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PubMed2002

Rates of household firearm ownership and homicide across US regions and states, 1988-1997.

OBJECTIVES: In this study we explored the association between rates of household firearm ownership and homicide across the United States, by age groups. METHODS: We used cross-sectional time-series data (1988-1997) to estimate the association between rates of household firearm ownership and homicide. RESULTS: In region- and state-level analyses, a robust association between rates of household firearm ownership and homicide was found. Regionally, the association exists for victims aged 5 to 14 years and those 35 years and older. At the state level, the association exists for every age group over age 5, even after controlling for poverty, urbanization, unemployment, alcohol consumption, and nonlethal violent crime. CONCLUSIONS: Although our study cannot determine causation, we found that in areas where household firearm ownership rates were higher, a disproportionately large number of people died from homicide.

Adolescent↗
PubMed2002

Does investor-ownership of nursing homes compromise the quality of care?

Quality problems have long plagued the nursing home industry. While two-thirds of U.S. nursing homes are investor-owned, few studies have examined the impact of investor-ownership on the quality of care. The authors analyzed 1998 data from inspections of 13,693 nursing facilities representing virtually all U.S. nursing homes. They grouped deficiency citations issued by inspectors into three categories ("quality of care," "quality of life," and "other") and compared deficiency rates in investor-owned, nonprofit, and public nursing homes. A multivariate model was used to control for case mix, percentage of residents covered by Medicaid, whether the facility was hospital-based, whether it was a skilled nursing facility for Medicare only, chain ownership, and location by state. The study also assessed nurse staffing. The authors found that investor-owned nursing homes provide worse care and less nursing care than nonprofit or public homes. Investor-owned facilities averaged 5.89 deficiencies per home, 46.5 percent higher than nonprofit and 43.0 percent higher than public facilities, and also had more of each category of deficiency. In the multivariate analysis, investor-ownership predicted 0.679 additional deficiencies per home; chain-ownership predicted an additional 0.633 deficiencies per home. Nurse staffing ratios were markedly lower at investor-owned homes.

Aged↗
PubMed2005

Correlates of credit card ownership in men and women.

In a sample of 352 students, correlates of credit card ownership differed by sex. For both men and women, credit card ownership was predicted by their affective attitude toward credit cards. However, whereas for men concern with money as a tactic for gaining power predicted credit card ownership, for women feelings of insecurity about having sufficient money and having a conservative approach to money predicted credit card ownership.

Adult↗
PubMedDate not supplied

Errors in data on hospital ownership.

In recent years, there has been increased public concern about changes in hospital ownership and consolidation in the hospital market. Numerous studies have examined the relationship between hospital ownership and prices, costs, organization, service mix, access to care and quality of care. However, the data on which these studies are based are often incomplete and inaccurate. In this paper, we examine several sources of data employed by researchers examining hospital ownership and discuss the degree of inaccuracy we found in each source. Substantial primary data collection is necessary to accurately account for changes in ownership and system affiliation.

American Hospital Association↗
PubMed2003

Changes in hospital performance after ownership conversions.

This paper examines the effects of ownership conversions on hospital performance between 1987 and 1998 in areas of financial performance, staffing, capacity, and unprofitable care. Conversions to government and for-profit ownership both increased the profit margin: the former due to rising revenue, and the latter due to reduced operating costs and rising revenue. Hospitals that converted to for-profit ownership had the greatest reduction in staffing relative to other converted hospitals. There was little change in bed capacity after conversion to for-profit status, but some reductions in bed capacity after conversion to government or nonprofit status. No conversion of any kind led to a reduced amount of unprofitable care, but conversion to private ownership (nonprofit and for-profit) increased the probability of trauma center closures.

Financial Management, Hospital↗
PubMed1989

Rights of the medical staff in the transfer of hospital ownership.

In the current uncertain economic climate, a greater number of hospitals than ever before are changing ownership through sale or merger. This article explores the legal implications of a change in hospital ownership for both the individual medical staff physicians and the medical staff organization. The article takes the position that, with respect to individual physicians, their vested rights in staff membership and clinical privileges cannot be altered simply because of a change in hospital ownership. In addition, with respect to the medical staff organization, the medical staff bylaws contract remains intact and, therefore, a change in hospital ownership does not permit the new hospital owners to make wholesale changes in the medical staff organization.

Civil Rights↗
PubMed2001

Impact of HMO ownership on management processes and utilization outcomes.

OBJECTIVE: To examine the effects of health maintenance organization (HMO) ownership characteristics on selected utilization outcomes and management processes affecting utilization. STUDY DESIGN: We used 1995 HMO data from the American Association of Health Plans. PATIENTS AND METHODS: Using regression analysis, we examined the relation between HMO utilization (hospital discharges, days, and average length of stay; cardiac catheterization procedures; and average cost of outpatient prescriptions) and the structural characteristics of HMOs: ownership type (insurance company, hospital, physician, independent, and national managed care company), HMO size, for-profit status, model type, geographic region, and payer mix. RESULTS: HMO ownership type is significantly associated with medical management processes, including risk sharing by providers, risk sharing by consumers, and other management strategies. Relative to hospital-owned HMOs, insurance company-owned HMOs have fewer hospital discharges, fewer hospital days, and longer lengths of stay. National managed care organization-owned HMOs have fewer cardiac catheterizations and lower average outpatient prescription costs. Independently owned HMOs have more cardiac catheterizations. For-profit HMOs have lower prescription costs. Relative to hospital-owned HMOs, insurance company-owned HMOs are more likely to use hospital risk sharing and provider capitation and less likely to use out-of-pocket payments for hospital use and a closed formulary. National managed care organization-owned HMOs are less likely to use provider capitation, out-of-pocket payments for hospital use, catastrophic case management, and hospital risk sharing. Physician-hospital-owned HMOs are less likely to use catastrophic case management. For-profit HMOs are more likely to use hospital risk sharing and catastrophic case management. CONCLUSION: HMO ownership type affects utilization outcomes and management strategies.

Case Management↗
PubMed1980

Values and limitations of pet ownership.

A questionnaire was used to collect information concerning the values and limitations of pet ownership. The major reasons given for nonownership were housing limitations, emotional dissatisfaction with animals, destructive habits of pets, and a transient household status. Various stages of the family's "life cycle" had a role in determining pet ownership. The pet's agreeable temperament (eg, intelligence, gentleness, and playfulness) was considered to be the major advantages of pet ownership. The major negative characteristics of pet ownership were the destructiveness and overaggressiveness of the pet.

Aggression↗
PubMed2004

Lung function at age 3 years: effect of pet ownership and exposure to indoor allergens.

OBJECTIVE: To investigate the effect of pet ownership and exposure to indoor allergens on lung function in 3-year-old children. DESIGN: Birth cohort study. SETTING: Community. PARTICIPANTS: Children recruited prenatally and followed prospectively to age 3 years. MAIN OUTCOME MEASURES: Specific airway resistance (sRaw) (measured with body plethysmograph) at age 3 years; skin-prick tests; data on cat and dog ownership collected prospectively; allergen levels measured in dust collected from homes (high exposure defined as mite allergens >2 microg/g in mattress, and dog >10 microg/g and cat >8 microg/g allergens on the living room floor). RESULTS: There was no effect of cat or dog ownership at birth or age 3 years on lung function, and no association between lung function and mite, dog, or cat allergen exposure. Sensitized children exposed to high levels of sensitizing allergen had significantly poorer lung function (n = 49, sRaw kiloPascal per second [kPa/s]; geometric mean [GM], 1.20; 95% confidence interval [CI], 1.13-1.28) than children who were not sensitized and not exposed (n = 114; GM, 1.08; 95% CI, 1.04-1.12); not sensitized, but exposed (n = 282; GM, 1.07; 95% CI, 1.05-1.10); or sensitized and not exposed (n = 53; GM, 1.12; 95% CI, 1.06-1.18; P = .005). In a multivariate model, independent significant associates of lung function were maternal and paternal asthma, and the combination of sensitization and exposure to sensitizing allergen, with significant interaction between them. Lung function was substantially worse in sensitized and highly exposed children with both asthmatic parents (GM, 2.23; 95% CI, 1.68-2.97), compared with those with neither (GM, 1.09; 95% CI, 1.04-1.16) or just 1 of these features. CONCLUSIONS: Pet ownership, sensitization without exposure, or exposure in nonsensitized individuals have no effect on lung function. However, the combination of specific sensitization and exposure to sensitizing allergen is associated with significantly poorer lung function in early life.

Air Pollution, Indoor↗
PubMed1989

Firearm ownership among nonurban adolescents.

Firearm injury is the second leading cause of death among teenagers. In this study we examined firearm acquisition and ownership in a biracial cohort of 664 teenagers (313 male and 351 female). Ownership was prevalent among male adolescents (48%) and rare among female adolescents (4%). Among these suburban and rural teenagers, the ownership rate was highest for white male adolescents (56%). Handgun ownership was more frequent among male school dropouts (22%) than enrollees (7%). The first firearm was typically acquired by late childhood or early adolescence (median age, 12.5 years). An adult male family member (eg, father, grandfather, uncle) was the primary source. The prevalence, developmental timing, and sociodemographic correlates of firearm acquisition should be useful for informing preventive clinical practice and interventions.

Adolescent↗
PubMed1993

Pet ownership protects against the risks and consequences of coronary heart disease.

Despite decreasing coronary heart disease mortality among both men and women, this disease still remains the leading cause of death in the United States. In addition to known physiologic factors, such as hypertension, smoking, and elevated plasma cholesterol, psychosocial factors including anxiety, marital status, and social isolation have been shown to contribute to the risk of coronary heart disease. There is increasing evidence suggesting that pet ownership causes measurable short term psychological and physiological effects in people, including reduction of blood pressure and mitigation of psychological indicators of anxiety. There is also evidence that pet ownership is associated with clinically significant health effects in people, including improved survival after a coronary event. We hypothesize that pet ownership, though its ability to positively influence psychosocial risk factors, results in a lowered risk of coronary heart disease and increased survival after a coronary event if it occurs, and that increased pet ownership would further reduce mortality from coronary heart disease.

Animals↗
PubMed2006

Media analyses based on Microsoft NTFS file ownership.

The ever-increasing size of digital media presents a continuous challenge to digital investigators who must rapidly assess computer media to find and identify evidence. To meet this challenge, methods must continuously be sought to expedite the examination process. This paper investigates using the file ownership property as an analytical tool focusing on activity by individuals associated with the computer. Research centered on the New Technology File System (NTFS), which is the default file system in Microsoft Windows Operating System (OS). This was done because Microsoft's worldwide market penetration makes Windows and NTFS the most likely OS and file system to be encountered in digital forensic examinations. Significantly, digital forensic software now allows examination of NTFS file attributes and properties including the ownership property. The paper outlines potential limitations regarding interpreting ownership findings, and suggests areas for further research. Overall, file ownership is seen as a potentially viable new digital forensic tool.

Journal Article↗
PubMed2006

Influence of dog ownership and high endotoxin on wheezing and atopy during infancy.

BACKGROUND: Increased exposure to microbial products early in life may protect from development of atopic disorders in childhood. Few studies have examined the relationship of endotoxin exposure and pet ownership on atopy and wheezing during infancy. OBJECTIVE: Evaluate relationships among high endotoxin exposure, pet ownership, atopy, and wheezing in high-risk infants. METHODS: Infants (n = 532; mean age, 12.5 +/- 0.8 months) with at least 1 parent with confirmed atopy were recruited. A complete medical history and skin prick testing to foods and aeroallergens were performed at age 1 year. House dust samples were analyzed for endotoxin. RESULTS: Prevalences of wheezing were not independently associated with dog or cat ownership or endotoxin levels. Percutaneous reactivity to at least 1 allergen was observed in 28.6% of infants. Univariate analyses showed significant associations of any wheezing, recurrent wheezing, and recurrent wheezing with an event with daycare attendance, number of siblings, respiratory infections, maternal smoking, and history of parental asthma. Logistic regression adjusting for the latter variables showed that recurrent wheezing (odds ratio, 0.4; 95% CI, 0.1-0.9) as well as 2 other wheeze outcomes were significantly reduced in homes with high endotoxin exposure in the presence of 2 or more dogs. CONCLUSION: Pet ownership or endotoxin did not independently modify aeroallergen sensitization or wheezing during infancy. However, high endotoxin exposure in the presence of multiple dogs was associated with reduced wheezing in infants. CLINICAL IMPLICATIONS: A home environment with many dogs and high levels of endotoxin may be conducive to reduced wheezing in infancy.

Allergens↗
PubMed2004

Factors associated with ownership and use of written asthma action plans in North-West Melbourne.

PURPOSE: Written asthma action plans (WAAPs) have become a core component of asthma management in Australia. We investigated ownership, utilisation and factors associated with ownership of asthma action plans by caregivers. METHODS: 443/776 (57%) caregivers of children aged 2-14 years with asthma were identified from 32 GP clinics as part of a randomised controlled trial (RCT), and completed self-administered questionnaires. RESULTS: Only 29% of participants owned a WAAP, while 13% possessed verbal instructions, and 56% had no plan. An asthma action plan for children, which was developed by a general practitioner (GP) was more likely to comprise verbal instructions (p = 0.001), while action plans developed by paediatricians were more likely to be written (p < 0.001). Just over one half of caregivers (59%) reported discussing their child's action plan the last time they visited their doctor for asthma. Factors associated with WAAP ownership included nights waking (p = 0.013), self reported severity (p = 0.001), and days lost from school (p = 0.037). Children who had seen a GP in the last 3 months for asthma, or who had been to the Emergency Department (ED) or hospital were more likely to possess a WAAP (p < 0.001). Caregivers who were less satisfied with their child's asthma control were more likely to own a WAAP (p = 0.037). Caregivers with any action plan found it useful and 82% reported using their action plan for management of an acute attack. However, caregivers with a WAAP were more likely to adhere to the plan for an acute attack compared to caregivers with verbal instructions (OR = 4.5, p < 0.05). Caregivers with a WAAP were more knowledgeable about asthma (p = 0.002), better able to recognise the difference between preventer and reliever medications (p = 0.01), and better able to recognise an asthma attack (p = 0.006). CONCLUSIONS: Ownership of WAAPs in this group was still too low. Importantly, caregivers with written instructions were more knowledgeable about asthma and more likely to report following the action plan during an asthma attack.

Journal Article↗
PubMed2001

Smoke alarm ownership and installation: a comparison of a rural and a suburban community in Georgia.

As part of a smoke alarm giveaway and installation program (The Get-Alarmed Campaign), a total of 454 households were surveyed in two counties in Georgia, one metropolitan and one nonmetropolitan. The targeted communities in these counties had a high prevalence of low-income and minority populations and thus were at high risk of house fire-related morbidity and mortality. The objectives of the program were to determine the prevalence of and predictors for installed, functioning smoke alarms, and to install at least one smoke alarm and/or smoke alarm batteries in 100% of participating homes in need. Characteristics associated with smoke alarm ownership included home ownership, having a higher income, and having a central heating source, factors which should be considered in targeting future intervention strategies. At onset, 159/454 households (35.0%) had no smoke alarms installed and 56/275 households with existing smoke alarms (20.4%) had none that were functional. Regardless of ownership status, a free smoke alarm was installed in the household of 93.8% of participants and new batteries were installed in existing smoke alarms for 31.7% of participants. This project illustrates the usefulness of a door-to-door campaign in increasing smoke alarm ownership in both a rural and a suburban community with a high concentration of residents at high risk of house fire-related morbidity and mortality.

Accident Prevention↗
PubMed1996

Isolation, car ownership, and small area variation in incidence of acute lymphoblastic leukaemia in children.

To determine whether increased rates of childhood acute lymphoblastic leukaemia (ALL) which had been reported in isolated areas could be attributed to higher proportions of households owning cars, ecological analysis was performed with electoral wards as area units. Previous data were re-analysed using the proportion of households having no car, taken from the 1981 census of England and Wales, as an additional explanatory factor. A specialist registry of haematopoietic malignancies covering one-third of England and Wales (3270 electoral wards) recorded 438 cases of ALL in children diagnosed 1984-89, including 304 in the childhood peak (at ages 1-7 years). Relative risks were derived by Poisson regression of total childhood ALL and at ages 1-7 years for groups of electoral wards classified by isolation and car ownership. Multivariable analyses included adjustment for socio-economic status. No evidence of increased risk of childhood ALL in areas where more households own cars was found. ALL at ages 1-7 years was inversely associated with car ownership (risk in wards with least cars relative to those with most cars = 2.28, 95% CI: 1.12-4.64). The associations with geographic isolation persisted after allowing for car ownership (risks for ALL in young children in isolated relative to built-up areas = 2.19, 95% CI: 1.44-3.33). Levels of car ownership cannot explain the increased rates of childhood ALL which have been observed in isolated areas. No support has been found for a hypothesis relating these excesses to benzene exposure of children transported in cars. The previous explanation for the small area variation of childhood ALL in terms of geographical isolation and interpretation in terms of exposure to common infections continues to be justified.

Adolescent↗
PubMed2003

Advance directives and emergency department patients: ownership rates and perceptions of use.

BACKGROUND: Advance directives (ADs) are rarely available in Australia to guide management but may become more important as our population ages. AIMS: The present study aimed to determine patient knowledge, perception and ownership rates of ADs and the factors that impact upon these variables. METHODS: A cross-sectional survey of emergency department patients was undertaken. The main outcome measures were: (i) prior discussion about the extent of medical treatment and ADs, (ii) knowledge and perceptions of ADs, (iii) present AD ownership rates and (iv) likelihood of future AD ownership. Generalized linear models were used for analysis. RESULTS: Four hundred and three patients were enrolled. The mean age of patients was 73 years and 239 (59.3%) were male. Two hundred and forty patients (59.6%) had discussed the extent of treatment. Only 81 patients (20.1%) had discussed the use of an AD. One hundred and thirty-seven patients (34.0%) knew of one type of AD and 333 patients (82.6%) thought some ADs were a good idea. Only 32 patients (7.9%) owned an AD, although 276 (68.5%) would consider owning one. The main reason for never obtaining an AD was "always wanting full treatment" (93 patients, 23.1%). Level of education was the only characteristic that impacted significantly upon an outcome measure. Patients with a higher level of education were more likely to have known and spoken about ADs, to own an AD and to consider owning one. CONCLUSIONS: AD knowledge and ownership rates were low. However, most patients perceive them favourably and many would consider owning one. Intervention strategies to improve AD awareness are indicated. This may empower patients to more effectively participate in their own advance care planning.

Advance Directives↗
PubMedDate not supplied

Pet ownership and health in older adults: findings from a survey of 2,551 community-based Australians aged 60-64.

BACKGROUND: It is commonly assumed that owning a pet provides older residents in the community with health benefits including improved physical health and psychological well-being. It has also been reported that pet owners are lower on neuroticism and higher on extraversion compared with those without pets. However, findings of research on this topic have been mixed with a number of researchers reporting that, for older people, there is little or no health benefit associated with pet ownership. OBJECTIVE: To identify health benefits associated with pet ownership and pet caring responsibilities in a large sample of older community-based residents. METHODS: Using survey information provided by 2,551 individuals aged between 60 and 64 years, we compared the sociodemographic attributes, mental and physical health measures, and personality traits of pet owners and non-owners. For 78.8% of these participants, we were also able to compare the health services used, based on information obtained from the national insurer on the number of general practitioner (GP) visits they made over a 12-month period. RESULTS: Compared with non-owners, those with pets reported more depressive symptoms while female pet owners who were married also had poorer physical health. We found that caring for a pet was associated with negative health outcomes including more symptoms of depression, poorer physical health and higher rates of use of pain relief medication. No relationship was found between pet ownership and use of GP services. When we examined the personality traits of pet owners and carers, we found that men who cared for pets had higher extraversion scores. Our principal and unexpected finding, however, was that pet owners and carers reported higher levels of psychoticism as measured by the Revised Eysenck Personality Questionnaire. CONCLUSIONS: We conclude that pet ownership confers no health benefits for this age group. Instead, those with pets have poorer mental and physical health and use more pain relief medication. Further, our study suggests that those with pets are less conforming to social norms as indicated by their higher levels of psychoticism.

Animals↗