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PubMed1999

The association between for-profit hospital ownership and increased Medicare spending.

BACKGROUND AND METHODS: The rate of conversion to for-profit ownership of hospitals has recently increased in the United States, with uncertain implications for health care costs. We compared total per capita Medicare spending in areas served by for-profit and not-for-profit hospitals. We used American Hospital Association data to categorize U.S. hospital service areas as for-profit (meaning that all beds in the area were in for-profit hospitals), not-for-profit (all beds were in not-for-profit hospitals), or mixed in 1989, 1992, and 1995. We then used data from the Continuous Medicare History Sample to calculate the 1989, 1992, and 1995 spending rates in each area, adjusting for other characteristics known to influence spending: age, sex, race, region of the United States, percentage of population living in urban areas, Medicare mortality rate, number of hospitals, number of physicians per capita, percentage of beds in hospitals affiliated with medical schools, percentage of beds in hospitals belonging to hospital chains, and percentage of Medicare beneficiaries enrolled in health maintenance organizations. RESULTS: Adjusted total per capita Medicare spending in the 208 areas where all hospitals remained under for-profit ownership during the study years was greater than in the 2860 areas where all hospitals remained under not-for-profit ownership ($4,006 vs. $3,554 in 1989, $4,243 vs. $3,841 in 1992, and $5,172 vs. $4,440 in 1995; P<0.001 for each comparison). Mixed areas had intermediate spending rates. Spending in for-profit areas was greater than in not-for-profit areas in each category of service examined: hospital services, physicians' services, home health care, and services at other facilities. The greatest increases in per capita spending between 1989 and 1995 were for hospital services (a mean increase of $395 in for-profit areas and $283 in not-for-profit areas, P=0.03 for the comparison between for-profit and not-for-profit areas) and home health care (an increase of $457 in for-profit areas and $324 in not-for-profit areas, P<0.001). Between 1989 and 1995, spending in the 33 areas where all hospitals converted from not-for-profit to for-profit ownership grew more rapidly than in the 2860 areas where all hospitals remained under not-for-profit ownership ($1,295 vs. $866, P=0.03). CONCLUSIONS: Both the rates of per capita Medicare spending and the increases in spending rates were greater in areas served by for-profit hospitals than in areas served by not-for-profit hospitals.

Health Expenditures↗
PubMed2006

Neural signatures of body ownership: a sensory network for bodily self-consciousness.

Body ownership refers to the special perceptual status of one's own body, which makes bodily sensations seem unique to oneself. We studied the neural correlates of body ownership by controlling whether an external object was accepted as part of the body or not. In the rubber hand illusion (RHI), correlated visuotactile stimulation causes a fake hand to be perceived as part of one's own body. In the present study, we distinguished between the causes (i.e., multisensory stimulation) and the effect (i.e., the feeling of ownership) of the RHI. Participants watched a right or a left rubber hand being touched either synchronously or asynchronously with respect to their own unseen right hand. A quantifiable correlate of the RHI is a shift in the perceived position of the subject's hand toward the rubber hand. We used positron emission tomography to identify brain areas whose activity correlated with this proprioceptive measure of body ownership. Body ownership was related to activity in the right posterior insula and the right frontal operculum. Conversely, when the rubber hand was not attributed to the self, activity was observed in the contralateral parietal cortex, particularly the somatosensory cortex. These structures form a network that plays a fundamental role in linking current sensory stimuli to one's own body and thus also in self-consciousness.

Adult↗
PubMed1990

Validating survey responses to questions about gun ownership among owners of registered handguns.

While survey-based data on firearm ownership are essential for epidemiologic studies of the relation between gun ownership and injuries, the validity of respondent answers to questions about gun ownership has not been confirmed. In order to assess the accuracy of interview data about firearms, in June to August 1987, the authors attempted to contact residents of 75 homes in the cities of Memphis, Tennessee and Seattle, Washington listed as the address of the owner of a recently registered handgun. Despite problems with inaccurate registration data, contact was ultimately made with 55 households, 35 of which consented to a general interview that included a series of questions about gun ownership. Respondents in 31 of these 35 households (88.6%) readily acknowledged that one or more guns were kept in their home. Respondents in three of the remaining four households (8.6%) stated that guns were recently kept in their homes but were no longer kept there. Only one respondent (2.9%) denied categorically that guns of any kind were kept in her home. The authors conclude that, at least among registered gun owners, respondent answers to questions about gun ownership are generally valid and that survey data of this type can be utilized with confidence.

Adult↗
PubMed2006

Current cat ownership may be associated with the lower prevalence of atopic dermatitis, allergic rhinitis, and Japanese cedar pollinosis in schoolchildren in Himeji, Japan.

The aim of the study was to clarify the relationship between current pet ownership, passive smoking, and allergic diseases among the Japanese children. From 1995 to 2001, we distributed the Japanese edition of the questionnaire of the American Thoracic Society and the Division of Lung Diseases (ATS-DLD) to survey allergic diseases among 35,552 6-yr-old children at primary school in the city of Himeji, Japan. We analyzed the data by multiple logistic regression and calculated adjusted odds ratios for environmental factors, including passive smoking and pet (dog and/or cat) ownership. There were no significant relationships between the prevalence of asthma and current pet ownership and passive smoking. However, current cat ownership was related to a significantly lower prevalence of atopic dermatitis [adjusted odds ratio (aOR) 0.79, 95% confidence interval (CI) 0.67-0.93], allergic rhinitis (aOR: 0.71, 95% CI 0.57-0.89) and Japanese cedar pollinosis (aOR 0.57, 95% CI 0.44-0.75). Strikingly, passive smoking was also related to a significantly lower prevalence of allergic rhinitis (aOR 0.83, 95% CI 0.77-0.89) and Japanese cedar pollinosis (aOR 0.81, 95% CI 0.74-0.88). Current cat ownership was associated with a lower prevalence of atopic dermatitis, allergic rhinitis, and Japanese cedar pollinosis. In addition, passive smoking was also associated with a lower prevalence of allergic rhinitis and Japanese cedar pollinosis.

Allergens↗
PubMed2005

The effects of creating psychological ownership on physicians' acceptance of clinical information systems.

OBJECTIVE: Motivated by the need to push further our understanding of physicians' acceptance of clinical information systems, we propose a relatively new construct, namely, psychological ownership. We situated the construct within a nomological net using a prevailing and dominant information technology adoption behavior model as a logical starting point. DESIGN: A mail survey was sent to the population of users of a regional physician order entry (POE) system aimed at speeding up the transmission of clinical data, mainly laboratory tests and radiology examinations, within a community health network. MEASUREMENTS: All scales, but one, were measured using previously validated instruments. For its part, the psychological ownership scale was developed using a multistage iterative procedure. RESULTS: Ninety-one questionnaires were returned to the researchers, for a response rate of 72.8%. Our findings reveal that, in order to foster physicians' adoption of a clinical information system, it is important to encourage and cultivate a positive attitude toward using the new system. In this connection, positive perception of the technology's usefulness is crucial. Second, results demonstrate that psychological ownership of a POE system is positively associated with physicians' perceptions of system utility and system user friendliness. Last, through their active involvement and participation, physicians feel they have greater influence on the development process, thereby developing feelings of ownership toward the clinical system. CONCLUSION: Psychological ownership's highly significant associations with user participation and crucial beliefs driving technology acceptance behaviors among physicians affirm the value of this construct in extending our understanding of POE adoption.

Attitude of Health Personnel↗
PubMedDate not supplied

A survey of attitudes toward responsible pet ownership.

The concerns of medical and community officials about responsible pet ownership have increased. Before a practical solution can be found for irresponsible ownership and community health problems associated with pet populations, the public's attitudes on issues related to responsible pet ownership must be determined. Such issues include attitudes on dog and cat overpopulation, potential public health problems associated with pet populations, and methods of controlling pet populations and stray animals. Responses to a questionnaire were used to evaluate the attitudes of 910 pet owners and nonowners toward factors comprising responsible pet ownership. The median age of the respondents was 33 years; 414 (45 percent) were men, and 496 (55 percent) were women. At the time of the study, 18 percent owned a cat and a dog, 35 percent owned only a dog, 11 percent showed only a cat, and 36 percent were nonowners. Not only the sex of the respondent but also the category of pet ownership affected opinions on overpopulation of dogs and cats, nuisance and pollution problems associated with these animals, and methods of controlling pet populations in the community. For example, owners agreed strongly on family planning for pets, but a majority of male owners stated that they would not have their dogs neutered.

Adolescent↗
PubMed2001

Interventions for promoting smoke alarm ownership and function.

BACKGROUND: Residential fires caused at least 67 deaths and 2,500 non-fatal injuries to children aged 0-16 in the United Kingdom in 1998. Smoke alarm ownership is associated with a reduced risk of residential fire death. OBJECTIVES: We evaluated interventions to promote residential smoke alarms, to assess their effect on smoke alarm ownership, smoke alarm function, fires and burns and other fire-related injuries. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, Cochrane Injuries Group database, MEDLINE, EMBASE, PsycLIT, CINAHL, ERIC, Dissertation Abstracts, International Bibliography of Social Sciences, ISTP, FIREDOC and LRC. Conference proceedings, published case studies, and bibliographies were systematically searched, and investigators and relevant organisations were contacted, to identify trials. SELECTION CRITERIA: Randomised, quasi-randomised or nonrandomised controlled trials completed or published after 1969 evaluating an intervention to promote residential smoke alarms. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed trial quality. MAIN RESULTS: We identified 26 trials, of which 13 were randomised. Overall, counselling and educational interventions had only a modest effect on the likelihood of owning an alarm (OR=1.26; 95% CI: 0.87 to 1.82) or having a functional alarm (OR=1.19; 0.85 to 1.66). Counselling as part of primary care child health surveillance had greater effects on ownership (OR=1.96; 1.03 to 3.72) and function (OR=1.72; 0.78 to 3.80). Results were sensitive to trial quality, however, and effects on fire-related injuries were not reported. In two non randomised trials, direct provision of free alarms significantly increased functioning alarms and reduced fire-related injuries. Media and community education showed little benefit in non randomised trials. REVIEWER'S CONCLUSIONS: Counselling as part of child health surveillance may increase smoke alarm ownership and function, but its effects on injuries are unevaluated. Community smoke alarm give-away programmes apparently reduce fire-related injuries, but these trials were not randomised and results must be interpreted cautiously. Further efforts to promote smoke alarms in primary care or through give-away programmes should be evaluated by adequately designed randomised controlled trials measuring injury outcomes.

Burns↗
PubMed2006

Dog ownership, health and physical activity: a critical review of the literature.

This review examines the association between dog ownership and adult physical activity levels. While there is evidence to suggest that dog ownership produces considerable health benefit and provides an important form of social support that encourages dog owners to walk, there is limited evidence on the physical environmental and policy-related factors that affect dog owners walking with their dog. With the high level of dog ownership in many industrialized countries, further exploration of the relationship between dog ownership and physical activity levels may be important for preventing declining levels of physical activity and the associated detrimental health effects.

Adult↗
PubMed2006

State-level homicide victimization rates in the US in relation to survey measures of household firearm ownership, 2001-2003.

Two of every three American homicide victims are killed with firearms, yet little is known about the role played by household firearms in homicide victimization. The present study is the first to examine the cross sectional association between household firearm ownership and homicide victimization across the 50 US states, by age and gender, using nationally representative state-level survey-based estimates of household firearm ownership. Household firearm prevalence for each of the 50 states was obtained from the 2001 Behavioral Risk Factor Surveillance System. Homicide mortality data for each state were aggregated over the three-year study period, 2001-2003. Analyses controlled for state-level rates of aggravated assault, robbery, unemployment, urbanization, per capita alcohol consumption, and a resource deprivation index (a construct that includes median family income, the percentage of families living beneath the poverty line, the Gini index of family income inequality, the percentage of the population that is black and the percentage of families headed by a single female parent). Multivariate analyses found that states with higher rates of household firearm ownership had significantly higher homicide victimization rates of men, women and children. The association between firearm prevalence and homicide victimization in our study was driven by gun-related homicide victimization rates; non-gun-related victimization rates were not significantly associated with rates of firearm ownership. Although causal inference is not warranted on the basis of the present study alone, our findings suggest that the household may be an important source of firearms used to kill men, women and children in the United States.

Adolescent↗
PubMed1997

Ownership of genetic material and information.

As a result of the International Human Genome Project genetic information is rapidly multiplying. To avoid some of the problems regarding the availability and use of genetic information, it is sometimes suggested to apply the concept of ownership. This article focuses on the clarification of the status of genetic material and genetic information, obtained as a result of screening and counseling of individual patients. First, some philosophical theories of ownership are examined for a justification of the use of the concept of ownership with regard to the human body. Next, arguments with regard to ownership of the human body are examined. The results of this analysis are applied to genetic material and genetic information.

Ethics, Medical↗
PubMed2004

Motorcycle ownership and injury in China.

BACKGROUND: China has made tremendous progress in its economic development in the past two decades. Accompanying this economic development has been an evident shift in the modes of transport, from walking and cycling to the use of motorcycles and, increasingly, four-wheel vehicles. Such changes are likely to have also produced changes in the patterns and numbers of road traffic injuries, including increases in motorcycle injuries. However, such changes have not been well documented. The work described in this paper sought, therefore, to document the changes in motorcycle ownership, motorcyclist mortality and injury rates in China since 1987. METHODS: National traffic ownership and injury data from 1987 to 2001 were obtained from the National Bureau for Traffic Administration. Additionally, traffic ownership and injury records from 1997 to 2001 were collected from local police offices from 20 counties in Guangxi Region. Population data were obtained from the national and county statistics bureaus. Motorcycle ownership, fatality and injury trends over time were calculated. RESULTS: Nationally, motorcycles accounted for 23.4% of all registered motor vehicles in 1987, increasing to 63.2% in 2001. Motorcyclist fatalities and injuries increased 5.5-fold and 9.3-fold, respectively, between 1987 and 2001. In 1987, 7.5% of all traffic fatalities and 8.8% of all traffic injuries were sustained by motorcyclists, with the corresponding proportions increasing to 18.9% and 22.8%, respectively, in 2001. The changing proportions of both traffic fatalities and injuries sustained by motorcyclists were positively correlated with the change in the proportion of motorcycles among all motor vehicles. In the 20 counties in Guangxi, motorcyclist fatality and injury rates also increased between 1997 and 2001. Moreover, these rates were considerably higher than the national rates. CONCLUSIONS: Motorcyclist injury in China is a serious public health problem. Motorcyclist fatalities and injuries are likely to continue to increase unless appropriate intervention programmes are implemented.

Accidents, Traffic↗
PubMed1998

Cycle helmet ownership and wearing; results of a survey in South Staffordshire.

BACKGROUND: Despite increasing evidence indicating that wearing cycle helmets can reduce the severity of head injuries, particularly in children, there is a paucity of local data on cycle helmet ownership and wearing rates. These data together with an understanding of the factors which influence these rates are important in developing appropriate health promotion programmes. METHOD: The objectives were to (1) establish patterns of cycle helmet ownership and wearing rates, and (2) determine factors influencing these rates. A descriptive survey involving a self-completed questionnaire was undertaken and a series of focus groups were also established. The setting was two high schools and four primary schools in each of the six boroughs or district councils within South Staffordshire involving 932 Year 6 and 2005 Year 10 children. RESULTS: The response ratio was 70.9 per cent from Year 6 and 80.9 per cent from Year 10, giving an overall response rate of 77.8 per cent. Most children (86.6 per cent) rode a bicycle and of these 42.8 per cent owned a cycle helmet. Just over a third (36.8 per cent) of Year 6 cyclists wore a helmet always or nearly always, compared with 13.7 per cent of Year 10 cyclists. Although the protective effect of cycle helmets was appreciated, many children did not see themselves as being personally at risk, particularly on short journeys. The appearance and comfort of the helmet appeared to be stronger factors influencing the uptake of helmets compared with cost. Both year groups were similarly concerned with comfort, but Year 10 children appeared more concerned with appearance than Year 6 children. CONCLUSIONS: Cycle helmet ownership and wearing is still disappointingly low, especially amongst older children. The factors influencing patterns of ownership and wearing are numerous and the interrelationships between them are complex, requiring a co-ordinated approach from a range of agencies. Cycle helmet legislation should be considered by the Government.

Bicycling↗
PubMed2000

Hospital ownership and preventable adverse events.

OBJECTIVE: To determine if type of hospital ownership is associated with preventable adverse events. DESIGN: Medical record review of a random sample of 15,000 nonpsychiatric, non-Veterans Administration hospital discharges in Utah and Colorado in 1992. MEASUREMENTS AND MAIN RESULTS: A two-stage record review process using nurse and physician reviewers was used to detect adverse events. Preventability was then judged by 2 study investigators who were blinded to hospital characteristics. The association among preventable adverse events and hospital ownership was evaluated using logistic regression with nonprofit hospitals as the reference group while controlling for other patient and hospital characteristics. We analyzed 4 hospital ownership categories: nonprofit, for-profit, major teaching government (e.g., county or state ownership), and minor or nonteaching government. RESULTS: When compared with patients in nonprofit hospitals, multivariate analyses adjusting for other patient and hospital characteristics found that patients in minor or nonteaching government hospitals were more likely to suffer a preventable adverse event of any type (odds ratio [OR] 2.46; 95% confidence interval [CI], 1.45 to 4.20); preventable operative adverse events (OR, 4.85; 95% CI, 2.44 to 9.62); and preventable adverse events due to delayed diagnoses and therapies (OR, 4.27; 95% CI, 1.48 to 12.31). Patients in for-profit hospitals were also more likely to suffer preventable adverse events of any type (OR, 1.57; 95% CI, 1.03 to 2.38); preventable operative adverse events (OR, 2.63; 95% CI, 1.42 to 4.87); and preventable adverse events due to delayed diagnoses and therapies (OR, 4.15; 95% CI, 1. 84 to 9.34). Patients in major teaching government hospitals were less likely to suffer preventable adverse drug events (OR, 0.38; 95% CI, 0.16 to 0.89). CONCLUSIONS: Patients in for-profit and minor teaching or nonteaching government-owned hospitals were more likely to suffer several types of preventable adverse events. Further research is needed to determine how these events could be prevented.

Colorado↗
PubMed2006

Dog ownership, walking behavior, and maintained mobility in late life.

OBJECTIVES: To examine dog walking among dog owners and the relationship between walking behavior of dog owners and non-dog owners and maintained gait speed over 3 years. DESIGN: Cross-sectional and longitudinal analyses of a prospective cohort study. SETTING: Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS: Two thousand five hundred thirty-three community-dwelling adults aged 71 to 82 at 36 months of the Health, Aging and Body Composition Study. MEASUREMENTS: Dog ownership, reported walking behavior, change in walking behavior, and usual and rapid gait speed over 3 years. RESULTS: Of 394 dog owners, only 36% walked their dogs at least three times per week. Cross-sectionally, dog walkers were more likely to achieve 150 minutes of walking per week and had faster usual and rapid walking speeds (1.20 vs 1.14 m/s and 1.62 vs 1.52 m/s, respectively; P < .01 for both) than non-dog owners who did not walk at least three times per week and similar speeds as non-dog owners who walked at least 150 minutes per week (P > .50). Three years later, subjects who had been dog walkers at baseline were approximately twice as likely as any other group to achieve recommended walking levels, independent of covariates. Dog walkers experienced similar declines in usual and rapid walking speed as non-dog owners who walked at least three times per week but maintained their initial mobility advantage. CONCLUSION: Although dog ownership appears to facilitate walking behavior, only a minority of older dog owners walk their dogs. The mobility advantage of dog ownership was seen only in dog walkers and was similar to that associated with any walking. Given suboptimal walking activity in older adults, examining the degree to which dog ownership promotes walking activity in persons who do little walking on their own appears worth pursuing.

Aged↗
PubMed2000

Patterns and correlates of gun ownership among nonmetropolitan and rural middle school students.

Examined prevalence of gun ownership and the links among gun ownership, reasons for gun ownership, and antisocial behavior in a sample of nonmetropolitan and rural middle school students. Participants completed the Questionnaire for Students (Olweus, 1995) and included 6,263 students from 36 elementary and middle schools, of whom most were African American (range = 46%-95% per school). Reasons for gun ownership were strongly associated with rates of antisocial behavior. Youths who owned guns for sporting reasons reported rates of antisocial behavior that were only slightly higher than those reported by youths who did not own guns. Youths who owned guns to gain respect or to frighten others reported extremely high rates of antisocial behavior. These high-risk adolescent gun owners were likely to come from families of high-risk gun owners, associate with friends who were high-risk gun owners, and engage in high rates of bullying behavior. Findings suggest that effective violence prevention programs must target high-risk youths, address risk factors that go beyond individual settings, and address a comprehensive array of risk factors.

Adolescent↗
PubMedDate not supplied

Public expectations of nonprofit and for-profit ownership in American medicine: clarifications and implications.

Policymakers, advocates, and scholars frequently make claims about how the American public sees ownership affecting the delivery of medical care. In this paper we provide a comprehensive assessment of how Americans think about nonprofit and for-profit ownership. We summarize findings from surveys fielded between 1985 and 2000 and supplement them with findings from a new survey. Most Americans believe that ownership matters for multiple aspects of medical care; they expect nonprofit hospitals and health plans to be more trustworthy, fair, and humane but lower in quality. People who are better informed about ownership have more positive expectations about nonprofits' performance.

Delivery of Health Care↗
PubMed2005

The association between presence of children in the home and firearm-ownership and -storage practices.

OBJECTIVE: American children's ready access to firearms contributes to high rates of firearm-related injuries. Understanding the factors that influence storage decisions is critical for prevention. This study examined the influence of geography and presence of children <16 years old in the home on firearm-ownership and storage decisions of northeast-Ohio residents. METHODS: Analysis was based on 522 responses to randomized telephone surveys of urban and rural households in northeast Ohio. Relationships between 4 dependent variables (firearm ownership, type of firearm owned, reasons for owning, and storage) and 2 independent variables (geography and presence of children in the home) were evaluated using odds ratios and multinomial logistic regression. RESULTS: Firearms were significantly more common in rural (31%) than in urban (13%) households. Twenty-two percent of gun owners reported securing all firearms with trigger locks or storing them in locked safes, drawers, or gun cabinets; 12% reported storing guns unlocked and either loaded or together with ammunition. Most gun owners (66%) reported storing all firearms unlocked, unloaded, and separate from ammunition. Rural respondents without children were approximately twice as likely as those with children to have handguns, but children did not influence long-gun ownership. In the urban group, the presence of children was not related to likelihood of firearm ownership. Having children in the home was not significantly associated with higher rates of safe storage for either group. DISCUSSION: These results illustrate the inadequacy of 1-size-fits-all interventions and highlight the need to better understand gun owners' reasoning about children and guns to design and implement successful interventions. Physicians and others interested in reducing pediatric exposure to firearms cannot be credible messengers on gun-safety topics if they cannot demonstrate an understanding of the issues from the perspective of patients and their families.

Child↗
PubMed1992

Ownership and performance of outpatient substance abuse treatment centers.

BACKGROUND: Little is known about the organization and performance of outpatient substance abuse treatment (OSAT) centers. We examine several performance measures of OSAT units, including clients treated, services provided, revenue sources, financial performance, and access to care, in relation to ownership of the center. METHODS: Data were drawn from a national random sample of 575 OSAT centers (85.8% response rate) participating in a telephone survey conducted in 1988. Analysis of variance by ownership was conducted on each performance measure, with differences subjected to tests of statistical significance. RESULTS: Descriptive results show that major funding sources differ by ownership. Private for-profit centers generate higher profits, charge higher prices, and achieve higher levels of financial performance than public and not-for-profit centers. Public centers provide better access to care for persons who are unable to pay. CONCLUSIONS: There appear to be substantial and interrelated differences by ownership type in the financing and operation of OSAT units.

Financing, Organized↗