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PubMed2004

That's my hand! Activity in premotor cortex reflects feeling of ownership of a limb.

When we look at our hands, we immediately know that they are part of our own body. This feeling of ownership of our limbs is a fundamental aspect of self-consciousness. We have studied the neuronal counterparts of this experience. A perceptual illusion was used to manipulate feelings of ownership of a rubber hand presented in front of healthy subjects while brain activity was measured by functional magnetic resonance imaging. The neural activity in the premotor cortex reflected the feeling of ownership of the hand. This suggests that multisensory integration in the premotor cortex provides a mechanism for bodily self-attribution.

Body Image↗
PubMed2001

Pet ownership, but not ace inhibitor therapy, blunts home blood pressure responses to mental stress.

In the present study, we evaluated the effect of a nonevaluative social support intervention (pet ownership) on blood pressure response to mental stress before and during ACE inhibitor therapy. Forty-eight hypertensive individuals participated in an experiment at home and in the physician's office. Participants were randomized to an experimental group with assignment of pet ownership in addition to lisinopril (20 mg/d) or to a control group with only lisinopril (20 mg/d). On each study day, blood pressure, heart rate, and plasma renin activity were recorded at baseline and after each mental stressor (serial subtraction and speech). Before drug therapy, mean responses to mental stress did not differ significantly between experimental and control groups in heart rate (94 [SD 6.8] versus 93 [6.8] bpm), systolic blood pressure (182 [8.0] versus 181 [8.3] mm Hg), diastolic blood pressure (120 [6.6] versus 119 [7.9] mm Hg), or plasma renin activity (9.4 [0.59] versus 9.3 [0.57] ng. mL(-1). h(-1)). Lisinopril therapy lowered resting blood pressure by approximately 35/20 mm Hg in both groups, but responses to mental stress were significantly lower among pet owners relative to those who only received lisinopril (P<0.0001; heart rate 81 [6.3] versus 91 [6.5] bpm, systolic blood pressure 131 [6.8] versus 141 [7.8] mm Hg, diastolic blood pressure 92 [6.3] versus 100 [6.8] mm Hg, and plasma renin activity 13.9 [0.92] versus 16.1 [0.58] ng. mL(-1). h(-1)). We conclude that ACE inhibitor therapy alone lowers resting blood pressure, whereas increased social support through pet ownership lowers blood pressure response to mental stress.

Analysis of Variance↗
PubMed1992

[Clear connection between gun ownership and suicide. 92 per cent of attempts result in death].

In a retrospective study involving 20 police districts in Sweden, 348 completed or attempted suicides with firearms were found to have occurred during the period, 1976-88. Statistics on civilian firearms ownership were obtained from police authorities. Firearm suicide was found to be significantly correlated to gun ownership, through the 25 per cent increase in gun ownership during the period was not accompanied by a corresponding increase in the overall suicide rate. The head was the primary target in suicide attempts, both with longarms (rifles and shotguns) and with handguns (pistols and revolvers). Handgun injuries were more common among the survivors. Only 4.6 per cent of the victims survived and could be discharged from hospital. Nearly 10 per cent of those using shotguns or rifles used a string, a rod or their toes to reach the trigger; all of them died. Apart from such well-known predisposing factors such as psychiatric disorders or alcohol abuse that were present in 43 per cent of cases, 24 per cent of the victims were found to have had somatic problems instead.

Adolescent↗
PubMed1995

[Transformation of ownership in occupational health services].

The process of the ownership transformation in occupational health services began in 1991. At that time Section X of the Labour Code was amended by introducing the system according to which employers participate in the costs of organization of occupational health services and other expenditure involved in health care of their workers. In addition, the Health Service Institutions Act of August 30, 1991 prepared the ground for the organization of health care units by various economic subjects including employers if the responsibility for taking care of workers' health is included in the statute of such a unit. From 1992 the process of the ownership transformation in occupational health services has started to progress. New non-public occupational health care units began to be established mainly by numerous institutions. In 1992 already 62 units were set up in six voivodships (provinces). In 1993 their number increased to 306 and they were located in 20 voivodships. The analysis of facilities and activities of non-public occupational health care units, based on the data available, indicated, however, that the process of the ownership transformation has not satisfied to date all expectations concerning the change in the quality of services rendered. Although these new units have not been established by the state administration their activities show similar week points as those belonging to the old system of industrial health services. Still treatment accounts for 80% of their activities, secondary care represents almost the same standard as in the public health service sector.(ABSTRACT TRUNCATED AT 250 WORDS)

Employer Health Costs↗
PubMed1993

[Visits to emergency rooms and hospital ownership categories].

Trends in emergency room (ER) visits in Israeli general hospitals were analyzed and differences were found according to category of hospital ownership, Data for 1986-90 were gathered from 23 hospitals which included 90% of the country's acute care beds. An upward trend in ER visits in the 1970's and early 1980's ended in 1987. Despite a 7% increase in population during 1987-90, total ER visits decreased by 4%. In Jerusalem's public hospitals ER visits decreased by 13%, in government and government-municipal hospitals by 7%, while in Kupat Holim Clalit hospitals there was a 2% increase. The proportion of ER visits resulting in hospital admissions also varied by hospital ownership and also among individual hospitals within any given ownership category. Factors which might influence ER visits include size and composition of populations, development of alternative sources of care in the communities, price of services, changes in hospital admission policies, nature of the competition between hospitals, supply of physicians, and the use of ER's for primary care.

Emergency Service, Hospital↗
PubMedDate not supplied

Firearm ownership and safety practices: a random-digit dial survey of San Diego.

A random-digit dialing procedure was used to identify correlates of gun ownership and storage for a defined population. Of subjects contacted, 525 (64.7%) completed the survey. Subjects were generally representative of the population with slight underrepresentation of minority groups (16% were non-Caucasian). Of respondents, 129 (25.2%) reported owning a gun. Of these, 72.6% owned a handgun, 55% kept firearms for protection, 27.7% kept gun(s) loaded and ready to shoot, 66.4% kept gun(s) locked, and 46.2% carried gun(s) in the car some of the time. The strongest correlates of ownership were formal training (odds ratio [OR] = 3.52; 95% confidence intervals [CI] = 2.18, 5.67) and having been shot at (OR = 2.15; 95% CI = .97, 4.75). The strongest correlates of loaded gun status were children in the home (OR = 6.46; 95% CI = 1.18, 35.42), formal training (OR = 4.65; 95% CI = 1.04, 20.77), and keeping a gun for protection (OR = 8.82; 95% CI = .87, 89.83). Having been shot at was negatively correlated with keeping one's gun(s) locked (OR = .26; 95% CI = .07, 1.01). The strongest correlates of keeping a gun in the car were handgun ownership (OR = 11.44; 95% CI = 1.02, 128.65), keeping one's gun(s) loaded (OR = 3.79; 95% CI = 1.00, 14.43), and formal training (OR = 3.34; 95% CI = .82, 13.65). The data suggest that leaving firearms loaded and unlocked is common. Results may provide guidance in the design of interventions to decrease firearm-related morbidity and mortality.

Adult↗
PubMed2001

The effect of health on acute care supplemental insurance ownership: an empirical analysis.

The empirical effect of health status on private insurance ownership is a mixture of the effect of health on the demand for insurance (subjected to adverse selection) and its effect on the insurer's underwriting practice (subjected to risk-selection). Using bivariate partial observability probit models, this paper provides an empirical identification of health effects on the probability of application and on the probability of rejection in the Israeli market for acute care supplemental health insurance. The analysis shows that while the reduced-form health effect on ownership is negligible, the structural effects are sizeable and indicate that sicker individuals are more likely to apply, but are also more likely to be rejected. The policy implications of the above findings are discussed in the context of the Israeli health system.

Acute Disease↗
PubMed1995

Physician ownership of ancillary services: indirect demand inducement or quality assurance?

This paper analyzes two competing explanations for the ownership of ancillary facilities by referring physicians: indirect demand inducement and quality assurance. Consistent with the demand-inducement explanation we find physician-owned clinics treat patients for 50 percent more visits than do independent clinics and the differential is directly related to factors facilitating demand inducement. We find no difference in quality of care across ownership structures, however. In further support of the demand-inducement hypothesis we find that physical therapists are less likely to work in physician-owned clinics in states where therapists are allowed to practice independently.

Ambulatory Care Facilities↗
PubMed2006

Pet ownership in immunocompromised children--a review of the literature and survey of existing guidelines.

Pet ownership has been associated with both emotional and physical health benefits. However, owning pets may also pose health risks to immunocompromised patients through zoonotic transmission of disease. Our initial impression was that there is a lack of any evidence base in information given by health care professionals regarding these risks. We therefore aimed to produce evidence-based guidelines addressing this issue. A Pubmed search was undertaken and a variety of literature on zoonoses reviewed. Existing guidelines were evaluated and a survey of all Paediatric Oncology Centres in the UK performed. There is a paucity of level 1 and 2 data addressing this issue and clearly more studies, particularly Randomised Controlled Trials (RCTs), are required. Nevertheless, general themes emerged and certain specific guidance was produced based on that produced by the Centres for Disease Control and Prevention in the US. Animal-associated pathogens of concern include Toxoplasma gondii, Cryptosporidium spp., Salmonella spp., Campylobacter spp., Giardia lamblia, Rhodococcus equi, Bartonella spp., Bordetella bronchiseptica, Chlamydia psittaci and dermatophytes. Despite this, the literature would suggest that with the exception of Bartonella henselae and dermatophytes only a relatively small number of infections in people are likely to be associated with pet contact. The majority of pet species do not appear to pose a major risk to immunocompromised children. Some animals, particularly reptiles, should be avoided because of the high risk of salmonellosis. Guidelines include general advice on good hygiene practices, veterinary care, pet foods, purchasing of new pets and age restrictions. Health care professionals should actively enquire about household pets and provide accurate information and practical advice on how to minimise the risk of infection. However, the overall benefits of the human-animal bond must be considered and with proper handling and husbandry immunocompromised patients should be able to continue to enjoy the significant benefits of pet ownership.

Age Factors↗
PubMed2001

Hospital ownership and cost and quality of care: is there a dime's worth of difference?

Nonprofit organizations may predominate when output quality is difficult to monitor. Hospital care has this characteristic. This study compared program cost and quality of care for Medicare patients hospitalized following onset of four common conditions by hospital ownership. Payments on behalf of Medicare patients admitted to for-profit hospitals during the first 6 months following a health shock were higher than for those admitted to other hospitals. With quality measured in terms of survival, changes in functional and cognitive status, and living arrangements, we found no differences in outcomes by hospital ownership.

Aged↗
PubMed2004

Evaluating the effect of regulatory prohibitions against risk selection by health status on supplemental insurance ownership in Israel.

In Israel, supplemental insurance, which covers services not included in the mandatory basic benefits package, is offered by sick funds and regulated by the Ministry of Health. In 1998, policy regulations were set to eliminate barriers that prevented the ill from purchasing supplemental insurance, thereby increasing equality and risk solidarity. In this paper, we examine whether these regulations have indeed changed the extent of ownership and characteristics of policyholders, using data from surveys conducted in 1995, 1997, 1999, and 2001. The findings indicate that while there were no significant changes between 1995 and 1997, there was a significant increase in ownership among those with poor health status after the new regulations came into effect. We conclude that administrative regulations can influence the structure of supplemental insurance to achieve desired social values, and discuss additional policy options that are currently under debate in Israel to further promote equality and solidarity in this market by increasing accessibility to low income and other underserved populations.

Adult↗
PubMed1997

Situation models and abstract ownership relations.

Six experiments used a fan-effect paradigm to test whether people can use the abstract relation of ownership to help integrate information into situation models. People studied sentences of the form The [person] owns/is buying the [object] for a later recognition test. The integration of sentences into a situation model (as evidenced by an attenuated or absent fan effect) was observed when the verb phrase referred to a specific event (is buying) and the objects could all be bought in the same place (e.g., a drugstore). This organization did not occur either when the verb phrase referred to general ownership (owns) or when the items were unlikely to be purchased in a single location (e.g., television and car). It was concluded that although abstract relations can be used to segregate information into sets that can be integrated into situation models, this integration is more likely when it can be embedded within a spatial-temporal framework.

Attention↗
PubMed2005

The possessive self as a barrier to conflict resolution: effects of mere ownership, process accountability, and self-concept clarity on competitive cognitions and behavior.

The authors propose that people have difficulty managing conflict because they quickly develop ownership of arguments and positions they use in the dispute, that these arguments and positions become part of their (extended) self-concept, and that any opposition or counterargumentation therefore becomes an ego-threat. Four studies reveal that individuals value arguments and beliefs more when these are associated with the self and that anticipated or real opposition triggers ego-defensive cognition and behavior, including competitive communication, retaliatory responses, negative perceptions of the partner, and attitude polarization. These effects were weaker when epistemic needs were raised through process accountability or when individuals had high rather than low self-concept clarity. The authors conclude that because people develop ownership of arguments and make these part of their self-concept, conflict is difficult to manage and bound to escalate.

Adaptation, Psychological↗
PubMed2002

Transgenic crops, biotechnology and ownership rights: what scientists need to know.

Ownership of intellectual and tangible property (IP/TP) rights in agricultural biotechnology (ag-biotech) and transgenic plants has become critically important. For scientists in all institutions, whether industrialized or developing country, public or private sector, an understanding of IP/TP rights is fundamental in both research and development. Transgenic plants and ag-biotech products embody numerous components and processes, each of which may have IP/TP rights attached. To identify these rights, a transgenic plant or ag-biotech product must be dissected into its essential components and processes, with each 'piece' analysed under the IP/TP 'microscope'. This product deconstruction is an integral step in product clearance (PC) analysis leading to freedom to operate (FTO). To facilitate a PC analysis, the following points are important: (1) knowing what one has and where it's from, (2) organizing material transfer agreements and licences, (3) researching scientific and patent databases and relevant literature, (4) instituting a laboratory notebook policy, (5) keeping track of ownership of germplasm and plant genetic resources, and (6) promoting ongoing IP/TP management, awareness and training. However, a FTO opinion does not solve the IP/TP issues of releasing a transgenic plant or ag-biotech product; rather, it is a management tool for assessing the risks of litigation. When transferring transgenic plants or ag-biotech to developing nations, scientists from industrialized countries have the heightened responsibility of verifying that IP/TP issues are fully addressed and documented. Successful technology transfer goes beyond research, development and licensing; it is an holistic package leading to long-term partnerships in international development. Managing IP/TP requires capacity-building in scientists and technology transfer offices, in both industrialized and developing countries.

Biotechnology↗
PubMed1988

The effects of regulation, competition, and ownership on mortality rates among hospital inpatients.

We examined the influence of the regulation of hospital rates, state certificate-of-need programs, competition, and hospital ownership on mortality rates among inpatients receiving care under Medicare for 16 selected clinical conditions that were studied as a group. Data were obtained from the records of 214,839 patients who received care in 981 hospitals in 45 states from July 1, 1983, through June 30, 1984. We found significant associations between higher mortality rates among inpatients and the stringency of state programs to review hospital rates (P less than or equal to 0.05), the stringency of certificate-of-need legislation (P less than or equal to 0.01), and the intensity of competition in the marketplace, as measured by enrollment in health maintenance organizations (P less than or equal to 0.05). Hospitals in the states with the most stringent review procedures for hospital rates had ratios of actual to predicted death rates that were 6 to 10 percent higher than those of hospitals in states with less stringent rate-review programs (P less than or equal to 0.001). Hospitals in the states with the most stringent procedures for reviewing applications for certificates of need had ratios of actual to predicted death rates that were 5 to 6 percent higher than those of hospitals in states with less stringent certificate-of-need procedures (P less than or equal to 0.05). There was no statistically significant association between mortality rates among inpatients and either the type of hospital ownership or the number of hospitals competing in the market area. Additional analyses, which examined alternative explanations for these findings, failed to change the results. These findings raise serious concerns about the welfare of patients who are admitted to hospitals in highly regulated areas and those admitted to hospitals in relatively competitive markets. They suggest that it is important to incorporate quality-assurance procedures and systems to monitor patients' outcomes into public and private programs designed to contain costs or promote competition, or both.

Aged↗
PubMed1992

Consequences of physicians' ownership of health care facilities--joint ventures in radiation therapy.

BACKGROUND: Physicians are increasingly the owners of health care facilities to which they refer patients for services but at which they do not practice. We studied such ownership arrangements, known as "joint ventures," in the field of radiation therapy, examining their effects on access, use of services, costs, and quality. METHODS: Because 44 percent of free-standing facilities providing radiation therapy in Florida in 1989 were joint ventures, as compared with 7 percent elsewhere (95 percent confidence interval, 3 to 10 percent), we compared data for Florida with comparable data for the remainder of the United States. We also compared radiation-therapy facilities in Florida that were established as joint ventures with those that were not. Since most data were derived from entire populations rather than from samples, any differences found were of necessity statistically significant. RESULTS: No joint-venture facilities providing radiation therapy were located in inner-city neighborhoods or rural areas, but 11 percent of other free-standing facilities and hospital-based facilities were located in such areas. Among free-standing facilities, joint ventures received 39 percent of their revenues from patients with well-paying insurance coverage, as compared with 31 percent for facilities that were not joint ventures (P < 0.01). The frequency and costs of radiation-therapy treatments at free-standing centers were 40 to 60 percent higher in Florida than in the rest of the United States; there was no below-average use of radiation therapy at hospitals or higher cancer rates that explained the higher rates of use or higher costs in Florida. Radiation physicists at joint-venture facilities (the principal personnel involved in quality control other than physicians) spent 18 percent less time with each patient over the course of treatment than did their counterparts at free-standing facilities that were not joint ventures (P < 0.05). Mortality among patients with cancer in Florida was not lower than the U.S. average, even though joint ventures are much more common in that state. CONCLUSIONS: Joint ventures in radiation therapy appear to have adverse effects on patients' access to care. They also appear to increase the use of services and costs substantially. Some indicators show that joint ventures cause either no improvement in quality or a decline. Our results add to the evidence indicating that physicians' self-referral generally has negative consequences. We recommend legislation to ban ownership of joint ventures by referring physicians. Such legislation needs to be carefully designed in order to achieve its objectives and forestall new, financially abusive arrangements.

Ambulatory Care Facilities↗
PubMed1990

An analysis of hospital union election activity: 1985-1987--by hospital ownership, size, and system, and employee organization and bargaining-unit size.

During the three-year period 1985-1987, there were 238 elections in nongovernmental, short-term hospitals to determine whether or not unions would represent the employees. Unions had a success rate of 47.1 percent, similar to that of earlier years. This study reports these election results by hospital and election characteristics. For hospitals, the analysis includes elections by census region, ownership, bed size, and multi-institutional characteristics. For elections, the analysis includes the nature and type of election, employee organization, and employee bargaining-unit-size characteristics. This study concludes that the number of union elections decline as hospital bed size increases, and the union success rate is curvilinear and higher in both small and very large hospitals; union success declines as bargaining-unit size increases. Investor-owned and nonprofit, religious hospitals that are members of multi-institutional systems have lower union success rates than nonsystem hospitals do in their ownership category. However, unions are much more successful in multi-union and decertification elections compared with single-unit elections and initial recognition elections.

Data Collection↗
PubMed1997

Is ownership more important than the scientific credibility of audit protocols? A survey of medical audit advisory groups.

BACKGROUND: It is commonly accepted that ownership is an important factor in determining the acceptability and use of protocols or guidelines. OBJECTIVES: We aimed to determine whether Medical Audit Advisory Groups (MAAGs) are prepared to accept and use audit protocols developed systematically by an external agency. METHOD: A postal questionnaire was sent to all 105 MAAG chairmen in England and Wales to seek their views on the external development of protocols, the inclusion of evidence-based prioritized criteria, the general design of the protocols issued by the Lilly Audit Centre and the numbers of practices reported by MAAGs as making use of at least one of the first four protocols issued. RESULTS: Ninety-five MAAGs (90%) responded. Of these, 86% were in favour of the external development of protocols, and 98% and 94%, respectively, found evidence-based and prioritized criteria valuable; 98% felt the overall design and content of the Audit Centre protocols were excellent or good. A total of 1018 practices was known to have made use of one of these protocols, 261 taking part in multi-practice audits organized by their MAAGs. CONCLUSION: Ownership is not necessarily more important than scientific credibility and/or perceived utility. Externally developed audit protocols containing evidence-based, prioritized review criteria are acceptable to MAAGs, which are prepared to recommend their use in practice. Accordingly, such systematically developed protocols offer a promising and practical method for improving clinical effectiveness. Further research is needed, however, to determine the comparative impact on standards of care of protocols and other methods such as clinical guidelines.

Attitude of Health Personnel↗