (NIM) 
 
HEALTH PERSONNEL is listed in the M1 and N2 Categories with all of the specific  
personnel terms indented under it.  These are the people actually working in or  
employed in health facilities and services.  Occasionally, articles will discuss  
health personnel in general, rather than focusing on a particular group of  
providers. 
 
Occupational safety of health personnel: 
	*HEALTH PERSONNEL 
	*OCCUPATIONAL HEALTH 
 
Articles on the availability, distribution, or supply of health personnel in  
general are indexed as HEALTH MANPOWER.  HEALTH MANPOWER and HEALTH PERSONNEL  
are listed at the same level in the N2 Category--neither one is indented under  
the other.  
 
CAREGIVERS is used for persons who provide care to those who need supervision or  
assistance in illness or disability.  While it includes health professionals, it  
is more likely to be used for non-professional health personnel, such as family  
members, spouses, parents, friends, clergy, teachers, etc.  In Categories M1 and  
N2 CAREGIVERS is indented at the next level under HEALTH PERSONNEL. 
 
Home caregiver stress in caring for patients with Alzheimer's disease: 
	CAREGIVERS / * psychol 
	HOME NURSING / * psychol 
	ALZHEIMER'S DISEASE / * nurs  
	STRESS, PSYCHOLOGICAL 
 

35.12		Distinguishing between the main headings ALLIED HEALTH OCCUPATIONS  
and ALLIED HEALTH PERSONNEL. 
 
ALLIED HEALTH OCCUPATIONS is listed in the G2 Category with several specialties  
indented under it.  It is the specialty term for the allied health fields in  
general. 
 
Curriculum development for allied health occupations: 
	ALLIED HEALTH OCCUPATIONS / * educ 
	*CURRICULUM 
 
ALLIED HEALTH PERSONNEL is listed in Categories M1 and N2 at the next level  
under HEALTH PERSONNEL, with specific allied health personnel indented under it.   
These are the people actually working in or employed in health facilities and  
services. 
 
Fear of contracting AIDS from treating HIV-infected patients among allied health  
personnel: 
	ALLIED HEALTH PERSONNEL / * psychol 
ACQUIRED IMMUNODEFICIENCY DISEASE / * transm 
*DISEASE TRANSMISSION, PATIENT-TO-PROFESSIONAL 
	FEAR 
 

35.13		Distinguishing between the main headings STATE MEDICINE, DELIVERY OF  
HEALTH CARE, NATIONAL HEALTH PROGRAMS, and PUBLIC HEALTH ADMINISTRATION.  (Note:  
None of these terms is limited to the United States and all require the addition  
of a geographic main heading.) 
 
STATE MEDICINE is socialized medicine, a system of medical care regulated,  
controlled, and financed by the government, in which the government owns the  
health centers and facilities and employs the health personnel who practice in  
these facilities.  The health services in Great Britain and Sweden are examples  
of state medicine. 
 
The British National Health Service is undergoing increased privatization: 
	STATE MEDICINE / * organ 
	*PRIVATIZATION 
	GREAT BRITAIN 
 
DELIVERY OF HEALTH CARE is used both for health care delivery to a specific  
population or geographic area and for the national health care system of a  
country.  In the latter context it is the term that expresses the organization,  
administration, financing, and control of the health care system in general. 
 
The U.S. health care system is financed and regulated by both the public and  
private sectors: 
DELIVERY OF HEALTH CARE / * organ / econ / legis  
	*PUBLIC SECTOR 
	*PRIVATE SECTOR 
	UNITED STATES 
 
NATIONAL HEALTH PROGRAMS are components of a national health care system which  
administer specific services.  The term does not refer to the national health  
care system in general.  
 
The Canadian national health insurance system: 
	NATIONAL HEALTH PROGRAMS / * econ 
	*INSURANCE, HEALTH 
	CANADA 
 
Laws regulating the national medical emergency response system in the United  
States: 
	NATIONAL HEALTH PROGRAMS / * legis 
	EMERGENCY MEDICAL SERVICES / * legis 
	UNITED STATES 
 
Note:  There is a pre-coordinated term for national health insurance in the  
United States:  NATIONAL HEALTH INSURANCE, UNITED STATES. 
 
PUBLIC HEALTH ADMINISTRATION refers to the management of public health  
organizations or agencies.  In the United States such agencies include, among  
others, the DEPARTMENT OF HEALTH AND HUMAN SERVICES, the PUBLIC HEALTH SERVICE,  
the CENTERS FOR DISEASE CONTROL AND PREVENTION, and the DEPARTMENT OF VETERANS  
AFFAIRS.  In the United States and other countries this term is not limited to  
national government, but is also used for state departments of health or  
agencies of other political divisions, such as counties, cities, provinces, etc.   
However, in countries with socialized medicine, STATE MEDICINE is used rather  
than PUBLIC HEALTH ADMINISTRATION. 
 
The Pennsylvania Department of Health: 
	*PUBLIC HEALTH ADMINISTRATION 
	PENNSYLVANIA 
 

35.14		STATE HEALTH PLANS was formerly used solely for state plans prepared  
by State Health Planning and Development Agencies (SHPDA) in the United States.   
Currently, the term is still limited to the United States and is also used for  
state regulated health programs.  Always supply a geographic. 
 
Oregon enacts a state program that rations Medicaid services: 	 
STATE HEALTH PLANS / * legis / econ 
	MEDICAID / * legis 
	HEALTH CARE RATIONING / * legis 
	OREGON 
 
Hawaii enacts an employment-based state health insurance program: 
	STATE HEALTH PLANS / * legis / econ 
HEALTH BENEFIT PLANS, EMPLOYEE / * legis 
	HAWAII 
 

35.15		Distinguishing between REGIONAL HEALTH PLANNING and REGIONAL MEDICAL  
PROGRAMS.  (Note: Neither of these terms is limited to the United States and  
both require the addition of a geographic main heading.) 
 
REGIONAL HEALTH PLANNING is planning for the allocation of resources  
(facilities, manpower, services, diagnostic and therapeutic technologies) at a  
community or regional level.  It refers to a planning activity in which  
facilities interact with each other or are regulated by government agencies in  
order to control the supply and costs of area health resources. 
 
Regional planning for lithotripsy facilities in Miami and the surrounding areas: 
	*REGIONAL HEALTH PLANNING 
	*LITHOTRIPSY 
	FLORIDA 
 
REGIONAL MEDICAL PROGRAMS are established, coordinated programs between health  
facilities within defined geographic areas that provide improved delivery and  
quality of medical care to specific populations.  The emphasis here is on  
ensuring delivery of quality care, rather than on regulating the distribution of  
resources or cost control and it usually involves a specific clinical service. 
 
Providing care in a rural area of Montana to seriously ill newborns through a  
neonatal intensive care network: 
	*REGIONAL MEDICAL PROGRAMS 
	INTENSIVE CARE, NEONATAL / * organ 
	*RURAL HEALTH 
	MONTANA 
 

35.16		Distinguishing between RURAL POPULATION and RURAL HEALTH.  (Note:  
Always supply a geographic term with RURAL POPULATION and RURAL HEALTH when  
given.)  
 
RURAL POPULATION is used for the inhabitants of rural areas or of small towns  
classified as rural.  It is frequently statistical and is a synonym for the non- 
print entry terms RURAL COMMUNITIES and RURAL SPATIAL DISTRIBUTION.  Use it for  
articles on non-health aspects of rural areas and population. 
 
Statistics on crime in rural areas of the United States: 
	RURAL POPULATION / * statist 
	CRIME / * statist 
	UNITED STATES 
 
Income of physicians who practice in rural versus urban areas of Maryland: 
	PHYSICIANS / * econ 
	PROFESSIONAL PRACTICE LOCATION / * econ 
	*INCOME 
	RURAL POPULATION 
	URBAN POPULATION 
	MARYLAND 
 
Social problems in rural areas: 
	*SOCIAL PROBLEMS 
	*RURAL POPULATION 
 
RURAL HEALTH is used for articles dealing only with the problems of health in  
rural areas.  These may be general articles about rural health or  
epidemiological articles about the incidence of specific diseases in rural  
populations.  Since it is a synonym for the non-print entry terms RURAL HEALTH  
SERVICES and RURAL HEALTH CENTERS, it is also used for articles on aspects of  
rural health care delivery.  When using RURAL HEALTH, consider using the more  
specific terms HOSPITALS, RURAL or MEDICALLY UNDERSERVED AREA. 
 
Comparison of the incidence of AIDS in urban and rural populations in England: 
	AIDS / * epidemiol 
	RURAL HEALTH / statist 
	URBAN HEALTH / statist 
	ENGLAND / epidemiol 
 
Adolescent health services in rural Kansas: 
	*ADOLESCENT HEALTH SERVICES 
	*RURAL HEALTH 
	KANSAS 
 
Health status of rural Iowans: 
	*HEALTH STATUS 
	*RURAL HEALTH 
	IOWA 
 
Medicare use by rural populations in the United States: 
	MEDICARE / * util 
	*RURAL HEALTH 
	UNITED STATES 
 

35.17		Distinguishing between URBAN POPULATION and URBAN HEALTH.  The same  
holds true as is described above in Section 35.16 for RURAL POPULATION and RURAL  
HEALTH.  When using URBAN HEALTH, consider using the more specific terms  
HOSPITALS, MUNICIPAL and HOSPITALS, URBAN.  Always supply a geographic with  
URBAN POPULATION and URBAN HEALTH when given.