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PubMed2005

Hospital rates of maternal and neonatal infection in a low-risk population.

BACKGROUND: In 2003, the Agency for Healthcare Quality and Research (AHRQ) published its Quality Indicators for healthcare, and set out methodological criteria for the evaluation of potential candidates. OBJECTIVES: Because perinatal infections may result from poor obstetrical practices, we intended to describe the variability of maternal and congenital neonatal infections across different types of hospital ownership (e.g., not for profit, government), and to assess whether rates of these infections meet criteria as quality indicators. RESEARCH DESIGN: Population-based cohort study. SUBJECTS: All laboring women without maternal, fetal, or placental complications who delivered in California in 1997, and their neonates, as reported through hospital discharge data. MEASURES: A Bayesian hierarchical logistic regression model was used to quantify the effects of both "patient-level" risk factors such as parity and prior cesarean history, and "hospital-level" risk factors such as ownership and teaching status. RESULTS: The 308,841 mother-newborn pairs in this low-risk study population delivered at 281 hospitals; 0.39% had uterine infections and 1.3% had neonatal infections. Hospital ownership and teaching status were strongly associated with perinatal infection. Secondly, methods used to estimate and analyze hospital-specific infection rates identified hospitals with exceptionally high rates. Twenty-eight hospitals had neonatal infection rates that ranged from 3% to 28%. CONCLUSIONS: The methods presented here were consistent with AHRQ methods and criteria for potential Quality Indicators. They also identified hospitals with exceptionally high rates of infectious morbidity. The relationship between hospital ownership and obstetrical practice patterns, and the feasibility of practice improvement, remain to be studied.

California↗
PubMed1989

Suicide and increased availability of handguns in the United States.

During the 25 years between 1959 and 1984, the suicide rate in the United States increased from 10.5/100,000 to 12.4/100,000. The increase was confined to those suicides using a firearm, which had reached 58.5% of the total by the end of the period. At the same time, there was a marked increase in the household ownership of handguns (but not of shotguns and rifles). The present study investigates whether the increase in suicide might be due to the increase in the ownership of handguns. Regression analyses showed a strong relationship between handgun ownership and the rate of gun suicides, but not between handgun ownership and the overall rate of suicide. These results support the hypothesis that the rise in handguns has led to an increase in gun suicides, but, they do not permit a choice between two further competing hypotheses: (i) that more people are now committing suicide because there are more handguns available or, (ii) that people who would otherwise have killed themselves in some different way are now using guns. Because of the potential implications for prevention, further study of these issues is needed.

Firearms↗
PubMed1996

Paget's disease of bone and unvaccinated dogs.

The etiology of Paget's disease is unknown, but several observations suggest a viral cause. Since canine distemper virus is among those proposed to be a causal agent, we investigated the hypothesis that dog ownership may increase the risk of Paget's disease of bone by means of a case control study. One hundred and fifty patients with Paget's disease and 185 controls were interviewed using a structured questionnaire administered by the same interviewer. Participants were asked about their socioeconomic background and their exposure to pets. The risk of Paget's disease was not significantly increased in individuals. However, ownership of a mongrel dog was associated with a significant increase in risk (OR = 1.6; 95% CI = 1.0-2.4) and the risk increased still further with the ownership of an unvaccinated dog (OR = 2.8; 95% CI = 1.8-4.5). Additionally, ownership of cats and birds excluding dog owners, increased the risk of Paget's disease (OR = 2.5; 95% CI = 1.0-5.0; OR = 2.3; 95% CI = 1.0-5.3, respectively). These data suggest that previous exposure to cats, birds, and dogs unvaccinated for canine distemper may increase the risk of an individual developing Paget's disease of bone.

Adult↗
PubMed2002

The road to obesity or the path to prevention: motorized transportation and obesity in China.

OBJECTIVE: Dependence on motorized forms of transportation may contribute to the worldwide obesity epidemic. Shifts in transportation patterns occurring in China provide an ideal opportunity to study the association between vehicle ownership and obesity. Our objective was to determine whether motorized forms of transportation promote obesity. RESEARCH METHODS AND PROCEDURES: A multistage random-cluster sampling process was used to select households from eight provinces in China. Data were included on household vehicle ownership and individual anthropometric and sociodemographic status. Cross-sectional data (1997) from 4741 Chinese adults aged 20 to 55 years were used to explore the association between vehicle ownership and obesity. Cohort data (1989 to 1997) from 2485 adults aged 20 to 45 years in 1989 (59% follow-up) were used to measure the impact of vehicle acquisition on the odds of becoming obese. RESULTS: Our main outcome measure was current obesity status and the odds of becoming obese over an 8-year period. In 1997, 84% of adults did not own motorized transportation. However, the odds of being obese were 80% higher (p < 0.05) for men and women in households who owned a motorized vehicle compared with those who did not own a vehicle. Fourteen percent of households acquired a motorized vehicle between 1989 and 1997. Compared with those whose vehicle ownership did not change, men who acquired a vehicle experienced a 1.8-kg greater weight gain (p < 0.05) and had 2 to 1 odds of becoming obese. DISCUSSION: Encouraging active forms of transportation may be one way to protect against obesity.

Adult↗
PubMed2004

Changes in spatial position of hands modify tactile extinction but not disownership of contralesional hand in two right brain-damaged patients.

Somatic misperceptions and misrepresentations, like supernumerary phantom limb and denial of ownership of a given body part, have typically been reported following damage to the right side of the brain. These symptoms typically occur with personal or extrapersonal neglect and extinction of left-sided stimuli, suggesting that all these different symptoms may be linked to the same neural substrate. In the present research, we tested two right brain-damaged (RBD) patients to find out whether changing the position of the hands in space influences tactile extinction and denial of ownership to the same extent. Results showed that manipulation of the spatial position of the hands reduces tactile extinction but leaves denial of ownership of the left hand unaffected. Such a dissociation suggests that delusional misperceptions may be independent from somatic neglect and that representation of hands in space and attribution of ownership are dynamically mapped in at least partly separate neural substrates.

Aged↗
PubMed2006

Effects of compensation methods and physician group structure on physicians' perceived incentives to alter services to patients.

OBJECTIVE: To examine how health plan payment, group ownership, compensation methods, and other practice management tools affect physician perceptions of whether their overall financial incentives tilt toward increasing or decreasing services to patients. DATA SOURCE: Nationally representative data on physicians are from the 2000-2001 Community Tracking Study Physician Survey (N=12,406). STUDY DESIGN: Ordered and multinomial logistic regression were used to explore how physician, group, and market characteristics are associated with physician reports of whether overall financial incentives are to increase services, decrease services, or neither. PRINCIPAL FINDINGS: Seven percent of physicians report financial incentives are to reduce services to patients, whereas 23 percent report incentives to increase services. Reported incentives to reduce services were associated with reports of lower ability to provide quality care. Group revenue in the form of capitation was associated with incentives to reduce services whereas practice ownership and variable compensation and bonuses for employee physicians were mostly associated with incentives to increase services to patients. Full ownership of groups, productivity incentives, and perceived competitive markets for patients were associated with incentives to both increase and reduce services. CONCLUSIONS: Practice ownership and the ways physicians are compensated affect their perceived incentives to increase or decrease services to patients. In the latter case, this adversely affects perceived quality of care and satisfaction, although incentives to increase services may also have adverse implications for quality, cost, and insurance coverage.

Attitude of Health Personnel↗
PubMed1990

Magnitude and causes of socioeconomic differentials in mortality: further evidence from the Whitehall Study.

STUDY OBJECTIVE: The aim was to explore the magnitude and causes of the differences in mortality rates according to socioeconomic position in a cohort of civil servants. DESIGN: This was a prospective observational study of civil servants followed up for 10 years after baseline data collection. SETTING: Civil service offices in London. PARTICIPANTS: 11,678 male civil servants were studied, aged 40-64 at baseline screening between 1967 and 1969. Two indices of socioeconomic position were available on these participants--employment grade (categorised into four levels), and ownership of a car. MEASUREMENTS AND MAIN RESULTS: Main outcome measures were all cause and cause specific mortality, with cause of death taken from death certificates coded according to the eighth revision of the ICD. Employment grade and car ownership were independently related to total mortality and to mortality from the major cause groups. Combining the indices further improved definition of mortality risk and the age adjusted relative rate between the highest grade car owners and the lowest grade non-owners of 4.3 is considerably larger than the social class differentials seen in the British population. Factors potentially involved in the production of these mortality differentials were examined. Smoking, plasma cholesterol concentration, blood pressure, and glucose intolerance did not appear to account for them. The pattern of differentials was the same in the group who reported no ill health at baseline as it was in the whole sample, which suggests that health selection associated with frank illness was not a major determinant. The contribution of height, a marker for environmental factors acting in early life, was also investigated. Whereas adjustment for employment grade and car ownership attenuated the association between short stature and mortality, height differences within employment grade and car ownership groups explained little of the differential mortality. CONCLUSION: The use of social class as an index of socioeconomic position leads to underestimation of the association between social factors and mortality, which may be reflected in public health initiatives and priorities. Known risk factors could not be shown to account for the differentials in mortality, although the degree to which this can be explored with single measurements is limited.

Adult↗
PubMed1991

A national study of psychiatric hospital care.

BACKGROUND: The delivery system for psychiatric inpatient services in the United States has changed dramatically over the past 30 years, undergoing a marked privatization. METHOD: To assess the effect of changes in ownership and types of inpatient settings on the structure of the mental health services system, the authors surveyed a national sample of nonfederal mental health facilities in 1988. RESULTS: Comparing their data to those of earlier surveys, they found that a decline in the number of patients per staff occurred in most settings over the last decade, suggesting that this aspect of quality of care may have improved. They observed important ownership-related differences in 1988 in diagnostic mix (e.g., more schizophrenia treated in public facilities than in private ones) and in payer source (e.g., more third-party revenues in public facilities than occurred in the past). CONCLUSIONS: There was a significant interaction between ownership form and type of facility, suggesting that the type of inpatient setting, ownership, and the relation between the two should be considered in assessing the impact of privatization on the accessibility of health care available for the mentally ill. The authors found that the increase in private psychiatric hospitals has widened the availability and choice of treatment facilities for those with private funding sources (especially children and adolescents) but has not had a similar effect in increasing sources of care for the seriously mentally ill dependent upon public financing.

Adolescent↗
PubMed2000

Cat sensitivity: 7-yr audit in children attending a paediatric allergy clinic in North Italy.

Sensitivity to cats and exposure to cat allergen is a common cause of asthma exacerbation in children. To date, there is no data on the prevalence of cat sensitivity in children living in North Italy. Therefore, a 7-yr survey was performed in patients attending an allergy clinic for the first time. Skin prick tests (SPT) for perennial allergens and for pollens relevant to the region were performed in 4,957 children attending the outpatient clinic 1992-1998. A questionnaire on present or past cat ownership was presented to all cat-skin prick test positive children. An evaluation of cat ownership on the general population was made by telephone interview on a random sample of 1,268 families living in the same area. With a 3-mm wheal as a positive cut-off 439 (8.85%) children had a positive SPT to cats. Of these 103 (23.4%) had a cat at home and 336 (76.6%) never had a cat in the house. With a greater positive cut-off(a wheal diameter > or =4 mm) 140 (2.8%) showed a positive SPT to cats of these 35 (25%) had a cat at home and 105 (75%) had only an indirect exposure to the pet. Of the telephone interviewed families; 16% stated they had a cat at home. Cat sensitivity is less prevalent in Italy, in this hospital based population, compared with other European countries and this is in agreement with a lower rate of cat ownership. Cat sensitivity was three times more frequent in children who never had a cat at home, than in children living with cats, when the selected positive cut-off was either a wheal diameter of 3 mm or > or =4 mm. Thus in a population with a low prevalence of cat ownership public exposure seems to be more important than domestic exposure for the development of sensitivity.

Animals↗
PubMed1993

A proposal for the mandatory inclusion of helmets with new children's bicycles.

To reduce bicycle-related head injuries in children, we propose new regulations be established that mandate the inclusion of approved helmets with the sale of all new children's bicycles. Currently, purchasing a helmet is a separate economic decision that acts as a barrier to helmet ownership and use. The inclusion of a helmet with the bicycle would markedly increase helmet ownership. The increased demand would reduce the manufacturing cost per helmet, so the cost of the bicycle with the helmet would be lower than the current retail price of the two separately. This proposal could potentially be implemented by federal or state legislation, a Consumer Product Safety Commission regulation, or voluntary adoption of a practice or standard by bicycle manufacturers. Increased helmet ownership is necessary but not sufficient to raise helmet use rates. The increased ownership generated by this proposal, complemented by enhanced educational, promotional, and legal interventions, is probably the most practical and cost-effective public health strategy available to increase helmet usage and prevent bicycle-related head injuries in children.

Adolescent↗
PubMed1996

Jumping the gun: firearms and the mental health of Australians.

OBJECTIVES: The aims of this study were to (i) survey mental health-related correlates of firearms ownership and availability in Australia, and (ii) assess possible causal relationships between civilian gun deaths, gun availability and mental disorders. METHOD: Available data regarding firearms ownership, injuries and deaths were reviewed as well as studies of (i) gun ownership, suicide and homicide, and (ii) gun control laws and suicide. RESULTS: Findings indicated that 85% of firearm deaths are triggered by distress, as opposed to crime. Most firearm homicides are intrafamilial or involve familiar persons. Firearm suicide rates, although tapering off in recent years, continue to rise among certain groups. It was also found that: (1) Beyond reasonable doubt, a causal relationship exists between gun ownership and firearm suicides and homicides. The role of method substitution is controversial, but is probably less important among the young. (2) Outside the United States, legislation may be useful in reducing firearm and possibly overall suicide rates. (3) If firearm owners are representative of the community, then 15-20% suffer from a psychiatric disorder at any time. While a modest increase in risk of firearms misuse exists for this group, especially those with a history of substance abuse or violence, concern also arises regarding those with mental disorders who access firearms because owners have not secured them. No uniform definition or way of verifying self-reports exists for gun licence applicants regarding these issues. CONCLUSIONS: Further regulation of firearm safety and availability is warranted. Public health measures include improved surveillance regarding firearm events, advocacy for appropriate firearm legislation, and better education and communication about firearms.

Accidents↗
PubMedDate not supplied

Evaluation of a community bicycle helmet promotion campaign: what works and why.

PURPOSE: This study identifies effective components of a bicycle helmet promotion campaign, and mechanisms by which these components affect child helmet ownership. DESIGN: A random telephone survey identified parents whose children did not own helmets prior to an educational campaign. A follow-up survey was conducted six months later. Regression analysis estimated the effects of four campaign components on child helmet ownership and tested for mediation by cognitive variables. SETTING: Study participants were residents of a suburban community which undertook a citywide educational campaign to increase child helmet ownership. SUBJECTS: Subjects were 210 parents with at least one school-aged child, none of whom owned helmets. INTERVENTION: A multicomponent campaign was implemented by a community coalition. In addition, random subsamples of the study participants received direct mail or direct telephone communications. RESULTS: Of the eligible respondents identified in the baseline sample, 39% completed the follow-up survey. Regression analysis showed that children whose parents received either helmet advice from a physician or direct telephone communications were 2.6 and 2.2 times more likely, respectively, to own helmets as children whose parents did not experience similar communication. Parental worry mediated the association, but parental beliefs about the effectiveness of helmets did not. CONCLUSION: Future helmet campaigns should use interpersonal strategies to increase parental worry about their children being involved in a bicycle accident. Generalization of these findings is limited by the high socioeconomic status of the study participants, and by the outcome measure, which is helmet ownership, not helmet use.

Adolescent↗
PubMed2003

The Wisconsin Research Network Firearm Safety Survey.

National surveys have reported information on firearm ownership and storage practices, but primary care physicians question whether such information can be generalized to their communities and the patient populations they serve. In this study, an anonymous survey was distributed to 100 consecutive patients in 11 primary care clinics throughout Wisconsin. Demographic information and information on the patient's willingness to have firearm safety discussed as part of their routine care, firearm ownership in the household, firearm storage practices, and the patient's purpose for owning firearms were collected. The study found that patients were willing to answer anonymous survey questions about firearm ownership and storage in their homes. The most effective screening question on gun safety was whether firearms were kept in the home for personal protection. Patients at rural clinics were more likely to own firearms than patients in urban clinics. Keeping firearms for recreational purposes was more common than keeping them for personal protection, which was associated with unsafe storage practices. A majority of patients reported not wanting to receive information on firearm safety from their physician. Overall, the study found that it was not possible to generalize national information on firearm ownership and storage to surveyed patients of primary care clinics in Wisconsin.

Adult↗
PubMed1992

Urban high school youth and handguns. A school-based survey.

OBJECTIVE: To determine the prevalence of handgun ownership among urban high school youth and investigate associations with socioeconomic status, ethnicity, and deviant behaviors. DESIGN: Survey of half of the Seattle, Wash, public high schools, which enroll 50% of the school district's 11th-grade students (N = 970). MAIN OUTCOME MEASURES: Self-reports of handgun ownership, perceived access to handguns, racial/ethnic identity, social status (Hollingshead's Two Factor Index of Social Position), and social deviance (Seattle Self-Report Instrument) were determined. RESULTS: Thirty-four percent of the students reported easy access to handguns (47% of males, 22% of females) and 6.4% reported owning a handgun (11.4% of males, 1.5% of females). Reported firearm experiences indicated a high rate of handgun utilization: 33% of handgun owners had fired at someone, 9.7% of female students reported a firearm homicide or suicide in family members or close friends, and 6% of male students reported carrying a handgun to school sometime in the past. Handgun ownership was more common among students who reported deviant behaviors. Adjusting for age, gender, and racial/ethnic group and controlling for covariation among the problem behaviors, gang membership (odds ratio [OR], 8.8; 95% confidence interval [CI], 3.7 to 20.8), sentencing by a judge (OR, 4.6; 95% CI, 1.3 to 15.5), selling drugs (OR, 3.7; 95% CI, 1.8 to 7.8), suspension or expulsion from school (OR, 3.5; 95% CI, 1.7 to 7.0), and assault and battery (OR, 2.5; 95% CI, 1.1 to 5.9) were associated with handgun ownership. However, 22% of male handgun owners did not report any of the above behaviors. CONCLUSION: The availability of handguns to the urban high school students surveyed is pervasive, and it is not limited to high-risk groups.

Adolescent↗
PubMed2004

Dimensions of publicness and performance in substance abuse treatment organizations.

Changes in funding, clientele, and treatment practices of public and privately owned substance abuse treatment programs, compelled in part by increased cost containment pressures, have prompted researchers' investigations of the implications of organizational form for treatment programs. These studies primarily probe associations between ownership status, patient characteristics, and services delivered and do not empirically link organizational form or structure to treatment outcomes. Data from the National Treatment Improvement Evaluation Study (NTIES) were used to study the relationship of ownership and other dimensions of publicness identified in the public management literature to patient outcomes, controlling for patient characteristics, treatment experiences, and other program characteristics. A few effects of organizational form and structure on substance abuse treatment outcomes are statistically significant (primarily improved social functioning), although the specific contributions of measures of ownership and publicness to explaining program-level variation are generally small.

Evaluation Studies as Topic↗
PubMed2006

Suicide by shooting is correlated to rate of gun licenses in Austrian counties.

OBJECTIVES: Shooting as method of suicide has increased considerably in Austria over recent decades and represented 23.5% of all suicides among men during the period 1990-2000. It is thought that the availability of guns could lead to their use in acts of suicide, and therefore we investigated the numbers of gun licenses (which constitutes ownership of guns and permission to carry a gun) in the nine Austrian counties and their correlation with suicides by shooting and other methods. METHODS: We studied registered suicides, including the method used, between 1990 and 2000 in Austria and the numbers of gun licenses held in the nine counties of Austria in the same period. RESULTS: We found a strong correlation between the average gun license rate for the period 1990-2000 and suicides by shooting (r = 0.967), and only very weak correlation, and for some of the years under investigation a negative correlation, with other methods of committing suicide (r = 0.117) and the suicide rate in general (r = 0.383). CONCLUSIONS: As shooting as a method of suicide has increased in Austria in recent decades, and is a highly lethal method, the finding that the shooting suicide rate is related to the extent of gun ownership deserves attention, especially as there is evidence that restriction of gun ownership is an important factor in suicide prevention.

Austria↗
PubMed1996

Beyond the public-private debate: the mixed economy of health.

Can or should private organisations provide public healthcare services? What is the scope for private finance in public healthcare services? This paper reviews some of the arguments for and against public or private ownership management and financing of public healthcare services. It concentrates on health services, where non-economic values and ethical questions are as important as the efficiency considerations, and on health purchasing or funding organisations. The paper describes the increasingly complex interrelationship and forms of competition between public and private providers, purchasers and financiers in the UK health sector. It argues that the simple private/public distinction never did describe well the many different forms of financing ownership and operation of health services in any country and is now a handicap to both scientific and lay policy debate about future options. It proposes a framework for describing the main forms of ownership and operations of health services and considers the future for health service purchasing and funding.

Contract Services↗
PubMed2001

The technical efficiency of hospitals under a single payer system: the case of Ontario community hospitals.

Using DEA, we investigated the impact of ownership, size, and location on the relative technical efficiency of community hospitals in Ontario, which has a single payer system. Consistent with Hansmann's theory of non-profit organizations and contrary to US-based research, we find no significant differences in efficiency across ownership types (government, religious or secular non-profit). Nor do we find significant differences in efficiency by size or location. Our findings suggest that model formulation and differences in payer mix across types of hospitals in the US have a strong influence on the measurement of the hospital ownership-efficiency relationship.

Catchment Area, Health↗