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PubMedDate not supplied

Physician leadership: a roadmap for health-system change.

Physician involvement in health-system decision making and their support of health-system initiatives can be critical to a health system's success. Many physicians, however, do not have the business skills or perspective to be effective contributors. This paper identifies three levels of physician leader development: awareness and head knowledge; creating an "us" culture; and taking ownership of the marketplace. It also identifies three physician leader-development methods that health systems can use to reach these points: integrated executive education; project-based learning; and facilitating ownership. Based on health-system objectives, top management should choose an appropriate level of physician leader development and then implement an appropriate change plan by using the proposed physician leader-development methods.

Cooperative Behavior↗
PubMed2004

Seroprevalence of Bartonella henselae and Bartonella quintana infections in children from Central and Northern Jordan.

OBJECTIVE: To investigate the prevalence of antibodies to Bartonella henselae (B.henselae) and Bartonella quintana (B.quintana) among children from central and northern Jordan. METHODS: Sera from 482 children were randomly collected from referenced governmental hospitals in the central and northern parts of Jordan during the period between January 2001 to March 2003. An indirect immunofluorescent assay was used to determine serum antibody titers to B.henselae and B.quintana. Sera that were reactive at a dilution >/-1:64 were considered positive. In addition, blood from 20 cats belonged to children with high B.henselae titers were tested using polymerase chain reaction. RESULTS: Out of the 482 serum samples examined, 53 (11%) and 20 (4.1%) had positive antibody titers for B. henselae and B.quintana. Bartonella henselae was isolated from 4 cats that belonged to 3 children with high antibody titers to B.henselae-IgG. The seroprevalence of IgG antibodies to B.henselae was significantly higher (P<0.05) in children aged 7-10-years than in younger or older ones. Having a cat in the household and having a history of cat scratches or bites were strongly associated (P<0.01) with seropositivity to B.henselae-specific IgG. Cats ownership and history of cat scratches or bites had no impact on the prevalence of B.quintana. Seropositivity to B.henselae-specific IgG was significantly higher (P<0.01) in children from northern Jordan than in children from central Jordan. CONCLUSION: This study substantiates the presence of B.henselae in Jordan, documents the seroreactivity to 2 Bartonella antigens, and suggests that cat ownership and history of cat scratches or bites are important epidemiological risk factors for B.henselae infection in Jordan.

Animals↗
PubMed2005

Using return on equity and total profit margin to evaluate hospital performance in the U.S.: a piecewise regression analysis.

We investigated hospital profitability by comparing Total Profit Margin (TPM) and Return on Equity (ROE) as measures of profitability, while controlling for inflation and other salient factors. We controlled for variables such as, Disproportionate Share Hospital status, location, type of ownership control, teaching status, conversion to or from nonprofit status, Critical Access Hospital status, sole Medicare provider status, case mix adjusted patient length of stay, bed size, number of employees, and occupancy rate. We allowed for nonlinearities in our model, and used 1996 and 1998 data in our analysis to bridge potential effects of the Balanced Budget Act of 1997. Most of the hospitals we examined were nonprofit organizations that did not convert their type of ownership control. As a consequence, we found TPM to be a better measure of profitability than ROE, and profitability was mainly influenced by location, size, occupancy rate, volume of Medicare and Medicaid patients, and teaching status. Our results clarify the primary factors associated with profitability for our sample hospitals, and will assist creditors, managers and regulators in their assessments of comparative hospital financial performance.

Data Collection↗
PubMedDate not supplied

Computing knowledge, attitude and skills among healthcare professionals in Aminu Kano Teaching Hospital, Nigeria.

BACKGROUND: Health care professionals can no longer ignore the application of information technology to health care. This study was carried out to assess computing knowledge, attitude and skills among health care professionals and identify associated factors. METHODS: A cross section of 200 health care professionals- consisting of 64 doctors, 90 nurses, 35 laboratory scientists and 11 pharmacists in Aminu Kano Teaching Hospital were interviewed using a pre-tested, structured, closed-ended self-administered questionnaire. RESULTS: Only 181 (90.5%) of the respondents returned the completed questionnaires. Twenty six percent of the respondents had formal computer training whereas 34.8% owned a personal computer. Overall, 84 (46.4%) of the respondents had good knowledge of computing. Specifically, 41(66.0%), 5 (50.0%), 14 (51.0%) and 24 (30.0%) of these were doctors, pharmacists, laboratory scientists and nurses respectively. Computing knowledge was highest among doctors and lowest among nurses. These differences were statistically significant (chi2 = 19.1 df = 3 P < 0.01). Age, gender, computer ownership and formal computer training significantly influenced computing knowledge. Most healthcare professionals 160 (88.4%) had positive attitude towards computing and this was significantly influenced by respondent's age and previous computer training. Only 41 (22.7%) of the health care professionals had good computing skills and this was significantly associated with computer ownership (P < 0.01) and formal computer training (P < 0.01). CONCLUSION: Half of the healthcare professionals had good computing knowledge, majority had a positive attitude while many were quite deficient in computer skills. Computer loans and in-house computing courses were recommended to prepare our healthcare professionals for the challenges of the information technology age.

Adult↗
PubMedDate not supplied

[Effects of indoor exposures on respiratory and allergic disorders].

Several studies have shown that indoor pollution increases the risk for chronic pulmonary diseases and acute respiratory symptoms in children/adolescents. Some associations have been confirmed by studies. Other relations are still unclear, such as those regarding dog and cat ownership. In this study we assessed the relationships of the exposure to mould and dog/cat ownership with respiratory/allergic symptoms/diagnoses, such as wheezing, asthma, rhinoconjunctivitis, eczema, and cough/phlegm in 20,016 children (6-7 yrs old) and 13,266 adolescents (13-14 yrs old) from 12 Italian areas. Early mould exposure (in the first year of life) was positively related to all considered symptoms/diagnoses (significantly for wheezing, asthma, rhinoconjunctivitis in both children and adolescents, and for cough/phlegm among children); current exposure (in the last year) was a significant risk factor for wheeze, among children. In the latter, dog exposure only in the first year of life increased the risk for wheezing and cough/phlegm, whereas the presence of a dog lifetime seemed a protective factor (though not significant) for all symptoms/diagnoses; negative relations (but not significant) suggested a protective effect by the cat for asthma, independently of exposure period. Among adolescents, the presence of a dog both lifetime and only in the first year of life was significantly related to cough/phlegm; except for rhino-conjunctivitis, all symptoms/diagnoses were negatively related to the presence of a cat lifetime (though not significantly). In conclusion, our results confirmed the effects of mould exposure, especially when it occurs early, on the prevalence of respiratory disorders such as asthma, rhinitis and cough in the pediatric age. The complex relations between keeping a dog or cat at home and respiratory/allergic symptoms/diseases in childhood warrants further studies.

Adolescent↗
PubMedDate not supplied

The performance of Medicare, Medicaid, and individual commercial products.

Medicare, Medicaid, and individual nongovernmental insurance products are marketed by commercial health insurance companies. We propose that the product offerings be viewed as a group rather than as separate products competing for internal company resources. A study population consisting of 35 Aetna plans in 24 states, 124 Blue Cross Blue Shield plans (BCBS) in 45 states and the District of Columbia, 43 Cigna plans in 28 states, and 23 UnitedHealth plans in 22 states was examined on 29 variables, including financial, marketing, and medical management data. The findings revealed that Medicaid and individual nongovernmental products were terminated more often than other products across all ownership types. When BCBS plans were analyzed across for-profit, nonprofit, and mutual ownership types, the companies had distinct preferences for product offerings. The study provided evidence that health plans will limit their exposure to Medicare, Medicaid, and individual nongovernmental products in preference to comprehensive/group products.

Commerce↗
PubMed2005

What explains doctors' usage of Mobile Information and Communication Technologies? A comparison of US and Portuguese hospitals.

Doctors, either as a result of individual initiative or departmental policy, may use a number of different mobile computers. The relationship between device ownership/provision and usage is, however, rarely discussed. This paper therefore presents survey data (N=267) on mobile computer ownership and use by doctors in two Portuguese and two US hospitals, considering both devices owned by individuals and those supplied by the hospital. The results show that ownership is not clearly related to either usage pattern or frequency of use. Providing handheld computers also did not lead to higher number of users, higher frequency of use or significant differences in tasks carried out. Nevertheless, doctors owning handhelds alone or in combination with laptops used them more frequently than those using laptops alone. Differences in usage pattern proportions rather than demographics were a better indication of differences in usage frequencies and the tasks for which MICT devices were being used.

Adult↗
PubMed2005

Toxocariasis seroprevalence in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic inflammatory disease for which immunogenetic susceptibility factors have been defined. The aim of this study was to investigate seroprevalence of Toxocara canis (T. canis) in patients with RA. Forty-five patients with RA who were all diagnosed according to the ACR criteria and 48 health controls were included in this study. The mean age of patients with RA and of controls was 50+/-14 and 49+/-13, respectively. In both groups T. canis IgG antibodies were investigated with ELISA. Toxocara canis seroprevalence in patients with RA (35.6%) was significantly higher than that in the control group (8.3%) (p=0.001). There was no significant difference between patients with RA and control group in terms of behavioral factors (except in frequency of hand washing), demographic and socio-economic factors, while there was a difference in terms of owning dogs and cats or in the duration of ownership. When the patients with RA were divided into seropositive and seronegative, there were no significant differences between both groups in terms of demographic factors, socio-economic factors, behavioral factors, owning dogs and cats or duration of ownership and active or remission state of the illness, duration of disease and disability level in patients with RA (p > 0.05). In view of the present results, it is suggested that Toxocara infection was acquired before RA had developed and that high seroprevalence may result from exposure to pets and soil. It seems that this subject requires further investigations with larger numbers of samples in order to fully evaluate the causes of high seropositivity.

Journal Article↗
PubMed1990

Does quality influence choice of hospital?

In recent years, much information has been provided to the public and to physicians about hospital quality measured in terms of patient outcomes. To examine if, before these public data releases, quality influenced the attractiveness of a hospital to referring or admitting physicians and to patients, we estimated the influences of quality, charges, ownership, and distance on the choice of hospitals for patients with seven surgical procedures and five medical diagnoses in hospitals in three geographic areas in California in 1983. Greater distance and public or proprietary ownership consistently reduced the likelihood of selection while medical school affiliation increased the likelihood of selection. For five of seven surgical procedures and two of five medical diagnoses, hospitals with poorer than expected outcomes attracted significantly fewer admissions. The reverse held for two surgical procedures and one medical diagnosis. The results suggest that quality played an important role in choices among hospitals even before explicit data were widely available.

Aged↗
PubMed1990

[Raising fighting dogs].

Some experience is reported, referring to court trials of accidents involving members of the so-called "fighting dog" breeds. Analysis of the situation makes obvious that many breeders and owners of these or similar dogs demonstrate an irresponsible attitude, thereby fostering breed standards which should be corrected. A future solution of this problem and of others could only be brought about by a law, which would regulate companion animal breeding and ownership. A ban on special breeds or their integration into a "Dangerous animals act" seems for now to be feasible for breeds only which are explicitly standard-bred for aggressiveness against man. Responsible dog breeding and ownership is postulated in order to avoid a growing aversion against dogs in society, which certainly contributed to the stagnation of the dog population in the FRG during the last years.

Animals↗
PubMedDate not supplied

Discrepancies in birth weights between hospital records and health department data for low birth weight infants in New York City.

The study is one of the first to compare corresponding birth weights documented on New York City Health Department Vital Statistics (HDVS) birth tapes and the neonatal medical records of the hospital of birth. Only those infants with birth weights of 2,500 grams (g) or less were studied. Analyses were made of the scope, magnitude of error, and direction of the discrepancies observed. Concordance was considered present if the discrepancy in birth weight was 30 g or less. HDVS birth tapes and the hospital charts of 3,864 neonates were reviewed. The study population came from 48 of 53 hospitals in the metropolitan area. Hospitals were divided into three categories by the level of care offered. Each level of care was subdivided into groups by type of hospital ownership, that is, proprietary, voluntary, and municipal. Concordance was 87 percent overall and ranged from 67 to 96 percent among the study hospitals. More discrepancies were found for levels II and III hospitals than in level I hospitals, those with less sophisticated resources. Municipal hospitals had more discrepancies in birth weights than voluntary hospitals. Infants who had been transported from the birth facility to another facility had significantly higher concordance rates than the nontransported infants, after adjusting for levels of care, type of ownership of the hospital, and birth weight categories. Increased concordance rates were shown to be associated with increased birth weights.

Birth Weight↗
PubMed1984

Intestinal parasites in metropolitan Toronto day-care centres.

In 1981, 900 children (aged 3 months to 10 years) and 146 staff attending 22 day-care centres in metropolitan Toronto chosen at random provided a stool specimen in a survey for intestinal parasites. Of the children, 4% to 36% were infected in 20 of 22 centres. Overall, 19% of the children and 14% of the staff had intestinal parasites: 8.6% and 4.0% respectively had Dientamoeba fragilis, and 7.8% and 2.0% respectively had Giardia lamblia. The highest prevalence of dientamebiasis was in the 7- to 10-year-olds, whereas giardiasis was detected most frequently in the 6-year-olds. Infection with intestinal parasites was not correlated with age, sex, duration in the day-care centre, dog ownership, travel history, gastrointestinal symptoms or the proportion of children in the day-care centre who were born in less developed countries. Immigrant children and children of parents born in industrialized countries (including Canada) were more likely to be infected than were children born in Canada of parents from the developing world. Dientamebiasis was associated with cat ownership. Thus, intestinal protozoa--in particular, D. fragilis and G. lamblia--are endemic in Toronto day-care centres.

Canada↗
PubMedDate not supplied

[The elderly in traffic--future aspects].

In 1976 and 1982 two surveys about traffic and public transportation in the Federal Republic of Germany were undertaken. Four aspects which are meaningful for gerontological research are presented, i.e. possession of a driving license, ownership of a car, availability of a car in the own household and preferred transportation. The data are given for different age groups. These four aspects can be regarded as indicators for motor mobility. Far more people in younger age groups are in possession of a driving license than in older age groups. The same can be shown for the ownership and availability of a car. Compared with the 1976 data only few elderly people in 1982 had stopped using a car. So we can expect that German elderly people of the future will possess a driving license and drive a car in far greater numbers than elderly people today. The better possibilities of motor mobility will have consequences about traffic planning and psychological research about accidents, services for the elderly, and intergenerational relations.

Accidents, Traffic↗
PubMed1983

Private medical insurance in New Zealand: issues of membership and growth.

Questions concerning ownership of private medical insurance were included in a recent Department of Statistics' survey of a random sample of almost 7000 New Zealanders. The results indicated that 35% of those surveyed owned private medical insurance and such ownership was significantly related to various social, demographic and health related variables. The findings are discussed in terms of the possibilities for growth of private medical insurance and the implications of such growth for both the public and the private health care sectors.

Adolescent↗
PubMed1995

Local markets and systems: hospital consolidations in metropolitan areas.

OBJECTIVE: This study examines the formation of local hospital systems (LHSs) in urban markets by the end of 1992. We argue that a primary reason why hospitals join LHSs is to achieve improved positions of market power relative to threatening rivals. DATA SOURCES/DATA COLLECTION: The study draws from a unique database of LHSs located in and around metropolitan statistical areas (MSAs). Data were obtained from the 1991 AHA Annual Hospital Survey, updated to the year 1992 using information obtained from multiple sources (telephone contacts of systems, systems lists of hospitals, published changes in ownership, etc.). Other measures were obtained from a variety of sources, principally the 1989 Area Resources File. STUDY DESIGN: The study presents cross-sectional analyses of rival threats and other factors bearing on LHS formation. Three characteristics of LHS formation are examined: LHS penetration of urban areas, LHS size, and number of LHS members located just outside the urban boundaries. LHS penetration is analyzed across urban markets, and LHS size and rural partners are examined across the LHSs. PRINCIPAL FINDINGS: Major hypothesized findings are: (1) with the exception of the number of rural partners, all dependent variables are positively associated with the number of hospitals in the markets; the rural partner measure is negatively associated with the number of hospitals; (2) the number of doctors per capita is positively associated with all but the rural penetration measure; and (3) the percentage of the population in HMOs is positively associated with local cluster penetration and negatively associated with rural system partners. Other findings: (1) average income in the markets is negatively associated with all but the rural penetration measure; (2) LHS size and rural partners are both positively associated with nonprofit system ownership; and (3) they are also both negatively associated with the degree to which their multihospital systems are geographically concentrated in a single state. CONCLUSIONS: The findings generally support the argument that LHS formation is the product of hospital providers attempting to improve positions of power in their local markets.

Catchment Area, Health↗
PubMed1995

Pets, allergy and respiratory symptoms in children living in a desert country.

The aim of this paper was to study the effect of pets and other domestic animals effect on allergic respiratory symptoms among United Arab Emirates primary school children. A cross-sectional survey of 2200 school children living in both urban and rural areas was conducted using self-administered questionnaires between November 1993 and June 1994. The age range of the children studied was 6-12 years, with a mean of 9.23 and standard deviation of 2.14 years; 51% were girls and 49% were boys. Pet ownership was defined by the presence of birds, cats, camels, dogs, goats, poultry and rabbits in the home. One thousand and thirty-six (1036/2090 = 49.6%) of the 2090 families studied had at least one animal at home. However, respiratory symptoms, pet allergy, chronic cough, chronic wheeze, breathlessness or chest tightness, doctor-diagnosed asthma, rhinitis and eczema was reported by 633 families (30.3%) from 2090 studied families. The highest prevalence of reported respiratory allergy and symptoms was found in children who had pets in the past and currently. The lowest prevalence of reported respiratory allergy and symptoms was found in children who never had pets in their lives. Past pets ownership was generally associated with a higher prevalence of pets allergy and respiratory symptoms. No less than 218 (10.4%) reported removing pets in the past because of an allergy or other health problems in the child or in other family members. The risk of having pet allergy in children with animals was found to be twice than that of children without (RR: 2.13; 95% CI: 1.53-2.97; p < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Allergens↗
PubMed1995

Evaluation of a subsidy program to increase bicycle helmet use by children of low-income families.

OBJECTIVE: We have previously shown that an educational program was not effective in increasing bicycle helmet use in children of low-income families. The objective of this study was to evaluate a combined educational and helmet subsidy program in the same population, while controlling for secular trends. The secondary objective was to complete a third year of surveying children's bicycle helmet use throughout the study community. DESIGN: A prospective, controlled, before-and-after study. SUBJECTS: Bicycling children 5 to 14 years of age from areas of low average family income. SETTING: A defined geographic community within a large urban Canadian city. INTERVENTION: In April 1992, students in three schools located in the area of lowest average family income were offered $10 helmets and an educational program; three other low-income areas served as control areas. MAIN OUTCOME MEASURE: Helmet use was determined by direct observation of more than 1800 bicycling children. RESULTS: Nine hundred ten helmets were sold to a school population of 1415 (64%). Reported helmet ownership increased from 10% to 47%. However, observed helmet use in the low-income intervention area was no different from the rate in the three low-income control areas (18% versus 19%). There was no difference in the trend in helmet use during the period of 1990 through 1992 in the intervention area (4% to 18%) compared with the control areas (3% to 19%). Helmet use rates from all income areas have increased from 3.4% in 1990, to 16% in 1991, to 28% in 1992. In 1992, helmet use in the high-income areas was 48% and in the low-income areas was 20%. CONCLUSIONS: There has been a trend toward increasing helmet use in all income areas during the 3-year period. Despite encouraging helmet sales and increases in reported helmet ownership, the results of the observational study do not support the efficacy of a helmet subsidy program in increasing helmet use in children residing in areas of low average family income. Strategies to increase helmet use in children of low average family income remain a priority.

Adolescent↗
PubMed1975

Medicolegal implications of medical records.

The problem of ownership and possession of patient's medical records has been reviewed. The apparent fallacies in the presently accepted legal doctrines regarding ownership of the patient's records by health care providers have been submitted. The legal approaches and tactics available to implement the accessibility and availability of his records to the patient have been reviewed. The problems incident to the employment of statutory enactments as a means of putting the patient's record in his possession have been considered. The various legal theories that could conceivably be utilized in establishing this right on a case-to-case basis in the courts have been presented. The medicolegal implications relating to medical records have been discussed.

Confidentiality↗