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PubMed2002

Exposure to pets and atopic dermatitis during the first two years of life. A cohort study.

The aim of this study was to assess the association between keeping pets in early childhood and the occurrence of atopic dermatitis in an ongoing birth cohort followed up to the age of 2 years. We analyzed data of 4578 children in the intervention and observation part of an ongoing cohort study. The children were recruited at birth in the two study regions Wesel and Munich between January 1996 and June 1998. Information on atopic diseases and pet ownership was obtained by questionnaire at the child's first and second birthday. The logistic regression model showed a negative association between 'keeping any pet' and in particular 'keeping dogs' in the 1st year of life and the development of atopic dermatitis in the 1st and the 2nd years of life. The protective effects remained statistically significant after adjusting for several possible confounding variables (1st year(any) pet OR 0.71, 95% CI [0.55;0.92], 1st year(dog) OR 0.62, 95% CI [0.39;0.98], 2nd year(any) pet OR 0.74, 95% CI [0.57;0.97], 2nd year(dog) OR 0.63, 95% CI [0.40;0.98]). Ownership of small furred pets (hamster, rabbit and guinea pig) also showed a borderline protective effect for the 1st year. We assume an association between keeping pets and undefined environmental factor(s) that contribute protectively to the development of atopic dermatitis in early life, presumably by effects on the maturation of the immune system.

Animals↗
PubMed2002

Molecular determination of paternity in a natural population of the multiply mating polygynous lizard Eulamprus heatwolei.

We studied the mating system of the southern water skink, Eulamprus heatwolei, during spring and summer (encompassing the breeding season) in a population in southeastern Australia. We examined potential attributes that might influence the mating system and male reproductive success including home range size, physical proximity of adults and body size, and then genotyped all mothers, offspring and potential sires. Home range overlap of both sexes was extensive, with adult females sharing the greatest amount of space with each other and adult males the least amount of space with each other. However, not all adults hold home ranges. We classified approximately one quarter of adult males as home range holders and the rest as 'floaters'. Adult females occupy home ranges more than males, with approximately three-quarters classified as home range holders. Home range ownership is not correlated with body size for either sex, however, male body size is positively correlated with the number of adult female home ranges that his home range overlaps and adult male home ranges are larger than those of females. We used microsatellite genotyping to assign paternities to 55 offspring from 17 litters and then compared this data with our home range and behavioural observations. This species displays extreme levels of multiple paternity given the small mean clutch size of three. Multiple paternity was confirmed in 11 (64.7%) of 17 clutches but three other clutches (for a total of 82.4%) also may display multiple paternity. A total of 30 offspring from 12 litters were assigned to 10 of the 32 genotyped adult males from our study site. Of these 10 adult males, half were home range holders. Five complete clutches and a total of 25 out of the 55 offspring could not be positively assigned to any male surveyed as part of the study and were attributed to floater males or resident males adjacent to our study site that had not been genotyped. While sample sizes are small, neither male home range ownership nor body size is significantly correlated with the number of paternities a male obtained. Our study suggests a polygynous mating system for this species.

Animals↗
PubMed1999

Fel d 1 and Can f 1 in settled dust and airborne Fel d 1 in allergen avoidance day-care centres for atopic children in relation to number of pet-owners, ventilation and general cleaning.

BACKGROUND: Special day-care centres for atopic children have been established in Sweden. OBJECTIVE: To study concentrations of cat (Fel d 1) and dog (Can f 1) allergens in settled dust and airborne cat allergen in day-care centres in relation to pet ownership among children and staff, ventilation and general cleaning. METHODS: Twelve allergen avoidance day-care centres and 22 conventional day-care centres were included in the study. Settled dust was collected and analysed with ELISA. Airborne cat allergen levels were measured in eight allergen avoidance and seven conventional centres with a personal air sampler and analysed with an amplified ELISA. Air change rate per hour (ACH) was measured. A questionnaire which focused on keeping of cat and dog among staff and children and frequency of general cleaning was used. RESULTS: In the allergen avoidance day-care centres neither children nor staff reported ownership of cats or dogs, compared with 21/22 of the conventional centres in which children and staff kept furred animals. Fel d 1 and Can f 1 were found in settled dust in all day-care centres. In the allergen avoidance compared with the conventional centres the concentrations of Fel d 1 and Can f 1 were lower, Fel d 1: median 0. 64 microg/g vs 5.45 microg/g and Can f 1: 0.39 microg/g vs 2.51, both P < 0.001, and airborne Fel d 1 was also lower in the allergen avoidance centres compared with the control centres, 1.51 ng/m3 vs 15.8 ng/m3, P = 0.002. A correlation was found between airborne and settled Fel d 1, rs = 0.75, P < 0.001. Furthermore, a correlation was found between increased ACH and decreased levels of Fel d 1 in the air in the day-care centres with no cat-owners, rs = - 0.86, P = 0.007. No relation was found between levels of cat or dog allergen and amount of general cleaning. CONCLUSION: Not keeping pets seems to reduce children's exposure to pet-allergen in their 'working environment'. Additionally, appropriate ventilation seems to reduce Fel d 1 in the air in day-care centres.

Air Pollutants↗
PubMed2001

NAC Manchester Asthma and Allergy Study (NACMAAS): risk factors for asthma and allergic disorders in adults.

Asthma and atopic disorders are the most common chronic diseases in the developed countries. Knowledge of the risk factors for these disorders may facilitate the development of preventive strategies aimed at reducing prevalence rates. To investigate the risk factors for asthma and allergic diseases in a large number of adults who are the parents of children in the National Asthma Campaign Manchester Asthma and Allergy Study. All pregnant women and their partners attending "Booking" antenatal clinics were invited to take part in the study. Questionnaire data were collected including the history of asthma and other atopic diseases, pet ownership and smoking habits, and skin prick tests were performed. The prevalence of atopy and the risk factors for asthma and allergic disorders were investigated in all subjects who completed the questionnaire and underwent skin testing. Statistical analysis was carried out using logistic regression. Initially, risk factors were assessed by univariate analysis to see how each potential explanatory variable affected the probability of having allergic disease. Variables were then tested in a forward stepwise multivariate analysis. In 5687 adult subjects there was a very high (48.2%) prevalence of atopy, and 9.7% of subjects had a diagnosis of asthma. In a multivariate regression analysis sensitization to dust mite, cat, dog and mixed grasses were all independently associated with asthma. The odds ratios for current asthma increased with the increasing number of positive skin tests (any two allergens - OR 4.3, 95% CI 3.3-5.5; any three allergens - OR 7.0 95% CI 5.3-9.3; all four allergens - OR 10.4, 95% CI 7.7-14; P < 0.00001). Dog ownership (OR 1.31, 95% CI 1.10-1.57; P = 0.003) and current smoking (OR 1.36, 95% CI 1.15-1.62; P = 0.0004) were significantly and directly associated with "asthma ever". Thirteen per cent of participants reported a history of eczema. In the multivariate analysis the strongest independent associate of eczema was sensitization to dog (OR 1.37, 95% CI 1.14-1.63, P < 0.0001). Apart from dog, the strength of the association between sensitization to common allergens and eczema appeared to be much lower than in the case of asthma. The prevalence of hay fever was high (20.6%), and in the multivariate analysis the association between sensitization to pollen and hay fever was extremely strong (OR 13.6, 95% CI 11.3-16.3; P < 0.0001). The results of the current study emphasize the importance of sensitization to indoor allergens in asthma. However, evidence of a possible direct role of allergen exposure in asthma causation remains unclear.

Adult↗
PubMed2001

Pathways of disadvantage? Walking as a mode of transport among low-income mothers.

Research shows that lack of car ownership is associated with poorer health. It is often assumed that the reason for this observed relationship is that access to a car--or not--reflects access to household assets. Consequently, lack of car ownership is used as a standard marker of low socio-economic status. However, little attention has been paid to the experience of carlessness in the context of disadvantaged lives. This paper argues that "no access to a car" is not only an indicator of low socio-economic status but of walking as a mode of transport. These arguments are illustrated by data from a study of 30 low-income mothers with young children. Although walking is promoted as both an excellent and inexpensive form of exercise, these data suggest that reliance on walking can have negative effects on the welfare of families. The paper draws on qualitative data to describe the ways in which carlessness restricts access to health and social care resources such as food shops, health-care services and social networks. It also explores the impact of walking on the well being of mothers and their day-to-day relationships with children. This is compounded by walking through areas that are neglected and depressed. The paper concludes that strategies to reduce social exclusion must recognise the contradictory health effects of walking and aim to regenerate the physical fabric of social housing estates as well as improve public transport options.

Adult↗
PubMed2003

The prevalence of pediculosis capitis in schoolchildren in Mersin, Turkey.

BACKGROUND: Pediculosis capitis is an endemic parasitosis affecting many countries of the world. The aim of this study was to investigate the incidence of head lice infestation in Mersin, Turkey. METHODS: A total of 5318 elementary schoolchildren, aged 8-16 years, were examined for the presence of Pediculus capitis. If any evidence of head lice was detected, such as live or dead eggs, or nits, the child was considered to be infected. The following details were recorded for each child: age, sex, family size, monthly income, number of siblings, parents' education, presence or absence of social security of the family, pet (cat or dog) ownership, and frequency of hair washing (per week). The chi-squared test and logistic regression analysis were performed to analyze the results. RESULTS: Pediculosis capitis was detected in 360 (6.8%) children. The prevalence of infestation was significantly higher in girls (13.3%) than in boys (1.1%) (chi2 = 313.2, d.f. = 1, P = 0.000). Children aged 8-9 years exhibited a significantly lower prevalence rate than those aged 10-11 years and those aged 12 years and above. The following variables were found to be statistically significantly related to pediculosis capitis: sex, age, father's education level, and pet ownership (cat or dog). CONCLUSIONS: Our results show that the prevalence of pediculosis capitis is not very high in Mersin, Turkey, and is observed in all schools regardless of the socio-economic and personal hygiene status of the children.

Adolescent↗
PubMed1998

Amodal completion in the absence of image tangent discontinuities.

It has been widely believed since Helmholtz that tangent discontinuities in image contours, such as T-junctions or L-junctions, will occur when one object occludes another. Here we describe a class of occlusion relationships where changes in 'border ownership' and amodal completion take place in the absence of tangent discontinuities in the image. We propose that even subtle curvature discontinuities can be a signal to potential changes in border ownership, and are valid ecological cues for occlusion in certain scenes.

Depth Perception↗
PubMed2006

Who owns the contour of a visual hole?

Holes are useful in the study of shape, contour curvature, and border ownership. Several authors have suggested that holes have figural or quasi-figural status. I discuss three criteria to test the evidence that holes behave more like figures than like ground: (i) holes perceived as such; (ii) similar performance for holes and figures; (iii) different performance for holes and other ground regions. Using these criteria, I review the literature and conclude that holes do not have figural status in relation to border ownership. I also argue that holes are ideal stimuli to study figure-ground organisation.

Contrast Sensitivity↗
PubMed2000

Two separate tracks? A national multivariate analysis of differences between public and private substance abuse treatment programs.

OBJECTIVE: This study describes differences between public and private substance abuse treatment programs. METHOD: Data from the National Drug and Alcoholism Treatment Unit Survey (NDATUS) were analyzed with regression models that evaluated the association between ownership and program characteristics. RESULTS: Programs operated by state and local government and nonprofit agencies had more staff, but federal and for-profit programs employed more psychologists and medical doctors. We found that, in most treatment settings, for-profit programs were smaller and more likely to specialize in providing treatment in a single setting. Methadone maintenance programs were larger when operated under for-profit ownership, however. For-profit programs received more funding from private insurance and client fees. CONCLUSIONS: We found substantial differences between public and private programs, but this division was not strictly dichotomous. Federal programs differed from public programs operated by state and local governments. Programs operated by nonprofit agencies had characteristics that placed them between private for-profit and public programs. State and local agencies are contracting with private managed behavioral health care organizations to provide sub stance abuse treatment and other mental health care. The characteristics of for-profit programs may represent the future direction of substance abuse treatment.

Humans↗
PubMed2001

Cigarette smoking, but not sensitization to Alternaria, is associated with severe asthma in urban patients.

Hereditary susceptibility and allergen exposure have been identified as general risk factors for asthma. However, risk factors for severe asthma still remain to be identified. To further assess and quantify risk factors associated with severe asthma in adult patients apart from clinical exacerbations, 306 randomly selected subjects (mean age 40+/-17 years, 46% males) presenting to an inner city pulmonary practice between 1995 and 1996 were retrospectively investigated. Of these, 117 patients were atopic, 112 had current asthma, and 22 asthmatics had severe asthma. Risk factors associated with atopy were family history of atopy and any domestic pet ownership (OR: 3.1, 95% CI: 1.64-6.1). Asthma was generally associated with atopy (OR: 4.2, CI: 2.4-7.4) and pet ownership (OR: 2.4, CI: 1.2-4.6). Severe asthma was strongly associated with current smoking (OR: 4.8, CI: 1.3-18.3), and lung function was negatively correlated with the amount of consumed cigarettes per day (r = -0.61, p = 0.04). However, no association with sensitization to Alternaria was found in severe asthma. Cigarette smoking is an independent risk factor associated with severe asthma in urban patients, whereas sensitization to Alternaria is of less importance in these patients.

Adult↗
PubMed2005

Operational and financial performance of publicly traded hospice companies.

BACKGROUND: The performance of hospices owned by investor-owned, publicly traded hospice companies has been largely ignored by the literature. OBJECTIVE: The objective of this study was to perform a descriptive analysis that compares the operating and financial performance of hospices owned by publicly traded companies to private, for-profit hospices and to nonprofit hospices within small- and large-size categories based on patient days. DESIGN: A nonparametric median test was conducted using comparisons of median values for each measure between comparison ownership groups within the small and large size categories. SETTING: Financial and operational data for the three ownership groups included in our sample were obtained from the Centers for Medicare and Medicaid Services Cost Report Data over a 3-year period with the most recent fiscal year ending between September 30, 2002 and September 29, 2003. MEASUREMENT: We measured the operational and financial performance of hospices in three areas: utilization, services, and financial performance. RESULTS: Small hospices owned by publicly traded companies incurred a longer length of stay, lower operating expenses, generated higher revenue per day and profit margin, and served a greater proportion of Medicare patients compared to nonprofit counterparts. Large hospices owned by publicly traded hospices served a greater proportion of Medicare patients, offered fewer non-core services, had higher revenue per day and profit margin and incurred lower salary and benefit expense per day. CONCLUSIONS: Results suggest publicly traded for-profit hospices, in comparison to for-profit and nonprofit hospices, are able to earn substantially higher profits.

Efficiency, Organizational↗
PubMed2006

Cardiovascular disease prevention for underserved patients using the Internet: bridging the digital divide.

For underserved populations, telemedicine can address the high prevalence and suboptimal control of cardiovascular disease (CVD) risk factors. However, Internet access issues may limit the successful application of telemedicine. We tested the hypothesis that computer skills, and not access per se, was the main obstacle to using the Internet for health care. After informed consent, 44 participants with little or no computer experience received 2 hours of training covering 14 basic computer use skills, Internet access, and our telemedicine system. The telemedicine system enables reporting blood pressure, weight, physical activity, cigarette use, provider feedback, personal medication information, and educational information about CVD risk factors. The patient population included 12 males and 32 females. Of this total were 23 African Americans. The average patient age was 60.4 +/- 3 years, and 64% had annual family incomes under 25,000 dollars. Eighty-two percent of the participants averaged 4 or higher (on a scale of 1 to 5) on basic computer skills. Only 11% had an average score below 3. Thirty-seven of 44 participants reported on their health status from a local Internet access site within 10 days. Participants' successful use of the telemedicine system was not correlated with age, gender, education level, or ownership of a computer. Computer skill score had a positive effect on system use. Underserved populations without computer experience or skills and at increased risk for CVD can be educated to use an Internet telemedicine system to communicate health status to their health care providers. Ownership of a computer was not a factor that predicted system use.

Aged↗
PubMed2000

Risk factors for trachoma: 6-year follow-up of children aged 1 and 2 years.

The authors investigated the long-term stability of risk factors in predicting the presence of active trachoma and severe inflammatory trachoma in 176 children in Kongwa, Tanzania, who were aged 1 and 2 years in 1989 and were available for follow-up in 1995. Familial cattle ownership, living more than 2 hours away from a water source, and facial cleanliness at both time points were associated with the presence of active trachoma at both time points (odds ratio (OR) = 2.58, 95% confidence interval (CI): 1.15, 5.79; OR = 3.07, 95% CI: 1.23, 7.64; and OR = 0.52, 95% CI: 0.26, 1.03, respectively). An association of familial cattle ownership with facial cleanliness and water accessibility was observed. Having a clean face at both time points was associated with lower odds of active trachoma at both time points for children in non-cattle-herding families (OR = 0.40, 95% CI: 0.18, 0.87). Living more than 2 hours away from a water source at both time points increased the odds of active trachoma at both time points in children of cattle-herding families (OR = 8.00, 95% CI: 1.99, 32.10). Noticeably, severe inflammatory trachoma at baseline predicted mortality in children from villages in which trachoma was less common (OR = 3.75, 95% CI: 1.09, 12.98). The results suggest that risk factor reduction could diminish persistent disease.

Animals↗
PubMed2005

Self-reported heart symptoms are strongly linked to past and present poverty in Russia: evidence from the 1998 Taganrog interview survey.

BACKGROUND: In this Russian-Swedish collaborative study the question of how symptoms of heart disease are linked to poverty in Russia was addressed. METHOD: A random sample household survey was conducted in Taganrog, southern Russia. It covered questions about living circumstances, poverty and health. Health questions included both symptoms of heart problems, such as chest pain and high blood pressure, psychological problems such as depression and anxiety, as well as health-related behaviours such as alcohol drinking. Answers from 1972 women and men aged 18-70 are analysed here. RESULTS: The poorest fifth of the population were more than twice as likely as others to report heart symptoms. Problems in affording vegetables, meat or fish, clothes and footwear were linked to heart symptoms more closely than other economic indicators, such as car ownership or ownership of consumer durables. Psychological symptoms, sleeping problems and alcohol drinking were all related to self-reported heart symptoms, but explained little of the excess risks attributable to present poverty. Childhood poverty was also linked to present heart symptoms. CONCLUSION: Life-time accumulated experience of economic hardship contributes to present levels of heart disease symptomology in Russia.

Adolescent↗
PubMed2005

Changing social variations in self-assessed health in times of transition? The Baltic States 1994-1999.

BACKGROUND: Dramatic social changes took place in the Baltic States (Estonia, Latvia and Lithuania) in the 1990s. This study investigates the extent to which social variations in self-assessed health changed during that period. METHODS: Norbalt Living Conditions Survey I (1994) and II (1999) random population-based samples in Estonia, Latvia and Lithuania were analysed. Associations of self-assessed health with six social dimensions (education, economic activity, car ownership, number of rooms, ethnicity and residence) were studied for males and females aged 25-74 years (n = 16 970). RESULTS: Substantial and significant associations with poor health were found for education, economic activity, car ownership and, to a lesser extent, number of rooms. Ethnic differences were found only among women in Estonia. By and large, social variations in health were comparable for most indicators between the three countries. Differences in self-assessed health were stable between 1994 and 1999, except for the relatively worse position of the economically non-active in 1999. CONCLUSIONS: Substantial social inequalities in self-assessed poor health exist in the Baltic States. Despite dramatic social changes taking place, social variations in self-assessed health have been rather stable in the second half of the 1990s. The economically non-active seem to have become more disadvantaged.

Adult↗
PubMed1998

Use of guidelines in primary care--practitioners' perspectives.

BACKGROUND AND OBJECTIVES: Concern about the inadequate take-up of guidelines in general practice has concentrated on problems arising from the process of their development and implementation. However, these perspectives fail to take account of the needs, attitudes and problems of GPs themselves. In this study we aimed to identify barriers to the use of guidelines and opportunities for tackling them, from the point of view of the GP, so that future guideline development and policy could be more sensitive to the needs of GPs in the environment in which they work. METHOD: Twenty in-depth semi-structured interviews were audiotaped with GPs from within the Avon Health Authority area, representing GPs with different backgrounds and working environments. The transcribed data collected were analysed using a grounded theory approach. RESULTS: Utilization of guideline information is complex. GPs' appraisals of the value of guidelines interact with prior knowledge and beliefs, practicalities of existing information storage and retrieval systems, and individual working practices. Conditions where guidelines are most likely to be referred to may be those either very rarely or very commonly presenting in general practice. Key issues for the uptake of guidelines in the consultation are: general preference for certain formats of presentation; reputability and ownership; use of guidelines in shared decision-making; scope for computer-based systems; and GPs' attitudes to time pressures on information-seeking in relation to tolerance of uncertainty. CONCLUSION: Local initiatives might usefully explore the possibilities of supporting development of guideline-retrieval systems customized for individual GPs or practices. Novel means of stimulating 'ownership' and demonstrating reputability should be sought. The analysis provides a framework for understanding the complexities of the processes of GPs' use of guidelines in practice which can be useful in explaining the results of trials of guideline effectiveness. Guideline implementation occurs in the context of conflicting pressures for clinical autonomy and professional standardization and quality improvement.

Attitude of Health Personnel↗
PubMed2006

Organizational characteristics associated with staff turnover in nursing homes.

PURPOSE: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. DESIGN AND METHODS: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality, ownership, chain membership, size, and Medicaid census), using Online Survey, Certification, and Reporting (known as OSCAR) data. Turnover information came from primary data collected from 854 facilities in six states (Missouri, Texas, Connecticut, New York, Pennsylvania, and New Jersey). RESULTS: The 1-year turnover rates were 56.4%, 39.7%, and 35.8% for certified nurse aides, licensed practical nurses, and registered nurses, respectively. The results consistently show that, for all caregivers, lower staffing levels, lower quality, for-profit ownership, and higher bed size are associated with higher turnover. Some differences also are found for different levels of turnover, but there are few differences among types of nursing staff. IMPLICATIONS: Given that turnover rates are problematic, this study gives us a better understanding of the phenomenon and at the same time helps us further understand the wide variation that is known to exist between nursing homes, based on their organizational characteristics.

Aged↗
PubMed1995

Factors affecting acceptance of immunization among children in rural Bangladesh.

This paper uses the Bangladesh Fertility Survey 1989 data to identify the factors affecting acceptance of immunization among children in rural Bangladesh. Acceptance of DPT, measles and BCG vaccinations were the dependent variables. The independent variables included proximity to health facilities, frequency of visit by health worker, respondent's mobility, media exposure, education, age, economic status of household, region of residence, and gender of child. Logistic regression analysis was performed to assess the net effects of the variables in addition to univariate analysis. Among the independent variables, proximity to health facility, frequency of health worker's visit, mother's mobility, education, age, gender of child, ownership of radio, economic condition of household, and region of residence showed statistically significant association with acceptance of immunization. The effect of frequency of health worker's visit was dependent on region of residence, possession of radio, and mother's education. The effect of mother's ability to visit health centre alone was also dependent on ownership of radio, economic condition of household, and mother's education.

Adult↗