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PubMed2003

Perusing property rights in DNA.

Many practical questions have arisen since the use of patents relating to DNA has become progressively more common after the landmark case of Diamond v. Chakrabarty in 1980: What ownership rights do patents confer? What is owned? Who owns it? What does ownership mean to nonoweners? The central theme of the chapter is that much of the debate about patent rights relating to DNA is needlessly burdened by concerns that are inapposite, given an informed understanding of how things actually work in this area; and that as a result, insufficient attention is paid to exploring propositions that might elucidate or even alleviate pertinent problems in need of solutions. The approach of the chapter is more analytical than prescriptive. It endeavors to unpack how property rights in this area actually operate and concludes by making a few modest prescriptions about areas for future study, including efforts to explore the mechanisms that might be at play when actual transactions in basic biological materials and protocols break down. The intuition behind the chapter is that although many of the problems identified by patent critics do exist and, in theory, might be pernicious in creating some inefficiency in the form of dead-weight loss, in practice these problems turn out to be less pernicious than those likely to be caused by alternative regimes and are mitigated through various behaviors of market participants.

Commerce↗
PubMed1997

Cat allergen (Fel d 1) levels on school children's clothing and in primary school classrooms in Wellington, New Zealand.

BACKGROUND: New Zealand has a high prevalence of the major allergic diseases including asthma, rhinitis, and eczema, and cat ownership is common, with more than 50% of homes containing a cat. OBJECTIVE: The study was designed to examine the levels of cat allergen (Fel d 1) in the primary school environment, both on floors and on children's clothing. METHODS: We collected and analyzed dust samples from 11 school classrooms and from 202 children's garments using vacuum sampling and two-site monoclonal antibody ELISA, respectively. Environmental variables were identified by questionnaire. RESULTS: The geometric mean level of Fel d 1 in classrooms was 2.61 micro/gm (95% confidence interval, 1.28 to 3.84); however, seven classrooms had a floor sample with Fel d 1 greater than 8 microg/m2. Carpeted floor levels at 2.21 microg/gm (1.28 to 3.84) were considerably higher than those on uncarpeted floors, at 0.33 microg/gm (0.1 to 1.14). Floor levels and pupil cat ownership rates were positively correlated (r2 = 0.93, p = 0.0003). Children from homes with cats carried allergen on their clothes (mean Fel d 1, 6.10 microg per garment compared with non-cat owners (0.72 microg per garment). Wool and polyester garments contained more Fel d 1 than cotton clothing. Girls' clothing had significantly higher levels of allergen than did that of boys, even after controlling for cat status and fabric differences. CONCLUSIONS: Carpeting should be discouraged in environments such as schools and child care centers, where children spend considerable time. Transport of Fel d 1 on clothing from the domestic to the school environment is a major source of classroom cat allergen.

Adult↗
PubMed1999

Role of current and childhood exposure to cat and atopic sensitization. European Community Respiratory Health Survey.

BACKGROUND: Clinical and population studies have shown that exposure and sensitization to allergens derived from furred pets, particularly cats, represent an important risk factor of allergic respiratory disease and also a significant risk factor for asthma. OBJECTIVE: In the framework of the multicenter European Community Respiratory Health Survey an analysis of the association of current and childhood exposure to cat with atopic sensitization to cat was conducted. METHODS: This study included cross-sectional data from 35 centers representing 16 countries. Altogether, 18,097 subjects were included, of whom 13,509 (75%) provided a blood sample for the measurement of specific IgE. Exposure data and data for potential confounders were extracted from an interviewer-led questionnaire. RESULTS: The prevalence of sensitization to cat (serum specific IgE >0.35 kU/L) was 9%. Among those who did not report allergic symptoms in the presence of pets or house dust, those who owned cats were significantly more likely to be sensitized to cats than were those who did not (odds ratio [95% confidence interval] 1.57 [1.20-2.06]. Childhood exposure to pets including cats was associated with lower sensitization to cats in adulthood, particularly among those with a positive family history of atopy (odds ratio [95% confidence interval] 0.68 [0.51-0.93]. Positive correlations were found between the community prevalence of cat and the prevalences of sensitization to cat, respiratory symptoms, physician-diagnosed asthma, and current asthma medication. CONCLUSIONS: Current cat ownership represents a significant risk for sensitization to cat if cats are allowed indoors. Our results support the hypothesis that childhood exposure to pets, including cats, might modulate immunologic mechanisms and reduce sensitization to cat in adulthood. The significant correlation found between the community prevalence of cat ownership and community prevalence of specific sensitization to cat represents the first documentation of such a relationship.

Adult↗
PubMed1999

Exposure and sensitization to cat dander: asthma and asthma-like symptoms among adults.

BACKGROUND: Several pets, such as cats, dogs, and rodents, are known to produce allergens. Despite the clinical and laboratory evidence that exposure to pets can cause bronchoconstriction in sensitized subjects, the results of population studies have been contradictory. OBJECTIVES: The purpose of this study was to investigate the relationship between cat ownership and the prevalence of asthma, asthma-like symptoms, and bronchitic symptoms among subjects 20 to 44 years of age in Vancouver, Canada and to determine whether sensitization is responsible for such an association. METHODS: Two thousand nine hundred ninety-nine (88%) randomly selected subjects responded to a mail questionnaire. Of these, 504 participated in laboratory examination, including allergy skin testing. RESULTS: One thousand nineteen study responders (34%) were pet owners at the time of the study (current owners). Current pet owners were found to have a higher prevalence of current asthma, asthma-like symptoms, and bronchitic symptoms compared with those without pets. Cat owners had significantly higher risk of having current asthma and asthma-like symptoms. In the subset who had allergic skin tests, we found that those who were allergic to cat dander had a significantly higher risk of current asthma than those not allergic to cat dander and not owning a cat. CONCLUSION: This study provides evidence that sensitization to cat dander is a more important risk factor for current asthma and asthma-like symptoms than cat ownership itself.

Adult↗
PubMed1977

A possible association between house pets and multiple sclerosis.

29 patients with multiple sclerosis (M.S.) from families in New Jersey believed to have more than 1 member with this disease and 29 controls matched for age, sex, neighbourhood, and socio-economic status were questioned about their ownership of pets. No difference in ownership of cats or dogs was found. Exposure to small indoor pets (cats or dogs), however, was significantly higher in the M.S. group (P less than 0-001). Exposure to small indoor pets was particularly striking during the ten years before onset of initial symptoms of M.S. when the M.S. group was compared to the control group (P less than 0.01). 33 of 49 M.S. patients in these families had a cat or dog in the house within one year before onset of the first neurological symptom. 3 families had more than 1 member in whom initial symptoms of M.S. developed in the same year despite wide age ranges. These results suggest that exposure to house pets may sometimes be associated with subsequent M.S. Our findings should be interpreted with caution until they are confirmed by others.

Adult↗
PubMed2001

Ranch-management factors associated with antibody seropositivity for Neospora caninum in consignments of beef calves in Texas, USA.

A study was conducted with a 1998 retained-ownership population of Texas (USA) beef calves to determine the ranch-management practices associated with calf seroprevalence to Neospora caninum. Management practices of 76 Texas ranches that consigned 760 calves to a retained-ownership feedlot program were reviewed from a mailed questionnaire. Ninety-nine of 760 (13%; 95% CI, 9.4%, 17.7%) calves were positive to N. caninum and 59% of the ranches consigned at least one positive calf. In the logistic multiple-regression model which controlled for overdispersion, increased odds of calf-level seropositivity was associated with seasonal calving patterns, with stocking>1cow/calfunit/2.2ha, using a round-bale feeder, allowing wildlife access to the weaning supplement, and self-reared replacement heifers. However, decreased odds of seropositivity was associated with using a cattle-working dog and with using a self-contained cattle feeder. There was substantial overdispersion due to ranch.

Animal Husbandry↗
PubMed1983

Group practice--trend for the future.

Group practices in various forms and combinations appear to set the trend for small animal practice management. By pooling their financial resources, energies, and talents, veterinarians can share the burden of increasing overhead costs and enjoy the benefits of specialization, new technologies, continuing education, consultations and referrals, peer review, applied research and publication, and fringe benefits such as paid vacation and sick leave, profit sharing, and pension. Group practices preserve ownership continuity at fair market value and afford opportunities for the utilization of expert business consultants. There are prerequisites to establishing a successful group practice: An adequate personal income base, a sufficient pet population, and business associates with compatible practice philosophy. Special considerations must be given to the social, economic, and psychological forces at work in a group practice environment. Professional and personal interactions can make or break a group practice. The group concept, MIP treatment of clients and their pets, and personalized appointments are important features which must be emphasized. The law of supply and demand and the law of diminishing returns must be kept in focus at all times. In tandem, they dictate the fortunes of all business enterprises and group practices can be particularly vulnerable to them. Long-term business commitment is a condition of group practice ownership and may pose a conflict with other interests. A predetermined buy-sell agreement and deferred compensation plan may provide the answer in case of dissolution, termination, or early retirement. A system of animal and material transport and transfer of business transactions and medical records must be set up between satellite clinics and the base hospital. A hospital-owned-and-operated shuttle service appears to offer the greatest flexibility and convenience. Cost-effectiveness of a shuttle service depends on the volume of referral cases generated for the base hospital. Computers may provide the answer to rapid and reliable transfer of data between satellite clinics and central or base hospitals in the near future. New approaches to small animal medicine and practice management must be explored and adopted. Prepaid pet medical insurance seems to be the answer to rapidly growing sophistication and escalating cost of small animal patient care. Human and companion animal interactions have been given a fresh impetus by veterinary educators, clinical psychologists, psychiatrists, humane societies, organizations for the mentally and physically handicapped, gerontologic centers, and others.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1991

Behavioral medicine as a part of a comprehensive small animal medical program.

The rationale of incorporating behavioral medicine into veterinary practice is that it can expand the range of medical services offered, help obtain happier, more acceptable pets, and lead to longer pet ownership. In doing so, veterinarians should be able to increase their business both through an actual increase in pet ownership and retention and through increased services for individual pets. The range of services offered can differ from practice to practice but may include preventive, interventive, and ancillary services, as with other areas in contemporary veterinary medical practice. Each area of behavioral practice can be an economically feasible addition to veterinary practice from the perspective of medical services rendered, as a method of practice promotion, or as an area of public service. The choice depends on the level of competence of the practitioner, the practice philosophy, and the need for the services in a given service area.

Animals↗
PubMedDate not supplied

[Alternatives to pharmaceutical distribution and reimbursement].

In Spain pharmaceutical distribution is carried out mainly thorugh the 20,000 independent pharmacies located throughout the country. This situation contrasts with that in other countries where other health care providers play a major role in drug dispensation or where pharmacies form part of industrial conglomerates or commercial chains. We describe the pharmaceutical distribution chain in Spain wholesale and through the pharmacies and place particular emphasis on five aspects of relevance when considering alternatives: ownership of the pharmacy and norms of professional service, criteria for setting up a pharmacy, monopoly on dispensing, automatic ageement with the Spanish national health system and reimbursement system. Several alternatives found in comparable countries are described: mail order and on-line distribution, sale of over-the counter pharmaceutical products in establishments other than pharmacies, the estabilishment of pharmaceutical chains, dispensing by providers, the repercussions of electronic prescribing and the possibilities of the still-emerging Pharmacuetical Care. The characteristics of pharmacy reimbursement systems are also reviewed. We recommend modification of limitations on ownership of pharmacies, the establishment of optional agreements between pharmacies and the Spanish national health system and the authorization of alternative or complementary channels of distribution for some products. We propose a mixed model of reimbursement that would include: a) a ficed price for dispensing; b) almost total return of the cost of the product; c) reimbursement for services explicity defined by the financer, and d) the possibility of a selective fixed payment for certain situations depending on the agreed services or a guaranteed minimum income.

Pharmaceutical Preparations↗
PubMed2001

Epidemiology of Bartonella infection in domestic cats in France.

Blood samples were collected between February and June 1996 from a convenience sample of 436 domestic French cats living in Paris and its environs and were tested for Bartonella bacteremia and seropositivity. Seventy-two cats (16.5%) were Bartonella bacteremic, of which 36 cats (50%) were infected with Bartonella henselae type II (B.h. II) only, 15 cats (21%) were infected with Bartonella clarridgeiae (B.c.) only, and 11 cats (15%) were infected with B. henselae type I (B.h. I) only. Eight cats (11%) were co-infected with B. henselae and B. clarridgeiae (B.h. II/B.c.: five cats; B.h. I/B.c.: three cats). Two cats (2.8%) were concurrently bacteremic with B. henselae types I and II. Risk factors associated with bacteremia included ownership for <6months (prevalence ratio (PR)=1.80; 95% confidence interval (CI)=1.13-2.85), adoption from the pound or found as a stray (PR=1.67, 95% CI=1.05-2.65), and cohabitation with one or more cats (PR=1.60, 95% CI=1.01-2.53). Bartonella antibodies to either B. henselae or B. clarridgeiae were detected in 179 cats (41.1%). Risk factors associated with seroposivity paralleled those for bacteremia, except for lack of association with time of ownership. Prevalence ratios of bacteremic or seropositive cats increased with the number of cats per household (p=0.02). The lack of antibodies to B. henselae or B. clarridgeiae was highly predictive of the absence of bacteremia (predictive value of a negative test=97.3%). Multiple logistic regression analysis indicated that bacteremia, after adjustment for age and flea infestation, and positive serology, after adjustment for age, were associated with origin of adoption and number of cats in the household. Flea infestation was associated with positive serology.

Animals↗
PubMed2000

The antecedents of psychoses: a case-control study of selected risk factors.

Winter birth, urban birth and/or childhood residence, and perinatal complications have each been identified as environmental risk factors for the later development of schizophrenia, schizoaffective disorder, and bipolar disorder. A preliminary case-control study also identified cat exposure in childhood as a possible risk factor. To assess selected environmental events, including childhood exposure to pets, as possible risk factors for these diseases, a case-control telephone survey was carried out by the University of Maryland Survey Research Center for 264 mothers of cases and 528 mothers of matched controls. The cases were randomly selected mothers who were members of the National Alliance for the Mentally Ill, and whose children had been diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. The controls were mothers randomly selected from the same telephone exchanges. For five of the 19 major variables, there were statistically significant differences between cases and controls: fever during pregnancy, complications during delivery, city or suburban residence at birth, cat ownership between birth and age 13, and breast-feeding. In a multivariate logistic regression including these five variables, each variable made a significant contribution. The finding of perinatal complications, urban/suburban residence at birth, and cat ownership in childhood as risk factors for the later development of psychoses confirmed previous studies. Previous research on breast-feeding as a risk factor has yielded contradictory results. Additional research is needed to ascertain how such environmental risk factors interact with genetic risk factors. Understanding these could lead to better treatments and possible prevention strategies.

Adolescent↗
PubMed2001

Firearm prevalence and social capital.

PURPOSE: Previous studies have shown a correlation between measures of social capital and morbidity, mortality, and violent crime. This article examines the association across U.S. states between social capital (as measured by mutual trust and civic engagement) and firearm availability. METHODS: The analysis uses OLS to determine degrees of association across U.S. states. Measures of mutual trust come from responses to questions on the U.S. General Social Survey that "you can't be too careful in dealing with people," and most people "would try to take advantage of you." Measures of formal civic engagement come from responses to Lifestyle Survey questions concerning times volunteered, club meetings attended, community projects worked on, and church services attended. Informal civic engagement measures come from responses to number of times bowled, played cards, entertained at home, and gave or attended dinner parties, and number of greeting cards sent. The Lifestyle Survey also asked whether respondent believed whether "most people are honest." The percentage of suicides from firearms, and the average percentage of suicides and homicides from firearms, are used as proxies for state firearm ownership rates. Control variables are the degree of urbanization, the rates of poverty, and the percentage of nonwhites in the state. RESULTS: Across the U.S. states, higher levels of firearm ownership are associated with significantly lower levels of mutual trust and civic engagement. CONCLUSION: While the analysis cannot show causation, states with heavily armed civilians are also states with low levels of social capital.

Cross-Sectional Studies↗
PubMed1999

Using practical quality improvement approaches and tools in reproductive health services in east Africa.

BACKGROUND: A nonprofit, nongovernment organization, AVSC International provides technical assistance worldwide, including a range of reproductive health services and quality improvement (QI) approaches and tools. Current activities in East Africa involve several hundred sites, including referral hospitals, district-level hospitals, and individual family planning clinics. THE QI PACKAGE: AVSC and its local partners developed Client-Oriented, Provider-Efficient Services (COPE), a problem-solving process and set of tools to involve all levels of site staff members in assessing and improving the services. The COPE tools--self-assessment guides, client interview guides, client flow analyses, and action plans--promote involvement, ownership, and commitment to the QI process. Facilitative supervision and whole-site training complemented AVSC's traditional approaches of medical monitoring and informed choice. Facilitative supervision encourages supervisors and managers to consider staff members as internal customers, whose needs they must meet for staff to be able to meet the needs of external customers (clients). Whole-site training was developed to meet the needs of staff members and providers, who needed to function as a team responsible for providing high-quality services. CASE STUDY: A government hospital that has adopted the entire package of QI approaches, has used the Quality Improvement Quotient self-assessment surveys to track its progress in several elements of high-quality care, including management and supervision, safety, and information and client--provider interactions. For example, maternity ward staff learned how to pass on to their clients information about clients' rights and family planning methods through posters, pamphlets, sample contraceptives, and health talks. LESSONS LEARNED: AVSC's work with local organizations suggests a number of lessons learned, including the following: easy-to-use tools that promote staff involvement and ownership are essential in the QI process, QI requires considerable staff development and capacity building at all levels, and although the QI approaches were initially introduced for a relatively narrow field of services, they are applicable to and have increasingly been used in other departments and wards. (It is difficult, may be impossible, and certainly undesirable, to limit QI activities to one ward or service.) CONCLUSION: Activities in East Africa have shown that QI is possible even in very resource-poor settings. The same principles have guided the process in all the different programs, with some adaptation of the tools used. AVSC program activities are to continue to disseminate the experiences of sites implementing the package of tools and approaches, to advocate for investment in supervision and management capacity building as a means to support continuous quality improvement, and to further study the impact of the QI approaches on service quality.

Adult↗
PubMed2005

Outcome in adulthood of asymptomatic airway hyperresponsiveness to histamine and exercise-induced bronchospasm in childhood.

BACKGROUND: Studies of the clinical outcome in adulthood of asymptomatic airway hyperresponsiveness (AHR) to histamine or exercise-induced bronchospasm (EIB) detected in childhood in general population samples are sparse and have produced conflicting results. OBJECTIVE: To describe the outcome of asymptomatic AHR to histamine and EIB. METHODS: Data from a 12-year follow-up study of a random population sample of individuals aged 7 to 17 years at enrollment were analyzed; only individuals without asthma at enrollment were included in the analysis. AHR to inhaled histamine, EIB, lung function, and sensitization to aeroallergens were measured. RESULTS: Among the 281 nonasthmatic participants studied, 58 (22%) had AHR to histamine, 33 (12%) had EIB, and 82 (29%) had AHR to histamine and/or EIB. At follow-up, 37.9% of individuals with AHR to histamine and 30% of individuals with EIB had developed current asthma, compared with only 5% of individuals in whom these test results were negative. In patients with AHR to histamine, parental asthma (odds ratio [OR], 12.6; 95% confidence interval [CI], 1.5-108.5), furred pets ownership (OR, 6.0; 95% CI, 1.2-19.6), and dermatitis and/or rhinitis in childhood (OR, 2.2; 95% CI, 1.1-5.1) predicted the subsequent development of asthma, whereas no risk factors for the development of asthma could be identified in individuals with EIB CONCLUSION: Asymptomatic AHR to histamine and EIB in childhood predict the subsequent development of asthma in adulthood. A genetic disposition to asthma, furred pets ownership, and concomitant rhinitis or dermatitis increase the risk of asthma development in individuals with AHR to histamine.

Adolescent↗
PubMed2002

Personal health records on the internet: a snapshot of the pioneers at the end of the 20th Century.

Internet-based, personal health records have the potential to profoundly influence the delivery of health care in the 21st Century, by changing the loci and ownership of the record from one that is distributed among the various health care providers a patient has seen in his lifetime, to one with a single source that is accessible from anywhere in the world and under the shared ownership and control of the patient and his provider(s). Internet-based personal health records (PHRs) include any internet-accessible application that enables a patient (or his guardian, the 'mom') to review, annotate, create or maintain a record of any aspect(s) of his health condition, medication, medical problems, allergies, vaccination history, visit history or communications with his healthcare providers. The current state-of-the-art for personal health records is best characterized as 'beta releases'. As the field matures and gains more experience, these applications will improve significantly in ease of use and functionality.

Humans↗
PubMed1999

Mosquito avoidance and bed net use in the Greater Accra Region, Ghana.

Qualitative research and cross-sectional survey methods were used in a study conducted in rural and urban areas of the Greater Accra Region, Ghana, to explore people's understanding of the cause of malaria and patterns of mosquito avoidance, in particular bed net ownership and use. The study indicated far higher bed net ownership and use in rural than urban areas, which was related partly to perceived affordability and partly to the different contexts of and reasons for avoiding mosquitoes. Knowledge of an association between mosquitoes and malaria, the most common cause of illness in both areas, was related to residence but not to literacy or formal education, and this knowledge did not predict bed net use. The paper points to the complexity of social and personal factors implicated in behavioural interventions for malaria control, and questions behavioural models that assume a linear relationship between knowledge and practice.

Adult↗
PubMed1995

Sero-epidemiology of toxocariasis in school children.

The seroprevalence of toxocariasis was investigated in 2129 school children ranging in age from 4 to 19 years. Infection, as measured by titre, was found to be high compared to values obtained from children in other countries, with 31% having a titre of > or = 1:50 and 3.1% having titres of > or = 1:800. Relationships between seroprevalence and host factors including age, sex and location, and risk factors including geophagia, thumbsucking and pet ownership were explored. Age was found to be a significant factor in relation to infection with Toxocara. Males were significantly more infected than females, as were the inhabitants of rural schools versus urban schools. The percentage of seropositive children varied widely from school to school. Geophagia and pet ownership were found to be significantly associated with toxocariasis. Logistic regression analysis was used to model the relative contribution of these factors to infection with Toxocara. While this analysis identified factors which were highly significantly associated with Toxocara titre, the odds ratios were generally low indicating the low specificity of the model.

Adolescent↗
PubMed1997

Length of maternal hospital stay for uncomplicated deliveries, 1988-1995: the impact of maternal and hospital characteristics.

OBJECTIVES: To determine the independent association of selected maternal and hospital characteristics with length of maternal hospital stay for uncomplicated vaginal deliveries. METHOD: Linear regression analysis using National Hospital Discharge Survey data from 1988 to 1995. Independent variables were year, maternal age and race, method of payment, and hospital ownership, size, and geographic location. The outcome measure was length of maternal hospital stay for uncomplicated vaginal deliveries. RESULTS: Length of stay was independently associated with year, geographic region, payment method, and hospital size. From 1988 to 1995, the mean length of stay fell from 2.1 to 1.5 days. The rate of decrease was similar for all regions, methods of payment, and hospital size. Women in the West had a shorter mean length of stay (1.5 days) than women in the Northeast (2.2 days). The difference by method of payment was smaller. Length of stay was shortest for women without insurance (1.8 days) and longest for women covered by Blue Cross (2.1 days). Maternal age and race and type of hospital ownership were not independently associated with the length of stay. CONCLUSIONS: Significant variations existed in the length of time women are hospitalized for normal childbirth. These variations are primarily associated with where a woman lives and whether she is insured. Given the current public debate on the impact of shortened hospital stays, these variations need to be explored and their effects on maternal and infant well-being clarified.

Adolescent↗