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At least 451 records · Page 25Linked to original sources
PubMed2000

Excess coronary mortality among Australian men and women living outside the capital city statistical divisions.

OBJECTIVES: To compare rates of mortality from coronary heart disease (CHD) between populations living within and outside Australian capital city statistical divisions. DESIGN AND SETTING: Descriptive epidemiological study based on data for all residents of Australia aged 30-69 years who died between 1986 and 1996 in all States and Territories of Australia. MAIN OUTCOME MEASURES: Standardised mortality rates from all causes and coronary heart disease as coded by the Australian Bureau of Statistics, and estimated excess deaths in populations living outside capital city statistical divisions. RESULTS: Between 1986 and 1996, mortality from CHD declined by 46% in men and 51% in women, and accounted for 61% of the decline in mortality from all causes in men and 48% in women. More deaths than expected from acute myocardial infarction resulted in mortality rates from CHD up to 30% higher in men and 21% higher in women living outside the capital city statistical divisions, and accounted for an overall estimated excess of 3835 deaths from CHD in men (32% of excess deaths from all causes), and 1385 deaths from CHD in women (27% of excess deaths from all causes) over the 11-year study period. CONCLUSIONS: Although there were impressive declines in coronary mortality in all Australian States and Territories from 1986 to 1996, populations living outside capital cities continue to have higher death rates from CHD. These differences in mortality rates indicate a need for further research into factors which may influence mortality rates for CHD in rural and remote areas, and immediate measures to ensure optimal treatment of coronary risk factors and acute coronary events in such populations.

Adult↗
PubMed1986

Risky business: the risk-based, risk-sharing capitated HMO.

Hospitals are encountering a new type of HMO--the risk-based, risk-sharing capitated HMO. This new HMO arrangement redefines the role of the hospital, the physicians, and the HMO plan involved. Instead of placing the HMO at risk, the hospital and physicians are now financially responsible for services covered under the HMO plan. The capitated HMO is reduced to a third-party payer, serving as a broker between subscribers and providers. In this first of two articles on capitated HMOs, the risk-based, risk-sharing capitated HMO and its relationship to hospitals and physicians is defined. The second article will take this definition and apply it to managing, monitoring, and reporting on these types of programs from an accounting perspective.

California↗
PubMed2001

Service delivery and community: social capital, service systems integration, and outcomes among homeless persons with severe mental illness.

OBJECTIVES: This study evaluated the influence of features of community social environment and service system integration on service use, housing, and clinical outcomes among homeless people with serious mental illness. STUDY SETTING: A one-year observational outcome study was conducted of homeless people with serious mental illness at 18 sites. DATA SOURCES: Measures of community social environment (e.g., social capital) were based on local surveys and voting records. Housing affordability was assessed with housing survey data. Service system integration was assessed through interviews with key informants at each site to document interorganizational transactions. Standardized clinical measures were used to assess clinical and housing outcomes in face-to-face interviews. RESEARCH DESIGN: Structural equation modeling was used to determine the relationship between (1) characteristics of the social environment (social capital, housing affordability); (2) the level of integration of the service system for persons who are homeless in each community; (3) access to and use of services by individual clients; and (4) successful exit from homelessness or clinical improvement. PRINCIPAL FINDINGS: Social capital was associated with greater service systems integration, which was associated in turn with greater access to assistance from a public housing agency and to a greater probability of exiting from homelessness at 12 months. Housing affordability also predicted exit from homelessness. Neither environmental factors nor systems integration predicted outcomes for psychiatric problems, substance abuse, employment, physical health, or income support. CONCLUSION: Community social capital and service system integration are related through a series of direct and indirect pathways with better housing outcomes but not with superior clinical outcomes for homeless people with mental illness. Implications for designing improved service systems are discussed.

Case Management↗
PubMed1992

[Relative mortality trends for diabetes mellitus in the Brazilian state capitals, 1950-1985].

The article describes the trend of relative mortality from diabetes mellitus in the capitals of the Brazilian states and territories from 1950 to 1975 (by place of occurrence) and from 1977 to 1985 (deaths of inhabitants) on the basis of data obtained from the statistical yearbooks of Brazil and the Ministry of Health's mortality statistics. It also presents the importance of relative mortality from diabetes mellitus in each capital by sex and age group, starting with age 20. In the earlier time period this mortality was found to be on the rise at a rate of increase varying between 1.7 and 11.1 and with an average rate of increase of 3.4 for all capitals. In the latter period the rate ranged between 0.5 and 2.7, with an average rate of 1.5 for all capitals. The death rates were proportionally highest between the ages of 50 and 69, and were higher among women. The study also comments on underestimation of this mortality when the primary cause of death alone is considered.

Adult↗
PubMedDate not supplied

Social capital and youth suicide risk factors in First Nations communities.

The paper presents a model of plausible mechanisms linking social capital to suicide risk factors among First Nations youth, informed by a study that explored the concept of social capital in First Nations communities, and by a study on mental health services in First Nations communities in Manitoba. The model incorporates several components of social capital. The plausible impact of social capital on protective and risk factors of suicide among youth is explored.

Adolescent↗
PubMed1988

[The Graner capitate interposition arthroplasty in lunate malacia].

In capitate interpositional arthroplasty (Graner II) the necrotic lunate bone is removed and the congruity of the proximal carpal row is restored by interposition of the proximal half of the capitate. The carpal bones are fused except for the scaphotrapezial joint. In this fashion carpal instability can be safely treated. Good results are achieved for both grip strength and relief of pain. Motion is restricted but with a useful range of motion remaining. The arc of remaining motion can be shifted into extension through the use of an opening wedge osteotomy of the capitate. Capitate interpositional arthroplasty without an intercarpal arthrodesis has poor result because of remaining carpal instability.

Adult↗
PubMed1986

[Pseudarthrosis of the capitate].

A 54 years old railway engine-driver fell on his extended right hand in November 1978. In the next few hours he developed increasing pain. He reported similar slight trauma some fourteen months before, but without pain. The tomographic X-ray examination proved the presence of an isolated non-union of the capitate with some shortening. Four days after the second accident an autologous graft was performed following the technique of Matti. The non-union healed after three months in a plaster cast, and the patient returned to full work after four months. Examining him four years and nine months later, the patient complained about persisting pain when stressed. The mobility of the wrist was moderately reduced, and the healed capitate showed unchanged shortening. Isolated non-unions of the capitate can, therefore, be painless for a long time--a situation well-known with scaphoid non-unions. Considering the operative technique, a cancellous graft alone is not able to restore the function of the wrist because of associated collapse of the carpus. To obtain a better late result, the length of the capitate ought to be restored and a cortico-spongious graft inserted.

Carpal Bones↗
PubMed1995

Trends in relative mortality from cerebrovascular diseases in Brazilian state capitals, 1950-1988.

This article seeks to describe trends in relative mortality from cerebrovascular diseases (CVDs) in Brazilian state capitals from 1950 through 1988. Absolute numbers of deaths from all causes; from CVDs; and from ill-defined signs, symptoms, and afflictions were obtained from official Brazilian mortality statistics. In calculating relative CVD mortality, deaths from ill-defined signs, symptoms, and afflictions were excluded. The collected data permitted calculation of relative CVD mortality in most state capitals for 1950, 1955, 1960, 1961-1965, 1966-1970, 1971-1975, 1977-1980, 1981-1985, and 1986-1988. During the study period CVD mortality was found to play an increasing role in overall mortality in all the state capitals. Regional grouping of data showed greater relative CVD mortality in the South and Southwest Regions toward the start of the study period. However, over the course of this period the part that CVD mortality played in overall mortality grew most rapidly in the less-developed North, Northeast, and Center-West Regions. In general, relative CVD mortality data in nearly all the state capitals demonstrate the attention that needs to be devoted to CVDs within the context of adult public health. In particular, there is a clear need to greatly strengthen and improve the marginal existing programs for detection and control of hypertension and diabetes in Brazil. This should be done by assessing international experience with programs of this type and adapting that experience to Brazilian conditions. Beyond that, it will be important to support health promotion and protection efforts that can deal with risk factors and secure prevention through lifestyle modification--something that can provide benefits in dealing not only with CVDs but also with diabetes, obesity, and certain neoplasias.

Adult↗
PubMed1996

Natural history of untreated chronic slipped capital femoral epiphysis.

From 1915 to 1952, 31 hips in 28 patients with slipped capital femoral epiphysis were observed without interventional treatment at the University of Iowa Department of Orthopaedic Surgery. A slip was considered chronic if the symptoms had been present for 3 weeks or more. The severity of the slip was determined by radiographs. Assessment included Iowa Hip Rating and grading of radiographic degenerative changes. The mean duration of patient followup from the onset of symptoms was 41 years. The mean patient age was 54 years old at review, and 13 years old at onset of symptoms. Degenerative arthritis developed in hips with displaced slipped capital femoral epiphysis. Untreated slipped capital femoral epiphysis can progress to a severe degree. The natural history of chronic slipped capital femoral epiphysis is favorable provided that displacement is minimal and remains so.

Adolescent↗
PubMed1996

Valgus slipped capital femoral epiphysis. Fact or fiction?

The cases of 2 patients with valgus slipped capital femoral epiphysis are presented. Additional imaging studies provide support for true posterolateral epiphyseal displacement. Increased femoral anteversion and coxa valga contribute to the pathogenesis of valgus slipped capital femoral epiphysis. In situ pin fixation is recommended for stable valgus slipped capital femoral epiphysis. The importance of valgus slipped capital femoral epiphysis lies in its recognition and appropriate screw placement when internal fixation is used. The percutaneous technique should be used with caution. A limited open technique is recommended when the anterior skin portal is near the femoral neurovascular bundle.

Child↗
PubMed1993

International migration, economic policy and human capital accumulation: a simulation study.

"This paper examines the economic policy implications of international migration and human capital accumulation within a dynamic general equilibrium model. Each country produces by means of physical and human capital of two types (skilled and unskilled labour). Along optimal growth paths in a world of diverging population growth rates immigration can only be beneficial when the free rider effect (i.e., not paying for training costs) exceeds the capital dilution effect of an increase in population growth. Under quite general conditions the optimal immigration rate is zero."

Demography↗
PubMed1983

Hospital capital formation in the 1980s: is there a crisis?

Access to capital will be a serious problem for a subset of our nation's hospitals in the 1980s. Without adequate capital to modernize or maintain life-safety codes, certain facilities may have no other choice than to close their doors. The consequences of closure are far-reaching and long-lasting. The hospitals that exit from the market may be forced out as a result of their location or payor mix, and not as a consequence of their inefficiency. Allowing capital formation in the hospital industry to be determined by the market criteria of bottom-line performance may lead to a serious contraction of the field, to increased financial hardships for the hospitals that remain, to reduced service provision, and to plant deterioration.

Capital Expenditures↗
PubMed1980

Government moves to tighten capital investment.

In recent years, programs designed to control hospital capital investment have become a highly visible aspect of federal health policy. This article describes federal efforts to limit capital expenditures; describes the effect on hospitals of such capital limitation policies; and suggests how hospitals can deal with them.

Capital Expenditures↗
PubMed2002

What's your real cost of capital?

In valuing any investment project or corporate acquisition, executives must decide what discount rate to use in their estimates of future cash flows. The traditional approach is to apply the capital asset pricing model (CAPM), which has remained fundamentally unchanged for 40 years. But the formula--in particular, its beta element--has long been a source of frustration. In fact, corporate executives and investment bankers routinely fudge their CAPM estimates, say the authors, because experience and intuition tell them the model produces inappropriate discount rates. CAPM has three main problems: First, beta is a measure of both a stock's correlation and its volatility; second, beta is based on historical data; and third, CAPM rates don't take into account the term of the investment. These factors together result in discount rates that defy common sense. As an alternative to CAPM and its beta element, the authors developed a forward-looking approach to calculating a company's cost of capital, the market-derived capital pricing model (MCPM). It does not incorporate any measure of historical stock-to-market correlation, relying instead on estimates of future volatility derived from the options market. This is helpful since investor expectations from the options market are built into a company's current stock price. Using GE as an example, the authors give step-by-step instructions for how to calculate discount rates with MCPM. They also offer evidence from a range of industries to show that MCPM's discount rates are more realistic--especially from the corporate investor's perspective--than are CAPM's.

Accounting↗
PubMed2000

Physicians' attitudes about involvement in lethal injection for capital punishment.

BACKGROUND: Physicians could play various roles in carrying out capital punishment via lethal injection. Medical societies like the American Medical Association (AMA) and American College of Physicians have established which roles are acceptable and which are disallowed. No one has explored physicians' attitudes toward their potential roles in this process. METHODS: We surveyed physicians about how acceptable it was for physicians to engage in 8 actions disallowed by the AMA and 4 allowed actions involving lethal injection. Questions assessing attitudes toward capital punishment and assisted suicide were included. The impact of attitudinal and demographic variables on the number of disallowed actions deemed acceptable was analyzed via analysis of variance and multiple logistic regression analysis. RESULTS: Four hundred eighty-two physicians (51%) returned questionnaires. Eighty percent indicated that at least 1 of the disallowed actions was acceptable, 53% indicated that 5 or more were acceptable, and 34% approved all 8 disallowed actions. The percentage of respondents approving of disallowed actions varied from 43% for injecting lethal drugs to 74% for determining when death occurred. All 4 allowed actions were deemed acceptable by the majority of respondents. Favoring the death penalty (P<.001) and the acceptance of assisted suicide (P<.001) were associated with an increased number of disallowed actions that were deemed acceptable. CONCLUSIONS: Despite medical society policies, the majority of physicians surveyed approved of most disallowed actions involving capital punishment, indicating that they believed it is acceptable in some circumstances for physicians to kill individuals against their wishes. It is possible that the lack of stigmatization by colleagues allows physicians to engage in such practices. Arch Intern Med. 2000;160:2912-2916

Aged↗
PubMed1999

Addressing the inequity of capitation by variable soft contracts.

In the search for greater efficiency and cost-containment, many health systems have introduced the practice of medical care providers operating under a fixed budget, often referred to as the capitation or fundholding contract. Although the capitation contract seems equitable at first glance, the sequential decision-making practice of providers-shaped by their rate of present-preference and their attitude toward the risk of running out of budget-may result in serious violations of basic equity principles. We propose a variable soft (or mixed) payment contract (VSC), where the share of the retrospective payment increases over time, as a way to make the contracts more equitable. We also discuss how the parameters of the capitation contract (length of the budget period, soft or hard contracts, solo vs. consortium practice etc.), which are usually set by efficiency criteria, may have serious implications with regard to the equity of the system.

Budgets↗
PubMed2000

The effect of capitation on GPs' referral decisions.

In the Norwegian capitation trial, the payment system for general practitioners (GPs) has been changed; a practice allowance component has been replaced by a capitation component and the fee-per-item component constitutes a smaller part of a GPs practice income than previously. From the theoretical modelling of GPs' referral decisions, we predict that the replacement of the practice allowance by a capitation component will increase the rate of referrals to specialists. This hypothesis is supported by an exploratory empirical study with data from a sample of GPs participating in the experiment.

Aged↗
PubMed2005

The impact of mental health evidence on support for capital punishment: are defendants labeled psychopathic considered more deserving of death?

Controversy surrounds the use of the Hare Psychopathy Checklist--Revised (Hare, 1991, 2003) in capital murder cases, where it has been introduced to support prosecution claims that a defendant represents a "continuing threat to society". Although widely presumed to have a prejudicial impact (e.g., American Psychological Association, 2004), little is known about how the lay public reacts to data derived from ostensibly stigmatizing assessment instruments such as the PCL-R. The present study examined the effect of psychopathy data on layperson attitudes by having 203 undergraduates review a capital murder case where the results of the defendant's psychological evaluation were experimentally manipulated. When expert testimony described the defendant as psychopathic, a much larger percentage of participants supported a death sentence (60%) than when testimony indicated that he was psychotic (30%) or not mentally disordered (38%). Interestingly, participant ratings of how psychopathic they perceived the defendant to be--regardless of the testimony condition to which they had been assigned--also predicted support for a death sentence. Given the limited probative value of the PCL-R in capital cases and the prejudicial nature of the effects noted in this study, we recommend that forensic examiners avoid using it in these trials.

Antisocial Personality Disorder↗