New private facility woos public dollars in Calgary.
The opening of a private wing in an old hospital has caused consternation in Calgary because some people consider it a beachhead for private medicine.
Alberta↗
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Antibiotic rashes in children: a survey in a private practice setting.
OBJECTIVE: To document the frequency and severity of various types of rashes seen with commonly used oral antibiotics in the pediatric outpatient setting. DESIGN: A retrospective review of 5923 patient records at a pediatric office. SETTING: A private group pediatric practice in northern Virginia with about 12,000 registered active patients. PATIENTS AND METHODS: Approximately 50% of the clinic medical records were reviewed. All children (defined as those aged 0-18 years in this study) identified on their medical records as having developed a rash following treatment with 1 or more of the commonly used oral antibiotics were included in the study. For further validation, a questionnaire about parental recollection of description of rash, other associated symptoms, physician verification, and outcome was mailed to families with children designated as being allergic to an antibiotic. RESULTS: On a prescription basis, significantly more rashes were documented for cefaclor (4.79%) compared with penicillins (2.72%), sulfonamides (3. 46%), and other cephalosporins (1.04%). Based on the number of patients for whom each group of antibiotic was prescribed, the documented frequencies of rashes were 12.3%, 7.4%, 8.5%, and 2.6% for cefaclor, penicillins, sulfonamides, and other cephalosporins, respectively. None of the children had rashes severe enough to require hospitalization. CONCLUSIONS: In a review of almost 6000 records in a private pediatric primary care setting, rashes occurred in 7.3% of children who were given the commonly used oral antibiotics. Significantly more rashes were documented with cefaclor use than with use of any of the other oral antibiotics.
Administration, Oral↗
Patient interest in receiving audiotapes of information presented by their physicians. A survey of patients awaiting treatment in university and private practice settings.
OBJECTIVE: To investigate patient interest in, and willingness to pay for, tape recordings of physicians' explanations and recommendations. DESIGN: Survey. SETTINGS: An outpatient university-based practice and an outpatient private group practice of family physicians. SUBJECTS: A convenience sample of 425 patients. Of the 409 who agreed to complete the survey, 257 (63%) were awaiting treatment in a university practice and 152 (37%) were awaiting treatment in a private practice. RESULTS: Fifty-four percent of respondents believed that a tape would be helpful, 59.1% thought their family would ask to listen to it, and 77.5% said they would play it for family members. If asked to bring a blank tape, 84.5% indicated that they would do so. If recordings were available for purchase, respondents indicated they would be willing to pay a mean of $1.46 for them. CONCLUSIONS: If physicians offer recordings of their explanations and recommendations, patients are likely to want them. Investigations of actual compliance and health outcomes associated with the use of these recordings appear warranted.
Adult↗
The impact of Title VII departmental and predoctoral support on the production of generalist physicians in private medical schools.
Although federal support for medical education comes from several sources, only 1 targets generalist education--Title VII of the Public Health Service Act. With governmental streamlining and downsizing, the federal investment in medical education should be evaluated. We tested the relationship between 2 Title VII authorities and presence of a medical school generalist training infrastructure, and the relationship between this infrastructure and generalist production. Based on our definitions for receipt of Title VII support, generalist infrastructure, and generalist production, we found that, for private schools, sustained receipt of Title VII funds directed for undergraduate medical education is positively associated with presence of family medicine departments, which is positively associated with higher rates of generalist production. Establishment and maintenance of family medicine departments in private schools and their generalist production are positively associated with Title VII support. Title VII support in public schools, the major generalist producers, has less of a unique measurable impact on generalist production.
Education, Medical, Graduate↗
Primary care relationships in pediatric hospital clinics vs private offices.
OBJECTIVE: To explore residents' opinions regarding various aspects of continuity clinic in a hospital clinic vs private office, with emphasis on primary care relationships. DESIGN: Cross-sectional study. Residents (N = 47) who had spent time in both a clinic and an office setting were given a 49-question survey. Five-point Likert scales were used to quantify the residents' sense of quality of various aspects of training. A set of 10 statements was included to assess the degree to which residents took primary care responsibility for a cohort of patients. Residents also chose the combination of setting(s) (office, clinic, or both) that they considered optimal for their training. SETTING: Large metropolitan area. The hospital clinic, based in a freestanding children's hospital, served a primarily indigent population. The private offices (n = 20) served the surrounding suburbs and primarily middle- and upper-income families. HYPOTHESIS: Residents would perceive their clinic-based experience as significantly better than their office-based experience with respect to establishing primary care relationships with their patients. RESULTS: Residents' ratings for the primary care responsibility index were significantly higher for the clinic than for the office (mean + SD, 4.1 + 0.8 vs 2.2 + 0. 9; P<.001). Residents found many aspects of the 2 settings comparable, including overall educational value and the preceptor as a positive role model. The office was rated higher for business and managed care aspects, care of school-age children, and experience with adolescents. The clinic was rated higher for care of infants and complex psychosocial and complex medical issues. Two thirds of residents chose the combined half day in office and half day in clinic as their preferred training model. CONCLUSION: The opportunity for residents to take advantage of the unique strengths of both clinic- and office-based training may significantly improve their overall residency experience. Arch Pediatr Adolesc Med. 2000;154:1209-1213.
Attitude of Health Personnel↗
Newborn hypothyroid screening. The private sector.
Newborn hypothyroid screening in four private hospitals was prospectively evaluated and compared with a state screening program. During 1982 the hospitals screened a total of 10,786 infants compared with 47,525 by the state. Eight cases of primary hypothyroidism were confirmed by the state, for an incidence of one in 5,941. No cases were detected by the hospital programs. The cost for all infants screened in the private hospitals was 51.5 times more than the total cost of the state program, yet the state screened 4.4 times more infants.
Cost-Benefit Analysis↗
Outcome of patients with metastatic breast carcinoma treated at a private medical oncology clinic.
BACKGROUND: Metastatic breast carcinoma usually is fatal. The median survival after recurrence is 2 years. Five-year survival after recurrence is approximately 10-20%. Although encouraging data have been reported from clinical trials, two issues confound the translation of clinical research to the general medical community: patient selection bias and the absence of untreated controls. Therefore, the authors examined their community-based metastatic breast carcinoma patients, comparing their results with reports from clinical trials and with untreated historic controls. METHODS: This was a nonconcurrent cohort study of 407 community-based metastatic breast carcinoma patients treated at the authors' private medical oncology clinic in northeast Louisiana. Prognostic variables were correlated with survival time. RESULTS: The median age of the patients at the time of diagnosis of breast carcinoma was 61 years. The median age at the time of first recurrence was 65 years. The median overall survival and median survival after recurrence were 4. 5 years and 20.1 months, respectively. The 5-year and 10-year survival rates were 17% and 2.5%, respectively. CONCLUSIONS: Although clinical trial participants and the authors' private practice cohort are incommensurable, outcomes in these disparate groups were similar but, unfortunately, not much different from those of untreated historic controls.
Adult↗
Late-life depression in private practice depressed outpatients: a 203-case study.
OBJECTIVE: To establish the prevalence of late-life depression in unipolar/bipolar depressed outpatients in private practice, to compare it with depression in younger patients and to compare its early/late-onset subtypes. METHODS: Two hundred and three consecutive unipolar/bipolar depressed outpatients presenting for treatment of depression were interviewed with the Comprehensive Assessment of Symptoms and History structured interview and depression severity was assessed with the Montgomery and Asberg Depression Rating Scale and the Global Assessment of Functioning Scale. RESULTS: Prevalence was 21%. Late-life depression had significantly more unipolar/fewer bipolar patients, higher age at onset, longer duration of illness and lower psychiatric comorbidity than depression in younger patients. Severity, psychosis, chronicity and recurrences were not significantly different. Early-onset late-life depression had significantly lower age at baseline, longer duration of illness and more recurrences than late-life depression. CONCLUSIONS: Findings support suggested age subdivisions of depression and provide a picture of private practice late-life depression.
Adult↗
A myeloma M 104E private idiotope is represented predominantly among anti-dextran, peritoneal cavity Ly-1+ precursor B cells.
Public and private idiotopes (Id) had been defined in the BALB/c anti-dextran B1355 fraction S (Dex) response by means of syngeneic monoclonal anti-M 104E Id antibodies. Most of the primary anti-Dex antibodies shared the public Id-1 while the private Id-5 constituted a comparatively low, but highly variable proportion of humoral anti-Dex antibodies of individual mice. In the present work we have analyzed by limiting dilution the expression of these two Id by anti-Dex B cell precursors from the spleen and peritoneal cavity of BALB/c mice. Testing spleen cells we found about 65% of anti-Dex precursors to be Id-1+ and only a minority to be Id-5+. Treatment with anti-Ly-1 and complement was without any effect on anti-Dex precursors from spleen. Anti-Dex B cell precursors among peritoneal cavity lymphocytes differed from those found in the spleen in two ways. First, on average, 50% of them were Id-5+; second, about 80% carried the Ly-1 marker. Both markers are, therefore, expressed on at least 30% of anti-Dex B cell precursors from the peritoneal cavity but rarely on anti-Dex precursors from the spleen.
Animals↗
Private and social time preferences for health and money: an empirical estimation.
The main objective of this paper is to examine the relationship between individual time preference for health and money. To that end, we tested whether individuals discount their own health at the same rate as their own money and, similarly, whether they discount social health in the same terms as social money. To offer private and social money and health choices is, to the best of our knowledge, new in the literature on the estimation of time preferences and, in our view, represents a valid way in which to respond to the question of the uniform or differential discount of health, as against monetary, consequences. The results of our estimation suggest that a sample of students exhibit higher time preference rates for health than money, this being the case when the exchanges are both private and public.
Adult↗
Informed choice in women attending private clinics to undergo first-trimester screening for Down syndrome.
OBJECTIVES: Informed choice for prenatal screening has long been considered an essential aspect of service provision, and has been researched extensively in the second trimester. This study aims at examining whether women having first-trimester screening in a private clinic had made an informed choice. METHODS: A cross-sectional survey recruited women having first-trimester screening at specialist ultrasound practices. Two questionnaires containing a validated Multidimensional Measure of Informed Choice (MMIC) were self-administered pre- and post-screening. RESULTS: MMIC was completed by 81% (163/202) of women. Ninety-nine percent of women had a positive attitude towards screening, therefore informed choice was essentially measured on knowledge alone. Pre-screening, 68% made an informed choice, compared with 74% post-screening (chi2 = 1.6, p = 0.21 (McNemar)). Knowledge was associated with education level, information sources and perception of screening as routine or optional. CONCLUSIONS: The Australasian Guidelines on prenatal screening state that all women having testing should be provided with written information, and it should be ensured that they have appropriate understanding of the test(s). These guidelines are not being met, even in private clinical care. Health professionals should ensure that all women are provided with suitable information about prenatal screening that is tailored to their level of education and individual needs, and should emphasise that screening is optional.
Adult↗
Private polymorphisms: how many? How old? How useful for genetic taxonomies?
The data on the distribution and frequencies of private polymorphisms in the tribal populations of Central and South America are used to address the question of the extent to which such data can be used to address questions of phylogenetic history. It is shown that due to the great increases in population number that accompanied agricultural development, most private polymorphisms have arisen since population settlement and tribal differentiation. Conversely, the absence of Amerindian variants of wide distribution confirms the small size of the hemispheric population until relatively recent times. Patterns of recent population decline and recovery that accompanied European contact since 1492 have also had a strong impact on the age distribution of extant variants, eliminating many that were relatively young in 1492. The majority of surviving variants that have achieved polymorphic frequencies in a tribe or group of tribes are from 100 to 400 generations old (2500 to 10,000 years). Such genetic variants thus characterize tribes, or groups of closely related tribes, but do not provide a greater time depth of phylogenetic history.
Alleles↗
Hand-arm vibration syndrome and its prevalence in the present status of private forestry enterprises in Japan.
Currently there are no limitations on age of employment on private forestries in Japan. Hence, it was hypothesized that in these kind of enterprises, elderly chain saw operators, or those with long-term exposure, might be at higher risk of developing hand-arm vibration syndrome (HAVS). We consequently investigated the prevalence of HAVS in 447 chain saw workers on private forestries in Gifu Prefecture, Japan, with particular reference to age and exposure period. Of this population, 43 (9.6%) had signs and symptoms of vibration-induced white finger (VWF), and among these workers the severity of finger blanching was significantly correlated (P less than 0.01) with the exposure period. Classification of all subjects by exposure period showed that workers with greater than or equal to 30 years' exposure had higher prevalences of VWF (20.9%) and numbness of the hands (25.4%) compared to other groups. Significant differences (P less than 0.01) were found between the functional capacities of workers with VWF and those of control subjects. We concluded that (a) the elderly chain saw operators and those with longer exposure should be moved to other jobs with a lower or no risk of exposure to vibration, and (b) the results of screening tests, even without cold water immersion (which we did not employ, in order to protect workers' hands), could be helpful for the identification of workers with VWF.
Forestry↗
Conservation of HLA class I private epitopes in macaques.
Fifty mouse monoclonal antibodies (mAb) specific for HLA class I epitopes were compared for their reactivity against two closely related nonhuman primate species, pigtailed macaques (Macaca nemestrina, Mn) and longtailed macaques (M. fascicularis, Mfl), which diverged from the hominoids 23-40 million years ago. An analysis of Nei's genetic identity (I) and distance (D) based on reactivity of all class I-specific mAb showed, as expected, that the macaques are more closely related to each other (I = 0.959) than to man (I = 0.782 for Mn and 0.859 for Mfl). However, there were clear differences in genetic similarity with respect to certain epitopes. Macaques were most different from each other and from man in expression of heterologous epitopes recognized by the mouse that are not polymorphic among humans. In contrast, the most polymorphic epitopes unique to single HLA alleles, so-called private epitopes, were present in all the species, and neither macaque species could be distinguished from humans, suggesting that certain class I private epitopes may be highly conserved in evolution.
Animals↗
Monoclonal antibodies defining a minor and a private idiotope on human rheumatoid factors.
Two mouse monoclonal antibodies (mAb A216-5 and L 49-3) with antiidiotypic activity against two human monoclonal IgM rheumatoid factors (IgM RFs) were defined. Each of these monoclonal antibodies (two mouse IgG 1K) reacted with an idiotope located on the heavy chain of the immunizing monoclonal IgM RF and was able to inhibit RF fixation to the antigen. These monoclonal antibodies did not react with other monoclonal IgM RFs from patients with macroglobulinemias or cryoglobulinemias and, therefore, did not recognize the known cross-reactive idiotopes of human monoclonal RFs. The presence of both 216-5 and 49-3 idiotopes on polyclonal IgM RFs from unrelated patients was undetectable by the inhibition assays. However, using a four-stage solid-phase radioimmunoassay, the 216-5 idiotope (minor), but not the 49-3 idiotope (private), was frequently present at a low concentration on polyclonal IgM RFs from patients suffering from rheumatoid arthritis, primary Sjögren syndromes, various infectious diseases, systemic vasculitis, and sarcoidosis and during aging. Interestingly, the 216-5 idiotope was undetectable among polyclonal IgM RFs of 12 normal adults. The main conclusions of these data are the following. The definition of minor and private idiotopes of human RFs requires the use of assays able to detect low amounts of antibodies among polyclonal Ig. The anti-IgG B cells which are sometimes clonally expanded during Waldenström diseases and cryoglobulinemias can also be activated during nonneoplastic diseases, among the other RF-secreting B cells.(ABSTRACT TRUNCATED AT 250 WORDS)
Antibodies, Monoclonal↗
Types of private speech produced by hyperactive and nonhyperactive boys.
Types and amount of private speech (audible talking that is not addressed to another person) were assessed during the free play of 16 hyperactive and 16 nonhyperactive boys. Verbalizations were coded into nine categories that denoted the boys' level of use of verbal control of their own behavior (Luria, 1961; Kohlberg, Yeager, & Hjertholm; 1968). Differences in amount and type of private speech between hyperactive and nonhyperactive boys were found to indicate that hyperactive boys may be presenting a specific or general cognitive lag in development. Treatment ramifications are discussed.
Child↗
Private school activities and psychosomatic problems in Japanese children.
This paper investigates the relation between private school activities and psychosomatic problems in Japanese elementary school children. Of 1,073 children studied, 67.3 percent attended private schools to study such subjects as calligraphy, abacus, and music. Of these children, 25.3 percent attended three to four times per week, and 18.1 percent five times and more. Statistical analysis showed that frequently attending children exhibited symptoms of dizziness, sleep disturbance, and other psycholphsiological problems. The results may warn educators as well as parents of some of the unfavorable effects of these extracurricular activities.
Child↗
[Models for determining optimal nutrition in private households].
Members of private households have different nutrient requirements. In general, they eat the same dishes in different quantities. The menu plan is admissible if it corresponds to the recommended dietary allowances. It is acceptable if it meets the eating habits. It is optimal if it meets the constraints mentioned and best reaches an objective. It is the aim of this paper to describe models for the determination of optimal nutrition and to evaluate them with respect to their suitability for solving decision problems in private, multi-person-households. The fewer the model-intern restrictions in the variability of quantities of food stuffs, kind and/or quantities of dishes, the better are the "optimal" solutions that are found with the model. A simultaneous determination of kind and quantity of dishes reaches the model purpose better than a stepwise determination. This is shown in an example problem.
Feeding Behavior↗