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PubMed2002

Predicting closure of private substance abuse treatment facilities.

Researchers in organizational ecology have long been interested in identifying the factors associated with organizations closing their doors. Though the predictors of closure have been examined across many different types of organizations, private substance abuse treatment centers, often characterized as unstable and having high closure rates, have not been subject to empirical study. Data for this study were derived from a nationally representative longitudinal study of 450 private substance abuse treatment centers. Contrary to most previous research, center age was not a significant predictor of closure. Significant predictors included center capacity, being a freestanding facility, the percentage of clients covered by Medicaid, and the ratio of patients to full-time equivalents.

Forecasting↗
PubMedDate not supplied

Does service diversification enhance organizational survival?: Evidence from the private substance abuse treatment system.

The rate of closure among US substance abuse treatment facilities in the private sector is considerable, further reducing access to treatments that are already in short supply in many locales. Using a nationally representative sample of 450 substance abuse treatment centers, this research considers the extent to which specific types of service diversification reduce the likelihood of treatment center closure in the private sector. Over the study period, 26.4% of centers ceased to offer substance abuse treatment services. There was mixed evidence that centers offering a more diversified array of services had a lower likelihood of closure. Specifically, the number of treatment tracks tailored to specific demographic groups was negatively associated with the likelihood of closure. There was a positive association between closure and offering an inpatient psychiatric program. These findings suggest that there may be strategic benefits in expanding services to meet the needs of diverse clientele.

Adult↗
PubMed2003

[Structured treatment and teaching programs and an improvement in private health care lead to a better quality of diabetes care. JEVIN, a population-based trial 1989/90 up to 1999/2000].

UNLABELLED: AIMS AND HYPOTHESES: JEVIN ( Jena's St. Vincent Trial) is a prospective, 10-year follow-up, population-based survey of all insulin-treated patients with type 1 and type 2 diabetes mellitus aged 16-60 years and living in the city of Jena (100,000 inhabitants), Thuringia. It aims to show the effects of recent changes in the health care system and new treatment strategies. During the period from 1989/90 to 1994/95, the health care system was decentralized. There has been an broad implementation of postgraduate educational courses for primary care physicians, of structured treatment and teaching programs (TTP), of intensified insulin therapy, and blood glucose self-monitoring for all patients. PATIENTS AND METHODS: 190 patients (83% of the target population), 244 patients (90%) and 261 patients (90%) were studied in 1989/90, 1994/95 and 1999/2000, respectively. RESULTS: Up to 1994/95, the relative HbA(1c) (HbA(1c)/mean normal) of patients with type 1 diabetes increased (1994/95: 1.65 +/- 0.35 vs. 1989/90: 1.52 +/- 0.31; p = 0.002). For patients with type 2 diabetes mellitus it remained constant (1.75 +/- 0.4 vs. 1.78 +/- 0.31; p = 0.669). During the period from 1994/95 to 1999/2000, there was a substantial improvement in the relative HbA(1c) of both, patients with type 1 (1.48 +/- 0.3; p < 0.0001), and type 2 diabetes (1.47 +/- 0.25; p < 0.0001). Up to 1999/2000, 87.7% of the patients with type 1 (1989/90: 0%, 1994/95: 73.2%) and 96.6% of the patients with type 2 diabetes (1989/90: 0%, 1994/95: 89.7%) participated in TTPs. Similarly, the percentage of patients with intensified insulin therapy (type 1/2: 1989/90: 5.3%/3.4%, 1994/95: 80.3%/30.8%, 1999/2000: 94.7%/48.3%) and the frequency of weekly blood glucose self-monitoring (type 1/2: 1989/90: 1 [0-28]/0 [0-21], 1994/95: 25 [0-49]/14 [0-35], 1999/2000: 28 [0-70]/21 [0-46]) increased. Moreover, there was a drastic improvement in private health care: up to 1999/2000, about 90% of all the patients studied were treated by primary care physicians who took part in postgraduate educational courses. CONCLUSIONS: During the past decade, there has been a substantial improvement in the quality of diabetes control. The broad implementation of structured TTPs, intensified insulin therapy, and blood glucose self-monitoring for patients with type 1 and 2 diabetes mellitus seem to be the major cornerstones for the improved quality of diabetes care. However, the impressive improvement in the quality of diabetes care in patients with type 2 diabetes mellitus seems not to be related mainly to an increase (about 10% vs. 20% in type 1 diabetes) in the number of patients under specialist care, but rather to an improvement in the quality of diabetes therapy administered by private health care physicians.

Administration, Oral↗
PubMed2001

[Expert assessment of accident sequelae in statutory and private accident insurance].

Public and private accident insurance companies have in common that the insurance risk is the damage to health caused by trauma. Otherwise, they are fundamentally different. Public accident insurance as part of social law has the function of providing compensation for damage. Functional impairment due to trauma is compensated abstractly according to the general labor market. Private accident insurance as part of civil law is an insurance of fixed sums anchored in the agreement. It is completely unrelated to the consequences of trauma-induced limitation of function.

Adult↗
PubMed1998

Private support and social security.

"The issue is addressed whether assistance to persons in need can be left to the ¿family' and the ¿community'. In that case people depend on their social networks. The support a person receives through a given network of social ties is examined. However, ties are diverse and subject to change. By means of a model of the dynamics of social ties, the conditions for adequate private support are analyzed. The sustainability of private support over time is examined by incorporating the impact on social ties of lending and receiving support. It is shown that support is only an effective alternative in a limited number of situations."

Economics↗
PubMed1999

RESEARCH: Attitudes of Private- and Public-Land Managers in Wyoming, USA, Toward Beaver.

/ A mail survey concerning beaver (Castor canadensis) management in Wyoming, USA, was sent to 5265 private-land managers and 124 public-land managers during 1993. The survey was developed in response to increasing interest in beaver management and beaver reintroduction possibilities. Private-land managers responding to the survey supplied information on 62,859 km2 of land area and 20,037 km of streams. Primary concerns about beaver damage centered on (in decreasing order of importance) blocked irrigation ditches, girdled timber, blocked culverts, and flooded pastures, roads, crops, and timber. Primary benefits that landowners perceive that beaver give them were, in order of importance, elevated water tables, increased riparian vegetation, and increased stock-watering opportunities. Public-land managers also listed these benefits and detriments among their top concerns for beaver. Over 45% of landowners with beaver on their property and all of the public-land managers displayed an interest in a beaver reintroduction program and in more proactive beaver management. KEY WORDS: Beaver; Beaver management; Castor canadensis; Landowners; Mail surveys; Wildlife values; Wildlife damage

Journal Article↗
PubMed2002

[Prevalence and incidence of dementia among nursing home residents and residents in homes for the aged in comparison to private homes].

Based on a representative epidemiological study on dementia, prevalence and incidence rates of institutionalized individuals aged 75 years and older in comparison to those living in private homes are presented. The study was conducted between 1997 and 1999. Core component assessing cognitive function was the SIDAM (Structured Interview for the diagnosis of Dementia of the Alzheimer type, Multi-infarct dementia and dementias of other etiology according to ICD-10 and DSM-III-R, DSM-IV). If cognitive testing with study participants was not possible (e.g., due to fragility, death before examination) proxy interviews were performed with relatives or staff using the CDR (Clinical Dementia Rating). Prevalence and incidence rates in institutions were four times higher than in private homes. A prevalence rate of dementia for institutionalized individuals 75+ according to DSM-III-R of 47.6% was found; the annual incidence rate was 17.2%. This high proportion of people with dementia in institutions requires the development of new concepts of care to meet the demands of this changing situation in residential and nursing homes.

Aged↗
PubMed2006

Prevalence of anxiety and depression during pregnancy in a private setting sample.

OBJECTIVES: To estimate the prevalence and risk factors for antenatal anxiety (AA) and antenatal depression (AD). METHODS: We performed a cross sectional study of 432 women attending a private clinic in the city of Osasco, São Paulo, from 5/27/1998 to 5/13/2002. The following instruments were used: Spielberger state-trait anxiety inventory (STAI), Beck depression inventory (BDI), and a questionnaire for socio-demographic and obstetric data. Inclusion criteria were: pregnant women with no past or present history of depression, psychiatric treatment, alcohol or drug abuse and no clinical and obstetric complications. The prevalence of AA, according to STAI, and AD, according to Beck Inventory, were estimated with 95% confidence intervals (95% CI). Odds ratios and 95% CI were used to examine the association between AA and AD and exposures variables. RESULTS: The prevalence of AA, state and trait were 59.5 (95 CI%: 54.8:64.1%) and 45.3% (95% CI: 40.6:50.0), respectively. The prevalence of AD was 19.6 (95% CI:15.9:23.4). In the multivariate analysis, AA-trait (OR: 5.26; 95% CI 2.17:12.5, p < 0.001), AA-state (OR: 2.27; 95% CI 1.08:4.76, p = 0.02) and AD (OR: 2.43; 95% CI 1.40:4.34, p = 0.002) were associated with lower women's educational level. AA-trait (OR: 3.43; 95% CI 1.68:7.00, p = 0.001), AA-state (OR: 2.22; CI 95% 1.09:4.53, p = 0.02) and AD (OR: 2.82; CI 95% 1.35:5.97, p = 0.005) were also associated with not being married. AA-trait was associated with lower women's income (OR: 2.22; 95% CI 0.98:5.26, p = 0.05) and not being white (OR: 1.7; 95% CI 1.00:2.91, p = 0.04), while AD was associated with lower couple's income (OR: 2.43; 95% CI 1.40:4.34, p = 0.001) and greater number of previous abortions (OR: 2.21; 95% CI 1.23:3.97, p = 0.009). CONCLUSIONS: Prevalence of AA and AD were high in this sample of women attending a private care setting, particularly AA state and trace. AA and AD were associated with similar socio-demographic and socio-economic risk factors, suggesting some common environmental stressors may be involved.

Anxiety↗
PubMed2005

Lifetime cover in private insurance markets.

In the last few decades, private health insurance rates have declined in many countries. In countries and states with community rating, a major cause is adverse selection. In order to address age-based adverse selection, Australia has recently begun a novel approach which imposes stiff penalties for buying private insurance later in life, when expected costs are higher. In this paper, we analyze Australia's Lifetime Cover in the context of a modified version of the Rothschild-Stiglitz insurance model (Rothschild and Stiglitz, 1976). We allow empirically-based probabilities to increase by age for low-risk types. The model highlights the shortcomings of the Australian plan. Based on empirically-based probabilities of illness, we predict that Lifetime Cover will not arrest adverse selection. The model has many policy implications for government regulation encouraging long-term health coverage.

Actuarial Analysis↗
PubMed2006

Genetic testing and private insurance--a case of "selling one's body"?

Arguments against the possible use of genetic test results in private health and life insurance predominantly refer to the problem of certain gene carriers failing to obtain affordable insurance cover. However, some moral intuitions speaking against this practice seem to be more fundamental than mere concerns about adverse distributional effects. In their perspective, the central ethical problem is not that some people might fail to get insurance cover because of their 'bad genes', but rather that some people would manage to get insurance cover because of their 'good genes'. This paper tries to highlight the ethical background of these intuitions. Their guiding idea appears to be that, by pointing to his favourable test results, a customer might make an attempt to 'sell his body'. The rationale of this concept is developed and its applicability to the case at issue is critically investigated. The aim is to clarify an essential objection against the use of genetic information in private insurance which has not yet been openly addressed in the academic debate of the topic.

Commerce↗
PubMed2005

Sustainability of a privatized community-based animal health worker system in Mwingi District, Kenya.

This paper describes a study on the sustainability of Community-based Animal Health Worker (CAHW) services in Mwingi District, Kenya. These services began in 1992 and were supported by the District Veterinary Authority (DVA) with assistance from the Integrated Food Security Programme-Eastern (IFSP-E). Over time and using a process of participatory reviews with multiple stakeholders, the system evolved into a network of CAHWs. The study focused on CAHWs' service sustainability and their relationships with other animal health service providers. A mutually beneficial and supportive arrangement existed between the CAHWs and Animal Health Assistants (AHAs), based on a private drug supply system, referral and backstopping support. The CAHWs derived sufficient income from their veterinary work to maintain their interest in the system. Seventy percent of CAHWs were continuing to offer adequate animal health services 3 years or more after their initial training and the withdrawal of donor support. Ninety-five percent of sampled CAHWs (n = 40) viewed their business as successful and expanding. Considering the agro-ecological and socio-economic conditions of the district, the CAHW system can be viewed as an initial stage in the process of extending quality private sector veterinary services.

Animal Technicians↗
PubMed2007

Successful reentry: the perspective of private correctional health care providers.

Due to public health and safety concerns, discharge planning is increasingly prioritized by correctional systems when preparing prisoners for their reintegration into the community. Annually, private correctional health care vendors provide $3 billion of health care services to inmates in correctional facilities throughout the U.S., but rarely are contracted to provide transitional health care. A discussion with 12 people representing five private nationwide correctional health care providers highlighted the barriers they face when implementing transitional health care and what templates of services health care companies could provide to state and counties to enhance the reentry process.

Continuity of Patient Care↗
PubMed1981

Training internists: insights from private practice.

University internal medicine training programs concentrate on the traditional curriculum designed to produce well-trained academicians and researchers. Increasingly internists are involved in primary patient care with over two-thirds being office based practitioners. Residency training at these institutions must make available to all residents the opportunity to learn the skills taught by primary care programs. Clinical problem solving, skills in patient-physician negotiations and patient comfort, psychiatric techniques, medical ethics, cost effectiveness analysis, and practice management are areas in which the private practitioner frequently needs help. Feedback from training program graduates in private practice could help identify such deficiencies which could be incorporated into the teaching responsibility of a division of general internal medicine.

Cost-Benefit Analysis↗
PubMed1978

The mortality of bleeding esophageal varices in a private university hospital.

The mortality of patients with bleeding esophageal varices was studied in a private hospital where the modalities of treatment are considered optimal. Of the sixty-two patients in the study, twenty (32 per cent) died. Mortality was higher (p is less than 0.02) for those who had ascites or bilirubin more than 5 mg/dl, albumin less than 3 gm/dl, prothrombin time more than 4 seconds of control, or blood transfusions of more than 5 liters. The lower mortality in this study as compared with other studies among indigent population is the result of either private patients having less severe liver disease or having more effective care of both.

Adolescent↗
PubMed1991

The role of private body consciousness and anxiety in the report of somatic symptoms during magnetic resonance imaging.

The present study examined an information processing model of symptom reporting (Ahles, Cassens, & Stallings, Journal of Behavior Therapy and Experimental Psychiatry 18, 215-222, 1987) in a medical sample during an anxiety-arousing diagnostic medical evaluation. The predisposition to attend to physical sensations (private body consciousness), state anxiety, and symptom reporting were assessed in 47 patients undergoing a magnetic resonance imaging (MRI) procedure. The results of this study provide further support for the information processing model; the interaction between private body consciousness and state anxiety significantly predicted symptom reporting during the MRI. The pattern of results points to attention to physical sensations and anxiety as important mediators of symptom reporting.

Adult↗
PubMed1982

Psychological adjustment to inflammatory bowel disease: informational control and private self-consciousness.

Until recently the psychological and social factors related to inflammatory bowel disease have been studied as causes rather than as consequences of this condition. This study looks at the impact of these diseases by investigating correlates of psychological adjustment to inflammatory bowel disease. A curvilinear hypothesis predicted that patient adjustment to living with the disease would be related to the amount of information possessed about the disease, and that this relationship would be mediated by the patient's degree of private self-consciousness. Questionnaire returned by 143 members of the Houston Chapter of the National Foundation for Ileitis and Colitis were analyzed. Results indicate that a patient's general level of self-esteem and social competence is the best predictor of disease-related adjustment. Information and adjustment were inversely related for patients with a high degree of private self-consciousness, and unrelated at lower levels of this variable. Perception of control through information predicted adjustment better than information per se.

Adaptation, Psychological↗
PubMed1986

A protein A-binding, polyethylene glycol precipitation-based immunoradiometric assay. Application to the detection of immune complexes and C3 in human sera and of private antigens in cross-reacting parasite extracts.

An immunoradiometric assay, based on the precipitation of antigen-antibody complexes by polyethylene glycol (PEG) and on the subsequent binding of PEG-soluble radiolabelled staphylococcal protein A to the PEG-insoluble complexes, is described. The assay can be applied to the detection of naturally occurring, circulating immune complexes, and of complexes artificially created by mixing antigen and antibody solutions, which makes it of potential use for the detection of either antigen or antibody in several situations. Pre-treatment of the antibody-containing sera with 3% PEG greatly reduced the background values and increased the sensitivity of the assay. The assay was also applied to the detection and isolation of Leishmania donovani antigens that did not cross-react with antigens of the related parasite Trypanosoma cruzi (private antigens) and private antigens of insect-derived metacyclic trypomastigotes of T. cruzi in relation to culture-derived metacyclic trypomastigotes of T. cruzi. A simple and extremely effective procedure for washing precipitates with just one centrifugation is also described.

Animals↗
PubMed1984

Inpatient psychiatry: perspectives from the general, the private, and the state hospital.

Although it is widely recognized that inpatient psychiatry is different as it is practiced in the general, private, and state hospital, why and how it is different have not been clearly articulated. In this paper, the directors of inpatient units in a general hospital, a private hospital, and a state hospital first provide an analysis of how the history and the organizational structures of these units have shaped their identity. The authors then specifically detail the different patient populations, referral sources, financial bases, leadership arrangements, milieu philosophies, research and training activities, and lengths of stay on these units. Finally, on the basis of the reality and the value of different inpatient settings, a view toward the future of inpatient psychiatry is offered.

Community Mental Health Centers↗