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PubMed1990

Private midwives: a new approach to family planning service delivery in Ghana.

Data on 134 private sector midwives who were educated and trained in family planning service delivery by the Ghana Registered Midwives' Association (GRMA) showed that, for most, the course was the first they had received since qualifying as a midwife. Four out of five of the new family planning clients served by these midwives were first time contraceptive users. Approximately 9% of the clients were men, most of whom requested condoms. While delivering women is still the main function of the maternity homes, it is clear that family planning services have come to represent an important element of the health care the midwives provide. A follow-up study of family planning acceptors found extremely encouraging continuation rates. In addition, a survey of the women that the midwives had delivered showed that the contraceptive prevalence rate among these women was higher than the national rate. Providing family planning services through private sector midwives has been shown to be a very successful approach in Ghana, and one that has the potential to become a pillar of the nation's overall family planning delivery programme. As several other countries in Africa also have active private sector health networks, this approach holds promise far beyond its initial success in Ghana.

Adolescent↗
PubMed1999

Laparoscopic Burch urethropexy in a private clinical practice.

STUDY OBJECTIVE: To determine the effectiveness of laparoscopic Burch urethropexy in a private practice setting. DESIGN: Prospective, observational study (Canadian Task Force classification II-2). SETTING: Private practice. PATIENTS: Fifty-one consecutive women with stress urinary incontinence (15 genuine stress urinary incontinence, 36 concomitant degrees of pelvic organ prolapse). INTERVENTION: Laparoscopic Burch urethropexy was performed with sutures in 36 patients and with mesh and staples in 15, in combination with laparoscopic vaginal vault suspension, paravaginal repair, laparoscopic-assisted vaginal hysterectomy, and other procedures. MEASUREMENTS AND MAIN RESULTS: Intraoperative complications occurred in 10% of cases; all were recognized and repaired laparoscopically. Operating time ranged from 55 minutes to 3 hours (median 2 hrs 25 min). Forty-four (86%) surgeries were done on an outpatient basis, five women required an overnight stay, and two were admitted. Forty-seven (93%) patients were discharged without a catheter; two had urinary retention requiring a catheter for 5 days. Follow-up ranged from 12 to 42 months (average 24 mo). Forty-eight women (94%) were cured, three (6%) failed therapy, and six (12%) developed de novo detrusor instability. CONCLUSION: Burch urethropexy can be performed safely by laparoscopy in a private practice setting with success similar to that of open technique. Most intraoperative complications can be corrected laparoscopically with no increase in morbidity. (J Am Assoc Gynecol Laparosc 6(1):39-44, 1999)

Adult↗
PubMed2005

Mite and pet allergen exposure in Brazilian private cars.

BACKGROUND: The role of mite and pet allergens in the development of allergic diseases has been recognized for many years. OBJECTIVE: To determine mite (Dermatophagoides pteronyssinus [Der p 1] and Dermatophagoidesfarinae [Der f 1]), cat (Felis domesticus [Fel d 1]), and dog (Canis familiaris [Can f 1]) allergen levels in Brazilian private cars. METHODS: Mite, cat, and dog allergens were measured in dust samples collected from 60 upholstered seats of private vehicles using enzyme-linked immunosorbent assays. RESULTS: Mean levels of Der p 1 (0.24 microg/g of dust; range, 0.06-2.05 microg/g of dust) and Der f 1 (0.29 microg/g of dust; range, 0.06-2.07 microg/g of dust) were extremely low in most dust samples analyzed. In contrast, sensitizing mean levels of Can f 1 (1.51 microg/g of dust; range, 0.14-30.96 microg/g of dust) and Fel d 1 (0.43 microg/g of dust; range, 0.02-5.75 microg/g of dust) were observed in 32 (53%) and 12 (20%) samples, respectively. Mean Can f 1 levels were significantly higher in cars whose owners kept dogs at home (3.27 microg/g of dust) than in those without pets (0.57 microg/g of dust; P = .008). There were no significant differences in allergen levels regarding the age of the vehicle or the number of users and whether the owners transport pets inside the vehicles. CONCLUSIONS: Private cars constitute an important pet, but not mite, allergen reservoir for continuous contamination of the indoor environment. Pet allergens may be present even in cars whose owners do not have pets. Effective measures to reduce allergen exposure in cars should be taken routinely, especially for pet-allergic patients.

Allergens↗
PubMed2005

Landfill-gas-to-Energy projects: analysis of net private and social benefits.

Methane emissions from municipal landfills represent 3% of the total United States greenhouse gas emissions that contribute to climate change. These methane emissions can be released to the air or collected and flared. This landfill gas also has the potential to be used to generate electricity. In 1994,the Environmental Protection Agency(EPA) created the Landfill Methane Outreach Program, with the objective of promoting the development of landfill-gas-to-energy projects around the country. There are currently 2,300 active landfills in the United States. Although there are already 382 operational projects, there are many more landfills with the potential to use the gas. EPA has identified at least 630 candidate landfills for energy projects, and many more have still not been identified. The objective of this paper is to evaluate total private and social benefits of landfill-gas-to-energy projects, taking into consideration not only the costs of installing and maintaining the necessary equipment and the revenues obtained from selling the electricity but also a valuation of the greenhouse gas emissions that would be prevented and the emissions of criteria pollutants created by the electricity generating equipment. It also evaluates the breakeven government subsidies that would be required to make such projects economically viable from private and social perspectives in comparison to current subsidies. It was found that the private breakeven price of electricity for these projects is lower than dollar 0.04/kWh. Moreover, the optimum social subsidywas found to be less than dollar 0.0085/ kWh, which is about 40% lower than the currently available federal tax break of dollar 0.015/kWh. The method developed for this paper can be applied to other renewable energy technologies, to show their relative social costs and benefits.

Air Pollutants↗
PubMed1999

A preschool immunization project to enhance immunization levels, the public-private relationship, and continuity of care.

This study was conducted to determine whether implementing a program aimed at providing a variety of incentives to physicians who provide immunizations to preschool-aged children would help to improve immunization rates and reduce fragmented care for patients. Twenty physicians from 14 private practices that provide care to preschool-aged children from low income families in suburban Cook County, Illinois participated in the project. A randomly selected subset of patient case records from the physicians' offices were audited after the implementation of the project to determine the immunization status of children in the practices and the nature of services provided. These 310 records of children under three years of age who were treated between 1991-1994 (the intervention sample) were compared to 310 charts from a 1988-1990 cohort of records (baseline sample). The groups did not differ on race or gender; however, significantly more families in the 1988 through 1990 cohort of children under 3 years of age were insured privately when compared to the 1991 through 1994 cohort. Seventy percent (218) of the records in the intervention sample were up to date for age on immunizations compared to 45% (141) of the baseline records, reflecting a statistically significant difference (p < .00001). The intervention sample showed significantly more well child visits where immunizations were given and follow up visits where immunizations were given when compared to the baseline sample. Physicians completed surveys before and after implementation of the project. They were questioned about their knowledge and practices regarding immunizations as well as their opinion of specific project components. All of the physicians viewed the project as an effective means to improve immunization services to low income children. The project demonstrates a potential means of enhancing immunization levels and continuity of care among preschool-aged children. It also highlights the workable nature of the partnership between public and private sectors.

Child Health Services↗
PubMed1986

Adolescent loneliness, self-disclosure, and private self-consciousness: a longitudinal investigation.

This study builds on an earlier investigation of the causal relations that exist among loneliness, self-disclosure, and private self-consciousness (Franzoi & Davis, 1985). Using structural equation techniques and a longitudinal (Year 1-Year 2) design, the present investigation tested a theoretical model that links these variables. Participants were 406 high school students. As in the previous study, results generally indicated a good fit between the theoretical model and the observed relations. In particular, however, this investigation provided new evidence concerning two alternative interpretations of the original Franzoi and Davis study. First, this study supports the original hypothesis that private self-consciousness leads to greater self-disclosure to peers, but it offers no support for the alternative view that such disclosure in turn increases private self-consciousness. Second, this investigation is somewhat equivocal with respect to the original hypothesis that greater self-disclosure reduces loneliness. Both this hypothesis and the alternative view that greater loneliness reduces self-disclosure, receive some support from the data in this study. Finally, the difficulty in obtaining significant longitudinal paths (from Year 1 to Year 2) suggests that the time lags in the variables' effects on one another are relatively short rather than long.

Adolescent↗
PubMed2006

Once more: is beauty in the eye of the beholder? Relative contributions of private and shared taste to judgments of facial attractiveness.

Misconstruing the meaning of Cronbach's alpha, experts on facial attractiveness have conveyed the impression that facial-attractiveness judgment standards are largely shared. This claim is unsubstantiated, because information necessary for deciding whether judgments of facial attractiveness are more influenced by commonly shared or by privately held evaluation standards is lacking. Three experiments, using diverse face and rater samples to investigate the relative contributions of private and shared taste to judgments of facial attractiveness, are reported. These experiments show that for a variety of ancillary conditions, and contrary to the prevalent notion in the literature, private taste is about as powerful as shared taste. Important implications for scientific research strategy and laypeople's self-esteem are discussed.

Adolescent↗
PubMed1999

Rates of successful vaginal delivery after cesarean for patients with private versus public insurance.

OBJECTIVE: To examine the effect of insurance status on method of delivery while controlling for clinical and sociodemographic characteristics of women delivering at a single medical center. STUDY DESIGN: Sociodemographic and clinical characteristics of 878 women, who delivered their infants between 1985 and 1991 at a university hospital, were analyzed. Women were included if their previous infant was delivered by cesarean section and if the current pregnancy was > or = 37 weeks' gestation at nonemergent delivery with insurance status clearly specified. The outcome of interest was the rate of successful vaginal births after cesarean (VBAC) delivery by insurance status. RESULTS: The trial of labor rate for the cohort, defined as the rate of VBAC or cesarean deliveries following labor, was 55%; 61% were vaginal deliveries. Significant differences with regard to insurance status and several maternal factors were noted between trial of labor and cesarean section--no labor groups. After controlling for potentially confounding variables, the Medicaid/indigent group was more likely than the privately insured group to undergo a trial of labor (odds ratio, 1.5; 95% confidence interval, 1.1 to 2.4). Of women who underwent a trial of labor, after controlling for other characteristics, the Medicaid/indigent group was more likely than the privately insured group to deliver vaginally (odds ratio, 1.9; 95% confidence interval, 1.1 to 3.2). CONCLUSION: After controlling for other covariables, women with a history of a prior cesarean section with Medicaid/indigent insurance were more likely than privately insured women to attempt a trial of labor, and subsequently, to deliver vaginally, given that a trial of labor was attempted.

Adult↗
PubMed1998

Effects on criminal violence of different beverage types and private and public drinking.

AIM: The purpose of the study is to analyse the relationship between homicide and assault rates on one hand, and various indicators of alcohol consumption on the other. The latter include private and public drinking with a further disaggregation into beverage-specific drinking. MEASUREMENTS: The data comprise aggregate time series for Sweden during the period 1956-94. The assault rate is measured as the number of police reported assaults (at all degrees of aggravation) per 100,000 inhabitants (15+). The homicide rate is measured as the number of homicides (where the victim was at least one year old) per 100,000 inhabitants (15+). Private consumption is gauged as retail sales of alcohol, and public consumption as on -premise sales (litres 100% per inhabitant, 15+). These two measures are disaggregated further into beverage specific sales (beer, spirits and wine). FINDINGS: According to the findings, there is a statistically significant relationship between the assault rate and a combined measure of on-premise sales of beer and spirits. The estimated relationship corresponds to an attributable fraction of about 40%. The homicide rate is significantly associated with retail sales of spirits; the attributable fraction is estimated at about 50%. Wine sales are not related to any of the two violence indicators. CONCLUSIONS: The findings suggest that the assault rate is related to consumption of beer and spirits in bars and restaurants, while the homicide rate is linked to consumption of spirits in private contexts. The findings, notably specific to Sweden during a certain time period, can be interpreted as the outcome of the interplay of a number of factors, including opportunity structure, social control and context of drinking, drinking patterns associated with the different beverage types and characteristics of the drinkers.

Alcohol Drinking↗
PubMed2007

[Compensation for tinnitus in private accident insurance].

According to the provisions of private accident insurance, mental or psychic reactions are excluded from compensation. Until now, tinnitus was taken as fully psychic and therefore excluded. In two recently published judgments of the Federal Supreme Court in Germany the assessment of tinnitus in private accident insurance and particularly the exclusion clause section sign 2 Abs. 4 AUB 88 has been newly defined. According to this actual jurisdiction the compensation of tinnitus could be possible, when as physical underlying reason a proved harm in the inner ear or the auditory pathway (hearing loss), which can be traced back to the accident according to the rules of causality. This leads to the question how Tinnitus could be compensated without modification of the general terms and conditions of the private accident insurance. A compensating table is proposed, which recognizes the somatic (physical) part of tinnitus and is based on medical and scientific findings of the relation between hearing loss and tinnitus.

Disability Evaluation↗
PubMed1975

Private Initiative in PSRO.

Private initiative in PSRO (Pl) is a privately funded joint effort by five major professional organizations to influence the implementation of PSRO on behalf of the public interest. Working with five PSRO's, PI is testing a form of concurrent quality assurance and its effect on the immediate outcomes of hospital care. The project also promotes and evaluates participation in local PSRO's by representatives of the general public. The operating costs of PSRO's and their impact on hospital utilization and reimbursements by Medicare and Medicaid are being prospectively determined. A central issue addressed by PI is growing encroachment by the central administration of PSRO on private medicine's traditional responsibility for assuring the quality of care. PI seeks improved means of rendering a satisfactory public accounting in quality assurance as an alternative to federal regulation of this elemental professional function.

Community Participation↗
PubMed1996

Further contrasts between self-reflectiveness and internal state awareness factors of private self-consciousness.

Although widely used as a unitary measure of self-focused attention, the Private Self-Consciousness subscale (Fenigstein, Scheier, & Buss, 1975) contains two factors. In the present study, this subscale and its self-reflectiveness (SR) factor predicted greater shame, guilt, other-directedness, and social anxiety; but the internal state awareness (ISA) factor displayed relationships that were in the opposite direction. Contrasts between SR and ISA often became more obvious in partial correlations, when one factor was examined while controlling for the other. In relationships with personal and social identity, SR appeared to reflect public as much as private self-consciousness. These data support recent suggestions that it may be necessary to construct more adequate measures of private self-consciousness.

Adolescent↗
PubMed2002

A comparison of four causal factors of embarrassment in public and private situations.

In this study the authors investigated which of 4 causal factors of embarrassment is most characteristic in public and in private situations. University students (N = 288) were presented with 2 scenes representing public or private situations and were asked to rate 17 items related to the 4 factors causing embarrassment. The results indicated that in the public situation the causal factors were ordered as (a) disruption of social interaction, (b) apprehension of social evaluation, (c) inconsistency with self-image, and (d) loss of self-esteem, and in the private situation causal factors were ordered as (a) loss of self-esteem, (b) inconsistency with self-image, (c) apprehension of social evaluation, and (d) disruption of social interaction. From these results, new models for the mediating mechanism of embarrassment are proposed.

Adolescent↗
PubMed2003

The health and economic burden of genital warts in a set of private health plans in the United States.

We estimated the prevalence of and costs associated with genital warts among privately insured individuals from the perspective of a private health plan in the United States. Health care claims data were derived from a sample of 3,664,686 privately insured individuals. The database was limited to cases of disease for which an insurance claim was generated, with costs reflecting inpatient, outpatient, and pharmacy payments from all sources. We identified 5095 cases of genital warts (1.7 cases per 1000 person-years) billed through the health plans during 2000. The prevalences of and health plan costs associated with genital warts were highest among women aged 20-24 years (6.2 cases and $1692 in costs per 1000 person-years) and men aged 25-29 years (5.0 cases and $1717 in costs per 1000 person-years). On average, individual episodes of care for genital warts involved 3.1 physician visits and incurred costs of $436. These are the first age- and sex-specific estimates of the prevalence and cost of genital warts for a US health plan.

Condylomata Acuminata↗
PubMed2004

To isolate or not to isolate? Analysis of data from the German Nosocomial Infection Surveillance System regarding the placement of patients with methicillin-resistant Staphylococcus aureus in private rooms in intensive care units.

OBJECTIVE: To investigate whether isolating patients with MRSA in private rooms in ICUs (or cohorting) is a protective factor for nosocomial MRSA infection. DESIGN: Association between nosocomial MRSA infection rates and ICU structure and process parameters in the German Nosocomial Infection Surveillance System (KISS). SETTING: Two hundred twelve ICUs participating in KISS in 2001. METHODS: In June 2001, a structured questionnaire was sent to the participating ICUs regarding their preventive measures, their type and size, their patient-to-personnel ratios, and routine cultures. Univariate and multivariate analyses were conducted to identify risk factors for nosocomial MRSA infection. RESULTS: The questionnaire was completed by 164 (77.4%) of the ICUs. These ICUs had 325 nosocomial MRSA infections in a 5-year period (1997 to 2001). The mean incidence density of nosocomial MRSA infections was 0.3/1,000 patient-days. Ninety-one ICUs (55.5%) did not register any nosocomial MRSA infections during the observation period. Forty-two ICUs had an incidence density of at least 0.3/1,000 patient-days (75th percentile). Surgical ICUs were found to be a risk factor for a nosocomial MRSA infection rate above this threshold. Multivariate analysis found surgical ICUs to be an independent predictor and isolation in private rooms (or cohorts) to be a protective factor (OR, 0.36; CI95, 0.17-0.79). CONCLUSION: Many (34.4%) of the German ICUs have not isolated MRSA patients in private rooms or cohorts, a procedure associated with lower MRSA infection rates in this study.

Cross Infection↗
PubMed2004

A bitter pill to swallow: nonadherence with prophylactic antibiotics during the anthrax attacks and the role of private physicians.

To generate recommendations for improving adherence to public health advice during public health crises, we conducted semi-structured interviews with employees at the Brentwood Road Postal Facility and on Capitol Hill to identify key themes associated with decisions to adhere to recommended antibiotic prophylaxis during the 2001 anthrax attacks. Factors used in deciding to adhere to recommended prophylactic antibiotics and concerns about the official response were similar in Brentwood and Capitol Hill employees, and in adherent and nonadherent participants. All participants used multiple sources of information and support as they weighed the risk from anthrax against the advantages and disadvantages of antibiotics. We found that nonadherent participants were commonly following the advice of private physicians, whereas adherent participants commonly described ongoing support from multiple sources when discussing their decisions. Our findings highlight the need for better integration between the public and private health care systems during public health crises and the importance of equipping private physicians for their key role in aiding decision-making during a public health crisis. Special attention also should be given to enhancing support and information from multiple sources throughout the entire period of risk.

Anthrax↗
PubMed2006

Private idiotypes located on light and heavy chains of human myeloma proteins characterized by monoclonal antibodies.

Idiotypic determinant, an epitope located on the variable region of the heavy or light chain of an immunoglobulin molecule, could be classified into private and public forms. The private idiotype is a marker unique to a single clone of B cell and hence a fingerprint of an individual clone. It could therefore be exploited to monitor expansion of normal or malignant B cells and to target clonally expanded tumorous B cells specifically. In the present study, five murine monoclonal anti-idiotypic antibodies were generated against two human immunoglobulin G (IgG) myeloma proteins. These monoclonal antibodies (MAbs) are produced by hybridoma clones obtained by the fusion of myeloma cells with splenocytes from BALB/c mice immunized with either human IgG1 (three clones) or IgG2 (two clones) myeloma proteins. All MAbs reacted only with the immunizing antigens and had no reactivity with a panel of purified myeloma proteins of four IgG subclasses with different light chains, including IgG1 (n = 9), IgG2 (n = 4), IgG3 (n = 4) and IgG4 (n = 5). They reacted with the Fab, but not the Fc fraction of the immunizing antigen and displayed no reactivity with normal human serum or polyclonal IgG. Immunoblotting analysis demonstrated that two of the MAbs react with linear idiotypes on light chain, whereas the remaining three MAbs recognize heavy chain associated idiotopes, either conformational (n = 2) or linear (n = 1). Such MAbs with specificity for private idiotypes could have potential implications for monitoring and specific immunotherapy of B cell malignancies. They also are useful tools to study structural correlates of idiotypes.

Animals↗
PubMed1989

Opinions of people aged over 75 years on private and local authority residential care.

Two hundred and fifty-one randomly sampled elderly people aged 75 years and over living in their own homes were questioned about their experiences, knowledge and opinions of private rest homes and local authority residential homes. Very few respondents had stayed in either type of institution, and more had visited local authority homes than had visited private rest homes. For both types of institution, one-fifth of respondents or less stated that they would be pleased to enter them, and this did not vary significantly between the two institutions. For both types of institution, 'being well cared for' was the main perceived advantage, but while loss of independence was the main perceived disadvantage of local authority homes, cost was the most frequently cited disadvantage of private care.

Aged↗