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PubMed2026

Psychological consequences of AI-assisted training and the buffering role of mindfulness.

The integration of artificial intelligence (AI) into athletic training is accelerating, yet its psychological implications for athletes remain insufficiently understood. Drawing on the transactional model of stress and the stress-buffering framework of mindfulness, this study examined whether mindfulness training can mitigate adverse psychological responses associated with AI-assisted training. Using a randomized controlled factorial design, 160 collegiate athletes were assigned to AI-assisted training or standard training, with or without concurrent mindfulness intervention, and assessed at baseline, week 4, and week 8. Athletes exposed to AI-assisted training without psychological support exhibited increases in perceived stress and AI dependence over time. In contrast, these stress increases were substantially attenuated when mindfulness training was implemented alongside AI-assisted training. A significant AI × Mindfulness × Time interaction emerged for perceived stress at post-intervention, and difference-in-differences analyses corroborated a robust buffering effect. Mediation analyses further indicated that mindfulness training reduced stress partially through enhancing mindful awareness; a three-wave cross-lagged analysis showed that mindful awareness and stress were reciprocally related over time, with the hypothesized awareness-to-stress pathway remaining robust. Together, these findings suggest that AI-assisted training introduces a distinct form of evaluative pressure, and that mindfulness training may serve as an effective psychological buffer during the adoption of continuous algorithmic performance evaluation systems.

Humans↗
PubMed2004

Appraisal and coping strategy use in victims of school bullying.

BACKGROUND: Transactional models of coping (Lazarus & Folkman, 1984) can contribute to our understanding of why some children cope effectively with bullying while others suffer negative outcomes. However, previous research has relied on coping measures that are not comparable with adult measures, restricting investigation of developmental trends. Additionally, previous research has not included appraisals when measuring coping using an established coping measure. AIMS: To examine the factor structure of a coping measure that is directly comparable with the adult literature; to examine the content of pupils' threat and challenge appraisals concerning bullying; and to examine the relationships between appraisals and coping strategy use within the victims of school bullying. SAMPLE: Participants were 459 children aged 9 - 14 years. METHOD: A self-report bullying questionnaire, incorporating Halstead et al.'s (1993) adolescent version of the Ways of Coping Checklist, was completed by participants. Also included were control, threat and challenge appraisal items. RESULTS: Confirmatory factor analysis confirmed that Halstead et al.'s four-factor model of coping is valid for a population of school bullying victims. Content validity of items used to measure threat and challenge appraisal was demonstrated. Ambiguity of challenge appraisal influenced the use of Wishful Thinking, Seeks Social Support and Problem Focused coping. Wishful Thinking was also influenced by control appraisal. Avoidance coping was not influenced by the appraisals measured. CONCLUSION: Halstead et al.'s Revised Ways of Coping Checklist can be used to measure coping amongst child and adolescent victims of bullying. Furthermore, including appraisal variables improves our understanding of individual differences between victims' coping strategy choices.

Adaptation, Psychological↗
PubMed1995

[Computerized record system for the analysis of diagnosis of chronic diseases and their treatment in primary health care].

OBJECTIVE: To present the design and setting up of a computerised data base for primary care. DESIGN: A descriptive crossover study. The recording lasted a year. SETTING: Gómez Acebo Health Centre in Madrid. Primary Care. PATIENTS AND OTHER PARTICIPANTS: The whole of the health centre catchment population, comprising 14,407 people, as well as 20 doctors and nurses. INTERVENTIONS: The consultations of ten doctors and ten nurses at the health centre were computerised. The computer programme, language-designed for inter-related data bases, linked four data bases (users, chronic illnesses, medicines, and the diagnosis and treatment record-sheet). The population under study comprised 14,407 people over one year, 1993. MEASUREMENTS AND MAIN RESULTS: The users file held the data of 14,407 people. 7,867 of these contained 23,993 chronic diagnoses with 12,405 treatments. The commonest diagnosis groups were: cardiovascular, psychiatry, endocrinology and articulations. The therapeutic groups with most prescriptions were C (cardiovascular), A (digestive and metabolic), N (nervous system) and R (respiratory). Daily expenditure in medicines was 634,207 pesetas. CONCLUSIONS: The main contribution of this computerised data base is to be able to analyse the associations between pathologies and their associated treatments, along with the pharmacological cost per primary care transaction, interactions and adverse side-effects.

Adolescent↗
PubMed1999

Differentiating stranger murders: profiling offender characteristics from behavioral styles.

The literature on "offender profiling" suggests that different "styles" of homicide will reflect differences in the background characteristics of the offender. To test this suggestion, hypotheses were drawn from studies of aggression to propose that murder crime scenes would reveal stylistic distinctions in the role of the aggression in the offense. It was further hypothesized that these distinctions would be clearest for those crime scene indicators that reflect the instrument (cognitive) actions that shape the offense rather than the more expressive (impulsive and emotional) components. Hypotheses about associated offender characteristics were also deduced on the assumption that the murder scene theme revealed the killers' typical styles of interpersonal transaction. To test these hypotheses MDS analyses were carried out on the crime scene and offender characteristics derived from 82 single offender, single victim stranger homicides. A multivariate structure resulted, including all three hypothesized styles, allowing 65% of the cases to be assigned to unique styles and a further 36% to be assigned to appropriate hybrids. Offender characteristics related in the anticipated way to the different crime scene styles, providing a basis for law enforcement inferences about offenders in stranger murders.

Adolescent↗
PubMed1976

Transactions of an international conference. Worldwide concern: better dental care for more people. An international collaborative study. How social surveys were conducted.

It is assumed that utilization of dental care services and hence the state of oral health is dependent on social and psychological characteristics of both consumers and providers. The sociological variables studied included the basic facts of age, sex, residence and socioeconomic status. Attitudes to general health care, past oral health care and self assessment of oral health status were also investigated. Accessibility of oral health care facilities in terms of cost, loss of time and distance travelled was assessed, as was the consumers estimate of the dentist's sensitivity and competence, his attitude to preventive care, aesthetic values and knowledge of oral health care measures. Sociologists from the participating countries cooperated in the formulation of questionnaires which could be applied with comparable results despite differences in language and culture. Adults were interviewed in their own homes while younger groups completed the questionnaire in school under the supervision of the researchers. In all cases the sociological survey preceded the clinical examination to reduce the introduction of bias. The data were collected in Geneva and analysed to determine the extent to which oral health status could be related to perception of need, personal oral health practices, availability, accessibility, acceptability and utilization of services. Further analysis may help to determine whether observed differences between populations relate more to the characteristics of the systems of dental care or to features inherent in the population of the country.

Adolescent↗
PubMed1993

Phosphorylation of the human vitamin D receptor by protein kinase C. Biochemical and functional evaluation of the serine 51 recognition site.

We have reported previously that the human vitamin D receptor (hVDR) is selectively phosphorylated by protein kinase C-beta (PKC-beta), in vitro, on a serine residue in the sequence RRS51MKRK, which is located between the two zinc fingers of hVDR and is potentially important to its transacting function (Hsieh, J.-C., Jurutka, P.W., Galligan, M.A., Terpening, C.M., Haussler, C.A., Samuels, D.S., Shimizu, Y., Shimizu, N., and Haussler, M.R. (1991) Proc. Natl. Acad. Sci. U.S.A. 88, 9315-9319). In the present experiments we evaluated this phosphorylation event using a series of hVDR mutants in which serine 51 or its flanking residues were modified. Alteration of serine 51 to a non-phosphorylatable residue resulted in an approximately 60% reduction in basal hVDR phosphorylation in intact cells but did not diminish 1,25-dihydroxyvitamin D3-stimulated phosphorylation. Such mutations also abolished subsequent phosphorylation of immunoprecipitated hVDR by purified PKC-beta, in vitro, as did replacement of basic residues on either side of serine 51. Mutation of serine 51 to glycine (S51G) or to aspartic acid (S51D), as well as altering the basic residues flanking serine 51, abolished the interaction of hVDR with the vitamin D-responsive element (VDRE) as monitored by gel mobility shift analysis. Thus, we conclude that unmodified serine 51 and its surrounding basic residues are crucial not only for PKC-beta substrate recognition but also for the optimal VDRE binding of native hVDR. In transactivation assays, S51G and S51D possessed only 35 and 10% of wild-type hVDR activity, respectively. Mutation of serine 51 to threonine (S51T) restored phosphorylation by PKC-beta, in vitro, to about 40% of wild-type and transactivation to 45% of that of wild-type hVDR. Alteration of serine 51 to alanine, which is the residue in the corresponding position of the glucocorticoid, progesterone, mineral-ocorticoid, and androgen receptors, eliminated PKC-beta phosphorylation but completely preserved the specific DNA binding activity and transactivation capacity of hVDR. Thus, phosphorylation of hVDR at serine 51 is not required for either VDRE binding or transactivation. Finally, incubation of Escherichia coli-expressed hVDR with PKC-beta elicits marked phosphorylation of the receptor and significantly inhibits its ability to complex with the VDRE. We therefore speculate that posttranslational modification of hVDR at serine 51 may constitute a negative regulatory loop which could be operative when target cells are subject to PKC activation events.

Amino Acid Sequence↗
PubMed1998

Posttranscriptional regulation of thyrotropin beta-subunit messenger ribonucleic acid by thyroid hormone in murine thyrotrope tumor cells: a conserved mechanism across species.

Thyroid hormone (T3) negatively regulates TSH beta-subunit (TSHbeta) messenger RNA (mRNA) gene expression in whole rat pituitary, in part at the level of mRNA stability. However, the regulation of TSHbeta mRNA turnover by T3 in pure populations of thyrotropes and in other species is unknown. To further investigate this, we used murine thyrotropic TtT97 tumor cells. Using primary cultures of TtT97 cells, T3 down-regulated TSHbeta mRNA to approximately 35% of the control level by 8 h. Actinomycin D chase revealed that T3 destabilized TSHbeta mRNA, reducing the half-life from approximately 24 to 7 h, and was accompanied by a decrease in TSHbeta mRNA size. Ribonuclease H analysis revealed that this T3-induced decrease in size was due to a shortening of poly(A) tail from approximately 160 to approximately 30 nucleotides and was specific for TSHbeta mRNA. Cycloheximide mimicked the poly(A) tail effect observed with T3. In the absence of T3, actinomycin D deadenylated TSHbeta mRNA without inducing rapid decay. We conclude that T3 reduces the steady state half-life of TSHbeta mRNA in murine TtT97 thyrotropic tumor cells accompanied by a reduction in poly(A) tail length. However, in the absence of T3, deadenylation alone is not sufficient to induce TSHbeta mRNA decay. Together with the high degree of sequence conservation in the 3'-untranslated region of murine and rat TSHbeta mRNA sequences and the similarities of the T3 effect, these data provide the first evidence for a highly conserved posttranscriptional mechanism operative across species. We propose a model in which T3 coordinately regulates shortening of the poly(A) tail and the activity of a transacting RNA-binding protein and/or an exonuclease to accelerate TSHbeta mRNA turnover.

Animals↗
PubMed2002

Road traffic noise in Calcutta metropolis, India.

A comprehensive study on traffic noise level at twenty four pre-selected road transaction of Calcutta Metropolis was carried out during 1993-94. Noise levels were measured at each of twenty four sites, based on predetermined sampling interval and altogether 2880 observations were generated by recording data continuously for 24 hours. The Lcq 24, exceedence levels, LD, LN, LDN, LNP and TNI were determined. Traffic flow density as measured along with noise data recording were then compared for establishing relationship with noise level. Finally the clustering of the sites were made based on variable viz. Lcq 24 and traffic follow density.

Environmental Monitoring↗
PubMed1977

An operational model to achieve accountability for social work in health care.

This paper describes a social work accountability structure developed and implemented at the Social Service Department of University of Minnesota Hospitals. The structure is founded in a framework derived from Management by Objectives and is composed of the following elements: (a) a transaction-based Management Information System; (b) service definitions developed by the Southern Regional Educational Board; (c) problem identification and record keeping with Problem-Oriented Medical Records; and (d) outcome evaluation through Goal Attainment Scaling. The purpose of the structure is to monitor and document departmental activities, providing feedback reports to staff, management reports to the director, and summary reports to hospital administration. The structure is not a response to a particular set of organizational problems, but an attempt to develop a coherent operational model to guide department development, remaining responsive to future as well as current needs.

Costs and Cost Analysis↗
PubMed1976

Transactions of an international conference. Worldwide concern: better dental care for more people. An international collaborative study. How oral surveys were conducted.

A special form and field manuals defining examination criteria were prepared for recording the following: 1. Number of teeth present both primary and permanent 2. Periodontal disease (a) Oral hygiene using the simplified oral hygiene index. (b) Periodontal condition using a modified P.I. index. (c) Periodontal treatment requirements. 3. Dental caries The DMF index was used with separate coding for filled or crowned teeth having additional primary or secondary decay. 4. Dento facial anomalies Both treatment need and treatment status were recorded. 5. Prosthetic status Possession and requirements for partial or full dentures and bridges were recorded for the age groups 13-14 and 35-44. 6. Oral pathology Pathological conditions of the gingiva and oral mucosa. 7. Need for immediate attention Conditions causing or likely to cause pain or danger to general health unless immediate treatment was given. The recording was carried out using fibre optic illumination, disposable mirrors and sickle probes. X-rays were not utilized. Two roving epidemiologists first established reproducible criteria and then calibrated the local examiners. Re-calibration took place at intervals and repeat examinations of a small sample population ensured reproducibility of recordings. The completed charts were sent to the WHO Oral Health Unit where they were edited and the data transferred to computer tape for analysis. For the present reports three variables--number of carious teeth, caries treatment/need ratio and number of teeth with gingivitis were selected for special study.

Adolescent↗
PubMed2025

A cellular model of TDP-43 induces phosphorylated TDP-43 aggregation with distinct changes in solubility and autophagy dysregulation.

Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disease that affects neurons in the brain and spinal cord, causing loss of muscle control, and eventually leads to death. Phosphorylated transactive response DNA binding protein-43 (TDP-43) is the major pathological protein in both sporadic and familial ALS, forming cytoplasmic aggregates in over 95% of cases. Of the 10-15% of ALS cases that are familial, mutations in TDP-43 represent about 5% of those with a family history. We have developed an in vitro overexpression model by introducing three familial ALS mutations (A315T, M337V, and S379P) in the TDP-43 (TARDBP) gene which we define as 3X-TDP-43. This overexpression model TDP-43 shows deficits in autophagy flux and colocalization of TDP-43 with stress granules. We also observe a progressive shift of TDP-43 to the cytoplasm in this model. This overexpression model shows a reduction in solubility of phosphorylated TDP-43 from RIPA to urea soluble. Four glycolytic enzymes, phosphoglycerate kinase one (PGK1), aldolase A (ALDOA), enolase 1 (ENO1), and pyruvate dehydrogenase kinase 1 (PDK1) show significant time-dependent decreases in 3X-TDP-43 expressing cells. Shotgun proteomic analysis shows global changes in the importin subunit alpha-1 (KPNA2), heat shock 70 kDa protein 1A (HSPA1A), and protein disulfide-isomerase A3 (PDIA3) expression levels and coimmunoprecipitation reveals that these proteins complex with TDP-43. Overall, these results suggest that the 3X-TDP-43 model may provide new insights into pathophysiology and an avenue for drug screening in vitro for those suffering from ALS and related TDP-43 proteinopathies.

Autophagy↗
PubMed1993

Influence of the content in transcription factors on the phenotype of mouse hepatocyte-like cell lines (mhAT).

We have described new well-differentiated mouse hepatocyte-like cell lines (mhAT) derived from transgenic mice expressing simian virus 40 large T antigen under the control of antithrombin III gene promoter (Exp. Cell Res. (1992) 200, 175-185). In an attempt to understand the phenotypic variations of the different cell lines, we analyzed their content in liver-specific transcription factors at the level of both the proteins, by gel shift analysis, and the mRNA, by quantitative reverse-transcription PCR. Moreover, the transactivating ability of endogenous HNF1 alpha and C/EBP alpha was also evaluated by measuring the activity of transfected synthetic promoters consisting of DNA element homopolymers upstream of a TATA box. High levels of HNF1, HNF3, and HNF4 transcription factors were maintained in mhAT cells. In contrast, C/EBP alpha was much more variable between the different cell lines and was less abundant than it was in vivo, in the liver. We investigated the influence of HNF1 alpha and C/EBP alpha on the activity of transfected liver-specific promoters. HNF1 alpha was not limiting for the activity of transfected liver-type pyruvate kinase and albumin promoters. In contrast, the activity of the albumin promoter in the different lines was clearly dependent on the C/EBP alpha content, which seems, therefore, to be an essential factor modulating the expression of this gene in HNF1 alpha-containing cells. This work shows that the correlations between promoter activities and transacting factor contents in a panel of well-differentiated cultured cells can be used to determine the respective role of transcription factors on the strength of some promoters.

Animals↗
PubMed1995

Developmental outcome as a function of the goodness of fit between the infant's cry characteristics and the mother's perception of her infant's cry.

OBJECTIVE: To determine whether the "goodness of fit" between infant cry characteristics and the mother's perception of the cry is related to developmental outcome at 18 months of age. DESIGN: This was a prospective, longitudinal study from birth to 18 months performed in a blinded manner. SETTING: The study was conducted in a maternity hospital, including normal and special care nurseries and a laboratory for developmental follow-up. PATIENTS: The 121 term and preterm infants and their mothers were selected to meet medical criteria. MEASUREMENT: Acoustic analysis of 1-month infant cry and the mother's perception of the same cry was used to divide subjects into four groups representing matches and mismatches between infant cry characteristics and maternal cry perception. Primary outcome measures of cognitive, language, motor, and neurologic outcome were administered at 18 months. Caretaking environment measures were also recorded. RESULTS: Statistically significant (P < .05) findings showed that matched groups scored higher on measures of language and cognitive performance than infants in the mismatch groups, with a particular advantage for infants in the matched group in which mothers accurately perceived the higher-pitched cries of their infants. There were no differences between the groups in biologic or sociodemographic factors. Group differences were observed in social support and maternal self-esteem. CONCLUSIONS: Matches and mismatches between infant cry characteristics at 1 month and the mother's perception of the cry are related to cognitive and language outcome at 18 months in term and preterm infants. This relation is probably due to transactional processes in which developmental outcome is affected by the clarity of the infants' signals and by the ability of the mother to accurately perceive her infant's signals. The mother's ability to read her infant's cues may be affected by factors such as social support and self-esteem.

Adult↗
PubMed1996

Structure of the distal human gonadotropin releasing hormone (hGnrh) gene promoter and functional analysis in Gt1-7 neuronal cells.

To assess potential species-specific expression of gonadotropin releasing hormone (GnRH), the distal human (h) GnRH promoter was cloned, characterized and tested in gene transfer studies. The nucleotide sequence of approximately 3.8 kb of 5'-flanking region was determined. Homology to the rat (r) GnRH sequence was observed in the proximal promoter region between -551 h (-424 r) and the transcriptional start site and within multiple distal promoter regions. In contrast, there was little similarity in the sequences between -1131/-551 h and -1031/-424 r. A deletion panel of 5'-flanking hGnRH promoter constructs was made and tested in transient transfection assays in GnRH-producing mouse GT1-7 neuronal cells. The largest hGnRH promoter construct (-3832/+5 h) exhibited high levels of reporter activity, similar to that observed with the largest rGnRH construct (-3026/+116 r). However, in contrast to the rat gene, deletion of distal promoter sequences of the hGnRH promoter to -1971, -1131 or -551 did not result in a decrease in luciferase reporter activity. Further truncation to -350 resulted in a 3-fold decrease in luciferase activity. There was no preferential use of the putative upstream hGnRH start site in neuronal cells. DNase I protection assays showed unique protection patterns with nuclear extracts from GT1-7 and Gn10 neuronal cells and the hGnRH and rGnRH promoter fragments. These data suggest the presence of different cis-acting elements and transacting factors that mediate species-specific neuronal GnRH expression.

Animals↗
PubMed1999

The risk and protective functions of perceived family and peer microsystems among urban adolescents in poverty.

Utilized a pattern-based approach to discover the different constellations of perceived social transactions separately for family and peer systems and explored the risk and protective functions of these microsystem profiles for both depression and antisocial behavior among a sample of ethnically and racially diverse urban adolescents living in poverty. Measures of perceived social support, involvement and hassles with family and peers, as well as perceived social acceptance and peers' values were entered into two sets of iterative cluster analyses to identify distinct profiles of family and peer transactions. From each of the perceived family and peer transactional analyses, six replicated profiles emerged. Several of the profiles were consistent with expectations from prior literature such as Enmeshing families and Rejecting peer networks, while others were novel and intriguing such as Entangling peers. Family profiles were consistent in their risk and protective associations for both depression and antisocial behavior, while the peer profiles varied in their effects for each developmental outcome. For example, the Rejecting peer profile placed adolescents at increased risk for depression but protected them from antisocial behavior. Implications for future research and preventive intervention are discussed.

Adolescent↗
PubMed1997

The cost management organization: the next step for materiel management.

With Materiel Management's transition over the last decade from simple logistics to analysis and cost management, it has gained recognition as a key part of the management team responsible for supplies, equipment, standards, and associated processes to identify, purchase, store, distribute, issue, and dispose of supplies and equipment. The materiel manager's job consists of putting the right product in the right place at the right time and in the right quantity at the best total delivered cost. In this context, Materiel Management has made powerful impacts to lower costs associated with: Distribution--costs have been lowered by actively adopting advanced supply channel management techniques such as primary suppliers, JIT, stockless programs, case cart/custom kit/procedure based delivery systems, modified stockless programs as well as margin management through cost plus, flat fee, or margins paid per activity. Cost of goods--lowered through aggregated purchasing in the forms of regional and national purchasing alliances and local capitation or other gain/risk share programs. Internal process costs--lowered by out-sourcing and/or integrating supplier processes and personnel into operations via partnership approaches. We have also reduced transactional costs through EDI transaction sets and the emerging use of the inter and intranet/electronic commerce, procurement cards, and evaluated receipt settlement processes. De-layering--We have lowered the operating costs of Materiel Management overhead by re-design/re-engineering, resulting in reduced management and greater front line authority. Quality--We have learned to identify and respond to customer and supplier needs by using quality improvement tools and ongoing measurement and monitoring techniques. Through this we have identified the waste of non-beneficial products and services. We have adopted supplier certification measurers to ensure quality is built into processes and outcomes. With so much already accomplished, it should be easy to rest on these laurels and simply operate. However, we believe that this is just a beginning. A new generation of highly educated leaders are emerging and taking advantage of the contributions of pioneers who laid the ground work. These new leaders will have advanced management, statistics, and behavioral sciences skills. They will be analysts and organizational motivators. Their goal will be to improve financial and clinical performance measured by real time process and performance data. The new leaders will have information at their fingertips thanks to significant leaps forward in data collection, automated continuous replenishment processes, and software designed for better management of clinical and cost outcomes. This article documents significant Materiel management accomplishments and conceptualizes cost management processes. The cost management organization is the logical evolution in our efforts for better outcomes in healthcare Materiel management.

Contract Services↗
PubMed1996

[Electronic data processing in a surgical and medical intensive care unit].

A prospective documentation of patients data on an internal and a surgical intensive care unit (ICU) has been transacted. The physician and nursing staff used an online electronic documentation program, which has been developed in Frankfurt. Main emphasis has been placed on the epidemiological data, clinical diagnoses as well as diagnostically and therapy costs. The medical ICU of university hospital of Frankfurt has been analysed since 1992 and the surgical ICU of Städtisches Krankenhaus of Lüneburg since 1994. Up to now data from 2001 patients from Frankfurt are available. Period spent on the ICU was 4.7 +/- 0.16 days (average +/- SEM), mortality was 15%. 47% of the whole group suffered from cardiac disease, of which 211 had an acute myocardial infarction (10.6%), 156 patients a serious ventricular arrhythmia (7.8%) as well as 88 patients an unstable angina (4.4%). Long-term observation revealed a rise of the duration spent on the ICU (from 4.1 +/- 0.17 to 5.5 +/- 0.38 days, P < 0.0002), an increasing number of technical examinations (for example: chest x-ray from 2.25 +/- 0.13 to 4.52 +/- 0.4/patient, P < 0.0001) and a steady mortality between 1992 and 1994. Detailed analysis of patients with acute myocardial infarction showed an impressive reduction of total mortality within the 3 years observed. In Lüneburg data of 1004 patients have been recorded so far. The average time spent on the ICU was 6.4 +/- 0.33 days. 4.1% patients passed away. Neoplasia of gastric intestinal tract (143; 14.2%), femoral neck fracture (64; 6.4%) and ilei (54; 5.4%) have been the most frequent diagnoses. Patients underwent 2.2 +/- 0.12 chest x-rays and 1.4 +/- 0.1 ultrasound investigations. The study shows that an online data processing is practicable and can be integrated in the daily work flow. Furthermore, it can be seen that the collected data play an important role to secure the increasing administrative requisition to the modern medicine in view of costs and quality management.

Adult↗
PubMed1999

Factors affecting bargaining outcomes between pharmacies and insurers.

OBJECTIVE: To model the bargaining power of pharmacies and insurers in price negotiations and test whether it varies with characteristics of the pharmacy, insurer, and pharmacy market. DATA SOURCES/STUDY SETTING: Data from four sources. Pharmacy/insurer transactions were taken from Medstat's universe of 6.8 million pharmacy claims in their 1994 Marketscan database. Sources Informatics, Inc. supplied a three-digit zip code-level summary database containing pharmacy payments and self-reported costs for retail (cash-paying) customers for the top 200 pharmaceutical products by prescription size in 1994. The National Council of Prescription Drug Programs supplied their 1994 pharmacy database. Zip code-level socioeconomic and commercial information was taken from Bureau of the Census' 1990 Summary Tape File 3B and 1994 Zip Code Business Patterns database. STUDY DESIGN: The provider/insurer bargaining model first employed in Brooks, Dor, and Wong (1997, 1998) was adapted to the circumstances surrounding pharmacy and insurer bargaining. DATA COLLECTION/EXTRACTION METHODS: The units of observation in this study were single Medstat claims for each unique insurer/pharmacy combination in the database for selected pharmaceutical products. The four products selected varied in the conditions they treat, whether they are used to treat chronic or acute conditions, and by their sales volume. Used in the analysis were 9,758 Zantac, 2,681 Humulin, 3,437 Mevacor, and 1,860 Dilantin observations. PRINCIPAL FINDINGS: We find statistically significant variation in pharmacy bargaining power. Pharmacy bargaining power varies significantly across markets, insurers, and pharmacy types. With respect to market structure, pharmacy bargaining power is negatively related to pharmacies per capita and pharmacies per employer and positively related to pharmacy concentration at higher concentration levels. In addition, the higher the percentage of independent pharmacies in an area, the lower the pharmacy bargaining power. With respect to socioeconomic conditions, pharmacy bargaining power is higher in areas with lower per capita income and higher rates of public assistance. CONCLUSIONS: The bargaining power of pharmacies in contract negotiations with insurers varies considerably with exogenous factors. Local area pharmacy ownership concentration enhances pharmacy bargaining. As a result, anti-trust law prohibiting the collective bargaining of independent pharmacies with insurers leaves independents at a disadvantage with respect to chains.

Commerce↗