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At least 1,603 records · Page 89Linked to original sources
PubMed2001

Partner management for gonococcal and chlamydial infection: expansion of public health services to the private sector and expedited sex partner treatment through a partnership with commercial pharmacies.

BACKGROUND: Public health partner notification (PN) services currently affect only a small minority of patients with gonorrhea or chlamydial infection and new approaches to PN are needed. OBJECTIVES: To expand PN for gonorrhea and chlamydial infection to private sector patients and to assess the feasibility of treating sex partners through commercial pharmacies. METHODS: Selected patients were offered PN assistance and were randomly offered medication to deliver to their partners. RESULTS: Providers permitted the health department to contact 3613 (91%) of 3972 potentially eligible patients, and 1693 (67%) of 2531 successfully contacted patients consented to interview. Of these, 1095 (65%) reported at least one untreated partner. Most patients (90%) wished to notify partners themselves. Patients were more likely to have partners who had not yet been treated and to request PN assistance if they had more than one sex partner in the preceding 60 days or a partner they did not anticipate having sex with in the future. These two factors characterized 49% of all patients interviewed, 70% of those with a partner that was untreated 7 or more days after index patient treatment, and 83% of those accepting PN assistance. Among 458 randomly selected patients with untreated partners at time of study interview, 346 (76%) agreed to deliver treatment to a partner. Of these, most (266) chose to obtain medication for a partner at a pharmacy, of whom 223 (84%) successfully did so. CONCLUSION: A substantial minority of private sector patients have untreated partners more than 7 days after their own treatment; some need help with PN, but most will agree to deliver medication to partners themselves.

Adolescent↗
PubMed1980

Low-dose insulin for treatment of diabetic ketoacidosis in a private community hospital.

We evaluated 21 patients with the diagnosis of diabetic ketoacidosis, involving 25 admissions to a large private community hospital, to evaluate the efficacy of low-dose insulin therapy by measuring time required for correction of hyperglycemia and acidosis, and to evaluate any associated morbidity or mortality. The protocols and laboratory tests were relatively loose and less stringent than our previous protocols, to permit flexibility of therapy by various physicians and to simulate the prevailing practice in such a hospital. All patients responded with correction of hyperglycemia within nine hours and acidosis within 12 hours, with averages of 5.61 and 6.8 hours, respectively. No deaths were recorded in the group. From these data, it is apparent that the low-dose insulin regimen is a safe, effective, and practical method for therapy of DKA in the private community hospital.

Adult↗
PubMed1982

Critical care medicine in a private hospital.

Technologic advances in the past ten years, coupled with the advent of a new specialty of critical care medicine, have made it possible for patients to survive major surgical procedures and critical illnesses which, ten years ago, would have resulted in certain death. In 1979, a group of emergency physicians, with training and experience in critical care medicine, initiated a program of critical care at Cedars of Lebanon Health Care Center, a private nonprofit hospital. This program provides critical care physician (intensivist) coverage similar to that presently available in emergency departments throughout the country. This program has completely changed the pattern of practice in the critical care area. Since its implementation, critical care procedures and aggressive therapy are provided around the clock. We believe that such coverage is essential and suggest that, just as the emergency department became fully staffed ten years ago, in the future, most intensive care units of private hospitals of 300 beds or more will be covered by intensivists working around the clock to provide care at the time it is needed.

Emergency Medicine↗
PubMed2000

Systematic review of psychosocial factors at work and private life as risk factors for back pain.

STUDY DESIGN: A systematic review of observational studies. OBJECTIVES: To assess whether psychosocial factors at work and in private life are risk factors for the occurrence of back pain. SUMMARY OF BACKGROUND DATA: Several reviews on risk factors for back pain have paid attention to psychosocial factors. However, in none of the published reviews was a strict systematic approach used to identify and summarize the available evidence. METHODS: A computerized bibliographical search of several databases was performed, restricted to studies with a cohort or case-control design. A rating system was used to assess the strength of the evidence for various factors, based on the methodologic quality of the studies and the consistency of the findings. RESULTS: Eleven cohort and two case-control studies were included in this review. Strong evidence was found for low social support in the workplace and low job satisfaction as risk factors for back pain. Insufficient evidence was found for an effect of a high work pace, high qualitative demands, low job content, low job control, and psychosocial factors in private life. CONCLUSIONS: Evidence was found for an effect of low workplace social support and low job satisfaction. However, the result for workplace social support was sensitive to slight changes in the rating system, and the effect found for low job satisfaction may be a result of insufficient adjustment for psychosocial work characteristics and physical load at work. In addition, the combined evaluation of job content and job control, both aspects of decision latitude, led to strong evidence of a role for low job decision latitude. Thus, based on this review, there is evidence for an effect of work-related psychosocial factors, but the evidence for the role of specific factors has not been established yet.

Humans↗
PubMed1980

Separate clones of cytotoxic T lymphocytes are generated against private and public H-2 antigens.

By cytolysis and monolayer absorption tests, the kinetics of the generation of CBA/H cytotoxic lymphocytes (Tc) in response to stimulation by H-2b antigens have been analyzed in vitro. The Tc population which reacts with public antigens of H-2b and H-2d strains shows peak activity in culture at 4 to 5 days, then rapidly decreases. The population with cytotoxic activity against the private antigens of H-2b cells peaks later and persists longer. The antipublic cytolytic activity was shown to be specific and not attributable to antibody-dependent cell-mediated cytotoxicity (ADCMC), but was attributable to Ly1-, 2+ effector cells. By suitable conditions of absorption on C57BL/10 monolayers, the precursors of the antiprivate clone could be selectively removed without impairing the antipublic H-2d response. These and previous results present an argument that the cross-reactivity which Tc display on different H-2 haplotypes is attributable to clones directed against shared determinants and is not attributable to low affinity binding of Tc activated by private H-2 antigens.

Absorption↗
PubMed1990

Multiscreen serum analysis of highly sensitized renal dialysis patients for antibodies toward public and private class I HLA determinants. Implications for computer-predicted acceptable and unacceptable donor mismatches in kidney transplantation.

A multiscreen serum analysis program has been developed that permits a determination of antibody specificity for the vast majority of highly sensitized patients awaiting transplantation. This program is based on a 2 x 2 table analysis of correlations between serum reactivity with an HLA-typed cell panel and incorporates two modifications. One implements the concept of public HLA determinants based on the serologic crossreactivity among class I HLA antigens. The other modification derives from the premise that most highly sensitized patients maintain the same PRA and antibody profiles over many months and even years. Monthly screening results for patients with persistent PRA values can therefore be combined for analysis. For 132 of 150 highly sensitized patients with greater than 50% PRA, this multiscreen serum analysis program yielded information about antibody specificity toward public and private class I HLA determinants. The vast majority of patients (108 of 112) with PRA values between 50 and 89% showed antibody specificity generally toward one, two, or three public markers and/or the more common private HLA-A,B antigens. For 24 of 38 patients with greater than 90% PRA, it was possible to define one or few HLA-specific antibodies. The primary objective of the multiscreen program was to develop an algorithm about computer-predicted acceptable and unacceptable donor HLA-A,B antigens for patients with preformed antibodies. A retrospective analysis of kidney transplants into 89 highly sensitized patients has demonstrated that allografts with unacceptable HLA-A,B mismatches had significantly lower actuarial survival rates than those with acceptable mismatches (P = 0.01). This was shown for both groups of 32 primary transplants (44% vs. 67% after 1 year) and 60 retransplants (50% vs. 68%). Also, serum creatinine levels were significantly higher in patients with unacceptable class I mismatches (3.0 vs. 8.4 mg% [P = 0.007] after 2 weeks; 3.9 vs. 9.1 mg% [P = 0.014] after 4 weeks). Histopathologic analysis of allograft tissue specimens from 47 transplant recipients revealed a significantly higher incidence of humoral rejection (P = 0.02), but not cellular rejection, in the unacceptable mismatch group. These results suggest that the multiscreen program can establish which donor HLA-A,B mismatches must be avoided in kidney transplantation for most highly sensitized patients. For 18 of 150 high PRA renal dialysis patients, the multiscreen program could not define HLA-specific antibody. Most patients had greater than 90% PRA, and many of their sera appeared to contain IgM type nonspecific lymphocytotoxins that could be inactivated by dithioerythreitol (DTE).(ABSTRACT TRUNCATED AT 400 WORDS)

Antibodies↗
PubMed1992

Public and private insurer designation of transplantation programs.

In an effort to assure quality and contain costs, several major private health insurers now restrict payment of transplantation procedures to designated programs, often referred to as centers of excellence. These insurers underwrite coverage for over 100 million people. Few transplantation programs meet the criteria set forth by insurers, thus raising concerns about patient access to care. The criteria being used by five private insurers and Medicare were obtained and reviewed. Insurers now designate kidney, heart, liver, heart-lung, pancreas, and bone marrow transplant programs based upon total annual transplant volume as well as one- and two-year patient and graft survival rates. Transplant center criteria vary according to procedure and type of recipient (i.e., pediatric vs. adult). Most insurers require hospitals to perform a minimum of at least 6, and up to 50 procedures annually. Expected one-year patient survival rates may exceed 90% and are often higher than 80%, although standards are usually lower for heart-lung and bone marrow transplantation. In addition, if centers meet the minimum volume and outcome criteria, insurers expect transplant centers to discount per procedure changes by as much as 25%. Patients are often offered incentives to use designated centers with insurers frequently paying travel costs and reducing or waiving copayment amounts. The designation of transplant programs by third-party payers has merit, although program volume requirements may have less validity than individual transplant surgeon and physician experience. Other problems are also apparent. For example, discount pricing is suspect, given the lack of data on actual transplant procedure costs. Also, some insurers intend to regionalize transplant programs, thus unnecessarily limiting patient access to care. Alternatively, the concentration of transplant activity at a smaller number of centers may enhance research opportunities. Nonetheless, transplant professionals, hospital administrators, and patient advocates remain wary of insurer objectives. There is concern that the designation of centers is simply another method by which insurers can avoid paying for transplants.

Costs and Cost Analysis↗
PubMed2005

The privatization of wine sales in Quebec in 1978 and 1983 to 1984.

BACKGROUND: In 1978, grocery stores in Quebec were allowed to sell domestically produced wine along with wine that was imported and bottled by the Liquor Board in Quebec. This right was extended in 1983 to include imported wine that was bottled by privately owned manufacturers in Quebec. Larger grocery store chains were also allowed to sell wine in 1984. The aim of this study was to evaluate the effects of these policy changes on alcohol sales, primarily on sales of wine and total sales but also on sales of spirits and beer. METHODS: Interrupted time-series analysis (ARIMA) with a quasi-experimental control area design was used. Canada, with the exception of the province of Quebec, was the control area. All time series were differenced to remove long-term trends. Possible permanent effects of the policy changes on alcohol sales were measured by means of intervention variables. Alcohol sales, in liters of pure alcohol per inhabitant aged 15 and above, were used as the dependent variable. Alcohol prices and the inhabitants' disposable income were used as control variables. RESULTS: Contrary to earlier studies regarding these policy changes in Quebec, the results presented in this study showed a significant and permanent effect of the policy change in 1978. The sale of wine increased by 10%, but the effect was not so large as to affect total sales. Sales of spirits and beer were not significantly affected. In 1983 to 1984, no immediate significant increase in sales of wine was found. CONCLUSIONS: The estimated effect of the policy change in 1978 was modest compared with results presented in most earlier studies regarding the privatization of wine sales in other jurisdictions. One explanation could be that the policy change in Quebec was valid only for a limited number of wines, which accounted for only a fraction of the total alcohol sales market.

Alcoholic Beverages↗
PubMed2003

A practical guideline for identifying research intent with projects that collect private, identifiable health information.

Radiation oncologists frequently engage in activities that involve the collection and analysis of data from medical records. Access to health information is an ethical issue because, if not done according to appropriate guidelines, it constitutes an invasion of privacy or breach in confidentiality. To protect patients for the social harm that may result from medical record review, our society has established laws and regulations that apply to projects that require medical record review. A major branch point in the guidelines for such projects is whether private information will be collected for research or nonresearch purposes. However, a problem with discussing privacy protection in terms of a research versus nonresearch model is that it is difficult to make this distinction for many kinds of projects. The purpose of this paper is to establish a practical guideline that can be used to decide if a project that involves analysis of private, identifiable medical information should be considered research from the regulatory standpoint.

Access to Information↗
PubMed2003

Racial and ethnic differences in public and private medical care expenditures among aged Medicare beneficiaries.

This study examines the current allocation of medical care expenditures among non-Hispanic white, non-Hispanic black, and Hispanic seniors who are Medicare beneficiaries. Analyses of both "need-based" and "demand-based" perspectives found that white, black, and Hispanic seniors in similar health had similar total annual expenditures for medical care. The groups did, however, differ substantially in the distribution of expenditures between public and private sources of payment. Notably, racial and ethnic differences in public and private expenditures all but vanished when socioeconomic variables and health insurance coverage were included in the analyses. The findings suggest that public sources of payment for medical care services, especially public supplementary coverage have helped to eliminate racial and ethnic gaps in expenditures.

Black or African American↗
PubMed1975

Home bases for private work and study. Are multidisciplinary laboratories the best answer?

Since 1970 we have measured the use of our multidisciplinary laboratories as home study bases for out-of-hours private work, and find that our students make little use of them in this way, preferring to work in study-bedrooms or libraries. We consider that there is no need to incorporate private study areas in the design of multidisciplinary laboratories, with the result that uncluttered areas with free sight lines can be used for a variety of purposes; we suggest that multidisciplinary laboratories will evolve in the future along this multi-purpose, multifunction line.

Curriculum↗
PubMed1992

Public-private partnerships: the Connecticut model for financing long-term care.

Responses to the growing crisis in long-term care financing have included efforts to negotiate partnerships between the private and public sectors for the purpose of developing innovative models for long-term care insurance. One such set of models has been encouraged by support from the Robert Wood Johnson Foundation's "Long Term Care Insurance Program" grants. The Connecticut Partnership for Long Term Care uses a cooperative approach to encourage the development of private sector long-term care insurance products that are integrated with Medicaid eligibility determinations. The Connecticut model is described, accompanied by a history of its development, and a comparison is made with other models currently under consideration by national policy analysts.

Connecticut↗
PubMed2002

Survival of Escherichia coli O157:H7 in private drinking water wells: influences of protozoan grazing and elevated copper concentrations.

The survival characteristics of Escherichia coli O157:H7 in private drinking water wells were investigated to assess the potential for human exposure. A non-toxigenic, chromosomally lux-marked strain of E. coli O157:H7 was inoculated into well water from four different sites in the North East of Scotland. These waters differed significantly in their heavy metal contents as well as nutrient and bacterial grazer concentrations. Grazing and other biological factors were studied using filtered (3 and 0.2 microm) and autoclaved water. The survival of E. coli O157:H7 was primarily decreased by elevated copper concentrations. This hypothesis was supported by acute toxicity assay data. In addition, significant protozoan predation effects were observed in untreated water when compared with survival rates in filtered water. The combination of these two factors in particular determines the survival time of the pathogen in a private water well. It therefore appears that wells with higher water quality as assessed using the European Union Drinking Water Directive standards will also allow survival of E. coli O157:H7 for much longer periods.

Animals↗
PubMed2006

A five-year life-table analysis on wide neck ITI implants with prosthetic evaluation and radiographic analysis: results from a private practice.

This paper reports a 5-year life-table analysis on wide neck (WN) ITI implants placed in a private practice. In 212 patients, 263 implants were placed in the posterior region; 97% rehabilitated the molar area. Implants in the mandible and in the maxilla were 61.2% and 38.8%, respectively; the mean implant length was 9.7 and 8.9 mm, respectively. Eighty-nine percent sites had both vestibular and buccal bone lamellae > or =1 mm, 9.1% had one of them <1 mm and 1.9% had both lamellae <1 mm. Sinus perforation during surgery occurred in 52% of the maxillary implants. Prosthetic information was available for 249 implants; implants were involved in 157 single crowns (SC) and 80 fixed partial dentures (FPD). Radiographic analysis was performed on 102 implants that reached the 2-year control, and crestal bone loss (CBL) was measured. Results showed that five implants failed; the 5-year cumulative survival rate was 97.89%. The 1-year survival rate based on 259 implants was 98.8% and the 2-year survival rate based on 174 implants was 97.7%. In this 5-year timeframe, 94.3% of the SCs and 96.2% of the FPDs were free of complication. The mean CBL at the mesial and distal sides was 0.71 and 0.60 mm, respectively; bone losses >1 and >2 mm were recorded for 29.7% and 2.5% of the sides, respectively. This mid-term study showed that the WN ITI implants were highly predictable in private practice and that prosthetic complication in the molar area was an infrequent event.

Adult↗
PubMed1984

Prevalence and distribution of traumatic injuries to the permanent teeth of Dominican children from private schools.

The purpose of this study was to describe by age and sex, the prevalence, etiology, distribution and type of injury to permanent incisors of children from private schools of Santo Domingo, Dominican Republic, located in the Caribbean archipelago. The sample consisted of 1633 children, 5-14 yr enrolled in several private schools of Santo Domingo. The prevalence of injury was 10.0% (5.0% in boys and 5.1% in girls). The largest number of injuries was found in the 5- and 6-yr-old children, followed by the 7- and 8-yr-olds. There was no significant difference in the number of teeth injured in both sexes (0.1%). The most common type of injury in both sexes was concussion (42.7%) with no significant difference between sexes (5.7%). The most common cause of injury in both sexes was falling against an object (77.8% in boys and 78.3% in girls). Most boys injured their teeth playing baseball (86.4%) and most girls playing on roller skates (72.3%). More girls suffered injuries (not significantly) with the ratio of boys to girls being 0.91 to 1.

Adolescent↗
PubMed1989

National survey of oral health care in Finnish private old people's homes.

As oral health status depends greatly on the dental care arrangements available, the aim of this study was to investigate the dental services provided for elderly people living in private old people's homes in Finland. The study involved all 94 old people's homes that offered private care in 1987. The directors of the old people's homes were asked to fill in a questionnaire. The response rate was 100%. The study showed that the dental care arrangements were inadequate: regular oral examinations and comprehensive dental treatment were infrequent. In 96% of the homes the need for treatment normally came to light only when the residents themselves complained about a dental problem. In 60% of the homes the residents had to pay the full cost of their dental treatment. These must be considered the two greatest weaknesses in the dental service for the elderly in the old people's homes studied. The ignorance among the directors of the importance of oral health was alarming: only one fifth considered dental care of the elderly more important than services such as hairdressing. It is obvious that uniform regulations are needed for the whole country concerning dental services for the elderly in institutions.

Aged↗
PubMed1993

Computer use in private dental practice in Australia, 1991.

There was a 70 per cent response to a mail questionnaire to a 1:3 sample of Australian Dental Association members in private practices (n = 1931). Computers were used by 37 per cent of practices. Main computer applications used were for: accounting (84%); patient billing (80%); word processing (79%); and patient recall (61%). External bureau services were used by 4 per cent of practices with most computers being in-house (single terminal 66%; multiple terminal 33%). The more dentists in a practice, the more likely was a computer to be used. Principal users were secretary/receptionists. Service and software were the most important factors in choice of computer system. Many practice computer users (67%) also had a Personal Computer at home compared with only 36 per cent of the non-users. Many respondents indicated the need for continuing education in computers (67% users; 61% non-users). More than half of the non-users indicated future use of computers for accounting, billing and recall. There has been a considerable increase in the use of computers in private practice (37%) since the Australian Dental Association Dental Practice Survey in 1983/84 (9%).

Age Factors↗
PubMed2002

Practice activity trends among Australian private general dental practitioners: 1983-84 to 1998-99.

AIM: To investigate time trends in practice activity. DESIGN: Four cross-sectional surveys across a 15 year period. SETTING: Australian private general practice. PARTICIPANTS: A random sample of dentists. METHODS: Dentists were surveyed by mailed questionnaire in 1983, 1988, 1993 and 1998 (response rates 71%-75%). Data were weighted to provide representative estimates for the age by sex distribution of private general practitioners in 1983, 1988, 1993 and 1998. MAIN OUTCOME MEASURES: Hours per year worked, patient visits per hour and patient visits per year. RESULTS: The number of patient visits per year declined across the period, related to parallel decreases in the number of patient visits per hour (ANOVA; P<0.05), while there was no significant difference during the period in the number of hours per year devoted to work. The interaction of dentist sex by time of survey indicated that while numbers of patient visits per year had remained stable for female dentists, there was a trend for the higher number of patient visits per year among male dentists at the beginning of the survey period to decline over time. CONCLUSIONS: Male dentists had higher levels of practice activity compared with female dentists, but a decline in the number of patient visits per year reflected a convergence of male practice patterns towards that of female dentists.

Adult↗