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PubMed2001

Management of childhood acute respiratory infections at private pharmacies in Vietnam.

OBJECTIVE: To investigate the knowledge and practice among private pharmacy staff in Hanoi regarding case management of mild acute respiratory infection (ARI) in children. METHODS: Sixty private pharmacies in Hanoi were randomly selected. Knowledge was assessed through interviews with pharmacy staff using a questionnaire; practice was assessed through the Simulated Client Method. RESULTS: In the questionnaire, 20% of the pharmacy staff stated that they would dispense antibiotics. In practice, 83% of the pharmacies dispensed antibiotics. Only 36% of the cases were handled according to guidelines. In the questionnaire, 81% of interviewees stated that antibiotics are not effective in short therapeutic courses. In practice, 48% of the antibiotics were dispensed in courses less than five days. Traditional herbal medicines were dispensed in 41% of the encounters. In the questionnaire, 53% of the pharmacy staff stated that they would ask the patient about difficulty of breathing. In practice, questions related to difficulty of breathing were asked in less than 10% of the encounters. CONCLUSIONS: Dispensing of antibiotics for mild ARI was common practice among private pharmacies, and there was a significant difference between knowledge and practice. Interventions are needed to improve pharmacy practice in Hanoi.

Acute Disease↗
PubMed2003

Prenatal psychosocial needs: differences between a TennCare group and a privately insured group in Appalachia.

The purpose of this study was to determine the prenatal psychosocial needs of a group of women enrolled in TennCare, a Medicaid managed care program designed to cover all otherwise uninsured people in Tennessee, and compare them with privately insured women. Face-to-face interviews were conducted using standard and reliable questionnaires with a convenience sample of 120 pregnant women between 14 and 44 years of age and 16 to 28 weeks gestation at three prenatal clinics in East Tennessee. Chi-square analysis revealed that the TennCare enrollees in East Tennessee were significantly more likely to report higher psychosocial needs in pregnancy than the privately insured group. Women enrolled in TennCare had a significantly higher incidence of physical abuse, depressive symptoms, and smoking than the privately insured group. Pregnancy provides a window of opportunity for assessing and intervening with vulnerable women enrolled in Medicaid managed care who report psychosocial problems.

Adolescent↗
PubMed2001

Quality of hospital care of children with asthma: Medicaid versus privately insured patients.

Asthma is an important condition to study in the Medicaid population because it is the most frequent reason for hospital admission of Medicaid children, with rates substantially higher than those of non-Medicaid children. This study addressed how the quality of hospital care provided to children with asthma on Medicaid compares with that provided to privately insured children. Children inpatient records were studied in California, Georgia, and Michigan, comparing the care that was provided to standards created by a national panel of physician experts. Process-of-care analysis showed that Medicaid children in each state were more likely than privately insured children to be discharged on suboptimal medication regimens. This study concluded that hospitals serving Medicaid children, at least in these three states, are providing asthma inpatient care of fairly comparable quality to that of privately insured children. However, there remain significant problems surrounding outpatient medication regimens and follow-up care.

Adolescent↗
PubMedDate not supplied

What drove private health insurance spending on mental health and substance abuse care, 1992-1999?

Trends in MH/SA treatment spending from 1992 to 1999 were examined using employer claims data from approximately 1.7 million covered lives in each year. The analysis finds that employer-based private insurance spending on MH/SA treatment did not keep pace with total employer-based private insurance spending or general price inflation. MH/SA spending dropped from 7.2 percent of total private insurance spending in 1992 to 5.1 percent in 1999. The decline was attributable to a dramatic decrease in inpatient MH/SA treatment--specifically, the probability of admissions and average length-of-stay.

Actuarial Analysis↗
PubMedDate not supplied

Medicare versus private insurance: rhetoric and reality.

Many policymakers have called for the remodeling of Medicare to more closely resemble private insurance, which is often assumed to work better than public programs do. However, evidence from this 2001 survey demonstrates that Medicare beneficiaries are generally more satisfied with their health care than are persons under age sixty-five who are covered by private insurance. Medicare beneficiaries report fewer problems getting access to care, greater confidence about their access, and fewer instances of financial hardship as a result of medical bills. Making the program more like private insurance runs the risk of undermining a program that is working well from the perspective of beneficiaries.

Adult↗
PubMed2005

A comparison of dental services received by Medicaid and privately insured adult populations.

BACKGROUND: Few studies have compared differences in dental care utilization rates between a publicly and a privately insured adult population in the same geographic area. The authors conducted this study to compare the demographic characteristics and use of dental services for enrollees in the Iowa Medicaid program and in the Delta Dental Plan of Iowa. The focus was on the overall use of dental services, with an emphasis on the use of tertiary care services such as endodontic therapy and tooth extraction services. METHODS: The authors used insurance claims data for adults aged 21 to 64 years who were enrolled in Delta Dental of Iowa and the Iowa Medicaid program for fiscal year 1998. They calculated utilization of dental services rates by type of dental procedure. RESULTS: In fiscal year 1998, 69.3 percent of Delta Dental enrollees and 27.2 percent of Medicaid enrollees had a dental visit. More than 90 percent of those in both populations with a dental visit had used preventive dental services during the year. Medicaid users were nearly twice as likely as Delta Dental enrollees to receive endodontic therapy (9.9 percent versus 5.0 percent, respectively) and nearly four times as likely to have had a tooth extracted (27.4 percent versus 7.1 percent, respectively). CONCLUSIONS: Privately insured enrollees were more likely to use dental services that were Medicaid enrollees. The greater use of tertiary care services by the Medicaid population than by the privately insured population is indicative of a lower oral health status for this group at the time they sought care, even though it was a much younger group of adults. PRACTICE IMPLICATIONS: The oral health status of low-income adults enrolled in Medicaid could benefit greatly from higher use of routine preventive dental services and earlier treatment of oral diseases to prevent the substantial need for preventable tertiary care services.

Adult↗
PubMed2005

Understanding the incomprehensible: private theories of first-episode psychotic patients and their therapists.

Private theories about psychosis, its background, and cure were studied using narratives of first-time psychotic patients and their therapists. Both patients and their therapists were interviewed on three occasions over a period of 1 1/2 years. Three cases were chosen as dyads in point in order to highlight different relations between the patient's and the therapist's private theories, different patterns of recovery from psychosis, and different outcomes. The cases are contrasted by paired comparisons. The study indicates that an awareness and joint discussion of incompatibilities between the two participants' private theories might be a substantial contribution to the process of recovery from psychosis.

Adult↗
PubMed2003

Childhood drowning: barriers surrounding private swimming pools.

OBJECTIVE: To investigate the causes of child drowning and determine the need for changes in the legislation as well as improvements to the inspection and enforcement of current legislation related to barriers surrounding private swimming pools. METHODS: There were 3 stages to the study: a retrospective review of coroner's data, an audit of swimming pool inspections, and in-depth interviews with swimming pool inspectors in Western Australia. The incidence of childhood drowning (per population) and compliance rates of swimming pools (per 1000 swimming pools) to the legislation were measured. RESULTS: During the 12-year observational period (1988-2000) 50 children younger than 5 years drowned in private swimming pools in Western Australia with an overall incidence of drowning of 4.4 per 100 000 children per year. Sixty-eight percent of drownings occurred in pools that did not have 4-sided fencing with an almost 2-fold increased risk (incidence rate ratio: 1.78; 95% confidence interval: 1.40-1.79) of a child's drowning in a swimming pool with 3-sided versus 4-sided fencing. The compliance rate of swimming pools (compliance to the current legislation) at first inspection was approximately 400 per 1000 swimming pools. CONCLUSIONS: Almost two thirds of the swimming pools in which children drowned had only 3-sided fencing. With a combination of a change in legislation, enhanced inspection processes, and public education, the incidence of drowning in private swimming pools in Western Australia could be reduced in the coming years.

Architectural Accessibility↗
PubMed2000

[Health behavior among students of public and private schools in the metropolitan area of São Paulo, Brazil].

OBJECTIVE: To investigate the prevalence of several health behaviors among students of public and private schools in S. Paulo, Brazil. METHODS: An epidemiological survey about health behaviors among high school students was carried out in S. Paulo in 1998. Seventh to eleventh graders from ten public and seven private schools were interviewed. All students were asked to fill out a Portuguese version of the questionnaire used by the Centers for Disease Control and Prevention in their annual "Youth Health Risk Behavior Survey". This questionnaire includes questions on driving-related behavior, violence, substance abuse, sexual practices, dietary habits and body weight control. RESULTS: A significant proportion of the students, mainly in the range of 15--18 years old, reported engaging in health-risk behaviors. In public schools, the most prominent risk behaviors were: riding a motorcycle without helmets (reported by 70.4% of the students who were either passengers or the driver); not using condoms in the last sexual intercourse (34% among those sexually active); carrying guns (4.8% in the last year), and suicide attempts (8.6% in the last year). In private schools, substance abuse was the most prominent risk-behavior: 25% reported at least one episode of binge-drinking in the last 30 days, 20.2% sniffed solvents at least once in the last year and 22.2% smoked marijuana in the same period; 13.8% reported using tobacco on a regular basis. Not wearing helmets while riding a motorcycle was also very high, reported by 66.3%. Female students reported less risk-behaviors, except for suicide attempts and unhealthy weight control methods. CONCLUSIONS: The information gathered could contribute to the development of preventive programs at school level, which takes into consideration the students' risk behaviors.

Adolescent↗
PubMedDate not supplied

The Bambuí Health and Aging Study (BHAS): private health plan and medical care utilization by older adults.

The aim of this cross sectional study was to investigate whether holding a private health plan affects the consumption of medical services (hospitalization and visits to a doctor) and use of medications by older adults. All residents in Bambuí town (Minas Gerais, Brazil) aged >/= 60 years (n = 1,742) were selected. From these, 92.2% were interviewed and 85.9% were examined (blood tests and physical measurements). After adjustments for worse health status, reported less visits to a doctor, and used a small number of prescribed medications. The main explanation for the aged holding a private health plan was economic, not health. Even though those who had only public health coverage complained more in relation to medical care (70.9%), an important proportion of the aged with a private health care plan presented some kind of complaint (45.2%). Another worrying factor was the difficulty to acquire medication because of financial problems (47.2 and 25.2% reported, respectively). Further investigations are needed to verify whether our results can be generalized to other communities of the country.

Aged↗
PubMed2005

[Evidence of control and prevention of surgical site infection by shoe covers and private shoes: a systematic literature review].

The study is about shoe cover and private shoe usage and aimed to find scientific evidence on their direct relation in the control of surgical site contamination and/or infection transmitted by floor microorganisms. A systematic review of basic research on shoe covers and private shoes usage was carried out, covering the period from 1950 to 2003, by means of a search in electronic sources, bibliographies of relevant studies and proceedings of scientific events. The analysis was supported by two researchers, both of whom were experienced in this theme and one of them in research methodology. The research methods revealed a diverse range and various problems. Only 4 studies obtained a dispersion of floor microorganisms to the air environment, although not significant, and none of them was directly related to surgical site contamination and/or infection. Results do not suggest direct evidence on their efficacy but there is evidence, nonetheless, that barrier and microorganisms transfer from one specific area to another depend on the type of shoe cover, with lower transfer rates when private shoes and shoe covers are employed. Occupational contamination risk during shoe cover attire and removal is also evident and the decision about continuity of their usage needs to be technically and administratively controlled.

Humans↗
PubMed1993

The nitrate contamination of private well water in Iowa.

The State-Wide Rural Well-Water Survey was conducted between April 1988 and June 1989. About 18% of Iowa's private, rural drinking-water wells contain nitrate above the recommended health advisory level (levels of NO3-N greater than 10 mg/L); 37% of the wells have levels greater than 3 mg/L, typically considered indicative of anthropogenic pollution. Thirty-five percent of wells less than 15 m deep exceed the health advisory level, and the mean concentration of nitrate-nitrogen for these wells exceeds 10 mg/L. Depth of well is the best predictor of well-water contamination. Individually, NO3-N levels of more than 10 mg/L occurred alone in about 4% of the private wells statewide; pesticides were present alone in about 5%. Total coliform positives occurred alone at 27% of the sites. In a cumulative sense, these three contaminants were detected in nearly 55% of rural private water supplies.

Enterobacteriaceae↗
PubMed2005

Supplemental private health insurance and depressive symptoms in older married couples.

Stress process theory is applied to examine lack of supplemental private health insurance as a risk factor for depressive symptomatology among older married couples covered by Medicare. Dyadic data from 130 African-American couples and 1,429 White couples in the 1993 Asset and Health Dynamics Among the Oldest-Old Survey were analyzed using hierarchical generalized linear modeling. Lack of supplemental insurance is operationalized at the household level in terms of neither spouse covered, one spouse covered, or both spouses covered. Controlling for covariates at both individual and couple levels, supplemental insurance has significant impact on depression, but the pattern differs by race. White couples report the highest depression when neither spouse is covered by private health insurance; African-American couples report the highest depression when only one spouse is covered. Results suggest lack of supplemental private health insurance coverage is a stressor that significantly affects depressive symptoms.

Aged↗
PubMed2001

Good Practice Guidelines for occupational health research funded by the private sector.

The role of the private sector in funding academic research is increasing and the well-developed guidelines for government-sponsored research do not apply to the academic-industry arena. Good Practice Guidelines for privately funded occupational health research are necessary. Industry sponsors and academic researchers belong to differing systems with differing goals and means to achieve and evaluate them. As a result, problems are inherent in the relationship. Guidelines would benefit industry by providing criteria against which industry-funded research could be judged and evaluated. Guidelines would help university researchers assure that their work is examined and criticized on its merits. Such protection would foster quality research over the long term. Here, we consider the issues involved and explore questions that came out of a workshop convened under the auspices of the Centers for Disease Control and Prevention. When private funding is involved, university scientists have a professional responsibility to ensure that the integrity of researchers, subjects, and the research process is well protected. A body of experience allows us to create Good Practice Guidelines beneficial to all parties.

Journal Article↗
PubMed2005

Mirror and camera self-focusing effects on complexity of private and public aspects of identity.

Complexity of private and public aspects of identity was investigated as a function of mirror and camera self-focusing. Using a sorting task to assess self-complexity, complexity of private but not public aspects of identity was greater under mirror self-focusing than under camera or no self-focusing, and complexity of public but not private aspects of identity was greater under camera self-focusing than under mirror or no self-focusing. The findings complement and extend previous research on the articulation of self-schemas as a function of self-focusing and self-consciousness.

Adolescent↗
PubMed1991

Private self-consciousness: does it influence convergent and discriminant validity of self-reported anxiety and depression?

A continuing problem in measurement of anxiety and depression with self-report is lack of discriminant validity. It is argued that private self-consciousness might be expected to be related to both convergent and discriminant validity of self-reported anxiety and depression. Several self-report measures of anxiety and depression were administered to 157 female undergraduates, ages 20 to 36 years, but no evidence was found for a moderating influence of private self-consciousness. The possibility of lack of correspondence between private self-consciousness and self-awareness with regard to attentiveness to internal states is discussed as a possible explanation.

Adult↗
PubMed2005

Perceptions and practices of vaginal birth after Caesarean section among privately practicing obstetricians in Kenya.

OBJECTIVE: To determine perceptions, preferences and practices of vaginal birth after Caesarean. DESIGN: Cross-sectional descriptive study. SETTING: Private clinics of obstetricians in five major towns of Kenya. SUBJECTS: Obstetricians in private practice. MAIN OUTCOME MEASURES: Practice and experiences in trial of labour (TOL); need for, and application of, selection criteria in TOL; perceptions on outcomes of TOL and patient preference; perception on trends of vaginal birth after Caesarean (VBAC) and need for policy on TOL. RESULTS: Nearly all respondents (98.4%) believed in the need for, and application of, selection criteria for allowing TOL. However, only 23% believed in routine screening with radiological pelvimetry, while 63.2% believed in routine foetal weight estimation. All obstetricians (100%) have ever managed TOL in private practice, and 74% had managed at least one case in the last six months. Despite lack of tangible selection criteria, 83.1% think that most women prefer TOL while 95.1% discourage it if perceived as inappropriate. Failure rate of TOL was perceived to be more than 50% by 35.2% of the respondents. A majority of the respondents (about 75%) would prefer TOL on themselves or their spouses. Those who perceived that there was a falling trend of VBAC were 58%, citing increased demand by mothers (45.7%), obstetricians' convenience (40.0%) and fear of litigation (26.8%) as the reasons for this observation. A fluid policy of "TOL whenever it is deemed as appropriate" was preferred by 88.7%. CONCLUSION: The perception of obstetricians is that desire for VBAC predominates over elective repeat Caesarean. However, consensus on appropriate selection criteria is lacking, which leaves the obstetrician in a management dilemma. Hence, there is need to study outcomes of both ERC and TOL in order to come out with objective policy guidelines on management of one previous Caesarean in pregnancy.

Adult↗
PubMed1995

Differences in work activities between private and community health centre general practitioners.

OBJECTIVE: To investigate differences in the characteristics of general practitioners (GPs) and patients, referral rates, rates of prescribing and ordering of tests and x-rays, and types of counselling and consultation, between private and community health centre (CHC) GPs in Victoria. METHOD: All 51 full-time Victorian CHC GPs were invited to enrol in the Australian Morbidity and Treatment Survey (AMTS) developed by the Family Medicine Research Unit at the University of Sydney in 1992. The control group comprised the 114 Victorian GPs involved in this survey in 1991. RESULTS: Thirty-nine CHC GPs (76%) provided complete data. CHC GPs were more likely to be younger, female, and to have less experience in general practice. Patient age and gender distributions were similar. CHC GPs had higher rates of offering counselling and advice and of referral to allied health professionals, but similar rates of referral to medical specialists to those of private GPs. We found no differences in prescribing after multivariate analysis. CONCLUSIONS: Counselling, and referral to allied health professionals, were the only striking differences after multivariate analysis. It may be that any movement toward non-throughput-related remuneration may, in isolation, have less impact on general practitioner work patterns than imagined. Patient throughput was not measured, and this would be important in any future global assessment of the cost-effectiveness of CHC and private general practitioners.

Adult↗