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At least 1,207 records · Page 67Linked to original sources
PubMed1992

Surveillance of nosocomial infection in private psychiatric hospitals: an exploratory study.

BACKGROUND: The vast majority of work published about infection control programs, procedures, and practices addresses general acute care facilities. Consequently, infection-control coordinators at psychiatric hospitals have few established norms or models to use in adapting available standards to the unique needs of psychiatric hospitals and their patients. This descriptive study explored practices for the surveillance of nosocomial infections in private psychiatric hospitals. METHODS: A survey was mailed to the infection control coordinator of the 284 hospitals belonging to the National Association of Private Psychiatric Hospitals. Questionnaire data were collected anonymously. Surveys were returned by 103 (36%) of the hospitals. RESULTS: The most frequent criteria used to define the presence of nosocomial infections were the Center for Disease Control guidelines and clinical judgment, used by 38% and 39% of the respondents, respectively. Most (64%) of the respondents indicated that they did calculate a nosocomial infection rate. The most frequent method used to calculate infection rates was based on patient discharges. Sixty-five hospitals (63%) reported their most recent yearly infection rate, which ranged from 0.00 to 0.35, with a median rate of 0.05 (mean, 0.06; SD, 0.07). CONCLUSIONS: Overall, the findings reflected much variability in respondents' practices in defining nosocomial infections and calculating infection rates. We therefore suggest that both the method used to calculate the rate and facilities' definitions of nosocomial infection be considered when comparing infection rates across facilities.

Cross Infection↗
PubMed2003

The predicted impact of private sector MMR vaccination on the burden of Congenital Rubella Syndrome.

In many developing countries, Measles-Mumps-Rubella (MMR) vaccine is available through the private but not the public sectors, and there is no systematic rubella vaccination among adult women. In this paper, we extend previous modeling studies to demonstrate that in developing countries with a medium-high force of infection (200-400/1000 per year), current levels of private sector MMR coverage (<60%) would lead to increases in the incidence of Congenital Rubella Syndrome (CRS) both among unvaccinated individuals and the general population even when mixing between vaccinated and unvaccinated individuals is fairly minimal. Our findings highlight the need for countries to establish surveillance of trends in susceptibility to rubella and CRS incidence and perhaps introduce rubella vaccination among women of child-bearing age.

Adult↗
PubMed2001

The impact of privatization on access in Tanzania.

In the late 1980s, many developing countries were forced to adopt structural adjustment policies as a condition for securing loans from the International Monetary Fund (IMF) and the World Bank. One of the World Bank's recommended policies was to change the mix of private and public health facilities. This study, based on fieldwork done in Tanzania in 1993, examines the impact of this policy on health-care accessibility in two northern Tanzanian districts, one rural and one urban. Accessibility was measured in terms of equality and equity of coverage. The placement of the very few government clinics opened during the years 1985-1993 did much more to improve coverage than the haphazard location of many new private clinics. Equity was not improved as very few clinics were placed in demographically needy areas.

Ambulatory Care Facilities↗
PubMed2002

From retreat to health centre: legislation, commercial opportunity and the repositioning of a Victorian private asylum.

This paper examines the interplay of commercial imperatives and health care legislation in the survival of a privately owned psychiatric hospital in Guelph, Ontario, Canada. Using documentary and archival evidence, we show how the Homewood Retreat (later Sanitarium, and eventually Health Centre) was able to respond to and anticipate legislative developments through the agency of successive medical superintendents and the structural positioning of the institution as an inextricably integrated element in local and provincial mental health provision. Our case study is used to draw out wider lessons concerning agency, legislative context and treatment modality in the determination of organizational histories. We conclude by noting the important role of the private sector in ensuring the continued provision of an asylum form of mental health care.

Facility Regulation and Control↗
PubMed1999

The role of the privatization process on tuberculosis control in HoChiMinh City Province, Vietnam.

In Vietnam, tuberculosis is a major health problem, especially in HoChiMinh City Province where living conditions are marginal and HIV infection is increasing. As Vietnam has gradually shifted to a market economy, this also has implications for the health care system. More and more private practitioners are emerging. At present, case-finding and treatment of tuberculosis is under the control of Vietnam's National Tuberculosis Program (NTP). The authors argue that the process of privatization might have consequences for the implementation of a public health program such as the NTP. This argument has been illustrated by using a case study on the functioning of the NTP in HoChiMinh City Province.

Communicable Disease Control↗
PubMedDate not supplied

Hepatitis C screening practices among private practitioners: impact of an information campaign.

OBJECTIVES: A campaign designed to enhance screening for hepatitis C virus infection (HCV) by private practitioners was conducted in the Lyon area from April 2000 to March 2001. The target population for screening was composed of individuals with active/previous intravenous drug abuse habits or had received blood products before 1991 or who presented elevated serum transaminase levels. The objectives of the present study were to validate the campaign's organization and its impact on screening practices. METHODS: The impact of the campaign was estimated from the number of prescribed and performed HCV screening and confirmation tests, the number of physicians who prescribed HCV screening tests, and the number of HCV screening tests prescribed by each physician. Indicators/practices observed during the 12-month campaign were compared with the same indicators/practices observed during the 12-month period preceding the campaign. RESULTS: During the campaign, 15952 HCV serology tests were prescribed by 1798 of the 3052 physicians (58.9%) practising in the Lyon area. Among physicians who prescribed serology, 11.4% of the general practitioners and 10.9% of the specialists prescribed HCV serology tests for the first time during the campaign. Prescriptions for HCV serology increased significantly between the two calendar periods (+15.6%, epsilon = 17.7), similarly for general practitioners and specialists. The number of general practitioners who prescribed more than five serology tests per year increased 15.3% while the number of general practitioners who did not prescribe serology tests decreased 9.7% (P = 0.02). More HCV-positive patients were detected during the campaign (276 patients) than during the previous period (231 patients) [epsilon = 2.8]. CONCLUSION: When provided with pertinent information and training adapted to their medical practice, private practitioners become actively involved in screening for HCV infection.

France↗
PubMed1999

Tuberculosis screening in private physicians' offices, Pennsylvania, 1996.

OBJECTIVE: To assess tuberculin skin testing practices of physicians after community-wide screening of 1400 children exposed to a pediatrician with active tuberculosis (TB). DESIGN: A self-administered questionnaire. SETTING: Medium-sized city in eastern Pennsylvania. PARTICIPANTS: Pediatricians and family practitioners seeing pediatric patients. MAIN OUTCOME MEASURES: Percentages of physicians who followed published recommendations for placement and reading of TB skin tests published by the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC). RESULTS: Questionnaires were completed by 60/80 (75%) physicians. The 60 physicians had practiced a mean of 17 years (range 3-38 years), and only one did not do TB skin testing for pediatric patients. The 59 physicians doing TB skin testing reported routinely tuberculin testing more than 900 children per month. Only 8/59 (14%) physicians followed published guidelines for placement and reading of tuberculin tests. Those physicians screened 158 (17%) of the pediatric patients undergoing TB skin testing in a typical month. CONCLUSION: In this community where a highly publicized TB case prompted massive pediatric screening, most physicians seeing children in private practice do not follow standard TB skin testing guidelines. Increased understanding of how private-practice physicians learn about and decide to use recommended standards are needed if tuberculin tests are to be correctly performed and TB appropriately diagnosed.

Child↗
PubMedDate not supplied

Cognitive-behavior therapy of obsessive-compulsive disorder in private practice: an effectiveness study.

A controversy exists over whether or not the results of randomized controlled trials (RCTs) are generalizable to routine clinical practice. The present study examines the effectiveness of cognitive-behavior therapy (CBT) for obsessive-compulsive disorder (OCD) in a private practice setting. Twenty-six consecutive clients referred to a private anxiety disorders specialty clinic began treatment for OCD. Of the 19 (73%) clients who completed treatment, 84% were treatment responders. Clients, treatment, and outcome of the present study are compared with those of representative RCTs, and it is concluded that there are more similarities than differences. It is concluded that CBT can be effectively delivered in routine clinical practice.

Adult↗
PubMed1999

100 total laparoscopic hysterectomies in private practice in Brazil.

STUDY OBJECTIVE: To evaluate of 100 total laparoscopic hysterectomies performed in a private practice. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: Private hospital. PATIENTS: One hundred women. INTERVENTIONS: Total laparoscopic hysterectomy (TLH). MEASUREMENTS AND MAIN RESULTS: The most common indications for TLH were chronic menorrhagia (uterine myomas), pelvic pain (severe endometriosis), and uterine enlargement. Four of our first 20 procedures were converted to laparotomy in which bipolar was used exclusively. In the others cases the Endo Gia stapler was used in the first step of the procedure (section of broad ligaments) in combination with bipolar coagulation. Mean operating time was 90 minutes (range 45-150 min) and hospital stay was 36 hours (range 18 hrs-2 days). The two intraoperative complications were hemorrhage requiring blood transfusion and a rectal injury; the four postoperative complications were two cases of vesicovaginal fistula, and one each of colonic vaginal fistula and vaginal cuff infection (total complication rate 5%). Ninety-six women returned to work in 2 weeks. CONCLUSION: Total laparoscopic hysterectomy can be performed safely and effectively when the surgical team is sufficiently trained and experienced in managing complications. We believe that it will become standard treatment for benign uterine disease. (J Am Assoc Gynecol Laparosc 6(2):169-171, 1999)

Adult↗
PubMed1996

Technology and staffing in Japanese university hospitals. Government versus private.

We examined staffing levels, acquisition of medical technologies, and utilization of those technologies in private and government teaching hospitals in Japan. Adjusting for size and case mix, we found that government hospitals acquire more technology, use that technology less, and employ a more highly skilled staff than do private hospitals.

Diffusion of Innovation↗
PubMedDate not supplied

Panel 2.17: private commercial sector partnerships for health action in crises.

This is a summary of the presentations and discussion of Panel 2.17, Private Commercial Sector Partnerships for Health Action in Crises of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to private sector partnerships for health action in crises as pertain to the responses to the damage created by the Tsunami. It is presented in the following sections: (1) key questions; (2) issues and challenges; (3) lessons learned; (4) what was done well?; (5) what could have been done better?; and (6) conclusions and recommendations.

Cooperative Behavior↗
PubMed2006

Efficacy and safety of lamotrigine for adults with bipolar disorder in a private practice setting.

INTRODUCTION: Lamotrigine is approved by the Food and Drug Administration for maintenance therapy in patients with bipolar I disorder. However, several studies of acute-phase and maintenance treatment support the efficacy of lamotrigine for bipolar I and bipolar II disorders. This chart review was performed to assess the efficacy and safety of lamotrigine in the treatment of bipolar disorder in a private psychiatric practice setting and to investigate differences in response among patients with different diagnostic subtypes of bipolar disorder. METHODS: The charts of 587 adult outpatients with a primary diagnosis of bipolar disorder who received treatment with lamotrigine in a private practice setting between July 1998 and May 2004 were reviewed retrospectively. Treatment response was assessed with the Clinical Global Impression-Improvement scale and was defined as achievement of a score of <2. RESULTS: Three hundred forty-nine patients (59.5%) responded to lamotrigine. Response rates were comparable among patients with bipolar I disorder, bipolar II disorder, bipolar disorder not otherwise specified, and among patients with bipolar I disorder who presented with depressive, manic, or mixed episodes. Nonserious rash (12.8%) and headache (2.9%) were the most frequently reported adverse events. CONCLUSION: These results suggest that lamotrigine is effective and well-tolerated in the treatment of bipolar disorder across the spectrum of subtypes of the illness.

Adolescent↗
PubMed1998

Administrative update: utilization of services. I. Comparing use of public and private mental health services: the enduring barriers of race and age.

Data from the NIMH-Epidemiologic Catchment Area Project were used to predict differential use of private versus public outpatient mental health services, a salient concern in integrating public and private services in market-based health care reform efforts. Having a recent psychiatric disorder, being age 25-44, female, white, of higher educational level, and unmarried increase the odds of any mental health service use. However, odds of treatment in the public sector are increased for males, African Americans, those with low educational and income levels, and odds are markedly decreased for the elderly, suggesting significant barriers to care for these mentally ill subpopulations.

Adolescent↗
PubMed1998

Racial/ethnic disparities in admissions to public and private psychiatric inpatient settings: the effect of managed care.

This study investigates the effect of managed care on access patterns among people of color who are severely and persistently mentally ill. The distribution of admissions to public and private psychiatric hospitals was compared for African-American, Asian, Latino, and white case managed clients of the Massachusetts Department of Mental Health before and after implementation of Medicaid managed mental health care in October 1997. Managed care appears to have increased access to private services across all racial and ethnic groups, although admissions of non-white patients were still more likely to take place in publicly operated settings. These data suggest that equalizing access to putatively better inpatient treatment settings may be an externality of managed care.

Adult↗
PubMed2002

Employer offers, private coverage, and the tax subsidy for health insurance: 1987 and 1996.

Economists have long been interested in the effect of tax-based subsidies on private health insurance coverage. We examine this relationship using pooled data from the 1987 National Medical Expenditure Survey and the 1996 Medical Expenditure Panel Survey. Our main tax price elasticity estimates for employer offers and for private coverage are near the mid-point of the existing literature. However, these estimates may mask substantial differences in tax-price responsiveness across subsets of workers. Our more disaggregated analysis reveals tax price responsiveness to be significantly above average for low-income workers, workers with low health risks, and workers in small firms--precisely those groups whose continued participation in employment-related risk pooling is of greatest policy concern. In addition, we present family-level elasticities that allow for joint decision-making in two-worker families.

Adult↗
PubMed1991

Characteristics of persons served by private psychiatric hospitals, United States: 1986.

Overall about 71,000 persons were under care in the inpatient, outpatient, and partial care programs of private psychiatric hospitals in the United States on April 1, 1986, and about 300,000 persons were admitted to these programs during 1986. Inpatient programs served the largest number of people, 223,851; outpatient programs served 133,217; and partial care programs served a much smaller population, only 13,541. The relative distribution of persons admitted, versus persons under care, differed considerably by type of program. Although the number of those admitted was larger than the number of those under care for both inpatient and outpatient programs, the difference between the two populations was much more pronounced within inpatient programs (chart A). Most of the persons admitted to private psychiatric hospitals in 1986 were admitted to inpatient programs, 207 thousand or 69 percent of all admissions, while most of those under care were outpatients, 47 thousand or 66 percent of all those under care on a single day. Children and youth under age 18 comprised the largest percentage of persons under care in inpatient programs, while persons in the 25-44 age group comprised the largest percentage of those admitted to inpatient programs. Approximately 41 percent of all persons under care in inpatient programs were under 18 years of age, compared with only 20 percent of all persons admitted to inpatient programs. The large number of children and youth found in the population under care within inpatient programs indicates the high median length of inpatient stay for persons within this age group (41 days compared with 24 days overall). Children and youth and the 25-44 year group each represented over one-third of those admitted to outpatient programs. The 25-44 age group made up the largest percentage of persons under care in outpatient programs and among those admitted to partial care programs. Among those under care within partial care programs, differences among age groups were not statistically significant. Of persons admitted to partial care programs, 92 percent had a history of some type of prior mental health treatment; for those admitted to inpatient and outpatient programs, the corresponding percentages were 70 percent and 48 percent, respectively. Affective disorders were a frequently occurring diagnostic grouping, comprising almost half of all persons admitted to and under care in inpatient programs, approximately one-third of those admitted and those under care in partial care programs, and around one-fourth of those admitted to and under care in outpatient programs.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed2006

Private biotech 2004--the numbers.

Compared with the plethora of financial information about the publicly traded elite of the biotech world, little is known about the multitude of private biotech firms. Here, Nature Biotechnology's Editor-at-Large provides an analysis of the financial performance of the privately held biotech sector.

Biotechnology↗
PubMed1999

Geographic distribution of private dentists in Hong Kong in 1989 and 1998.

More than 80% of the dentists in Hong Kong are in private practice and third party payment schemes are uncommon. Thus, most dentists have to work according to the rules of a free market and have to respond to the demands of the population. Using official data, it was found that the geographic distribution of private dentists was highly uneven. In 1989, the dentist to population ratio in the commercial districts was below 1:2,500 while in the new towns the ratio was larger than 1:20,000. There has been an improvement in the availability of dentists in the under-served areas during the past 10 years although there are still a considerable number of dentists practising in the areas on both sides of the Victoria Harbour.

Dentists↗