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PubMed2004

An alternative approach to social capital: exploring the linkage between health consciousness and community participation.

In recent years, social capital has received a great deal of attention in health communication. The fundamental premise behind the increased attention to social capital is the positive health outcome of social capital. Social capital is treated as an antecedent to health. Building on recent research that points out the role of trait-level variables in the production of social capital, this article examines the role of health consciousness in the production of social capital. The central idea here is that health conscious individuals choose to participate in their communities because of the positive health benefits of such participation.

Adult↗
PubMed2006

[Social capital and the research agenda in epidemiology].

Social capital refers to those features of social organization that enable participants to act together and more effectively pursue common goals. A growing body of evidence suggests that societies with high levels of social capital have lower morbidity and mortality rates and higher life expectancy and are less violent. The main goal of this article is to review the relationship between social capital and health. First, the main concepts and criticisms of social capital theory are discussed. Next, commonly used assessment tools are elucidated. Then, the relationship between social capital and health is analyzed. Finally, the article comments on the theory's application to Brazilian reality. If scientific rigor is applied to social capital research, recognizing theoretical and methodological difficulties, it can expand the research agenda and contribute to a better understanding of how to effectively deal with health inequalities.

Biomedical Research↗
PubMed2005

Idiopathic slipped capital femoral epiphysis in Amish children.

BACKGROUND: Of the many studies of slipped capital femoral epiphysis, none have specifically addressed Amish children. The Amish reflect a small gene pool relative to the general white North American population. Additional knowledge of the demographics of this disorder in Amish children may provide genetic insights. The purpose of this study was to review the demographics of slipped capital femoral epiphysis in the Amish population. METHODS: A retrospective review of the cases of twenty-five Amish children with slipped capital femoral epiphysis treated at two institutions was performed. The child's gender, age, weight, height, and body mass index at the time of the diagnosis; duration of symptoms; laterality of the slip; birth weight; family history; and slip severity were recorded. The slip was classified as stable or unstable. Patients who had been included in a previously published multicenter study served as a control group. RESULTS: There were seventeen boys and eight girls with a total of thirty-three slipped capital femoral epiphyses; eight of the slips were bilateral. At the time of the diagnosis, the mean age (and standard deviation) was 13.4 +/- 1.6 years, the mean weight and height were 55.6 +/-12.4 kg and 155.5 +/- 10.2 cm, and the mean body mass index was 23.4 +/- 5.4 kg/m(2). The mean duration of symptoms was 6.6 +/-9.0 months. There were thirty-one stable and two unstable slips with a mean slip angle of 38 degrees +/- 20 degrees . Nine (39%) of twenty-three children for whom the information had been recorded had a positive family history of slipped capital femoral epiphysis, a rate that is higher than the 9% and 14.5% rates reported in two other series (p = 0.002). The Amish children were not as heavy as their non-Amish counterparts (55.6 +/- 12.4 kg compared with 66.4 +/- 17.7 kg, p = 0.0036). CONCLUSIONS: Although the children in this study were moderately heavy, they could not be classified as obese on the basis of weight-for-age or body-mass-index percentiles. The high prevalence of family members with slipped capital femoral epiphysis may reflect either a genetic or environmental component, or an interaction between genetics and environment (for example, work load or common chores requiring particular physical positions) in the Amish population.

Body Height↗
PubMed2006

Demographic predictors of severity of stable slipped capital femoral epiphyses.

BACKGROUND: The outcome of stable slipped capital femoral epiphysis is directly related to the severity of the slip. If it is assumed that the slip will be less severe if it is diagnosed early, then early diagnosis should improve the prognosis. It was our purpose to determine demographic predictors of the severity of a slipped capital femoral epiphysis. METHODS: A retrospective study of 243 children with a total of 328 stable slipped capital femoral epiphyses was performed. Gender, race, age, and symptom duration were noted. Slip severity was classified as mild (<30 degrees ), moderate (30 degrees to 50 degrees ), or severe (>50 degrees ). Statistical analyses included bivariate, multivariate, linear correlation, and logistic regression techniques. RESULTS: There were 159 boys and eighty-four girls; 149 children had unilateral and ninety-four had bilateral slipped capital femoral epiphysis. Of the bilateral slips, forty-two were simultaneous and fifty-two were sequential. The mean age (and standard deviation) was 12.6 +/- 1.8 years, the mean duration of the symptoms was 5.2 +/- 7.4 months, and the mean slip angle was 29 degrees +/- 20 degrees . There were 199 mild, sixty-eight moderate, and forty-five severe slips. The mean duration of symptoms was 3.5 +/- 5.0 months for the mild slips, 7.7 +/- 9.0 months for the moderate slips, and 8.8 +/- 10.6 months for the severe slips (p < 0.0001). Older children had more severe slips: the average age was 12.3 +/- 1.8 years for the children with a mild slip, 13.0 +/- 1.6 years for those with a moderate slip, and 13.8 +/- 1.8 years for those with a severe slip (p < 0.0001). Multivariate analyses demonstrated that, among the factors studied, only the age of the patient and the duration of the symptoms were associated with the slip severity. Symptom duration and patient age were used as predictors of slip severity in a logistic regression analysis, with > or =30 degrees and <30 degrees used as the categories for slip severity, older than 12.5 years old compared with 12.5 years old or younger used as the categories for age, and more than 2.0 months compared with 2.0 months or less used as the categories for symptom duration. This model predicted the probability of a slip with confidence (p < 0.0001). The odds ratios (with 95% confidence intervals) for age and symptom duration were 2.0 (1.15 to 3.53) and 4.1 (2.34 to 7.12), respectively. Thus, a child with a stable slipped capital femoral epiphysis is 2.0 times more likely to have a moderate or severe slip if he or she is older than 12.5 years of age at the time of the diagnosis and 4.1 times more likely to have a moderate or severe slip if the duration of symptoms was longer than two months. CONCLUSIONS: The only two known significant predictors of the severity of a slipped capital femoral epiphysis are age at diagnosis and symptom duration. For any individual child, slip severity and symptom duration are unique; in a large population, there is a general correlation between slip severity and increases in patient age and increases in the duration of symptoms.

Adolescent↗
PubMed2002

Economic inequality, working-class power, social capital, and cause-specific mortality in wealthy countries.

This study tests two propositions from Navarro's critique of the social capital literature: that social capital's importance has been exaggerated and that class-related political factors, absent from social epidemiology and public health, might be key determinants of population health. The authors estimate cross-sectional associations between economic inequality, working-class power, and social capital and life expectancy, self-rated health, low birth weight, and age- and cause-specific mortality in 16 wealthy countries. Of all the health outcomes, the five variables related to birth and infant survival and nonintentional injuries had the most consistent association with economic inequality and working-class power (in particular with strength of the welfare state) and, less so, with social capital indicators. Rates of low birth weight and infant deaths from all causes were lower in countries with more "left" (e.g., socialist, social democratic, labor) votes, more left members of parliament, more years of social democratic government, more women in government, and various indicators of strength of the welfare state, as well as low economic inequality, as measured in a variety of ways. Similar associations were observed for injury mortality, underscoring the crucial role of unions and labor parties in promoting workplace safety. Overall, social capital shows weaker associations with population health indicators than do economic inequality and working-class power. The popularity of social capital and exclusion of class-related political and welfare state indicators does not seem to be justified on empirical grounds.

Adolescent↗
PubMed2003

Secular trends in physiological capital: implications for equity in health care.

Over the past three centuries, there has been a rapid accumulation of physiological capital in Organisation for Economic Cooperation and Development (OECD) countries. Enhanced physiological capital is tied to long-term reduction in environmental hazards and to the conquest of chronic malnutrition, since both nutritional status and the quality of the external and intrauterine environments appear to be linked to the quality of organ development and to the onset of chronic diseases later in life. Data on heights and birth weights suggest that physiological capital has become more equally distributed, thereby reducing socioeconomic disparities in the burden of disease. These developments have a number of health care policy implications: (1) enhanced physiological capital has done more to reduce inequities in health status than has wider access to health care; (2) the main contribution of more advanced medical treatment so far has been to retard depreciation in individuals' physiological capital; (3) prenatal and early childhood care and environmental issues are key for interventions aimed at enhancing physiological capital and at affecting its rate of depreciation; (4) lifestyle change is the most important issue affecting health equity in rich countries; and (5) greater access to clinical care should be promoted through aggressive outreach, since expanded insurance coverage by itself is inadequate.

Female↗
PubMed2003

Epidemiology of slipped capital femoral epiphysis in a population with a high proportion of New Zealand Maori and Pacific children.

AIM: To describe the epidemiology of slipped capital femoral epiphysis in NZ Maori and Pacific children residing in Auckland compared with NZ European children. METHODS: The charts and radiographs of 211 children admitted with 307 slipped capital femoral epiphyses to Starship Children's Hospital between 1988 and 2000 were reviewed. RESULTS: The average age at first presentation was 132.6 +/-16.7 months in girls (range 95 to 170 months) and 149.5 +/- 19.3 months in boys (range 99 to 190 months), p <0.05. The age at presentation was not statistically different between the three ethnic groups. One hundred and seventy one children (81%) presented with a unilateral slipped capital femoral epiphysis. Forty children presented with bilateral simultaneous slipped capital femoral epiphyses; however, after two years of follow up, a further 56 children had been readmitted for pinning of the opposite hip, giving an overall rate of bilateral hip pinning of 45.5%. The relative racial frequency of slipped capital femoral epiphysis in the New Zealand Maori and the Pacific population was 4.2 times and 5.6 times the New Zealand European population, respectively. CONCLUSIONS: Children as young as eight years are now presenting with slipped capital femoral epiphyses. General practitioners should be aware of the possibility of this diagnosis, particularly in children of NZ Maori or Pacific ethnicity.

Adolescent↗
PubMed1983

A new anatomic classification of capital fragments in femoral neck fractures with the epiphyseal scar as a guide.

Seventy femoral neck fractures were examined clinically, radiologically, and histologically to ascertain whether the shape of the capital fragment, irrespective of the nature or age of the fracture, could be a determinant of the biologic condition within the head. Three types of excised capital fragments were defined according to the anatomic location of the fracture surface, with particular reference to the epiphyseal scar. Type I fragments, in which the fracture surface lies along the epiphyseal scar, showed complete capital necrosis, whereas Types II and III fragments, with the fracture surface in the subepiphyseal and subcapital zones, respectively, were found to be histologically viable. Moreover, Type III specimens tended to be more abundant in biologic response than Type II specimens. Thus, the biologic condition of the capital fragment is closely related to its shape. Since the type of capital fragment is, in most cases, judged correctly on the preoperative roentgenogram, this classification can be a helpful clue to the choice of treatment. From the biologic point of view, osteosynthesis should be limited to fractures with Type III capital fragments. The authors also hypothesize that the fractured femoral head, if untreated, may decrease in size and, therefore, in vascularity during the postfracture course.

Adolescent↗
PubMed1994

[Unusual course of scapho-capitate syndrome].

The scapho-capitate-syndrome has been defined as combined fractures of the scaphoid and capitate with rotation of the proximal fragment of the capitate through 90 or 180 degrees. Most injuries are due to falls from heights or car accidents. Only 26 cases of the scapho-capitate fracture syndrome have been reported since 1937. In nearly one third of these cases, there was a delay of more than two weeks in diagnosis. We report a case of a young man in whom the complex injury was erroneously diagnosed as an isolated fracture of the scaphoid. The scaphoid fracture was treated by a screw and healed well. Although the patient suffered persistent pain in his wrist, the correct diagnosis was made only two years later. During revision operation we found the head of the capitate still inverted and with marked signs of avascular necrosis and destruction of the lunate cartilage. The avascular fragment was removed and substituted by a graft from the iliac crest. The capitate and lunate were fused.

Adult↗
PubMed2001

Increasing the efficiency and flexibility of capital funding for public and private hospitals.

This paper outlines the recent history of capital funding in the health sector in Australia. It focuses on the trends in capital expenditures and the roles of the public and private sectors. The demand for future capital funding will depend upon a number of factors, including the state of the current capital stock and uncertain future impacts of technology and changes in patient demands. Because of these uncertainties, capital funding for the future must be flexible to meet any changes in operations and demand. The paper highlights the possible use of joint ventures between various public and private organisations, based on the principles of competition and cooperation.

Australia↗
PubMed2004

Access to capital--a growing concern.

Access to capital over the next ten years will be one of the biggest challenges healthcare organizations will face as they strive to remain competitive and serve their communities. Meeting the growing needs for capital will require a disciplined and honest assessment of the capital sources that will be available and the best ways of positioning an organization to maximize their uses. It is incumbent on chief executive officers and other senior leaders to create a disciplined process for allocating capital and conveying how that process will be linked to the organization's strategic plan. All of the credit constituencies "buying" healthcare need to fully understand how the organization is positioning itself for future growth and success, and detailed bond marketing plans need to be implemented well before the actual sale of a new bond issue. Large and small healthcare providers will have sufficient access to capital in the future if investors believe that senior hospital executives have a credible plan and are disciplined enough to execute it.

Capital Expenditures↗
PubMed1986

Capital projects funding for psychiatric hospitals, 1972-1981.

Data on capital projects funding in nonfederal U.S. hospitals in the years 1972, 1977, 1978, and 1981 were analyzed to identify changes in the number, cost, and funding sources of capital projects in public and private psychiatric hospitals and to compare them with changes in public and private general hospitals. The study identified three major trends over the ten-year period: a larger decrease in the number of capital projects and a larger increase in the average cost per project in public psychiatric hospitals compared with other types of hospitals, and a greater dependence by all types of hospitals on borrowed money to fund capital projects. The author suggests that the decreased number and higher cost of capital projects in public psychiatric hospitals may be related to the hospitals' increasing reliance over the ten-year period on debt financing rather than on government funding. Because of the high costs involved in debt financing--costs unrelated to the size of the debt--these hospitals may have consolidated their building projects.

Capital Expenditures↗
PubMed1983

Which will survive? The $150 billion capital question.

There are many misconceptions and commonly held "truisms" that cloud our understanding of hospital capital formation. In this attempt to clarify the issues related to hospital capital formation, three arguments are developed: 1) There are significant and frequently overlooked operating costs associated with capital investment projects, which can contribute significantly to hospital cost inflation. 2) The demand for hospital replacement, renovation and modernization is real but overstated. 3) Many hospitals will be unable to gain access to the capital market because of the populations they serve and their locations. It is argued that a coherent, targeted private and public sector policy on hospital capital formation is needed that addresses these points.

Capital Expenditures↗
PubMed2000

Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians.

BACKGROUND: It is widely believed that the method of payment of physicians may affect their clinical behaviour. Although payment systems may be used to achieve policy objectives (e.g. cost containment or improved quality of care), little is known about the effects of different payment systems in achieving these objectives. OBJECTIVES: To evaluate the impact of different methods of payment (capitation, salary, fee for service and mixed systems of payment) on the clinical behaviour of primary care physicians (PCPs). SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care Group specialised register; the Cochrane Controlled Trials Register; MEDLINE (1966 to October 1997); BIDS EMBASE (1980 to October 1997); BIDS ISI (1981 to October 1997); EconLit (1969 to October 1997); HealthStar (1975 to October 1997) Helmis (1984 to October 1997); health economics discussion paper series of the Universities of York, Aberdeen, Sheffield, Bristol, Brunel, and McMaster; Swedish Institute of Health Economics; RAND corporation; and reference lists of articles. SELECTION CRITERIA: Randomised trials, controlled before and after studies and interrupted time series analyses of interventions comparing the impact of capitation, salary, fee for service (FFS) and mixed systems of payment on primary care physician satisfaction with working environment; cost and quantity of care; type and pattern of care; equity of care; and patient health status and satisfaction. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Four studies were included involving 640 primary care physicians and more than 6400 patients. There was considerable variation in study setting and the range of outcomes measured. FFS resulted in more primary care visits/contacts, visits to specialists and diagnostic and curative services but fewer hospital referrals and repeat prescriptions compared with capitation. Compliance with a recommended number of visits was higher under FFS compared with capitation payment. FFS resulted in more patient visits, greater continuity of care, higher compliance with a recommended number of visits, but patients were less satisfied with access to their physician compared with salaried payment. REVIEWER'S CONCLUSIONS: It is noteworthy that so few studies met the inclusion criteria. There is some evidence to suggest that the method of payment of primary care physicians affects their behaviour, but the findings' generalisability is unknown. More evaluations of the effect of payment systems on PCP behaviour are needed, especially in terms of the relative impact of salary versus capitation payments.

Capitation Fee↗
PubMed2001

A matter of life or death: special considerations and heightened practice standards in capital sentencing evaluations.

Mental health evaluations at capital sentencing represent a complex and specialized arena of practice. The moral culpability focus of capital sentencing is distinct from guilt-phase considerations of criminal responsibility, and has a specialized literature. Capital violence risk assessment is uniquely oriented to a prison context, relying on past adjustment to incarceration, as well as group statistical data specific to capital offenders and other inmate groups. Personality testing is a more complex consideration in capital sentencing evaluations. The implications of interviewing the defendant, as well as the parameters and documentation of an interview, make full disclosure and informed consent of particular importance. Defense- and prosecution-retained experts are subject to specific ethical vulnerabilities. These are examined in this paper through the lens of current professional standards.

Capital Punishment↗
PubMedDate not supplied

Effects of different remuneration methods on general medical practice: a comparison of capitation and fee-for-service payment.

There are severe methodological problems to be overcome in comparing the effects of different payment methods on general medical practice, not least because there are many factors which affect the pattern of service delivery. Also, the reliability and comparability of data may be poor. This article emphasises that the effects of capitation and fee-for-service payment methods on general medical practice should be carefully compared with factual information, especially numerical data. In so doing, it is shown that there are supporting data for the contention that a fee-for-service system encourages more consultations, more diagnostic tests, higher drug use, higher surgical rates and higher costs than a capitation system. On the other hand, a capitation system may lead doctors to hastier and less courteous care than a fee-for-service system. The geographical distribution of general practitioners (GPs) may be more even, and continuity of care may be better maintained, under a capitation system; but there may be excessive referrals from GPs to specialists under this system of payment. There is no evidence for the contention that a capitation system encourages preventive medicine, but the financial coverage for preventive procedures does encourage such procedures.

Capitation Fee↗
PubMed1999

The economic impact of capitated care for high utilizers of public mental health services: the Los Angeles PARTNERS program experience.

Los Angeles PARTNERS, or "people achieving rehabilitation together need empowering respectful support," is a treatment program that uses capitation to shift risk for treatment costs of high utilizers of public mental health services to private community-based treatment organizations. This analysis reveals two important findings from PARTNERS. First, the economic incentives created by capitation contributed to the dis-enrollment of PARTNERS clients; furthermore, factors such as not speaking English or Spanish or having schizophrenia increased the probability of dis-enrollment. Second, analyses of health costs for enrollees in the PARTNERS capitation program suggest that the program did not result in a change in total costs. However, the program increased the use of community-based care and increased treatment costs for clients with lower preprogram costs but decreased costs for the clients with high preprogram costs. These results suggest that future capitation programs for this severely ill population would benefit from using detailed clinical information to determine program eligibility and to set risk-adjusted capitation rates.

Capitation Fee↗
PubMed2000

Implementing capitation of Medicaid mental health services in Colorado: is "readiness" a necessary condition?

Two consortia of community mental health centers in Colorado varied in their administrative readiness for changing to a capitated system and, ultimately, implemented capitation using different organizational arrangements. The objective was to assess the impact of this natural experiment on administrative change, costs, and utilization of services during the first two years postcapitation. Prior to capitation, one was rated as having greater "readiness" than the other and received a capitation contract from the state, while the other did not. A private, for-profit managed behavioral health organization was awarded a contract and formed a joint venture with the less "ready" consortium, providing managed care expertise to complement the consortium's expertise in delivering mental health services. Two years later, these consortia do not look different either administratively or in their patterns of service utilization and costs. These findings suggest alternative ways of successfully implementing a capitated public mental health system.

Capitation Fee↗