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PubMed1999

Evaluation of a drowning prevention campaign in King County, Washington.

OBJECTIVES: A three year drowning prevention campaign focused on increasing the use of life vests among children 1-14 years old. An evaluation was conducted to determine campaign awareness, change in ownership and use of life vests by children, and predictors of life vest use. SETTING: King County, Washington. METHODS: Four telephone surveys were conducted with parents before, during, and after the campaign. RESULTS: The campaign was recalled by 50% of families surveyed. From before to after the campaign, reported life vest use by children on docks, beaches, or at pools increased from 20% to 29% (p < 0.01) and life vest ownership for children increased from 69% to 75% (p = 0.06). Among parents aware of the campaign, reported child life vest use increased from 20% to 34% (p < 0.001) and ownership increased from 69% to 80% (p < 0.01). Among families unaware of the campaign, neither life vest use nor ownership changed significantly. Children were more often reported to wear life vests if a parent knew of the campaign, was confident fitting the vest, was younger than 40 years, felt the child could not swim well, and owned a life vest for the child. CONCLUSIONS: A community-wide drowning prevention campaign resulted in a significant, although modest, increase in reported life vest use and ownership among children.

Accident Prevention↗

PubMed2006

To have or not to have a pet for better health?

BACKGROUND: Pet ownership is thought to have health benefits, but not all scientific explorations have been founded on proper applications of representative samples or statistically correct methodologies. Databanks have been too small for proper statistical analyses; or, instead of a random sample, participation has been voluntary. The direction of causality has been evaluated incorrectly or control of relevant factors noted deficient. This study examined the associations of pet ownership with perceived health and disease indicators by taking into account socio-demographic background factors together with health risk factors, including exercise. METHODOLOGY/PRINCIPAL FINDINGS: The present study used baseline data from the 15-year Health and Social Support Study (the HeSSup Study). The Finnish Population Register Centre was used to draw population-based random samples stratified according to gender and four age groups (20-24, 30-34, 40-44, and 50-54 years). A total of 21,101 working-aged Finns responded to the baseline survey questionnaire of the 15-year HeSSup Study in 1998. Ordinal and binary logistic regression was used to analyze the cross-sectional data. Pet ownership was associated with poor rather than good perceived health. BMI surfaced as the risk factor most strongly associated with pet ownership. CONCLUSIONS/SIGNIFICANCE: Pet owners set in their ways and getting older were found to have a slightly higher BMI than the rest. Additional research is needed for the testing of hypotheses involving effects of pet ownership with various health dimensions within population groups that are composed of different kinds of background characteristics.

Adult↗

PubMed1998

Charges for childhood asthma by hospital characteristics.

BACKGROUND: The ownership, location, and teaching status of hospitals affect their missions, policies, finances, and operations. OBJECTIVE: This study assesses the relationship of hospital ownership, location, and teaching status with charges and length of stay for children with asthma, the most common reason for pediatric admission after birth. METHODS: All 28 545 complete records of patients </=18 years of age with the principal diagnosis asthma in 1994 were extracted from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, providing a stratified sample of 735 nonfederal, acute-care hospitals in 17 states. Multiple regression analysis on log transformed data was used to calculate mean total charges and average length of stay (ALOS) after adjusting for illness severity and mortality risk (four All Patient Refined-Diagnosis Related Group classes based on secondary diagnoses and procedures); payer (Medicaid, private, uninsured, other); patient age, sex, income (four categories based on ZIP code of residence); state; bed size (three categories varying by location); hospital ownership; location; teaching status; and admission month. RESULTS: Asthma severity did not differ significantly by hospital location or teaching status. Nonprofit hospitals treated a slightly higher proportion of children with major or extreme severity asthma than either public or for-profit hospitals. Urban teaching hospitals treated more children with asthma who lived in low-income neighborhoods, were uninsured, or received Medicaid coverage than urban nonteaching hospitals. For-profit hospitals admitted fewer children with asthma from low-income areas than did public hospitals. The ALOS was 2.5 days and did not differ significantly by hospital ownership, location, or teaching status. However, the mean total charges, after adjusting for all other significant covariates, was higher at for-profit ($4203) than at nonprofit ($3640) or public hospitals ($3620). Average charges also were higher at urban teaching ($4230) and lower at rural institutions ($2910) compared with urban nonteaching hospitals ($3424). CONCLUSIONS: Despite similar ALOS, mean charges for childhood asthma varied significantly by hospital ownership, location, and teaching status. Implications. Additional clinical and outpatient data are needed to study variations in quality of care by hospital characteristics. With the proliferation of investor-owned hospitals, both the reasons for and the impact of higher average charges at for-profit institutions require additional investigation. With the expanding needs of the medically underserved, socially just policies are required for financing hospitals that care for a disproportionate share of economically disadvantaged children.

Adolescent↗

PubMed2005

Respiratory symptoms and hamsters or other pets: a large-sized population survey in Saitama Prefecture.

BACKGROUND: Keeping hamsters as pets has been increasing markedly. Clinical reports have suggested that hamster or other pet ownership is associated with respiratory symptoms. However, this association has not been fully investigated by population-based studies in Japan. The aim of the present study was to investigate the relationship between hamster ownership and respiratory symptoms by using a questionnaire. METHODS: During the period of August 1 to 20, 2002, we conducted a cross-sectional survey in Saitama Prefecture, which has a total population of approximately 7 million. First, we selected, proportionally to the population size, 100 areas from 5 administration districts of Saitama Prefecture. From each area, 30 households were chosen: 15 living in detached houses and 15 living in other types of dwelling, such as apartment houses. In this way, 2 groups based on type of dwelling (detached house versus other types) could be studied. A lay away plan was carried out. For the survey, 2 questionnaires were developed. One was a questionnaire dealing with household conditions, including pet keeping. The other sought details regarding individual health and lifestyle conditions. The questionnaire dealing with respiratory symptoms asked "whether the respondents had experienced respiratory symptoms (wheezing and/or breathlessness and/or bad cough) in the last 12 months." RESULTS: The response rate was 78.9%. There were 7,395 respondents in 2,368 households. There was no association between either dog or cat ownership and respiratory symptoms. In contrast, hamsters kept in the home were positively associated with respiratory symptoms. In a multivariate logistic regression analysis, hamster ownership increased the odds ratio for respiratory symptoms (odds ratio: 1.57; 95% confidence interval: 1.18-2.10). CONCLUSION: This large size population-survey indicated that hamster ownership is associated with respiratory symptoms.

Adolescent↗

PubMed2002

[Does the presence of a pet at home influence the prevalence of asthma and rhinitis?].

INTRODUCTION: Recent epidemiological studies have shown an increase in the prevalence of asthma and allergic diseases. Among aetiological factors, the domestic environment and, in particular, pet ownership may be a part of it. The relationship between severity of asthma and pets is still unclear. The aim of this study was to evaluate the relationship of asthma and rhinitis prevalence in teenagers with pet ownership. PATIENTS AND METHODS: ISAAC I studied 3,303 teenagers (13-14 years old) in Bordeaux in 1994. They completed a written questionnaire about asthma, rhinitis, eczema and their domestic environment. Four groups (asthmatics, asthmatics with rhinitis, teenagers with only rhinitis and a control group without asthma and rhinitis) were studied. RESULTS: 4.6% had only asthma. 43.2% had only rhinitis. 10.3% had asthma and rhinitis, 41.7% had no allergic disease. 34.9% kept a cat and 79.4% allowed the cat to go inside. No difference was found between the four groups with regard cat, dog, bird or other pet ownership irrespective if the pet was kept in-doors or out doors. The prevalence of previous asthma was 45.8% and 50.3% for current asthma. No difference was found between the severity of asthma and pet ownership. CONCLUSIONS: This is an epidemiological study based on a written questionnaire. Furthermore there is no data on the presence of pets during the first year of life. However, our results suggest that pet ownership amongst asthma and rhinitis sufferers is not different to that in the group without allergic disease.

Adolescent↗

PubMed1999

Self-inflicted and unintentional firearm injuries among children and adolescents: the source of the firearm.

CONTEXT: The source and ownership of guns used by children to shoot themselves or others is largely unknown. OBJECTIVE: To determine the ownership and usual storage location of firearms used in unintentional and self-inflicted intentional firearm deaths and injuries. DESIGN: Retrospective case series. SETTING: King County, Washington. PATIENTS: Youths aged from birth to 19 years who sought medical treatment at a level I trauma center for a self-inflicted or unintentional firearm injury between 1990 and 1995 or who presented to the county medical examiner with a fatal self-inflicted or unintentional firearm injury between 1990 and 1995. DATA SOURCES: County medical examiner records, regional police investigative reports, medical records from a level I trauma center, and surveys of victims' families. MAIN OUTCOME MEASURES: Source and ownership of the associated firearm. RESULTS: Fifty-six fatal injuries and 68 nonfatal firearm injuries that met the criteria were identified. Of these, 59 were intentionally self-inflicted deaths and injuries and 65 were unintentional deaths and injuries. A firearm owned by a household member living with the victim was used in 33 (65%) of 51 suicides and suicide attempts and 11 (23%) of 47 unintentional injuries and deaths. Additionally, a firearm owned by another relative, friend, or parent of a friend of the victim was used in 4 (8%) of the 51 suicides and suicide attempts and 23 (49%) of the 47 unintentional injuries and deaths. Parental ownership accounted for 29 (57%) of the 51 suicides and suicide attempts and 9 (19%) of the 47 unintentional injuries and deaths. More than 75% of the guns used in suicide attempts and unintentional injuries were stored in the residence of the victim, a relative, or a friend. CONCLUSION: Most guns involved in self-inflicted and unintentional firearm injuries originate either from the victim's home or the home of a friend or relative.

Accidents, Home↗

PubMed2006

Educational intervention on dog sterilization and retention in Taiwan.

We conducted a controlled randomized study to evaluate whether an educational intervention could alter dog owners' decisions to have their dogs sterilized and to retain the dogs in the household. One hundred and twenty-six new dog owners were recruited from 15 animal clinics across Taiwan and were successfully followed up for 3-8 months. Among them, 66 were randomly assigned to the intervention group and the other 60 were in the control group. At the end of the study, 22 had their dogs sterilized and 23 reported having an unsuccessful dog ownership. The educational intervention did not affect the owners' decisions to sterilize their dogs (hazard rate ratio (HRR) for the intervention group against control group=0.7, 95% confidence interval (CI)=0.4, 1.3). We found a heterogeneous effect of the applied education on the rate of unsuccessful dog ownership. The intervention group had a higher rate of unsuccessful ownership than the control group in the first 4 months of their ownership (HRR=19.2, 95% CI=4.6, 79.7), and the effect reversed after 4 months (HRR=0.5, 95% CI=0.2, 1.1).

Animal Husbandry↗

PubMed2001

Pickup truck use in the National Personal Transportation Survey.

To guide interventions to prevent injuries to pickup-truck occupants, we characterized pickup truck ownership, drivers and use in the 1995 National Personal Transportation Survey, which collects travel data from the civilian noninstitutionalized population of the US. SUDAAN software was used to account for the complex nature of the sample. Pickup truck ownership was more common in households with more vehicles, in rural households, in households living in single family homes and mobile homes, and in middle-income households. Among US regions, pickup truck ownership was highest among households in the mountain west. Pickup truck ownership was greater in households with two adults, whether or not children or youths were present, but this was largely due to the number of vehicles in these households. Driving a pickup on the sample day was more frequent among men, among drivers with less education and among full-time workers. A higher proportion of trips to work, work-related trips, longer trips and trips with fewer people were by pickup truck. Seat belt use was lower among pickup truck drivers than drivers of other vehicles. For only 0.5% of households (those with three or more members and a pickup truck as their only vehicle), restrictions on travel in cargo areas might be burdensome. Restrictions on cargo area travel, strengthening existing seat belt laws and social marketing strategies might increase the safety of pickup truck occupants.

Accidents, Traffic↗

PubMed2004

Property rights in genetic information.

The primary theme of this paper is the normative case against ownership of one's genetic information along with the source of that information (usually human tissues samples). The argument presented here against such "upstream" property rights is based primarily on utilitarian grounds. This issue has new salience thanks to the Human Genome Project and "bio-prospecting" initiatives based on the aggregation of genetic information, such as the one being managed by deCODE Genetics in Iceland. The rationale for ownership is twofold: ownership will protect the basic human rights of privacy and autonomy and it will enable the data subjects to share in the tangible benefits of the genetic research. Proponents of this viewpoint often cite the principle of genetic exceptionalism, which asserts that genetic information needs a higher level of protection than other kinds of personal information such as financial data. We argue, however, that the recognition of such ownership rights would lead to inefficiency along with the disutility of genetic discoveries. Biomedical research will be hampered if property rights in genes and genetic material are too extensive. We contend that other mechanisms such as informed consent and strict confidentiality rules can accomplish the same result as a property right without the liabilities of an exclusive entitlement.

Access to Information↗

PubMed2000

Development of a multiple regression model to identify multi-family residential buildings with a high prevalence of sick building syndrome (SBS).

The aim was to develop a multiple logistic regression model to identify multi-family houses with an increase of sick building syndrome (SBS). In Stockholm, 609 multi-family buildings with 14,235 dwellings were selected by stratified random sampling. The response rate was 77%. Multiple logistic regression analysis was applied, adjusting for ownership of the building, building age and size, age, gender, and atopy. Females, subjects with allergy, those above 65 yr, and those in new buildings reported significantly more SBS. Subjects owning their own building reported less SBS, but the relationship between ownership and building age was strong. A regression model, including factors with a high explanatory value was developed. According to the model, 5% of all buildings built before 1961, 13% of those built 1976-1984, and 15% of those built 1985-1990 would have significantly more SBS than expected. In conclusion, SBS is related to personal factors, building age, and ownership of the building. To identify multi-family buildings with more SBS than expected, it is necessary to adjust for ownership and population characteristics.

Adolescent↗

PubMed2006

Housing tenure and early retirement for health reasons in Sweden.

AIMS: To assess the association between housing tenure and early retirement for health reasons in Sweden with a view to psychosocial vs. material values of home ownership. METHODS: The data come from linked registers that cover all people resident in Sweden during 1990-2000. The study population consists of 449,233 people aged 40-63 years in 1997. Of these, 19,350 retired early for health reasons in 1998-99. The remaining 429,883 continued their employment without extended sick leave or income decline. None moved during 1990-2000. We calculated the odds of early retirement for four forms of juridical relationship to one's housing (private owner; part owner in a cooperative; private rental; rental from a public housing company), for men and women separately, controlling for age, education, employment income, household disposable income, region, foreign birth, and housing type. RESULTS: Men in cooperative ownership had lower odds of early retirement than those in the three other tenure forms, for which the odds were similar. Among women, public and private renters had similar odds of early retirement, which were higher than those of women in private or cooperative ownership. For both genders, inclusion of housing type in the model after housing tenure explained little additional variance. CONCLUSIONS: The odds of early retirement for health reasons varied across different housing tenure forms in Sweden in 1998-99. The pattern of associations differed as a function of gender. Home ownership appears to involve health resources independent of basic socio-physical factors captured with differences in housing type.

Adult↗

PubMed2002

The effect of older people's economic resources on care home entry under the United Kingdom's long-term care financing system.

OBJECTIVE: To determine how older people's economic resources affect their likelihood of care home entry in the United Kingdom. METHODS: In 1988, income, home ownership, and health data were collected for 1,425 people aged 75+. Participants received up to five subsequent health assessments before the study endpoint (1999), in which care home entry was also recorded. Care home entry was identified from death certificates for those who died. Using proportional hazards regression, the effect of home ownership and income on the risk of care home entry was estimated, controlling for predisposing, enabling, and need factors, and health service utilization. RESULTS: Age, living alone, activities of daily living restriction, cognitive impairment, poor/fair self-perceived health, and contact with services increased the risk of care home entry. Home ownership decreased it. Gender was not a significant predictor of care home entry once other factors were controlled for, and no significant effect was found for income. DISCUSSION: UK public authorities can require older home owners to use the value of their homes to pay for institutional but not community-based care, thus producing a financial incentive to place home owners in institutional settings. However, we find that home ownership reduces the likelihood of care home entry, suggesting that other factors dominate the decision process.

Activities of Daily Living↗

PubMed2002

A national study of efficiency for dialysis centers: an examination of market competition and facility characteristics for production of multiple dialysis outputs.

OBJECTIVE: To examine market competition and facility characteristics that can be related to technical efficiency in the production of multiple dialysis outputs from the perspective of the industrial organization model. STUDY SETTING: Freestanding dialysis facilities that operated in 1997 submitted cost report fonns to the Health Care Financing Administration (HCFA), and offered all three outputs--outpatient dialysis, dialysis training, and home program dialysis. DATA SOURCES: The Independent Renal Facility Cost Report Data file (IRFCRD) from HCFA was utilized to obtain information on output and input variables and market and facility features for 791 multiple-output facilities. Information regarding population characteristics was obtained from the Area Resources File. STUDY DESIGN: Cross-sectional data for the year 1997 were utilized to obtain facility-specific technical efficiency scores estimated through Data Envelopment Analysis (DEA). A binary variable of efficiency status was then regressed against its market and facility characteristics and control factors in a multivariate logistic regression analysis. PRINCIPAL FINDINGS: The majority of the facilities in the sample are functioning technically inefficiently. Neither the intensity of market competition nor a policy of dialyzer reuse has a significant effect on the facilities' efficiency. Technical efficiency is significantly associated, however, with type of ownership, with the interaction between the market concentration of for-profits and ownership type, and with affiliations with chains of different sizes. Nonprofit and government-owned Facilities are more likely than their for-profit counterparts to become inefficient producers of renal dialysis outputs. On the other hand, that relationship between ownership form and efficiency is reversed as the market concentration of for-profits in a given market increases. Facilities that are members of large chains are more likely to be technically inefficient. CONCLUSIONS: Facilities do not appear to benefit from joint production of a variety of dialysis outputs, which may explain the ongoing tendency toward single-output production. Ownership form does make a positive difference in production efficiency, but only in local markets where competition exists between nonprofit and for-profit facilities. The increasing inefficiency associated with membership in large chains suggests that the growing consolidation in the dialysis industry may not, in fact, be the strategy for attaining more technical efficiency in the production of multiple dialysis outputs.

Ambulatory Care Facilities↗

PubMed2006

Rolling out insecticide treated nets in Eritrea: examining the determinants of possession and use in malarious zones during the rainy season.

OBJECTIVE: This paper describes determinants of insecticide treated net (ITN) ownership and use in malarious areas of Eritrea. With ITN distribution and re-treatment now free for all living in these areas, we examine barriers (other than cost) to access and use of ITNs. We explore the differences between use of an ITN as a proportion of all households in the survey (the roll back malaria indicator), and use of an ITN as a proportion of those households who already own an ITN. METHODS: A modified two-stage cluster design was used to collect data from a sample of households (n = 2341) in the three most malarious administrative zobas (zones or provinces). Logistic regression was used to analyse the data. RESULTS: Our findings suggest environmental heterogeneity among zobas (including program effects specific to each zoba), perception of risk, and proximity to a clinic are important predictors of ITN possession and use. Among households with at least one ITN, 17.0% reported that children under five were not under an ITN the night before the survey, while half of all such households did not have all occupants using them the night before the survey. The number of ITNs, as well as zoba, was also significant determinants of use in these households with at least one ITN. CONCLUSION: Current efforts to disseminate ITNs to vulnerable populations in Eritrea are working, as suggested by high ITN ownership and net-to-person ratios inside households. However, the gap between ITN ownership and use, given ownership, is large, and may represent lost opportunities to prevent infection. Closing this gap requires concerted efforts to change behaviour to ensure that all household members use ITNs as consistently and correctly as possible during and following the rains.

Attitude to Health↗

PubMed2005

Does the impact of managed care on substance abuse treatment services vary by provider profit status?

OBJECTIVE: To extend our previous research by determining whether, and how, the impact of managed care (MC) on substance abuse treatment (SAT) services differs by facility ownership. DATA SOURCES: The 2000 National Survey of Substance Abuse Treatment Services, which is designed to collect data on service offerings and other characteristics of SAT facilities in the U.S. These data are merged with data from the 2002 Area Resource File, a county-specific database containing information on population and MC activity. We use data on 10,513 facilities, virtually a census of all SAT facilities. STUDY DESIGN: For each facility ownership type (for-profit [FP], not-for-profit [NFP], public), we estimate the impact of MC on the number and types of SAT services offered. We use instrumental variables techniques that account for possible endogeneity between facilities' involvement in MC and service offerings. PRINCIPAL FINDINGS: We find that the impact of MC on SAT service offerings differs in magnitude and direction by facility ownership. On average, MC causes FPs to offer approximately four additional services, causes publics to offer approximately four fewer services, and has no impact on the number of services offered by NFPs. The differential impact of MC on FPs and publics appears to be concentrated in therapy/counseling, medical testing, and transitional services. CONCLUSION: Our findings raise policy concerns that MC may reduce the quality of care provided by public SAT facilities by limiting the range of services offered. On the other hand, we find that FP clinics increase their range of services. One explanation is that MC results in standardization of service offerings across facilities of different ownership type. Further research is needed to better understand both the specific mechanisms of MC on SAT and the net impact on society.

Health Facilities, Proprietary↗

PubMed2002

Attitudes of suburban Western Australians to proposed cat control legislation.

OBJECTIVE: To determine the knowledge, attitudes and practices of cat-owners and non-owners in suburban Perth, Western Australia, on issues relating to proposed local government regulation of cat-ownership. DESIGN: The 1,261 respondents to a mailed survey were ranked on issues regarding restrictions on cat-ownership and cat roaming (control scale), attitudes to wildlife in suburbia and putative impacts of cats on wildlife (wildlife scale), knowledge of cat behaviour and husbandry (knowledge scale) and attitudes and practices regarding cat sterilisation (sterilisation scale). Age, gender and cat-ownership status of the survey respondents were explored to see if any of these factors influenced the position of respondents on the scales. RESULTS: Cat-owners, particularly female owners, scored significantly higher on the knowledge scale than non-owners, whilst non-owners scored significantly higher than cat-owners on the control and wildlife scales. Women were more likely to favour compulsory sterilisation of pet cats than men, but men were more willing to implement controls on cat-ownership. Age was also a significant factor, with older people more willing to implement controls. Analysis of specific questions showed that both cat-owners and non-owners agreed that there was a need for cat control legislation and supported measures such as compulsory sterilisation, registering of cats, restricting cats' ability to roam and stipulating a maximum number of cats per property. Nevertheless, both groups rejected the idea that local governments should enforce cat-free zones. CONCLUSION: Cat legislation that avoids or educates about the contentious issue of cat-free zones should receive solid community support.

Adolescent↗

PubMed1988

Correlates of reported smoke detector usage in an inner-city population: participants in a smoke detector give-away program.

As part of a smoke detector give-away program, 388 adults were surveyed to characterize smoke detector ownership in a low-income population and to identify those who would acquire a free smoke detector following their child's visit to the hospital. Factors associated with smoke detector ownership included higher education, home ownership (vs public housing), knowledge of the city smoke detector law, and the practice of other injury prevention measures. Regardless of ownership, the great majority of parents (82 per cent) acquired a free smoke detector, but those previously without a smoke detector were more likely to do so. These characteristics of smoke detector usage and acquisition should be considered in targeting future intervention strategies.

Adolescent↗

PubMed1999

Which factors determine the use of diagnostic imaging technologies for gastrointestinal complaints in general medical practice?

OBJECTIVE: Even though gastrointestinal complaints are among the most frequent reasons to contact general medical practitioners, little is known about the actual care of these patients, especially the use of diagnostic imaging technologies. METHODS: In a network of 57 family practitioners and 29 general internists in Lower Saxony, Germany, 1,217 contacts with patients with gastrointestinal diseases (16%, gastritis; 12%, gastroenteritis; 6%, cholelithiasis; 5% each, ulcus ventriculi and duodeni, and 14%, no final diagnosis) were documented. The effects of patient and physician/practice side factors on the use of ultrasonography and radiography were modeled using multivariate logistic regression. RESULTS: For ultrasonography, diagnosis and ownership of an ultrasound unit (odds ratio [OR] = 3.33) were highly significant predictors (p < .0001), followed by unknown diagnosis at beginning of contact (OR = 1.92; p = .0019), physician specialty (OR for internists = 1.89; p = .0025), and severity (p = .0085). For radiography, ownership of an ultrasound unit was the most significant factor (OR = 0.34; p < .0001), followed by severity (p < .0009), ownership of x-ray apparatus (OR = 2.56; p = .0025), physician specialty (OR for internists = 1.98; p = .0358), and unknown diagnosis at beginning of contact (OR = 1.79; p = .0451). Not significant were age and sex of patient and diagnosis for radiography. CONCLUSIONS: Physicians use diagnostic imaging technologies for patients with gastrointestinal complaints according to severity and knowledge about the diagnosis, but ownership of technology is the most predictive factor.

Adult↗