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PubMed1993

A national study of the efficiency of hospitals in urban markets.

Using a sample of 3,000 urban hospitals, this article examines the contributions of selected hospital characteristics to variations in hospital technical efficiencies, while it accounts for multiple products and inputs, and controls for local environmental variations. Four hospital characteristics are examined: hospital size, membership in a multihospital system, ownership, and payer mix (managed care contracts, percent Medicare, and percent Medicaid). Ownership and percent Medicare are consistently found to be related significantly to hospital efficiency. Within the ownership variable, government hospitals tend to be more efficient and for-profit hospitals less efficient than other hospitals. Higher percentages of Medicare payment are negatively related to efficiency. While not consistently significant across all five of the MSA size categories in which the analyses are conducted, possession of managed care contracts, membership in a multihospital system, and size all are consistently related positively to hospital technical efficiency. These variables are also all significant when the hospitals are examined in a combined analysis. Percent Medicaid was not significant in any of the analyses. Implications for policy and the need for methodological work are discussed.

Analysis of Variance↗
PubMed1990

Commercial exploitation of the human genome: what are the problems?

Commercial activities frequently take place against a background of the ownership of intellectual property, for example patents or know-how. This is particularly true of human health care companies and companies operating in the field of biotechnology, where the high cost and long time frames of research and development demand a degree of exclusivity in order to achieve an acceptable return on the investment. It follows that any company with an interest in using biotechnology to generate human health care products will have a strong interest in the ownership of property, much of which will have its origins in knowledge of the human genome. Claims to the ownership of portions of the human genome have been made public in recent times and these have been treated with everything from disgust to derision. However, a more considered analysis of this question will be found to turn on the relationship between discovery and invention in this field. This paper examines this question in relation to current commercial activities where information from the human genome is being used and attempts to draw some conclusions about what may be the impact of knowledge of the genome on commercial activities in the future.

Biotechnology↗
PubMed2002

[Social inequality and health of the elderly--classical or alternative status indicators?].

This article is focussed on the following two questions: first, whether socio-economic status (SES) differentials in health among the aged vary by the indicators of health and SES applied. Secondly it is investigated how SES differentials in health vary by age. The analyses are based on a telephone survey of 821 older people (> or = 60 years) living in a private household in Germany. In addition to the traditional indicators of SES (education, income and occupational status) two alternative indicators (assets and home ownership) are used in the study. Self-rated health, depression (CES-D) and functional status according to Advanced Activities of Daily Living are introduced as health indicators. Results of multiple regression analyses show that associations between income and the health indicators were comparably strongest. Education, occupational prestige, assets and home ownership were not consistently related to health, especially after controlling for the remainder of the SES indicators. Thus, home ownership and assets do not predict health significantly beyond the effect of the traditional indicators of SES. With regard to age-related variations of the social gradient results were not consistent: In terms of self-rated health associations do not differ between the age groups (60-65, 66-74, 75+), while associations between traditional SES indicators and depression tend to become stronger among those aged 75 years and older. With regard to functional status there were no significant associations with socio-economic status in the multivariate model among those aged 75 years and older. The present study shows that the magnitude of the association between social inequality and health among the aged as well as age related changes in the social gradient depend on the indicators of SES and health applied. Because the analyses are based on cross-sectional data it is not possible to identify causal relationships or to separate age effects from cohort effects. Therefore longitudinal studies are needed in which traditional as well as alternative indicators of SES are used that are appropriate for older adults in general and important for an explanation of differentials in health among the aged in particular.

Activities of Daily Living↗
PubMed2005

Pets and the development of allergic sensitization.

Sensitization to pets remains a risk factor for asthma and rhinitis, and can occur in people who have never lived with a pet. Several reports have indicated that living with a pet reduces the risk for becoming sensitized to that pet. Having a pet in the home gives exposure to more than just allergens. In areas with high frequency of pet ownership, community exposure to pet allergens is almost certainly sufficient to induce sensitization among non-pet owners. In this review, we examine the results of recent studies that have investigated the relationship between pet ownership, specific sensitization to that pet, and allergic sensitization in general. For cat ownership, the results are inconsistent between studies of similar design, with some studies suggesting an increase in risk and others a decrease among cat owners. For dogs, results are more consistent, generally suggesting that owning a dog has no effect or indeed may be protective against the development of specific sensitization to dog and allergic sensitization in general.

Adolescent↗
PubMed1990

Dogs, distemper and osteitis deformans: a further epidemiological study.

There is extensive evidence linking paramyxoviruses, notably measles and respiratory syncytial virus, with Paget's disease of bone. The epidemiology of Paget's disease does not fit with that of known human paramyxovirus infections and it is possible that the disease is a zoonosis with domestic animals acting as host. Canine distemper, a paramyxovirus of the morbillovirus family (closely related to measles) is therefore a potential candidate. We have surveyed previous pet ownership in 150 Paget's patients each of whom was matched with two general practice controls; one from an inner city practice and the other from a suburban practice both in Greater Manchester. Recall of previous dog ownership was higher in Paget's patients with differences being more marked against inner city than suburban controls. 88% of the patients had lived in the same household as a dog at some stage compared with 79% of the inner city controls (P less than 0.05) and 83% of the suburban controls (n.s.). The differences were greater in the years 1930-60 during which the proportion of patients owning dogs was largest. For Paget's patients and controls alike, recalled exposure to dogs with canine distemper appeared to cluster in certain periods between 1930 and 1960. Unexpectedly, significantly more (7 out of 22, P less than 0.01) of the patients with a known first degree relative suffering from Paget's disease had no previous history of dog ownership when compared with the other patients (10 out of 128).

Adult↗
PubMed2006

ACRM's evolving mission: opportunities to promote rehabilitation research.

This presidential address reflects on the history and mission of the American Congress of Rehabilitation Medicine (ACRM) and considers the benefits derived from joint ownership of Archives of Physical Medicine and Rehabilitation with the American Academy of Physical Medicine and Rehabilitation (AAPM&R). Much of ACRM's history has been distinguished by collaboration with AAPM&R on essential concerns. Evolving organizational priorities have resulted in distinct association missions that have consequences for joint ownership of Archives. The journal has grown in important ways in the past 86 years from a solo editor to an editorial board and to joint ownership and sponsorship of alternating issues. The quality of Archives has improved substantially in the past decade, with an improving impact factor and an increasing number of manuscript submissions. A new contract with the publisher provides an opportunity to consider the relationship between the Congress and Archives and what kind of benefit ACRM desires it to be for its members, to the larger community of physical medicine and rehabilitation (PM&R), and to the persons with disabilities we as PM&R professionals seek to serve. Archives is well positioned to fulfill ACRM's focus on promoting rehabilitation research and facilitating information dissemination and technology transfer. An internationally respected journal is an excellent means to disseminate rehabilitation research that promotes health, independence, productivity, and quality of life for people with disabling conditions. This new chapter in the relationship between Archives and the Academy and Congress provides several opportunities for rehabilitation research leadership. More than ever, Archives provides a premier mechanism to fulfill the Congress's mission and to promote our sense of community.

Biomedical Research↗
PubMed2005

Quality of fertility clinic websites.

OBJECTIVE: To evaluate the overall quality of the Society for Assisted Reproductive Technology (SART)-affiliated fertility clinic websites, according to American Medical Association (AMA) Internet health information guidelines. DESIGN: Cross-sectional evaluation. SETTING: Two hundred sixty-six websites drawn from the SART directory and the World Wide Web. INTERVENTION(S): Three objective scoring scales (ownership, content, and navigation) adapted from AMA guidelines. MAIN OUTCOME MEASURES: Seven objective criteria for ownership, 8 for content, and 11 for website navigation. RESULT(S): Two thirds of SART-affiliated fertility clinics have functional websites. Of the 236 sites evaluated, 58 belong to hospital centers. Overall, the scores for the three scoring scales were low. Compared with the websites of non-hospital clinics, those of hospital centers were more likely to include information about site ownership and affiliations (89.7% vs. 60.7%) and patient privacy (34.5% vs. 20.8%). Also, contents of hospital center websites were significantly easier to distinguish from advertisements (70.7% vs. 47.7%), and reference sources for specific contents were easier to identify (27.6% vs. 8.4%). Hospital center websites were more likely to indicate affiliations and financial disclosures of authors (25.9% vs. 10.7%), to feature a site map (25.9% vs. 12.3%), and to have a search function (31.0% vs. 5.6%). CONCLUSION(S): Websites of SART-affiliated clinics fail to meet most of the AMA health information guidelines. The quality of the hospital centers' websites is better than that of private clinics.

Academic Medical Centers↗
PubMed2005

Cat and dust mite sensitivity and tolerance in relation to wheezing among children raised with high exposure to both allergens.

BACKGROUND: Recent evidence has suggested that high exposure to cat allergens is associated with decreased prevalence of sensitization to cat and, in some studies, decreased asthma. OBJECTIVE: Our objective was to study antibodies to cat and mite allergens and their relationship to wheezing in a country with high exposure to both allergens. METHODS: Sera from 112 wheezing and 112 control children aged 10 to 11 years in a nested case-control study in New Zealand were assayed for specific IgE antibody, as well as IgG antibody and IgG4 antibody, to Der p 1 and Fel d 1. RESULTS: IgE antibody to both mite (99/224) and cat (41/224) were strongly associated with wheezing (odds ratios, 5.2 and 6.5, respectively). Children who had ever lived with a cat were less likely to have IgE antibody to cat (20/141 vs 21/83, P < .04); however, cat ownership had no effect on IgE antibody to mite (67/141 vs 32/83, P = .23). Among sensitized children, cat ownership was associated with a lower prevalence of IgE antibody to cat (28% vs 66%, P < .001), and this analysis remained significant after exclusion of children whose families had chosen not to own a cat. Among sensitized subjects, the mean titer of IgE antibody to cat (1.7 IU/mL) was 10-fold lower than for mite (22.1 IU/mL). A cat in the home had no significant effect on endotoxin or mite allergen in house dust, whereas cat allergen was much higher (40.8 vs 3.3 microg/g). CONCLUSION: The response to these 2 allergens was distinct on the basis of the prevalence of sensitization, the titer of IgE antibody, and the effect of cat ownership. The results suggest that induction of tolerance to cat allergen is an allergen-specific phenomenon that cannot be attributed to endotoxin or family choice. The strength of the IgE antibody response to dust mite in humid climates could contribute to the increased prevalence and severity of asthma.

Allergens↗
PubMed2006

Cat allergen level: its determinants and relationship to specific IgE to cat across European centers.

BACKGROUND: Cat allergen level in settled house dust and its determinants in Europe are unknown. OBJECTIVE: The aim of this study is to quantify the level of cat allergens in mattress dust, to study its determinants, and to analyze the relationship with cat specific IgE on community level across European centers. METHODS: Trained field workers collected dust from approximately 3000 mattresses during home visits in 22 European Community Respiratory Health Survey II centers. Sieved dust extracts were assayed for cat allergen using a mAb ELISA assay. RESULTS: The overall geometric mean cat allergen was 0.94 microg/g, ranging from 0.12 microg/g in Huelva, Spain, to 3.76 microg/g in Antwerp, Belgium. Current cat owners' homes showed substantially higher levels than past cat owners' and never cat owners' homes (geometric mean and 95% CI, 61.4 microg/g [48.4-77.9] vs 1.37 microg/g [0.97-1.9] vs 0.29 microg/g [0.27-0.31]). Community prevalence of cat ownership was moderately correlated with cat allergen levels in noncat owners (r(s) = 0.50), but not for past or current cat owners. The multilevel model identified community prevalence of cat keeping as the only statistically significant determinant of mattress cat allergen levels for noncat owners. However, averaged cat allergen levels per center were not related to community prevalence of detectable specific IgE to cat. CONCLUSION: Not having a cat in the home is associated with substantially lower Fel d 1 concentration, but does not protect against high Fel d 1 exposure in communities where cat ownership is common. CLINICAL IMPLICATIONS: People (including patients with cat allergy) who do not own cats may be exposed to high levels of cat allergen in their home, particularly if they live in communities with high levels of cat ownership.

Allergens↗
PubMed2006

Socioeconomic gradients in cardiorespiratory disease and diabetes in the 1960s: baseline findings from the GPO study.

OBJECTIVES: To describe the socioeconomic distribution of risk factors for cardiorespiratory disease and diabetes in employed women and men in the late 1960s. STUDY DESIGN AND METHODS: Cross-sectional data were collected from 3345 General Post Office (GPO) employees in London, via a questionnaire and clinical examination, between October 1966 and April 1967. RESULTS: Our occupational grade classification conformed to expected patterns of greater car ownership and gardening among higher-grade women and men, and greater height in higher-grade men (highest-lowest grade 175.0-170.7 cm, P<0.001). A strong inverse grade gradient in bronchitis (2.1-9.4%, P<0.001) and a strong positive gradient in FEV1 (3.10-2.58l, P<0.001) were observed in men, although smoking was less consistently associated with grade. There was no consistent inverse association between grade and any cardiovascular risk factor in either sex, but strong inverse gradients in prevalence of impaired glucose tolerance (IGT) (5.1-18.2%, P<0.001) and 2-h glucose (4.14-4.25 mmol/l, P<0.001) in non-diabetic men. Using car ownership as an alternative measure of socioeconomic position, findings in men were replicated for respiratory measures, IGT and 2-h glucose prevalence. Inverse gradients were additionally observed for blood pressure, cholesterol and electrocardiogram abnormalities. CONCLUSIONS: The GPO study confirms existing evidence of socioeconomic gradients in respiratory risk factors and provides new evidence of gradients in risk factors for diabetes in men. Although there was no conclusive evidence of an occupational gradient in any cardiovascular risk factor, car ownership was a good indicator of lower risk in men. No socioeconomic gradients in cardiorespiratory or diabetic risk factors were observed in women.

Adolescent↗
PubMed2006

Rabbit allergens: a significant risk for allergic sensitization in subjects without occupational exposure.

BACKGROUND: Although rabbits are becoming popular as pets, data about the characteristics of allergic sensitization to rabbit allergens in patients without professional exposure are scarce. AIMS OF THE STUDY: To determine the characteristics of allergic sensitization to pet rabbits, and the role of direct and indirect exposure to rabbits and rabbit allergens in non-professionally exposed patients. METHODS: From among 1124 consecutive outpatients, we selected all subjects with an immediate skin reaction to rabbit dander. A clinical history including a careful evaluation of the modality of rabbit exposure, the results of skin-prick tests (SPTs) and total/specific IgE antibodies were recorded. The prevalence of rabbit ownership in the Naples area was also calculated. RESULTS: Among 753 SPT-positive patients, 20 (2.65%) were sensitized to rabbit dander (5 patients were mono-sensitized). Fifteen patients reported direct rabbit contact (7 were rabbit owners and 8 had occasional contact outside the home); 3 patients had indirect exposure through contact with rabbit owners and 2 patients denied any direct or indirect exposure. Rabbit mono-sensitized owners of pet rabbits had persistent (moderate-severe) symptoms. The prevalence of rabbit ownership is 1.56%. CONCLUSIONS: In susceptible not professionally exposed individuals, direct rabbit contact and, in some cases, indirect or no apparent exposure, may induce allergic sensitization to rabbit allergens. A progressive increase in rabbit sensitization (also by indirect exposure) may be expected as a consequence of the increase in rabbit ownership.

Adolescent↗
PubMed2005

The pet connection: pets as a conduit for social capital?

There is growing interest across a range of disciplines in the relationship between pets and health, with a range of therapeutic, physiological, psychological and psychosocial benefits now documented. While much of the literature has focused on the individual benefits of pet ownership, this study considered the potential health benefits that might accrue to the broader community, as encapsulated in the construct of social capital. A random survey of 339 adult residents from Perth, Western Australia were selected from three suburbs and interviewed by telephone. Pet ownership was found to be positively associated with some forms of social contact and interaction, and with perceptions of neighbourhood friendliness. After adjustment for demographic variables, pet owners scored higher on social capital and civic engagement scales. The results suggest that pet ownership provides potential opportunities for interactions between neighbours and that further research in this area is warranted. Social capital is another potential mechanism by which pets exert an influence on human health.

Adult↗
PubMed2001

Explaining national road fatalities.

The purpose of this paper is to report on a model that can be used to explain the differences in road fatalities of individual countries. National infrastructure, transportation and socio-economic variables from international databases were considered as possible variables. The model was developed by means of stepwise regression analyses. It was found that the passenger car ownership is a better predictor of fatalities per 100000 passenger cars than vehicle ownership as a predictor of fatalities per 100000 vehicles. Many individual infrastructure and socio-economic variables have a significant effect on the fatality rate. The final model includes passenger car ownership, the Human Development Index (HDI), and the percentage of other vehicles as explanatory variables.

Accidents, Traffic↗
PubMed2001

The Icelandic genome debate.

Three of the central issues in contemporary debates about the commodification of the human body are those of property, ownership, and access. This article uses the case of the central medical database on Icelanders to discuss contesting claims about the ownership of the human genome, with respect to the rapid development of biotechnology, human genome projects and DNA collections. We emphasize the contrast between commercial and communitarian perspectives and to illustrate our argument we explore debates about the Icelandic database. These debates have been intense, focusing on a range of issues, including ethics, academic freedom, public health and, last but not least, the control and ownership of medical records, genetic information and genealogical data. This article should be seen primarily as an anthropological commentary on ongoing developments.

Bioethics↗
PubMed1998

Development of a patient classification system for chronic hemodialysis patients.

The purpose of this project was to develop a patient classification system that could indicate the caregiver time required by chronic hemodialysis patients during one dialysis treatment session. A patient acuity tool that used a condition indicator model was developed and validated. Initial indicator weights were established by an expert panel of 12 center directors. An experimental design was formulated that permitted evaluation of the influence of independent factors, such as type of ownership and cost-per-treatment environment on the acuity-time relationship. Acuity-time data were collected on more than 600 individual treatments performed in 12 different centers across the country. Results indicate that patient acuity, measured by The American Nephrology Nurses' Association (ANNA)/MECON acuity tool, is a strong predictor of the caregiver time that will be required by the patient during that treatment session (P < 0.0001) and that centers differ in the amount of time that caregivers spend with patients who are rated at the same level of acuity (P = 0.001). The overall average time spent by caregivers ranged from 61 minutes per treatment for level I patients to 97 minutes per treatment for level 5 patients. Ownership and cost-per-treatment effects were not significant as independent factors. However, some combinations of ownership and cost-per-treatment data may be significant.

Humans↗
PubMed2003

Rural/urban differences in the association between deprivation and healthcare utilisation.

Whilst associations between inequalities in healthcare utilisation and socio-economic deprivation are well established in the UK it is argued that deprivation indices, such as the Townsend index, remain insensitive to rural/urban differences. This study examines how Townsend and its components differ in their association with healthcare utilisation across the rural/urban spectrum of a large health region. Our research was carried out in the West Midlands National Health Service region (population 5.3 million), comprising of a similar geographical population diversity to that of the United Kingdom (UK) using Hospital Episode Statistics (1994/5-1998/9) and 1991 census socio-demographic data. Retrospective multilevel multivariate models compare three ward-level healthcare utilisation measures (standardised episode-, admission-, and bed-rates) in relation to the Townsend index of material deprivation, its components, and four rural/urban characteristics (population density, population potential, electoral ward area and perimeter size). The associations between outcomes and Townsend were generally not attenuated by the rural/urban characteristics. The constituent component of car-ownership was similarly unperturbed, whereas population potential significantly perturbed the home-ownership model and overcrowding was significantly perturbed by all four rural/urban characteristics considered. A deprivation index may encapsulate different meanings to that of its components when used to assess variations in healthcare utilisation. Constituent components may yield considerable perturbation in relation to healthcare utilisation across the rural/urban spectrum, whilst the composite measure does not. In particular, and contrary to anecdotal opinion, car-ownership and unemployment (as recorded in the 1991 UK census) exhibited a stable relationship across different rural/urban areas with respect to healthcare utilisation.

Automobiles↗
PubMed1998

Social class and substance use disorders: the value of social class as distinct from socioeconomic status.

The relationship between social class and substance use disorders (SUDs) is explored and compared to the relationship between SES and SUDs. Social class and SES are two different conceptualizations of socioeconomic inequality (SEI) which emanate from two different theoretical orientations in sociology. SES is commonly used in epidemiological research and is usually measured in terms of education, income or occupational prestige. Social class is less known and less used. Here, following the work of Wright et al. (Wright, E. O., Hachen, D. and Costello, C. et al. (1982) The American class structure. American Sociological Review 47, 709-726) it is measured in terms of four types of control people have in their work place: ownership, control over budget decisions, control over other workers, and control over one's own work. Data are derived from an epidemiological survey, conducted in Israel, using a two stage sampling procedure for the identification of cases. In the first stage 4914 respondents were screened with the Psychiatric Epidemiological Research Interview (PERI). In the second stage (n = 2741), those who screened positive (and a sample of the negatives) were diagnosed by psychiatrists using a structured interview that yielded diagnoses according to the Research Diagnostic Criteria (RDC). The results indicate that those who are advantaged in terms of ownership, i.e. self-employed, have higher rates of SUDs compared to employees. Furthermore, it appears that most disorders have an onset subsequent to entry into the current job, indicating that ownership plays a causal role in the onset of SUDs rather than the other way around. These results are contrasted with those of a previous report from the same study by Dohrenwend et al. (Dohrenwend, B. P., Levav, I. and Shrout, P. E. et al. (1992) Socioeconomic status and psychiatric disorders: the causation selection issue. Science 255, 946-952) which showed just the opposite association between SES and SUDs, i.e. those who are advantaged in terms of SES have lower rates of SUDs. As an explanation of these apparently conflicting results, the possibility is entertained that social class and SES represent independent causal pathways to the onset of SUDs with social class mainly related to primary SUDs and SES mainly to secondary SUDs.

Adult↗
PubMedDate not supplied

Asthma and allergy in Turkish university students: Two cross-sectional surveys 5 years apart.

BACKGROUND: prevalence of asthma and allergic diseases is increasing worldwide. We investigated the first-year university students to a) determine prevalence of asthma, and allergic diseases, b) compare prevalence with a similar study conducted in 1994, and c) investigate determinants of asthma, current wheeze and seasonal rhinitis. METHODS: an ECRHS based questionnaire was distributed to 5,406 students and completed by 4,639 (response: 85.3 %) in september 1999. Information from the students residing in Turkey was used in the analyses (1,800 boys, 2,712 girls). RESULTS: prevalence % of asthma (symptom and/or medicine), current wheeze and seasonal rhinitis were 2.1, 6.9 and 12.7 in boys, and 2.5, 7.2 and 14.5 in girls. Current smoking, pet ownership and family atopy was reported more frecuently in 1999 than 1994. Cough and seasonal rhinitis increased almost twofold. Asthma diagnosis and attack rate was similar in 1999 and 1994. Family atopy, pet in childhood, smoking and passive smoking in childhood increased the risk of asthma, and current wheeze. Family atopy, passive smoking and current pet ownership increased the risk of seasonal rhinitis. CONCLUSION: increased rate of smoking and pet ownership could contribute to the increased prevalence of asthma and allergic diseases in the last 5 years.

Adolescent↗