WorldWideScience

Sample records for private practice cohort

  1. Predictors of Colorectal Polyp Recurrence after the First Polypectomy in Private Practice Settings: A Cohort Study

    Science.gov (United States)

    Viel, Jean-François; Studer, Jean-Marie; Ottignon, Yves; Hirsch, Jean-Pierre

    2012-01-01

    Background Supplementary observational data in the community setting are required to better assess the predictors of colorectal polyp recurrence and the effectiveness of colonoscopy surveillance under real circumstances. Aim The goal of this study was to identify patient characteristics and polyp features at baseline colonoscopy that are associated with the recurrence of colorectal polyps (including hyperplastic polyps) among patients consulting private practice physicians. Patients and Methods This cohort study was conducted from March 2004 to December 2010 in 26 private gastroenterology practices (France). It included 1023 patients with a first-time diagnosis of histologically confirmed polyp removed during a diagnostic or screening colonoscopy. At enrollment, interviews were conducted to obtain data on socio-demographic variables and risk factors. Pathology reports were reviewed to abstract data on polyp features at baseline colonoscopy. Colorectal polyps diagnosed at the surveillance colonoscopy were considered as end points. The time to event was analyzed with an accelerated failure time model assuming a Weibull distribution. Results Among the 1023 patients with colorectal polyp at baseline, 553 underwent a surveillance colonoscopy. The mean time interval from baseline colonoscopy to first surveillance examination was 3.42 (standard deviation, 1.45) years. The recurrence rates were 50.5% and 32.9% for all polyps and adenomas, respectively. In multivariate models, the number of polyps at baseline was the only significant predictor for both polyp recurrence (hazard ratio [HR] 1.19, 95% CI 1.06 to 1.33), and adenoma recurrence (HR 1.17, 95% CI 1.03 to 1.34). Conclusion The efficacy of surveillance colonoscopy in community gastroenterology practice compared favorably with academic settings. This study provides further evidence that the number of initial colorectal polyps is useful for predicting the risk of polyp recurrence, even in the community setting. PMID

  2. House Calls in Private Practice.

    Science.gov (United States)

    Whittington, Ronaele

    1985-01-01

    Relates the experiences of a social worker in private practice who offered house calls as an ongoing setting for counseling and psychotherapy to individuals and families. Describes advantages and disadvantages, liability, and target populations. (JAC)

  3. Private Practice Is Alive and Well

    Science.gov (United States)

    Levin, Arnold M.

    1976-01-01

    Is private practice a superior service delivery mechanism? The author contends that, in affording the client his choice of a helper, private practice embodies the basic values of social work and stimulates workers to become more responsible and knowledgeable.

  4. Resources to Manage a Private Practice.

    Science.gov (United States)

    Aigner, John; Cheek, Fredricka; Donati, Georgia; Zuravicky, Dori

    1997-01-01

    Includes four theme articles: "The Digital Toolkit: Electronic Necessities for Private Practice" (John Aigner); "Organizing a Private Practice: Forms, Fees, and Physical Set-up (Fredricka Cheek); "Career Development Resources: Guidelines for Setting Up a Private Practice Library" (Georgia Donati); and "Books to…

  5. The scope of private practice nursing in an Australian sample.

    Science.gov (United States)

    Wilson, Anne; Averis, Andrea; Walsh, Ken

    2004-01-01

    The changing Australian health care system is creating new opportunities for nurses who work directly with clients in private practice settings. This study examines the scope of practice of a cohort of nurses in private practice. In a questionnaire sent to 106 self-employed nurse entrepreneurs, questions were asked pertaining to the participants' scope of practice, their clients, the types of services offered, and their fee structures. Questions about scope of practice were divided into domains of clinical practice, business consultancy, education, and research. Quantitative and qualitative data were collected for a final sample 54 eligible responses. Participants had been in private practice for an average of 7.6 years (range: 1-20) and reported a mean of 21 years of nursing experience (range: 4-42) before entering private practice. Over half held diplomas in specialty areas. Most participants reported clinical practice, consultancy, or education as the primary work domain; research was much less important as a work activity. Nurses reported difficulties with building client base and receiving adequate fees for service, particularly in clinical practice. Increasing awareness within the nursing profession and health sector about various aspects of private practice nursing could improve service quality for their clients.

  6. Investigating Philosophies Underpinning Dietetic Private Practice

    Directory of Open Access Journals (Sweden)

    Claudia Harper

    2017-03-01

    Full Text Available There is limited theory or knowledge regarding dietitians’ practice philosophies and how these philosophies are generated and incorporated into their professional practices. For the purposes of this study, a conceptual framework will explain and define the ‘philosophies’ as three different types of knowledge; episteme, techne, and phronesis. This study aimed to develop an explanatory theory of how dietitians in private practice source, utilise, and integrate practice philosophies. A grounded theory qualitative methodology was used to inform the sampling strategy, data collection, and analytical processes. Semi-structured interviews with dietitians in private practice were undertaken and data were collected and analysed concurrently. The results show that dietitians form collaborative relationships with their clients, in order to nurture change over time. They use intrinsic and intertwined forms of episteme, techne, and phronesis, which allow them to respond both practically and sensitively to their clients’ needs. The learning and integration of these forms of knowledge are situated in their own practice experience. Dietitians adapt through experience, feedback, and reflection. This study highlights that private practice offers a unique context in which dietitians deal with complex issues, by utilising and adapting their philosophies.

  7. Practicing physiotherapy in Danish private practice: an ethical perspective

    DEFF Research Database (Denmark)

    Præstegaard, Jeanette; Gard, Gunvor; Glasdam, Stinne

    2013-01-01

    Despite an increasingly growth of professional guidelines, textbooks and research about ethics in Health care, awareness about ethics in Danish physiotherapy private practice seen vague. This article explores how physiotherapists in Danish private practice, from an ethical perspective, perceive...... to practice physiotherapy. The empirical data consists of interviews with twenty-one physiotherapists. The interviews are analysed from a hermeneutic approach, inspired by Ricoeur’s textual interpretation of distanciation. The analysis follows three phases: naı¨ve reading, structural analysis...... and comprehensive analysis. Four main themes are constructed: Beneficence as the driving force; Disciplining the patient through the course of physiotherapy; Balancing between being a trustworthy professional and a businessperson; The dream of a code of practice. Private practice physiotherapy is embedded...

  8. Satisfaction with joint replacement in public versus private hospitals: a cohort study.

    Science.gov (United States)

    Adie, Sam; Dao, Alan; Harris, Ian A; Naylor, Justine M; Mittal, Rajat

    2012-09-01

    In Australia, the majority of total knee and hip replacement surgeries occur in the private sector. Outcome-based research needs to be inclusive of this sector if the findings are intended to reflect the broader picture. This study compares outcomes up to 1 year post knee and hip replacement between patients treated in the public and private sectors. A prospective, observational study was performed in four high-volume joint replacement centres: two public, two private. Experienced orthopaedic surgeons contributed via their public and private practices. Knee and hip patients were recruited preoperatively. Self-reported questionnaires were completed preoperatively and at 6 and 12 months post-operatively. The primary outcome was satisfaction with surgery. Secondary outcomes included Oxford score, and SF-36 physical and mental component summary scores. Regression modelling was performed to adjust for potential confounders. Three hundred and thirty-one patients (184 public, 147 private; 215 knees, 116 hips) were recruited, with 6- and 12-month follow-up rates of 95% and 89%, respectively. Satisfaction rates were high in both public and private patients (approximately 90%) at 6 and 12 months, but private patients were less likely to be satisfied after adjusting for the strong effect of patient expectation. For both hip and knee cohorts, no between-sector differences were found in either the magnitude or rate of improvement in Oxford score or quality of life post-operatively. Joint replacement outcomes are similar for patients treated in public and private hospitals. Surgeons should manage patient expectation prior to surgery, particularly in private patients. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

  9. A certified private practice - a report

    International Nuclear Information System (INIS)

    Boehm, J.

    2005-01-01

    Based on the requirements for internal quality assurance in our private practice a model for quality management was implemented. Using such a quality management system (QM-system) resulted in a systematic optimization and higher quality of operating procedures in all work areas. The realization of the new QM-system led to a higher transparency, improved economical efficiency, and an increase in personal motivation. Internal frictional losses could be effectively reduced saving time and money. The efforts in time, costs and personal resources during implementation of the QM-system, which had been considered as downsides in the beginning, are outweighed by the benefits by far according to our experience. In summary: ''We consider it worthwhile in all respects''. (orig.)

  10. AMHCA and VMHCA Members in Private Practice in Virginia.

    Science.gov (United States)

    Seligman, Linda; Whitely, Nancy

    1983-01-01

    Surveyed 58 Virginia mental health counselors in private practice to examine working hours, fees, and the nature of their practices. Results showed most respondents had only a part time private practice and were employed elsewhere as well. The bulk of their counseling consisted of individual and family counseling. (JAC)

  11. Review of Private Sector Personnel Screening Practices

    Science.gov (United States)

    2000-10-01

    private sector investigative sources or methods would be useful to the DoD for conducting national security background investigations. The federal government by and large examines more sources and conducts more thorough investigations than industry. In general, private employers (1) have less access to information about applicants...outsource many elements of background checks. It is recommended that the DoD periodically evaluate private sector screening programs and data sources in order to monitor

  12. Medical student attachments in private practice – The experience ...

    African Journals Online (AJOL)

    Background: Medical student attachments with family/general practitioners (GPs) in non-academic or private practice are a valued resource in the undergraduate teaching of Family Medicine. This study describes the experience and views of GPs in private practice with final-year medical student attachments from the ...

  13. Genetic Counsellors and Private Practice: Professional Turbulence and Common Values.

    Science.gov (United States)

    Collis, Sarah; Gaff, Clara; Wake, Samantha; McEwen, Alison

    2017-12-27

    Genetic counsellors face tensions between past and future identities: between established values and goals, and a broadening scope of settings and activities. This study examines the advent of genetic counsellors in private practice in Australia and New Zealand from the perspectives of the small numbers working in this sector and those who have only worked in public practice. Semi-structured interviews were conducted with 16 genetic counsellors who had experience in private practice, and 14 genetic counsellors without private sector experience. Results demonstrated that circumstantial and personal factors can mitigate the challenges experienced and the amount of support desired by those who had established a private practice, and those who were employed by private companies. Notably, most participants with private sector experience perceived themselves to be viewed negatively by other genetic counsellors. Most participants without private sector experience expressed concern that the challenges they believed genetic counsellors face in private practice may impact service quality, but wished to address such concerns by providing appropriate support. Together, our results reinforce that participants in private and public sectors are strong advocates for peer support, multidisciplinary team work, and professional development. These core values, and seeking understanding of different circumstances and support needs, will enable genetic counsellors in different sectors to move forward together. Our results suggest supports that may be acted upon by members of the profession, professional groups, and training programs, in Australia, New Zealand, and overseas.

  14. Two management systems in a nursing private practice group.

    Science.gov (United States)

    Zahourek, R P

    1979-09-01

    Entry into private practice can be rewarding for nurses who are willing to risk personal, financial, and professional security. Among the problems faced by the nurse in this new role is the administration of the practice, since few, if any, adequate models exist. This article describes the struggle of nurses in one private nursing practice, Creative Health Services, to meet their needs for individual freedom within an organization that is regulated sufficiently to maintain its viability.

  15. Media Ecology and the Blurring of Private and Public Practices

    DEFF Research Database (Denmark)

    de Franco, Chiara

    2016-01-01

    can produce changes in the social settings where international practices develop. It particular, it argues that the media ecology can affect the articulation of public and private and lead to the emergence of international practices where appropriate and competent behaviour reconstitute the private...... such a group has developed a Transnational Activist Network (TAN) bringing people together through shared private experiences.......This paper aims at posing the basis for a new conceptualization of the impact of ‘old’ and ‘new’ media in international politics by creating a dialogue between the practice theoretical approach in IR (Adler and Pouliot 2011) and the medium theory in media studies (Meyrowitz 1985). Building...

  16. Facets of private practice nursing: a conceptual model.

    Science.gov (United States)

    Wilson, Anne; Averis, Andrea

    2002-04-01

    This paper critically examines the literature relating to private practice nursing. Particular attention is given to the reasons nurses choose private practice and the major issues involved. A conceptual model has been developed based on this information. Nurses' roles are expanding into different work domains. Private practice nursing is one of the advanced practice options available. It also requires the nurse to develop business knowledge and skills. A literature search was conducted of Pub-Med, Cinahl, Medline and InfoTrac databases using the terms 'private practice', 'nurse entrepreneur', 'nurses in business', Inurse practitioners', 'self-employed nurse', 'advanced practice' and 'clinical nurse specialist'. Further relevant articles were identified from the reference lists of papers detected by this literature search. In addition, conference proceedings were examined for any other material on this topic. A thorough search of the existing literature revealed one unpublished theoretically based study which examined limited aspects of private practice nursing in Victoria. A reasonable number of articles and publications that provided anecdotal and personal accounts of being a nurse in business were identified. This review highlights the need for further theoretically based research in this area of nursing, so as to expand nursing knowledge. Suggestions are given for further research in this topical area. Existing research into private practice nursing is limited and not sufficient to inform changes to policy and nurse education. More research is needed.

  17. Clinical education in private practice: an interdisciplinary project.

    Science.gov (United States)

    Doubt, Lorna; Paterson, Margo; O'Riordan, Anne

    2004-01-01

    Education of rehabilitation professionals traditionally has occurred in acute care hospitals, rehabilitation centres, and other publicly funded institutions, but increasing numbers of rehabilitation professionals are now working in the community in private agencies and clinics. These privately owned clinics and community agencies represent underutilized resources for the clinical training of students. Historically, private practitioners have been less likely to participate in clinical education because of concerns over patient satisfaction and quality of care, workload, costs, and liability. Through a program funded by the Ministry of Health of Ontario, we conducted a series of interviews and focus groups with private practitioners, which identified that several incentives could potentially increase the numbers of clinical placements in private practices, including participation in the development of student learning objectives related to private practice, professional recognition, and improved relationships with the university departments. Placement in private practices can afford students skills in administration, business management, marketing and promotion, resource development, research, consulting, networking, and medical-legal assessments and processes. This paper presents a discussion of clinical education issues from the perspective of private practitioners, based on the findings of a clinical education project undertaken at Queen's University, Kingston, Ontario, and previous literature.

  18. Tuberculosis management practices by private practitioners in Andhra Pradesh, India.

    Science.gov (United States)

    Achanta, Shanta; Jaju, Jyoti; Kumar, Ajay M V; Nagaraja, Sharath Burugina; Shamrao, Srinivas Rao Motta; Bandi, Sasidhar Kumar; Kumar, Ashok; Satyanarayana, Srinath; Harries, Anthony David; Nair, Sreenivas Achutan; Dewan, Puneet K

    2013-01-01

    Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India. To evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC. Cross- sectional survey using semi-structured interviews. Of 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine. Few private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.

  19. Tuberculosis management practices by private practitioners in Andhra Pradesh, India.

    Directory of Open Access Journals (Sweden)

    Shanta Achanta

    Full Text Available SETTING: Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India. OBJECTIVES: To evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC, and factors associated with compliance with ISTC. DESIGN: Cross- sectional survey using semi-structured interviews. RESULTS: Of 296 randomly selected private practitioners, 201 (68% were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6% followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14% private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment. Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine. CONCLUSION: Few private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.

  20. Factors influencing the future of paediatric private practice in Malta.

    Science.gov (United States)

    Grech, Victor; Savona-Ventura, Charles; Gatt, Miriam; Attard-Montalto, Simon

    2011-06-16

    In Malta, the health system is hybrid, with similarities to both UK system and the US system, where the National Health Service is supplemented by private practice. This is widely performed either as a primary job or as a supplement to a government salary. This article reviews unfavourable secular trends in Maltese fertility, births, marriages, separations, single parenthood and loans incurred after marriage, and relates them to (equally unfavourable in terms of private practice) escalating numbers of paediatricians working in private practice. Overall, future prospects appear bleak for private practice in this branch of medicine, with a dwindling patient pool being shared by an ever-increasing number of paediatricians. The only identifiable factor that may mitigate is the potential for more private health insurance uptake. This must be coupled with a movement to improve the perception of a substantial proportion of the public that facilities are poorer in the private health sector than in the NHS service. Since Malta is a developed, EU country, these results may (cautiously) be extrapolated to other, larger developed countries.

  1. Factors influencing the future of paediatric private practice in Malta

    Directory of Open Access Journals (Sweden)

    Victor Grech

    2011-06-01

    Full Text Available In Malta, the health system is hybrid, with similarities to both UK system and the US system, where the National Health Service is supplemented by private practice. This is widely performed either as a primary job or as a supplement to a government salary. This article reviews unfavourable secular trends in Maltese fertility, births, marriages, separations, single parenthood and loans incurred after marriage, and relates them to (equally unfavourable in terms of private practice escalating numbers of paediatricians working in private practice. Overall, future prospects appear bleak for private practice in this branch of medicine, with a dwindling patient pool being shared by an ever-increasing number of paediatricians. The only identifiable factor that may mitigate is the potential for more private health insurance uptake. This must be coupled with a movement to improve the perception of a substantial proportion of the public that facilities are poorer in the private health sector than in the NHS service. Since Malta is a developed, EU country, these results may (cautiously be extrapolated to other, larger developed countries.

  2. Guidelines for starting today's private practice

    Directory of Open Access Journals (Sweden)

    Schmitz ED

    2012-11-01

    Full Text Available No abstract available. Article truncated at 150 words. Starting a new practice may seem like a daunting task. The purpose of this article is to demystify the process of creating a new practice from the beginning. The cardinal rule is to keep costs low and not to outsource work that can easily be performed by any competent physician and staff. You do not need a manager, lawyer, business partner, coder or biller individually; you may be able to perform many of these services yourself. What you do need is a commitment to making your practice a success. Do not spend too much on your office space, furnishings or equipment. Start with the bare essentials. Immediately start applying to all insurance companies especially Medicare. Request an employer identification number. Set up a basic business banking account and submit the account number to the insurance companies you plan to work with. You can purchase an entire electronic healthcare record (EHR …

  3. Surviving and Thriving Your First Year in Private Practice

    Science.gov (United States)

    Schwab, Elizabeth Falk

    2016-01-01

    Taking the leap toward a career as a private practice owner is daunting. When in the initial stages of starting a private practice, I searched for current advice from an audiologist who had recently confronted the same challenges I was about to face. Because of the limited information available, I documented my process in hopes of providing an overview of my startup experience to help others. Included is a timeline of startup tasks and a sample budget to use as a reference. In this chapter, I share my experiences, both the positives and the negatives, and tips with the goal of helping you survive and thrive in your first year in private practice. PMID:28028322

  4. Opportunities outside private practice before 1860.

    Science.gov (United States)

    Deacon, Harriet; van Heyningen, Elizabeth

    2004-01-01

    This chapter discusses the restrictions and opportunities which salaried employment offered Cape doctors in the pay of government and charitable organisations during the first two thirds of the nineteenth century. Although Cape doctors often acted as agents of the colonial state there were many nuances within this relationship. While military doctors played an important role in the profession during the first few decades of the century, by the 1840s civilian doctors were beginning to assert greater influence in Cape Town, if not yet in the Eastern Cape. Hospital posts and an expanding network of charitable organisations and government-funded district surgeoncies provided part-time employment for some doctors throughout the colony. This helped urban-based doctors to sustain practices and encouraged more doctors to practice in the smaller country towns serving large farming areas.

  5. The Economics of Private Practice versus Academia in Surgery.

    Science.gov (United States)

    Baimas-George, Maria; Fleischer, Brian; Korndorffer, James R; Slakey, Douglas; DuCoin, Christopher

    2018-04-16

    Residents often make career decisions regarding future practice without adequate knowledge to the realities of professional life. Currently there is a paucity of data regarding economic differences between practice models. This study seeks to illuminate the financial differences of surgical subspecialties between academic and private practice. Data were collected from the Association of American Medical College (AAMC) and the Medical Group Management Association's (MGMA) 2015 reports of average annual salaries. Salaries were analyzed for general surgery and 7 subspecialties. Fixed time of practice was set at 30 years. Assumptions included 5 years as assistant professor, 10 years as associate professor, and 15 years as full professor. Formula used: (average yearly salary) × [years of practice (30 yrs - fellowship/research yrs)] + ($50,000 × yrs of fellowship/research) = total adjusted lifetime revenue. As a full professor, academic surgeons in all subspecialties make significantly less than their private practice counterparts. The largest discrepancy is in vascular and cardiothoracic surgery, with full professors earning 16% and 14% less than private practitioners. Plastic surgery and general surgery are the only 2 disciplines that have similar lifetime revenues to private practitioners, earning 2% and 6% less than their counterparts' lifetime revenue. Academic surgeons in all surgical subspecialties examined earn less lifetime revenue compared to those in private practice. This difference in earnings decreases but remains substantial as an academic surgeon advances. With limited exposure to the diversity of professional arenas, residents must be aware of this discrepancy. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  6. Physical Education Policies and Practices in California Private Secondary Schools.

    Science.gov (United States)

    Kahan, David; McKenzie, Thomas L

    2017-02-01

    Physical education (PE) is mandated in most states, but few studies of PE in private schools exist. We assessed selected PE policies and practices in private secondary schools (grades 6 to 12) in California using a 15-item questionnaire related to school characteristics and their PE programs. Responding schools (n = 450; response rate, 33.8%) were from 37 counties. Most were coeducational (91.3%) and had a religious affiliation (83%). Secular schools had more PE lessons, weekly PE min, and smaller class sizes. Most schools met guidelines for class size, but few met national recommendations for weekly PE minutes (13.7%), not permitting substitutions for PE (35.6%), and programs being taught entirely by PE specialists (29.3%). Private schools, which serve about 5 million US children and adolescents, may be falling short in providing quality PE. School stakeholders should encourage adoption and implementation of policies and practices that abide by professional guidelines and state statutes.

  7. USING A LOCUM TENENS IN A PRIVATE PRACTICE

    African Journals Online (AJOL)

    10332324

    The focus of this article is only on medical practitioners in a private practice making ..... advisable and in the interest of the locum when signing a contract. .... 11.2 Any single act in the exercise of the calling of a medical practitioner (or dental.

  8. Overview of the Global Trend in Private Medical Practice | Afolabi ...

    African Journals Online (AJOL)

    More over, many governments face various constraints that force them to prioritize and restrict government spending. This make it impossible for any government to provide free health care for her ever increasing population. Private medical practice is an alternative to complement government efforts in providing health care ...

  9. Knowledge, Attitude and Practice of Private Medical Practitioners in ...

    African Journals Online (AJOL)

    Knowledge, Attitude and Practice of Private Medical Practitioners in Calabar towards Post-Abortion Care. ... The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors ...

  10. Maternity leave policies in academic and private radiology practices

    International Nuclear Information System (INIS)

    Spirt, B.A.; Rauth, V.; Price, A.P.F.; Pagani, A.H.

    1988-01-01

    In 1987, the American Association of Women Radiologists surveyed both academic and private radiology departments regarding pregnancy and maternity leave policies. One hundred academic institutions (70% response), 30 radiotherapy departments (38% response), and 31 private practices responded. Details were obtained regarding maternity leave policy for residents and attending physicians; availability of paternity leave; policies regarding on-call time, fluoroscopy time and intracavitary/interstitial applications during pregnancy; and problems that occurred during resident or attending physician pregnancies. There was a wide range of responses regarding paid leave time, availability of additional time, and the use of vacation time during maternity leave

  11. Knowledge, attitudes, and practices of private sector immunization service providers in Gujarat, India.

    Science.gov (United States)

    Hagan, José E; Gaonkar, Narayan; Doshi, Vikas; Patni, Anas; Vyas, Shailee; Mazumdar, Vihang; Kosambiya, J K; Gupta, Satish; Watkins, Margaret

    2018-01-02

    India is responsible for 30% of the annual global cohort of unvaccinated children worldwide. Private practitioners provide an estimated 21% of vaccinations in urban centers of India, and are important partners in achieving high vaccination coverage. We used an in-person questionnaire and on-site observation to assess knowledge, attitudes, and practices of private immunization service providers regarding delivery of immunization services in the urban settings of Surat and Baroda, in Gujarat, India. We constructed a comprehensive sampling frame of all private physician providers of immunization services in Surat and Baroda cities, by consulting vaccine distributors, local branches of physician associations, and published lists of private medical practitioners. All providers were contacted and asked to participate in the study if they provided immunization services. Data were collected using an in-person structured questionnaire and directly observing practices; one provider in each practice setting was interviewed. The response rate was 82% (121/147) in Surat, and 91% (137/151) in Baroda. Of 258 participants 195 (76%) were pediatricians, and 63 (24%) were general practitioners. Practices that were potential missed opportunities for vaccination (MOV) included not strictly following vaccination schedules if there were concerns about ability to pay (45% of practitioners), and not administering more than two injections in the same visit (60%). Only 22% of respondents used a vaccination register to record vaccine doses, and 31% reported vaccine doses administered to the government. Of 237 randomly selected vaccine vials, 18% had expired vaccine vial monitors. Quality of immunization services in Gujarat can be strengthened by providing training and support to private immunization service providers to reduce MOVs and improve quality and safety; other more context specific strategies that should be evaluated may involve giving feedback to providers on quality of services

  12. The experiences of private somatology therapists on their self-management in a private practice

    Directory of Open Access Journals (Sweden)

    Karien Richter

    2013-07-01

    Full Text Available Somatology therapists have a demanding occupation, both physically and emotionally. Long working hours coupled with handling clients on a daily basis, notwithstanding the strain of ensuring high quality client care, are all aspects that place pressure on the therapist. These aspects, in the backdrop of a lack of self-management of a therapist, could result in impaired judgement and substandard performance in the workplace. The purpose of this study included exploring and describing the experiences of private somatology therapists in self-management, from which recommendations for improved self-management within private somatology practices were described. For the purpose of this study, self-management was defined as a method of managing not only the interaction with clients and work stressors, but also the feelings of the therapists, by practising a variety of techniques such as self-discipline. A descriptive, exploratory and contextual qualitative design was followed. The accessible population consisted of therapists (n = 15 practising at six private somatology facilities in the Pretoria North region. Purposeful sampling was followed. Ten individual unstructured interviews as well as a pilot study were conducted in which field notes were taken. Open-coding data analysis identified four themes with subthemes. Lincoln and Guba’s model was used to ensure trustworthiness and ethical considerations were followed throughout the process. Informed consent was granted by the private somatology practices and the therapists. One of the themes indicated that self-management strategies should be displayed, in order to gain a sense of control. The study identified that there is a definite need to nurture the therapist within this demanding working environment which we call the somatology practice.

  13. Physiotherapy practice in the private sector: organizational characteristics and models.

    Science.gov (United States)

    Perreault, Kadija; Dionne, Clermont E; Rossignol, Michel; Poitras, Stéphane; Morin, Diane

    2014-08-29

    Even if a large proportion of physiotherapists work in the private sector worldwide, very little is known of the organizations within which they practice. Such knowledge is important to help understand contexts of practice and how they influence the quality of services and patient outcomes. The purpose of this study was to: 1) describe characteristics of organizations where physiotherapists practice in the private sector, and 2) explore the existence of a taxonomy of organizational models. This was a cross-sectional quantitative survey of 236 randomly-selected physiotherapists. Participants completed a purpose-designed questionnaire online or by telephone, covering organizational vision, resources, structures and practices. Organizational characteristics were analyzed descriptively, while organizational models were identified by multiple correspondence analyses. Most organizations were for-profit (93.2%), located in urban areas (91.5%), and within buildings containing multiple businesses/organizations (76.7%). The majority included multiple providers (89.8%) from diverse professions, mainly physiotherapy assistants (68.7%), massage therapists (67.3%) and osteopaths (50.2%). Four organizational models were identified: 1) solo practice, 2) middle-scale multiprovider, 3) large-scale multiprovider and 4) mixed. The results of this study provide a detailed description of the organizations where physiotherapists practice, and highlight the importance of human resources in differentiating organizational models. Further research examining the influences of these organizational characteristics and models on outcomes such as physiotherapists' professional practices and patient outcomes are needed.

  14. [The ethical concerns of the private practice nurse].

    Science.gov (United States)

    Pivot, Annie

    2015-12-01

    Ethics, by its definition, is a philosophical discipline which enables human beings to behave, to act and to be, in the best way possible, between themselves and towards their environment. In private nursing practice, the ethical dimension is based on personal reflection which enables each individual to adapt their attitude in order to act for the best. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  15. Prioritizing lean management practices in public and private hospitals.

    Science.gov (United States)

    Hussain, Matloub; Malik, Mohsin

    2016-05-16

    Purpose - The purpose of this paper is to prioritize 21 healthcare wastes in public and private hospitals of United Arab Emirates (UAE). Design/methodology/approach - Seven healthcare wastes linked with lean management are further decomposed in to sub-criteria and to deal with this complexity of multi criteria decision-making process, analytical hierarchical process (AHP) method is used in this research. Findings - AHP framework for this study resulted in a ranking of 21 healthcare wastes in public and private hospitals of UAE. It has been found that management in private healthcare systems of UAE is putting more emphasis on the inventory waste. On the other hand, over processing waste has got highest weight in public hospitals of UAE. Research limitations/implications - The future directions of this research would be to apply a lean set of tools for the value stream optimization of the prioritized key improvement areas. Practical implications - This is a contribution to the continuing research into lean management, giving practitioners and designers a practical way for measuring and implementing lean practices across health organizations. Originality/value - The contribution of this research, through successive stages of data collection, measurement analysis and refinement, is a set of reliable and valid framework that can be subsequently used in conceptualization, prioritization of the waste reduction strategies in healthcare management.

  16. Private Pilot Practical Test Standards for Airplane (SEL, MEL, SES, MES)

    Science.gov (United States)

    1995-05-01

    The Private Pilot - Airplane Practical Test Standards book has been : published by the Federal Aviation Administration (FAA) to establish the : standards for the private pilot certification practical tests for the airplane : category and the single-e...

  17. Practice improvement, part II: trends in employment versus private practice.

    Science.gov (United States)

    Coleman, Mary Thoesen; Roett, Michelle A

    2013-11-01

    A growing percentage of physicians are selecting employment over solo practice, and fewer family physicians have hospital admission privileges. Results from surveys of recent medical school graduates indicate a high value placed on free time. Factors to consider when choosing a practice opportunity include desire for independence, decision-making authority, work-life balance, administrative responsibilities, financial risk, and access to resources. Compensation models are evolving from the simple fee-for-service model to include metrics that reward panel size, patient access, coordination of care, chronic disease management, achievement of patient-centered medical home status, and supervision of midlevel clinicians. When a practice is sold, tangible personal property and assets in excess of liabilities, patient accounts receivable, office building, and goodwill (ie, expected earnings) determine its value. The sale of a practice includes a broad legal review, addressing billing and coding deficiencies, noncompliant contractual arrangements, and potential litigations as well as ensuring that all employment agreements, leases, service agreements, and contracts are current, have been executed appropriately, and meet regulatory requirements. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  18. Development of the private practice management standards for psychology.

    Science.gov (United States)

    Mathews, Rebecca; Stokes, David; Littlefield, Lyn; Collins, Leah

    2011-01-01

    This paper describes the process of developing a set of private practice management standards to support Australian psychologists and promote high quality services to the public. A review of the literature was conducted to identify management standards relevant to psychology, which were further developed in consultation with a panel of experts in psychology or in the development of standards. Forty-three psychologists in independent private practice took part in either a survey (n=22) to provide feedback on the relevance of, and their compliance with, the identified standards, or a 6-month pilot study (n=21) in which a web-based self-assessment instrument evaluating the final set of standards and performance indicators was implemented in their practice to investigate self-reported change in management procedures. The pilot study demonstrated good outcomes for practitioners when evaluation of compliance to the standards was operationalized in a self-assessment format. Study results are based on a small sample size. Nevertheless, relevance and utility of the standards was found providing an initial version of management standards that have relevance to the practice of psychology in Australia, along with a system for evaluating psychological service provision to ensure best practice in service delivery. © 2010 National Association for Healthcare Quality.

  19. Exploring healthcare communication models in private physiotherapy practice.

    Science.gov (United States)

    Hiller, Amy; Guillemin, Marilys; Delany, Clare

    2015-10-01

    This project explored whether models of healthcare communication are evident within patient-physiotherapist communication in the private practice setting. Using qualitative ethnographic methods, fifty-two patient-physiotherapist treatment sessions were observed and interviews with nine physiotherapists were undertaken. Data were analyzed using thematic analysis. In these clinical encounters physiotherapists led the communication. The communication was structured and focussed on physical aspects of the patient's presentation. These features were mediated via casual conversation and the use of touch to respond to the individual patient. Physiotherapists did not explicitly link their therapeutic communication style to established communication models. However, they described a purposeful approach to how they communicated within the treatment encounter. The communication occurring in the private practice physiotherapy treatment encounter is predominantly representative of a 'practitioner-centred' model. However, the subtle use of touch and casual conversation implicitly communicate competence and care, representative of a patient-centred model. Physiotherapists do not explicitly draw from theories of communication to inform their practice. Physiotherapists may benefit from further education to achieve patient-centred communication. Equally, the incorporation of casual conversation and the use of touch into theory of physiotherapy patient-centred communication would highlight these specific skills that physiotherapists already utilize in practice. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Audiology, Entrepreneurship and Innovation: A perspective on private practice

    Directory of Open Access Journals (Sweden)

    Alex Antonites

    2013-12-01

    Full Text Available Objective: This paper investigates the correlation and contact points between entrepreneurship as a discipline and the profession of audiology. The research focuses on specific areas of entrepreneurship (e.g. innovation as an entrepreneurial skill and the impact it has on audiology private practices as key role players in the biotechnology industry. Design: This study used a two-stage research design comprising of an exploratory study and a formal study to survey the entrepreneurial and business skills of audiologists as entrepreneurs in private practice. Findings: The findings describe severe deficiencies - specifically the business and entrepreneurial skill sets of the professional audiologist as an entrepreneur. The mind-set of the audiologist is not that of an entrepreneur, but rather of a small business owner. A lack of self-confidence to be creative, take risks, and identify new opportunities or innovate in terms of products, process and services was found. Audiologists are not necessarily concerned about the creation of employment, or the growth and profitability of their practices. Autonomy and security are the primary objectives of most practice owners. Keywords: Innovation, Entrepreneurs, Women Entrepreneurs, Entrepreneurship, Audiology, Biotechnology

  1. Infection control practice in private dental laboratories in Riyadh

    International Nuclear Information System (INIS)

    AlKheraif, Abdulaziz A; Mobarak, Fahmy A

    2008-01-01

    In view of the risk of infection of dental health care workers and patients, interruption of possible chains of infection is to be demanded. The objective of this study was to assess infection control practice in private dental laboratories in Riyadh City, Kingdom of Saudi Arabia. The study was conducted on thirty-two private dental laboratories in Riyadh City regarding infection control practiced by these laboratories. The instrument of the study consisted of ten open-ended questions that were asked from the laboratories directors. A large percentage of the surveyed laboratories (87.5 %) did not implement any infection control protocol during their practice. The mean number of impressions received per week was 16. Most of the surveyed laboratories (90.6 %) had no way of communication with the clinics regarding the disinfection procedures. The results indicated that 62.5 % of the laboratories reported that they were aware that they may get infection from non-disinfected items. Only a small percentage (6.2%) of the laboratories added disinfecting agent to pumice slurry. Wearing laboratory coats was reported by 75% of the laboratory workers. The use of gloves during work was reported by 59.3% of the laboratories while 56.2% reported the use protective eyewear. Only 21.8% of the laboratories use face masks during work. Construction of infection control manuals that contain updated and recommended guidelines to ensure aseptic practice in private dental laboratories is highly recommended. Also, a way of communication between dentists and dental technicians regarding disinfection of laboratory items should be strongly encouraged. (author)

  2. Using a Locum Tenens in a Private Practice

    Directory of Open Access Journals (Sweden)

    Magda Slabbert

    2013-12-01

    Full Text Available Many medical practitioners in private practice use a locum tenens when they themselves are not available to practice. The locums are often appointed without consideration of the legal consequences or requirements. Legislation distinguishes between an employee and an independent contractor. If the locum is appointed as an employee the doctrine of vicarious liability comes into play which is not the case with an independent contractor. Contracts currently available to appoint a locum give the contracting parties a choice between being appointed as an employee or an independent contractor; this should be changed in that all locums should be appointed as independent contractors especially if the working of the Consumer Protection Act is also taken into consideration. Furthermore, according to the rules of the Health Professions Council of South Africa (HPCSA the onus to ensure that the locum tenens is registered and fit to practice, rests with the principal.

  3. Effort-reward imbalance and depression among private practice physicians.

    Science.gov (United States)

    Tsutsumi, Akizumi; Kawanami, Shoko; Horie, Seichi

    2012-02-01

    Current private practice physicians provide medical services in a harsh economic situation. The effort-reward imbalance (ERI) model puts its emphasis on an imbalance between high efforts spent and low rewards received in occupational life. ERI model includes three different reward factors from task to organizational levels. We examined whether ERI in terms of low organizational reward (poor prospective and job insecurity) could be the most relevant and strongly associated with depression among private practice physicians. This is a cross-sectional questionnaire study of 1,103 private practice physicians who were currently working in clinical settings and completed the data of exposure and outcome. The study questionnaire was mailed to all the physicians listed as members of a local branch of the Japan Medical Association (n = 3,441) between November and December 2008. Outcomes were prevalence of depression as measured by the Center for Epidemiologic Studies Depression Scale and adjusted odds ratios (OR) of depression with respect to ERI. Fifty-seven percent of physicians were exposed to ERI, and 18% of the physicians were depressed. Logistic regression analyses revealed that ERI was significantly associated with depression (OR and 95% confidence interval = 3.57; 2.43-5.26). ERI with regard to organizational reward was most prevalent (60%) and had the strongest association with depression (5.14; 3.36-7.92). Predominant prevalence of ERI in terms of organizational level low reward and strong associations between the ERI component and depression suggests that countermeasures from social perspective are crucial.

  4. A brief history of equine private practice in South Africa

    Directory of Open Access Journals (Sweden)

    C.H.B. Marlow

    2010-05-01

    Full Text Available Horse breeding in South Africa started in 1652, shortly after the 1st European settlement in the Cape. African horsesickness posed a serious problem and after a devastating outbreak of the disease in 1719, horses were largely replaced by oxen for agricultural and transport purposes but remained important from a sporting and military point of view. Examples of the latter are the export of horses for military use to India in the mid-19th century and for use in the Crimean War in 1854, reaching a zenith in the Anglo-Boer war in which an estimated 450 000 horses succumbed. Research and disease control and initially also health services were the responsibility of state veterinary authorities. Private equine practice was pioneered by Jack Boswell in the late 1930s, mainly involving race horses and Thoroughbred studs as part of a general practice. Specialised equine private practices were only initiated 10 years later and developed further during the 2nd half of the 20th century. These developments are described in some detail, including resumés of the veterinarians involved, clinical challenges encountered, scientific advances as well as developments in the equine industry with the emphasis on Thoroughbreds and the racing community. The regulatory environment, especially regarding the import and export of horses, and the role of various organisations and associations are also briefly discussed.

  5. Radionuclide salivary imaging usefulness in a private otolaryngology practice

    International Nuclear Information System (INIS)

    Schall, G.L.; Smith, R.R.; Barsocchini, L.M.

    1981-01-01

    Radionuclide salivary gland scans were performed on 44 patients using sodium pertechnetate Tc 99m. The accuracy of the scans and their usefulness in the clinical treatment of the patients were reviewed. The scan provided helpful information in 31 of 38 cases in which adequate follow-up data were available, although it proved diagnostic in only six patients. It was particularly useful in the evaluation of primary salivary gland neoplasms, acute and chronic sialadenitis, and sialolithiasis, as well as in the differential diagnosis of xerostomia. The value of this procedure in the elucidation of a variety of morphologic and functional diseases of these glands warrants its greater application in private otolaryngologic practices

  6. Knowledge and practice regarding pulmonary tuberculosis among private practitioners

    Directory of Open Access Journals (Sweden)

    M Basu

    2013-12-01

    Full Text Available Background: India leads the world in its burden of tuberculosis (TB. General practitioners are the backbone of health care system. Objective: To assess the knowledge and practice of the allopathic private practitioners regarding TB. Method: In June 2012– October 2012, a cross-sectional study was conducted in West Bengal, India among 180 private practitioners who treat TB patients; using a self-administered semi-structured questionnaire. Results: About 58.3 % and 56.7 % study population knew full form of RNTCP (Revised National Tuberculosis Control Program and DOTS (Directly Observed Treatment Short Course respectively. The correct modes of transmission were expressed by 75.0 % of them. The most common symptom of TB was rightly answered by 46.7 %. About 43.3 % and 33.3 % replied correctly about number of sputum samples collected and timing of collection. More than half participants knew number of categories and 8.3 % knew categorisation correctly. About 66.7 % could correctly state the names of recommended 1st line anti-TB drugs; frequency of drug administration told correctly by 68.3 %. Very few Private Practitioners (PPs knew treatment regimens correctly for each category. Almost all participants knew that treatment under DOTS was given supervised. About 78.3 % PPs expressed correctly that treatment for TB was given in two phases; the duration of treatment of 6-8 months was stated by 53.3 %. Conclusion: Many gaps were found in the knowledge and practices of PPs regarding Tuberculosis. PPs should be properly trained and sensitized to use RNTCP guidelines.

  7. WHAT ARE THEY BUYING IN PRIVATE TUITION? MICRO-LEVEL PERSPECTIVE ON THE PRACTICE OF PRIVATE TUITION BY GRADE 9 STUDENTS IN KALE TOWNSHIP, MYANMAR

    OpenAIRE

    Kam Tung Tuang Suante

    2017-01-01

    Private tuition is the practice of academic teaching and learning from outside of the school with a fee but a few of studies acknowledged what private tuition provides to the receivers beyond the teaching of academic subjects. This study explored the intensity and nature of private tuition through 1119 Grade 9 students’ survey reports and 18 interviewees’ responses. The study revealed the common practice of private tuition in Myanmar and 69.5% of the participants are in private boarding tuiti...

  8. Preparedness for physiotherapy in private practice: Novices identify key factors in an interpretive description study.

    Science.gov (United States)

    Atkinson, Robyn; McElroy, Theresa

    2016-04-01

    Physiotherapists in Australia deliver services to a diverse range of clients, across many settings, however little research exists examining graduate preparedness for practice, even in the populous field of private practice. To explore novice physiotherapist perspectives on preparedness for work in private practice. The qualitative approach of interpretive description was used to guide in-depth interviews with 8 novice physiotherapists from 3 universities working in 5 private practices in Melbourne. All interviews were digitally recorded, transcribed verbatim and analyzed thematically. Four main themes influencing graduate preparedness for work in private practice were identified: 1) non-curricular experiences (e.g. sports training) 2) elective curricular: practicum experiences; 3) curricular: attainment of skills specific to private practice; and 4) the private practice setting: supportive colleagues. This combination of non-curricular, curricular, and practice setting factors offered the necessary scaffolding for the graduates to report feeling prepared for work in private practice. Non-curricular activities, radiological instruction, clinical placements, building supportive colleague relations and professional development in private practice are recommended as potential means of building preparedness in novice therapists. Findings have implications for physiotherapy students, educators and private practice clinics looking to recruit new graduates. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Women's preferences and mode of delivery in public and private hospitals: a prospective cohort study.

    Science.gov (United States)

    Mazzoni, Agustina; Althabe, Fernando; Gutierrez, Laura; Gibbons, Luz; Liu, Nancy H; Bonotti, Ana María; Izbizky, Gustavo H; Ferrary, Marta; Viergue, Nora; Vigil, Silvia I; Zalazar Denett, Gabriela; Belizán, José M

    2016-02-08

    Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women's preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors. A prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women's preferences: a survey using a tailored questionnaire, and a discrete choice experiment. Only 8 and 6% of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40% ended their pregnancies by caesarean section in public and private hospitals, respectively. The preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35% caesarean sections are unlikely related to their preferences for mode of delivery.

  10. REJUVENATING CHRONIC DISEASE MANAGEMENT IN MALAYSIAN PRIVATE GENERAL PRACTICE

    Directory of Open Access Journals (Sweden)

    PITERMAN L

    2010-01-01

    Full Text Available Rapid epidemiological transition globally has witnessed a rising prevalence of major chronic diseases such as hypertension, diabetes, hyperlipidaemia, obesity, chronic respiratory diseases and cancers over the past 30 years. In Malaysia, these conditions are commonly managed in primary care and published evidence has consistently shown suboptimal management and poor disease control. This in turn, has led to the massive burden of treating complications in secondary care, burden tothe patients and their families with regards to morbidity and premature death, and burden to the country with regards to premature loss of human capital. The crushing burden and escalating health care costs in managing chronic diseases pose a daunting challenge to our primary care system, as we remain traditionally oriented to care for acute, episodic illnesses. This paper re-examines the current evidence supporting the implementation of Wagner Chronic Care Model in primary careglobally; analyses the barriers of implementation of this model in the Malaysian private general practice through SWOT(strengths, weaknesses, opportunities and threats analysis; and discusses fundamental solutions needed to bridge the gap to achieve better outcomes.

  11. Consensus double reading of mammograms in private practice

    International Nuclear Information System (INIS)

    Pacher, B.; Tscherney, R.; Litmann-Rowenta, B.; Liskutin, J.; Mazewski, I.; Leitner, H.; Tscholakoff, D.

    2004-01-01

    Purpose: To evaluate retrospectively the results of consensus double reading of mammograms in a private practice for a period of 1.5 years (November 2001 to March 2003). Materials and Method: Two independent experts with dedicated training read all mammograms on a weekly basis. All mammograms including sonographic examinations were evaluated independently and categorized using the Bl-RADS classification. The achieved consensus included a possible recommendation for recall or therapy. A total of 3936 mammograms and 1912 sonography studies were evaluated. All cases with BI-RADS 4 and 5 categories were compared with the histologic results. For a period of three months, the acceptance of double reading including a delay of the final report by one week was tested with a questionnaire and informed consent sheet. Results: BI-RADS categories 4 and 5 were found in 57 cases, with 41 consensus results by two independent readers and 26 carcinomas verified by histology. No consensus could be reached in 16 patients, of which 10 had a final histologic result, with 5 benign lesions and 5 carcinomas of less than 1 cm in diameter. Clinical symptoms or alterations were absent in all patients. The 5 carcinomas were discovered by the double reading procedure. The result of the questionnaire (695 questionnaires) showed a refusal rate of 0.7%, with only 5 women refusing the opportunity of double reading their mammograms. Conclusion: Double reading of mammograms by independent experts is feasible, shows a measurable increase in quality and is accepted by almost all women. (orig.)

  12. Nuclear decommissioning - practical experience of the private sector

    International Nuclear Information System (INIS)

    Brant, A.W.

    1988-01-01

    There is a growing requirement for decommissioning of redundant nuclear facilities. This has led to a number of opportunities for private sector organisations to carry out the work. This paper, based on two actual projects in the United Kingdom, outlines the input required from private sector contractors in executing such work. (author)

  13. The pattern of trauma in private general medical practice set-up Port ...

    African Journals Online (AJOL)

    BACKGROUND: Private general medical practice establishments appear to be treating a significant number of trauma cases including more serious ones. Aim: To find out the extent of such treatment of trauma and what has made this possible. METHODS: All trauma cases treated in a private general medical practice set up ...

  14. Private Practice Teachers in Public Schools: Reexamining Tensions between Professionalism and Bureaucratic Control.

    Science.gov (United States)

    Goldring, Ellen B.; Ogwa, Rodney

    This paper examines the phenomenon of private-practice teachers in public schools. It helps frame the debates surrounding market-driven reforms that are aimed at freeing schools from bureaucratic control and raises several questions about the potential impact of private-practice teachers. It asks whether market-driven reforms within public schools…

  15. Inequities in maternal postnatal visits among public and private patients: 2004 Pelotas cohort study

    Directory of Open Access Journals (Sweden)

    Marco Paula L

    2009-09-01

    Full Text Available Abstract Background The postnatal period is the ideal time to deliver interventions to improve the health of both the newborn and the mother. However, postnatal care shows low-level coverage in a large number of countries. The objectives of this study were to: 1 investigate inequities in maternal postnatal visits, 2 examine differences in postnatal care coverage between public and private providers and 3 explore the relationship between the absence of maternal postnatal visits and exclusive breastfeeding, use of contraceptive methods and maternal smoking three months after birth. Methods In the calendar year of 2004 a birth cohort study was started in the city of Pelotas, Brazil. Mothers were interviewed soon after delivery and at three months after birth. The absence of postnatal visits was defined as having no consultations between the time of hospital discharge and the third month post-partum. Logistic regression analysis was used to estimate the association between absence of postnatal visits and type of insurance scheme adjusting for potential confounding factors. Results Poorer women, black/mixed, those with lower level of education, single mothers, adolescents, multiparae, smokers, women who delivered vaginally and those who were not assisted by a physician were less likely to attend postnatal care. Postnatal visits were also less frequent among women who relied in the public sector than among private patients (72.4% vs 96% among public and private patients, respectively, x2 p Conclusion Postpartum care is available for every woman free of charge in the Brazilian Publicly-funded health care system. However, low levels of postpartum care were seen in the study (77%. Efforts should be made to increase the percentage of women receiving postpartum care, particularly those in socially disadvantaged groups. This could include locally-adapted health education interventions that address women's beliefs and attitudes towards postpartum care. There

  16. Barriers to implementing evidence-based practice in a private ...

    African Journals Online (AJOL)

    A quantitative research design was used to collect data from nurses in a private ICU in the ... Although the findings were similar to other studies, this study showed that nurses ... working in the ICU and the position held; additional qualifications).

  17. An investigation of the international literature on nurse practitioner private practice models.

    Science.gov (United States)

    Currie, J; Chiarella, M; Buckley, T

    2013-12-01

    To investigate and synthesize the international literature surrounding nurse practitioner (NP) private practice models in order to provide an exposition of commonalities and differences. NP models of service delivery have been established internationally and most are based in the public healthcare system. In recent years, opportunities for the establishment of NP private practice models have evolved, facilitated by changes in legislation and driven by identification of potential patient need. To date, NP private practice models have received less attention in the literature and, to the authors' knowledge, this is the first international investigation of NP private practice models. Integrative literature review. A literature search was undertaken in October 2012. Database sources utilized included Medical Literature Analyses and Retrieval (MEDLINE), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and the Cochrane Database of Systematic Reviews (CDSR). The grey literature was also searched. The following Medical Subject Headings (MeSH) and search terms used both individually and in combination included nurse practitioners; private practice; joint practice; collaboration; and insurance, health and reimbursement. Once literature had been identified, a thematic analysis was undertaken to extract themes. Thirty manuscripts and five publications from the grey literature were included in the final review. Private practice NP roles were identified in five countries, with the majority of the literature emanating from the USA. The thematic analysis resulted in the identification of five themes: reimbursement, collaborative arrangements, legislation, models of care and acceptability. Proportionally, there are very few NPs engaged in private practice internationally. The most common NP private practice models were community based, with NPs working in clinic settings, either alone or with other health professionals. Challenges in the

  18. Practical Solutions for Addressing Labor-Related Barriers to Bhutan's Private Employment Growth

    OpenAIRE

    World Bank Group

    2017-01-01

    This note provides practical solutions for addressing the labor-related barriers that impede Bhutan's private sector employment growth: (i) lack of workers with relevant experience and skills, (ii) restrictions on employing non-Bhutanese workers, and (iii) lack of interest among Bhutanese workers in private sector employment opportunities (Enterprise Survey 2015). This note draws on intern...

  19. Human resource management practices in public and private ...

    African Journals Online (AJOL)

    The results, among others, showed that private schools generally better managed their human resources than the public ones. Hence, it was recommended that there should be standard guidelines for operators of schools while human resource managers in the school system should be groomed in managerial psychology.

  20. Perceptions of community health center impact on private primary care physician practice.

    Science.gov (United States)

    Duffrin, Christopher; Jackson, Natalie; Whetstone, Lauren; Cummings, Doyle; Watson, Ricky; Wu, Qiang

    2014-01-01

    Community health centers (CHCs) were created in the mid-1960s to expand access to care in impoverished and underserved areas. The number of CHC sites has more than tripled in eastern North Carolina from 28 primary care centers in 2000 to 89 in 2010. This study determined the perceptions of physicians on the impact of CHC expansion on the local practice environment. Descriptive statistics and correlations were used to compare responses regarding perceptions and differences between practice characteristics as well as physician ratios by year. Both CHC and private practice physician addresses were mapped using ArcGIS. Surveys were sent to 1422 (461 returns/32.5% response rate) primary care physicians residing in 43 predominantly rural eastern North Carolina counties. A large percentage of the respondents (82.7%) affirmed that they felt neutral or did not view CHCs to be competitors, whereas a minority (17%) did view them to be difficult to compete against. Forty-two percent of private practice respondents disagreed that CHCs offer a wider range of services despite significantly more CHC physicians than private practice respondents indicating that their facility provided basic services. The CHCs were perceived to offer a wider range of services, employ more staff, and have more practice locations than private practices. However, private practice physicians did not perceive CHCs to have a competitive advantage or to unfairly impact their practices, possibly due to inconsistent population growth in relation to the physician retention during the last 10 years.

  1. The experiences of private somatology therapists on their self-management in a private practice

    Directory of Open Access Journals (Sweden)

    Karien Richter

    2013-07-01

    Somatologie terapeute het ‘n veeleisende werk hetsy fisies en emosioneel. Lang werksure, gekoppel met die hantering van kliënte op ‘n daaglikse basis, asook die stremming om te alle tye ‘n hoë gehalte kliëntesorg te verseker, is als faktore wat spanning op die terapeut plaas. Die gebrek aan selfbestuur van ’n terapeut – in die agtergrond van die bogenoemde bydraende faktore − kan tot ’n swak oordeelsvermoë en dienooreenkomstige substandaard optrede in die werkplek lei. Die doel van hierdie studie was onder andere om die ervarings van privaat somatologie-terapeute te ondersoek en te omskryf, waarvolgens aanbevelings vir verbeterde selfbestuur in privaat somatologie-praktyke beskryf was. Vir die doeleindes van hierdie study, word selfbestuur gedefinieër as ‘n metode om nie alleenik die interaksies met die kliënte en die werkstressors te bestuur nie, maar ook om die gevoelens van die terapeute te bestuur, deur middel van die uitoefening van ‘n verskeidenheid tegnieke, onder andere, self-dissipline. ’n Beskrywende, ondersoekende en kontekstuele kwalitatiewe ontwerp is gevolg. Die toeganklike populasie het uit terapeute (n = 15 in ses private somatologie-praktyke in die Pretoria-Noordstreek bestaan. ’n Doelgerigte steekproef is gevolglik geneem. Tien individuele ongestruktureerde onderhoude, asook ‘n loodstudie is uitgevoer en veldnotas is geneem. Oop kodering het vier temas met subtemas geïdentifiseer. Die model van Lincolin en Guba is gebruik om betroubaarheid te verseker en etiese oorwegings is tydens die navorsingsproses gevolg. Ingeligte toestemming is deur die privaat kliniekpraktyke en deelnemers verleen. Een tema het inderdaad aangedui dat selfbestuurstrategieë gedemonstreer behoort te word om sodoende ’n gevoel van beheer te bekom. Hierdie studie het geidentifiseer dat daar ‘n definitiewe behoefte is om die terapeut binne die veeleisende werksomgewing te koester wat ons die somatologiepraktyk noem.

  2. Private inherited microdeletion/microduplications: implications in clinical practice.

    Science.gov (United States)

    Mencarelli, Maria Antonietta; Katzaki, Eleni; Papa, Filomena Tiziana; Sampieri, Katia; Caselli, Rossella; Uliana, Vera; Pollazzon, Marzia; Canitano, Roberto; Mostardini, Rosa; Grosso, Salvatore; Longo, Ilaria; Ariani, Francesca; Meloni, Ilaria; Hayek, Josef; Balestri, Paolo; Mari, Francesca; Renieri, Alessandra

    2008-01-01

    The introduction of array-CGH analysis is allowing the identification of novel genomic disorders. However, this new high-resolution technique is also opening novel diagnostic challenges when inherited private CNVs of unclear clinical significance are found. Oligo array-CGH analysis of 84 patients with mild to severe mental retardation associated with multiple congenital anomalies revealed 10 private CNVs inherited from a healthy parent. Three were deletions (7q31, 14q21.1, Xq25) and seven duplications (12p11.22, 12q21.31, 13q31.1, 17q12, Xp22.31, Xq28) ranging between 0.1 and 3.8Mb. Six rearrangements were not polymorphic. Four overlapped polymorphic regions to the extent of 10-61%. In one case the size was different between the proband and the healthy relative. Three small rearrangements were gene deserts. The remaining seven had a mean gene content of five (ranging from 1 to 18). None of the rearranged genes is known to be imprinted. Three disease-genes were found in three different cases: KAL1 in dupXp22.31, STS in another dupXp22.31 and TCF2 in dup17q12. The patient carrying the last duplication presents sex reversal, Peters' anomaly and renal cysts and the duplication is located 4Mb away from the HSD17B1 gene, coding a key enzyme of testosterone biosynthesis. Considering the overlap with polymorphic regions, size-identity within the family, gene content, kind of rearrangement and size of rearrangement we suggest that at least in five cases the relationship to the phenotype has not to be excluded. We recommend to maintain caution when asserting that chromosomal abnormalities inherited from a healthy parent are benign. A more complex mechanism may in fact be involved, such as a concurrent variation in the other allele or in another chromosome that influences the phenotype.

  3. Comparison of Rate of Utilization of Medicare Services in Private Versus Academic Cardiology Practice.

    Science.gov (United States)

    Hovanesyan, Arsen; Rubio, Eduardo; Novak, Eric; Budoff, Matthew; Rich, Michael W

    2017-11-15

    Cardiovascular services are the third largest source of Medicare spending. We examined the rate of cardiovascular service utilization in the community of Glendale, CA, compared with the nearest academic medical center, the University of Southern California. Publicly available utilization data released by Medicare for the years 2012 and 2013 were used to identify all inpatient and outpatient cardiology services provided in each practice setting. The analysis included 19 private and 17 academic cardiologists. In unadjusted analysis, academic physicians performed half as many services per Medicare beneficiary per year as those in private practice: 2.3 versus 4.8, p cardiology practice settings in southern California, medical service utilization per Medicare beneficiary was nearly 2-fold higher in private practice than in the academic setting, suggesting that there may be opportunity for substantially reducing costs of cardiology care in the community setting. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. The private-practice perspective of the manpower crisis in radiology: greener pastures?

    Science.gov (United States)

    Swayne, Lawrence C

    2004-11-01

    Rising consumer expectations and a rapidly aging population point to a long-term shortage of all physicians, including radiologists. While attention has been drawn to the escalating manpower crisis in academic radiology departments, the private-practice perspective has been generally overlooked. Although clinical workloads and income are higher in private practice, studies have shown higher satisfaction levels (likely because of a greater variety of work) among academic radiologists. As the distinction between community and teaching hospitals has become increasingly blurred, there is now considerable overlap in the skill sets, sources of job satisfaction, and stresses that are encountered in both practice settings. Perhaps more than at any time in the recent past, diagnostic radiologists in academic and private practice share more in common than any perceived differences. Both groups must work together in concert with the ACR to address the growing manpower shortage, as well as the other challenges that confront diagnostic radiology at the beginning of the 21st century.

  5. Medical student attachments in private practice – The experience ...

    African Journals Online (AJOL)

    doctors in full-time governmental practice. However, since 2000, final year students spend one week of ... Background: Medical student attachments with family/general practitioners (GPs) in non-academic .... Giving the patient a free choice to.

  6. New Digital Marketing Actors: Private Shopping Clubs and Their Advertising Practices

    Directory of Open Access Journals (Sweden)

    Nazlım Tüzel Uraltaş

    2014-12-01

    In the first part of the study the concept of digital marketing and its historical background will be explained. In the second part online shopping behavior, online shopping training activities in Turkey and private shopping clubs will be examined.  The last part of the study will deal with the advertising practices of private shopping clubs. The study is essentially a literature review; thus, the resources are mostly secondary in nature.

  7. Advanced psychiatric nurse practitioners' ideas and needs for supervision in private practice in South Africa.

    Science.gov (United States)

    Temane, Annie M; Poggenpoel, Marie; Myburgh, Chris P H

    2014-04-07

    Supervision forms an integral part of psychiatric nursing. The value of clinicalsupervision has been demonstrated widely in research. Despite efforts made toward advancedpsychiatric nursing, supervision seems to be non-existent in this field. The aim of this study was to explore and describe advanced psychiatric nursepractitioners' ideas and needs with regard to supervision in private practice in order tocontribute to the new efforts made in advanced psychiatric nursing in South Africa. A qualitative, descriptive, exploratory, and contextual design using a phenomenological approach as research method was utilised in this study. A purposive sampling was used. Eight advanced psychiatric nurse practitioners in private practice described their ideas and needs for supervision during phenomenological interviews. Tesch's method of open coding was utilised to analyse data. After data analysis the findings were recontextualised within literature. The data analysis generated the following themes - that the supervisor should have or possess: (a) professional competencies, (b) personal competencies and (c) specificfacilitative communication skills. The findings indicated that there was a need for supervision of advanced psychiatric nurse practitioners in private practice in South Africa. This study indicates that there is need for supervision and competent supervisors in private practice. Supervision can be beneficial with regard to developing a culture of support for advanced psychiatric practitioners in private practice and also psychiatric nurse practitioners.

  8. Job satisfaction among obstetrician-gynecologists: a comparison between private practice physicians and academic physicians.

    Science.gov (United States)

    Bell, Darrel J; Bringman, Jay; Bush, Andrew; Phillips, Owen P

    2006-11-01

    Physician job satisfaction has been the subject of much research. However, no studies have been conducted comparing academic and private practice physician satisfaction in obstetrics and gynecology. This study was undertaken to measure satisfaction levels for academic and private practice obstetrician-gynecologists and compare different aspects of their practice that contributed to their satisfaction. A survey was mailed to randomly selected obstetrician-gynecologists in Memphis, TN; Birmingham, AL; Little Rock, AR; and Jackson, MS. Physicians were asked to respond to questions concerning demographics and career satisfaction. They were also asked to assess the contribution of 13 different aspects of their practice in contributing to their job selection and satisfaction using a Likert scale. A score of 1 meant the physician completely disagreed with a statement regarding a factor's contribution or was completely dissatisfied; a score of 5 meant the physician completely agreed with a factor's contribution or was completely satisfied. Simple descriptive statistics, as well as the 2-sample t test, were used. Likert scale values were assumed to be interval measurements. Of the 297 questionnaires mailed, 129 (43%) physicians responded. Ninety-five (74%) respondents rated their overall satisfaction as 4 or 5. No significant difference was found between academic and private physicians when comparing overall job satisfaction (P = .25). When compared to private practice physicians, the aspects most likely contributing to overall job satisfaction for academic physicians were the ability to teach, conduct research, and practice variety (P = .0001, P = .0001, and P = .007, respectively). When compared with academic physicians, the aspects most likely contributing to job satisfaction for private practice physicians were autonomy, physician-patient relationship, and insurance reimbursement (P = .0058, P = .0001, and P = .0098, respectively). When choosing a practice setting

  9. Does Ownership Matter? Employee Selection Practices in Private and Public Sectors

    Directory of Open Access Journals (Sweden)

    Codruţa OSOIAN

    2011-06-01

    Full Text Available The continuous need to adapt to the dynamics of the environment requires employers from both public and private sectors to select qualified human resources. It is people who lead the organization towards performance, and selecting competent employees is critical for competitive success. The paper is focused on the job selection practices implemented by hiring organizations in a developing country. Due to the differences that exist regarding the employee selection policy between public and private organizations, the paper aims to understand the characteristics of the job selection process according to the ownership of the employer agent. Based on a quantitative survey applied on 64 companies, the results analyze the main selection stages implemented in private vs. public sector employers in a developing country. While in private companies the most frequently used selection stages are the job selection interview, CVs screening and trial period, in public institutions the hiring process is based on the job selection interview, written knowledge tests, and practical tests. Compared to private companies, in public institutions the written knowledge tests rank a higher position in the selection stages hierarchy, but the private employers rely more on CVs screening stage than public institutions. Emphasis is laid on understanding the reasons leading to variations in job selection practices according to the ownership of the employing agent. The predictive validity of the job selection stages implemented by the companies is also discussed.

  10. Private or salaried practice: how do young general practitioners make their career choice? A qualitative study.

    Science.gov (United States)

    Kinouani, Shérazade; Boukhors, Gary; Luaces, Baptiste; Durieux, William; Cadwallader, Jean-Sébastien; Aubin-Auger, Isabelle; Gay, Bernard

    2016-09-01

    Young French postgraduates in general practice increasingly prefer salaried practice to private practice in spite of the financial incentives offered by the French government or local communities to encourage the latter. This study aimed to explore the determinants of choice between private or salaried practice among young general practitioners. A qualitative study was conducted in the South West of France. Semi-structured interviews of young general practitioners were audio-recorded until data saturation. Recordings were transcribed and then analyzed according to Grounded Theory by three researchers working independently. Sixteen general practitioners participated in this study. For salaried and private doctors, the main factors governing their choice were occupational factors: working conditions, need of varied scope of practice, quality of the doctor-patient relationship or career flexibility. Other factors such as postgraduate training, having worked as a locum or self-interest were also determining. Young general practitioners all expected a work-life balance. The fee-for-service scheme or home visits may have discouraged young general practitioners from choosing private practice. National health policies should increase the attractiveness of ambulatory general practice by promoting the diversification of modes of remuneration and encouraging the organization of group exercises in multidisciplinary medical homes and community health centers.

  11. Choosing academia versus private practice: factors affecting oral maxillofacial surgery residents' career choices.

    Science.gov (United States)

    Lanzon, Jesse; Edwards, Sean P; Inglehart, Marita R

    2012-07-01

    This study explored how residents who intend to enter private practice versus academic careers differ in their background and educational characteristics, engagement in different professional activities, professional values, and satisfaction. Survey data were collected from 257 residents in oral and maxillofacial surgery programs in the United States. The responses of the respondents who planned a career in private practice (65%) and who considered academia (35%) were compared with χ(2) and independent-sample t tests. Residents who considered academia were more likely to be women (29% vs 8%; P career compared with residents interested in private practice. Future clinicians placed a higher value on having manageable hours and more time performing outpatient procedures than future educators. These findings showed, first, that the characteristics at the beginning of residency programs that are likely to indicate an increased interest in academic careers are being a woman, from a non-European American background, and having an interest in research. Second, once residents are admitted, different types of surgeries and different types of professional activities tend to appeal to residents who want to practice in private practice settings versus work in academia. Third, residents interested in academia have a relatively lower level of satisfaction compared with residents interested in practicing outside of academia. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  12. An empirical analysis of public and private medical practice in Australia.

    Science.gov (United States)

    Cheng, Terence C; Joyce, Catherine M; Scott, Anthony

    2013-06-01

    The combination of public and private medical practice is widespread in many health systems and has important consequences for health care cost and quality. However, its forms and prevalence vary widely and are poorly understood. This paper examines factors associated with public and private sector work by medical specialists using a nationally representative sample of Australian doctors. We find considerable variations in the practice patterns, remuneration contracts and professional arrangements across doctors in different work sectors. Both specialists in mixed practice and private practice differ from public sector specialists with regard to their annual earnings, sources of income, maternity and other leave taken and number of practice locations. Public sector specialists are likely to be younger, to be international medical graduates, devote a higher percentage of time to education and research, and are more likely to do after hours and on-call work compared with private sector specialists. Gender and total hours worked do not differ between doctors across the different practice types. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  13. Asthma prescribing practices of government and private doctors in Malaysia--a nationwide questionnaire survey.

    Science.gov (United States)

    Loh, Li-Cher; Wong, Pel-Se

    2005-03-01

    A self-answered, anonymously completed questionnaire survey was performed between June 2002 and May 2003 where doctors from government and private sectors in Malaysia were invited to participate by post or during medical meetings. One hundred and sixteen government doctors and 110 private doctors provided satisfactorily completed questionnaires (effective respondent rate: 30.1%). The most preferred medications for 'first-line', 'second-line' and 'third-line' treatment were for government doctors: inhaled short-acting beta2-agonist (SABA) (98%), inhaled corticosteroids (CS) (75%), and leukotriene antagonist (52%); and for private doctors: oral SABA (81%), inhaled CS (68%), and oral CS (58%). The first choice inhaler device for most government and private doctors were metered dose inhalers, with cost and personal preferences (for private doctors), and technical ability (for government doctors) as the key considerations when deciding on the choice of device. This benchmark data on the asthma prescribing practices of a healthcare delivery system fully dichotomized into government and private sector, provides evidence for practice differences affected by the nature of the healthcare system, and might have implications on healthcare systems of other countries that share similarities with that of Malaysia.

  14. Practical private database queries based on a quantum-key-distribution protocol

    International Nuclear Information System (INIS)

    Jakobi, Markus; Simon, Christoph; Gisin, Nicolas; Bancal, Jean-Daniel; Branciard, Cyril; Walenta, Nino; Zbinden, Hugo

    2011-01-01

    Private queries allow a user, Alice, to learn an element of a database held by a provider, Bob, without revealing which element she is interested in, while limiting her information about the other elements. We propose to implement private queries based on a quantum-key-distribution protocol, with changes only in the classical postprocessing of the key. This approach makes our scheme both easy to implement and loss tolerant. While unconditionally secure private queries are known to be impossible, we argue that an interesting degree of security can be achieved by relying on fundamental physical principles instead of unverifiable security assumptions in order to protect both the user and the database. We think that the scope exists for such practical private queries to become another remarkable application of quantum information in the footsteps of quantum key distribution.

  15. Physiotherapy as a disciplinary institution in modern society - A Foucauldian perspective on physiotherapy in Danish private practice

    DEFF Research Database (Denmark)

    Præstegaard, Jeanette

    2015-01-01

    In many Western countries, physiotherapy in a private context is practiced and managed within a neoliberal ideology. Little is known about how private physiotherapeutic practice functions, which is why this study aims to explore how physiotherapy is practiced from the perspective...

  16. Practices regarding hospital waste management at public and private sector hospitals of Lahore

    International Nuclear Information System (INIS)

    Mahmood, S.; Din, N.U.; Mohsin, J.

    2011-01-01

    Health care (Biomedical) waste is a term used for all waste arising from health care establishments. In most of health care centers of Pakistan, including Lahore, hospital wastes are simply mixed with the municipal waste in collecting bins at road-sides and disposed off similarly. Proper Management of biomedical waste, especially the hazardous one, being produced in hospital settings is important in terms of their ability to cause harm to the related per-sons and the environment as well. To Observe and compare the practices regarding Hospital Waste management of the public sector hospital with private sector hospital. Descriptive, Cross sectional. Methodology: Standardized checklist was used to assess the practices of nursing and sanitary staff. Practices regarding waste segregation were same at both hospitals. While practices regarding waste collection and transportation were better at The Children's Hospital. Public sector hospital has, paradoxically, better practices regarding hospital waste management in comparison to private sector hospital. (author)

  17. Public-private partnerships in practice: collaborating to improve health finance policy in Ghana and Kenya.

    Science.gov (United States)

    Suchman, Lauren; Hart, Elizabeth; Montagu, Dominic

    2018-06-13

    Social health insurance (SHI), one mechanism for achieving universal health coverage, has become increasingly important in low- and middle-income countries (LMICs) as they work to achieve this goal. Although small private providers supply a significant proportion of healthcare in LMICs, integrating these providers into SHI systems is often challenging. Public-private partnerships in health are one way to address these challenges, but we know little about how these collaborations work, how effectively, and why. Drawing on semi-structured interviews conducted with National Health Insurance (NHI) officials in Kenya and Ghana, as well as with staff from several international NGOs (INGOs) representing social franchise networks that are partnering to increase private provider accreditation into the NHIs, this article examines one example of public-private collaboration in practice. We found that interviewees initially had incomplete knowledge about the potential for cross-sector synergy, but both sides were motivated to work together around shared goals and the potential for mutual benefit. The public-private relationship then evolved over time through regular face-to-face interactions, reciprocal feedback, and iterative workplan development. This process led to a collegial relationship that also has given small private providers more voice in the health system. In order to sustain this relationship, we recommend that both public and private sector representatives develop formalized protocols for working together, as well as less formal open channels for communication. Models for aggregating small private providers and delivering them to government programmes as a package have potential to facilitate public-private partnerships as well, but there is little evidence on how these models work in LMICs thus far.

  18. Ethical issues in physiotherapy--reflected from the perspective of physiotherapists in private practice.

    Science.gov (United States)

    Praestegaard, Jeanette; Gard, Gunvor

    2013-02-01

    An important aspect of physiotherapy professional autonomy is the ethical code of the profession, both collectively and for the individual member of the profession. The aim of this study is to explore and add additional insight into the nature and scope of ethical issues as they are understood and experienced by Danish physiotherapists in outpatient, private practice. A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analyzed, using a phenomenological hermeneutic framework. One main theme emerged: The ideal of being beneficent toward the patient. Here, the ethical issues uncovered in the interviews were embedded in three code-groups: 1) ethical issues related to equality; 2) feeling obligated to do one's best; and 3) transgression of boundaries. In an ethical perspective, physiotherapy in private practice is on a trajectory toward increased professionalism. Physiotherapists in private practice have many reflections on ethics and these reflections are primarily based on individual common sense arguments and on deontological understandings. As physiotherapy by condition is characterized by asymmetrical power encounters where the parties are in close physical and emotional contact, practiced physiotherapy has many ethical issues embedded. Some physiotherapists meet these issues in a professional manner, but others meet them in unconscious or unprofessional ways. An explicit ethical consciousness among Danish physiotherapists in private practice seems to be needed. A debate of how to understand and respect the individual physiotherapist's moral versus the ethics of the profession needs to be addressed.

  19. Orthodontic treatment need among young Saudis attending public versus private dental practices in Riyadh.

    Science.gov (United States)

    Al-Jobair, Asma M; Baidas, Laila F; Al-Hamid, Anfal A; Al-Qahtani, Sara G; Al-Najjar, Amani T; Al-Kawari, Huda M

    2016-01-01

    To assess and compare the severity of malocclusion and orthodontic treatment need among young Saudis receiving free treatment at public dental practices versus those paying for treatment at private practices. This retrospective study evaluated the records of 300 patients (179 females, 121 males; age 13-21 years) treated at orthodontic clinics from 2013 through 2015. The public sample was selected from orthodontic clinics at the College of Dentistry, King Saud University (KSU); the private sample was selected from five private orthodontic clinics in Riyadh, Saudi Arabia. The records were examined for the severity of malocclusion and for orthodontic treatment need using the Dental Health Component of the Index of Orthodontic Treatment Need. The prevalence of each occlusal discrepancy and the Dental Health Component grade were recorded. The severity of malocclusion and orthodontic treatment need were compared between practice types, age groups, and sexes with the chi-square test. Displacement, increased overjet, and Class II and III malocclusion were the most common orthodontic problems in this study. Patients attending public clinics at KSU generally had more severe malocclusion than the patients attending private clinics. Seventy-seven percent of orthodontically treated patients at KSU clinics were in great need of treatment, compared with 58.5% of patients treated at private clinics ( P =0.003). Among the patients with great treatment need, approximately 62% of male patients and 70% of patients ≤16 years of age were treated at KSU clinics, compared with 38% and 48%, respectively, treated at private clinics ( P orthodontic treatment at public clinics at KSU had more severe malocclusion with greater need of orthodontic treatment than the patients paying for treatment at private clinics.

  20. Use and perception of nitrous oxide sedation by French dentists in private practice: a national survey.

    Science.gov (United States)

    Vilanova-Saingery, C; Bailleul-Forestier, I; Vaysse, F; Vergnes, J-N; Marty, M

    2017-12-01

    The aim of this national survey was to record the use of nitrous oxide and the perceptions of French dental practitioners to this form of sedation. The use of nitrous oxide sedation (NOS) has been authorised in private dental practice in France since December 2009 but, to date, no study implementing both quantitative and qualitative methods has explored such use. The data were collected using a Google Forms questionnaire. A mixed methodology was used for data analysis: a quantitative approach to explore the use of conscious sedation and a qualitative thematic approach (using Nvivo software) to determine the practitioner's perception of it. Responses were collected from 225 practitioners (19% of the target population of 1185). Most of the responders were trained in NOS use in private dental clinics. Seventy-three percent of those who trained privately actually used NOS, compared to 53% of those trained at university (p-value = 0.0052). Above all, NOS was used for children requiring restorative dentistry. The average price of the sedation was 50 Euros and it lasted, on average, for 37 min. The qualitative and thematic analysis revealed the financial and technical difficulties of implementing NOS in private practice. However, it also showed the benefits and pleasure associated with NOS use. This statistical survey of French dental practitioners offers an insight of the current state of the use of conscious sedation with nitrous oxide in private general dental practice in France. It also includes the first report of dental practitioners' perceptions of NOS use and may lead to a better understanding of the reasons why sedation is sometimes not used in private practice.

  1. A Longitudinal Study of Changes in Marketing Practices at Private Christian Colleges

    Science.gov (United States)

    Vander Schee, Brian A.

    2009-01-01

    This article presents the results of a longitudinal study investigating current marketing practices at selected church-related, private, four-year compared to those in place in 1997. The role that institutional selectivity plays in the use of marketing activities was also investigated. The researcher surveyed the admissions directors or enrollment…

  2. Perceptions of Parents on the Practice of Private Tuition in Public Learning Institutions in Kenya

    Science.gov (United States)

    Mwebi, Robert B.; Maithya, Redempta

    2016-01-01

    The practice of private tuition outside normal class hours is a phenomenon which has prevailed in Kenyan basic learning institutions despite the repeated ban by the government. The purpose of the study was to establish parental perceptions on extra tuition in public schools in Kenya. Descriptive survey design was used for the study. A total of 40…

  3. HRM Practices in Public and Private Universities of Pakistan: A Comparative Study

    Science.gov (United States)

    Iqbal, Muhammad Zafar; Arif, Muhammad Irfan; Abbas, Furrakh

    2011-01-01

    The purpose of this study was to compare the HRM practices of public and private universities in Punjab province of Pakistan. The data for the study was collected through a questionnaire comprising 30 items mainly related to job definition, training and development, compensation, team work, employee's participation and performance appraisal. The…

  4. An Assessment of Mississippi's Nonindustrial Private Forest Landowners' Knowledge of Forest Best Management Practices

    Science.gov (United States)

    Andrew James Londo; John Benkert Auel

    2004-01-01

    This study examined the knowledge levels of Mississippi nonindustrial private forest (NIPF) landowners relative to best management practices (BMPs) for water quality. Data were collected through surveys of participants in BMP programs held in conjunction with County Forestry Association (CFA) meetings throughout Mississippi during 2001-02. Ten CFAs participated in this...

  5. Leadership and Decision-Making Practices in Public versus Private Universities in Pakistan

    Science.gov (United States)

    Zulfqar, A.; Valcke, M.; Devos, G.; Tuytens, M.; Shahzad, A.

    2016-01-01

    The goal of this study is to examine differences in leadership and decision-making practices in public and private universities in Pakistan, with a focus on transformational leadership (TL) and participative decision-making (PDM). We conducted semi-structured interviews with 46 deans and heads of department from two public and two private…

  6. The pattern of mental disorders in private general practice: A six ...

    African Journals Online (AJOL)

    To determine the pattern of mental disorders in a private (general) practice in a selected Nigerian community, a cross- sectional, descriptive study was conducted. Two hundred and nine patients seen by a general practitioner (GP), and 291 patients (total 500) seen by a psychiatrist were retrospectively and prospectively ...

  7. Physiotherapy in a Danish private context – a social and ethical practice

    DEFF Research Database (Denmark)

    Præstegaard, Jeanette

    2014-01-01

    , they require ethical reflections and pedagogical strategies in order to keep them in the business. Beneficence is seen as the core value of physiotherapeutic private practice and as having importance in different relationships: towards the patient, the physiotherapists themselves and their businesses...

  8. Do Private Religious Practices Moderate the Relation between Family Conflict and Preadolescents' Depression and Anxiety Symptoms?

    Science.gov (United States)

    Davis, Kelly A.; Epkins, Catherine C.

    2009-01-01

    We extended past research that focused on the relation between family conflict and preadolescents' depressive and anxiety symptoms. In a sample of 160 11- to 12-year-olds, we examined whether private religious practices moderated the relations between family conflict and preadolescents' depressive and anxiety symptoms. Although preadolescents'…

  9. Treatment practices in pulmonary tuberculosis by private sector physicians of Meerut, Uttar Pradesh.

    Science.gov (United States)

    Yadav, A; Garg, S K; Chopra, H; Bajpai, S K; Bano, T; Jain, S; Kumar, A

    2012-01-01

    Majority of the qualified medical practitioners in the country are in the private sector and more than half of patients with tuberculosis (TB) seek treatment from them. The present study was conducted with the objective of assessing the treatment modalities in pulmonary tuberculosis by the private physicians in Meerut City, Uttar Pradesh, India. A cross-sectional study was carried out covering all the private physicians (graduates and postgraduates in Medicine and Chest Diseases) registered under the Indian Medical Association, Meerut Branch (n = 154). The physicians were interviewed by a pre-designed and pre-tested questionnaire about the treatment modalities practiced by them. Only 43.5% private physicians had attended any Revised National Tuberculosis Control Programme (RNTCP) training in the past five years. Only 33.1% of them were aware of the International Standards of Tuberculosis Care (ISTC). Fifty-three different regimens were used to treat the patients. Majority of physicians (76%) prescribed daily regimens while 24% administered both daily and intermittent treatment. None of the private physicians prescribed exclusive intermittent regimen. Eighty-seven different treatment regimens were used for the treatment of multidrug-resistant TB (MDR-TB) with none of them prescribing standard treatment under RNTCP. As majority of private practitioners do not follow RNTCP guidelines for treating TB, there is an urgent need for their continued education in this area.

  10. [Internet presence of neurologists, psychiatrists and medical psychotherapists in private practice].

    Science.gov (United States)

    Kuhnigk, Olaf; Ramuschkat, Meike; Schreiner, Julia; Anger, Anina; Reimer, Jens

    2014-04-01

    The world wide web provides new options to physicians in terms practice marketing, information brokerage, and process optimization. This study explores prevalence and content of homepages of neurologists, psychiatrists and medical psychotherapists in private practice. Through the legal bodies of physicians in private practice in six northern German states neurologists, psychiatrists and medical psychotherapists were identified. According to a standardized and operationalized criteria catalogue, homepages were rated. 1804 physicians were identified, 352 (19.5 %) had operated a homepage. Higher frequencies of homepages found for male physicians (vs. female physicians), practice centres (vs. single practices) and urban practices (vs. rural practices). In average, practices reached 18.8 (± 5.3) of 42 points; contact data and accessibility information were generally available; information as to qualification and specialization was provided more infrequently. Legal specifications were not considered in more than every second homepage, interactive elements like online appointment of follow-up prescription were only rarely offered. Only every fifth neurological or psychiatric practice operates an own homepage, higher competition (urban area) and higher professionalization (practice centres) seem to act as promotors. The legal framework has to be focused, and patient needs should be taken into account. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Internationally Recommended Best Practices in Transportation Financing Public-Private Partnerships (P3s)

    DEFF Research Database (Denmark)

    Martin, Lawrence; Lawther, Wendell; Hodge, Graeme

    2013-01-01

    Transportation financing public-private partnerships (P3s) are a common practice in many countries. However, they represent a relatively new approach to transportation infrastructure financing for state and local governments in the United States. In a transportation financing P3 project, a private...... sector partner designs-builds-finances-operates- maintains (DBFOM) a transportation infrastructure asset (road, highway, bridge, tunnel, etc.) with an emphasis on financing. Under this type of arrangement, the private sector partner is primarily responsible for securing all or substantially all...... of the funding necessary to construct new transportation infrastructure and/or rehabilitate existing transportation infrastructure. This study reviews the international experience of national and sub-national governments with transportation financing P3s. The primary purpose of this study is to identify...

  12. Are Australasian Genetic Counselors Interested in Private Practice at the Primary Care Level of Health Service?

    Science.gov (United States)

    Sane, Vrunda; Humphreys, Linda; Peterson, Madelyn

    2015-10-01

    This study explored the perceived interest in development of private genetic counseling services in collaboration with primary care physicians in the Australasian setting by online survey of members of the Australasian Society of Genetic Counselors. Four hypothetical private practice models of professional collaboration between genetic counselors and primary care physicians or clinical geneticists were proposed to gauge interest and enthusiasm of ASGC members for this type of professional development. Perceived barriers and facilitators were also evaluated. 78 completed responses were included for analysis. The majority of participants (84.6 %) showed a positive degree of interest and enthusiasm towards potential for clinical work in private practice. All proposed practice models yielded a positive degree of interest from participants. Model 4 (the only model of collaboration with a clinical geneticist rather than primary care physician) was the clearly preferred option (mean = 4.26/5), followed by Model 2 (collaboration with a single primary care practice) (mean = 4.09/5), Model 3 (collaboration with multiple primary care clinics, multidisciplinary clinic or specialty clinic) (mean = 3.77/5) and finally, Model 1 (mean = 3.61/5), which was the most independent model of practice. When participants ranked the options in the order of preference, Model 4 remained the most popular first preference (44.6 %), followed by model 2 (21.6 %), model 3 (18.9 %) and model 1 was again least popular (10.8 %). There was no significant statistical correlation between demographic characteristics (age bracket, years of work experience, current level of work autonomy) and participants' preference for private practice models. Support from clinical genetics colleagues and the professional society was highly rated as a facilitator and, conversely, lack of such support as a significant barrier.

  13. Public-private partnerships in translational medicine: concepts and practical examples.

    Science.gov (United States)

    Luijten, Peter R; van Dongen, Guus A M S; Moonen, Chrit T; Storm, Gert; Crommelin, Daan J A

    2012-07-20

    The way forward in multidisciplinary research according to former NIH's director Elias Zerhouni is to engage in predictive, personalized, preemptive and participatory medicine. For the creation of the optimal innovation climate that would allow for such a strategy, public-private partnerships have been widely proposed as an important instrument. Public-private partnerships have become an important instrument to expedite translational research in medicine. The Netherlands have initiated three large public-private partnerships in the life sciences and health area to facilitate the translation of valuable basic scientific concepts to new products and services in medicine. The focus of these partnerships has been on drug development, improved diagnosis and regenerative medicine. The Dutch model of public-private partnership forms the blueprint of a much larger European initiative called EATRIS. This paper will provide practical examples of public-private partnerships initiated to expedite the translation of new technology for drug development towards the clinic. Three specific technologies are in focus: companion diagnostics using nuclear medicine, the use of ultra high field MRI to generate sensitive surrogate endpoints based on endogenous contrast, and MRI guidance for High Intensity Focused Ultrasound mediated drug delivery. Copyright © 2012 Elsevier B.V. All rights reserved.

  14. Recovery opportunities, work-home conflict, and emotional exhaustion among hematologists and oncologists in private practice.

    Science.gov (United States)

    Nitzsche, Anika; Neumann, Melanie; Groß, Sophie E; Ansmann, Lena; Pfaff, Holger; Baumann, Walter; Wirtz, Markus; Schmitz, Stephan; Ernstmann, Nicole

    2017-04-01

    Hematologists and oncologists in private practice play a central role in the care provided for cancer patients. The present study analyzes stress and relaxation aspects in the work of hematologists and oncologists in private practice in Germany in relation to emotional exhaustion, as a core dimension of burnout syndrome. The study focuses on the opportunities for internal recovery using breaks and time out during the working day, the frequency of working on weekends and on vacation, and the physician's work-home and home-work conflict. Postulated associations between the constructs were analyzed using a structural equation model. If work leads to conflicts in private life (work-home conflict), it is associated with greater emotional exhaustion. Working frequently at the weekend is associated with greater work-home conflict and indirectly with greater emotional exhaustion. By contrast, the availability of opportunities to relax and recover during the working day is associated with less work-home conflict and indirectly with less emotional exhaustion. These results underline the importance of internal recovery opportunities during the working day and a successful interplay between working and private life for the health of outpatient hematologists and oncologists.

  15. Job stress and job satisfaction of physicians in private practice: comparison of German and Norwegian physicians.

    Science.gov (United States)

    Voltmer, Edgar; Rosta, Judith; Siegrist, Johannes; Aasland, Olaf G

    2012-10-01

    This study examined job satisfaction and job stress of German compared to Norwegian physicians in private practice. A representative sample of physicians in private practice of Schleswig-Holstein, Germany (N = 414) and a nationwide sample of Norwegian general practitioners and private practice specialists (N = 340) were surveyed in a cross-sectional design in 2010. The questionnaire comprised the standard instruments "Job Satisfaction Scale (JSS)" and a short form of the "Effort-Reward Imbalance Questionnaire (ERI)". Norwegian physicians scored significantly higher (job satisfaction scale compared to German physicians (M 5.57, SD 0.74 vs. M 4.78, SD 1.01). The effect size was highest for the items freedom to choose method (d = 1.012), rate of pay (d = 0.941), and overall job satisfaction (d = 0.931). While there was no significant difference in the mean of the overall effort scale between German and Norwegian physicians, Norwegian physicians scored significantly higher (p job satisfaction. Job satisfaction and reward were significantly higher in Norwegian than in German physicians. An almost threefold higher proportion of German physicians exhibited a high level of work-related stress. Findings call for active prevention and health promotion among stressed practicing physicians, with a special focus on improved working conditions.

  16. Poor Documentation of Inflammatory Bowel Disease Quality Measures in Academic, Community, and Private Practice.

    Science.gov (United States)

    Feuerstein, Joseph D; Castillo, Natalia E; Siddique, Sana S; Lewandowski, Jeffrey J; Geissler, Kathy; Martinez-Vazquez, Manuel; Thukral, Chandrashekhar; Leffler, Daniel A; Cheifetz, Adam S

    2016-03-01

    Quality measures are used to standardize health care and monitor quality of care. In 2011, the American Gastroenterological Association established quality measures for inflammatory bowel disease (IBD), but there has been limited documentation of compliance from different practice settings. We reviewed charts from 367 consecutive patients with IBD seen at academic practices, 217 patients seen at community practices, and 199 patients seen at private practices for compliance with 8 outpatient measures. Records were assessed for IBD history, medications, comorbidities, and hospitalizations. We also determined the number of patient visits to gastroenterologists in the past year, whether patients had a primary care physician at the same institution, and whether they were seen by a specialist in IBD or in conjunction with a trainee, and reviewed physician demographics. A univariate and multivariate statistical analysis was performed to determine which factors were associated with compliance of all core measures. Screening for tobacco abuse was the most frequently assessed core measure (89.6% of patients; n = 701 of 783), followed by location of IBD (80.3%; n = 629 of 783), and assessment for corticosteroid-sparing therapy (70.8%; n = 275 of 388). The least-frequently evaluated measures were pneumococcal immunization (16.7% of patients; n = 131 of 783), bone loss (25%; n = 126 of 505), and influenza immunization (28.7%; n = 225 of 783). Only 5.8% of patients (46 of 783) had all applicable core measures documented (24 in academic practice, none in clinical practice, and 22 in private practice). In the multivariate model, year of graduation from fellowship (odds ratio [OR], 2.184; 95% confidence interval [CI], 1.522-3.134; P measures. We found poor documentation of IBD quality measures in academic, clinical, and private gastroenterology practices. Interventions are necessary to improve reporting of quality measures. Copyright © 2016 AGA Institute. Published by Elsevier Inc

  17. Private health purchasing practices in the public sector: a comparison of state employers and the Fortune 500.

    Science.gov (United States)

    Maxwell, James; Temin, Peter; Petigara, Tanaz

    2004-01-01

    State governments are influential purchasers of health benefits but have not been studied extensively. In a recent survey of senior benefit managers, we examine the extent to which states have followed the private-sector approach to purchasing health care. We found that states have adopted "industrial purchasing" practices similar to those of large private employers but offer greater choice of carriers and pay a higher percentage of premiums. Unions continue to influence health care purchasing in both the public and private sectors. Double-digit increases in health costs and the current budget crisis may force states to align their purchasing practices with the private sector to cut costs.

  18. Realities of Private VET Practice through VET Teachers' Lenses: Learning Contexts for International Students in Private VET in Australia

    Science.gov (United States)

    Pasura, Rinos

    2014-01-01

    Since the introduction of the competitive vocational education and training market model in the Australia in the 1990s, the growth and participation of international students and private providers has led to sustained debates about training standards in commercial-for-profit, private registered training organisations. Much of this debate has been…

  19. Solid waste management practices under public and private sector in Lahore, Pakistan

    Directory of Open Access Journals (Sweden)

    Usman Ashraf

    2016-10-01

    Full Text Available Solid waste management (SWM practices in Lahore, provincial capital of Punjab, were privatised in 2012. This study draws a comparison of solid waste management practices by public and private sector in Lahore. The comparison is done by taking following factors in consideration; administrative structure, waste collection, street sweeping, waste storage capacity and logistics, disposal, mechanical sweeping and washing, monitoring system. Privatisation of solid waste management in Lahore is celebrated as complete success story. In contrast to this, we found the results of privatisation are mixed. Privatisation has improved some components of the system. Monitoring system has been the key innovation under private sector. It has enabled better allocation, management and channelization of available resources. Yet little to no improvement has been done in street sweeping, disposal of waste and administrative structure of waste management in the city.

  20. Comparison of private versus academic practice for general surgeons: a guide for medical students and residents.

    Science.gov (United States)

    Schroen, Anneke T; Brownstein, Michelle R; Sheldon, George F

    2003-12-01

    Medical students and residents often make specialty and practice choices with limited exposure to aspects of professional and personal life in general surgery. The purpose of this study was to portray practice composition, career choices, professional experiences, job satisfaction, and personal life characteristics specific to practicing general surgeons in the United States. A 131-question survey was mailed to all female members (n = 1,076) and a random 2:1 sample of male members (n = 2,152) of the American College of Surgeons in three mailings between September 1998 and March 1999. Respondents who were not actively practicing general surgery in the United States and both trainees and surgeons who did not fit the definition of private or academic practice were excluded. Detailed questions regarding practice attributes, surgical training, professional choices, harassment, malpractice, career satisfaction, and personal life characteristics were included. Separate five-point Likert scales were designed to measure influences on career choices and satisfaction with professional and personal matters. Univariate analyses were used to analyze responses by surgeon age, gender, and practice type. A response rate of 57% resulted in 1,532 eligible responses. Significant differences between private and academic practice were noted in case composition, practice structure, and income potential; no major differences were seen in malpractice experience. Propensity for marriage and parenthood differed significantly between men and women surgeons. Overall career satisfaction was very high regardless of practice type. Some differences by surgeon gender in perceptions of equal career advancement opportunities and of professional isolation were noted. This study offers a comprehensive view of general surgery to enable more informed decisions among medical students and residents regarding specialty choice or practice opportunities.

  1. Road casualties in work-related and private contexts: Occupational medical impact: Results from the ESPARR cohort.

    Science.gov (United States)

    Fort, E; Pélissier, C; Fanjas, A; Charnay, P; Charbotel, B; Bergeret, A; Fontana, L; Hours, M

    2018-05-22

    Road accidents may impact victims' physical and/or mental health and socio-occupational life, notably including return to work. To assess whether the occupational medical consequences sustained by subjects injured in road accidents occurring in a work-related context differ from those associated with private accidents. 778 adults who were in work or occupational training at the time of their accident were included. Two groups were distinguished: 354 (45.5%) injured in road accidents occurring in a work-related context (commuting or on duty) and 424 (54.5%) injured in a private accident. The groups were compared on medical and occupational factors assessed on prospective follow-up at 6 months and 1 and 3 years. Multivariate analysis explored for factors associated at 6 months and 1 year with sick leave following the accident and duration of sick leave. There were no significant differences between groups for demographic data apart from a slightly higher injury severity in private accidents (32.5% of private accidents with MAIS3+(Maximum Abbreviated Injury Scale greater or equal to 3) vs. 23.7% for work-related accidents, p = 0.007). Victims of work-related accidents were more often on sick leave (OR = 1.8; 95% CI, 1.1-2.9). Although the length of sick leave is higher for work-related accidents that for private accidents, multivariate analysis showed that the injury severity and the post-traumatic stress disorder (PTSD) are significant factors to explain the time to return to work. There were no significant differences according to occupational impact during follow-up, notably including sick-leave duration, number of victims returning to work within 3 years and number of victims out of work due to incapacity. In the ESPARR (follow-up study of a road-accident population in the Rhône administrative county: Etude de Suivi d'une Population d'Accidentés de la Route dans le Rhône) cohort, the fact that a road accident occurred in a work-related context did not affect

  2. Group supervision in a private setting: Practice and method for theory and practice in psychotherapy

    Directory of Open Access Journals (Sweden)

    Graziana Mangiacavallo

    2015-05-01

    Full Text Available The report aims to tell the experience of a supervision group in a private setting. The group consists of professional psychotherapists driven by the more experienced practitioner, who shares a clinical reasoning on psychotherapy with younger colleagues. The report aims to present the supervision group as a methode and to showcase its features. The supervision group becomes a container of professional experiences that speak of the new way of doing psychotherapy. 

  3. School health services and its practice among public and private primary schools in Western Nigeria.

    Science.gov (United States)

    Kuponiyi, Olugbenga Temitope; Amoran, Olorunfemi Emmanuel; Kuponiyi, Opeyemi Temitola

    2016-04-06

    Globally the number of children reaching school age is estimated to be 1.2 billion children (18% of the world's population) and rising. This study was therefore designed to determine the school health services available and its practices in primary schools in Ogun state, Western Nigeria. The study was a comparative cross-sectional survey of private and public primary schools in Ogun state using a multi-stage sampling technique. Participants were interviewed using a structured, interviewer administered questionnaire and a checklist. Data collected was analyzed using the SPSS version 15.0. A total of 360 head teachers served as respondents for the study with the overall mean age of 45.7 ± 9.9 years. More than three quarters of the respondents in both groups could not correctly define the school health programme. There were no health personnel or a trained first aider in 86 (47.8%) public and 110 (61.1%) private schools but a nurse/midwife was present in 57 (31.7%) and 27 (15.0%) public and private schools. (χ(2) = 17.122, P = 0.002). In about 95% of the schools, the teacher carried out routine inspection of the pupils while periodic medical examination for staff and pupils was carried out in only 13 (7.2%) public and 31 (17.2%) private schools (χ(2) = 8.398, P = 0.004). A sick bay/clinic was present in 26 (14.4%) and 67 (37.2%) public and private schools respectively (χ(2) = 24.371, P = 0.001). The practice of school health programme was dependent on the age (χ(2) = 12.53, P = 0.006) and the ethnicity of the respondents (χ(2) = 6.330, P = 0.042). Using multivariate analysis only one variable (type of school) was found to be a predictor of school health programme. (OR 4.55, CI 1.918-10.79). The study concludes that the practice of the various components of school health services was poor but better in private primary schools in Nigeria. Routine inspection by teachers was the commonest form of health appraisal. This may suggest that more health personnel need to

  4. Is the practice of public or private sector doctors more evidence-based? A qualitative study from Vellore, India.

    Science.gov (United States)

    Akinyemi, Oluwaseun O; Martineau, Tim; Tharyan, Prathap

    2015-06-01

    The literature on the use of evidence-based practice is sparse, both in the public and private sectors in middle-and low-income countries, and the present literature shows that physician understanding and use of evidence-based practice is poor. The study aimed to explore the perception of medical practitioners in the private for-profit, private not-for-profit and government sectors in Vellore, India, on evidence-based practice, in order to explain the factors affecting the use of evidence-based practice among the practitioners and to inform local policy and management decisions for improvement in quality of care. Qualitative methodology was employed in the study. Sixteen in-depth and two key informant interviews were carried out with medical practitioners selected by purposive sampling in the private for-profit, private not-for-profit and government sectors. The interviews explored participants' knowledge of evidence-based practice, factors affecting its use and possible ways of improving the use of evidence-based practice among physicians in all the health sectors. Data from the in-depth and key informant interviews were analyzed with the NVIVO (version 8) software package using the framework approach. Although most practitioners interviewed have heard of evidence-based practice, knowledge about evidence-based practice seems inadequate. However, doctors in the private not-for-profit sector seem to be more familiar with the concept of evidence-based practice. Also, practitioners in the private not-for profit sector appear to use medical evidence more in their practices compared to government practitioners or doctors in the private for-profit sector. Perceived factors affecting physician use of evidence-based practice include lack of personal time for literature appraisal as a result of high case load, weak regulatory system, pressure from patients, caregivers and pharmaceutical companies, as well as financial considerations. Opinions of the respondents are that use

  5. Childhood diarrhoea management practices in Bangladesh: private sector dominance and continued inequities in care.

    Science.gov (United States)

    Larson, Charles P; Saha, Unnati Rani; Islam, Rafiqul; Roy, Nikhil

    2006-12-01

    Monitoring for disparities in health and services received based upon gender, income, and geography should continue as renewed efforts to reduce under-five mortality are made in response to millennium development goal #4. The purpose of this survey was to provide a nationally representative description of current childhood diarrhoea management practices and disparities in Bangladesh. A nationally representative, cross-sectional, cluster-sample survey was carried out in randomly selected rural and urban populations across Bangladesh. The survey was completed over an 8 month period between November 2003 and June 2004. A total of 7308 children with a prevalent diarrhoeal illness episode within 560 clusters were identified and enrolled in the survey. In 61% of the cases help was sought from a health care provider, with over 90% practicing in the private sector. Caretaker practice disparities favouring males and higher income households were identified. Significant trends (P gender disparities were limited to females being less likely to receive an antibiotic, adj OR 0.74 (95% CI 0.65, 0.86). Households seeking help from a health provider overwhelmingly utilize the private sector in Bangladesh. Gender inequities in the utilization of licensed providers and purchase of antibiotics, favouring males were identified. Findings suggest that higher income, urban households tend to practice greater gender discrimination. In order to better understand health dynamics in urban populations, in particular slum-dwellers, there is a need to disaggregate survey data by household location.

  6. Impact of the Medicare Chronic Disease Management program on the conduct of Australian dietitians' private practices.

    Science.gov (United States)

    Jansen, Sarah; Ball, Lauren; Lowe, Catherine

    2015-04-01

    This study explored private practice dietitians' perceptions of the impact of the Australian Chronic Disease Management (CDM) program on the conduct of their private practice, and the care provided to patients. Twenty-five accredited practising dietitians working in primary care participated in an individual semistructured telephone interview. Interview questions focussed on dietitians' perceptions of the proportion of patients receiving care through the CDM program, fee structures, adhering to reporting requirements and auditing. Transcript data were thematically analysed using a process of open coding. Half of the dietitians (12/25) reported that most of their patients (>75%) received care through the CDM program. Many dietitians (19/25) reported providing identical care to patients using the CDM program and private patients, but most (17/25) described spending substantially longer on administrative tasks for CDM patients. Dietitians experienced pressure from doctors and patients to keep their fees low or to bulk-bill patients using the CDM program. One-third of interviewed dietitians (8/25) expressed concern about the potential to be audited by Medicare. Recommendations to improve the CDM program included increasing the consultation length and subsequent rebate available for dietetic consultations, and increasing the number of consultations to align with dietetic best-practice guidelines. The CDM program creates challenges for dietitians working in primary care, including how to sustain the quality of patient-centred care and yet maintain equitable business practices. To ensure the CDM program appropriately assists patients to receive optimal care, further review of the CDM program within the scope of dietetics is required.

  7. Physiotherapy as a disciplinary institution in modern society - a Foucauldian perspective on physiotherapy in Danish private practice.

    Science.gov (United States)

    Praestegaard, Jeanette; Gard, Gunvor; Glasdam, Stinne

    2015-01-01

    In many Western countries, physiotherapy in a private context is practiced and managed within a neoliberal ideology. Little is known about how private physiotherapeutic practice functions, which is why this study aims to explore how physiotherapy is practiced from the perspective of physiotherapists in Danish private practice, within a Foucauldian perspective. This study consisted of 21 interviews with physiotherapists employed in private practice and observation notes of the clinic. Interviews and observation notes were analyzed through the lens of Foucault's concepts of discipline, self-discipline, power and resistance. Three categories were constructed: (1) the tacit transition from person to patient; (2) the art of producing docile bodies; and (3) the inhibition of freedom of action by practicing in private homes. From a Foucauldian perspective, private physiotherapeutic practices have a disciplinary function in modern society as the physiotherapists produce docile bodies through disciplinary technologies, whereby their business becomes profitable. Most patients support the physiotherapists' "regime of truth" but if they resist, they are either excluded or accepted as "abnormal" but as a necessary source of income. The physiotherapists appear to be unconscious of the bio-powers working "behind their backs" as they are subject to the Western medical logic, and the neoliberal framework that rules their businesses.

  8. A qualitative exploration of the factors influencing the job satisfaction and career development of physiotherapists in private practice.

    Science.gov (United States)

    Davies, J M; Edgar, S; Debenham, J

    2016-09-01

    The aim of this study was to investigate factors contributing to job satisfaction at different career stages, among private practice physiotherapists in Australia. Qualitative case study design utilising focus groups. Sixteen participants allocated to 3 focus groups: new graduates (n = 6), post graduates (n = 5) and practice owners (n = 5). Focus groups were transcribed verbatim and a thematic analysis was undertaken to determine themes and subthemes from each focus group. The key themes identified within each focus group included the role of peer support and mentoring, professional development, professional relationships, new graduate employment issues and career pathways within private practice. In particular, issues surrounding the new graduate experience in private practice were explored, with all groups noting lack of support and financial pressures were of concern. Findings demonstrated that new graduates are underprepared to work in private practice and modifications to the delivery of peer support, mentoring and professional development is required. Key recommendations include physiotherapy undergraduate program reform to reflect industry requirements in private practice, an increase in private practice clinical placement numbers, as well as streamlining the physiotherapy profession to improve career development pathways. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Ethical Issues related to First Time Patient Encounters – reflected from the perspective of physiotherapists in private practice

    DEFF Research Database (Denmark)

    Præstegaard, Jeanette; Gard, Gunvor

    2011-01-01

    of the physiotherapists in private practice. Methods A qualitative approach was chosen and semi-structured interviews with 21 physiotherapists were carried out twice and analysed by using a phenomenological framework. Results Four descriptive themes emerged: general reflections on ethics in physiotherapy; the importance...... reflects and acts ethically. Further exploration of ethical issues in private practice is recommendable, and as management policy is deeply embedded within the Danish public sector there are reasons to explore public contexts of physiotherapy as well....... to meet society's expectations and demands of professional competence as well as ethical competence. Since it is becoming increasingly popular to choose a carrier in private practice in Denmark this context constitutes the frame of this study. Physiotherapy in private practice involves mainly a meeting...

  10. Learning management by self-employed occupational therapists in private practice.

    Science.gov (United States)

    Millsteed, Jeannine; Redmond, Janice; Walker, Elizabeth

    2017-04-01

    This study explored how occupational therapists in private practice developed the business skills needed to operate a successful private practice. The literature shows that many small-business owner-managers have poorly developed business skills, and some experience high rates of failure. This indicates that to be successful in private practice, occupational therapists need to gain mastery of management competencies in addition to their professional clinical competencies. A qualitative study, using in-depth interviews, collected data from twenty-six self-employed occupational therapists on their experiences of becoming a small-business owner-manager. A narrative analysis built an understanding about how these therapists developed their business competencies. Analysis revealed the factors affecting the development of business competencies were interactions between the initial motivations for start-up, growth aspirations and engagement with external business environments. Business competencies developed through a combination of formal learning prior to starting their businesses, and informal learning once their businesses were in operation. Lower level learning occurred in the routine and operational processes, with higher level learning through discontinuous events resulting in a transformation in the therapists' understanding about themselves as business owner-managers. Findings led to a proposition that occupational therapists make the transition to becoming successful small-business owner-manager through management learning that includes elements of self-reflection, identifying environmental opportunities and risks, developing capabilities, and strategic planning for growth and development. It provides insights on what occupational therapists need to consider to become successful small-business owner-managers. © 2016 Occupational Therapy Australia.

  11. Attitude of clinical faculty members in Shiraz Medical University towards private practice physicians' participation in ambulatory care education

    Directory of Open Access Journals (Sweden)

    Khatereh Mahori

    2002-04-01

    Full Text Available Background: Improvement of medical education is necessary for meeting health care demands. Participation of private practice physicians in ambulatory care training is an effective method for enhancing medical students' skills. Purpose This study was undertaken to determine clinical professors' views about participation of physicians with private office in ambulatory care training. Methods: Participants composed of 162 Shiraz Medical University faculty members from 12 disciplines. A questionnaire requesting faculty members' views on different aspects of ambulat01y care teaching and interaction of community-based organizations was distributed. Results: Of 120 (74.1% respondents, 64 (54.2% believed that clinical settings of medical university are appropriate for ambulatory care training. Private practice physicians believed more than academic physicians without private office that private offices have wider range of patients, more common cases, and better follow up chance; and is also a better setting for learning ambulatory care compared with medical university clinical centers. Overall, 32 (29.1% respondent’s found the participation of physicians with private practice on medical education positive. Key words medical education, ambulatory medicine, private practice

  12. "Practical knowledge" and perceptions of antibiotics and antibiotic resistance among drugsellers in Tanzanian private drugstores

    Directory of Open Access Journals (Sweden)

    Tomson Göran

    2010-09-01

    Full Text Available Abstract Background Studies indicate that antibiotics are sold against regulation and without prescription in private drugstores in rural Tanzania. The objective of the study was to explore and describe antibiotics sale and dispensing practices and link it to drugseller knowledge and perceptions of antibiotics and antibiotic resistance. Methods Exit customers of private drugstores in eight districts were interviewed about the drugstore encounter and drugs bought. Drugsellers filled in a questionnaire with closed- and open-ended questions about antibiotics and resistance. Data were analyzed using mixed quantitative and qualitative methods. Results Of 350 interviewed exit customers, 24% had bought antibiotics. Thirty percent had seen a health worker before coming and almost all of these had a prescription. Antibiotics were dispensed mainly for cough, stomachache, genital complaints and diarrhea but not for malaria or headache. Dispensed drugs were assessed as relevant for the symptoms or disease presented in 83% of all cases and 51% for antibiotics specifically. Non-prescribed drugs were assessed as more relevant than the prescribed. The knowledge level of the drugseller was ranked as high or very high by 75% of the respondents. Seventy-five drugsellers from three districts participated. Seventy-nine percent stated that diseases caused by bacteria can be treated with antibiotics but 24% of these also said that antibiotics can be used for treating viral disease. Most (85% said that STI can be treated with antibiotics while 1% said the same about headache, 4% general weakness and 3% 'all diseases'. Seventy-two percent had heard of antibiotic resistance. When describing what an antibiotic is, the respondents used six different kinds of keywords. Descriptions of what antibiotic resistance is and how it occurs were quite rational from a biomedical point of view with some exceptions. They gave rise to five categories and one theme: Perceiving antibiotic

  13. Profile of Immunization Practice by General Practitioners and Pediatricians in Private Setting

    Directory of Open Access Journals (Sweden)

    Soedjatmiko Soedjatmiko

    2017-12-01

    Full Text Available Basic immunization coverage in Indonesia in 2013 was still low (59.2% (IBHS, 2013. Physicians’ attitude and practice were among the determinant factors of a successful immunization program. This survey aimed to describe general practitioner’s (GP and pediatrician’s attitude towards immunization and its coverage  in private practices. This cross-sectional study was performed by distributing questionnaires consisting of 5 items on opinion and 10 items on immunization practices to 100 respondents in November 2014. Completed questionnaires were obtained from 29 GPs and 65 pediatricians. Most respondents considered that the Expanded Program in Immunization vaccine should be given. First dose of hepatitis B vaccine was mostly given in the first 12 hours after birth (90% GPs and 74% pediatricians. Oral polio vaccine was mostly given shortly before hospital discharge (65% of GPs and 81% pediatricians while the DTwP-HB-Hib vaccine were given by 27% of GPs and 21% of pediatricians to >75% patients. Pneumococcal, rotavirus, hepatitis A, typhoid, and influenza vaccines were provided by less than 25% GPs and pediatricians, except for the influenza vaccine which was provided by 31% pediatricians. MMR vaccine was given to >75% patients by 16% of GPs and 29% of pediatricians. This pilot survey of immunization practice in private setting might be the first study in Indonesia that this can be considered as a preliminary report of immunization in private setting. Further studies need to be done, especially regarding problems in immunization in private practices.  Key words: Attitude, general practitioners, immunization practice, private setting, pediatricians Gambaran Praktek Imunisasi Dokter Umum dan Dokter Spesialis Anak di Praktek Swasta Riset Kesehatan Dasar 2013 melaporkan bahwa cakupan imunisasi Indonesia masih rendah (59,2%. Sikap dan praktik imunisasi dokter merupakan salah satu faktor penentu keberhasilan. Tujuan penelitian ini mengetahui sikap

  14. A profile of professional nursing practice in the private sector in the R.S.A.

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    S. Pera

    1988-09-01

    Full Text Available The purpose of this study was to develop a profile of professional nursing practice in private enterprise health care services in the Republic of South Africa. In the light of the future health care needs and the relationship between the private and public sector health care establishments, information about the role and task of the I professional nurse was needed. Information would provide a data base about the registered nurse and so facilitate future health care planning. An exploratory field study was undertaken to locate the various work environments of the registered nurse in four statistical urban regions. Questionnaires were handed out and collected from a proportional stratified sample of professional nurses who were working in thirteen types of health care environments in the period between I June 1983 and 30 September 1983. A return rate of 68 percent yielded 340 completed questionnaires from 501 registered nurses. The study revealed that the majority of nurses in the private sector were relatively young. White, female, English-speaking professionals who were practising in four broad areas of health care: • Custodial care environments such as residential homes for the aged, institutions for the chronic sick and frail aged, homes for children and homes for the adult handicapped. • Hospitals and related special health centres catering for drug addicts, alcoholics and patients suffering from psychiatric/nervous disorders. • Institutions for child and adult education which included crèches/nursery schools, primary and secondary hoarding schools, special schools for the handicapped, and university based student health centres. • Medical and dental consulting room practices. • Other entrepreneurial employment settings such as business and industrial occupational health care services, nursing service agencies, and mobile emergency care units.

  15. Ethical issues in physiotherapy – Reflected from the perspective of physiotherapists in private practice

    DEFF Research Database (Denmark)

    Præstegaard, Jeanette; Gard, Gunvor

    2013-01-01

    Background: An important aspect of physiotherapy professional autonomy is the ethical code of the profession, both collectively and for the individual member of the profession. The aim of this study is to explore and add additional insight into the nature and scope of ethical issues as they are u......Background: An important aspect of physiotherapy professional autonomy is the ethical code of the profession, both collectively and for the individual member of the profession. The aim of this study is to explore and add additional insight into the nature and scope of ethical issues......: The ideal of being beneficent toward the patient. Here, the ethical issues uncovered in the interviews were embedded in three code-groups: 1) ethical issues related to equality; 2) feeling obligated to do one's best; and 3) transgression of boundaries. Conclusions: In an ethical perspective, physiotherapy...... in private practice is on a trajectory toward increased professionalism. Physiotherapists in private practice have many reflections on ethics and these reflections are primarily based on individual common sense arguments and on deontological understandings. As physiotherapy by condition is characterized...

  16. 20 CFR 1002.7 - How does USERRA relate to other laws, public and private contracts, and employer practices?

    Science.gov (United States)

    2010-04-01

    ... USERRA relate to other laws, public and private contracts, and employer practices? (a) USERRA establishes... law (including any local law or ordinance), contract, agreement, policy, plan, practice, or other... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false How does USERRA relate to other laws, public...

  17. The Issue of Private Tuition: An Analysis of the Practice in Mauritius and Selected South-east Asian Countries

    Science.gov (United States)

    Foondun, A. Raffick

    2002-11-01

    Private tuition is an issue of growing concern and is practised in both developed and developing countries. Although it has certain positive effects, it imposes a considerable financial burden on parents and often gives rise to abuses. The present study, which focuses on the primary level, addresses a number of questions, such as the extent of the practice, its implications, the various forms that it takes, attitudes towards it, why children take private tuition, why teachers provide it, and policies to deal with the issue. The discussion ends with a plea for more research on private tuition in order to provide a basis for policies to address the problem.

  18. Domestic waste disposal practice and perceptions of private sector waste management in urban Accra.

    Science.gov (United States)

    Yoada, Ramatta Massa; Chirawurah, Dennis; Adongo, Philip Baba

    2014-07-08

    Waste poses a threat to public health and the environment if it is not stored, collected, and disposed of properly. The perception of waste as an unwanted material with no intrinsic value has dominated attitudes towards disposal. This study investigates the domestic waste practices, waste disposal, and perceptions about waste and health in an urban community. The study utilised a mixed-method approach. A cross-sectional survey questionnaire and in-depth interview were used to collect data. A total of 364 household heads were interviewed in the survey and six key informants were interviewed with the in-depth interviews. The results of the study revealed that 93.1% of households disposed of food debris as waste and 77.8% disposed of plastic materials as waste. The study also showed that 61.0% of the households disposed of their waste at community bins or had waste picked up at their homes by private contractors. The remaining 39.0% disposed of their waste in gutters, streets, holes and nearby bushes. Of those who paid for the services of private contractors, 62.9% were not satisfied with the services because of their cost and irregular collection. About 83% of the respondents were aware that improper waste management contributes to disease causation; most of the respondents thought that improper waste management could lead to malaria and diarrhoea. There was a general perception that children should be responsible for transporting waste from the households to dumping sites. Proper education of the public, the provision of more communal trash bins, and the collection of waste by private contractors could help prevent exposing the public in municipalities to diseases.

  19. Domestic waste disposal practice and perceptions of private sector waste management in urban Accra

    Science.gov (United States)

    2014-01-01

    Background Waste poses a threat to public health and the environment if it is not stored, collected, and disposed of properly. The perception of waste as an unwanted material with no intrinsic value has dominated attitudes towards disposal. This study investigates the domestic waste practices, waste disposal, and perceptions about waste and health in an urban community. Methods The study utilised a mixed-method approach. A cross-sectional survey questionnaire and in-depth interview were used to collect data. A total of 364 household heads were interviewed in the survey and six key informants were interviewed with the in-depth interviews. Results The results of the study revealed that 93.1% of households disposed of food debris as waste and 77.8% disposed of plastic materials as waste. The study also showed that 61.0% of the households disposed of their waste at community bins or had waste picked up at their homes by private contractors. The remaining 39.0% disposed of their waste in gutters, streets, holes and nearby bushes. Of those who paid for the services of private contractors, 62.9% were not satisfied with the services because of their cost and irregular collection. About 83% of the respondents were aware that improper waste management contributes to disease causation; most of the respondents thought that improper waste management could lead to malaria and diarrhoea. There was a general perception that children should be responsible for transporting waste from the households to dumping sites. Conclusion Proper education of the public, the provision of more communal trash bins, and the collection of waste by private contractors could help prevent exposing the public in municipalities to diseases. PMID:25005728

  20. Human Resource Management Practices and Employees’ Satisfaction Towards Private Banking Sector in Bangladesh

    Directory of Open Access Journals (Sweden)

    Md. Tofael Hossain Majumder

    2012-01-01

    Full Text Available Dramatic advances of Information and Communication Technology (ICT, changing mix and personal values of the workforce, emergence of the knowledge economy and increasing global competition have created enormous challenges on organizations. To cope with the challenges efficiently, human resource has been considered as one of the most important factors in today’s hyper-competitive market place. The focus of this study is to gain an insight into the current HRM practices and its impact on employee’s satisfaction on the private banking sector in Bangladesh. For conducting this research, 100 bank employees are selected from the chosen banks and out of this 88 employees responses properly, the response rate is 88 percent. The questionnaire consists of different questions on nine HRM dimensions such as recruitment and selection systems, compensation package, job security, career growth, training and development, management style, job design and responsibilities, reward and motivation and working environment. The questionnaire was developed by using a five point Likert scale. In this study, some statistical measures such as Z-test, mean and proportion analysis is used to examine employee’s satisfaction. The study reveals that all HRM dimensions exercised in the private banking sector of Bangladesh does not satisfied to the employees equally. Most of the employees are dissatisfied with compensation package followed by reward and motivation, career growth, training and development, management style, and job design and responsibilities. So, these HRM dimensions quality should be improved for the betterment of the bank’s success.

  1. Tuberculosis management practices of private practitioners in Pune municipal corporation, India.

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    Sandeep Bharaswadkar

    Full Text Available BACKGROUND: Private Practitioners (PP are the primary source of health care for patients in India. Limited representative information is available on TB management practices of Indian PP or on the efficacy of India's Revised National Tuberculosis Control Programme (RNTCP to improve the quality of TB management through training of PP. METHODS: We conducted a cross-sectional survey of a systematic random sample of PP in one urban area in Western India (Pune, Maharashtra. We presented sample clinical vignettes and determined the proportions of PPs who reported practices consistent with International Standards of TB Care (ISTC. We examined the association between RNTCP training and adherence to ISTC by calculating odds ratios and 95% confidence intervals. RESULTS: Of 3,391 PP practicing allopathic medicine, 249 were interviewed. Of these, 55% had been exposed to RNTCP. For new pulmonary TB patients, 63% (158/249 of provider responses were consistent with ISTC diagnostic practices, and 34% (84/249 of responses were consistent with ISTC treatment practices. However, 48% (120/249 PP also reported use of serological tests for TB diagnosis. In the new TB case vignette, 38% (94/249 PP reported use of at least one second line anti-TB drug in the treatment regimen. RNTCP training was not associated with diagnostic or treatment practices. CONCLUSION: In Pune, India, despite a decade of training activities by the RNTCP, high proportions of providers resorted to TB serology for diagnosis and second-line anti-TB drug use in new TB patients. Efforts to achieve universal access to quality TB management must account for the low quality of care by PP and the lack of demonstrated effect of current training efforts.

  2. Tuberculosis management practices of private practitioners in Pune municipal corporation, India.

    Science.gov (United States)

    Bharaswadkar, Sandeep; Kanchar, Avinash; Thakur, Narendra; Shah, Shubhangi; Patnaik, Brinda; Click, Eleanor S; Kumar, Ajay M V; Dewan, Puneet Kumar

    2014-01-01

    Private Practitioners (PP) are the primary source of health care for patients in India. Limited representative information is available on TB management practices of Indian PP or on the efficacy of India's Revised National Tuberculosis Control Programme (RNTCP) to improve the quality of TB management through training of PP. We conducted a cross-sectional survey of a systematic random sample of PP in one urban area in Western India (Pune, Maharashtra). We presented sample clinical vignettes and determined the proportions of PPs who reported practices consistent with International Standards of TB Care (ISTC). We examined the association between RNTCP training and adherence to ISTC by calculating odds ratios and 95% confidence intervals. Of 3,391 PP practicing allopathic medicine, 249 were interviewed. Of these, 55% had been exposed to RNTCP. For new pulmonary TB patients, 63% (158/249) of provider responses were consistent with ISTC diagnostic practices, and 34% (84/249) of responses were consistent with ISTC treatment practices. However, 48% (120/249) PP also reported use of serological tests for TB diagnosis. In the new TB case vignette, 38% (94/249) PP reported use of at least one second line anti-TB drug in the treatment regimen. RNTCP training was not associated with diagnostic or treatment practices. In Pune, India, despite a decade of training activities by the RNTCP, high proportions of providers resorted to TB serology for diagnosis and second-line anti-TB drug use in new TB patients. Efforts to achieve universal access to quality TB management must account for the low quality of care by PP and the lack of demonstrated effect of current training efforts.

  3. Public–private partnerships on cyber security: a practice of loyalty

    DEFF Research Database (Denmark)

    Christensen, Kristoffer Kjærgaard; Petersen, Karen Lund

    2017-01-01

    The governance of cyber-security risks is seen as increasingly important to the security of the nation. However, cyber-security risks are characterized by a fundamental uncertainty, which poses a great challenge to their governance and calls for new modes of organizing security politics. Public......–private partnerships (PPPs) are often seen as the answer to this challenge by enhancing flexibility and robustness through knowledge-sharing. Engaging with the literature on PPPs and the Danish practice on cyber security, we show how PPPs involve controversies over different threat realities of cyber security....... This plays out as controversies over what is considered threatened, the scope of the issue and the kind of expertise to be mobilized. Arguing that PPPs on security are not defined narrowly by short-sighted strategic self-interest but also loyalty and commitment, we suggest that the innovative potential...

  4. Evaluating the Quality of Website Information of Private-Practice Clinics Offering Cell Therapies in Japan.

    Science.gov (United States)

    Kashihara, Hidenori; Nakayama, Takeo; Hatta, Taichi; Takahashi, Naomi; Fujita, Misao

    2016-05-24

    Although the safety and effectiveness of stem cell therapies are yet to be proven, recent studies show that such therapies are being advertised with some questionable marketing techniques to effect positive portrayal of the therapies on the webpages of private-practice clinics to sell their therapies worldwide. In such context, those clinics communicate directly with consumers (patients and their family members) via the clinics' websites. Meanwhile, the Health Science Council at the Ministry of Health, Labour, and Welfare (MHLW) in Japan has pointed out noncompliance of some local clinics with the provisions concerning medical advertising in the Medical Care Act in the past. However, locally little is known about the current status of those clinics including the quality of their webpage information disseminated. To evaluate the quality of website information of private-practice clinics offering cell therapies in Japan. Twenty-four websites with 77 treatments from the Google search were identified for evaluation. The following three exploratory analyses were performed: first in order to ascertain web-based portrayal of private-practice clinics offering cell therapies, a descriptive analysis was conducted using a coding frame; second we evaluated the quality of the target website information from the viewpoint of the level of consideration taken for patients and their family members, using 10 quality criteria ("the Minimum Standard") from the e-Health Code of Ethics 2.0; third we counted and coded expressions that matched set categories for "name-dropping" and "personalized medicine" in the information posted on these websites. Analysis on the treatments (N=77) revealed 126 indications (multiple response): the top three indications were "cancer," "skin-rejuvenation/antiaging/anti-skin aging," and "breast augmentation/buttock augmentation." As for the portrayal of treatment risks and benefits, 78% (60/77) of treatments were mentioned with "benefits," whereas 77% (59

  5. Prevalence of Low-Cost Generic Program Use in a Nationally Representative Cohort of Privately Insured Adults.

    Science.gov (United States)

    Pauly, Nathan James; Brown, Joshua David

    2015-12-01

    Administrative claims data are used for a wide variety of research and quality assurance purposes. Despite their utility, they are prone to medication exposure misclassification if medications are purchased without utilizing an insurance benefit. Low-cost generic programs (LCGPs) offered at major chain pharmacies are a relatively new and sparsely investigated source of exposure misclassification. Since they were implemented in 2006, LCGPs are now available at 8 of the 10 largest pharmacy chains and include a wide variety of medication classes. LCGP medications are often purchased out of pocket; thus, a pharmacy claim may never be submitted and exposure may go unobserved in claims data. There are little data regarding the utilization of these programs, and estimates of their use can provide important insights into the potential impact LCGPs may have on exposure misclassification in claims data. To (a) quantify the prevalence of LCGP users in a privately insured adult population, (b) assess patterns of LCGP use, and (c) compare clinical and demographic characteristics associated with LCGP users and nonusers. The study cohort consisted of 19,037 privately insured adults aged 18-64 who participated in the Medical Expenditure Panel Survey (MEPS) from 2007-2011. MEPS captures medication utilization at the pharmacy level, so prescription fills can be observed irrespective of a claim being filed. Pharmaceutical utilization was assessed at the individual level for each year of the study period, and LCGP use was recorded as a binary variable for each individual. An LCGP medication fill was identified if the total cost of the drug was paid out of pocket and matched the cost of medications listed on LCGP formularies available from Target, Walmart, CVS, or other major pharmacy retailers during these years. Cohort demographics and characteristics of interest included age, gender, race, employment status, marital status, family income, education level, residence in a metropolitan

  6. Ethical Issues Raised by Private Practice Physiotherapy Are More Diverse than First Meets the Eye: Recommendations from a Literature Review

    Science.gov (United States)

    Drolet, Marie-Josée; Williams-Jones, Bryn

    2015-01-01

    ABSTRACT Purpose: Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues. Method: After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed. Results: A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized. Conclusions: The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported—through education, research, and good governance—in providing the best possible care for their patients. PMID:25931663

  7. Ethical issues raised by private practice physiotherapy are more diverse than first meets the eye: recommendations from a literature review.

    Science.gov (United States)

    Hudon, Anne; Drolet, Marie-Josée; Williams-Jones, Bryn

    2015-01-01

    Physiotherapy in private practice differs from physiotherapy practised in a public setting in several ways, the most evident of which is the for-profit nature of private physiotherapy clinics; these differences can generate distinct and challenging ethical issues. The objectives of this article are to identify ethical issues encountered by physiotherapists in private practice settings and to identify potential solutions and recommendations to address these issues. After a literature search of eight databases, 39 studies addressing ethical issues in a private practice context were analyzed. A total of 25 ethical issues emerging from the included studies were classified into three main categories: (1) business and economic issues (e.g., conflicts of interests, inequity in a managed care context, lack of time affecting quality of care); (2) professional issues (e.g., professional autonomy, clinical judgment, treatment effectiveness, professional conduct); and (3) patients' rights and welfare issues (e.g., confidentiality, power asymmetries, paternalism vs. patient autonomy, informed consent). Recommendations as to how physiotherapists could better manage these issues were then identified and categorized. The physiotherapy community should reflect on the challenges raised by private practice so that professionals can be supported-through education, research, and good governance-in providing the best possible care for their patients.

  8. Human Rights and Social Work, a recognizable relationship in private practice within the profession?

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    Berta A. Moneo-Estany

    2018-05-01

    Full Text Available This work revises the relationship of Social Work with Human Rights, understanding that Social Work has been and continues to be an ideal means for the social and political implementation of Human Rights. In this long-standing dialogue, events such as the recent economic crisis, the progressive specialization of social intervention, changes in the socio-demographic structure and the questioning of the Welfare State model have posed professional challenges to Social Work. Among these events, the re-reading of the free exercise of Social Work in Spain and its relationship with Human Rights. Without neglecting the principles and values characterizing Social Work since its beginning as a scientific discipline and its close relationship with Human Rights, the aim of this work is to identify whether or not the relationship between Human Rights and the private practice of Social Work is recognised. After a profuse bibliographic review it can be stated that sufficient evidences (theoretical evidences or practical experiences to make the reality of such relationship explicit have not been found. Everything suggests that the free exercise is a reality which still needs to methodize its practice and demonstrate its close relationship with the principles and values of Social Work and Human Rights.

  9. Physician's sociodemographic profile and distribution across public and private health care: an insight into physicians' dual practice in Brazil.

    Science.gov (United States)

    Miotto, Bruno Alonso; Guilloux, Aline Gil Alves; Cassenote, Alex Jones Flores; Mainardi, Giulia Marcelino; Russo, Giuliano; Scheffer, Mário César

    2018-04-23

    The intertwined relation between public and private care in Brazil is reshaping the medical profession, possibly affecting the distribution and profile of the country's medical workforce. Physicians' simultaneous engagement in public and private services is a common and unregulated practice in Brazil, but the influence played by contextual factors and personal characteristics over dual practice engagement are still poorly understood. This study aimed at exploring the sociodemographic profile of Brazilian physicians to shed light on the links between their personal characteristics and their distribution across public and private services. A nation-wide cross-sectional study using primary data was conducted in 2014. A representative sample size of 2400 physicians was calculated based  on the National Council of Medicine database registries; telephone interviews were conducted to explore physicians' sociodemographic characteristics and their engagement with public and private services. From the 2400 physicians included, 51.45% were currently working in both the public and private services, while 26.95% and 21.58% were working exclusively in the private and public sectors, respectively. Public sector physicians were found to be younger (PR 0.84 [0.68-0.89]; PR 0.47 [0.38-0.56]), less experienced (PR 0.78 [0.73-0.94]; PR 0.44 [0.36-0.53]) and predominantly female (PR 0.79 [0.71-0.88]; PR 0.68 [0.6-0.78]) when compared to dual and private practitioners; their income was substantially lower than those working exclusively for the private (PR 0.58 [0.48-0.69]) and mixed sectors (PR 0.31 [0.25-0.37]). Conversely, physicians from the private sector were found to be typically senior (PR 1.96 [1.58-2.43]), specialized (PR 1.29 [1.17-1.42]) and male (PR 1.35 [1.21-1.51]), often working less than 20 h per week (PR 2.04 [1.4-2.96]). Dual practitioners were mostly middle-aged (PR 1.3 [1.16-1.45]), male specialists with 10 to 30 years of medical practice (PR 1.23 [1

  10. Antimalarial drug prescribing practice in private and public health facilities in South-east Nigeria: a descriptive study

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    Okebe Joseph

    2007-05-01

    Full Text Available Abstract Background Nigeria's national standard has recently moved to artemisinin combination treatments for malaria. As clinicians in the private sector are responsible for attending a large proportion of the population ill with malaria, this study compared prescribing in the private and public sector in one State in Nigeria prior to promoting ACTs. Objective To assess prescribing for uncomplicated malaria in government and private health facilities in Cross River State. Method Audit of 665 patient records at six private and seven government health facilities in 2003. Results Clinicians in the private sector were less likely to record history or physical examination than those in public facilities, but otherwise practice and prescribing were similar. Overall, 45% of patients had a diagnostic blood slides; 77% were prescribed monotherapy, either chloroquine (30.2%, sulphadoxine-pyrimethamine (22.7% or artemisinin derivatives alone (15.8%. Some 20.8% were prescribed combination therapy; the commonest was chloroquine with sulphadoxine-pyrimethamine. A few patients (3.5% were prescribed sulphadoxine-pyrimethamine-mefloquine in the private sector, and only 3.0% patients were prescribed artemisinin combination treatments. Conclusion Malaria treatments were varied, but there were not large differences between the public and private sector. Very few are following current WHO guidelines. Monotherapy with artemisinin derivatives is relatively common.

  11. Physicians in private practice: reasons for being a social franchise member

    Science.gov (United States)

    2012-01-01

    Background Evidence is emerging on the cost-effectiveness, quality and health coverage of social franchises. But little is known about the motivations of providers to join or remain within a social franchise network, or the impact that franchise membership has on client volumes or revenue earnings. Methods (i) Uncontrolled facility based of a random sample of 230 franchise members to assess self-reported motivations; (ii) A 24 month prospective cohort study of 3 cohorts of physicians who had been in the franchise for 4 years, 2 years and new members to track monthly case load and revenue generated. Results The most common reasons for joining the franchise were access to high quality and cheap drugs (96.1%) and feelings of social responsibility, (95.2%). The effects of joining the franchise on the volume of family planning services is shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician during their first 2 years in the franchise, (pfranchise membership, as the 2007 cohort reported increases of monthly average family planning service volume from 71.2 per physician to 102.8 per physician (pfranchise. The results for cohorts 2007 and 2005 also show a generalized trend in increasing income. Conclusions The findings show how franchise membership impacts the volume of franchise and non-franchised services. The increases in client volumes translated directly into increases in earnings among the franchise members, an unanticipated effect for providers who joined in order to better serve the poor. This finding has implications for the social franchise business model that relies upon subsidized medical products to reduce financial barriers for the poor. The increases in out of pocket payments for health care services that were not price controlled by the franchise is a concern. As the field of social franchises continues to mature its business models towards more sustainable and cost recovery

  12. Physicians in private practice: reasons for being a social franchise member.

    Science.gov (United States)

    Huntington, Dale; Mundy, Gary; Hom, Nang Mo; Li, Qingfeng; Aung, Tin

    2012-08-01

    Evidence is emerging on the cost-effectiveness, quality and health coverage of social franchises. But little is known about the motivations of providers to join or remain within a social franchise network, or the impact that franchise membership has on client volumes or revenue earnings. (i) Uncontrolled facility based of a random sample of 230 franchise members to assess self-reported motivations; (ii) A 24 month prospective cohort study of 3 cohorts of physicians who had been in the franchise for 4 years, 2 years and new members to track monthly case load and revenue generated. The most common reasons for joining the franchise were access to high quality and cheap drugs (96.1%) and feelings of social responsibility, (95.2%). The effects of joining the franchise on the volume of family planning services is shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician during their first 2 years in the franchise, (pfranchise membership, as the 2007 cohort reported increases of monthly average family planning service volume from 71.2 per physician to 102.8 per physician (pfranchise. The results for cohorts 2007 and 2005 also show a generalized trend in increasing income. The findings show how franchise membership impacts the volume of franchise and non-franchised services. The increases in client volumes translated directly into increases in earnings among the franchise members, an unanticipated effect for providers who joined in order to better serve the poor. This finding has implications for the social franchise business model that relies upon subsidized medical products to reduce financial barriers for the poor. The increases in out of pocket payments for health care services that were not price controlled by the franchise is a concern. As the field of social franchises continues to mature its business models towards more sustainable and cost recovery management practices, attention should be

  13. Hearing aid patients in private practice and public health (Veterans Affairs) clinics: are they different?

    Science.gov (United States)

    Cox, Robyn M; Alexander, Genevieve C; Gray, Ginger A

    2005-12-01

    In hearing aid research, it is commonplace to combine data across subjects whose hearing aids were provided in different service delivery models. There is reason to question whether these types of patients are always similar enough to justify this practice. To explore this matter, this investigation evaluated similarities and differences in self-report data obtained from hearing aid patients derived from public health (Veterans Affairs, VA) and private practice (PP) settings. The study was a multisite, cross-sectional survey in which 230 hearing aid patients from VA and PP audiology clinic settings provided self-report data on a collection of questionnaires both before and after the hearing aid fitting. Subjects were all older adults with mild to moderately severe hearing loss. About half of them had previous experience wearing hearing aids. All subjects were fitted with wide-dynamic-range-compression instruments and received similar treatment protocols. Numerous statistically significant differences were observed between the VA and PP subject groups. Before the fitting, VA patients reported higher expectations from the hearing aids and more severe unaided problems compared with PP patients with similar audiograms. Three wks after the fitting, VA patients reported more satisfaction with their hearing aids. On some measures VA patients reported more benefit, but different measures of benefit did not give completely consistent results. Both groups reported using the hearing aids an average of approximately 8 hrs per day. VA patients reported age-normal physical and mental health, but PP patients tended to report better than typical health for their age group. These data indicate that hearing aid patients seen in the VA public health hearing services are systematically different in self-report domains from those seen in private practice services. It is therefore risky to casually combine data from these two types of subjects or to generalize research results from one

  14. Information Technology Practices Amongst Dental Undergraduate Students at a Private Dental Institution in India

    Directory of Open Access Journals (Sweden)

    S. Kumar

    2009-09-01

    Full Text Available Objective: In dental and medical education, information and communication technology (ICT has been playing an important role and its use is rapidly increasing. In developing countries, however, information technology is still only available to a minority of health professionals. The present study aimed to assess the level of computer use among dental undergraduate students pursuing their career at a private dental institution in India.Materials and Methods: The study population comprised dental undergraduate students from first to fourth year pursuing their career in a private dental institution of India. Informationtechnology practices were assessed using a questionnaire that consisted of 14 questions.Results: In total, 247 students with an overall response rate of 66% participated in the study. Only 58.3% of the study population mentioned that they had access to computers.Students from preclinical years reported to be competent in IT skills more frequently than the clinical year students (chi square test, P=0.007. Compared to women, men used computers more regularly both for academic activities (P=0.082 and personal use (P=0.006.Similarly, students of clinical years used computers more than preclinical students for both purposes (academic activities, P=0.045; personal use, P=0.124.Conclusion: The present study revealed that computer literacy of Indian dental undergraduate students was comparable with students of other countries whereas accessibility of IT sources was poor. Expansion of computer-assisted learning which requires careful strategic planning, resource sharing, staff incentives, active promotion of multidisciplinary working, and effective quality control should be implemented.

  15. Physicians in private practice: reasons for being a social franchise member

    Directory of Open Access Journals (Sweden)

    Huntington Dale

    2012-08-01

    Full Text Available Abstract Background Evidence is emerging on the cost-effectiveness, quality and health coverage of social franchises. But little is known about the motivations of providers to join or remain within a social franchise network, or the impact that franchise membership has on client volumes or revenue earnings. Methods (i Uncontrolled facility based of a random sample of 230 franchise members to assess self-reported motivations; (ii A 24 month prospective cohort study of 3 cohorts of physicians who had been in the franchise for 4 years, 2 years and new members to track monthly case load and revenue generated. Results The most common reasons for joining the franchise were access to high quality and cheap drugs (96.1% and feelings of social responsibility, (95.2%. The effects of joining the franchise on the volume of family planning services is shown in the 2009 cohort where the average monthly service volume increased from 18.5 per physician to 70.6 per physician during their first 2 years in the franchise, (prd and 4th year of franchise membership, as the 2007 cohort reported increases of monthly average family planning service volume from 71.2 per physician to 102.8 per physician (p Conclusions The findings show how franchise membership impacts the volume of franchise and non-franchised services. The increases in client volumes translated directly into increases in earnings among the franchise members, an unanticipated effect for providers who joined in order to better serve the poor. This finding has implications for the social franchise business model that relies upon subsidized medical products to reduce financial barriers for the poor. The increases in out of pocket payments for health care services that were not price controlled by the franchise is a concern. As the field of social franchises continues to mature its business models towards more sustainable and cost recovery management practices, attention should be given towards

  16. Calculating Clinically Significant Change: Applications of the Clinical Global Impressions (CGI) Scale to Evaluate Client Outcomes in Private Practice

    Science.gov (United States)

    Kelly, Peter James

    2010-01-01

    The Clinical Global Impressions (CGI) scale is a therapist-rated measure of client outcome that has been widely used within the research literature. The current study aimed to develop reliable and clinically significant change indices for the CGI, and to demonstrate its application in private psychological practice. Following the guidelines…

  17. The business of medicine: how to overcome financial obstacles and secure financing for your private practice and ancillary services business.

    Science.gov (United States)

    Nayor, David

    2012-01-01

    Doctors across the country who operate private medical practices are facing increasing financial obstacles, namely shrinking income as a result of rising costs and lower reimbursements. In addition, as hospitals have become overburdened many physicians have opened up private surgical centers; magnetic resonance imaging and computed tomography and positron emission tomography scanning facilities; pathology labs; colonoscopy/endoscopy suites; lithotripsy centers; and other medical businesses typically performed within the hospital. Moreover, many doctors seek loans to purchase existing practices or for their capital contribution in medical partnerships. The past decade has thus seen a significant increase in the number of doctors taking out small business loans. Indeed, banks view the healthcare industry as a large growth market. This article includes practical information, advice, and resources to help doctors to secure bank financing for their practices, ancillary services business, real estate, and equipment on the best possible market terms.

  18. Inter-Professional Practices of Private-Sector Physiotherapists for Low Back Pain Management: Who, How, and When?

    Science.gov (United States)

    Perreault, Kadija; Dionne, Clermont E; Rossignol, Michel; Poitras, Stéphane; Morin, Diane

    Purpose : Although there have been increasing demands for health care providers to take part in inter-professional practices in recent years, very little attention has been paid to the actualization of such practices in the private sector. This study describes private-sector physiotherapists' inter-professional practices regarding low back pain (LBP) management and identifies organizational and provider-level variables associated with the intensity of such practices. Method : A total of 327 randomly selected physiotherapists were surveyed in the province of Quebec. Data were analyzed using descriptive and multiple regression analyses. Results : Physiotherapists reported frequent interactions with other physiotherapists (daily/weekly for 52.6%), family physicians (51.0%), and physiotherapy (PT) assistants (45.2%), but infrequent interactions with psychologists (3.6%), neurosurgeons (0.9%), and chiropractors (0.3%). Frequently reported means of interactions were written and oral messages sent through clients (55.1% and 24.1%, respectively), face-to-face unplanned discussions (41.9%), and faxed or mailed letters (23.2%). Variables associated with the intensity of inter-professional practices (mean of 6.7 [ SD 1.7] out of 10 on the Intensity of Interprofessional Practices Questionnaire for Private Sector Physiotherapists) were related to physiotherapists' clientele, social activities with other providers, and perceptions of inter-professional practices as well as organizational models, vision, and provision of PT training. Conclusions: There is room to improve inter-professional practices with private-sector physiotherapists involved in managing LBP. Targets for action include physiotherapists and their workplaces.

  19. Prevalence of illicit drug use in pregnant women in a Wisconsin private practice setting.

    Science.gov (United States)

    Schauberger, Charles W; Newbury, Emily J; Colburn, Jean M; Al-Hamadani, Mohammed

    2014-09-01

    We sought to measure the prevalence of illicit drug use in our obstetric population, to identify the drugs being used, and to determine whether a modified version of the 4Ps Plus screening tool could serve as an initial screen. In this prospective study, urine samples of 200 unselected patients presenting for initiation of prenatal care in a Wisconsin private practice were analyzed for evidence of the use of illicit drugs. Of 200 patients, 26 (13%) had evidence of drugs of abuse in their urine samples. Marijuana (7%) and opioids (6.5%) were the most commonly identified drugs. Adding 5 questions about drug or alcohol use to the obstetric intake questionnaire proved sensitive in identifying patients with high risks of having a positive drug screen. The rate of drug use in our low-risk population was higher than expected and may reflect increasing rates of drug use across the United States. Enhanced screening should be performed to identify patients using illicit drugs in pregnancy to improve their care. Medical centers and communities may benefit from periodic testing of their community prevalence rates to aid in appropriate care planning. Copyright © 2014 Mosby, Inc. All rights reserved.

  20. Quality of Life and Job Satisfaction of Dispensing Pharmacists Practicing in Tehran Private-sector Pharmacies.

    Science.gov (United States)

    Majd, Marzieh; Hashemian, Farshad; Younesi Sisi, Farnaz; Jalal, Masoud; Majd, Zahra

    2012-01-01

    As there is no evidence of previous studies on evaluating the level of job satisfaction and the major causes of dissatisfaction among the pharmacists in Iran, this study was designed. This study is a cross-sectional descriptive analysis of pharmacists practicing in Tehran private-sector pharmacies. We selected a stratified random sampling using number of prescriptions as a variable for stratification. The questionnaire was divided into three sections containing the demographic characteristics, general health perception and job satisfaction. Of all the participants, 62% were the owners of pharmacies and 38% were pharmacists in charge (non-owner). Seventy-eight percent of respondents reported satisfaction about their psychological and physical state. Just 11% of pharmacists were financially satisfied and 49% felt relaxed at the workplace. There was no correlation between the satisfaction and owning the pharmacy or sex of respondents. Spearman›s correlation showed that the income satisfaction correlated negatively with age (p ≤ 0.001) and years of experience (p women (p quality of life among the respondents were at satisfactory level. However, work-related satisfaction was not high enough and most interviewed pharmacists were financially dissatisfied.

  1. Practical quantum private query with better performance in resisting joint-measurement attack

    Science.gov (United States)

    Wei, Chun-Yan; Wang, Tian-Yin; Gao, Fei

    2016-04-01

    As a kind of practical protocol, quantum-key-distribution (QKD)-based quantum private queries (QPQs) have drawn lots of attention. However, joint-measurement (JM) attack poses a noticeable threat to the database security in such protocols. That is, by JM attack a malicious user can illegally elicit many more items from the database than the average amount an honest one can obtain. Taking Jacobi et al.'s protocol as an example, by JM attack a malicious user can obtain as many as 500 bits, instead of the expected 2.44 bits, from a 104-bit database in one query. It is a noticeable security flaw in theory, and would also arise in application with the development of quantum memories. To solve this problem, we propose a QPQ protocol based on a two-way QKD scheme, which behaves much better in resisting JM attack. Concretely, the user Alice cannot get more database items by conducting JM attack on the qubits because she has to send them back to Bob (the database holder) before knowing which of them should be jointly measured. Furthermore, JM attack by both Alice and Bob would be detected with certain probability, which is quite different from previous protocols. Moreover, our protocol retains the good characters of QKD-based QPQs, e.g., it is loss tolerant and robust against quantum memory attack.

  2. Public-Private Partnership as Political Phenomenon: Perspectives of Adaptation of Successful Foreign Practices to the Russian Reality

    Directory of Open Access Journals (Sweden)

    Надежда Викторовна Шуленина

    2013-12-01

    Full Text Available Public-private partnership show great development in modern Russia. Since the technology of interaction between business and government came from abroad it requires detailed consideration of the successes and current practices in the modern world. It is particularly important to identify relationships between form of government and decision making, both for political and economic decisions, as in most cases, these factors have the strongest influence on the formation of public-private partnership as an institution of the modern political process in Russia.

  3. Diagnosis and Treatment of Childhood Pulmonary Tuberculosis: A Cross-Sectional Study of Practices among Paediatricians in Private Sector, Mumbai.

    Science.gov (United States)

    Tauro, Carolyn Kavita; Gawde, Nilesh Chandrakant

    2015-01-01

    Majority of children with tuberculosis are treated in private sector in India with no available data on management practices. The study assessed diagnostic and treatment practices related to childhood pulmonary tuberculosis among paediatricians in Mumbai's private sector in comparison with International Standards for Tuberculosis Care (ISTC) 2009. In this cross-sectional study, 64 paediatricians from private sector filled self-administered questionnaires. Cough was reported as a symptom of childhood TB by 77.8% of respondents. 38.1% request sputum smear or culture for diagnosis and fewer (32.8%) use it for patients positive on chest radiographs and 32.8% induce sputum for those unable to produce it. Sputum negative TB suspect is always tested with X-ray or tuberculin skin test. 61.4% prescribe regimen as recommended in ISTC and all monitor progress to treatment clinically. Drug-resistance at beginning of treatment is suspected for child in contact with a drug-resistant patient (67.7%) and with prior history of antitubercular treatment (12.9%). About half of them (48%) request drug-resistance test for rifampicin in case of nonresponse after two to three months of therapy and regimen prescribed by 41.7% for multidrug-resistant TB was as per ISTC. The study highlights inappropriate diagnostic and treatment practices for managing childhood pulmonary TB among paediatricians in private sector.

  4. Diagnosis and Treatment of Childhood Pulmonary Tuberculosis: A Cross-Sectional Study of Practices among Paediatricians in Private Sector, Mumbai

    Directory of Open Access Journals (Sweden)

    Carolyn Kavita Tauro

    2015-01-01

    Full Text Available Majority of children with tuberculosis are treated in private sector in India with no available data on management practices. The study assessed diagnostic and treatment practices related to childhood pulmonary tuberculosis among paediatricians in Mumbai’s private sector in comparison with International Standards for Tuberculosis Care (ISTC 2009. In this cross-sectional study, 64 paediatricians from private sector filled self-administered questionnaires. Cough was reported as a symptom of childhood TB by 77.8% of respondents. 38.1% request sputum smear or culture for diagnosis and fewer (32.8% use it for patients positive on chest radiographs and 32.8% induce sputum for those unable to produce it. Sputum negative TB suspect is always tested with X-ray or tuberculin skin test. 61.4% prescribe regimen as recommended in ISTC and all monitor progress to treatment clinically. Drug-resistance at beginning of treatment is suspected for child in contact with a drug-resistant patient (67.7% and with prior history of antitubercular treatment (12.9%. About half of them (48% request drug-resistance test for rifampicin in case of nonresponse after two to three months of therapy and regimen prescribed by 41.7% for multidrug-resistant TB was as per ISTC. The study highlights inappropriate diagnostic and treatment practices for managing childhood pulmonary TB among paediatricians in private sector.

  5. Public Presentation versus Private Actions in Psychotherapy Research, Training and Practice.

    Science.gov (United States)

    McMullen, Linda M.

    1995-01-01

    Reacts to Martin's (1995) essay concerning scientism in psychotherapy. Contends that the image psychotherapists' present to the public is often quite different from private actions, and that a focus of these private actions might reveal not only a less scientific endeavor, but also a paradigm for future research. (JPS)

  6. Attitudes and Perceptions about Private Philanthropic Giving to Arizona Community Colleges and Universities: Implications for Practice

    Science.gov (United States)

    Martinez, George Andrew

    2009-01-01

    Wide disparity exists in philanthropic giving to public, two-year community colleges as compared to public, four-year universities. Recent estimates indicate that 0.5 to 5% of all private philanthropic giving to U.S. higher education annually goes to public, two-year community colleges, with the remainder going to public and private four-year…

  7. The Role of HRM Practices in Predicting Faculty Turnover Intention: Empirical Evidence from Private Universities in Bangladesh

    Directory of Open Access Journals (Sweden)

    Mohd H.R. Joarder

    2012-04-01

    Full Text Available The present study was designed to examine the relationship between human resource management practices and turnover intention among the faculty members of private universities in Bangladesh. The prime objective of this study was to understand whether the institution’s HRM practices can influence faculty turnover decision. A total of 317 faculty members of different private universities located in Dhaka Metropolitan Area(DMA participated in the survey and returned the questionnaire to the researchers which represented 57% response rate of the study. Multiple regression analyses were used to test thehypotheses of the study. The study found faculty compensation, supervisory support and job security as statistically significant predictors of faculty turnover intention. Therefore, privateuniversity management should pay much attention to this area of human resource practices (compensation, supervisory support, job security to retain the potential faculty, thus reducing turnover intention. Limitations and suggestions for latest news headline are forwarded.

  8. Allocating Overhead Costs in a Navy Working Capital Fund Environment: An Analysis and Comparison of Current Navy Policy and Private Sector Practice

    National Research Council Canada - National Science Library

    Schulte, Steven

    1999-01-01

    .... The objective of this thesis was to evaluate the overhead allocation practices of five private sector organizations for the potential improvement of overhead allocation practices in Navy Working Capital Fund activities...

  9. Teacher Externships as a Practice of Inter-organizational Collaboration Between Institutions of Higher Education and Public and Private Organizations

    DEFF Research Database (Denmark)

    Linde, Stine; Just, Sine Nørholm

    The present paper takes a practice theoretical approach (Rouse, 2006) to investigating the extent to which the phenomenon of teacher externships can be used as an initiative for creating long-lasting and strong collaborations between institutions of higher education and public and private...... at institutions of higher education within the region of Zealand, Denmark entered into collaborations with 35 public and private organizations, we present two preliminary conclusions: existing networks are strengthened and broadened through externships, and teachers feel enlightened by the experience...... on Danish universities to ‘turn to practice’, we ask how externships may contribute to the inter-organizational collaboration between institutions of higher education and public and private organizations. Based on a qualitative analysis of an externship program in which a total of 25 lecturers...

  10. Private costs almost equal health care costs when intervening in mild Alzheimer's: a cohort study alongside the DAISY trial

    DEFF Research Database (Denmark)

    Søgaard, Rikke; Sørensen, Jan; Waldorff, Frans B

    2009-01-01

    BACKGROUND: Alzheimer's disease is the leading cause of dementia and affects about 25 million people worldwide. Recent studies have evaluated the effect of early interventions for dementia, but few studies have considered private time and transportation costs associated with the intervention. Thi...... in access to health care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN74848736....... of counselling sessions, courses and informational packages. The typical duration of the intervention was 7 months. A micro-costing approach was applied using prospectively collected data on resource utilisation that included estimates of participant time and transportation. Precision estimates were calculated...... using a bootstrapping technique and structural uncertainty was assessed with sensitivity analysis. RESULTS: The direct intervention cost was estimated at EUR 1,070 (95% CI 1,029;1,109). The total cost (including private costs) was estimated at EUR 2,020 (95% CI 1,929;2,106) i.e. the ratio of private...

  11. Sales with Privately Made Deed Over The Object Under Hak Tanggungan Based on The Authorization to Sell in Banking Practice

    Directory of Open Access Journals (Sweden)

    Sri Budi Purwaningsih

    2014-06-01

    Full Text Available The extension of credit contain a risk that must be covered by the bank, because the credit is given now and pay later. To minimize the risk of loans, the bank will ask the debtor to provide collateral as a source of repayment of the debt if the debtor default or breach of the contract. According to Article 1131 Civil Code (KUH Perdata, all assets of a debtor, either moving or fixed objects, both existing and new will exist in the future, a guarantee for all debts of the engagement. This means that by itself or in order to pass laws providing collateral by a debtor to any creditor for all debtor's property. Sales with Privately Made Deed over the object in the hak tanggungan banking practices may be more effective and efficient both in terms of time and costs for the settlement of non-performing loans. But in practice, occurs some offense prescribed procedure leading to doubts about the legality aspect of sales with privately made deed over the object under hak tanggungan based on the authorization to sell in banking practice. How To Cite: Purwaningsih, S. (2014. Sales with Privately Made Deed Over The Object Under Hak Tanggungan Based on The Authorization to Sell in Banking Practice. Rechtsidee, 1(2, 191-204. doi:http://dx.doi.org/10.21070/jihr.v1i2.100

  12. Prevalence and associated factors of dental erosion in children and adolescents of a private dental practice.

    Science.gov (United States)

    Nahás Pires Corrêa, Maria Salete; Nahás Pires Corrêa, Fernanda; Nahás Pires Corrêa, José Paulo; Murakami, Christiana; Mendes, Fausto Medeiros

    2011-11-01

    BaCKGROUND. The prevalence of dental erosion seems to be rising in young populations, particularly among individuals of higher socioeconomic status. AIM. To assess the prevalence and associated factors of dental erosion in children and adolescents of a private dental practice. DESIGN. A total of 232 participants, aged 2-20 years, were examined. Dietary habits, oral hygiene, and medical data were collected from dental records. Logistic regression analyses were conducted. RESULTS. Dental erosion prevalence was of 25.43% and was highest on the occlusal surfaces (76%). Associated factors were: frequent consumption of soft drinks (OR = 2.33; 95% CI = 1.01-5.38) and candies (OR = 3.23; 95% CI = 1.25-8.32); and interaction between these two factors (OR = 3.95; 95% CI = 1.60-9.75). On anterior teeth, associated factors were: frequent consumption of fruits (OR = 2.53; 95% CI = 1.09-5.91); and age (OR = 1.07 95% CI = 1.01-1.14). Milk consumption was associated with a lower prevalence of dental erosion (OR = 0.40; 95% CI = 0.17-0.94). CONCLUSIONS.  A relatively high prevalence of erosion was found in association with frequent intake of soft drinks, candies, and fruits. The consumption of milk seemed to protect against dental erosion on anterior teeth. © 2011 The Authors. International Journal of Paediatric Dentistry © 2011 BSPD, IAPD and Blackwell Publishing Ltd.

  13. Knowledge of diabetes mellitus in privately- funded diabetic patients attending a rural optometric practice in Malmesbury, South Africa*

    Directory of Open Access Journals (Sweden)

    K. C. Phillips

    2012-12-01

    ment of DM. This study indicates that, despite access to private health care, these subjects level of knowledge of DM and its ocular effects was sub-optimal. It also indicated poor self-management practices of the diabetic patients towards diabetes care and management. Optometrists should form part of a team of health professionals to assist in the management of DM. (S Afr Optom 2012 71(2 70-77

  14. Psychological distress as a predictor of frequent attendance in family practice: a cohort study

    DEFF Research Database (Denmark)

    Vedsted, Peter; Fink, Per; Olesen, Frede

    2001-01-01

    In cross-sectional studies, psychological distress has been associated with frequent health care utilization. However, there is a need for prospective studies to confirm these findings. This cohort study evaluated whether psychological distress predicted frequent attendance in family practice.......16 [0.99-1.36] for SCL and OR 1.31 [1.05-1.65] for Whiteley). Psychological distress involved an increased risk of future frequent attendance among adult patients consulting family practice in the daytime about an illness....

  15. Academic Employees’ perceptions of Work - Life Balance practices: A Case Analysis of Private Universities in Ogun State, Nigeria

    Directory of Open Access Journals (Sweden)

    Anthonia Adenike Adeniji

    2016-01-01

    Full Text Available This study investigates academic employees' perceptions and experiences of work–life balance (WLB in private Universities in Ogun State. A descriptive research design involves in-depth interviews among 129 academic employees in private Universities in Ogun State. Specifically, the main objectives are to critically examine the practices of work-life balance in the Universities. The study assesses the types of WLB policies and practices within the Universities and factors which influence the employee’s perception of work-life balance within the framework of employment relationship in the various Universities in Nigeria. Using spill-over theory, the findings reveal various dimensions in the academic employees' concept of WLB and show that academic employee experience the strain of work intensification and long hours of work. There is a wide gap between corporate WLB practices and the academic employee understanding of WLB. The paper suggests policy implications which would aid the implementation of WLB policies within Private Universities and suggests directions for future research.

  16. Differences in characteristics among new pediatric neurology patients: the effect of a newly established private pediatric neurology practice.

    Science.gov (United States)

    Van Cleave, Jeanne; Woodruff, Brian; Freed, Gary L

    2008-01-01

    To investigate changes in volume and characteristics of new patients referred when a private pediatric neurology practice (PP) opened in 2004 in an area served primarily by an academic medical center's (AMC) pediatric neurology practice. Retrospective analysis of medical and billing records to examine changes in volume, diagnosis, and sociodemographic factors of new patients at the AMC from July 2004 to June 2005; the PP during the same period; and the AMC during the year before. One year after the PP opened, 40% more new pediatric neurology patients were seen in this area than the year before. Compared with the AMC, PP saw a greater proportion of seizures (34% vs 26%, P 20 miles from the practice (32% vs 64%, P pediatric neurology patients in this area. After the PP opened, the AMC continued to care for most patients with rare diseases and fewer financial resources. Future research should examine whether the increase in volume reflects relief of pent-up demand or increased referral rates due to eased access, and should elucidate how differences in patient populations at academic and private subspecialty practices relate to access to subspecialty care and financial well-being of academic practices.

  17. Physicians in private practice: reasons for being a social franchise member

    OpenAIRE

    Huntington Dale; Mundy Gary; Hom Nang; Li Qingfeng; Aung Tin

    2012-01-01

    Abstract Background Evidence is emerging on the cost-effectiveness, quality and health coverage of social franchises. But little is known about the motivations of providers to join or remain within a social franchise network, or the impact that franchise membership has on client volumes or revenue earnings. Methods (i) Uncontrolled facility based of a random sample of 230 franchise members to assess self-reported motivations; (ii) A 24 month prospective cohort study of 3 cohorts of physicians...

  18. Control of type 2 diabetes mellitus among general practitioners in private practice in nine countries of Latin America.

    Science.gov (United States)

    Lopez Stewart, Gloria; Tambascia, Marcos; Rosas Guzmán, Juan; Etchegoyen, Federico; Ortega Carrión, Jorge; Artemenko, Sofia

    2007-07-01

    To better understand how diabetes care and control are being administered by general practitioners/nonspecialists in private practice in nine countries of Latin America, and to identify the most significant patient- and physician-related barriers to care. A multicenter, cross-sectional, epidemiological survey was conducted in nine countries in Latin America: Argentina, Brazil, Chile, Costa Rica, Ecuador, Guatemala, Mexico, Peru, and Venezuela. General practitioners in private practice were asked to provide care and control data for patients 18 to 75 years of age with type 2 diabetes mellitus (T2DM), including demographics, medical and medication history, laboratory exams, and information on the challenges of patient management. Of the 3 592 patient questionnaires returned by 377 physicians, 60% of the patients had a family history of diabetes, 58% followed a poor diet, 71% were sedentary, and 79% were obese or overweight. Poor glycemic control (fasting blood glucose >or= 110 mg/dL) was observed in 78% of patients. The number of patients with HbA1c 15 years). Considering the differences between private and public health care in Latin America, especially regarding the quality of care and access to medication, further studies are called for in the public setting. Overall, a more efficient and intensive program of T2DM control is required, including effective patient education programs, adjusted to the realities of Latin America.

  19. The study and practice of public-private partnerships in the Low Countries

    NARCIS (Netherlands)

    Hueskes, Marlies; Koppenjan, Joop; Verweij, Stefan

    2016-01-01

    Public-Private Partnerships (PPPs) have attracted considerable attention in the Netherlands and Flanders (Belgium), as witnessed by the recent wave of doctoral theses on this topic. This paper presents a review of fourteen Dutch and Flemish doctoral theses, published in the period 2012-2015. The

  20. Comparison of Ethical Dilemmas across Public and Private Sectors in Rehabilitation Counseling Practice

    Science.gov (United States)

    Beveridge, Scott; Garcia, Jorge; Siblo, Matt

    2015-01-01

    Purpose: To examine the nature of ethical dilemmas most frequently reported by rehabilitation counselors in the private and public sectors and determine if significant differences exist in how practitioners experience ethical dilemmas in these two settings. Method: A mixed-methods internet-based survey design was utilized and included descriptive,…

  1. In private practice, informed consent is interpreted as providing explanations rather than offering choices: a qualitative study.

    Science.gov (United States)

    Delany, Clare M

    2007-01-01

    How do physiotherapists working in private practice understand and interpret the meaning and significance of informed consent in everyday clinical practice? Qualitative study using semi-structured interviews. Seventeen physiotherapists purposefully recruited from metropolitan private practices where treatment was on a one-on-one basis. Therapists defined informed consent as an implicit component of their routine clinical explanations, rather than a process of providing explicit patient choices. Therapists' primary concern was to provide information that led to a (therapist-determined) beneficial therapeutic outcome, rather than to enhance autonomous patient choice. Explicit patient choice and explicit informed consent were defined as important only if patients requested information or therapists recognised risks associated with the treatment. Physiotherapists defined informed consent within a context of achieving therapeutic outcomes rather than a context of respect for patient autonomy and autonomous choice. Physiotherapy practice guidelines developed to ensure compliance with ethical and legal obligations may therefore be followed only if they fit with therapists' understanding and interpretation of a desired therapeutic outcome.

  2. Telephone survey of private patients' views on continuity of care and registration with general practice in Ireland.

    LENUS (Irish Health Repository)

    Carmody, Patricia

    2007-01-01

    BACKGROUND: The desire of patients for personal continuity of care with a General Practitioner (GP) has been well documented, but not within non-registered private patients in Ireland. This study set out to examine the attitudes and reported behaviours of private fee-paying patients towards continuity of GP care and universal registration for patients. METHODS: Cross-sectional telephone survey of 400 randomly chosen fee-paying patients living within County Dublin. There is no formal system of registration with a GP for these patients. Main outcomes were attendance of respondents at primary health care facilities and their attitudes towards continuity of care and registration with a GP. Data was analysed using descriptive statistics and using parametric and non-parametric tests of association. Pearson correlation was used to quantify the association between the described variables and attitudes towards continuity and registration with a GP. Variables showing significance at the 5% level were entered into multiple linear regression models. RESULTS: 97% of respondents had seen a GP in the previous 5 years. The mean number of visits to the GP for respondents was 2.3 per annum. 89% of respondents had a regular GP and the mean length of time with their GP was 15.6 years. 96% preferred their personal medical care to be provided within one general practice. 16% of respondents had consulted a GP outside of their own practice in the previous year. They were more likely to be female, commute a longer distance to work or have poorer health status. 81% considered it important to be officially registered with a GP practice of their choice. CONCLUSION: Both personal and longitudinal continuity of care with a GP are important to private patients. Respondents who chose to visit GPs other than their regular GP were not easily characterised in this study and individual circumstances may lead to this behaviour. There is strong support for a system of universal patient registration

  3. Public Private Partnerships: Identifying Practical Issues for an Accounting Research Agenda

    OpenAIRE

    Nick Sciulli

    2014-01-01

    This article provides a structured framework for research into the accounting implications of Public Private Partnerships (PPPs). PPPs worldwide have taken on increasing significance as a tool that governments can use to develop infrastructure and for the delivery of services. Given the minimal coverage in the literature of the Victorian State Government experience to date regarding the efficacy of PPPs, this report establishes a number of parameters from which academics can conduct research ...

  4. Knowledge, attitude and practice of private practitioners regarding tb-dots in a rural district of Sindh, Pakistan

    International Nuclear Information System (INIS)

    Ahmed, M.; Fatmi, Z.; Ali, S.; Ahmed, S.; Ara, N.

    2009-01-01

    Tuberculosis is prevailing in both urban and rural areas of Pakistan. Knowledge, attitude and practice (KAP) of private practitioners (PPs) regarding tuberculosis management have been reported only in urban areas of Pakistan. This survey was conducted for the first time in a rural area of Sindh, Pakistan. This survey was conducted in January 2007 at Thatta, a rural district of Sindh, Pakistan. Study subjects were twenty-two allopathic qualified (MBBS) doctors of district Thatta, who were practicing in private setups for at least last one year. Before TB-DOTS training PPs had filled the KAP questionnaire regarding tuberculosis (TB) diagnosis and management through DOTS. Survey data was analysed through SPSS version 11.05 software. On average, five TB suspects per month were seen by each PP. Only 14% of PPs advised sputum microscopy solely for pulmonary TB diagnosis, while 86% of PPs used different combination of tests (chest x-ray/sputum microscopy/ESR/tuberculin test) for TB diagnosis. Over 40% PPs did not prescribe TB treatment regimen according to TB-DOTS category. Majority PPs (85%) did not follow the treatment through sputum microscopy and instead relied on clinical improvement and x-ray clearance. Nearly 60% of TB patients at PPs clinic did not show compliance to the TB treatment and none of PPs were following the retrieval of default cases. A gross lack of PPs knowledge and right practice regarding TB diagnosis and management through DOTS was identified and needed to be addressed through providing DOTS training. (author)

  5. [Management practices in medium-sized private hospitals in São Paulo, Brazil].

    Science.gov (United States)

    Brito, Luiz Artur Ledur; Malik, Ana Maria; Brito, Eliane; Bulgacov, Sergio; Andreassi, Tales

    2017-04-03

    Traditional management practices are sometimes considered merely a necessary condition for superior performance. Other resources and competencies with higher barriers to imitation are assumed to be potential sources of competitive advantage. This study describes and analyzes the effect of traditional management practices on the performance of medium-sized hospitals. Medium-sized companies frequently display the greatest differences in management practices, and only recently did the hospital sector seek ways to develop its competitiveness in the administrative arena. The results generally indicate that basic management practices can make differences in performance, offering support for the new practice-based view (PBV). Hospitals with the highest rate of adoption of practices had the highest occupancy rate, hospital-bed admissions, and accreditation. Lack of adoption of management practices by medium-sized hospitals limits their competitive capacity and can be viewed as a component of the so-called Brazil cost, but in this case an internal component.

  6. A proposed approach to monitor private-sector policies and practices related to food environments, obesity and non-communicable disease prevention.

    Science.gov (United States)

    Sacks, G; Swinburn, B; Kraak, V; Downs, S; Walker, C; Barquera, S; Friel, S; Hawkes, C; Kelly, B; Kumanyika, S; L'Abbé, M; Lee, A; Lobstein, T; Ma, J; Macmullan, J; Mohan, S; Monteiro, C; Neal, B; Rayner, M; Sanders, D; Snowdon, W; Vandevijvere, S

    2013-10-01

    Private-sector organizations play a critical role in shaping the food environments of individuals and populations. However, there is currently very limited independent monitoring of private-sector actions related to food environments. This paper reviews previous efforts to monitor the private sector in this area, and outlines a proposed approach to monitor private-sector policies and practices related to food environments, and their influence on obesity and non-communicable disease (NCD) prevention. A step-wise approach to data collection is recommended, in which the first ('minimal') step is the collation of publicly available food and nutrition-related policies of selected private-sector organizations. The second ('expanded') step assesses the nutritional composition of each organization's products, their promotions to children, their labelling practices, and the accessibility, availability and affordability of their products. The third ('optimal') step includes data on other commercial activities that may influence food environments, such as political lobbying and corporate philanthropy. The proposed approach will be further developed and piloted in countries of varying size and income levels. There is potential for this approach to enable national and international benchmarking of private-sector policies and practices, and to inform efforts to hold the private sector to account for their role in obesity and NCD prevention. © 2013 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of the International Association for the Study of Obesity.

  7. Importance of Public-Private Partnerships: Strengthening Laboratory Medicine Systems and Clinical Practice in Africa.

    Science.gov (United States)

    Shrivastava, Ritu; Gadde, Renuka; Nkengasong, John N

    2016-04-15

    After the launch of the US President's Emergency Plan for AIDS Relief in 2003, it became evident that inadequate laboratory systems and services would severely limit the scale-up of human immunodeficiency virus infection prevention, care, and treatment programs. Thus, the Office of the US Global AIDS Coordinator, Centers for Disease Control and Prevention, and Becton, Dickinson and Company developed a public-private partnership (PPP). Between October 2007 and July 2012, the PPP combined the competencies of the public and private sectors to boost sustainable laboratory systems and develop workforce skills in 4 African countries. Key accomplishments of the initiative include measurable and scalable outcomes to strengthen national capacities to build technical skills, develop sample referral networks, map disease prevalence, support evidence-based health programming, and drive continuous quality improvement in laboratories. This report details lessons learned from our experience and a series of recommendations on how to achieve successful PPPs. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  8. Petit bourgeois health care? The big small-business of private complementary medical practice.

    Science.gov (United States)

    Andrews, Gavin J; Phillips, David R

    2005-05-01

    Although small business private complementary medicine (CAM) has grown to be a significant provider of health care in many Western societies, there has been relatively little research on the sector in business terms and on its wider socio-economic position and role. Using a combined questionnaire and interview survey, and the concept of small business petit bourgeoisie as a framework, this paper considers the character of therapists and their businesses in England and Wales. The findings suggest that typical of the core characteristics of both the petit bourgeoisie and therapists are the selling of goods with a considerable market viability, at the same time financial insecurity; the modest size of businesses; small amounts of direct employment generation and business owners undertaking everyday 'hands-on' work themselves. Certain of the therapists' and business characteristics depart from the stereotypical image of a small businesses class, such as the high incidence of part-time self-employment and incomes being supplemented often by unrelated waged employment. However, given the acknowledged diversity of the petit bourgeoisie between societies and over time, the framework is arguably appropriate in this context, and private CAM a latest guise. Indeed, just as the petit bourgeoisie have traditionally found market niches either neglected or rejected by bigger business, small business CAM has provided the forms of health care neglected and sometimes rejected by orthodox medicine.

  9. [The treatment needs of migrant children according to child and adolescent psychiatrists from medical clinics and in private practice].

    Science.gov (United States)

    Siefen, Georg; Kirkcaldy, Bruce; Adam, Hubertus; Schepker, Renate

    2015-03-01

    How does the German child and adolescent psychiatry system respond to the increasing number of migrant children and adolescents? Senior doctors from German child and adolescent psychiatric hospitals (Association of Medical Hospital Directors in Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Germany, BAG) completed a specially constructed questionnaire about the treatment needs of migrant children, while a «random, representative» sample of child and adolescent psychiatrists in private practice (German Professional Association for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, BKJPP) was administered a slightly modified version. The 100 psychiatrists in private practice represented only about one-eighth of their group, whereas the 55 medical directors comprised a representative sample. One-third of the hospitals has treatments tailored to the specific needs of migrants. In both settings, however, competent interpreters were rarely found, despite the treatment problems arising from the understanding the illness by the parents, language problems, and the clinical knowledge of the patient. Cultural diversity is perceived as enriching. The migration background and the sex of child and adolescent psychiatrists influence the treatment of migrants. Facilitating the process of «cultural opening» in child and adolescent psychiatry involves enacting concrete steps, such as the funding of interpreter costs.

  10. Standards of teeth preparations for anterior resin bonded all-ceramic crowns in private dental practice in Jordan

    Directory of Open Access Journals (Sweden)

    Ziad Nawaf AL-Dwairi

    2011-08-01

    Full Text Available OBJECTIVES: To investigate if general dental practitioners (GDPs in private practice in Jordan follow universal guidelines for preparation of anterior teeth for resin bonded all-ceramic crowns (RBCs. MATERIAL AND METHODS: A sample (n=100 of laboratory models containing 208 tooth preparations for IPS Empress and In Ceram, featuring work from different GDPs, was obtained from 8 commercial dental laboratories. Aspects of preparations were quantified and compared with accepted criteria defined following a review of the literature and recommendations of the manufactures' guidelines. RESULTS: Subgingival margins on the buccal aspect were noticed in 36% of the preparations, 54% demonstrated overpreparation with a tendency to overprepare the teeth on the mesiodistal plane more than buccolingual plane. Twenty percent of samples presented a shoulder finish line while a chamfer margin design was noticed in 39%. Twenty-nine percent and 12% of samples had either a feathered or no clear margin design respectively. Incisal underpreparation was observed in 18% of dies of each type. Only 17% of all preparations were found to follow the recommended anatomical labial preparations while 29% of the RBC preparations were found to have the recommended axial convergence angle. In total, 43% of preparations were found to have the recommended depth of the finish line. CONCLUSIONS: It was found that relevant guidelines for RBC preparations were not being fully adhered to in private practice in Jordan.

  11. Owners' insights into private practice dentistry in New South Wales and the Australian Capital Territory.

    Science.gov (United States)

    Fischer, J E; Marchant, T

    2010-12-01

    The aim of this study was to investigate aspects of practice ownership including debt on graduation, the time period between graduation and acquiring practice ownership and small business skills. A mail survey of 400 dentists with practice ownership, in New South Wales (NSW) and the Australian Capital Territory (ACT), addressed demographics, setting up practice, technology and business management. Most respondents were male and nearly half had 20 years of practice ownership. Dentists agreed with the need to be taught small business management skills. Average debt on graduation was AUD$18 000 and the figure was higher for post 1995 graduates. On average, it took five years to acquire some form of practice ownership, but nearly half acquired ownership within three years. Few favoured opening a new practice. Staff were the most frequently nominated contributors to a successful practice, with fees, profit and parking noted least frequently. There was no question that these experienced dentists thought small business skills should be taught to the dental fraternity. Given the significance of staff to a successful practice, dentists may need to learn more about advanced human resource management including professional development and performance management. © 2010 Australian Dental Association.

  12. Safe meat-handling knowledge, attitudes and practices of private and government meat processing plants' workers: implications for future policy.

    Science.gov (United States)

    Adesokan, H K; Raji, A O Q

    2014-03-01

    Food-borne disease outbreaks remain a major global health challenge and cross-contamination from raw meat due to poor handling is a major cause in developing countries. Adequate knowledge of meat handlers is important in limiting these outbreaks. This study evaluated and compared the safe meat-handling knowledge, attitudes and practices (KAP) of private (PMPP) and government meat processing plants' (GMPP) workers in south-western Nigeria. This cross sectional study comprised 190 meat handlers (PMPP = 55; GMPP = 135). Data concerning their safe meat-handling knowledge, attitudes and practices as well as their socio-demographic characteristics, such as age, gender and work experience were collected. A significant association was observed between the type of meat processing plants and their knowledge (p = 0.000), attitudes (p = 0.000) and practices (p = 0.000) of safe meat-handling. Meat handlers in the GMPP were respectively, about 17 times (OR = 0.060, 95% CI: 0.018-0.203), 57 times (OR = 0.019, 95% CI: 0.007-0.054) and 111 times (OR = 0.009, 95% CI: 0.001- 0.067) less likely to obtain good knowledge, attitude and practice level of safe meat-handling than those from PMPP. Further, KAP levels were significantly associated with age group, education and work experience (p < 0.05). Study findings suggest the need for future policy in food industry in developing countries to accommodate increased involvement of private sector for improved food safety and quality delivery. Public health education on safe food handling and hygiene should be on the front burner among food handlers in general.

  13. A systematic assessment of the concept and practice of public-private mix for tuberculosis care and control.

    Science.gov (United States)

    Malmborg, Rasmus; Mann, Gillian; Squire, S Bertel

    2011-11-10

    The STOP TB Partnership aims to improve global tuberculosis (TB) control through expanding access to the directly observed treatment short course (DOTS) strategy. One approach to this is 'Engaging all Care Providers', which evolved from 'Public-Private Mix (PPM) DOTS'. The overall aim of this study was to systematically assess whether and to what degree the STOP TB Partnership's four global objectives of engaging all care providers are met through existing PPM interventions. These four objectives are; 1) Increase TB case detection; 2) Improve TB treatment outcomes; 3) Enhance access and equity; 4) Reduce financial burden on patients. The specific objectives of this assessment were to 1) Understand what PPM means to the STOP TB Partnership's PPM Subgroup and to National Tuberculosis Programme managers; 2) Scope the nature of existing country-level PPM interventions and 3) Review PPM practice against the global PPM objectives. We undertook a systematic, multi-facetted assessment. The methods included interviews with National Tuberculosis Programme managers from high burden countries, clarification of key issues with the STOP TB Partnership PPM secretariat and a review of publicly accessible reports and published articles on PPM projects. Both the literature review and interviews with the National Tuberculosis Programme managers yielded data on project characteristics; PPM models at country level; National Tuberculosis Programme partners; and mechanisms for engagement. Matrices were developed from the literature review and the interviews to show the relationship between services and service providers for different PPM projects. Data from the literature were assessed against each of the four global PPM objectives. Twelve National Tuberculosis Programme managers from high burden countries were interviewed about the scope of PPM partnerships. Understanding of PPM and types of engaged providers varied considerably; 'private-for-profit qualified clinical providers' were

  14. Psychological distress as a predictor of frequent attendance in family practice: a cohort study

    DEFF Research Database (Denmark)

    Vedsted, Peter; Fink, Per; Olesen, Frede

    2001-01-01

    In cross-sectional studies, psychological distress has been associated with frequent health care utilization. However, there is a need for prospective studies to confirm these findings. This cohort study evaluated whether psychological distress predicted frequent attendance in family practice.......16 [0.99-1.36] for SCL and OR 1.31 [1.05-1.65] for Whiteley). Psychological distress involved an increased risk of future frequent attendance among adult patients consulting family practice in the daytime about an illness........ In 1990, 185 consecutive adults who consulted their primary care physician (PCP) about an illness were rated on two psychometric scales (Hopkins Symptom Check List [SCL-8] and Whiteley-7), and their annual number of face-to-face contacts with a family practice was followed until 1996. Frequent attenders...

  15. The practice of commissioning healthcare from a private provider: learning from an in-depth case study.

    Science.gov (United States)

    Chambers, Naomi; Sheaff, Rod; Mahon, Ann; Byng, Richard; Mannion, Russell; Charles, Nigel; Exworthy, Mark; Llewellyn, Sue

    2013-01-01

    The direction of health service policy in England is for more diversification in the design, commissioning and provision of health care services. The case study which is the subject of this paper was selected specifically because of the partnering with a private sector organisation to manage whole system redesign of primary care and to support the commissioning of services for people with long term conditions at risk of unplanned hospital admissions and associated service provision activities. The case study forms part of a larger Department of Health funded project on the practice of commissioning which aims to find the best means of achieving a balance between monitoring and control on the one hand, and flexibility and innovation on the other, and to find out what modes of commissioning are most effective in different circumstances and for different services. A single case study method was adopted to explore multiple perspectives of the complexities and uniqueness of a public-private partnership referred to as the "Livewell project". 10 single depth interviews were carried out with key informants across the GP practices, the PCT and the private provider involved in the initiative. The main themes arising from single depth interviews with the case study participants include a particular understanding about the concept of commissioning in the context of primary care, ambitions for primary care redesign, the importance of key roles and strong relationships, issues around the adoption and spread of innovation, and the impact of the current changes to commissioning arrangements. The findings identified a close and high trust relationship between GPs (the commissioners) and the private commissioning support and provider firm. The antecedents to the contract for the project being signed indicated the importance of leveraging external contacts and influence (resource dependency theory). The study has surfaced issues around innovation adoption in the healthcare context

  16. Energy drinks consumption practices among medical students of a Private sector University of Karachi, Pakistan.

    Science.gov (United States)

    Usman, Asma; Bhombal, Swaleha Tariq; Jawaid, Ambreen; Zaki, Samar

    2015-09-01

    Consumption of energy drinks has become popular among students and athletes over the past few years. To explore the phenomenon, a cross-sectional survey was conducted through a self-administered pilot-tested questionnaire. Frequency of energy drinks consumption was found to be 121(52%) in a sample of 233 medical students. Red bull was the most common brand consumed 101(43%). The major reasons reported for its usage were to gain/replenish energy by 36(15.4%), and studying for examination by 34(14.6%). Television was reported as the major source of information 153(66%) followed by friends 113(48%). There was a high frequency of energy drinks' consumption among medical students of a private university. There is a strong need to create awareness regarding these drinks, especially among adolescents and teenagers.

  17. Referral system in the Asir Region, Saudi Arabia: knowledge, attitude, and practice of physicians working in urban areas--a comparative study of governmental and private health sectors.

    Science.gov (United States)

    al-Erian, R A; Mahfouz, A A; Alakija, W; al-Khozayem, A A

    1994-01-01

    A comparative study of knowledge, attitude and practice regarding referral system was undertaken among all governmental primary health care and private dispensary physicians (56 and 50 respectively) in Abha and Kamis, Asir Region. Results show that knowledge about referral is adequate in both groups, but the attitudes and practice of both groups need to be positively modified specially among the private sector physicians. The paper recommends more orientation programs for both groups of physicians and urges the private sector physicians to be more involved in Ministry of Health training programs and activities. Cooperation in referral between the private sector and government hospitals is seen as one way of improving health care in Saudi Arabia.

  18. Interprofessional Communities of Practice in Continuing Medical Education for Promoting and Sustaining Practice Change: A Prospective Cohort Study.

    Science.gov (United States)

    Barker, Megan; Lecce, Julia; Ivanova, Anna; Zawertailo, Laurie; Dragonetti, Rosa; Selby, Peter

    2018-01-01

    Standard knowledge delivery formats for CME may have limited impact on long-term practice change. A community of practice (CoP) is one tool that may enhance competencies and support practice change. This study explores the utility of an interprofessional CoP as an adjunct to a CME program in tobacco addiction treatment (Training Enhancement in Applied Counselling and Health [TEACH] Project) to promote and sustain practice change. A prospective cohort design was utilized to examine the long-term impact of the TEACH CoP on practice change. An online survey was administered to TEACH-trained practitioners to assess perceived feasibility, importance, and confidence related to course competencies, involvement in TEACH CoP activities, engagement in knowledge transfer (KT), and implementation of new programming. Chi-square tests were used to detect differences in KT and program development associated with CoP participation. Course competency scores from immediate postcourse surveys and long-term follow-up surveys were compared. No significant differences in participant characteristics were found between those who did (n = 300) and did not (n = 122) participate in the TEACH CoP. Mean self-perceived competency scores were greater immediately after course than at long-term follow-up; however, self-ratings of competency in pharmacological interventions and motivational interviewing were higher at follow-up. TEACH CoP participation was associated with significantly greater engagement in KT and implementation of new programming after training. The findings from this evaluation suggest the value of interprofessional CoPs offered posttraining as a mechanism to enhance practice. CME providers should consider offering CoPs as a component of training programs to promote and sustain practice change.

  19. Government regulation of forestry practices on private forest land in the United States: an assessment of state government responsibilities and program performance

    Science.gov (United States)

    Paul V. Ellefson; Michael A. Kilgore; James E. Granskog

    2006-01-01

    In 2003, a comprehensive assessment of state government, forest practice regulatory programs in the United States was undertaken. Involved was an extensive review of the literature and information gathering h m program administration in all 50 states. The assessment determined that regulatory programs focus on a wide range of forestry practices applied to private...

  20. Effects of Cesarean Delivery on Breastfeeding Practices and Duration: A Prospective Cohort Study.

    Science.gov (United States)

    Chen, Cheng; Yan, Yan; Gao, Xiao; Xiang, Shiting; He, Qiong; Zeng, Guangyu; Liu, Shiping; Sha, Tingting; Li, Ling

    2018-01-01

    Mothers are encouraged to exclusively breastfeed for the first 6 months. However, cesarean delivery rates have increased worldwide, which may affect breastfeeding. Research aim: This study aimed to determine the potential effects of cesarean delivery on breastfeeding practices and breastfeeding duration. This was a 6-month cohort study extracted from a 24-month prospective cohort study of mother-infant pairs in three communities in Hunan, China. Data about participants' characteristics, delivery methods, breastfeeding initiation, use of formula in the hospital, exclusive breastfeeding, and any breastfeeding were collected at 1, 3, and 6 months following each infant's birth. The chi-square test, logistic regression model, and Cox proportional hazard regression model were used to examine the relationship between breastfeeding practices and cesarean delivery. The number of women who had a cesarean delivery was 387 (40.6%), and 567 (59.4%) women had a vaginal delivery. The exclusive breastfeeding rates at 1, 3, and 6 months were 80.2%, 67.4%, and 21.5%, respectively. Women who had a cesarean delivery showed a lower rate of exclusive breastfeeding and any breastfeeding than those who had a vaginal delivery ( p cesarean delivery was related with using formula in the hospital and delayed breastfeeding initiation. Cesarean delivery also shortened the breastfeeding duration (hazard ratio = 1.40, 95% confidence interval [1.06, 1.84]). Healthcare professionals should provide more breastfeeding skills to women who have a cesarean delivery and warn mothers about the dangers of elective cesarean section for breastfeeding practices.

  1. Insights of private general practitioners in group practice on the introduction of National Health Insurance in South Africa

    Directory of Open Access Journals (Sweden)

    Shabir Moosa

    2016-06-01

    Full Text Available Background: The South African government intends to contract with ‘accredited provider groups’ for capitated primary care under National Health Insurance (NHI. South African solo general practitioners (GPs are unhappy with group practice. There is no clarity on the views of GPs in group practice on contracting to the NHI. Objectives: To describe the demographic and practice profile of GPs in group practice in South Africa, and evaluate their views on NHI, compared to solo GPs. Methods: This was a descriptive survey. The population of 8721 private GPs in South Africa with emails available were emailed an online questionnaire. Descriptive statistical analyses and thematic content analysis were conducted. Results: In all, 819 GPs responded (568 solo GPs and 251 GPs in groups. The results are focused on group GPs. GPs in groups have a different demographic practice profile compared to solo GPs. GPs in groups expected R4.86 million ($0.41 million for a hypothetical NHI proposal of comprehensive primary healthcare (excluding medicines and investigations to a practice population of 10 000 people. GPs planned a clinical team of 8 to 12 (including nurses and 4 to 6 administrative staff. GPs in group practices saw three major risks: patient, organisational and government, with three related risk management strategies. Conclusions: GPs can competitively contract with NHI, although there are concerns. NHI contracting should not be limited to groups. All GPs embraced strong teamwork, including using nurses more effectively. This aligns well with the emergence of family medicine in Africa. Keywords: Capitation, human resource, primary health care,  family medicine, South Africa, health systems

  2. Lessons learned from the reimbursement profile of a mature private medical toxicology practice: office-based practice pays.

    Science.gov (United States)

    Thompson, Trevonne M; Leikin, Jerrold B

    2015-03-01

    We previously reported the financial data for the first 5 years of one of the author's medical toxicology practice. The practice has matured; changes have been made. The practice is increasing its focus on office-based encounters and reducing hospital-based acute care encounters. We report the reimbursement rates and other financial metrics of the current practice. Financial records from October 2009 through September 2013 were reviewed. This is a period of 4 fiscal years and represents the currently available financial data. Charges, payments, and reimbursement rates were recorded according to the type and setting of the medical toxicology encounter: forensic consultations, outpatient clinic encounters, nonpsychiatric inpatient consultations, emergency department (ED) consultations, and inpatient psychiatric consultations. All patients were seen regardless of ability to pay or insurance status. The number of billed Current Procedural Terminology (CPT) codes for office-based encounters increased over the study period; the number of billed CPT codes for inpatient and ED consultations reduced. Office-based encounters demonstrate a higher reimbursement rate and higher payments. In the fiscal year (FY) of 2012, office-based revenue exceeded hospital-based acute care revenue by over $140,000 despite a higher number of billed CPT encounters in acute care settings, and outpatient payments were 2.39 times higher than inpatient, inpatient psychiatry, observation unit, and ED payments combined. The average payment per CPT code was higher for outpatient clinic encounters than inpatient encounters for each fiscal year studied. There was an overall reduction in CPT billing volume between FY 2010 and FY 2013. Despite this, there was an increase in total practice revenue. There was no change in payor mix, practice logistics, or billing/collection service company. In this medical toxicology practice, office-based encounters demonstrate higher reimbursement rates and overall

  3. [Early suspension of private practice: the current trends for general practitioners in three counties in western France].

    Science.gov (United States)

    Delansorne, Fanny; Buis, Hélène; Robino, Stéphane; Tomas, Josiane; Huez, Jean-François; Fanello, Serge

    2009-01-01

    The purpose of this study is to conduct a census of general practitioners in order to better understand their early withdrawal from primary care practice and to assess the impact of such withdrawal on current medical demography. The study covers the withdrawals from January 2000 to December 2005 in three western French counties. Data were collected through the district councils of the practitioners'guild, followed by a questionnaire filled in by 75 doctors. The participation rate was 60%. The study reveals that only 29% of these withdrawals are due to retirement. More than one in two doctors left to pursue another paid employment, and more than 25% chose to relocate their practice in a different area of the county. Two thirds of them were practicing in rural or semi-rural locations. Less than half, 47%, were replaced by a successor. General practitioners surveyed did not stop all professional medical care provision and service activities. Their careers are complex, and they are mobile professionals. The main reasons for suspending their activities in a given location were essentially related to the difficulties they had in dealing with their work loads and in maintaining a healthy work-life balance. They have noted that they will leave a range of possibilities open, either looking for private practice or not, exploring the possibility of primary care or not; the basis of their decision is whether a new position will correspond to their desire of mobility and meet their needs for more free.

  4. Theoretical frameworks used to discuss ethical issues in private physiotherapy practice and proposal of a new ethical tool.

    Science.gov (United States)

    Drolet, Marie-Josée; Hudon, Anne

    2015-02-01

    In the past, several researchers in the field of physiotherapy have asserted that physiotherapy clinicians rarely use ethical knowledge to solve ethical issues raised by their practice. Does this assertion still hold true? Do the theoretical frameworks used by researchers and clinicians allow them to analyze thoroughly the ethical issues they encounter in their everyday practice? In our quest for answers, we conducted a literature review and analyzed the ethical theoretical frameworks used by physiotherapy researchers and clinicians to discuss the ethical issues raised by private physiotherapy practice. Our final analysis corpus consisted of thirty-nine texts. Our main finding is that researchers and clinicians in physiotherapy rarely use ethical knowledge to analyze the ethical issues raised in their practice and that gaps exist in the theoretical frameworks currently used to analyze these issues. Consequently, we developed, for ethical analysis, a four-part prism which we have called the Quadripartite Ethical Tool (QET). This tool can be incorporated into existing theoretical frameworks to enable professionals to integrate ethical knowledge into their ethical analyses. The innovative particularity of the QET is that it encompasses three ethical theories (utilitarism, deontologism, and virtue ethics) and axiological ontology (professional values) and also draws on both deductive and inductive approaches. It is our hope that this new tool will help researchers and clinicians integrate ethical knowledge into their analysis of ethical issues and contribute to fostering ethical analyses that are grounded in relevant philosophical and axiological foundations.

  5. Neonatal outcomes of deliveries in occiput posterior position when delayed pushing is practiced: a cohort study.

    Science.gov (United States)

    Dahlqvist, Kristina; Jonsson, Maria

    2017-11-14

    To examine the impact of occiput posterior position, compared to occiput anterior position, on neonatal outcomes in a setting where delayed pushing is practiced. The specific aim was to estimate the risk of acidaemia. Cohort study from a university hospital in Sweden between 2004 and 2012. Information was collected from a local database of 35,546 births. Umbilical artery sampling was routine. Outcomes were: umbilical artery pH pushing, birth in occiput posterior compared with anterior position is not associated with acidaemia. The higher risk of neonatal morbidity is of concern and any long-term consequences need to be investigated in future studies.

  6. Barriers to implementing evidence-based practice in a private intensive care unit in the Eastern Cape

    Directory of Open Access Journals (Sweden)

    Portia Janine Jordan

    2016-11-01

    Full Text Available Background. Evidence-based practices (EBPs have been promoted to enhance the delivery of patient care, reduce cost, increase patient and family satisfaction and contribute to professional development. Individual and organisational barriers can hamper the implementation of EBP, which can be detrimental to healthcare delivery. Objective. To determine the individual and organisational implementation barriers of EBP among nurses in a private intensive care unit (ICU. Methods. A quantitative research design was used to collect data from nurses in a private ICU in the Eastern Cape Province, South Africa. The structured questionnaire (Cronbach’s alpha: 0.72 was administered to 70 respondents, with a response rate of 93%. Results. Barriers at individual level were identified, and include lack of familiarity with EBP, individual perceptions that underpin clinical decision-making, lack of access to information required for EBP, inadequate sources to access evidence, inability to synthesise the literature available, and resistance to change. Barriers related to organisational support, change and operations were identified. Conclusion. Although the findings were similar to other studies, this study showed that nurses younger than 40 years of age were more familiar with the concepts of EBP. Physicians were perceived as not being very supportive of EBP implementation. In order to enhance healthcare delivery in the ICUs, nurse managers need to take cognisance of the individual and organisational barriers that might hamper the implementation of EBP.

  7. Prolonged fasting of children before anaesthesia is common in private practice.

    Science.gov (United States)

    Buller, Y; Sims, C

    2016-01-01

    Fasting guidelines for children are well established. Despite these guidelines, previous studies have shown children are often fasted for prolonged periods before anaesthesia, potentially causing discomfort and distress. Moreover, recent publications indicate shorter fasting times for oral clear fluids in children may be safe. We audited fasting times of children having elective surgery at a local large private hospital that provides care for both adults and children. We gave feedback and education to our caregivers, then repeated the audit. Data were collected from 307 children (age 6.0 ± 4.1 years) in an initial eight-week audit, and from 153 children (age 6.7 ± 4.5 years) in a follow-up four-week audit. We found fasting durations were excessive in many children. Sixty-two percent of children in each audit fasted longer than four hours for clear fluids. Children on morning lists fasted longer than children on afternoon lists. Fasting from solids was also excessively long. In the initial audit, 30% fasted more than 12 hours for solids, including 18 who last ate more than 16 hours before surgery. Data from the follow-up audit were similar. We conclude that fasting of children at our hospital is excessive, despite our efforts to shorten the duration. We suspect that our hospital is not the only one with a high incidence of prolonged fasting for children and suggest possible solutions.

  8. Private Finance Initiative (PFI for Road Projects in UK: Current Practice with a Case Study

    Directory of Open Access Journals (Sweden)

    Rifat Akbiyikli

    2011-05-01

    Full Text Available The long-term sustainable provision of new and high quality maintained road stock is vitally important, especially in times of economic constraint such as Europe is currently experiencing. The Private Finance Initiative (PFI is one method of financing such large-scale, capital intensive projects. An important aspect of this form of financing projects is that the risks are borne not only by the sponsors but are shared by different types of investors such as equity holders, debt providers, and quasi-equity investors. Consequently, a comprehensive and heuristic risk management process is essential for the success of the project. The proposition made within this paper is that the PFI mechanism provides a Value-for-Money and effective mechanism to achieve this. The structure of this PFI finance and investment on a particular road project therefore enables all project stakeholders to take a long-term perspective. This long-term perspective is reflected in the mechanism of a case study of UK – Class A trunk roads which are examined in detail. This paper presents a novel solution to a modern dilemma.

  9. Private initiatives, public support, and war practices: development of fertilisers in Russia.

    Science.gov (United States)

    Elina, Olga Y

    2011-03-01

    The scarcity of experiments with fertilisers, the poor domestic industry, and high prices for imported products made Russia lag far behind the leading agrarian countries in the research and use of fertilisers. The first experiments on fertilisers were connected mostly with the private estates of Russian nobility. Things began to change slowly by the turn of the twentieth century, when the Ministry of Agriculture launched a policy of agricultural science promotion, including the development of agricultural chemistry. It was the outbreak of World War I that created a powerful stimulus for fertiliser research in Russia. A specific Russian "symbiosis" emerged between military industry and agricultural chemistry. The numerous factories of explosives set up ad hoc produced vast amounts of waste products; modified, they could serve as fertilisers. In 1915, the Public Committee for Support of Fertilisers was organised. Eventually, this committee gave birth to the Institute of Fertilisers, the first institute founded by the Bolshevik government. Thus, the project of "chemicalisation of agriculture," usually described as a revolutionary endeavour, was firmly rooted in World War I.

  10. Italians posing between public and private. Theories and practices of Social Heritage

    Directory of Open Access Journals (Sweden)

    Daniela Calanca

    2011-08-01

    Full Text Available According to the Convention for the Safeguarding of the Intangible Heritage (Unesco 2003, from the point of view on Social Heritage, the Family Photo, and by extension Family Albums, play a particular significant role. In particular, Family Albums are a specific referent point for conservation, transmission and development of a community Social Heritage. At the same time, Family Album can be considered “places” of the Italian memory and places of transmission between public and private, because the photography, since its debut, is a public space, as if to say: posing is already being in public. Amateurs photographs and professional photographs offer a chance to see a visual history of Italy and so a visual history of dominant ideologies, perceptual and cultural models of Italian life. In this sense, with Family Album we can analyzed the continuous interweaving between the idea of history and history of ideological, economic and political thinking, factors influencing consumers, tastes change and the impact of scientific progress. Specifically, Family photo is a new source for the study of Italian family’s history, that is “The True Homeland of the Italian” and so the institution on which the national identity is found (Ginsborg 2001.

  11. Complete Denture Impression Techniques Practiced by Private Dental Practitioners: A Survey

    OpenAIRE

    Kakatkar, Vinay R.

    2012-01-01

    Impression making is an important step in fabricating complete dentures. A survey to know the materials used and techniques practiced while recording complete denture impressions was conducted. It is disheartening to know that 33 % practitioners still use base plate custom trays to record final impressions. 8 % still use alginate for making final impressions. An acceptable technique for recording CD impressions is suggested.

  12. Private Feelings, Public Expressions: Professional Jealousy and the Moral Practice of Teaching

    Science.gov (United States)

    Chen, Yen-Hsin; Kristjansson, Kristjan

    2011-01-01

    This paper explores the issue of personal factors that impinge upon education. More specifically, it addresses professional jealousy among teachers and how it affects the moral practice of teaching. Our focus is teachers' emotions in general and teachers' jealousies in particular, in the context of the ideal of the moral teacher. We identify and…

  13. Law and Management of a Counseling Agency or Private Practice. The ACA Legal Series. Volume 3.

    Science.gov (United States)

    Bullis, Ronald K.

    This monograph addresses laws that govern the business and management of mental health practices. The preface warns that this book only raises legal issues, concentrates on federal law, and does not exhaust the issues and information on any topic. A glossary of terms such as "burden of proof,""fiduciary,""negligence," and "torts" is presented.…

  14. Hand hygiene knowledge and practice among university students: evidence from Private Universities of Bangladesh

    Directory of Open Access Journals (Sweden)

    Sultana M

    2016-02-01

    Full Text Available Marufa Sultana,1 Rashidul Alam Mahumud,1 Abdur Razzaque Sarker,1 Sarder Mahmud Hossain,21Health Economics and Financing Research Group, Centre for Equity and Health System (CEHS, International Centre for Diarrhoeal Disease Research, Bangladesh, 2Department of Public Health, Northern University Bangladesh, Dhaka, BangladeshAbstract: Hand hygiene has achieved the reputation of being a convenient means of preventing communicable diseases. Although causal links between hand hygiene and rates of infectious disease have also been established earlier, studies focusing on hand hygiene among university-going students are not adequate in number. This study evaluated handwashing knowledge, practice, and other related factors among the selected university students in the city of Dhaka, Bangladesh. A cross-sectional study was conducted among 200 undergraduate students from four selected universities. A pretested, semistructured questionnaire, that included a checklist associated with handwashing practice, was applied to capture all relevant data. The mean (± SD age of the participants was 20.4 (±1.8 years. The majority of the students washed their hands with water, but only 22.5% washed their hands effectively by maintaining the correct steps and frequency of handwashing with water, and soap or hand sanitizer. The mean (± SD score of the participants’ hand hygiene practice was 50.81 (±4.79, while the total score with all perfect answers was considered as 66. Regression coefficient demonstrated that age has a negative influence on hand hygiene practice, as older students have lower scores compared to the younger ones (P<0.01. However, the unmarried students were a significant predictor for influencing the incensement of handwashing practice compared to the married ones (P<0.01. Findings of this study designate widespread insufficient hand hygiene practice in the university-going students and indicate a need for an extensive public health education

  15. Radiology and social media: are private practice radiology groups more social than academic radiology departments?

    Science.gov (United States)

    Glover, McKinley; Choy, Garry; Boland, Giles W; Saini, Sanjay; Prabhakar, Anand M

    2015-05-01

    This study assesses the prevalence of use of the most commonly used social media sites among private radiology groups (PRGs) and academic radiology departments (ARDs). The 50 largest PRGs and the 50 ARDs with the highest level of funding from the National Institutes of Health were assessed for presence of a radiology-specific social media account on Facebook, Twitter, Instagram, Pinterest, YouTube, and LinkedIn. Measures of organizational activity and end-user activity were collected, including the number of posts and followers, as appropriate; between-group comparisons were performed. PRGs adopted Facebook 12 months earlier (P = .02) and Twitter 18 months earlier (P = .02) than did ARDs. A total of 76% of PRGs maintained ≥1 account on the social media sites included in the study, compared with 28% of ARDs (P Instagram, 2%. The prevalence of radiology-specific social media accounts for ARDs was: Facebook, 18%; LinkedIn, 0%; Twitter, 24%; YouTube, 6%; Pinterest, 0%; and Instagram, 0%. There was no significant difference between ARDs and PRGs in measures of end-user or organizational activity on Facebook or Twitter. Use of social media in health care is emerging as mainstream, with PRGs being early adopters of Facebook and Twitter in comparison with ARDs. Competitive environments and institutional policies may be strong factors that influence how social media is used by radiologists at the group and department levels. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  16. Synthesis of public-private partnerships : potential issues and best practices for program and project implementation and administration.

    Science.gov (United States)

    2015-08-01

    Public-private partnerships (P3s or PPPs) offer an innovative procurement method for the public sector. : P3s involve collaborations between the public and private sectors to finance, develop or maintain transportation : infrastructure. In an era of ...

  17. University clinic and private practice treatment outcomes in Class I extraction and nonextraction patients: A comparative study with the American Board of Orthodontics Objective Grading System.

    Science.gov (United States)

    Mislik, Barbara; Konstantonis, Dimitrios; Katsadouris, Alexios; Eliades, Theodore

    2016-02-01

    The aim of this study was to compare treatment outcomes in university vs private practice settings with Class I patients using the American Board of Orthodontics Objective Grading System. A parent sample of 580 Class I patients treated with and without extractions of 4 first premolars was subjected to discriminant analysis to identify a borderline spectrum of 66 patients regarding the extraction modality. Of these patients, 34 were treated in private orthodontic practices, and 32 were treated in a university graduate orthodontic clinic. The treatment outcomes were evaluated using the 8 variables of the American Board of Orthodontics Objective Grading System. The total scores ranged from 10 to 47 (mean, 25.44; SD, 9.8) for the university group and from 14 to 45 (mean, 25.94; SD, 7.7) for the private practice group. The university group achieved better scores for the variables of buccolingual inclination (mean difference, 2.28; 95% confidence interval [CI], 0.59, 3.98; P = 0.01) and marginal ridges (mean difference, 1.32; 95% CI, 0.28, 2.36; P = 0.01), and the private practice group achieved a better score for the variable of root angulation (mean difference, -0.65; 95% CI, -1.26, -0.03; P = 0.04). However, no statistically intergroup differences were found between the total American Board of Orthodontics Objective Grading System scores (mean difference, -0.5; 95% CI, -3.82, 4.82; P = 0.82). Patients can receive similar quality of orthodontic treatment in a private practice and a university clinic. The orthodontists in the private practices were more successful in angulating the roots properly, whereas the orthodontic residents accomplished better torque control of the posterior segments and better marginal ridges. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  18. Private-by-Design Advertising and Analytics: From Theory to Practice

    OpenAIRE

    Reznichenko, Alexey

    2015-01-01

    There are a number of designs for an online advertising system that allow for behavioral targeting without revealing user online behavior or user interest profiles to the ad network. Although these designs purport to be practical solutions, none of them adequately consider the role of ad auctions, which today are central to the operation of online advertising systems. Moreover, none of the proposed designs have been deployed in real-life settings. In this thesis, we present an effort to fill ...

  19. Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons.

    NARCIS (Netherlands)

    Donker, G.A.; Slotman, F.G.; Spreeuwenberg, P.; Francke, A.L.

    2013-01-01

    Background: Little is known about the quantity and reasons for use of palliative sedation in general practice. Aim: To gain more insight into the trends of and reasons for palliative sedation in Dutch general practice. Design and setting: Dynamic cohort study using registrations and questionnaire

  20. Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons

    NARCIS (Netherlands)

    Donker, G.A.; Slotman, F.G.; Spreeuwenberg, P.; Francke, A.L.

    2013-01-01

    Background: Little is known about the quantity and reasons for use of palliative sedation in general practice. Aim: To gain more insight into the trends of and reasons for palliative sedation in Dutch general practice. Design and setting: Dynamic cohort study using registrations and questionnaire

  1. Determinants related to gender differences in general practice utilization: Danish Diet, Cancer and Health Cohort.

    Science.gov (United States)

    Jørgensen, Jeanette Therming; Andersen, John Sahl; Tjønneland, Anne; Andersen, Zorana Jovanovic

    2016-09-01

    This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50-65 years. Cohort-based cross-sectional study. Danish general practice. Totally, 54,849 participants of the Danish Diet, Cancer and Health cohort (50-65 years). The sum of cohort members' face-to-face consultations with general practitioner (GP) at the cohort baseline year (1993-1997). We obtained data on GP visits from the Danish National Health Service Register at the cohort baseline (1993-1997), when information on lifestyle (smoking, body mass index (BMI), alcohol use, physical activity), medical conditions (somatic and mental), employment, education, gravidity, and hormone therapy (HT) use was collected by questionnaire. Women had on average 4.1 and men 2.8 consultations per year. In a crude model, women had 47% higher rate of GP visits than men (incidence rate ratio: 1.47; 95% Confidence Interval: 1.45-1.50), which remained unchanged after adjustment for lifestyle, socio-demographic and medical factors, but attenuated to 18% (1.18; 1.13-1.24) after adjustment for female factors (gravidity and post-menopausal HT. In a fully adjusted model, subjects with hypertension (1.63; 1.59-1.67), mental illness (1.63; 1.61-1.66), diabetes (1.56; 1.47-1.65), angina pectoris (1.28; 1.21-1.34), and unemployed persons (1.19; 1.18-1.21) had highest rates of GP visits. Gravidity and HT use explain a large proportion, but not all of the gender difference in GP utilization. Medical conditions (somatic and mental) and unemployment are the main determinants of GP utilization in men and women, while lifestyle has minor effect. Key points Female gender remained a dominant determinant of GP utilization, after adjustment for lifestyle, socio-demography, medical and gender specific factors, with females consulting their GP 18% more often than males. Female reproductive factors (use of postmenopausal hormone therapy and gravidity) explained a large proportion of

  2. [Supplementary services used as marketing tools in the competition among private practice doctors].

    Science.gov (United States)

    Meurers, Horst

    2009-01-01

    What is the relation between additional healthcare services, marketing and competition among office-based physicians? The best and truly effective marketing strategy is a satisfied patient recommending his doctor's services to others. Hence, good marketing starts with a convincing service concept, not just with advertising. More and more frequently patients ask for supplementary health service offerings. Additional services tailored to individual practices--e.g., in the field of nutrition, sports, fitness, wellness, aesthetics--meet the patients' demands, but at the same time they provide a competitive advantage over the ordinary medical practice. And what is more, these additional healthcare services have a nice side effect: they earn an additional income which is not unwelcome in times of decreasing revenues from the public healthcare system. The much sought-after potential for additional services and income can be achieved by offering commercial medical services, e.g., the sale of healthcare products. The coexistence of the doctor's commercial and non-commercial medical services is admissible as long as certain rules of professional conduct and tax laws are followed.

  3. Learning to learn self-regulation in practice: a 2 cohort evaluation.

    Science.gov (United States)

    Sharples, Kath; Moseley, Laurence G

    2011-11-01

    The transfer of nurse training into higher education following 'Project 2000' dramatically changed the status of student nurses. While the majority received a grant or bursary, students were no longer regarded as belonging to the hospital staffing complement. Elcock et al. (2007), argue that the intended advantage of supernumerary status following the move of nurse education into higher education has not been reflected in the student learning experience. Students have reported difficulties in being accepted into the community of practice, as they are no longer viewed as belonging in the professional sense to the practice environment (Cope et al., 2000). Students must therefore be prepared for their supernumerary role through the development of appropriate skills for learning in practice (Elcock et al., 2007). The Thames Valley University pre-registration nursing curriculum promotes the effective socialisation of students into the professional role (Fitzpatrick et al., 1996) through a 35-day practice orientation programme in the Common Foundation Programme. The results of a 2 cohort evaluation of a 35-day programme facilitated in the Brent and Harrow learning community indicate that novice pre-registration students will not always possess the self-directed ability to spontaneously engage with nursing care in practice. Students must be provided the opportunity to develop the skills that define the self-regulated learner (Langendyk, 2006). Students must be empowered to self-assess what they know and what they do not know. It is argued that in order to learn during practice experiences, the student nurse of today must first learn how to be self-regulated. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. The influence of early feeding practices on fruit and vegetable intake among preschool children in 4 European birth cohorts.

    Science.gov (United States)

    de Lauzon-Guillain, Blandine; Jones, Louise; Oliveira, Andreia; Moschonis, George; Betoko, Aisha; Lopes, Carla; Moreira, Pedro; Manios, Yannis; Papadopoulos, Nikolaos G; Emmett, Pauline; Charles, Marie Aline

    2013-09-01

    Fruit and vegetable intake in children remains below recommendations in many countries. The long-term effects of early parental feeding practices on fruit and vegetable intake are not clearly established. The purpose of the current study was to examine whether early feeding practices influence later fruit and vegetable intake in preschool children. The study used data from 4 European cohorts: the British Avon Longitudinal Study of Parents and Children (ALSPAC), the French Etude des Déterminants pre et postnatals de la santé et du développement de l'Enfant study, the Portuguese Generation XXI Birth Cohort, and the Greek EuroPrevall study. Fruit and vegetable intake was assessed in each cohort by food-frequency questionnaire. Associations between early feeding practices, such as breastfeeding and timing of complementary feeding, and fruit and/or vegetable intake in 2-4-y-old children were tested by using logistic regressions, separately in each cohort, after adjustment for infant's age and sex and maternal age, educational level, smoking during pregnancy, and maternal fruit and vegetable intake. Large differences in early feeding practices were highlighted across the 4 European cohorts with longer breastfeeding duration in the Generation XXI Birth Cohort and earlier introduction to complementary foods in ALSPAC. Longer breastfeeding duration was consistently related to higher fruit and vegetable intake in young children, whereas the associations with age of introduction to fruit and vegetable intake were weaker and less consistent across the cohorts. Mothers' fruit and vegetable intake (available in 3 of the cohorts) did not substantially attenuate the relation with breastfeeding duration. The concordant positive association between breastfeeding duration and fruit and vegetable intake in different cultural contexts favors an independent specific effect.

  5. [Health care waste management of potentially infectious medical waste by healthcare professionals in a private medical practice: a study of practices].

    Science.gov (United States)

    Brunot, Alain; Thompson, Céline

    2010-01-01

    A cross-sectional study was conducted with a sample of 278 health professionals (GPs and specialists, dentists, physical therapists and nurses) in a private medical practice in Paris to study the medical waste management practices related to the production and disposal of potentially hazardous health care waste. With the exception of physical therapists, most professionals produced medical waste (72% to 96,2% according to occupation), with a monthly median of 3 liters (inter-quartile range 1-15 liters). All sharp objects and needles were separated and 91% of them eliminated via a specific process for that sector. These percentages were respectively 84% and 69% concerning contaminated waste that was neither needles or used for cutting. 48% of the professionals reported the existence of documents that could track the disposal of their medical waste. To improve practice, professionals cited collection on-site at the office (74%) and reliability of the contracted service provider to collect the waste (59%). The study showed that health professionals need information on the regulations regarding potentially infectious medical waste, in particular on the traceability of its elimination. They also noted the lack of clarity and precision with regard to the definition of risk of infection: 31,7% of professionals only declare the production of sharp or cutting waste without having specified criteria for risk of infection.

  6. Medical resource utilization and costs associated with autosomal dominant polycystic kidney disease in the USA: a retrospective matched cohort analysis of private insurer data

    Science.gov (United States)

    Knight, Tyler; Schaefer, Caroline; Krasa, Holly; Oberdhan, Dorothee; Chapman, Arlene; Perrone, Ronald D

    2015-01-01

    Background Autosomal dominant polycystic kidney disease (ADPKD) results in kidney cyst development and enlargement, resulting in chronic kidney disease (CKD) leading to renal failure. This study sought to determine if ADPKD patients in the early stages of CKD contribute to a sizable economic burden for the US health care system. Methods This was a retrospective, matched cohort study, reviewing medical resource utilization (MRU) and costs for adults in a US private-payer claims database with a diagnosis code of ADPKD (ICD-9-CM 753.13). ADPKD patients were matched by age grouping (0–17, 18–34, 35–44, 45–54, 55–64, and 65+ years) and sex to controls to understand the burden of ADPKD. Descriptive statistics on 6-month MRU and costs were assessed by CKD stages, dialysis use, or previous renal transplant. Results The analysis included ADPKD patients in CKD stages 1–5 (n=316 to n=860), dialysis (n=586), and post-transplant (n=615). Mean ages did not differ across CKD stages (range 43–56 years). Men were the majority in the later stages but the minority in the early stages. The proportion of patients with at least one hospitalization increased with CKD stage, (12% to >40% CKD stage 2 to stage 5, dialysis or post-transplant). The majority had at least one hospital outpatient visit and at least one pharmacy claim. Total 6-month per-patient costs were greater among ADPKD patients than in age-matched and sex-matched healthy non-ADPKD controls (P<0.001 for all comparisons). Conclusion ADPKD patients with normal kidney function are associated with a significant economic burden to the health care system relative to the general population. Any treatments that delay progression to later stages of CKD may provide potential health care cost offsets. PMID:25759590

  7. Child discipline and nurturing practices among a cohort of Pacific mothers living in New Zealand.

    Science.gov (United States)

    Cowley-Malcolm, Esther Tumama; Fairbairn-Dunlop, Tagaloa Peggy; Paterson, Janis; Gao, Wanzhen; Williams, Maynard

    2009-02-01

    The Pacific Islands Families (PIF) study is a longitudinal investigation of a cohort (N=1376) of Pacific infants born in New Zealand (NZ), and their mothers and fathers. The PIF study aimed to determine: (1) the prevalence of disciplinary and nurturing parenting practices used with children at 12 months of age, and (2) the demographic, maternal and lifestyle factors associated with parenting practices. At the 12-month measurement point, mothers (N=1207) were interviewed about their parenting practices using a modified version of the Parent Behaviour Checklist. High nurturance was significantly associated with Samoan ethnicity and post school qualifications, and low nurturance was significantly associated with post-natal depression, alcohol consumption and gambling. At the univariate level, high discipline scores were significantly associated with gambling, postnatal depression and lack of alignment to either Pacific or to European traditions. However the strongest association with discipline was the ethnicity variable with Tongan mothers reporting significantly higher disciplinary behaviours that all other ethnicities. It is clear that there are a number of common underlying lifestyle issues that need to be considered when dealing with parenting problems in families with young children. However specific to Pacific families, is Tongan ethnicity accounting for a strong cultural effect on parenting style, in particular high discipline scores relative to other Pacific groups. This important finding may be used to guide social policy and prevention programmes that are focused on the wellbeing of Pacific mothers and their children.

  8. Infant Feeding Practices in a Multi-Ethnic Asian Cohort: The GUSTO Study

    Directory of Open Access Journals (Sweden)

    Jia Ying Toh

    2016-05-01

    Full Text Available The optimal introduction of complementary foods provides infants with nutritionally balanced diets and establishes healthy eating habits. The documentation of infant feeding practices in multi-ethnic Asian populations is limited. In a Singapore cohort study (GUSTO, 842 mother-infant dyads were interviewed regarding their feeding practices when the infants were aged 9 and 12 months. In the first year, 20.5% of infants were given dietary supplements, while 5.7% took probiotics and 15.7% homeopathic preparations. At age 9 months, 45.8% of infants had seasonings added to their foods, increasing to 56.3% at 12 months. At age 12 months, 32.7% of infants were given blended food, although 92.3% had begun some form of self-feeding. Additionally, 87.4% of infants were fed milk via a bottle, while a third of them had food items added into their bottles. At both time points, more than a third of infants were provided sweetened drinks via the bottle. Infants of Indian ethnicity were more likely to be given dietary supplements, have oil and seasonings added to their foods and consumed sweetened drinks from the bottle (p < 0.001. These findings provide a better understanding of variations in infant feeding practices, so that healthcare professionals can offer more targeted and culturally-appropriate advice.

  9. Biomarkers in patients with Chronic Obstructive Pulmonary Disease in general practice: A prospective cohort study

    DEFF Research Database (Denmark)

    Waldorff, Frans Boch; Halling, Anders; Ledderer, Loni

    Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common chronic disease primarily treated in primary care. It is a complex and heterogeneous disease and the trajectory is difficult to predict. The overall aim of this study is to investigate predictors of the trajectory of COPD...... were a diagnosis of COPD (ICPC code R95-), age ≥ 40 years, Danish language speaking, no severe psychiatric or cognitive disease and ability to visit the GP surgery. Prevalent as well as incident patients diagnosed with COPD were eligible. Baseline data included a patient questionnaire and validated...... treated in primary care and to determine the added value of selected biomarkers such as microfibrillar-associated protein 4 (MFAP4) and surfactant protein D (SP-D). Methods: Prospective cohort study comprising COPD patients. A total of 38 Danish practices were included in the study. Criteria for inclusion...

  10. Closing the Gap: Communicating to Change Gardening Practices in Support of Native Biodiversity in Urban Private Gardens

    Directory of Open Access Journals (Sweden)

    Yolanda M. van Heezik

    2012-03-01

    Full Text Available Private gardens collectively comprise the largest green space in most cities and the greatest potential for increasing the extent of wildlife-friendly and native-dominated habitat, improving the quality of ecosystem services, and providing opportunities for urban dwellers to reconnect with nature. Because attitudes and values driving landscape preferences in gardens are complex and often not conducive to biodiversity, and a gap exists between the possession of knowledge or values and the expression of pro-environmental behavior, facilitating change in gardening behavior is challenging. We attempted to improve knowledge and influence values, attitudes, and gardening behavior of 55 householders in favor of native biodiversity and environmentally friendly practices, through a two-way communication process, or interactive dialog, during a process of biodiversity documentation of their gardens. Informative feedback on their garden with a normative component was also provided. Despite being well educated and knowledgeable about common species at the start of the study, an increase in knowledge and shift in attitude was detected in 64% of householders: 40% reported a greater understanding of wildlife, and 26% made changes in their gardens, 13% to support native biodiversity. The normative component of our feedback information was of particular interest to 20% of householders. Because neighborhood norms influence gardening practices, changes adopted by a proportion of householders should be perpetuated across neighborhoods. The process of biodiversity assessment, dialog, and feedback was effective in improving knowledge of wildlife and native species, and stimulated a shift in attitude that resulted in native-friendly gardening practices. These changes were detected primarily through open self-report questions, rather than quantitative measures.

  11. Public policies, private choices: Consumer desire and the practice of energy efficiency

    Science.gov (United States)

    Deumling, Reuben Alexander

    Refrigerator energy consumption has been the subject of regulatory attention in the US for some thirty years. Federal product standards, energy labels, and a variety of programs to get consumers to discard their existing refrigerators sooner and buy new, more energy efficient ones have transformed the refrigerator landscape and changed how many of us think about refrigerators. The results of these policies are celebrated as a successful model for how to combine regulatory objectives and consumer preferences in pursuit of environmental outcomes where everyone wins. Yet per capita refrigerator energy consumption today remains (much) higher in the US than anywhere else, in part because energy efficiency overlooks the ways behavior, habit, emulation, social norms, advertising, and energy efficiency policies themselves shape energy consumption patterns. To understand these dynamics I investigate how people replacing their refrigerators through a state-sponsored energy efficiency program make sense of the choices facing them, and how various types of information designed to aid in this process (Consumer Reports tests, Energy Guide labels, rebate programs) frame the issue of responsible refrigerator consumption. Using interviews and archival research I examine how this information is used to script the choice of a refrigerator, whose priorities shape the form and content of these cues, and what the social meanings generated by and through encounters with refrigerators and energy efficiency are. I also helped build a model for estimating historic refrigerator energy consumption in the US, to measure the repercussions of refrigerator energy inefficiency. My focus in this dissertation is on the ways the pursuit of energy efficiency improvements for domestic refrigerators intersects with and sometimes reinforces escalating demand for energy. My research suggests that the practice of pursuing energy efficiency improvements in refrigerators subordinates the issue of

  12. Private Schools

    Data.gov (United States)

    Department of Homeland Security — This Private Schools feature dataset is composed of all Private elementary and secondary education features in the United States as defined by the Private School...

  13. Homeopathic medical practice: Long-term results of a cohort study with 3981 patients

    Directory of Open Access Journals (Sweden)

    Baur Roland

    2005-11-01

    Full Text Available Abstract Background On the range of diagnoses, course of treatment, and long-term outcome in patients who chose to receive homeopathic medical treatment very little is known. We investigated homeopathic practice in an industrialized country under everyday conditions. Methods In a prospective, multicentre cohort study with 103 primary care practices with additional specialisation in homeopathy in Germany and Switzerland, data from all patients (age >1 year consulting the physician for the first time were observed. The main outcome measures were: Patient and physician assessments (numeric rating scales from 0 to 10 and quality of life at baseline, and after 3, 12, and 24 months. Results A total of 3,981 patients were studied including 2,851 adults (29% men, mean age 42.5 ± 13.1 years; 71% women, 39.9 ± 12.4 years and 1,130 children (52% boys, 6.5 ± 3.9 years; 48% girls, 7.0 ± 4.3 years. Ninety-seven percent of all diagnoses were chronic with an average duration of 8.8 ± 8 years. The most frequent diagnoses were allergic rhinitis in men, headache in women, and atopic dermatitis in children. Disease severity decreased significantly (p Conclusion Disease severity and quality of life demonstrated marked and sustained improvements following homeopathic treatment period. Our findings indicate that homeopathic medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.

  14. Private and Public Sector Enterprise Resource Planning System Post-Implementation Practices: A Comparative Mixed Method Investigation

    Science.gov (United States)

    Bachman, Charles A.

    2010-01-01

    While private sector organizations have implemented enterprise resource planning (ERP) systems since the mid 1990s, ERP implementations within the public sector lagged by several years. This research conducted a mixed method, comparative assessment of post "go-live" ERP implementations between public and private sector organization. Based on a…

  15. Effect of maternal country of birth on breastfeeding practices: results from Portuguese GXXI birth cohort.

    Science.gov (United States)

    Kana, Musa Abubakar; Rodrigues, Carina; Fonseca, Maria João; Santos, Ana Cristina; Barros, Henrique

    2018-01-01

    Maternal country of birth has been associated with perinatal health outcomes but less is known regarding breastfeeding practices in contemporary European settings. This study investigated effect of maternal country of birth on breastfeeding initiation and duration by comparing native Portuguese and migrant mothers. We analyzed data of 7065 children of the Generation XXI (GXXI) birth cohort recruited at birth (2005-06) and followed-up 4 years later. Logistic regression was used to assess the effect of maternal country of birth on breastfeeding initiation. Kaplan-Meier estimate was used to compare breastfeeding duration by maternal country of birth and length of residence by migrant mothers in Portugal. Breastfeeding initiation and the type of breastfeeding practice were similar for native Portuguese and migrant mothers. The migrants had significantly higher median duration in months of any breastfeeding (Odds Ratio [OR] 6.0, 95% Confidence Interval [CI] 5.4,6.6) and exclusive breastfeeding (OR 4.0, 95% CI 3.8,4.2) than native Portuguese mothers (OR 4.0, 95% CI 3.8,4.2 and OR 3.0, 95% CI 2.9,3.0). Migrant mothers who resided in Portugal for either ≤5 years (OR 5.0, 95% CI 3.9,6.1 and OR 4.0, 95% CI 3.8,4.2) or >  5 years (OR 6.0, 95% CI 5.5,6.5 and OR 4.0, 95% CI 3.7,4.3) years had similar duration of any breastfeeding or exclusive breastfeeding, in both cases higher than the native Portuguese mothers. No significant differences were found when world regions were compared. Maternal country of birth does not influence breastfeeding initiation and type of feeding practice. However, migrant mothers have longer breastfeeding duration of either exclusive or any breastfeeding, which was not changed by length of residence in Portugal.

  16. Safety of bevacizumab in clinical practice for recurrent ovarian cancer: A retrospective cohort study

    Science.gov (United States)

    SELLE, FRÉDÉRIC; EMILE, GEORGE; PAUTIER, PATRICIA; ASMANE, IRÈNE; SOARES, DANIELE G.; KHALIL, AHMED; ALEXANDRE, JEROME; LHOMMÉ, CATHERINE; RAY-COQUARD, ISABELLE; LOTZ, JEAN-PIERRE; GOLDWASSER, FRANÇOIS; TAZI, YOUSSEF; HEUDEL, PIERRE; PUJADE-LAURAINE, ERIC; GOUY, SÉBASTIEN; TREDAN, OLIVIER; BARBAZA, MARIE O.; ADY-VAGO, NORA; DUBOT, CORALINE

    2016-01-01

    The poor outcome of patients with recurrent ovarian cancer constitutes a continuous challenge for decision-making in clinical practice. In this setting, molecular targets have recently been identified, and novel compounds are now available. Bevacizumab has been introduced for the treatment of patients with ovarian cancer and is, to date, the most extensively investigated targeted therapy in this setting. However, potential toxicities are associated with the use of this monoclonal antibody. These toxicities have been reported in clinical trials, and can also be observed outside of trials. As limited data is currently available regarding the safety of bevacizumab treatment in daily clinical practice, the current retrospective study was designed to evaluate this. Data from 156 patients with recurrent ovarian cancer who had received bevacizumab treatment between January 2006 and June 2009 were retrospectively identified from the institutional records of five French centers. In contrast to clinical trials, the patients in the present study were not selected and had a heterogeneous profile according to their prior medical history, lines of treatment prior to bevacizumab introduction and number of relapses. The results first confirm the effect of heavy pretreatment on the occurrence of serious and fatal adverse events in clinical practice, as previously reported for clinical trials and for other retrospective cohort studies. Importantly, the data also demonstrates, for the first time, that medical history of hypertension is an independent predictive risk factor for the development of high-grade hypertension during bevacizumab treatment. These results thus suggest that treating physicians must consider all risk factors for managing bevacizumab toxicity prior to its introduction. Such risk factors include the time of bevacizumab introduction, a patient's history of hypertension and a low incidence of pre-existing obstructive disease. PMID:26998090

  17. Medical resource utilization and costs associated with autosomal dominant polycystic kidney disease in the USA: a retrospective matched cohort analysis of private insurer data

    Directory of Open Access Journals (Sweden)

    Knight T

    2015-02-01

    Full Text Available Tyler Knight,1 Caroline Schaefer,1 Holly Krasa,2 Dorothee Oberdhan,2 Arlene Chapman,3 Ronald D Perrone4 1Covance Market Access Services Inc., Gaithersburg, MD, 2Otsuka Pharmaceutical Development and Commercialization, Inc., Rockville, MD, 3Emory University, Atlanta, GA, 4Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA Background: Autosomal dominant polycystic kidney disease (ADPKD results in kidney cyst development and enlargement, resulting in chronic kidney disease (CKD leading to renal failure. This study sought to determine if ADPKD patients in the early stages of CKD contribute to a sizable economic burden for the US health care system. Methods: This was a retrospective, matched cohort study, reviewing medical resource utilization (MRU and costs for adults in a US private-payer claims database with a diagnosis code of ADPKD (ICD-9-CM 753.13. ADPKD patients were matched by age grouping (0–17, 18–34, 35–44, 45–54, 55–64, and 65+ years and sex to controls to understand the burden of ADPKD. Descriptive statistics on 6-month MRU and costs were assessed by CKD stages, dialysis use, or previous renal transplant. Results: The analysis included ADPKD patients in CKD stages 1–5 (n=316 to n=860, dialysis (n=586, and post-transplant (n=615. Mean ages did not differ across CKD stages (range 43–56 years. Men were the majority in the later stages but the minority in the early stages. The proportion of patients with at least one hospitalization increased with CKD stage, (12% to >40% CKD stage 2 to stage 5, dialysis or post-transplant. The majority had at least one hospital outpatient visit and at least one pharmacy claim. Total 6-month per-patient costs were greater among ADPKD patients than in age-matched and sex-matched healthy non-ADPKD controls (P<0.001 for all comparisons. Conclusion: ADPKD patients with normal kidney function are associated with a significant economic burden to the health care system

  18. LAPAROSCOPY IN PRIVATE PRACTICE*

    African Journals Online (AJOL)

    We have found the laparoscope our most useful aid for making a quick and accurate diagnosis of pelvic masses. On inspection the difference between fibromyomata and endometriosis is apparent. In the case of suspected ectopic pregnancy, where there has been only scant intra- peritoneal bleeding, the traditional method ...

  19. Evidence-based practice profiles of physiotherapists transitioning into the workforce: a study of two cohorts

    Directory of Open Access Journals (Sweden)

    McEvoy Maureen P

    2011-11-01

    Full Text Available Abstract Background Training in the five steps of evidence-based practice (EBP has been recommended for inclusion in entry-level health professional training. The effectiveness of EBP education has been explored predominantly in the medical and nursing professions and more commonly in post-graduate than entry-level students. Few studies have investigated longitudinal changes in EBP attitudes and behaviours. This study aimed to assess the changes in EBP knowledge, attitudes and behaviours in entry-level physiotherapy students transitioning into the workforce. Methods A prospective, observational, longitudinal design was used, with two cohorts. From 2008, 29 participants were tested in their final year in a physiotherapy program, and after the first and second workforce years. From 2009, 76 participants were tested in their final entry-level and first workforce years. Participants completed an Evidence-Based Practice Profile questionnaire (EBP2, which includes self-report EBP domains [Relevance, Terminology (knowledge of EBP concepts, Confidence, Practice (EBP implementation, Sympathy (disposition towards EBP]. Mixed model analysis with sequential Bonferroni adjustment was used to analyse the matched data. Effect sizes (ES (95% CI were calculated for all changes. Results Effect sizes of the changes in EBP domains were small (ES range 0.02 to 0.42. While most changes were not significant there was a consistent pattern of decline in scores for Relevance in the first workforce year (ES -0.42 to -0.29 followed by an improvement in the second year (ES +0.27. Scores in Terminology improved (ES +0.19 to +0.26 in each of the first two workforce years, while Practice scores declined (ES -0.23 to -0.19 in the first year and improved minimally in the second year (ES +0.04. Confidence scores improved during the second workforce year (ES +0.27. Scores for Sympathy showed little change. Conclusions During the first two years in the workforce, there was a

  20. Association of preresidency peer-reviewed publications with radiation oncology resident choice of academic versus private practice career.

    Science.gov (United States)

    McClelland, Shearwood; Thomas, Charles R; Wilson, Lynn D; Holliday, Emma B; Jaboin, Jerry J

    The decision of radiation oncology residents to pursue academic versus private practice careers plays a central role in shaping the present and future of the field, but factors that are potentially predictive of this decision are lacking. This study was performed to examine the role of several factors publicly available before residency on postresidency career choice, including preresidency peer-reviewed publications (PRPs), which have been associated with resident career choice in comparably competitive subspecialties such as neurosurgery. Using a combination of Internet searches, telephone interviews, and the 2015 Association of Residents in Radiation Oncology directory, a list of 2016 radiation oncology resident graduates was compiled, along with their postresidency career choice. PRP was defined as the number of PubMed publications encompassing the end of the calendar year (2010) in which residency applications were due; this number was then correlated with career choice. A total of 163 residents from 76 Accreditation Council for Graduate Medical Education-certified programs were examined: 78% were male, 22% were MDs/PhDs, and 79 graduates (48%) chose academic careers. Fifty-two percent of graduates had at least 1 PRP at the time of application to radiation oncology residency; 35% had more than 1 PRP. Regarding career choice, the difference between 0 and 1+ PRP was statistically significant (odds ratio, 3.3; P 1 PRP. Sex, PhD, or non-PhD dual degree status were not associated with career choice. Radiation oncology residency graduates with 1 or more PRPs at the time of residency application were roughly 2 times more likely to choose an academic career as their initial career choice than graduates with no preresidency PRPs. This information may prove useful to medical students, medical school advisors, and residency program directors and deserves further prospective investigation. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier

  1. Does the accreditation of private dental practices work? Time to rethink how accreditation can improve patient safety.

    Science.gov (United States)

    Jean, Gillian

    2017-10-09

    Accreditation to demonstrate engagement with the National Safety and Quality Health Service Standards (Standards) is compulsory for most hospital and healthcare settings, but to date remains voluntary for private dental practices (PDPs). The regulatory framework governing the dental profession lacks a proactive element to drive improvements in quality and safety of care, and an accreditation scheme can strengthen existing regulation. The current model of accreditation operating in accordance with the Australian Health Service Safety and Quality Accreditation Scheme (Scheme) is based on the Standards, which were written for a hospital model of healthcare service. The majority of PDPs are small office-based businesses with clear leadership structure and employing six staff or fewer. The Scheme is overly bureaucratic given the simplicity of the PDP business model. This article considers whether accreditation has a proven track record of improving quality of service and offers opinions about how a more appropriate safety management program for PDPs may look. What is known about the topic? There has been minimal research about the impact of accreditation schemes in improving patient safety in PDP. What does this paper add? This paper proposes a redesign of the Scheme to make it more relevant to PDPs. The paper offers strategies to minimise duplication of purpose between accreditation and existing legislation; and to strengthen critical elements of accreditation to improve effects on patient safety. What are the implications for practitioners? A redesigned accreditation scheme will support dental practitioners to implement a quality assurance system with improved efficiency, reduced administrative burden, and optimised patient safety.

  2. Private Speech in Ballet

    Science.gov (United States)

    Johnston, Dale

    2006-01-01

    Authoritarian teaching practices in ballet inhibit the use of private speech. This paper highlights the critical importance of private speech in the cognitive development of young ballet students, within what is largely a non-verbal art form. It draws upon research by Russian psychologist Lev Vygotsky and contemporary socioculturalists, to…

  3. Incidence of fractures among epilepsy patients: a population-based retrospective cohort study in the General Practice Research Database.

    Science.gov (United States)

    Souverein, Patrick C; Webb, David J; Petri, Hans; Weil, John; Van Staa, Tjeerd P; Egberts, Toine

    2005-02-01

    To compare the incidence of various fractures in a cohort of patients with epilepsy with a reference cohort of patients not having epilepsy. Patients were included in the epilepsy cohort if they had at least one diagnosis of epilepsy in their medical history and had sufficient evidence of "active" epilepsy (use of antiepileptic drugs, diagnoses) after the practice was included in the General Practice Research Database (GPRD). Two reference patients were sampled for each patient with epilepsy from the same practice. Primary outcome was the occurrence of any fracture during follow-up. Poisson regression analysis was used to estimate incidence density ratios (IDRs). The study population comprised 40,485 and 80,970 patients in the epilepsy and reference cohorts, respectively. The median duration of follow-up was approximately 3 years. The overall incidence rate in the epilepsy cohort was 241.9 per 10,000 person-years. This rate was about twice as high as that in reference cohort: age- and sex-adjusted IDR, 1.89 (95% CI, 1.81-1.98). When comparing IDRs among the different groups of fractures, the highest relative-risk estimate was found for hip and femur fractures (adjusted IDR, 2.79; 95% CI, 2.41-3.24). IDRs were consistently elevated across age and sex groups and across fracture subtypes. The overall risk of fractures was nearly twice as high among patients with epilepsy compared with the general population. The relative fracture risk was highest for hip and femur. Further study is necessary to elucidate whether this elevated risk is due to the disease, the use of antiepileptic drugs, or both.

  4. Pulpa dentis D30 for acute reversible pulpitis: A prospective cohort study in routine dental practice.

    Science.gov (United States)

    Hamre, Harald Johan; Mittag, Inge; Glockmann, Anja; Kiene, Helmut; Tröger, Wilfried

    2011-01-01

    Pulpa dentis D30 (PD: dental pulp of the calf, prepared in a homeopathic D30 potency) has been used in acute reversible pulpitis for pain relief and to avoid or postpone invasive dental treatment. To study short-term clinical outcomes of PD therapy for acute reversible pulpitis in routine dental practice. Prospective, observational, open-label, single-arm cohort study. Eleven dental primary care practices in Germany. Thirty-two patients starting monotherapy with PD for acute reversible pulpitis without visible or radiological abnormalities. PD was applied as 1-mL submucous injections into the mucobuccal fold, repeated daily as needed. Avoidance of invasive dental treatment (pulp capping, root canal therapy, tooth extraction) and remission of pain, measured on a 0-10 point scale (partial remission: reduction by > or =3 points; complete remission: reduction from > or =4 points to 0-1 points) during the 10-day follow-up period. Median pain duration was 14.0 days. The patients received a median of two PD applications (range 1-7). A total of 81% (n=26/32) of patients did not require invasive dental treatment, and 19% (n= 6) had root canal therapy. Remission status was evaluable in 24 patients. Of these, 63% (n = 15/24) achieved pain remission, 58% (n = 14) remitted without invasive dental treatment (complete remission: n=12, partial remission: n=2), and 29% (n= 7) had a close temporal relationship between PD and remission (ratio "time to remission after first PD application vs pain duration prior to first PD application" pulpitis, 58% of evaluable patients achieved pain remission without invasive dental treatment. The open-label pre-post design does not allow for conclusions about comparative effectiveness. However, more than one-fourth of evaluable patients remitted with a close temporal relationship between the first PD application and pain remission, suggesting a causal relationship between therapy and remission.

  5. Antibiotic prescribing in public and private practice: a cross-sectional study in primary care clinics in Malaysia.

    Science.gov (United States)

    Ab Rahman, Norazida; Teng, Cheong Lieng; Sivasampu, Sheamini

    2016-05-17

    Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia. We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014. NMCS contained demographic, diagnoses and prescribing from 129 public clinics and 416 private clinics. We identified all encounters who were prescribed antibiotic and analyse the prescribing rate, types of antibiotics, and diagnoses that resulted in antibiotic. Five thousand eight hundred ten encounters were prescribed antibiotics; antibiotic prescribing rate was 21.1 % (public clinics 6.8 %, private clinics 30.8 %). Antibiotic prescribing was higher in private clinics where they contributed almost 87 % of antibiotics prescribed in primary care. Upper respiratory tract infection (URTI) was the most frequent diagnosis in patients receiving antibiotic therapy and accounted for 49.2 % of prescriptions. Of the patients diagnosed with URTI, 46.2 % received antibiotic treatment (public 16.8 %, private 57.7 %). Penicillins, cephalosporins and macrolides were the most commonly prescribed antibiotics and accounted for 30.7, 23.6 and 16.0 % of all antibiotics, respectively. More recently available broad-spectrum antibiotics such as azithromycin and quinolones were more frequently prescribed in private clinics. Antibiotic prescribing rates are high in both public and private primary care settings in Malaysia, especially in the latter. This study provides evidence of excessive and inappropriate antibiotic prescribing for self-limiting conditions. These data highlights the needs for more concerted interventions targeting both prescribers and public. Improvement strategies should focus on reducing

  6. Teaching practices and professional development of biology professors at small, private, liberal arts colleges in the Southeast

    Science.gov (United States)

    Mallory, Sarah Elizabeth Bradford

    Science teaching in pre-college institutions has been undergoing reform in recent years, particularly since 1996, when the National Science Education Standards were published. This reform includes inquiry-based teaching, student-centered classrooms, authentic assessment, and collaborative learning. Professional development is also recommended in the Standards document as the means for preparing teachers for reform-based teaching in pre-college classrooms. In post-secondary institutions, there is no curriculum-governing body to institute reform, and college faculty have devised their own standards and methods for teaching science, most often in the form of lecture and traditional procedure-driven laboratory exercises. This study was conducted to find examples of reform-based biology teaching in small, private, liberal arts colleges in the Southeast, where teaching innovations may be more likely to occur due to the size and independence of the schools. Professional development opportunities were also examined, since these would be important in the development of new curricula and methods of teaching. Data were collected from 151 participants, representing 78.3% of these colleges in eight southeastern states, by survey and from three volunteers by on-site interviews. Teaching was the main responsibility reported by all respondents, with both lower and upper level biology courses taught by all participants. Significant differences were found in the use of reform-based teaching in lower level biology courses versus upper level biology courses. Overall average use of inquiry-based teaching was 70.5%, while student-centered learning was reported on average by 57% of respondents, authentic assessment was reported on average by 56.6% of respondents, and collaborative learning was reported on average by 56% of respondents. Professional development opportunities most frequently used were reported to be journal, books, and videotapes. Multivariate regression analyses revealed

  7. Outcomes of Dabigatran and Warfarin for Atrial Fibrillation in Contemporary Practice: A Retrospective Cohort Study.

    Science.gov (United States)

    Go, Alan S; Singer, Daniel E; Toh, Sengwee; Cheetham, T Craig; Reichman, Marsha E; Graham, David J; Southworth, Mary Ross; Zhang, Rongmei; Izem, Rima; Goulding, Margie R; Houstoun, Monika; Mott, Katrina; Sung, Sue Hee; Gagne, Joshua J

    2017-12-19

    Dabigatran (150 mg twice daily) has been associated with lower rates of stroke than warfarin in trials of atrial fibrillation, but large-scale evaluations in clinical practice are limited. To compare incidence of stroke, bleeding, and myocardial infarction in patients receiving dabigatran versus warfarin in practice. Retrospective cohort. National U.S. Food and Drug Administration Sentinel network. Adults with atrial fibrillation initiating dabigatran or warfarin therapy between November 2010 and May 2014. Ischemic stroke, intracranial hemorrhage, extracranial bleeding, and myocardial infarction identified from hospital claims among propensity score-matched patients starting treatment with dabigatran or warfarin. Among 25 289 patients starting dabigatran therapy and 25 289 propensity score-matched patients starting warfarin therapy, those receiving dabigatran did not have significantly different rates of ischemic stroke (0.80 vs. 0.94 events per 100 person-years; hazard ratio [HR], 0.92 [95% CI, 0.65 to 1.28]) or extracranial hemorrhage (2.12 vs. 2.63 events per 100 person-years; HR, 0.89 [CI, 0.72 to 1.09]) but were less likely to have intracranial bleeding (0.39 vs. 0.77 events per 100 person-years; HR, 0.51 [CI, 0.33 to 0.79]) and more likely to have myocardial infarction (0.77 vs. 0.43 events per 100 person-years; HR, 1.88 [CI, 1.22 to 2.90]). However, the strength and significance of the association between dabigatran use and myocardial infarction varied in sensitivity analyses and by exposure definition (HR range, 1.13 [CI, 0.78 to 1.64] to 1.43 [CI, 0.99 to 2.08]). Older patients and those with kidney disease had higher gastrointestinal bleeding rates with dabigatran. Inability to examine outcomes by dabigatran dose (unacceptable covariate balance between matched patients) or quality of warfarin anticoagulation (few patients receiving warfarin had available international normalized ratio values). In matched adults with atrial fibrillation treated in

  8. Determinants of completion of advance directives: a cross-sectional comparison of 649 outpatients from private practices versus 2158 outpatients from a university clinic.

    Science.gov (United States)

    Pfirstinger, Jochen; Bleyer, Bernhard; Blum, Christian; Rechenmacher, Michael; Wiese, Christoph H; Gruber, Hans

    2017-12-21

    To compare outpatients from private practices and outpatients from a university clinic regarding the determinants of completion of advance directives (AD) in order to generalise results of studies from one setting to the other. Five determinants of completion of AD were studied: familiarity with AD, source of information about AD, prior experiences with own life-threatening diseases or family members in need of care and motives in favour and against completion of AD. Observational cross-sectional study. Private practices and a university clinic in Germany in 2012. 649 outpatients from private practices and 2158 outpatients from 10 departments of a university clinic. Completion of AD, familiarity with AD, sources of information about AD (consultation), prior experiences (with own life-threatening disease and family members in need of care), motives in favour of or against completion of AD, sociodemographic data. Determinants of completion of AD did not differ between outpatients from private practices versus university clinic outpatients. Prior experience with severe disease led to a significantly higher rate of completion of AD (33%/36% with vs 24%/24% without prior experience). Participants with completion of AD had more often received legal than medical consultation before completion, but participants without completion of AD are rather aiming for medical consultation. The motives in favour of or against completion of AD indicated inconsistent patterns. Determinants of completion of AD are comparable in outpatients from private practices and outpatients from a university clinic. Generalisations from university clinic samples towards a broader context thus seem to be legitimate. Only one-third of patients with prior experience with own life-threatening diseases or family members in need of care had completed an AD as expression of their autonomous volition. The participants' motives for or against completion of AD indicate that ADs are considered a kind of

  9. Exploring Factors Affecting Voluntary Adoption of Electronic Medical Records Among Physicians and Clinical Assistants of Small or Solo Private General Practice Clinics.

    Science.gov (United States)

    Or, Calvin; Tong, Ellen; Tan, Joseph; Chan, Summer

    2018-05-29

    The health care reform initiative led by the Hong Kong government's Food and Health Bureau has started the implementation of an electronic sharing platform to provide an information infrastructure that enables public hospitals and private clinics to share their electronic medical records (EMRs) for improved access to patients' health care information. However, previous attempts to convince the private clinics to adopt EMRs to document health information have faced challenges, as the EMR adoption has been voluntary. The lack of electronic data shared by private clinics carries direct impacts to the efficacy of electronic record sharing between public and private healthcare providers. To increase the likelihood of buy-in, it is essential to proactively identify the users' and organizations' needs and capabilities before large-scale implementation. As part of the reform initiative, this study examined factors affecting the adoption of EMRs in small or solo private general practice clinics, by analyzing the experiences and opinions of the physicians and clinical assistants during the pilot implementation of the technology, with the purpose to learn from it before full-scale rollout. In-depth, semistructured interviews were conducted with 23 physicians and clinical assistants from seven small or solo private general practice clinics to evaluate their experiences, expectations, and opinions regarding the deployment of EMRs. Interview transcripts were content analyzed to identify key factors. Factors affecting the adoption of EMRs to record and manage health care information were identified as follows: system interface design; system functions; stability and reliability of hardware, software, and computing networks; financial and time costs; task and outcome performance, work practice, and clinical workflow; physical space in clinics; trust in technology; users' information technology literacy; training and technical support; and social and organizational influences. The

  10. Involving private persons and corporations in the planning process according to paragraph 9b German nuclear law - practicability and limits

    International Nuclear Information System (INIS)

    Altmann, J.; Roesel, H.

    1978-01-01

    The 4th Amendment to the German Nuclear Law has procured the legal base for the disposal of radioactive waste in the German Federal Republic. The Nuclear Law states that the Physikalisch-Technische Bundesanstalt (PTB) in Braunschweig is responsible for the disposal of radioactive waste. The PTB can be assisted in its responsibilities by persons and institutions of private character. Involving private persons and corporations in the licensing process figures a legal problem, and there has been a seminar in the PTB discussing such problems. The present contribution gives a brief summary of the opinions stated by the various legal experts taking part in this seminar. (orig./HP) [de

  11. Is the association between high strain work and depressive symptoms modified by private life social support: a cohort study of 1,074 Danish employees?

    Science.gov (United States)

    Madsen, Ida E H; Jorgensen, Anette F B; Borritz, Marianne; Nielsen, Martin L; Rugulies, Reiner

    2014-07-08

    Previous studies have shown that psychosocial working conditions characterized by high psychological demands and low decision latitude (i.e., high strain work) are associated with increased risk of depressive symptoms. Little is known, however, concerning how this association may be modified by factors outside the working environment. This article examines the modifying role of private life social support in the relation between high strain work and the development of severe depressive symptoms. Data were questionnaire-based, collected from a cross-occupational sample of 1,074 Danish employees. At baseline, all participants were free of severe depressive symptoms, measured by the Mental Health Inventory. High strain work was defined by the combination of high psychological demands at work and low control, measured with multi-dimensional scales. Private life social support was operationalized as the number of life domains with confidants and dichotomized as low (0-1 domains) or high (2 or more domains). Using logistic regression we examined the risk of onset of severe depressive symptoms, adjusting for sex, age, occupational position, and prior depressive symptoms. Separately, neither high strain work nor low private life social support statistically significantly predicted depressive symptoms. However, participants with joint exposure to high strain work and low private life social support had an Odds ratio (OR) for severe depressive symptoms of 3.41 (95% CI: 1.36-8.58), compared to participants with no work strain and high private life social support. There was no increased risk for participants with high strain work and high private life social support (OR = 1.32, 95% CI: 0.65-2.68). The interaction term for departure from additivity was, however, not statistically significant (p = 0.18). Our findings suggest that high strain work may increase risk of depressive symptoms in individuals with low private life social support, although the effect-modification was

  12. Is the association between high strain work and depressive symptoms modified by private life social support: a cohort study of 1,074 Danish employees?

    Science.gov (United States)

    2014-01-01

    Background Previous studies have shown that psychosocial working conditions characterized by high psychological demands and low decision latitude (i.e., high strain work) are associated with increased risk of depressive symptoms. Little is known, however, concerning how this association may be modified by factors outside the working environment. This article examines the modifying role of private life social support in the relation between high strain work and the development of severe depressive symptoms. Methods Data were questionnaire-based, collected from a cross-occupational sample of 1,074 Danish employees. At baseline, all participants were free of severe depressive symptoms, measured by the Mental Health Inventory. High strain work was defined by the combination of high psychological demands at work and low control, measured with multi-dimensional scales. Private life social support was operationalized as the number of life domains with confidants and dichotomized as low (0–1 domains) or high (2 or more domains). Using logistic regression we examined the risk of onset of severe depressive symptoms, adjusting for sex, age, occupational position, and prior depressive symptoms. Results Separately, neither high strain work nor low private life social support statistically significantly predicted depressive symptoms. However, participants with joint exposure to high strain work and low private life social support had an Odds ratio (OR) for severe depressive symptoms of 3.41 (95% CI: 1.36-8.58), compared to participants with no work strain and high private life social support. There was no increased risk for participants with high strain work and high private life social support (OR = 1.32, 95% CI: 0.65-2.68). The interaction term for departure from additivity was, however, not statistically significant (p = 0.18). Conclusions Our findings suggest that high strain work may increase risk of depressive symptoms in individuals with low private life social

  13. Effects of ICT Integration in Management of Private Secondary Schools in Nairobi County, Kenya: Policy Options and Practices

    Science.gov (United States)

    Oyier, Charles Richard; Odundo, Paul Amollo; Lilian, Ganira Khavugwi; Wangui, Kahiga Ruth

    2015-01-01

    The convergence between telecommunication, broadcasting multimedia and related technologies commonly known as Information and Communication Technologies (ICT), promises a fundamental change in educational management. ICT could be the missing tool in improving efficiency of private secondary schools to cope with rapidly changing world to…

  14. A medical student in private practice for a 1-month clerkship: a qualitative exploration of the challenges for primary care clinical teachers.

    Science.gov (United States)

    Muller-Juge, Virginie; Pereira Miozzari, Anne Catherine; Rieder, Arabelle; Hasselgård-Rowe, Jennifer; Sommer, Johanna; Audétat, Marie-Claude

    2018-01-01

    The predicted shortage of primary care physicians emphasizes the need to increase the family medicine workforce. Therefore, Swiss universities develop clerkships in primary care physicians' private practices. The objective of this research was to explore the challenges, the stakes, and the difficulties of clinical teachers who supervised final year medical students in their primary care private practice during a 1-month pilot clerkship in Geneva. Data were collected via a focus group using a semistructured interview guide. Participants were asked about their role as a supervisor and their difficulties and positive experiences. The text of the focus group was transcribed and analyzed qualitatively, with a deductive and inductive approach. The results show the nature of pressures felt by clinical teachers. First, participants experienced the difficulty of having dual roles: the more familiar one of clinician, and the new challenging one of teacher. Second, they felt compelled to fill the gap between the academic context and the private practice context. Clinical teachers were surprised by the extent of the adaptive load, cognitive load, and even the emotional load involved when supervising a trainee in their clinical practice. The context of this rotation demonstrated its utility and its relevance, because it allowed the students to improve their knowledge about the outpatient setting and to develop their professional autonomy and their maturity by taking on more clinical responsibilities. These findings show that future training programs will have to address the needs of clinical teachers as well as bridge the gap between students' academic training and the skills needed for outpatient care. Professionalizing the role of clinical teachers should contribute to reaching these goals.

  15. A medical student in private practice for a 1-month clerkship: a qualitative exploration of the challenges for primary care clinical teachers

    Directory of Open Access Journals (Sweden)

    Muller-Juge V

    2017-12-01

    Full Text Available Virginie Muller-Juge, Anne Catherine Pereira Miozzari, Arabelle Rieder, Jennifer Hasselgård-Rowe, Johanna Sommer, Marie-Claude Audétat Unit of Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland Purpose: The predicted shortage of primary care physicians emphasizes the need to increase the family medicine workforce. Therefore, Swiss universities develop clerkships in primary care physicians’ private practices. The objective of this research was to explore the challenges, the stakes, and the difficulties of clinical teachers who supervised final year medical students in their primary care private practice during a 1-month pilot clerkship in Geneva.Methods: Data were collected via a focus group using a semistructured interview guide. Participants were asked about their role as a supervisor and their difficulties and positive experiences. The text of the focus group was transcribed and analyzed qualitatively, with a deductive and inductive approach.Results: The results show the nature of pressures felt by clinical teachers. First, participants experienced the difficulty of having dual roles: the more familiar one of clinician, and the new challenging one of teacher. Second, they felt compelled to fill the gap between the academic context and the private practice context. Clinical teachers were surprised by the extent of the adaptive load, cognitive load, and even the emotional load involved when supervising a trainee in their clinical practice. The context of this rotation demonstrated its utility and its relevance, because it allowed the students to improve their knowledge about the outpatient setting and to develop their professional autonomy and their maturity by taking on more clinical responsibilities.Conclusion: These findings show that future training programs will have to address the needs of clinical teachers as well as bridge the gap between students’ academic training and the skills needed for

  16. History, Politics and Practice of Public-Private Partnership in the Basic Models of Interaction Between Government and Business

    Directory of Open Access Journals (Sweden)

    Надежда Викторовна Шуленина

    2012-09-01

    Full Text Available Public-private partnership is a new institute of collaboration between business and government for Russia. Formulated in 2004, the position of top officials on this matter gave a significant acceleration to the process of launching projects using the PPP. But due to lack of necessary experience and knowledge there is often a substitution of notions. This entails the disruption of important projects for the national economy.

  17. The Public and Private Epistolary Practice of Giovanni Querini, Ambassador of the Venetian Republic in Spain (1768-1773

    Directory of Open Access Journals (Sweden)

    Javier ANTÓN PELAYO

    2014-02-01

    Full Text Available This article analyses the letter writing of Giovanni Querini, ambassador of the Republic of Venice in Spain from 1768 to 1772. Through examination of the official letters sent by him to his government and though the correspondence he maintained with his wife Caterina Contarini, the author describes the contingencies of the post, the duality of these epistolary discourses and the effectiveness of private letters for preserving marital intimacy and family sociability from a distance.

  18. Factors for and against establishing and working in private practice correlated with work-related behavior and experience patterns of Ferman physicians in Schleswig-Holstein: A 2-year longitudinal study

    Directory of Open Access Journals (Sweden)

    Edgar Voltmer

    2017-06-01

    Full Text Available Objectives: To identify factors in favor of or against establishing and working in private practice, to determine the quality of life and work-related behavior and experience patterns of German physicians working in private practice, and to analyze the correlation of those factors. Material and Methods: A representative sample of physicians in private practice in Schleswig-Holstein, Germany, was surveyed according to a 2-year longitudinal design (T1 – 2008, N = 549 and T2 – 2010, N = 414. The study included 22 items regarding the attractiveness of establishing and working in private practice, and the questionnaires: the Short Form-12 Health Survey (SF-12, and Work-related Behavior and Experience Pattern (Arbeitsbezogenes Verhaltens- und Erlebensmuster – AVEM. Results: Job satisfaction among those private practitioners decreased over time but their willingness to choose the profession once again remained unchanged. Patient care and the continuity of physician-patient relationship encouraged establishing and working in private practice; state regulation, financial risk, and administrative effort weighed against it. At both T1 and T2, physicians scored significantly lower for mental health than general population. About 20% of physicians showed a healthy behavior and experience pattern but 40% of them showed the pattern of reduced working motivation. About 20% of participants were at elevated risk for overexertion and for burnout. Physical and mental health as well as the total distribution of patterns did not change significantly during the 2-year observation period. Physicians at higher burnout risk rated tasks related to patient care considerably less positively than those with healthy pattern. Conclusions: In order to improve job satisfaction and quality of life, and to make private practice more attractive, those German physicians require a improved legislation, b educational programs that promote the attractiveness of private practice

  19. Private Labels

    OpenAIRE

    Kolmačková, Zuzana

    2013-01-01

    This Bachelor Thesis titled Private labels deals with distribution strategy based on the introduction of private labels especially in retail chains. At the beginning it is focused on the general concept of private label offered by retailers, where is mentioned basic characteristics, history and structuring of distribution brands. Subsequently this thesis informs readers about the introduction of new special distribution brands, which focus primarily on the new consumption habits of customers....

  20. Privat boligudlejning

    DEFF Research Database (Denmark)

    Andersen, Hans Skifter

    2008-01-01

    for private udlejningsboligers pris, økonomi og kvalitet. Det økonomiske afkast af investering i private udlejningsejendomme har været højt i de sidste 10 år, men fortrinsvist pga. værdistigninger. For tiden er disse gået i stå, hvilket gør den økonomiske fremtid for den private udlejningssektor mindre...

  1. Impact of Collaborative Care on Absenteeism for Depressed Employees Seen in Primary Care Practices: A Retrospective Cohort Study.

    Science.gov (United States)

    Adaji, Akuh; Newcomb, Richard D; Wang, Zhen; Williams, Mark

    2018-01-01

    The impact of "real world" collaborative care on depression and absenteeism for depressed employees seen in primary care practices using objective employer absence data. A retrospective cohort study comparing depressed employees seen in primary care practices who enrolled for a "real world" collaborative care program to practice as usual (PAU) on objective absence days and depression response and remission at 6, and 12-month time periods. Absence days were more in the collaborative care group compared with the PAU group at 3 and 6 months but at 12 months the difference was no longer statistically significant. Collaborative care led to better response and remission depression scores compared with PAU at 12 months. Collaborative care led to faster improvement in depression symptoms but did not translate to less time away from work.

  2. Cross-sectional survey of treatment practices for urethritis at pharmacies, private clinics and government health facilities in coastal Kenya: many missed opportunities for HIV prevention

    Science.gov (United States)

    Mugo, Peter M; Duncan, Sarah; Mwaniki, Samuel W; Thiong'o, Alexander N; Gichuru, Evanson; Okuku, Haile Selassie; van der Elst, Elise M; Smith, Adrian D; Graham, Susan M; Sanders, Eduard J

    2013-01-01

    Background While bacterial sexually transmitted infections (STIs) are important cofactors for HIV transmission, STI control has received little attention in recent years. The aim of this study was to assess STI treatment and HIV testing referral practices among health providers in Kenya. Methods In 2011 we assessed quality of case management for male urethritis at pharmacies, private clinics and government health facilities in coastal Kenya using simulated visits at pharmacies and interviews at pharmacies and health facilities. Quality was assessed using Ministry of Health guidelines. Results Twenty (77%) of 26 pharmacies, 20 (91%) of 22 private clinics and all four government facilities in the study area took part. The median (IQR) number of adult urethritis cases per week was 5 (2–10) at pharmacies, 3 (1–3) at private clinics and 5 (2–17) at government facilities. During simulated visits, 10% of pharmacies prescribed recommended antibiotics at recommended dosages and durations and, during interviews, 28% of pharmacies and 27% of health facilities prescribed recommended antibiotics at recommended dosages and durations. Most regimens were quinolone-based. HIV testing was recommended during 10% of simulated visits, 20% of pharmacy interviews and 25% of health facility interviews. Conclusions In an area of high STI burden, most men with urethritis seek care at pharmacies and private clinics. Most providers do not comply with national guidelines and very few recommend HIV testing. In order to reduce the STI burden and mitigate HIV transmission, there is an urgent need for innovative dissemination of up-to-date guidelines and inclusion of all health providers in HIV/STI programmes. PMID:23698510

  3. Cross-sectional survey of treatment practices for urethritis at pharmacies, private clinics and government health facilities in coastal Kenya: many missed opportunities for HIV prevention.

    Science.gov (United States)

    Mugo, Peter M; Duncan, Sarah; Mwaniki, Samuel W; Thiong'o, Alexander N; Gichuru, Evanson; Okuku, Haile Selassie; van der Elst, Elise M; Smith, Adrian D; Graham, Susan M; Sanders, Eduard J

    2013-11-01

    While bacterial sexually transmitted infections (STIs) are important cofactors for HIV transmission, STI control has received little attention in recent years. The aim of this study was to assess STI treatment and HIV testing referral practices among health providers in Kenya. In 2011 we assessed quality of case management for male urethritis at pharmacies, private clinics and government health facilities in coastal Kenya using simulated visits at pharmacies and interviews at pharmacies and health facilities. Quality was assessed using Ministry of Health guidelines. Twenty (77%) of 26 pharmacies, 20 (91%) of 22 private clinics and all four government facilities in the study area took part. The median (IQR) number of adult urethritis cases per week was 5 (2-10) at pharmacies, 3 (1-3) at private clinics and 5 (2-17) at government facilities. During simulated visits, 10% of pharmacies prescribed recommended antibiotics at recommended dosages and durations and, during interviews, 28% of pharmacies and 27% of health facilities prescribed recommended antibiotics at recommended dosages and durations. Most regimens were quinolone-based. HIV testing was recommended during 10% of simulated visits, 20% of pharmacy interviews and 25% of health facility interviews. In an area of high STI burden, most men with urethritis seek care at pharmacies and private clinics. Most providers do not comply with national guidelines and very few recommend HIV testing. In order to reduce the STI burden and mitigate HIV transmission, there is an urgent need for innovative dissemination of up-to-date guidelines and inclusion of all health providers in HIV/STI programmes.

  4. Private prisons

    Directory of Open Access Journals (Sweden)

    Dimovski Darko

    2014-01-01

    Full Text Available The author, based on the circumstances that contributed to the creation of private prisons, has explained the historical development of private prisons in the United States and Great Britain. After that, the author has analyzed the strengths and weaknesses of the prison run by private companies. Namely, the author has, stating the benefits of private prisons (reduced overcrowding penitencijarnih institution, cheaper accommodation cost per prisoner, provide better services, the possibility of applying a new philosophy in the manner of execution of sentence, with modern Penitentiary program, with the aim of re-socialization and the reduction of recidivism and weaknesses of the private prisons (the question of legitimac, a chronic lack of space in the Penitentiary system is not solved, business-oriented policies of private prisons, less salaries, poor performance of the security service, worst food, weak enforcement of parole, lack of appropriate penitentiary program, wanted to draw attention to the professional public about controversy of the introduction private companies in the management structure of penitentiary institutions . As the Republic of Serbia is, constantly in the last twenty years, faced with the increasing number of inmates, as well as the chronic shortage of money, which affects on the situation in industrial areas of prisons, there are options to give licenses to private companies to manage prisons. Therefore, the author has paid special attention to potential problems of introducing private prisons in the penitentiary system in Serbia.

  5. Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study.

    Science.gov (United States)

    Carbajal, Ricardo; Eriksson, Mats; Courtois, Emilie; Boyle, Elaine; Avila-Alvarez, Alejandro; Andersen, Randi Dovland; Sarafidis, Kosmas; Polkki, Tarja; Matos, Cristina; Lago, Paola; Papadouri, Thalia; Montalto, Simon Attard; Ilmoja, Mari-Liis; Simons, Sinno; Tameliene, Rasa; van Overmeire, Bart; Berger, Angelika; Dobrzanska, Anna; Schroth, Michael; Bergqvist, Lena; Lagercrantz, Hugo; Anand, Kanwaljeet J S

    2015-10-01

    Neonates who are in pain or are stressed during care in the intensive care unit (ICU) are often given sedation or analgesia. We investigated the current use of sedation or analgesia in neonatal ICUs (NICUs) in European countries. EUROPAIN (EUROpean Pain Audit In Neonates) was a prospective cohort study of the management of sedation and analgesia in patients in NICUs. All neonates admitted to NICUs during 1 month were included in this study. Data on demographics, methods of respiration, use of continuous or intermittent sedation, analgesia, or neuromuscular blockers, pain assessments, and drug withdrawal syndromes were gathered during the first 28 days of admission to NICUs. Multivariable linear regression models and propensity scores were used to assess the association between duration of tracheal ventilation (TV) and exposure to opioids, sedatives-hypnotics, or general anaesthetics in neonates (O-SH-GA). This study is registered with ClinicalTrials.gov, number NCT01694745. From Oct 1, 2012, to June 30, 2013, 6680 neonates were enrolled in 243 NICUs in 18 European countries. Mean gestational age of these neonates was 35.0 weeks (SD 4.6) and birthweight was 2384 g (1007). 2142 (32%) neonates were given TV, 1496 (22%) non-invasive ventilation (NIV), and 3042 (46%) were kept on spontaneous ventilation (SV). 1746 (82%), 266 (18%), and 282 (9%) neonates in the TV, NIV, and SV groups, respectively, were given sedation or analgesia as a continuous infusion, intermittent doses, or both (panalgesia was 89.3% (70.0-100) for neonates in the TV group. Opioids were given to 1764 (26%) of 6680 neonates and to 1589 (74%) of 2142 neonates in the TV group. Midazolam was given to 576 (9%) of 6680 neonates and 536 (25%) neonates of 2142 neonates in the TV group. 542 (25%) neonates in the TV group were given neuromuscular blockers, which were administered as continuous infusions to 146 (7%) of these neonates. Pain assessments were recorded in 1250 (58%) of 2138, 672 (45%) of 1493, and

  6. Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis.

    Science.gov (United States)

    Adams, N; Tudehope, D; Gibbons, K S; Flenady, V

    2018-01-01

    To examine whether disparities in stillbirth, and neonatal and perinatal mortality rates, between public and private hospitals are the result of differences in population characteristics and/or clinical practices. Retrospective cohort study. A metropolitan tertiary centre encompassing public and private hospitals. Women accessed care from either a private obstetrician or from public models of care - predominantly midwife-led care or care shared between midwives, general practitioners, and obstetricians. A total of 131 436 births during 1998-2013: 69 037 public and 62 399 private. Propensity score matching was used to select equal-sized public and private cohorts with similar characteristics. Logistic regression analysis was then used to explore the impact of public-private differences in the use of assisted reproductive technologies, plurality, major congenital anomalies, birth method, and gestational age. Stillbirth, and neonatal and perinatal mortality rates. After controlling for maternal and pregnancy factors, perinatal mortality rates were higher in the public than in the private cohort (adjusted odds ratio, aOR 1.53; 95% confidence interval, 95% CI 1.29-1.80; stillbirth aOR 1.56, 95% CI 1.26-1.94; neonatal death aOR 1.48, 95% CI 1.15-1.89). These disparities reduced by 15.7, 20.5, and 19.6%, respectively, after adjusting for major congenital anomalies, birth method, and gestational age. Perinatal mortality occurred more often among public than private births, and this disparity was not explained by population differences. Differences in clinical practices seem to be partly responsible. The impact of differences in clinical practices on maternal and neonatal morbidity was not examined. Further research is required. Private obstetrician-led care: more obstetric intervention and earlier births reduce perinatal mortality. Background Babies born in Australian public hospitals tend to die more often than those born in private hospitals. Our aim was to determine

  7. Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France-The EPIPAGE-2 Cohort Study.

    Science.gov (United States)

    Pierrat, Veronique; Coquelin, Anaëlle; Cuttini, Marina; Khoshnood, Babak; Glorieux, Isabelle; Claris, Olivier; Durox, Mélanie; Kaminski, Monique; Ancel, Pierre-Yves; Arnaud, Catherine

    2016-10-01

    To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. Prospective national cohort study of all births before 32 weeks of gestation. Twenty-five French regions. All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). None. Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8-7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies.

  8. Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000-2008): a linked data population-based cohort study.

    Science.gov (United States)

    Dahlen, Hannah G; Tracy, Sally; Tracy, Mark; Bisits, Andrew; Brown, Chris; Thornton, Charlene

    2014-05-21

    To examine the rates of obstetric intervention and associated perinatal mortality and morbidity in the first 28 days among low-risk women giving birth in private and public hospitals in NSW (2000-2008). Linked data population-based retrospective cohort study involving five data sets. New South Wales, Australia. 691 738 women giving birth to a singleton baby during the period 2000-2008. Rates of neonatal resuscitation, perinatal mortality, neonatal admission following birth and readmission to hospital in the first 28 days of life in public and private obstetric units. Rates of obstetric intervention among low-risk women were higher in private hospitals, with primiparous women 20% less likely to have a normal vaginal birth compared to the public sector. Neonates born in private hospitals were more likely to be less than 40 weeks; more likely to have some form of resuscitation; less likely to have an Apgar birth admission and to be readmitted to hospital in the first 28 days for birth trauma (5% vs 3.6%); hypoxia (1.7% vs 1.2%); jaundice (4.8% vs 3%); feeding difficulties (4% vs 2.4%) ; sleep/behavioural issues (0.2% vs 0.1%); respiratory conditions (1.2% vs 0.8%) and circumcision (5.6 vs 0.3%) but they were less likely to be admitted for prophylactic antibiotics (0.2% vs 0.6%) and for socioeconomic circumstances (0.1% vs 0.7%). Rates of perinatal mortality were not statistically different between the two groups. For low-risk women, care in a private hospital, which includes higher rates of intervention, appears to be associated with higher rates of morbidity seen in the neonate and no evidence of a reduction in perinatal mortality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Improved Childhood Diarrhea Treatment Practices in Ghana: A Pre-Post Evaluation of a Comprehensive Private-Sector Program

    Science.gov (United States)

    El-Khoury, Marianne; Banke, Kathryn; Sloane, Phoebe

    2016-01-01

    ABSTRACT Diarrhea is the fourth leading cause of child mortality in Ghana. In 2010, Ghana endorsed guidelines from the World Health Organization and the United Nations Children’s Fund for use of zinc with low-osmolarity oral rehydration salts (ORS) for the treatment of acute childhood diarrhea. From late 2011 through 2014, the Strengthening Health Outcomes through the Private Sector (SHOPS) project implemented a comprehensive program in 3 regions of Ghana to increase the availability and use of ORS and zinc and to decrease incorrect use of antibiotics and antidiarrheals. The program included (1) partnering with local pharmaceutical firms to introduce and market locally produced zinc products, (2) collaborating with the Ghanaian Pharmacy Council to provide training and supportive supervision of private-sector providers on diarrhea management, and (3) conducting mass media campaigns to raise caregiver awareness. We evaluated the effect of this program using a baseline survey of 754 caregivers of children under 5 with diarrhea at the start of the intervention in 2012 and a follow-up survey of 751 caregivers in 2014. Regression analysis showed that use of ORS with zinc increased from 0.8% in 2012 to 29.2% in 2014 (Pzinc. Additional efforts are required to reduce persistent incorrect antibiotic use. PMID:27353619

  10. Private Roads

    NARCIS (Netherlands)

    Verhoef, Erik T.

    2007-01-01

    This paper studies the efficiency impacts of private toll roads in initially untolled networks. The analysis allows for capacity and toll choice by private operators, and endogenizes entry and therewith the degree of competition, distinguishing and allowing for both parallel and serial competition.

  11. Improved Childhood Diarrhea Treatment Practices in Ghana: A Pre-Post Evaluation of a Comprehensive Private-Sector Program.

    Science.gov (United States)

    El-Khoury, Marianne; Banke, Kathryn; Sloane, Phoebe

    2016-06-20

    Diarrhea is the fourth leading cause of child mortality in Ghana. In 2010, Ghana endorsed guidelines from the World Health Organization and the United Nations Children's Fund for use of zinc with low-osmolarity oral rehydration salts (ORS) for the treatment of acute childhood diarrhea. From late 2011 through 2014, the Strengthening Health Outcomes through the Private Sector (SHOPS) project implemented a comprehensive program in 3 regions of Ghana to increase the availability and use of ORS and zinc and to decrease incorrect use of antibiotics and antidiarrheals. The program included (1) partnering with local pharmaceutical firms to introduce and market locally produced zinc products, (2) collaborating with the Ghanaian Pharmacy Council to provide training and supportive supervision of private-sector providers on diarrhea management, and (3) conducting mass media campaigns to raise caregiver awareness. We evaluated the effect of this program using a baseline survey of 754 caregivers of children under 5 with diarrhea at the start of the intervention in 2012 and a follow-up survey of 751 caregivers in 2014. Regression analysis showed that use of ORS with zinc increased from 0.8% in 2012 to 29.2% in 2014 (P<.001), and antibiotic use declined from 66.2% to 38.2% (P<.001) during the same period. The magnitude and statistical significance of these results remained the same after including potential confounding factors as covariates. Inappropriate antibiotic use, however, remained high at follow-up. We conclude that similar programs applied in other settings have the potential to rapidly scale up use of ORS and zinc. Additional efforts are required to reduce persistent incorrect antibiotic use. © El-Khoury et al.

  12. Allergen-specific immunotherapy prescription patterns in veterinary practice: a US population-based cohort study.

    Science.gov (United States)

    Tater, Kathy Chu; Cole, William Elliott; Pion, Paul David

    2017-08-01

    Poor adherence to continuing allergen-specific immunotherapy treatment (ASIT) may be an issue in veterinary medicine. No studies describe how allergen tests are used in general veterinary practice, including the percentage of patients that receive ASIT after allergen testing. Assess veterinary ASIT patterns in United States general practices. Dogs (n = 2,557) and 121 cats allergen-tested at 177 hospitals (173 general practice and four specialty practices) in 44 states. Invoiced service descriptions of allergen tests and ASIT orders were retrieved from an aggregated database of veterinary practices. In general practice, 42% (992 of 2,360) of patients did not begin ASIT after allergen testing. ASIT was not refilled for 29% (398 of 1,368) of patients after the initial order. ASIT was initiated and refilled more often in dogs (56.6%, 71.4%, respectively) than cats (38%, 67.4%). Specialty practice patients had the highest ASIT initiation (94.4%) and refill (92.7%) percentages in comparison to general practices (P < 0.001). Size, age, geographical region and type of practice were associated with whether dogs were started on ASIT. Geographical region was also associated with refilling a prescription for ASIT, which was considered to be evidence of adherence to continuing treatment. Almost one third of clients failed to continue ASIT beyond the initial order, which is a much shorter duration of therapy than the 12 months recommended for determining ASIT efficacy. A large number of general practice patients did not begin ASIT after allergen testing, likely due to differences in how clinicians in general and dermatology practices use allergen tests. © 2017 ESVD and ACVD.

  13. Current management and prognostic factors in physiotherapy practice for patients with shoulder pain: design of a prospective cohort study.

    Science.gov (United States)

    Karel, Yasmaine H J M; Scholten-Peeters, Wendy G M; Thoomes-de Graaf, Marloes; Duijn, Edwin; Ottenheijm, Ramon P G; van den Borne, Maaike P J; Koes, Bart W; Verhagen, Arianne P; Dinant, Geert-Jan; Tetteroo, Eric; Beumer, Annechien; van Broekhoven, Joost B; Heijmans, Marcel

    2013-02-11

    Shoulder pain is disabling and has a considerable socio-economic impact. Over 50% of patients presenting in primary care still have symptoms after 6 months; moreover, prognostic factors such as pain intensity, age, disability level and duration of complaints are associated with poor outcome. Most shoulder complaints in this group are categorized as non-specific. Musculoskeletal ultrasound might be a useful imaging method to detect subgroups of patients with subacromial disorders.This article describes the design of a prospective cohort study evaluating the influence of known prognostic and possible prognostic factors, such as findings from musculoskeletal ultrasound outcome and working alliance, on the recovery of shoulder pain. Also, to assess the usual physiotherapy care for shoulder pain and examine the inter-rater reliability of musculoskeletal ultrasound between radiologists and physiotherapists for patients with shoulder pain. A prospective cohort study including an inter-rater reliability study. Patients presenting in primary care physiotherapy practice with shoulder pain are enrolled. At baseline validated questionnaires are used to measure patient characteristics, disease-specific characteristics and social factors. Physical examination is performed according to the expertise of the physiotherapists. Follow-up measurements will be performed 6, 12 and 26 weeks after inclusion. Primary outcome measure is perceived recovery, measured on a 7-point Likert scale. Logistic regression analysis will be used to evaluate the association between prognostic factors and recovery. The ShoCoDiP (Shoulder Complaints and using Diagnostic ultrasound in Physiotherapy practice) cohort study will provide information on current management of patients with shoulder pain in primary care, provide data to develop a prediction model for shoulder pain in primary care and to evaluate whether musculoskeletal ultrasound can improve prognosis.

  14. Factors in Sustainable Development: Current and Innovative Livestock and Range Management Practices as Perceived by Cattle-Producing Ejidatarios and Private Cattle Ranchers of Sonora, Mexico. A Summary Report of Research. Department Information Bulletin 99-4.

    Science.gov (United States)

    Hamlett, Peggy J.

    A study was conducted to identify and compare livestock production and range management practices currently in use in the Texas/Mexico border corridor, and to determine the acceptance of selected innovative practices among cattle ranchers in the State of Sonora, Mexico. Information was collected from private livestock producers who were members of…

  15. Good practices in health care "management experimentation models": insights from an international public-private partnership on transplantation and advanced specialized therapies.

    Science.gov (United States)

    Longo, Maria Cristina

    2015-01-01

    The research analyzes good practices in health care "management experimentation models," which fall within the broader range of the integrative public-private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the "management experimentation models" are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations. In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC - Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies. The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable. The recognition of ISMETT's good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.

  16. Breastfeeding, Bottle Feeding Practices and Malocclusion in the Primary Dentition: A Systematic Review of Cohort Studies

    Directory of Open Access Journals (Sweden)

    Ana Paula Hermont

    2015-03-01

    Full Text Available The World Health Organization recommends exclusive breast feeding for at least six months. However, there is no scientific evidence of the benefits of breast feeding for oral health in children under primary dentition. This study aimed to search for scientific evidence regarding the following question: is bottle feeding associated with malocclusion in the primary dentition compared to children that are breastfed? An electronic search was performed in seven databases. The systematic review included 10 cohort studies. It was not possible to conduct meta-analysis; therefore a qualitative analysis was assessed. The majority of studies evaluated feeding habits by means of questionnaires and conducted a single examination. Three studies observed that bottle feeding was significantly associated with overjet and posterior crossbite. Studies reported several cut-off times for breastfeeding (varying from 1 month up to 3 years of age and several types of malocclusion. Controlling for non-nutritive sucking habits was reported for only half of the studies and this may have led to biased results. The scientific evidence could not confirm a specific type of malocclusion associated with the feeding habits or an adequate time of breastfeeding to benefit the children against malocclusion. Further cohort studies are needed to confirm this evidence.

  17. Quality Control Practices for Chemistry and Immunochemistry in a Cohort of 21 Large Academic Medical Centers.

    Science.gov (United States)

    Rosenbaum, Matthew W; Flood, James G; Melanson, Stacy E F; Baumann, Nikola A; Marzinke, Mark A; Rai, Alex J; Hayden, Joshua; Wu, Alan H B; Ladror, Megan; Lifshitz, Mark S; Scott, Mitchell G; Peck-Palmer, Octavia M; Bowen, Raffick; Babic, Nikolina; Sobhani, Kimia; Giacherio, Donald; Bocsi, Gregary T; Herman, Daniel S; Wang, Ping; Toffaletti, John; Handel, Elizabeth; Kelly, Kathleen A; Albeiroti, Sami; Wang, Sihe; Zimmer, Melissa; Driver, Brandon; Yi, Xin; Wilburn, Clayton; Lewandrowski, Kent B

    2018-05-29

    In the United States, minimum standards for quality control (QC) are specified in federal law under the Clinical Laboratory Improvement Amendment and its revisions. Beyond meeting this required standard, laboratories have flexibility to determine their overall QC program. We surveyed chemistry and immunochemistry QC procedures at 21 clinical laboratories within leading academic medical centers to assess if standardized QC practices exist for chemistry and immunochemistry testing. We observed significant variation and unexpected similarities in practice across laboratories, including QC frequency, cutoffs, number of levels analyzed, and other features. This variation in practice indicates an opportunity exists to establish an evidence-based approach to QC that can be generalized across institutions.

  18. Publication and non-publication of drug trial results: a 10-year cohort of trials in Norwegian general practice.

    Science.gov (United States)

    Brænd, Anja Maria; Straand, Jørund; Jakobsen, Rune Bruhn; Klovning, Atle

    2016-04-11

    Previously, we identified a 10-year cohort of protocols from applications to the Norwegian Medicines Agency 1998-2007, consisting of 196 drug trials in general practice. The aim of this study was to examine whether trial results were published and whether trial funding and conflicts of interest were reported. Cohort study of trials with systematic searches for published results. Clinical drug trials in Norwegian general practice. We performed systematic literature searches of MEDLINE, Embase and CENTRAL to identify publications originating from each trial using characteristics such as test drug, comparator and patient groups as search terms. When no publication was identified, we contacted trial sponsors for information regarding trial completion and reference to any publications. We determined the frequency of publication of trial results and trial characteristics associated with publication of results. Of the 196 trials, 5 were never started. Of the remaining 191 trials, 71% had results published in a journal, 11% had results publicly available elsewhere and 18% of trials had no results available. Publication was more common among trials with an active comparator drug (χ(2) test, p=0.040), with a larger number of patients (total sample size≥median, p=0.010) and with a longer trial period (duration≥median, p=0.025). Trial funding was reported in 85% of publications and increased over time, as did reporting of conflicts of interest among authors. Among the 134 main journal articles from the trials, 60% presented statistically significant results for the investigational drug, and the conclusion of the article was favourable towards the test drug in 78% of papers. We did not identify any journal publication of results for 29% of the general practice drug trials. Trials with an active comparator, larger and longer trials were more likely to be published. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  19. Palliative sedation in Dutch general practice from 2005 to 2011: a dynamic cohort study of trends and reasons.

    Science.gov (United States)

    Donker, Gé A; Slotman, Frank G; Spreeuwenberg, Peter; Francke, Anneke L

    2013-10-01

    Little is known about the quantity and reasons for use of palliative sedation in general practice. To gain more insight into the trends of and reasons for palliative sedation in Dutch general practice. Dynamic cohort study using registrations and questionnaire data of Dutch GPs. Method Data collected in the years from 2005 until 2011 in the Dutch Sentinel General Practice Network were analysed. Trends and reasons for use of palliative sedation were analysed using multilevel analyses to control for clustering of observations within general practices. From 2005-2011, 183 cases were reported from 56 general practices. The incidence of palliative sedation fluctuated between 33.7 per 100 000 patients in 2006 and 15.2 in 2011. No rise or decline during the period was observed. Palliative sedation was applied in 5.7% of all deaths and most frequently used in younger patients with cancer. The mean number of refractory symptoms was 2.6 (SD 1.2); pain (69.4%), dyspnoea (53.0%), and fear (39.3%). Patient involvement in decision making before the start of palliative sedation (87.4%) was less frequently present in patients suffering from cardiovascular or chronic obstructive pulmonary disease and in older patients compared to patients with cancer (Ppalliative sedation in these cases was clearly motivated. Palliative sedation is performed in a small proportion of dying patients in Dutch general practice, without a rise or decline observed from 2005 to 2011. Patients with non-cancer diseases are less frequently involved in decision making than patients with cancer, possibly related to sudden deterioration.

  20. Translating Neurodevelopmental Care Policies Into Practice: The Experience of Neonatal ICUs in France—The EPIPAGE-2 Cohort Study

    Science.gov (United States)

    Coquelin, Anaëlle; Cuttini, Marina; Khoshnood, Babak; Glorieux, Isabelle; Claris, Olivier; Durox, Mélanie; Kaminski, Monique; Ancel, Pierre-Yves; Arnaud, Catherine

    2016-01-01

    Objectives: To describe the implementation of neurodevelopmental care for newborn preterm infants in neonatal ICUs in France in 2011, analyze changes since 2004, and investigate factors associated with practice. Design: Prospective national cohort study of all births before 32 weeks of gestation. Setting: Twenty-five French regions. Participants: All neonatal ICUs (n = 66); neonates surviving at discharge (n = 3,005). Interventions: None. Measurements and Main Results: Neurodevelopmental care policies and practices were assessed by structured questionnaires. Proportions of neonates initiating kangaroo care during the first week of life and those whose mothers expressed breast milk were measured as neurodevelopmental care practices. Multilevel logistic regression analyses were used to investigate relationships between kangaroo care or breast-feeding practices and unit policies, taking into account potential confounders. Free visiting policies, bed availability for parents, and kangaroo care encouragement significantly improved between 2004 and 2011 but with large variabilities between units. Kangaroo care initiation varied from 39% for neonates in the most restrictive units to 68% in less restrictive ones (p neurodevelopmental care significantly influenced kangaroo care initiation (odds ratio, 3.5; 95% CI, 1.8–7.0 for Newborn Individualized Developmental Care and Assessment Program implementation compared with no training). Breast milk expression by mothers was greater in units with full-time availability professionals trained for breast-feeding support (60% vs 73%; p neurodevelopmental practices occurred between 2004 and 2011, but large variabilities between units persist. Practices increased in units with supportive policies. Specific neurodevelopmental care training with multifaceted interventions strengthened the implementation of policies. PMID:27518584

  1. Impact of the Jamaican birth cohort study on maternal, child and adolescent health policy and practice.

    Science.gov (United States)

    McCaw-Binns, A; Ashley, D; Samms-Vaughan, M

    2010-01-01

    The Jamaica Perinatal Morbidity and Mortality Survey (JPMMS) was a national study designed to identify modifiable risk factors associated with poor maternal and perinatal outcome. Needing to better understand factors that promote or retard child development, behaviour and academic achievement, we conducted follow-up studies of the birth cohort. The paper describes the policy developments from the JPMMS and two follow-up rounds. The initial study (1986-87) documented 94% of all births and their outcomes on the island over 2 months (n = 10 508), and perinatal (n = 2175) and maternal deaths (n = 62) for a further 10 months. A subset of the birth cohort, identified by their date of birth through school records, was seen at ages 11-12 (n = 1715) and 15-16 years (n = 1563). Findings from the initial survey led to, inter alia, clinic-based screening for syphilis, referral high-risk clinics run by visiting obstetricians, and the redesign and construction of new labour wards at referral hospitals. The follow-up studies documented inadequate academic achievement among boys and children attending public schools, and associations between under- and over-nutrition, excessive television viewing (>20 h/week), inadequate parental supervision and behavioural problems. These contributed to the development of a television programming code for children, a National Parenting Policy, policies aimed at improving inter-sectoral services to children from birth to 5 years (Early Childhood Commission) and behavioural interventions of the Violence Prevention Alliance (an inter-sectoral NGO) and the Healthy Lifestyles project (Ministry of Health). Indigenous maternal and child health research provided a local evidence base that informed public policy. Collaboration, good communication, being vigilant to opportunities to influence policy, and patience has contributed to our success.

  2. Melanocytic lesions in a private pathology practice. Comparison of histologic features in different tumor types with particular reference to dysplastic nevi.

    Science.gov (United States)

    Hastrup, N; Hou-Jensen, K

    1993-11-01

    This study reviews a total of 1000 melanocytic lesions--two separate 500 consecutive sample groupings from 1980 and 1989, respectively--diagnosed in a private non-hospital-associated pathology practice. Lesions were classified as lentigo simplex, congenital nevus, "common" nevus, dysplastic nevus, blue nevus, Spitz's nevus or malignant melanoma. A comparison of the two periods reveals an increase in dysplastic nevi from one in 1980 to nine in 1989. The histologic changes in these nevi were compared to those of the other tumors. Pronounced cytologic atypia was seen in the melanocytes of a few "common" nevi, but more often in the dysplastic nevi and in all of the melanomas. Slight nuclear atypia was usual in "common" nevi and lentigines, and also fibroplasia, lymphocytic infiltration, vessel proliferation and pigment incontinence were seen in both "common" nevi and dysplastic nevi. It is concluded that no single histologic variable was specific for dysplastic nevi.

  3. [The QuIK-Registry of the German Society of Cardiologists in private practice: countrywide and benchmarking quality assurance in invasive cardiology].

    Science.gov (United States)

    Albrecht, A; Levenson, B; Göhring, S; Haerer, W; Reifart, N; Ringwald, G; Troger, B

    2009-10-01

    QuIK is the German acronym for QUality Assurance in Invasive Cardiology. It describes the continuous project of an electronic data collection in Cardiac catheterization laboratories all over Germany. Mainly members of the German Society of Cardiologists in Private Practice (BNK) participate in this computer based project. Since 1996 data of diagnostic and interventional procedures are collected and send to a registry-center where a regular benchmarking analysis of the results is performed. Part of the project is a yearly auditing process including an on-site visit to the cath lab to guarantee for the reliability of information collected. Since 1996 about one million procedures have been documented. Georg Thieme Verlag KG Stuttgart , New York.

  4. Best Practices for Repositioning, towards Global Competitiveness in Academic Libraries of Privately-Owned Universities (ALPUS) in Nigeria

    Science.gov (United States)

    Eghe-Ohenmwen, Aghama

    2015-01-01

    Information is a bedrock of any developing society and that is the core purpose of university libraries. This enables staff and student to learn and teach students not just in theory but in practice. However, without well-established libraries the above role may not be implemented. Therefore, there is need for globally competitive libraries in…

  5. Beyond the hospital door: a retrospective, cohort study of associations between birthing in the public or private sector and women's postpartum care.

    Science.gov (United States)

    Brodribb, Wendy; Zadoroznyj, Maria; Nesic, Michelle; Kruske, Sue; Miller, Yvette D

    2015-01-22

    In Australia, maternity care is available through universal coverage and a parallel, competitive private health insurance system. Differences between sectors in antenatal and intrapartum care and associated outcomes are well documented but few studies have investigated differences in postpartum care following hospital discharge and their impact on maternal satisfaction and confidence. Women who birthed in Queensland, Australia from February to May 2010 were mailed a self-report survey 4 months postpartum. Regression analysis was used to determine associations between sector of birth and postpartum care, and whether postpartum care experiences explained sector differences in postpartum well-being (satisfaction, parenting confidence and feeling depressed). Women who birthed in the public sector had higher odds of health professional contact in the first 10 days post-discharge and satisfaction with the amount of postpartum care. After adjusting for demographic and postpartum contact variables, sector of birth no longer had an impact on satisfaction (AOR 0.95, 99% CI 0.78-1.31), but any form of health professional contact did. Women who had a care provider's 24 hour contact details had higher odds of being satisfied (AOR 3.64, 95% CI 3.00-4.42) and confident (AOR 1.34, 95% CI 1.08- 1.65). Women who birthed in the public sector appeared more satisfied because they had higher odds of receiving contact from a health professional within 10 days post-discharge. All women should have an opportunity to speak to and/or see a doctor, midwife or nurse in the first 10 days at home, and the details of a person they can contact 24 hours a day.

  6. Impact of influenza vaccination on respiratory illness rates in children attending private boarding schools in England, 2013-2014: a cohort study.

    Science.gov (United States)

    Brousseau, N; Green, H K; Andrews, N; Pryse, R; Baguelin, M; Sunderland, A; Ellis, J; Pebody, R

    2015-12-01

    Several private boarding schools in England have established universal influenza vaccination programmes for their pupils. We evaluated the impact of these programmes on the burden of respiratory illnesses in boarders. Between November 2013 and May 2014, age-specific respiratory disease incidence rates in boarders were compared between schools offering and not offering influenza vaccine to healthy boarders. We adjusted for age, sex, school size and week using negative binomial regression. Forty-three schools comprising 14 776 boarders participated. Almost all boarders (99%) were aged 11-17 years. Nineteen (44%) schools vaccinated healthy boarders against influenza, with a mean uptake of 48·5% (range 14·2-88·5%). Over the study period, 1468 respiratory illnesses were reported in boarders (5·66/1000 boarder-weeks); of these, 33 were influenza-like illnesses (ILIs, 0·26/1000 boarder-weeks) in vaccinating schools and 95 were ILIs (0·74/1000 boarder-weeks) in non-vaccinating schools. The impact of vaccinating healthy boarders was a 54% reduction in ILI in all boarders [rate ratio (RR) 0·46, 95% confidence interval (CI) 0·28-0·76]. Disease rates were also reduced for upper respiratory tract infections (RR 0·72, 95% CI 0·61-0·85) and chest infections (RR 0·18, 95% CI 0·09-0·36). These findings demonstrate a significant impact of influenza vaccination on ILI and other clinical endpoints in secondary-school boarders. Additional research is needed to investigate the impact of influenza vaccination in non-boarding secondary-school settings.

  7. What are the career planning and development practices for nurses in hospitals? Is there a difference between private and public hospitals?

    Science.gov (United States)

    Sonmez, Betul; Yildirim, Aytolan

    2009-12-01

    The aim was to determine the opinions of nurse managers about career planning and development for nurses in hospitals. Career planning and development are defined as an important and necessary tool in the development of nurses as professionals and in retaining nurses in a facility. A descriptive survey. The research population comprised nurse managers in 200+ bed hospitals on the European side of Istanbul province (n = 668). The entire population was targeted and 373 nurse managers were included in the study (55.8% return rate). Data were collected with a 32-item survey form that had three sections to determine the nurse managers' demographic characteristics, the career development practices at the facility where they worked, the nurse managers' responsibilities for career development and their expected competencies and recommendations. The findings of this study suggest that the most common technique used for nurses for career development was education programs, the career development practices of private hospitals were more developed than public hospitals and the nurse managers' perceptions about career development were different according to their management level, age group and educational level (p career development practices identified and the nurse managers did not have agreement on the subject of career development. Hospitals which provide opportunity for horizontal and vertical promotion and have clear development policies will be successful hospitals which are preferred by high quality nurses. This study draws attention to the importance of career planning in nursing and the need for nurse managers to take an active role in career planning and development.

  8. Management of children's urinary tract infections in Dutch family practice: a cohort study.

    NARCIS (Netherlands)

    Harmsen, M.; Wensing, M.J.P.; Braspenning, J.C.C.; Wolters, R.J.; Wouden, J.C. van der; Grol, R.P.T.M.

    2007-01-01

    BACKGROUND: Optimal clinical management of childhood urinary tract infections (UTI) potentiates long-term positive health effects. Insight into the quality of care in Dutch family practices for UTIs was limited, particularly regarding observation periods of more than a year. Our aim was to describe

  9. Management of children's urinary tract infections in Dutch family practice: A cohort study

    NARCIS (Netherlands)

    M. Harmsen (Mirjam); M.E. Wensing (Michel); J.C.C. Braspenning (Jozé); R.J. Wolters (René); J.C. van der Wouden (Hans); R.P.T.M. Grol (Richard)

    2007-01-01

    textabstractBackground. Optimal clinical management of childhood urinary tract infections (UTI) potentiates long-term positive health effects. Insight into the quality of care in Dutch family practices for UTIs was limited, particularly regarding observation periods of more than a year. Our aim was

  10. Meeting the Challenge of Preparing Social Workers for Integrated Health Practice: Evidence from Two MSW Cohorts

    Science.gov (United States)

    Rishel, Carrie W.; Hartnett, Helen P.

    2017-01-01

    Changes in health care policy have led to an expansion of integrated care models that rely on collaboration among interprofessional health teams. Recent federal funding has encouraged the development of innovative training models to prepare social workers for integrated health practice. This article presents evidence from the first two MSW cohorts…

  11. Translation of clinical prediction rules for febrile children to primary care practice : an observational cohort study

    NARCIS (Netherlands)

    van Ierland, Yvette; Elshout, Gijs; Berger, Marjolein Y.; Vergouwe, Yvonne; de Wilde, Marcel; van der Lei, Johan; Mol, Henritte A.; Oostenbrink, Rianne

    Background Clinical prediction rules (CPRs) to identify children with serious infections lack validation in low-prevalence populations, which hampers their implementation in primary care practice. Aim To evaluate the diagnostic value of published CPRs for febrile children in primary care. Design and

  12. The Changing Financial Landscape of Renal Transplant Practice: A National Cohort Analysis.

    Science.gov (United States)

    Axelrod, D A; Schnitzler, M A; Xiao, H; Naik, A S; Segev, D L; Dharnidharka, V R; Brennan, D C; Lentine, K L

    2017-02-01

    Kidney transplantation has become more resource intensive as recipient complexity has increased and average donor quality has diminished over time. A national retrospective cohort study was performed to assess the impact of kidney donor and recipient characteristics on transplant center cost (exclusive of organ acquisition) and Medicare reimbursement. Data from the national transplant registry, University HealthSystem Consortium hospital costs, and Medicare payments for deceased donor (N = 53 862) and living donor (N = 36 715) transplants from 2002 to 2013 were linked and analyzed using multivariate linear regression modeling. Deceased donor kidney transplant costs were correlated with recipient (Expected Post Transplant Survival Score, degree of allosensitization, obesity, cause of renal failure), donor (age, cause of death, donation after cardiac death, terminal creatinine), and transplant (histocompatibility matching) characteristics. Living donor costs rose sharply with higher degrees of allosensitization, and were also associated with obesity, cause of renal failure, recipient work status, and 0-ABDR mismatching. Analysis of Medicare payments for a subsample of 24 809 transplants demonstrated minimal correlation with patient and donor characteristics. In conclusion, the complexity in the landscape of kidney transplantation increases center costs, posing financial disincentives that may reduce organ utilization and limit access for higher-risk populations. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  13. Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study.

    Science.gov (United States)

    Chenot, Jean-François; Becker, Annette; Leonhardt, Corinna; Keller, Stefan; Donner-Banzhoff, Norbert; Baum, Erika; Pfingsten, Michael; Hildebrandt, Jan; Basler, Heinz-Dieter; Kochen, Michael M

    2007-12-18

    Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain. This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months A total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM. The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.

  14. The effect of sibutramine prescribing in routine clinical practice on cardiovascular outcomes: a cohort study in the United Kingdom.

    Science.gov (United States)

    Hayes, J F; Bhaskaran, K; Batterham, R; Smeeth, L; Douglas, I

    2015-09-01

    The marketing authorization for the weight loss drug sibutramine was suspended in 2010 following a major trial that showed increased rates of non-fatal myocardial infarction and cerebrovascular events in patients with pre-existing cardiovascular disease. In routine clinical practice, sibutramine was already contraindicated in patients with cardiovascular disease and so the relevance of these influential clinical trial findings to the 'real World' population of patients receiving or eligible for the drug is questionable. We assessed rates of myocardial infarction and cerebrovascular events in a cohort of patients prescribed sibutramine or orlistat in the United Kingdom. A cohort of patients prescribed weight loss medication was identified within the Clinical Practice Research Datalink. Rates of myocardial infarction or cerebrovascular event, and all-cause mortality were compared between patients prescribed sibutramine and similar patients prescribed orlistat, using both a multivariable Cox proportional hazard model, and propensity score-adjusted model. Possible effect modification by pre-existing cardiovascular disease and cardiovascular risk factors was assessed. Patients prescribed sibutramine (N=23,927) appeared to have an elevated rate of myocardial infarction or cerebrovascular events compared with those taking orlistat (N=77,047; hazard ratio 1.69, 95% confidence interval 1.12-2.56). However, subgroup analysis showed the elevated rate was larger in those with pre-existing cardiovascular disease (hazard ratio 4.37, 95% confidence interval 2.21-8.64), compared with those with no cardiovascular disease (hazard ratio 1.52, 95% confidence interval 0.92-2.48, P-interaction=0.0076). All-cause mortality was not increased in those prescribed sibutramine (hazard ratio 0.67, 95% confidence interval 0.34-1.32). Sibutramine was associated with increased rates of acute cardiovascular events in people with pre-existing cardiovascular disease, but there was a low absolute

  15. Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

    Science.gov (United States)

    Chenot, Jean-François; Becker, Annette; Leonhardt, Corinna; Keller, Stefan; Donner-Banzhoff, Norbert; Baum, Erika; Pfingsten, Michael; Hildebrandt, Jan; Basler, Heinz-Dieter; Kochen, Michael M

    2007-01-01

    Background Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM) therapies little is known on the extent patients are actually using CAM for back pain. Methods This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs) recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months Results A total of 691 (51%) respectively 928 (69%) out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM. Conclusion The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM. PMID:18088435

  16. Use of complementary alternative medicine for low back pain consulting in general practice: a cohort study

    Directory of Open Access Journals (Sweden)

    Baum Erika

    2007-12-01

    Full Text Available Abstract Background Although back pain is considered one of the most frequent reasons why patients seek complementary and alternative medical (CAM therapies little is known on the extent patients are actually using CAM for back pain. Methods This is a post hoc analysis of a longitudinal prospective cohort study embedded in a RCT. General practitioners (GPs recruited consecutively adult patients presenting with LBP. Data on physical function, on subjective mood, and on utilization of health services was collected at the first consultation and at follow-up telephone interviews for a period of twelve months Results A total of 691 (51% respectively 928 (69% out of 1,342 patients received one form of CAM depending on the definition. Local heat, massage, and spinal manipulation were the forms of CAM most commonly offered. Using CAM was associated with specialist care, chronic LBP and treatment in a rehabilitation facility. Receiving spinal manipulation, acupuncture or TENS was associated with consulting a GP providing these services. Apart from chronicity disease related factors like functional capacity or pain only showed weak or no association with receiving CAM. Conclusion The frequent use of CAM for LBP demonstrates that CAM is popular in patients and doctors alike. The observed association with a treatment in a rehabilitation facility or with specialist consultations rather reflects professional preferences of the physicians than a clear medical indication. The observed dependence on providers and provider related services, as well as a significant proportion receiving CAM that did not meet the so far established selection criteria suggests some arbitrary use of CAM.

  17. Interval between onset of psoriasis and psoriatic arthritis comparing the UK Clinical Practice Research Datalink with a hospital-based cohort.

    Science.gov (United States)

    Tillett, William; Charlton, Rachel; Nightingale, Alison; Snowball, Julia; Green, Amelia; Smith, Catherine; Shaddick, Gavin; McHugh, Neil

    2017-12-01

    To describe the time interval between the onset of psoriasis and PsA in the UK primary care setting and compare with a large, well-classified secondary care cohort. Patients with PsA and/or psoriasis were identified in the UK Clinical Practice Research Datalink (CPRD). The secondary care cohort comprised patients from the Bath PsA longitudinal observational cohort study. For incident PsA patients in the CPRD who also had a record of psoriasis, the time interval between PsA diagnosis and first psoriasis record was calculated. Comparisons were made with the time interval between diagnoses in the Bath cohort. There were 5272 eligible PsA patients in the CPRD and 815 in the Bath cohort. In both cohorts, the majority of patients (82.3 and 61.3%, respectively) had psoriasis before their PsA diagnosis or within the same calendar year (10.5 and 23.8%), with only a minority receiving their PsA diagnosis first (7.1 and 14.8%). Excluding those who presented with arthritis before psoriasis, the median time between diagnoses was 8 years [interquartile range (IQR) 2-15] in the CPRD and 7 years (IQR 0-20) in the Bath cohort. In the CPRD, 60.1 and 75.1% received their PsA diagnosis within 10 and 15 years of their psoriasis diagnosis, respectively; this was comparable with 57.2 and 67.7% in the Bath cohort. A similar distribution for the time interval between psoriasis and arthritis was observed in the CPRD and secondary care cohort. These data can inform screening strategies and support the validity of data from each cohort. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  18. An exploration of the basis for patient complaints about the oldness of magazines in practice waiting rooms: cohort study.

    Science.gov (United States)

    Arroll, Bruce; Alrutz, Stowe; Moyes, Simon

    2014-12-11

    To explore the basis for patient complaints about the oldness of most magazines in practice waiting rooms. Cohort study. Waiting room of a general practice in Auckland, New Zealand. 87 magazines stacked into three mixed piles and placed in the waiting room: this included non-gossipy magazines (Time magazine, the Economist, Australian Women's Weekly, National Geographic, BBC History) and gossipy ones (not identified for fear of litigation). Gossipy was defined as having five or more photographs of celebrities on the front cover and most gossipy as having up to 10 such images. The magazines were marked with a unique number on the back cover, placed in three piles in the waiting room, and monitored twice weekly. Disappearance of magazines less than 2 months old versus magazines 3-12 months old, the overall rate of loss of magazines, and the rate of loss of gossipy versus non-gossipy magazines. 47 of the 82 magazines with a visible date on the front cover were aged less than 2 months. 28 of these 47 (60%) magazines and 10 of the 35 (29%) older magazines disappeared (P=0.002). After 31 days, 41 of the 87 (47%, 95% confidence interval 37% to 58%) magazines had disappeared. None of the 19 non-gossipy magazines (the Economist and Time magazine) had disappeared compared with 26 of the 27 (96%) gossipy magazines (Pmagazines and none of the non-gossipy magazines [corrected] had disappeared by 31 days. The study was terminated at this point. General practice waiting rooms contain mainly old magazines. This phenomenon relates to the disappearance of the magazines rather than to the supply of old ones. Gossipy magazines were more likely to disappear than non-gossipy ones. On the grounds of cost we advise practices to supply old copies of non-gossipy magazines. A waiting room science curriculum is urgently needed. © Arroll et al 2014.

  19. Effectiveness of Training Program Related to Infection Control and Waste Management Practices in a Private Dental College, Pune − A Quasi-Experimental Study

    Directory of Open Access Journals (Sweden)

    Shruti Ladia

    2017-01-01

    Full Text Available Introduction: Healthcare workers, in general, are susceptible to contracting with infectious diseases. Thus, appropriate infection control practices are of prime importance in academic institutions, wherein under-graduate students form a major part of the oral healthcare team right from the 3rd year of the curriculum. This fact underlines the need to provide extensive training to prevent healthcare-related infections to the patient and themselves. Aim: To assess the effectiveness of training related to infection control and waste management practices among under-graduate students in a private dental institution. Materials and Methods: The present study conducted among 3rd year under-graduate dental students in Pune, 2015 assessed their knowledge, attitude, and practices related to infection control and waste management followed by an intervention in the form of training. A quasi-experimental design (before and after comparison was employed. Complete enumeration was performed. Results: Out of the 88 students, 46 (52.27% had good knowledge at baseline, which improved to 72 (81.81% after the training; 80 (90.90% had good attitude, which improved to 88 (100%; and 67 (76.13% had good practice, which improved to 88 (100%. At the baseline, the results showed that the mean knowledge score was 3.45 ± 1.03, the mean attitude score was 2.90 ± 0.28, and the mean practice score was 7.3 ± 0.76. After the training, the results showed that the mean knowledge score was 4.5 ± 0.25, the mean attitude score was 3, and the mean practice score was 8.1 ± 0.5. Conclusion: The training was effective in improving the over-all score of the participants related to the knowledge, attitude, and practice regarding infection control and waste management. Thus, we propose to train the students on various aspects of infection control and waste management and introduce an on-going training program in the curriculum.

  20. Privatization costs

    International Nuclear Information System (INIS)

    Jackson, I.

    2007-01-01

    The efforts in progress now in Great Britain to liberalize the nuclear decommissioning activity market imply that by 2012 the competitive commercial private companies will lead the national nuclear decommissioning and decontamination related activity market. Paper dwells upon the new market peculiar features and upon some peculiar features of the new market related activities [ru

  1. The feasibility of employing a home healthcare model for education and treatment of opioid overdose using a naloxone auto-injector in a private practice pain medicine clinic.

    Science.gov (United States)

    Dragovich, Anthony; Brason, Fred; Beltran, Thomas; McCoart, Amy; Plunkett, Anthony R

    2018-04-18

    The purpose of this study was to determine if employing a home healthcare model for education and treatment of opioid overdose using Evzio® (Naloxone)* auto-injector in a private practice pain clinic. A prospective survey was used to determine the feasibility of integrating a naloxone auto-injector within the patient's home with a home care training model. Twenty moderate or high-risk patients were enrolled from our chronic pain clinic. Patients who were moderate or high risk completed an evaluation survey. The naloxone auto-injector was dispensed to all patients meeting criteria. The treating provider after prescribing the naloxone auto-injector then consulted home health per standard clinical practice. All patients had home health consulted to perform overdose identification and rescue training. A Cochran's Q test was conducted to examine differences in patient knowledge pre and post training. The post training test was done 2-4 weeks later. Forty subjects enrolled after meeting inclusion/exclusion criteria. Twenty withdrew because their insurance declined coverage for the naloxone auto-injector. Those completing home health showed a statistically significant difference in their ability to correctly identify the steps needed to effectively respond to an overdose p = 0.03 Discussion: Preliminary evidence would suggest training on overdose symptom recognition and proper use of prescription naloxone for treatment in the home setting by home health staff would prove more beneficial than the clinic setting, but feasibility was hindered by unaffordable costs related to insurance coverage limitations.

  2. Demographic and practice factors predicting repeated non-attendance in primary care: a national retrospective cohort analysis

    Directory of Open Access Journals (Sweden)

    David A Ellis, PhD

    2017-12-01

    Full Text Available Summary: Background: Addressing the causes of low engagement in health care is a prerequisite for reducing health inequalities. People who miss multiple appointments are an under-researched group who might have substantial unmet health needs. Individual-level patterns of missed general practice appointments might thus provide a risk marker for vulnerability and poor health outcomes. We sought to ascertain the contributions of patient and practice factors to the likelihood of missing general practice appointments. Methods: For this national retrospective cohort analysis, we extracted UK National Health Service general practice data that were routinely collected across Scotland between Sept 5, 2013, and Sept 5, 2016. We calculated the per-patient number of missed appointments from individual appointments and investigated the risk of missing a general practice appointment using a negative binomial model offset by number of appointments made. We then analysed the effect of patient-level factors (including age, sex, and socioeconomic status and practice-level factors (including appointment availability and geographical location on the risk of missing appointments. Findings: The full dataset included information from 909 073 patients, of whom 550 083 were included in the analysis after processing. We observed that 104 461 (19·0% patients missed more than two appointments in the 3 year study period. After controlling for the number of appointments made, patterns of non-attendance could be differentiated, with patients who were aged 16–30 years (relative risk ratio [RRR] 1·21, 95% CI 1·19–1·23 or older than 90 years (2·20, 2·09–2·29, and of low socioeconomic status (Scottish Index of Multiple Deprivation decile 1: RRR 2·27, 2·22–2·31 significantly more likely to miss multiple appointments. Men missed fewer appointments overall than women, but were somewhat more likely to miss appointments

  3. Ventilation practices in subarachnoid hemorrhage: a cohort study exploring the use of lung protective ventilation.

    Science.gov (United States)

    Marhong, Jonathan D; Ferguson, Niall D; Singh, Jeffrey M

    2014-10-01

    Acute respiratory distress syndrome (ARDS) is common following aneurysmal subarachnoid hemorrhage (SAH), but the influence of mechanical ventilator settings on its development is unclear. We sought to determine adherence to lung protective thresholds in ventilated patients with SAH and describe the association between ventilator settings and subsequent development of ARDS. We conducted a retrospective cohort study of consecutive patients receiving mechanical ventilation within 72 h of SAH at a single academic center. Ventilator settings and blood gas data were collected twice daily for the first 7 days of ventilation along with ICU and hospital outcomes. Lung protective ventilation was defined as follows: tidal volume ≤8 mL/kg of predicted body weight, positive end-expiratory pressure (PEEP) ≥5 cm H(2)O, and peak or plateau pressure ≤30 cm H(2)O. The development of ARDS was ascertained retrospectively by PaO(2)/FiO(2) ≤300 with new bilateral lung opacities on chest X-ray within one day of hypoxemia. We identified 62 patients who underwent early mechanical ventilation following SAH. PS and Continuous Positive Airway Pressure were common ventilator modes with a median tidal volume of 7.8 mL/kg [interquartile range 6.8-8.8], median peak pressure of 14 cm H(2)O [IQR 12-17], and median PEEP of 5 cm H(2)O [IQR 5-6]. Adherence to tidal volumes ≤8 mL/kg was seen in 64 % of all observations and peak pressures protective criteria were seen in 58 % of all observations. Thirty-one patients (50 %) were determined to have ARDS. ARDS patients were more frequently ventilated with a peak pressure >30 cm H(2)O (11.3 % of ARDS ventilation days vs. 0 % of non-ARDS ventilation days; p mechanical ventilation frequently breathe spontaneously, generating tidal volumes above usual protective thresholds regardless of meeting ARDS criteria. In patients with SAH, the presence of an additional ARDS risk factor should prompt close screening for the development of ARDS and

  4. Changes in dietary habits and eating practices in adolescents living in urban South Africa: the birth to twenty cohort.

    Science.gov (United States)

    Feeley, Alison; Musenge, Eustasius; Pettifor, John M; Norris, Shane A

    2012-07-01

    To assess changes in the dietary habits and eating practices of a longitudinal cohort of adolescents over a 5-y period living in Soweto and Johannesburg. An interviewer-assisted questionnaire was used to gather data on the dietary habits and eating practices across three environments: in the home, in the school, and in the community. Participants (n = 1451, 49.1% male, 89% black, and 11% with mixed ancestry) 13, 15, and 17 y old with complete data were included in the analyses. The weekday breakfast consumption decreased over the 5-y period, from 76% to 65% (P breakfast during the weekend more regularly but this also decreased with age. Snacking while watching television increased with age, from 3.6 ± 4.6 to 6.7 ± 5.9 snacks/week, with female subjects consistently consuming more snacks than male subjects (P portion/week over the 5 y and confectionery consumption stayed the same, around 9 items/week in male subjects and 10 items/week in female subjects (P < 0.02). Lunch box usage decreased with age; conversely, the number of tuck shop purchases increased. Poor eating habits in all three environments were found; the participants' propensity for foods that were energy dense and micronutrient poor was high. This study also found that dietary patterns are well established by 13 y of age. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. Sun Protection and Skin Examination Practices in a Setting of High Ambient Solar Radiation: A Population-Based Cohort Study.

    Science.gov (United States)

    Olsen, Catherine M; Thompson, Bridie S; Green, Adèle C; Neale, Rachel E; Whiteman, David C

    2015-09-01

    Primary prevention and early detection are integral strategies to reduce the burden of skin cancer. To describe the prevalence of sun protection and skin examination practices in a population exposed to high levels of ambient solar radiation and to identify associated factors. Cross-sectional analyses of baseline data from a prospective cohort of 40,172 adults aged 40 through 69 years from Queensland, Australia, recruited in 2011. We obtained data on all melanoma diagnoses through 2009 via record linkage with the Queensland Cancer Registry (notifications have been mandatory since 1982). We calculated prevalence proportion ratios to compare prevalence of sun protection and skin examination practices in 3 separate groups: those with a history of melanoma (group 1), those with a self-reported history of treated actinic lesions (group 2), and those without either (group 3). We used multivariate generalized linear models to identify factors associated with each practice. Participants with a previously confirmed melanoma (group 1; n = 1433) and/or treated actinic lesions (group 2; n = 24,006) were more likely than those without (group 3; n = 14,733) to report sun protection practices, including regular use of sunscreen (53.3%, 45.1%, and 38.1%, respectively) and wearing hats (74.7%, 68.2%, and 58.2%, respectively). They were also more likely to have had a whole-body skin examination by a physician in the past 3 years (93.7%, 83.4%, and 52.1%, respectively). Within all 3 groups, the strongest association with sun protection practices was with sun-sensitive skin type. Within group 3 (no history of treated skin lesions), the strongest factor associated with clinical skin examinations was self-reported nevus density at 21 years of age, whereas a family history of melanoma was a significant factor in groups 2 and 3. In this large sample exposed to high levels of ambient solar radiation, sun protection and skin examination practices were most frequent among those

  6. Suspected cow's milk allergy in everyday general practice: a retrospective cohort study on health care burden and guideline adherence.

    Science.gov (United States)

    van den Hoogen, Sharayke C T A; van de Pol, Alma C; Meijer, Yolanda; Toet, Jaap; van Klei, Céline; de Wit, Niek J

    2014-08-09

    Cow's milk allergy (CMA) is the most common food allergy among infants. No data are available on the health care burden of suspected CMA in general practice. This study was conducted to evaluate the burden of suspected CMA in general practice (GP): (a) prevalence, (b) presenting symptoms, (c) diagnostic process, (d) guideline adherence, and (e) dietary measures. A retrospective cohort study was carried out in four Julius Healthcare Centers (JHCs). These JHCs form the core primary care academic network of the department of general practice of the University Medical Center of Utrecht. Electronic records of the first year of infants born May 2009 - April 2010 registered in the JHCs were screened for possible CMA suspicion. Preventive child healthcare (PCH) records were reviewed for additional information. Clinical presentation, diagnostic strategies and dietary measures were extracted. Of 804 infants evaluated, 55 presented with symptoms fitting the suspicion of CMA (prevalence of 7%). Presenting complaints involved the skin (71%); the gastrointestinal tract (60%); the respiratory tract (13%) or other symptoms (36%) and 23 infants presented with symptoms of two or more organ systems. In 31 children (56%) a food challenge was performed (n = 28 open and n = 3 double-blind). Open challenge test results were difficult to interpret due to inadequate implementation or reporting. None had confirmed CMA after an adequate challenge test. Long term milk substitute formulas were prescribed in 39 (71%) infants. On a yearly basis seven percent of children visit their GP for suspected CMA. A positive CMA diagnosis was rarely established after adequate implementation and reporting of diagnostics, yet long term dietary measures were prescribed in >70% of patients. There is definitely need for improvement of diagnosing CMA in primary care.

  7. Early predictors of need for remediation in the Australian general practice training program: a retrospective cohort study.

    Science.gov (United States)

    Magin, Parker; Stewart, Rebecca; Turnock, Allison; Tapley, Amanda; Holliday, Elizabeth; Cooling, Nick

    2017-10-01

    Underperforming trainees requiring remediation may threaten patient safety and are challenging for vocational training programs. Decisions to institute remediation are high-stakes-remediation being resource-intensive and emotionally demanding on trainees. Detection of underperformance requiring remediation is particularly problematic in general (family) practice. We sought to establish early-training assessment instruments predictive of general practice (GP) trainees' subsequently requiring formal remediation. We conducted a retrospective cohort study of trainees from a large Australian regionally-based GP training organization. The outcome factor was requirement for formal remediation. Independent variables were demographic factors and a range of formative assessments conducted immediately prior to or during early-stage training. Analyses employed univariate and multivariate logistic regression of each predictor assessment modality with the outcome, adjusting for potential confounders. Of 248 trainees, 26 (10.5 %) required formal remediation. Performance on the Colleague Feedback Evaluation Tool (entailing feedback from a trainee's clinical colleagues on clinical performance, communication and probity) and External Clinical Teaching Visits (half-day sessions of the trainee's clinical consultations observed directly by an experienced GP), along with non-Australian primary medical qualification, were significantly associated with requiring remediation. There was a non-significant trend for association with performance on the Doctors Interpersonal Skills Questionnaire (patient feedback on interpersonal elements of the consultation). There were no significant associations with entry-selection scores or formative exam or assessment scores. Our finding that 'in vivo' assessments of complex behaviour, but not 'in vitro' knowledge-based assessments, predict need for remediation is consistent with theoretical understanding of the nature of remediation decision-making and

  8. Common Manual Therapy Practices in the Netherlands for Infants With Upper Cervical Dysfunction: A Prospective Cohort Study.

    Science.gov (United States)

    Saedt, Eric R I C; Driehuis, Femke; Hoogeboom, Thomas J; van der Woude, Bé H; de Bie, Rob A; Nijhuis-van der Sanden, Maria W G

    2018-01-01

    The purpose of this study was to describe common clinical practices of manual therapists (MTs) in the Netherlands for infants with indications of upper cervical dysfunction (UCD). A prospective observational cohort study was conducted to gain insight into characteristics, reasons for seeking care, and common clinical practice for infants (<27 weeks) with indications of UCD, referred to MTs. Pre- and posttreatment self-reported questionnaires were used to collect data from parents and MTs. Parents reported on infant characteristics and perceived effect of treatment. Manual therapists reported on diagnostics, therapeutic procedures, and outcomes. Between 2006 and 2007, data regarding 307 referred infants (mean age: 11.2 weeks) were collected by parents and 42 MTs. The most frequent reasons for seeking care were positional preference, restlessness, and/or abnormal head position. Manual therapists observed active, spontaneous, and provoked mobility and passive upper cervical mobility. Of the 307 infants, 295 were diagnosed with UCD based on positive outcomes on the flexion-rotation test and/or lateral flexion test. After treatment with mobilization techniques, positive outcomes on the flexion-rotation test decreased from 78.8% to 6.8%. For the lateral flexion test, the positive outcomes decreased from 91.5% to 6.2%. All parents perceived positive treatment effects. No serious adverse events were reported during this study. This is the first study to describe common clinical practice for infants referred for manual therapy. Infants with UCD were treated mainly with upper cervical mobilization techniques, and the greatest perceived effect was observed after approximately 2 treatment sessions. Copyright © 2018. Published by Elsevier Inc.

  9. Sexual practices and condom usage in a cohort of homosexual men in relation to human immunodeficiency virus status.

    Science.gov (United States)

    Tindall, B; Swanson, C; Donovan, B; Cooper, D A

    1989-09-18

    Between January 1, and October 31, 1987, 420 homosexual men who participated in a cohort study of infection with the human immunodeficiency virus (HIV) completed a questionnaire that examined their sexual practices during the previous six months. Of the subjects, 205 (48.8%) men were HIV-seropositive and 215 (51.2%) men were HIV-seronegative. Although there was an appreciable level of condom usage in both groups, 13.5% of the HIV-seronegative men had engaged in unprotected receptive anal intercourse and 6.3% of the HIV-seropositive men had engaged in unprotected insertive anal intercourse. Condom breakage was reported on approximately 6% of occasions by a minority of subjects. Among subjects who were in a relationship with a regular male sexual partner, the most commonly reported sexual practices were deep kissing, mutual masturbation and receptive oral intercourse without ejaculation. No HIV-seronegative man engaged in unprotected receptive and/or insertive anal intercourse, receptive oral intercourse with ejaculation or receptive and/or insertive "fisting" with a regular partner who was HIV-seropositive. No HIV-seropositive man engaged in unprotected insertive anal intercourse to ejaculation with an HIV-seronegative partner, although they did so with partners who were HIV-seropositive or of unknown status. On multivariate analyses the subject's antibody status was found to be associated with receptive anal intercourse with a condom (P = 0.007) and mutual masturbation (P = 0.001), with HIV-seronegative men being more likely to practise either; no significant independent effect was associated with the partner's antibody status. These findings provide important information on the types and levels of sexual practices in a group of homosexual men after the recognition of the acquired immunodeficiency syndrome in this country.

  10. Private power in China

    International Nuclear Information System (INIS)

    Daniel, Martin

    1999-10-01

    Contains Executive Summary and Chapters on: Introduction; Political and economic background; Energy supply; The Chinese electricity sector; Private power in China; Issues for private investors; Fuel choice in private projects; Private investors in China; Listed Chinese generators; Private power prospects; Implemented private generation projects; Planned private Generation Projects; Plants owned by listed Chinese generators. (Author)

  11. Modeling practice effects in healthy middle-aged participants of the Alzheimer and Families parent cohort.

    Science.gov (United States)

    Sánchez-Benavides, Gonzalo; Gispert, Juan D; Fauria, Karine; Molinuevo, José Luis; Gramunt, Nina

    2016-01-01

    Repetitive administration of neuropsychological tests can lead to performance improvement merely due to previous exposure. The magnitude of such practice effects (PEs) may be used as a marker of subtle cognitive impairment because they are diminished in healthy individuals subsequently developing Alzheimer's disease (AD). To explore the relationship between sociodemographic factors, AD family history (FH), and APOE ε4 status, and the magnitude of PE, four subtests of the Wechsler Adult Intelligence Scale-IV were administered twice to 400 middle-aged healthy individuals, most of them first-degree descendants of AD patients. PEs were observed in all measures. Sociodemographic variables did not show a uniform effect on PE. Baseline score was the strongest predictor of change, being inversely related to PE magnitude. Significant effects of the interaction term APOE ε4 ∗ Age in processing speed and working memory were observed. PEs exert a relevant effect in cognitive outcomes at retest and, accordingly, they must be taken into consideration in clinical trials. The magnitude of PE in processing speed and working memory could be of special interest for the development of cognitive markers of preclinical AD.

  12. Nuclear privatization

    International Nuclear Information System (INIS)

    Jeffs, E.

    1995-01-01

    The United Kingdom government announced in May 1995 plans to privatize the country's two nuclear generating companies, Nuclear Electric and Scottish Nuclear. Under the plan, the two companies will become operating divisions of a unified holding company, to be called British Electric, with headquarters in Scotland. Britain's nuclear plants were left out of the initial privatization in 1989 because the government believed the financial community would be unwilling to accept the open-ended liability of decommissioning the original nine stations based on the Magnox gas-cooled reactor. Six years later, the government has found a way around this by retaining these power stations in state ownership, leaving the new nuclear company with the eight Advanced Gas-cooled Reactor (AGR) stations and the recently completed Sizewell B PWR stations. The operating Magnox stations are to be transferred to BNFL, which operates two Magnox stations of their own at Calder Hall and Chapelcross

  13. Private law

    DEFF Research Database (Denmark)

    working and researching in the key areas of law, security and privacy in IT, international trade and private law. Now, in 2010 and some seven conferences later, the event moves to Barcelona and embraces for the first time the three conference tracks just described. The papers in this work have all been...... blind reviewed and edited for quality. They represent the contributions of leading academics, early career researchers and others from an increasing number of countries, universities and institutions around the world. They set a benchmark for discussion of the current issues arising in the subject area...... and continue to offer an informed and relevant contribution to the policy making agenda. As Chair of the Conference Committee, I am once more very proud to endorse this work "Private Law: Rights, Duties & Conflicts" to all those seeking an up to date and informed evaluation of the leading issues. This work...

  14. Implications for cancer genetics practice of pro-actively assessing family history in a General Practice cohort in North West London.

    Science.gov (United States)

    Kohut, Kelly; D'Mello, Lucia; Bancroft, Elizabeth K; Thomas, Sarah; Young, Mary-Anne; Myhill, Kathryn; Shanley, Susan; Briggs, Brian H J; Newman, Michelle; Saraf, Ifthikhar M; Cox, Penny; Scambler, Sarah; Wagman, Lyndon; Wyndham, Michael T; Eeles, Rosalind A; Ferris, Michelle

    2012-03-01

    At present cancer genetics referrals are reactive to individuals asking for a referral and providing a family history thereafter. A previous pilot study in a single General Practice (GP) catchment area in North London showed a 1.5-fold increase in breast cancer risk in the Ashkenazi Jewish population compared with the non-Ashkenazi mixed population. The breast cancer incidence was equal in the Ashkenazim in both pre- and postmenopausal groups. We wanted to investigate the effect of proactively seeking family history data from the entire female population of the practice to determine the effect on cancer genetics referral. Objectives To determine the need for cancer genetics intervention for women in a single GP catchment area. (1) to determine the incidence and strength of family history of cancer in women aged over 18 in the practice, (2) to offer cancer genetics advice and determine the uptake of counselling in those with a positive family history, (3) to identify potential BRCA1/BRCA2 gene mutation carriers who can be offered clinical follow up with appropriate translational research studies. Design Population-based cohort study of one General Practice female population. Participants Three hundred and eighty-three women over the age of 18 from one General Practice who responded to a questionnaire about family history of cancer. The whole female adult GP population was the target and the total number sampled was 3,820. Results 10% of patients completed the questionnaire (n = 383). A family history of cancer was present in 338 cases, 95 went on to have genetic counselling or had previously had counselling and 47 were genetically tested. We identified three carriers of an Ashkenazi Jewish founder mutation in BRCA1. Conclusions Response rate to a family history questionnaire such as that used in genetics centres was low (10%) and other approaches will be needed to proactively assess family history. Although the Ashkenazim are present in 39% of the GP catchment

  15. Social capital and frequent attenders in general practice: a register-based cohort study.

    Science.gov (United States)

    Pasgaard, Alexander A; Mæhlisen, Maiken H; Overgaard, Charlotte; Ejlskov, Linda; Torp-Pedersen, Christian; Bøggild, Henrik

    2018-03-02

    Frequent attendance to primary care constitutes a large use of resources for the health care system. The association between frequent attendance and illness-related factors has been examined in several studies, but little is known about the association between frequent attendance and individual social capital. The aim of this study is to explore this association. The analysis is conducted on responders to the North Denmark Region Health Profile 2010 (n = 23,384), individually linked with information from administrative registers. Social capital is operationalized at the individual level, and includes cognitive (interpersonal trust and norms of reciprocity) as well as structural (social network and civic engagement) dimensions. Frequent attendance is defined as the upper-quartile of the total number of measured consultations with a general practitioner over a period of 148 weeks. Using multiple logistic regression, we found that frequent attendance was associated with a lower score in interpersonal trust [OR 0.86 (0.79-0.94)] and social network [OR 0.88 (0.79-0.98)] for women, when adjusted for age, education, income and SF12 health scores. Norms of reciprocity and civic engagement were not significantly associated with frequent attendance for women [OR 1.05 (0.99-1.11) and OR 1.01 (0.92-1.11) respectively]. None of the associations were statistically significant for men. This study suggests that for women, some aspects of social capital are associated with frequent attendance in general practice, and the statistically significant dimensions belonged to both cognitive and structural aspects of social capital. This association was not seen for men. This indicates a multifaceted and heterogeneous relationship between social capital and frequent attendance among genders.

  16. Counselor Attitudes toward and Use of Evidence-based Practices in Private Substance Use Disorder Treatment Centers: A Comparison of Social Workers and Non–Social Workers

    Science.gov (United States)

    Bride, Brian E.; Kintzle, Sara; Abraham, Amanda J.; Roman, Paul M.

    2012-01-01

    The purpose of this study was to examine factors that may be associated with variation in social workers' perceptions of effectiveness, perceptions of acceptability, and use of psychosocial evidence-based practices (EBPs) for the treatment of substance use disorders (SUD) in comparison to other SUD counselors who are non–social workers. A national sample of 1,140 counselors in private SUD treatment settings completed a mailed survey. Overall, counselors perceive both motivational interviewing (MI) and contingency management (CM) to be effective and acceptable interventions, with MI perceived to be both more effective and more acceptable than CM. The results of this study also shed light on the factors associated with perceptions of effectiveness and acceptability of MI and CM. The results of this study underscore the importance of exposure to EBPs in the development of positive attitudes toward and use of EBPs. In particular, professional networks are an important route to introduce social workers to EBPs, as is professional training on specific EBPs. Efforts to increase the uptake of evidence-based SUD interventions should not be limited to dissemination of information regarding effectiveness; rather, efforts should also be expended to expose social workers to EBPs. PMID:23193729

  17. Iodine Intake and Thyroid Function in Pregnant Women in a Private Clinical Practice in Northwestern Sydney before Mandatory Fortification of Bread with Iodised Salt

    Directory of Open Access Journals (Sweden)

    Norman Blumenthal

    2012-01-01

    Full Text Available Aim. The primary objective of the study was to assess the iodine nutritional status, and its effect on thyroid function, of pregnant women in a private obstetrical practice in Sydney. Methods. It was a cross-sectional study undertaken between November 2007 and March 2009. Blood samples were taken from 367 women at their first antenatal visit between 7 and 11 weeks gestation for measurement of thyroid stimulating hormone (TSH and free thyroxine (FT4 levels and spot urine samples for urinary iodine excretion were taken at the same time as blood collection. Results. The median urinary iodine concentration (UIC for all women was 81 μg/l (interquartile range 41–169 μg/l. 71.9% of the women exhibited a UIC of <150 μg/l. 26% of the women had a UIC <50 μg/l, and 12% had a UIC <20 μg/l. The only detectable influences on UIC were daily milk intake and pregnancy supplements. There was no statistically significant association between UIC and thyroid function and no evidence for an effect of iodine intake on thyroid function. Conclusions. There is a high prevalence of mild to moderate iodine deficiency in women in Western Sydney but no evidence for a significant adverse effect on thyroid function. The 6.5% prevalence of subclinical hypothyroidism is unlikely to be due to iodine deficiency.

  18. Importance of First and Second Authorship in Assessing Citation-Based Scholarly Activity of US Radiation Oncology Residents and Subsequent Choice of Academic Versus Private Practice Career.

    Science.gov (United States)

    McClelland, Shearwood; Mitin, Timur; Jagsi, Reshma; Thomas, Charles R; Jaboin, Jerry J

    2018-06-20

    The Hirsch index (h-index) has been shown to correlate with radiation oncology residents' having a first job in academics versus private practice, but it is limited by its inability to distinguish between the differing significance of coauthor roles in articles. A list of 2016 radiation oncology resident graduates and their postresidency career choices was compiled. The Scopus bibliometric citation database was then searched to collect h-index data for articles limited to first author only (h f ) and first or second-author only (h s ) for each resident. Mean h f was 2.06 for all resident graduates, and mean h s was 2.77. Residents with PhDs had significantly higher h f (3.11 versus 1.76, P gender. Only 10% of graduates without any first- and/or second-author articles cited at least once secured academic jobs. These findings indicate that stratifying publications by first or second authorship when developing benchmarks for evaluating resident productivity and postresidency career type may be useful. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  19. The effectiveness of family-based treatment for full and partial adolescent anorexia nervosa in an independent private practice setting: Clinical outcomes.

    Science.gov (United States)

    Goldstein, Mandy; Murray, Stuart B; Griffiths, Scott; Rayner, Kathryn; Podkowka, Jessica; Bateman, Joel E; Wallis, Andrew; Thornton, Christopher E

    2016-11-01

    Anorexia nervosa (AN) is a severe psychiatric illness with little evidence supporting treatment in adults. Among adolescents with AN, family-based treatment (FBT) is considered first-line outpatient approach, with a growing evidence base. However, research on FBT has stemmed from specialist services in research/public health settings. This study investigated the effectiveness of FBT in a case series of adolescent AN treated in a private practice setting. Thirty-four adolescents with full or partial AN, diagnosed according to DSM-IV criteria, participated, and were assessed at pretreatment and post-treatment. Assessments included change in % expected body weight, mood, and eating pathology. Significant weight gain was observed from pretreatment to post-treatment. 45.9% of the sample demonstrated full weight restoration and a further 43.2% achieved partial weight-based remission. Missing data precluded an examination of change in mood and ED psychopathology. Effective dissemination across different service types is important to the wider availability of evidence-based treatments. These weight restoration data lend preliminary support to the implementation of FBT in real world treatment settings. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1023-1026). © 2016 Wiley Periodicals, Inc.

  20. The role and functions of Clinical Nurse Consultants, an Australian advanced practice role: a descriptive exploratory cohort study.

    Science.gov (United States)

    Baldwin, Richard; Duffield, Christine Margaret; Fry, Margaret; Roche, Michael; Stasa, Helen; Solman, Annette

    2013-03-01

    The NSW Health Policy Directive (NSW Department of Health, 2000) lists clinical service and consultancy; clinical leadership; research; education; clinical services planning and management as the five domains of practice for nurses appointed as Clinical Nurse Consultants (CNCs), an Australian advanced practice nurse (APN) role. However, there is no clear definition of what is meant by advanced practice in the Australian nursing context. Nowhere is this more evident than in differentiating between the roles of Clinical Nurse Consultants (CNCs) and Nurse Practitioners (NP) in NSW. To date, limited empirical research has been done to characterise or delineate CNC role activity and responsibility. To investigate (i) the nature of CNC roles, activities and responsibilities, (ii) differentiate between CNCs by their work patterns and activities, and (iii) empirically conceptualize and differentiate ways CNCs practice in terms of an APN typology. The study sample was 56 CNCs at one tertiary level public hospital in Australia. A descriptive exploratory cohort study was conducted to explore CNC role characteristics and patterns of activity. Data were triangulated using an online survey, a follow-up survey, and semi-structured interviews. The data were analysed using descriptive statistics to examine differences between CNC work patterns and role activities. The survey data and the individual reports were thematically analysed to investigate for difference across the population of CNCs. Interpretation of survey and interview data led to an analyst-developed CNC typology of four CNC categories based on the work patterns and activities of Sole Practitioner, Clinic Coordinator, Clinical Team Coordinator and Clinical Leader. The typology was based on the themes interprofessional, role focus, clinical focus and setting as these themes distinguished and differentiated CNC roles. The study provides evidence of great diversity and prioritization within CNC roles. The CNC typology

  1. Lansoprazole use and tuberculosis incidence in the United Kingdom Clinical Practice Research Datalink: A population based cohort.

    Science.gov (United States)

    Yates, Tom A; Tomlinson, Laurie A; Bhaskaran, Krishnan; Langan, Sinead; Thomas, Sara; Smeeth, Liam; Douglas, Ian J

    2017-11-01

    Recent in vitro and animal studies have found the proton pump inhibitor (PPI) lansoprazole to be highly active against Mycobacterium tuberculosis. Omeprazole and pantoprazole have no activity. There is no evidence that, in clinical practice, lansoprazole can treat or prevent incident tuberculosis (TB) disease. We studied a cohort of new users of lansoprazole, omeprazole, or pantoprazole from the United Kingdom Clinical Practice Research Datalink to determine whether lansoprazole users have a lower incidence of TB disease than omeprazole or pantoprazole users. Negative control outcomes of myocardial infarction (MI) and herpes zoster were also studied. Multivariable Cox proportional hazards regression was used to adjust for potential confounding by a wide range of factors. We identified 527,364 lansoprazole initiators and 923,500 omeprazole or pantoprazole initiators. Lansoprazole users had a lower rate of TB disease (n = 86; 10.0 cases per 100,000 person years; 95% confidence interval 8.1-12.4) than omeprazole or pantoprazole users (n = 193; 15.3 cases per 100,000 person years; 95% confidence interval 13.3-17.7), with an adjusted hazard ratio (HR) of 0.68 (0.52-0.89). No association was found with MI (adjusted HR 1.04; 95% confidence interval 1.00-1.08) or herpes zoster (adjusted HR 1.03; 95% confidence interval 1.00-1.06). Limitations of this study are that we could not determine whether TB disease was due to reactivation of latent infection or a result of recent transmission, nor could we determine whether lansoprazole would have a beneficial effect if given to people presenting with TB disease. In this study, use of the commonly prescribed and cheaply available PPI lansoprazole was associated with reduced incidence of TB disease. Given the serious problem of drug resistance and the adverse side effect profiles of many TB drugs, further investigation of lansoprazole as a potential antituberculosis agent is warranted.

  2. Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study.

    Directory of Open Access Journals (Sweden)

    Bijaya K Padhi

    2015-07-01

    Full Text Available The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs. We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India.A prospective cohort of pregnant women (n = 670 in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation. A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs and adjusted odds ratios (AORs and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4% preterm births, 95 (14.2% births with low birth weight, 11 (1.7% spontaneous abortions, and six (0.9% stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72-3.71, preterm birth (OR: 2.36; 95% CI: 1.54-3.62, and low birth weight (OR: 2.00; 95% CI: 1.24-3.23 were found to be significantly associated with open defecation practices. After adjustment for potential confounders such as maternal socio-demographic and clinical factors, open defecation was still significantly associated with increased odds of APOs (AOR: 2.38; 95% CI: 1.49-3.80 and preterm birth (AOR: 2.22; 95% CI: 1.29-3.79 but not low birth weight (AOR: 1.61; 95% CI: 0.94-2.73. The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the

  3. Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study.

    Science.gov (United States)

    Padhi, Bijaya K; Baker, Kelly K; Dutta, Ambarish; Cumming, Oliver; Freeman, Matthew C; Satpathy, Radhanatha; Das, Bhabani S; Panigrahi, Pinaki

    2015-07-01

    The importance of maternal sanitation behaviour during pregnancy for birth outcomes remains unclear. Poor sanitation practices can promote infection and induce stress during pregnancy and may contribute to adverse pregnancy outcomes (APOs). We aimed to assess whether poor sanitation practices were associated with increased risk of APOs such as preterm birth and low birth weight in a population-based study in rural India. A prospective cohort of pregnant women (n = 670) in their first trimester of pregnancy was enrolled and followed until birth. Socio-demographic, clinical, and anthropometric factors, along with access to toilets and sanitation practices, were recorded at enrolment (12th week of gestation). A trained community health volunteer conducted home visits to ensure retention in the study and learn about study outcomes during the course of pregnancy. Unadjusted odds ratios (ORs) and adjusted odds ratios (AORs) and 95% confidence intervals for APOs were estimated by logistic regression models. Of the 667 women who were retained at the end of the study, 58.2% practiced open defecation and 25.7% experienced APOs, including 130 (19.4%) preterm births, 95 (14.2%) births with low birth weight, 11 (1.7%) spontaneous abortions, and six (0.9%) stillbirths. Unadjusted ORs for APOs (OR: 2.53; 95% CI: 1.72-3.71), preterm birth (OR: 2.36; 95% CI: 1.54-3.62), and low birth weight (OR: 2.00; 95% CI: 1.24-3.23) were found to be significantly associated with open defecation practices. After adjustment for potential confounders such as maternal socio-demographic and clinical factors, open defecation was still significantly associated with increased odds of APOs (AOR: 2.38; 95% CI: 1.49-3.80) and preterm birth (AOR: 2.22; 95% CI: 1.29-3.79) but not low birth weight (AOR: 1.61; 95% CI: 0.94-2.73). The association between APOs and open defecation was independent of poverty and caste. Even though we accounted for several key confounding factors in our estimates, the possibility

  4. Self-reported breast feeding practices and the Baby Friendly Hospital Initiative in Riyadh, Saudi Arabia: prospective cohort study.

    Science.gov (United States)

    Mosher, Cynthia; Sarkar, Abdullah; Hashem, Alaa AbouBakr; Hamadah, Reem E; Alhoulan, Asma; AlMakadma, Yosra A; Khan, Tehreem A; Al-Hamdani, Abdurahman K; Senok, Abiola

    2016-12-16

    The Baby Friendly Hospital Initiative (BFHI) is a practice guideline for healthcare providers to promote breastfeeding and increase breastfeeding rates. This study aimed to examine reported experiences and views on breastfeeding of women using prenatal and postnatal services, and opinions of staff, in the context of the BFHI programme in Riyadh, Saudi Arabia. Prospective cohort study. This prospective, longitudinal study was conducted from December 2013 to September 2015 at two healthcare facilities (BFHI and non-BFHI) in Riyadh Saudi Arabia. Women 36-40 weeks gestation receiving antenatal care at the hospitals were enrolled. Questionnaires were administered prenatally, at 1, 3 and 6 months postnatal and to the administrator and maternity staff. We recruited 277 women with an estimated 80% response rate. 156 (BFHI=78/139, non-BFHI=78/138, 56%) participants completed all questionnaires. Most BFHI-hospital participants (77.9%, n=8 for this question) acknowledged seeing the breast feeding policy compared to 23.5% (n=23) at the non-BFHI-hospital (p<0.01). Breast feeding education and encouragement was higher at the BFHI-hospital (93.3%) compared to the non-BFHI-hospital (48.2%; p<0.01). At postpartum discharge, 51% (n=53) of mothers in the BFHI-hospital were breast feeding exclusively versus 29.6% (n=29) at the non-BFHI-hospital. Where formula feed was introduced, women in the BFHI-hospital more often practiced mixed feeding rather than exclusive formula feeding with some switching from mixed feeding to exclusive breast feeding between 3 and 6 months postpartum. Exclusive breast feeding rates declined in both hospitals at 3 and 6 months postpartum with lack of community services for lactation being a major reason. Although BFHI-hospital staff (n=9) were more conversant with BFHI principles, defects in adherence to the BFHI 10 Steps were identified. This is the first study assessing the effectiveness of BFHI implementation in Saudi Arabia. Although women

  5. Cohort profile

    DEFF Research Database (Denmark)

    Maret-Ouda, John; Wahlin, Karl; Artama, Miia

    2017-01-01

    Purpose: To describe a newly created all-Nordic cohort of patients with gastro-oesophageal reflux disease (GORD), entitled the Nordic Antireflux Surgery Cohort (NordASCo), which will be used to compare participants having undergone antireflux surgery with those who have not regarding risk...... age at primary antireflux surgery ranged from 47 to 52 years in the different countries. The coding practices of GORD seem to have differed between the Nordic countries. Future plans: The NordASCo will initially be used to analyse the risk of developing known or potential GORD-related cancers, that is......, tumours of the oesophagus, stomach, larynx, pharynx and lung, and to evaluate the mortality in the short-term and long-term perspectives. Additionally, the cohort will be used to evaluate the risk of non-malignant respiratory conditions that might be caused by aspiration of gastric contents....

  6. Factors that Determine Academic Versus Private Practice Career Interest in Radiation Oncology Residents in the United States: Results of a Nationwide Survey

    International Nuclear Information System (INIS)

    Chang, Daniel T.; Shaffer, Jenny L.; Haffty, Bruce G.; Wilson, Lynn D.

    2013-01-01

    Purpose: To determine what factors US radiation oncology residents consider when choosing academic or nonacademic careers. Methods and Materials: A 20-question online survey was developed and sent to all US radiation oncology residents to assess factors that influence their career interest. Residents were asked to rate their interest in academics (A) versus private practice (PP) on a 0 (strong interest in A) to 100 (strong interest in PP) scale. Responses were classified as A (0-30), undecided (40-60), and PP (70-100). Residents were also asked to rank 10 factors that most strongly influenced their career interest. Results: Three hundred thirty-one responses were collected, of which 264 were complete and form the basis for this analysis. Factors that correlated with interest in A included having a PhD (P=.018), postgraduate year level (P=.0006), research elective time (P=.0003), obtaining grant funding during residency (P=.012), and number of publications before residency (P=.0001), but not number of abstracts accepted in the past year (P=.65) or publications during residency (P=.67). The 3 most influential factors for residents interested in A were: (1) baseline interest before residency; (2) academic role models; and (3) research opportunities during residency. The 3 most influential factors for residents interested in PP were: (1) baseline interest before residency; (2) academic role models; and (3) academic pressure and obligations. Conclusions: Interest in A correlated with postgraduate year level, degree, and research time during residency. Publications before but not during residency correlated with academic interest, and baseline interest was the most influential factor. These data can be used by residency program directors to better understand what influences residents' career interest

  7. Private placements

    International Nuclear Information System (INIS)

    Bugeaud, G. J. R.

    1998-01-01

    The principles underlying private placements in Alberta, and the nature of the processes employed by the Alberta Securities Commission in handling such transactions were discussed. The Alberta Securities Commission's mode of operation was demonstrated by the inclusion of various documents issued by the Commission concerning (1) special warrant transactions prior to listing, (2) a decision by the Executive Director refusing to issue a receipt for the final prospectus for a distribution of securities of a company and the reasons for the refusal, (3) the Commission's decision to interfere with the Executive Director's decision not to issue a receipt for the final prospectus, with full citation of the Commission's reasons for its decision, (4) and a series of proposed rules and companion policy statements regarding trades and distributions outside and in Alberta. Text of a sample 'short form prospectus' was also included

  8. Specific infant feeding practices do not consistently explain variation in anthropometry at age 1 year in urban United States, Mexico, and China cohorts.

    Science.gov (United States)

    Woo, Jessica G; Guerrero, M Lourdes; Ruiz-Palacios, Guillermo M; Peng, Yong-mei; Herbers, Patricia M; Yao, Wen; Ortega, Hilda; Davidson, Barbara S; McMahon, Robert J; Morrow, Ardythe L

    2013-02-01

    Infant feeding practices generally influence infant growth, but it is unclear how introduction of specific foods affects growth across global populations. We studied 3 urban populations in the Global Exploration of Human Milk study to determine the association between infant feeding and anthropometry at 1 y of age. Three hundred sixty-five breastfeeding mother-infant pairs (120 US, 120 China, and 125 Mexico) were recruited soon after the infant's birth. Enrollment required agreement to breastfeed ≥75% for at least 3 mo. Weekly, 24-h, food frequency data were conducted on infants for 1 y and exclusive breastfeeding (EBF) duration and timing of specific complementary food introduction were calculated. Weight and length were measured at age 1 y and anthropometry Z-scores calculated using WHO standards. Cohorts in the 3 urban populations (Shanghai, China; Cincinnati, USA; and Mexico City, Mexico) differed by median EBF duration (5, 14, and 7 wk, respectively; P Mexico City infants (P < 0.001). Adjusting for nonfeeding covariates, the only feeding variable associated with anthropometry was EBF duration, which was modestly inversely associated with weight-for-age but not length-for-age or BMI Z-scores at 1 y. Although feeding variables differed by cohort, their impact on anthropometry differences was not consistent among cohorts. Overall, across these urban, international, breast-fed cohorts, differences in specific feeding practices did not explain the significant variation in anthropometry.

  9. Specific Infant Feeding Practices Do Not Consistently Explain Variation in Anthropometry at Age 1 Year in Urban United States, Mexico, and China Cohorts12

    Science.gov (United States)

    Woo, Jessica G.; Guerrero, M. Lourdes; Ruiz-Palacios, Guillermo M.; Peng, Yong-mei; Herbers, Patricia M.; Yao, Wen; Ortega, Hilda; Davidson, Barbara S.; McMahon, Robert J.; Morrow, Ardythe L.

    2013-01-01

    Infant feeding practices generally influence infant growth, but it is unclear how introduction of specific foods affects growth across global populations. We studied 3 urban populations in the Global Exploration of Human Milk study to determine the association between infant feeding and anthropometry at 1 y of age. Three hundred sixty-five breastfeeding mother-infant pairs (120 US, 120 China, and 125 Mexico) were recruited soon after the infant’s birth. Enrollment required agreement to breastfeed ≥75% for at least 3 mo. Weekly, 24-h, food frequency data were conducted on infants for 1 y and exclusive breastfeeding (EBF) duration and timing of specific complementary food introduction were calculated. Weight and length were measured at age 1 y and anthropometry Z-scores calculated using WHO standards. Cohorts in the 3 urban populations (Shanghai, China; Cincinnati, USA; and Mexico City, Mexico) differed by median EBF duration (5, 14, and 7 wk, respectively; P Mexico City infants (P < 0.001). Adjusting for nonfeeding covariates, the only feeding variable associated with anthropometry was EBF duration, which was modestly inversely associated with weight-for-age but not length-for-age or BMI Z-scores at 1 y. Although feeding variables differed by cohort, their impact on anthropometry differences was not consistent among cohorts. Overall, across these urban, international, breast-fed cohorts, differences in specific feeding practices did not explain the significant variation in anthropometry. PMID:23236024

  10. Physician practicing preferences for conventional or homeopathic medicines in elderly subjects with musculoskeletal disorders in the EPI3-MSD cohort

    Directory of Open Access Journals (Sweden)

    Danno K

    2014-09-01

    Full Text Available Karine Danno,1 Clementine Joubert,1 Gerard Duru,2 Jean-Marie Vetel31Laboratoires Boiron, Messimy, France; 2Cyklad Group, Lyon, France; 3Centre Hospitalier du Mans, Le Mans, FranceBackground: Musculoskeletal pain is common in elderly persons. Analgesic use is high in the elderly and may involve unacceptable risk in individuals with chronic pain. Our aim was to compare the socio-demographic characteristics of elderly subjects with musculoskeletal disorders (MSD and to assess medication use and clinical evolution of musculoskeletal pain according to physician prescribing preference: homeopathy (Ho group, conventional medicine (CM group, or mixed prescription (MX group.Methods: The EPI3 study was a 1 year observational survey carried out among general practitioners in France between March 2007 and July 2008. This sub-analysis was carried out on elderly subjects aged ≥70 years from the original EPI3 cohort. Socio-demographic data were collected at inclusion using a self-administered patient questionnaire and medical data were recorded for each patient. Quality of life was measured using the Short Form-12 questionnaire. Patients completed a structured telephone interview on their functional status (evaluated with the QuickDash questionnaire, EIFEL scale or Lequesne index within 72 hours of inclusion. This telephone interview was repeated at 1, 3, and 12 months. Drug exposure was also assessed during these interviews.Results: 146 patients (mean age ± standard deviation: 75.8±4.8 years were analyzed (80.1% female, 74.7% MSD of the spine or lower limbs, 64.4% chronic MSD. Patients in the CM and MX groups were 3.7 times or 2.5 times more likely (odds ratio [OR] =3.71, 95% confidence interval [CI]: 1.12-12.30; OR =2.52, 95% CI: 1.05-6.05; respectively to have used non-steroidal anti-inflammatory drugs (NSAIDs than those in the Ho group. In contrast, analgesic use was comparable in the three groups (OR =1.06 [CM versus Ho], 95% CI: 0.09-12.11; OR =0

  11. Physician practicing preferences for conventional or homeopathic medicines in elderly subjects with musculoskeletal disorders in the EPI3-MSD cohort.

    Science.gov (United States)

    Danno, Karine; Joubert, Clementine; Duru, Gerard; Vetel, Jean-Marie

    2014-01-01

    Musculoskeletal pain is common in elderly persons. Analgesic use is high in the elderly and may involve unacceptable risk in individuals with chronic pain. Our aim was to compare the socio-demographic characteristics of elderly subjects with musculoskeletal disorders (MSD) and to assess medication use and clinical evolution of musculoskeletal pain according to physician prescribing preference: homeopathy (Ho) group, conventional medicine (CM) group, or mixed prescription (MX) group. The EPI3 study was a 1 year observational survey carried out among general practitioners in France between March 2007 and July 2008. This sub-analysis was carried out on elderly subjects aged ≥70 years from the original EPI3 cohort. Socio-demographic data were collected at inclusion using a self-administered patient questionnaire and medical data were recorded for each patient. Quality of life was measured using the Short Form-12 questionnaire. Patients completed a structured telephone interview on their functional status (evaluated with the QuickDash questionnaire, EIFEL scale or Lequesne index) within 72 hours of inclusion. This telephone interview was repeated at 1, 3, and 12 months. Drug exposure was also assessed during these interviews. 146 patients (mean age ± standard deviation: 75.8±4.8 years) were analyzed (80.1% female, 74.7% MSD of the spine or lower limbs, 64.4% chronic MSD). Patients in the CM and MX groups were 3.7 times or 2.5 times more likely (odds ratio [OR] =3.71, 95% confidence interval [CI]: 1.12-12.30; OR =2.52, 95% CI: 1.05-6.05; respectively) to have used non-steroidal anti-inflammatory drugs (NSAIDs) than those in the Ho group. In contrast, analgesic use was comparable in the three groups (OR =1.06 [CM versus Ho], 95% CI: 0.09-12.11; OR =0.34 [MX versus Ho], 95% CI: 0.07-1.57). Overall functional score evolution was similar in the three groups over time (P=0.16). NSAID use was significantly higher in elderly MSD patients consulting a conventional practice

  12. [Requests for emergency appointments with dermatologists in private practice in France: the ETude Urgences en DErmatologie libérale (ET.U.DE) study].

    Science.gov (United States)

    Penso-Assathiany, D; Bourdon-Lanoy, E; Derancourt, C; Roujeau, J-C; Bastuji-Garin, S

    2007-01-01

    Requests for emergency appointments are fairly common in private dermatologic practice in France. To our knowledge the frequency and reasons for such requests have not yet been evaluated. The primary objective of our study was to provide a quantitative and qualitative evaluation of such requests and to assess the underlying reasons. The secondary aim was to investigate for an association between emergency requests where response was justified within 48 hours and the symptoms reported by patients in order to establish a predictive score for the validity of requests. The study took place during one week in April 2004. Forty French dermatologists took part on a voluntary basis. They deliberately reduced their ongoing schedule to accommodate patients seeking an urgent appointment. We collected data regarding the normal professional activity of each dermatologist, reasons for appointments, symptoms, diagnosis and evaluation of the degree of emergency by the attending dermatologist. Univariate and multivariate analyses were performed and a score was attributed based on the results for the variables used in the logistic regression model. The mean number of patients seen at emergency appointments during the study week doubled in comparison with a normal period. During the week, 613 patients phoned and all questionnaires were completed for 538 (88%) patients. The most common reasons for requesting an appointment were: rash, eczema, pruritus, tumour modification, localized lesion and allergy. The most frequent diagnoses were: eczema, bacterial and viral infection, atopic dermatitis, mycosis and naevus. The dermatologists considered that the consultations were justified within 48 hours for one third of patients. In the multivariate analysis, factors significantly associated with a justified request were of a general medical rather than a dermatological nature: enlarged cysts, blisters, insomnia, impaired activity, onset or aggravation within the previous 7 days, inability to

  13. Private Security Contractors in Darfur

    DEFF Research Database (Denmark)

    Leander, Anna

    2006-01-01

    This article argues that the role of Private Security Contractors in Darfur reflects and reinforces neo-liberal governmentality in contemporary security governance. It is an argument (in line with other articles in this special issue) which is more interested in discussing how the privatization....... It underlines that governance is increasingly taking place through a set of (quasi-) markets, it is marked by entrepreneurial values, and a hands off approach to governance. We then discuss the way this overall change is reflected in and reinforced by the role of private security contractors in Darfur. Drawing...... at these processes is necessary to understand the role of private security contractors in Darfur. But more than this, practices in Darfur entrench neo-liberal governmentality in security more generally. The managerial and `de-politicizing' approach to security in Darfur displaces alternative views not only...

  14. Private sector approaches to workforce enhancement.

    Science.gov (United States)

    Wendling, Wayne R

    2010-06-01

    This paper addresses the private practice model of dental care delivery in the US. The great majority of dental care services are delivered through this model and thus changes in the model represent a means to substantially change the supply and availability of dental services. The two main forces that change how private practices function are broad economic factors, which alter the demand for dental care and innovations in practice structure and function which alter the supply and cost of services. Economics has long recognized that although there are private market solutions for many issues, not all problems can be addressed through this model. The private practice of dentistry is a private market solution that works for a substantial share of the market. However, the private market may not work to resolve all issues associated with access and utilization. Solutions for some problems call for creative private - public arrangements - another form of innovation; and market-based solutions may not be feasible for each and every problem. This paper discusses these economic factors and innovation as they relate to the private practice of dentistry, with special emphasis on those elements that have increased the capacity of the dental practice to offer services to those with limited means to access fee-based care. Innovations are frequently described as new care delivery models or new workforce models. However, innovation can occur on an ongoing and regular basis as dental practices examine new ways to combine capital and human resources and to leverage the education and skill of the dentists to a greater number of patients. Innovation occurs within a market context as the current and projected economic returns reward the innovation. Innovation can also occur through private-public arrangements. There are indications of available capacity within the existing delivery system to expand service delivery. The Michigan Medicaid Healthy Kids Dental program is discussed as

  15. Public-private partnership from theory to practice: Walgreens and the Boston Public Health Commission supporting each other before and after the Boston bombings.

    Science.gov (United States)

    Martin, Atyia; Williams, Jim

    2014-01-01

    This paper presents an overview of the public health and medical services continuity of operations, response and recovery efforts in the aftermath of the Boston bombings. Countless public and private organisations and agencies came together to support the community and the survivors. The efforts of these organisations define what it means to be Boston Strong.

  16. PROJECT BONDS IN FINANCING PUBLIC-PRIVATE PARTNERSHIPS IN UKRAINE

    Directory of Open Access Journals (Sweden)

    I. Ovsiannykova

    2014-12-01

    Full Text Available The theoretical principles concerning the financing of public private partnership' projects are deepened and practical recommendations for improving the procedure of raising funds for projects of public-private partnerships through the use project bonds are substantiated.

  17. Private Sector and Enterprise Development

    International Development Research Centre (IDRC) Digital Library (Canada)

    Ministry of Technical Education and Vocational Training ..... and ..structures that offer services to private sector enterprises and represent .... investment climate reform and the adoption of good governance practices. ..... Over two-thirds of the labour force in Jordan, the West Bank & Gaza, Iraq and Syria is in the service sector.

  18. Tandlægers erfaringer med at foreslå og få gennemført behandling med kroner og broer i privat praksis [Experiences of Danish dentists in private practice in motivating treatment with crowns and bridges

    DEFF Research Database (Denmark)

    Isidor, F.; Moore, R.

    2003-01-01

    and bridges, or lack of success in getting treatment completed hung mostly with practice type and location. Almost 76% of the dentists felt that it should be possible to learn how to motivate patients for the expensive treatments (eg bridges). More than 90% of the dentists felt the need for a better insurance...

  19. Privatization and Education

    Science.gov (United States)

    Dash, Neena

    2009-01-01

    This paper highlights emerging trends, programmes and policies in privatization of education in Western countries. These trends are educational vouchers, choice of private schools, private school liberalization, private contracting of specific services, tuition tax credits and deductions for parents ,subsidies and assistance grants to private…

  20. Private Water Projects

    OpenAIRE

    Izaguirre, Ada Karina; Hunt, Catherine

    2005-01-01

    Drawing on the World Bank's Private Participation in Infrastructure Project Database, this Note reviews developments in the water and sewerage sector of developing countries in 2004 and changes in private participation in the sector since 2001. Data for 2004 show that total investment in water and sewerage projects with private participation amounted to nearly US$2 billion. Recent private ...

  1. The ELENA Programme in the Province of Chieti - A Public Private Partnership Best Practice Improving Energy Efficiency of Buildings and Public Lighting Systems

    Directory of Open Access Journals (Sweden)

    Pierluigi Fecondo

    2015-09-01

    To date, the most relevant Project outcomes consist 87 municipalities involved, a structured database of energy audit and data about 144 buildings and about 46,000 public light points. Moreover, an effective engagement of public and private stakeholders, lays the foundation for a strong Energy Performance Contract framework able to leverage financing based on minimun guaranteed energy savings of 20% in respect to baseline values.

  2. The effect of a multifaceted evidence-based practice programme for nurses on knowledge, skills, attitudes, and perceived barriers: A cohort study.

    Science.gov (United States)

    van der Goot, Wieke E; Keers, Joost C; Kuipers, Ruud; Nieweg, Roos M B; de Groot, Martijn

    2018-04-01

    The Dutch professional nursing standard of 2012 stipulates that Dutch nursing practices are to be evidence-based. Not all practicing nurses can satisfy these requirements, therefore, an educational programme about Evidence-Based Practice (EBP) was developed for a Dutch teaching hospital. The aim of this study was to measure the effects of a six month in-house EBP programme on knowledge, skills, attitudes, and perceived barriers of nurses (four European Credits equals two US Credit Hours). A multiple-cohort study was conducted with a pre-post-test design. In the period of 2011-2015, a total of 58 nurses (9 cohorts) followed the programme. Baseline and follow-up assessments consisted of three questionnaires each: the Dutch Modified Fresno, the two subscales of the McColl questionnaire, and the BARRIER scale to assess knowledge and skills, attitudes, and perceived barriers, respectively. Fifty nurses completed both assessments. The results demonstrated that actual knowledge and skills significantly increased by approximately 40%. Self-perceived knowledge increased significantly, while attitudes towards EBP remained (moderately) positive. Perceived barriers did not notably change except for the Research subscale which received many "no opinion" responses prior to the programme but fewer afterwards. Our multifaceted in-house EBP programme led to a significant improvement of approximately 40% in EBP knowledge and skills of participating nurses. Most nurses who followed the EBP programme are currently applying their knowledge and skills in practice. Managerial support and allocated time for EBP are important facilitators for its implementation. Furthermore, to maintain and expand nurses' EBP knowledge and skills and translate them into practice, follow-up interventions, such as journal clubs, may well be beneficial. Based on the positive results of our programme, we will implement it throughout the hospital with an emphasis on training more groups of nurses. Copyright

  3. Strange Bedfellows? Reaffirming Rehabilitation and Prison Privatization

    Science.gov (United States)

    Wright, Kevin A.

    2010-01-01

    Private prisons are here to stay irrespective of empirical findings for or against their existence in the corrections industry. It is necessary, therefore, to step back and consider them on a broader level to assess how they can benefit current penological practice. It will be argued that prison privatization creates an opportunity to reassess the…

  4. Fuelling Economic Growth: The Role of Public–Private Sector ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2009-04-26

    Apr 26, 2009 ... At the same time, however, traditional sources of research funding – from ... Fuelling Economic Growth: The Role of Public–Private Sector ... IDRC congratulates first cohort of Women in Climate Change Science Fellows.

  5. Optional part-time and longer GP training modules in GP practices associated with more trainees becoming GPs - a cohort study in Switzerland.

    Science.gov (United States)

    Studerus, Lara; Ahrens, Regina; Häuptle, Christian; Goeldlin, Adrian; Streit, Sven

    2018-01-05

    Switzerland, like many other countries, has a shortage of General Practitioners (GPs). Optional GP training modules in GP practices were offered during the at least 5-year GP training program to increase student and trainee interest in becoming a GP. The training modules had not yet been evaluated. We determined how many Swiss GP trainees became practicing GPs after they completed optional training modules, and if longer modules were associated with higher rates of GP specialization. In this population-based cohort study, we included GP trainees who chose an optional GP training module in GP practice, provided by the Foundation to Promote Training in General Practice (WHM) between 2006 and 2015. GP trainees were invited to complete an online survey to assess the primary outcome (becoming a practicing GP by 2016). Data on non-responders was collected via an internet search. We calculated univariate time-to-event curves to become a practicing GP, stratified by trainee's gender, length, part-time training, and number of years after graduation until training modules were completed. We used a multivariate model to adjust for characteristics of participants, training, and satisfaction with training modules. We assessed primary outcome for 351 (92.1%) of 381 former GP trainees who participated in a WHM program between 2006 and 2015. Of these 218 (57%) were practicing GPs by 2016. When focusing on the trainees who had completed training between 2006 and 2010, the rate of practicing GPs was even 73%. Longer (p = 0.018) and part-time training modules (p = 0.003) were associated with higher rates of being a practicing GP. Most (81%) practicing GPs thought their optional GP training module was (very) important in their choice of specialty. GP trainees who spent more time training in a GP practice, or who trained part-time were more likely to become practicing GPs. Most (80%) rated their training module as (very) important in their choice of career, highlighting that

  6. Policy-into-practice for rheumatoid arthritis: randomized controlled trial and cohort study of e-learning targeting improved physiotherapy management.

    Science.gov (United States)

    Fary, Robyn E; Slater, Helen; Chua, Jason; Ranelli, Sonia; Chan, Madelynn; Briggs, Andrew M

    2015-07-01

    To examine the effectiveness of a physiotherapy-specific, web-based e-learning platform, "RAP-el," in best-practice management of rheumatoid arthritis (RA) using a single-blind, randomized controlled trial (RCT) and prospective cohort study. Australian-registered physiotherapists were electronically randomized into intervention and control groups. The intervention group accessed RAP-eL over 4 weeks. Change in self-reported confidence in knowledge and skills was compared between groups at the end of the RCT using linear regression conditioned for baseline scores by a blinded assessor, using intent-to-treat analysis. Secondary outcomes included physiotherapists' satisfaction with RA management and responses to RA-relevant clinical statements and practice-relevant vignettes. Retention was evaluated in a cohort study 8 weeks after the RCT. Eighty physiotherapists were randomized into the intervention and 79 into the control groups. Fifty-six and 48, respectively, provided baseline data. Significant between-group differences were observed for change in confidence in knowledge (mean difference 8.51; 95% confidence interval [95% CI] 6.29, 10.73; effect size 1.62) and skills (mean difference 7.26; 95% CI 5.1, 9.4; effect size 1.54), with the intervention group performing better. Satisfaction in ability to manage RA, 4 of the 6 clinical statements, and responses to vignettes demonstrated significant improvement in the intervention group. Although 8-week scores showed declines in most outcomes, their clinical significance remains uncertain. RAP-eL can improve self-reported confidence, likely practice behaviors and satisfaction in physiotherapists' ability to manage people with RA, and improve their clinical knowledge in several areas of best-practice RA management in the short term. © 2015, American College of Rheumatology.

  7. Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: a retrospective cohort study

    NARCIS (Netherlands)

    Vankan, E.; Schoorel, E.N.; Kuijk, S.M. van; Mol, B.J.; Nijhuis, J.G.; Aardenburg, R.; Alink, M.; Boer, K. de; Delemarre, F.M.; Dirksen, C.D.; Dooren, I.M. van; Franssen, M.T.; Kaplan, M.; Kleiverda, G.; Kuppens, S.M.; Kwee, A.; Langenveld, J.; Lim, F.T.; Melman, S.; Sikkema, M.J.; Smits, L.J; Visser, H.; Woiski, M.D.; Scheepers, H.C.; Hermens, R.P.M.G.

    2017-01-01

    INTRODUCTION: Large practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level. MATERIAL AND METHODS:

  8. Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level : A retrospective cohort study

    NARCIS (Netherlands)

    Vankan, Emy; Schoorel, Ellen N. C.; van Kuijk, Sander M. J.; Mol, Ben-Willem J.; Nijhuis, Jan G.; Aardenburg, Robert; Alink, Marleen; de Boer, Karin; Delemarre, Friso M. C.; Dirksen, Carmen D.; Van Dooren, Ivo M. A.; Franssen, Maureen T. M.; Kaplan, Mesrure; Kleiverda, Gunilla; Kuppens, Simone M. I.; Kwee, Anneke; Langenveld, Josje; Lim, Frans T. H.; Melman, Sonja; Sikkema, Marko J.; Smits, Luc J.; Visser, Harry; Woiski, Mallory; Scheepers, Hubertina C.; Hermens, Rosella P. M. G.

    IntroductionLarge practice variation exists in mode of delivery after cesarean section, suggesting variation in implementation of contemporary guidelines. We aim to evaluate this practice variation and to what extent this can be explained by risk factors at patient level. Material and methodsThis

  9. Private sector engagement in refugee education

    Directory of Open Access Journals (Sweden)

    Zeena Zakharia

    2018-02-01

    Full Text Available The involvement of the private sector in providing education for Syrian refugees has much to commend it but greater consideration needs to be paid to the ethical and practical concerns that may arise.

  10. Prevalência e fatores associados à prática de esportes individuais e coletivos em adolescentes pertencentes a uma coorte de nascimentos Individual and collective sports practice and associated factors among adolescents belonging to a birth cohort study

    Directory of Open Access Journals (Sweden)

    Suele Manjourany Silva

    2009-09-01

    Full Text Available O presente estudo investigou a prática de esportes individuais e coletivos e fatores associados em jovens com idade média de 11 anos, pertencentes a uma coorte de nascimentos. Informações dos jovens e de suas mães foram coletadas por meio de questionários. O desfecho foi dividido em prática de esportes individuais e coletivos. Uma análise por meio de regressão de Poisson foi conduzida para estabelecer os fatores associados à prática esportiva, obedecendo a um modelo conceitual de análise com as variáveis independentes hierarquizadas. Um total de 4350 jovens foi estudado. A prática de esportes coletivos foi menor nas meninas - 68,1% (IC95% 66,2 - 70,0 em comparação aos meninos - 82,1% (IC95% 80,5 - 83,7. Nos esportes individuais, a prevalência foi de 12,9% (IC95% 11,6 - 14,4 e 18,9% (IC95% 17,3 - 20,6 em meninas e meninos, respectivamente. Entre as meninas, a prática de esportes individuais relacionou-se diretamente com nível econômico e inversamente com assistir televisão. Nos meninos este desfecho associou-se com estudar em escolas privadas e ter mães fisicamente ativas. Em esportes coletivos, a prática foi menor naqueles que despendem maior tempo assistindo TV. Em ambos os sexos houve uma relação direta entre o uso regular do vídeo-game e a prática de esportes. Políticas públicas devem considerar os diferentes aspectos relacionados à prática esportiva e atender a disparidades socioeconômicas no acesso a diferentes modalidades esportivas. Além disso, o maior acesso a diferentes locais de práticas esportivas, bem como o incentivos de pais, amigos e ambiente escolar devem ser fortalecidos.The present study investigated individual and collective sports practice and associated factors among adolescents with a mean age of 11 years, belonging to a birth cohort study. Information on the adolescents and on their mothers were obtained through questionnaires. The outcome variable was divided into practice of individual

  11. Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study

    Directory of Open Access Journals (Sweden)

    de Vries Nanne K

    2011-03-01

    Full Text Available Abstract Background Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI development. Methods Questionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026 and 7 (N = 1819. Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation, and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake and activity behavior (i.e., physical activity and sedentary time at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics. Results Several child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these

  12. Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study.

    Science.gov (United States)

    Gubbels, Jessica S; Kremers, Stef P J; Stafleu, Annette; de Vries, Sanne I; Goldbohm, R Alexandra; Dagnelie, Pieter C; de Vries, Nanne K; van Buuren, Stef; Thijs, Carel

    2011-03-14

    Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development. Questionnaire data originated from the KOALA Birth Cohort Study for ages 5 (N = 2026) and 7 (N = 1819). Linear regression analyses were used to examine the association of child and parent background characteristics with parenting practices (i.e., diet- and activity-related restriction, monitoring and stimulation), and to examine the associations between these parenting practices and children's diet (in terms of energy intake, dietary fiber intake, and added sugar intake) and activity behavior (i.e., physical activity and sedentary time) at age 5, as well as BMI development from age 5 to age 7. Moderation analyses were used to examine whether the associations between the parenting practices and child behavior depended on child characteristics. Several child and parent background characteristics were associated with the parenting practices. Dietary monitoring, stimulation of healthy intake and stimulation of physical activity were associated with desirable energy balance-related behaviors (i.e., dietary intake and/or activity behavior) and desirable BMI development, whereas restriction of sedentary time showed associations with undesirable behaviors and BMI development. Child eating style and weight status, but not child gender or activity style, moderated the associations between parenting practices and behavior. Dietary restriction and monitoring showed weaker, or even undesirable associations for children with a deviant eating style, whereas these practices showed associations with desirable behavior for

  13. The role of the Public Private Partnership (PPP) in Cross Border Cooperation (CBC) as strategic practice in the EU Policies and cooperation tools for 2014-2020

    OpenAIRE

    Lussi, Manoela

    2014-01-01

    2012/2013 There is an increasingly widespread acknowledgement among all active actors in the development co-operation sector that the Public Private Partnership (PPP) can be a new important tool, not only to build important infrastructure (public works) but also to provide services to the citizens at central and local level as well as to have a strategic value in the Cross-Border Co-operation (CBC) in the next future. The European Commission defines PPPs in a rather broad and general wa...

  14. Feasibility of selected private money

    Directory of Open Access Journals (Sweden)

    Lukáš Nevěděl

    2012-01-01

    Full Text Available The goal of the entry: “Feasibility of selected private money” is the assessment of practicability of selected private money types as future currency especially in terms of attributes that the currency should meet to fulfil all claims required by its users. In the first step the features that the widely used currency has to have will be described and it will be analysed which of these features are characteristic for nowadays currencies (Czech crown and Euro too. In the second step private (unnationalized money will be described as well as several concepts derived from it. The paper will concern mainly on Hayek’s concept of private money and on particular variations of Local exchange trading systems. In the next part there will be pointed out good and bad features of these types of money, mainly from the view of characteristics that the proper currency should have. At the end it will be carried out the comparison of bad and good effects resulting from using of particular currencies types and I will decide about the applicability of analysed private money types. The paper uses the standard methods of scientific work. Firstly, the method of description is used to describe the development of private money concepts and characteristic features that the currency should have. Then, a comparative analysis is used to discuss the differences between contemporary currencies and unnationalized currencies as well as between required and real features of particular private money. At the end the method of synthesis, deduction and induction is used.

  15. Public-Private Partnerships

    DEFF Research Database (Denmark)

    Helby Petersen, Ole

    This PhD dissertation studies national similarities and differences in policy and regulation of public-private partnerships (PPPs), with an empirical focus on Denmark and Ireland. The starting point and motivation for the study is the observation that whereas PPPs are often depicted in the academic...... time, and how can their similarities and differences be explained?; (iii) how do differing national policy and regulation frameworks serve to facilitate or hinder the formation of PPPs, exemplified by four case studies from the schools sector?; (iv) what framework conditions does the EU set for PPP...... literature and in policy practice as a globally disseminated governance scheme, in reality, a closer examination of the PPP reform landscape reveals significant differences in national governments’ PPP policy and regulation and in the amount of actually implemented PPP projects. By comparing the initiatives...

  16. Private Water Districts

    Data.gov (United States)

    California Natural Resource Agency — Private Water District boundaries are areas where private contracts provide water to the district in California. This database is designed as a regions polygon...

  17. 16 CFR 2.3 - Policy as to private controversies.

    Science.gov (United States)

    2010-01-01

    ... 16 Commercial Practices 1 2010-01-01 2010-01-01 false Policy as to private controversies. 2.3 Section 2.3 Commercial Practices FEDERAL TRADE COMMISSION ORGANIZATION, PROCEDURES AND RULES OF PRACTICE... other action when the alleged violation of law is merely a matter of private controversy and does not...

  18. Patient characteristics in low back pain subgroups based on an existing classification system. A descriptive cohort study in chiropractic practice

    DEFF Research Database (Denmark)

    Eirikstoft, Heidi; Kongsted, Alice

    2014-01-01

    reducible disc syndromes followed by facet joint pain, dysfunction and sacroiliac (SI)-joint pain. Classification was inconclusive in 5% of the patients. Differences in pain, activity limitation, and psychological factors were small across subgroups. Within 10 days, 82% were reported to belong to the same......Sub-grouping of low back pain (LBP) is believed to improve prediction of prognosis and treatment effects. The objectives of this study were: (1) to examine whether chiropractic patients could be sub-grouped according to an existing pathoanatomically-based classification system, (2) to describe...... patient characteristics within each subgroup, and (3) to determine the proportion of patients in whom clinicians considered the classification to be unchanged after approximately 10 days. A cohort of 923 LBP patients was included during their first consultation. Patients completed an extensive...

  19. Changes in Veterinary Students' Attitudes Toward the Rural Environment and Rural Veterinary Practice: A Longitudinal Cohort Study.

    Science.gov (United States)

    Hashizume, Cary T; Woloschuk, Wayne; Hecker, Kent G

    2015-01-01

    There is a paucity of research regarding veterinary students' attitudes toward the rural environment and rural veterinary practice and how these attitudes might change over the course of a veterinary medicine program that includes rural clinical experience. Using a 23-item questionnaire, attitudes toward rural lifestyle, rural work-life balance, opportunities for career and skill development in rural veterinary practice, and inter-professional teamwork in the rural environment were assessed at the beginning and completion of a four-year veterinary medicine program. Eighty-six students (74.4% female) were included in this Canadian study over a six-year period. Thirty-one participants (36.1%) were rural students. Overall, students' attitudes toward the rural lifestyle, rural work-life balance, and inter-professional teamwork in rural veterinary practice all significantly decreased (pstudents, rural students had significantly higher rural lifestyle scores at both the beginning (pworking in a rural environment could influence students to exclude rural veterinary practice as a career choice. Rural clinical experiences designed to sustain or increase veterinary student interest in rural practice may not be sufficient to support positive rural attitudes. Given the demand for rural veterinary services in developed countries, the implications of this study may extend beyond Canada.

  20. Productivity of nonindustrial private forests in western Washington: alternative futures.

    Science.gov (United States)

    Ralph J. Alig; Darius M. Adams

    1995-01-01

    Nonindustrial private timberlands in western Washington have high productive potential and contribute harvest amounts somewhat more than proportional to their area. Of all private ownerships they are influenced the most by land use shifts and are affected in important ways by forest practice regulations. About 1 million acres of nonindustrial private timberland contain...

  1. Utilisation of psychiatrists and psychologists in private practice among non-Western labour immigrants, immigrants from refugee-generating countries and ethnic Danes

    DEFF Research Database (Denmark)

    Nielsen, Signe Smith; Jensen, Natasja Koitzsch; Kreiner, Svend

    2015-01-01

    ), and immigrants from RGC (Iran, Iraq, Lebanon, and Somalia). Survey data was linked to healthcare utilisation registries. Using Poisson regression, contacts with private practising psychiatrists and psychologists were estimated. Analyses were adjusted for socioeconomic factors and mental health status. RESULTS......: Overall, 2.2 % among ethnic Danes, 1.4 % among labour immigrants and 6.5 % among immigrants from RGC consulted a psychiatrist or psychologist. In adjusted analyses, for psychiatrists, compared with ethnic Danes, labour-immigrant women (multiplicative effect = 1.78), and immigrant women from RGC...... (multiplicative effect = 2.49) had increased use, while labour-immigrant men had decreased use (multiplicative effect = 0.03). For psychologists, immigrant men from RGC had increased use (multiplicative effect = 2.96), while labour-immigrant women had decreased use (multiplicative effect = 0.27) compared...

  2. Private Equity Waves

    NARCIS (Netherlands)

    J.T.J. Smit (Han); W.A. van den Berg (Ward)

    2006-01-01

    textabstractThis study presents a dynamic model for the private equity market in which information revelation and uncertainty rationally explain the cyclical pattern of investment flows into private equity. The net benefit of private equity over public equity is i) uncertain and ii) agents have

  3. More "Private" than Private Institutions: Public Institutions of Higher Education and Financial Management

    Science.gov (United States)

    Adams, Olin L., III; Robichaux, Rebecca R.; Guarino, A. J.

    2010-01-01

    This research compares the status of managerial accounting practices in public four-year colleges and universities and in private four-year colleges and universities. The investigators surveyed a national sample of chief financial officers (CFOs) at two points in time, 1998-99 and 2003-04. In 1998-99 CFOs representing private institutions reported…

  4. Infant and Young Child Feeding Practices in Infants Receiving Skin to Skin Care at Birth: Follow-up of Randomized Cohort.

    Science.gov (United States)

    Nimbalkar, Archana Somashekhar; Patel, Dipen Vasudev; Nimbalkar, Somashekhar Marutirao; Patel, Vijay Karshanbhai; Patel, Dhaval Nileshbhai; Phatak, Ajay Gajanan

    2016-12-01

    Skin to Skin Care (SSC) in neonatal period influences immediate breastfeeding outcomes in early childhood, especially the duration of exclusive breastfeeding. We investigated influence of 17 hours of SSC given from day one of life on Infant and Young Child Feeding (IYCF) practices through one year of life. Follow-up of a Superiority Randomized Control Trial (RCT) (CTRI/2013/06/003790) conducted in a teaching hospital located in central Gujarat. Mothers of 100 neonates (48 girls, 52 boys) from previous study cohort of RCT on SSC were followed. A survey on IYCF practices during the first year of life was administered after the end of infancy. In RCT, 50 neonates had received SSC beginning of 30 min- 1 hour after birth for average 17 hours on day 1 of life. In the control group, 50 newborn were placed next to the mother and conventional care was provided. There was a significant difference between hypothermia incidences in these groups in the first two days of life. There was no difference in the groups as far as the duration of exclusive breastfeeding, number of times breastfed per day, or stoppage of night feeds. No baby in either group received bottled feeds but about 53 received some form of extra lacteal feeds in the first 6 months without significant group difference. Fewer SSC mothers reported difficulties with breastfeeding or extra lacteal supplementation. All mothers who faced problems contacted physicians for advice and 20 were advised top milk and 6 given other foods. At one year of life 66% mothers were giving less than the recommended five food servings. There was no difference in practices related to hand washing, food preparation and storage, feeding habits of child and illness episodes in the children. IYCF practices in this small group were not as per guidelines. Few positive trends were seen with fewer SSC mothers facing problems related to breastfeeding. The study was underpowered to detect differences in IYCF practices in relation to SSC.

  5. Differences in diagnostic activity in general practice and findings for individuals invited to the danish screening programme for colorectal cancer: a population-based cohort study.

    Science.gov (United States)

    Juul, Jakob Søgaard; Andersen, Berit; Laurberg, Søren; Carlsen, Anders Helles; Olesen, Frede; Vedsted, Peter

    2018-06-22

    To investigate the diagnostic activity in general practice and the cumulative incidence of colorectal cancer (CRC) in individuals invited to the Danish national screening programme for CRC. A historical population-based cohort study. The Danish CRC screening programme and general practice. The 376,198 individuals invited to the Danish CRC screening programme from 1 March to 31 December 2014. The diagnostic activity (consultations and haemoglobin measures) in general practice in the year preceding the screening invitation and the cumulated incidence of CRC in the year following the screening invitation. Screening participants had significantly higher diagnostic activity than non-participants. Individuals with a positive faecal immunochemical test (FIT) had higher diagnostic activity compared to individuals with a negative FIT, and a small increase in the months leading up to the invitation. Individuals with a screen-detected CRC had lower diagnostic activity than individuals with no CRC. In total, 308 (25.3%) of CRCs diagnosed in the invited population were diagnosed outside the screening programme. Non-participants with CRC more often had low socio-economic status, high comorbidity and stage IV CRC than participants with CRC. There was a tendency that participants and those with a positive FIT had a higher diagnostic activity the year before the screening. This was not seen for those with CRC detected through screening. CRC must still be diagnosed in general practice in the invited population and non-participants are of special interest as they have higher risk of late stage CRC. Key Points Current awareness:Individuals with colorectal cancer (CRC) in screening may be symptomatic and CRC may still occur outside screening in the invited population. Most important points:The majority of individuals with CRC in screening cannot be expected to be diagnosed on symptomatic presentation in general practice GPs have to be aware that CRC still occurs outside screening in

  6. How private are Europe's private forests?

    DEFF Research Database (Denmark)

    Nichiforel, Liviu; Keary, Kevin; Deuffic, Philippe

    2018-01-01

    Private forests are widespread in Europe providing a range of ecosystem services of significant value to society, and there are calls for novel policies to enhance their provision and to face the challenges of environmental changes. Such policies need to acknowledge the importance of private...... across jurisdictions, we constructed an original Property Rights Index for Forestry encompassing five rights domains (access, withdrawal, management, exclusion and alienation). We documented substantial variation of the private forest owners' rights, and notably to i) make decisions in operational...... management and the formulation of management goals, ii) withdraw timber resources from their forest, and iii) exclude others from the use of forest resources. We identified broad relations between the scope for decision making of private forest owners and jurisdictions' former socio-political background...

  7. Gender influences on career opportunities, practice choices, and job satisfaction in a cohort of physicians with certification in sports medicine.

    Science.gov (United States)

    Pana, A L; McShane, J

    2001-04-01

    To examine the gender differences in practice patterns, experiences, and career opportunities for family physicians who practice sports medicine. Descriptive, self-administered questionnaire. Family physicians with Certificate of Added Qualification (CAQ) in sports medicine were surveyed. The survey was sent to all women with a CAQ in Sports Medicine and a random sample of 20% of the men with CAQs in sports medicine. Survey consisted of multiple choice, Likert scale, and opened-ended questions. The data was analyzed with contingency tables, with gender as the dependent variable. Response rate to the survey was 75%, which included 42 females and 102 males. Demographics of our population demonstrated some gender differences. Males were of higher average age (41.1 vs. 38.1), and more likely to be married and have children. Practice types, location, and time spent in sports medicine did not differ with the exception of training room and event coverage. Males were more likely to cover all levels of training room except at the Division I level, where the percent of males and females covering training rooms were equal. Males were also more likely to cover all types of sporting events. Job satisfaction and reasons for choosing current jobs did not show significant gender differences. However, factors affecting career opportunities did vary. Professional relationships with athletic trainers and coaches were perceived to be different by males and females surveyed. Our survey of sports medicine physicians showed some gender differences in practice patterns relative to training room and sporting event coverage. Surprisingly, there were not many differences in the factors that affected job choice and factors affecting job opportunities with the exception of gender itself. However, our study does not conclude how or when gender begins to affect the female sports medicine physician's career opportunities.

  8. Mortality rates and causes of death in children with epilepsy prescribed antiepileptic drugs: a retrospective cohort study using the UK General Practice Research Database.

    Science.gov (United States)

    Ackers, Ruth; Besag, Frank M C; Hughes, Elaine; Squier, Waney; Murray, Macey L; Wong, Ian C K

    2011-05-01

    Patients with epilepsy, including children, have an increased risk of mortality compared with the general population. Antiepileptic drugs (AEDs) were the most frequent class of drugs reported in a study looking at fatal suspected adverse drug reactions in children in the UK. The objective of the study was to identify cases and causes of death in a paediatric patient cohort prescribed AEDs with an associated epilepsy diagnosis. This was a retrospective cohort study supplemented with general practitioner-completed questionnaires, post-mortem reports and death certificates. The setting was UK primary care practices contributing to the General Practice Research Database. Participants were children and adolescents aged 0-18 years prescribed AEDs between 1993 and 2005. Causality assessment was undertaken by a consensus panel comprising paediatric specialists in neuropathology, neurology, neuropsychiatry, paediatric epilepsy, pharmacoepidemiology and pharmacy to determine crude mortality rate (CMR) and standardized mortality ratios (SMRs), and the likelihood of an association between AED(s) and the event of death. There were 6190 subjects in the cohort (contributing 26,890 person-years of data), of whom 151 died. Median age at death was 8.0 years. CMR was 56.2 per 10,000 person-years and the SMR was 22.4 (95% CI 18.9, 26.2). The majority of deceased subjects had severe underlying disorders. Death was attributable to epilepsy in 18 subjects; in 9 the cause of death was sudden unexpected death in epilepsy (SUDEP) [3.3 per 10 000 person-years (95% CI 1.5, 6.4)]. AEDs were probably (n = 2) or possibly (n = 3) associated causally with death in five subjects. Two status epilepticus deaths were associated causally with AED withdrawal. Children prescribed AEDs have an increased risk of mortality relative to the general population. Most of the deaths were in children with serious underlying disorders. A small number of SUDEP cases were identified. AEDs are not a major

  9. Factors associated with non-attendance in a general practice super clinic population in regional Australia: A retrospective cohort study.

    Science.gov (United States)

    Nancarrow, Susan; Bradbury, Joanne; Avila, Catherine

    2014-01-01

    Non-attendance at medical appointments is associated with increased patient morbidity and is a significant drain on health service resources. Australian studies have focused on secondary healthcare settings, screening, and interventions to reduce non-attendance. To explore factors associated with non-attendance in a regional primary care setting. A retrospective cohort of all patients with a scheduled appointment between October 2011 and October 2013 at a regional, primary care clinic providing medical and allied health services in a region of New South Wales (NSW) serving a large Aboriginal population (10.7 per cent). Using multivariate logistic regression, non-attendance was regressed on a range of covariates, including number of appointments per person, gender and ethnicity, and day of the week. The overall proportion of missed appointments was 7.6 per cent. Risk factors for non-attendance were day of the week [Mondays (8.1 per cent), Fridays (8.0 per cent), and Thursdays (7.9 per cent), (χ2(4)= 20.208, pattend (FTA) (95% CI: 11-28%)]; Aboriginality (OR=4.022, 95% CI: 3.263, 4.956), and female gender (OR=1.077; 95% CI 1.024, 1.132). There was a trend toward an interaction between gender and Aboriginality, with Aboriginal females being the group most likely to miss appointments (OR=1.272, 95% CI: 0.949, 1.705). This is the largest study of non-attendance in an Australian primary healthcare setting. While not a typical setting, the study had the advantage of a large, mixed population. The suggested high rates of non-attendance by Aboriginal females have potentially important policy implications.

  10. Characterisation of antibiotic prescriptions for acute respiratory tract infections in Danish general practice: a retrospective registry based cohort study.

    Science.gov (United States)

    Aabenhus, Rune; Hansen, Malene Plejdrup; Saust, Laura Trolle; Bjerrum, Lars

    2017-05-19

    Inappropriate use of antibiotics is contributing to the increasing rates of antimicrobial resistance. Several Danish guidelines on antibiotic prescribing for acute respiratory tract infections in general practice have been issued to promote rational prescribing of antibiotics, however it is unclear if these recommendations are followed. We aimed to characterise the pattern of antibiotic prescriptions for patients diagnosed with acute respiratory tract infections, by means of electronic prescriptions, labeled with clinical indications, from Danish general practice. Acute respiratory tract infections accounted for 456,532 antibiotic prescriptions issued between July 2012 and June 2013. Pneumonia was the most common indication with 178,354 prescriptions (39%), followed by acute tonsillitis (21%) and acute otitis media (19%). In total, penicillin V accounted for 58% of all prescriptions, followed by macrolides (18%) and amoxicillin (15%). The use of second-line agents increased with age for all indications, and comprised more than 40% of the prescriptions in patients aged >75 years. Women were more often prescribed antibiotics regardless of clinical indication. This is the first Danish study to characterise antibiotic prescription patterns for acute respiratory tract infections by data linkage of clinical indications. The findings confirm that penicillin V is the most commonly prescribed antibiotic agent for treatment of patients with an acute respiratory tract infection in Danish general practice. However, second-line agents like macrolides and amoxicillin with or without clavulanic acid are overused. Strategies to improve the quality of antibiotic prescribing especially for pneumonia, acute otitis media and acute rhinosinusitis are warranted. TRACKING THE OVERUSE OF ANTIBIOTICS: Better adherence to guidelines for prescribing antibiotics for different respiratory tract infections are warranted in Danish general practice. The over-use of antibiotics, particularly so

  11. Privatization in economic theory

    Directory of Open Access Journals (Sweden)

    Drakić Maja

    2007-01-01

    Full Text Available In reality privatization has never occurred according to the handbook rules of ordinary market transactions. Not even in advanced market economies can privatization transactions be described by the Walrasian or Arrowian, or Leontiefian equilibrium models, or by the equilibrium models of the game theory. In these economies transactions of privatization take place in a fairly organic way – which means that those are driven by the dominance of private property rights and in a market economy. But despite this fact Western privatization also some peculiar features as compared to ordinary company takeovers, since the state as the seller may pursue non – economic goals. Changes in the dominant form of property change positions and status of many individuals and groups in the society. That’s why privatization can even less be explained by ordinary market mechanisms in transition countries where privatizing state-owned property have happened in a mass scale and where markets and private property rights weren't established at the time process of privatization began. In this paper I’ll discuss and analyze the phenomenon of privatization in context of different economic theories arguing that empirical results go in favor of the public choice theory (Buchanan, 1978, theory of "economic constitution" (Brennan and Buchanan 1985, (Buchanan and Tullock, 1989, and theory of "collective action" (Olson, 1982. These theories argues that transition from one economic system into another, for example transition from collectivistic, socialistic system into capitalism and free market economy with dominant private property, will not happen through isolated changes of only few economic institutions, no matter how deep that changes would be. In other words privatization can not give results if it's not followed by comprehensive change of economic system because privatized companied wouldn't be able to operate in old environment.

  12. Stockholders' interests in the energy system privatization

    International Nuclear Information System (INIS)

    Matei, Magdalena; Matei, Lucian

    2004-01-01

    The paper highlights the benefits and objectives of competition and privatization in the power sector. The reasons for electric utility privatization are numerous and vary from country to country. Some of the more evident reasons include the following: - Raising revenues for the state through asset sales; - Acquiring investment capital; - Improving managerial performance; - Moving toward market-determined prices; - Technology transfer; - Reducing the frequency of power shortages; - Reducing the cost of electricity to consumers through efficiency gain; - Taking advantage of creating national and regional power grids. Several objectives commonly associated with privatization, includes: - Improving access to private capital resources for the rehabilitation, replacement and eventual expansion of the electric power infrastructure; - Improving access to new technology and management practices designed to improve the performance of the sector; - Reducing corruption through the introduction of commercial practices which will lead to strengthened collections, transparent and accountable delivery of electricity and reduced political interference in commercial operations; - Improving customer service and customer choice through continued reform of the power sector as a result of innovation and reform introduced by the new owners; - Human resources development; - Improving environmental performance . The paper addresses the following items: - Some elements of a successful power sector privatization; - Stockholders' position versus privatization in Romania; - Managing 'The Change'; - Power sector privatization in Romania. The paper demonstrates that the power sector privatization is a key condition for EU's support for Romania accession. The international organization push towards this essential economic change, which will guarantee a real competition and a liberalized energy market in facto. Strategic privatization can be a positive step in improving energy service and

  13. Counselor Attitudes toward and Use of Evidence-Based Practices in Private Substance Use Disorder Treatment Centers: A Comparison of Social Workers and Non-Social Workers

    Science.gov (United States)

    Bride, Brian E.; Kintzle, Sara; Abraham, Amanda J.; Roman, Paul M.

    2012-01-01

    The purpose of this study was to examine factors that may be associated with variation in social workers' perceptions of effectiveness, perceptions of acceptability, and use of psychosocial evidence-based practices (EBPs) for the treatment of substance use disorders (SUD) in comparison to other SUD counselors who are non-social workers. A national…

  14. Constitutional Law--State Action--Hiring and Promotion Practices of Private University Receiving Public Funds Held State Action--Braden v. University of Pittsburgh.

    Science.gov (United States)

    New York University Law Review, 1977

    1977-01-01

    In Braden vs University of Pittsburgh, a female professor filed suit against the University alleging sex discrimination in employment practices. The professor alleged that the school, which received state funds, was, in effect, a state actor and subject to constitutional restraints. This case and two relevant state action cases are discussed. (JMD)

  15. Oral cancer--current knowledge, practices and implications for training among an Irish general medical practitioner cohort.

    LENUS (Irish Health Repository)

    Ni Riordain, Richeal

    2009-11-01

    This study investigated the current knowledge and practices of general medical practitioners (GMPs) in Ireland regarding the examination of the oral cavity and the detection of oral malignancy and the training they had received at both undergraduate and postgraduate level and since commencing in practice. A questionnaire survey of GMPs in Ireland was conducted. One hundred and fifty four (65.3%) of the practitioners reported regularly examining the oral mucosa of their patients. Almost half of these (n=68) further qualified this response by stating that they only examined the oral mucosa if the patient reported pain in this area or if the patient specifically requested an oral examination for some reason. Eighty one (34.3%) practitioners surveyed felt confident in their ability to detect oral malignancies with the remaining two thirds unsure of whether they would be able to detect oral cancer. There was a significant association between the undergraduate and postgraduate teaching on examination of the oral cavity and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=4.811, p<0.05]. A statistically significant association was also found between the undergraduate and postgraduate teaching on the diagnosis of oral malignant disease and whether practitioners felt confident in their ability to detect oral cancer [chi(2)(1)=6.194, p<0.05]. In conclusion the level of knowledge of Irish general medical practitioners needs to be addressed with appropriate initiatives both at undergraduate level and via CME.

  16. ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS CONSANGUINEOUS MARRIAGES AMONG A COHORT OF MULTIETHNIC HEALTH CARE PROVIDERS IN SAUDI ARABIA.

    Science.gov (United States)

    Alnaqeb, Dhekra; Hamamy, Hanan; Youssef, Amira M; Al-Rubeaan, Khalid

    2018-01-01

    This study aimed to assess knowledge, attitude and practice related to consanguinity among multiethnic health care providers in the Kingdom of Saudi Arabia. Using a cross-sectional study design, a validated, self-administered close-ended questionnaire was randomly distributed to health care providers in different health institutions in the country between 1st August 2012 and 31st July 2013. A total of 1235 health care providers completed the study questionnaire. Of the 892 married participants (72.23% of total), 11.43% were married to a first cousin, and were predominantly Arabs, younger than 40 years and male. Only 17.80% of the patients seen by the health care providers requested consanguinity related counselling. A knowledge barrier was expressed by 27.49% of the participants, and 85.67% indicated their willingness to have more training in basic genetic counselling. A language barrier was expressed as a limiting factor to counselling for consanguinity among non-Arabs. The health care providers had a major dearth of knowledge that was reflected in their attitude and practice towards consanguinity counselling. This finding indicates the need for more undergraduate and postgraduate medical and nursing education and training in the counselling of consanguineous couples. It is recommended that consanguinity counselling is included in the current premarital screening and counselling programmes in the Kingdom.

  17. Can father inclusive practice reduce paternal postnatal anxiety? A repeated measures cohort study using the hospital anxiety and depression scale

    Directory of Open Access Journals (Sweden)

    Tohotoa Jenny

    2012-07-01

    Full Text Available Abstract Background Perinatal research on anxiety and depression has primarily focused on mothers. We have limited knowledge of fathers’ anxiety during the perinatal period yet there is evidence that the parenting capacity of a person can be compromised by anxiety and depression. The purpose of this paper is to identify the impact of a father inclusive intervention on perinatal anxiety and depression. The prime focus of the intervention was to provide education and support to fathers of breastfeeding partners with the aim of increasing both initiation and duration of breastfeeding. Methods A repeated measures cohort study was conducted during a RCT that was implemented across eight public maternity hospitals in Perth, Western Australia between May 2008 and June 2009. A baseline questionnaire which included the Hospital Anxiety and Depression Scale (HADS was administered to all participants on the first night of their hospital based antenatal education program and was repeated at six weeks postnatal. SPSS version 17 was used for reporting descriptive results. Results The mean anxiety levels at baseline for the fathers in the intervention group (n=289 and control group (n=244 were 4.58 and 4.22 respectively. At 6 weeks postnatal (only matched pairs, intervention and control group were 3.93 and 3.79. More intervention group fathers self-rated less anxiety compared to the fathers in the control group from baseline to post test (p=0.048. Depression scores for intervention fathers at baseline (mean =1.09 and at six weeks (mean=1.09 were very similar to fathers in the control group at baseline (mean=1.11 and at six weeks (mean =1.07 with no significant changes. Conclusions Both intervention and control group fathers experienced some anxiety prior to the birth of their baby, but this was rapidly reduced at six weeks. Paternal anxiety is common to new fathers and providing them with information and strategies for problem-solving can increase their

  18. Cohort Coefficients

    DEFF Research Database (Denmark)

    Kristensen, Gustav

    2013-01-01

    Cohorts are the aggregate of individuals who experience the same event within the same time interval. Cohorts can be based on people born in a given year, for example in 1940 or within a span of years, e.g. born in 1940-1944. The year of birth is here the defining event for cohorts. The health di...... differs between cohorts. This article focuses on the protective and detrimental cohort effect in relation to the risk of death from apoplexy. A dummy variable method is recommended to describe the changing cohort effect over a century....

  19. Prevalence of Comorbidities in Rheumatoid Arthritis and Evaluation of Their Monitoring in Clinical Practice: The Spanish Cohort of the COMORA Study.

    Science.gov (United States)

    Balsa, Alejandro; Lojo-Oliveira, Leticia; Alperi-López, Mercedes; García-Manrique, María; Ordóñez-Cañizares, Carmen; Pérez, Lorena; Ruiz-Esquide, Virginia; Corrales, Alfonso; Narváez, Javier; Rey-Rey, José; Rodríguez-Lozano, Carlos; Ojeda, Soledad; Muñoz-Fernández, Santiago; Nolla, Joan M; García-Torrón, José; Gamero, Fernando; García-Vicuña, Rosario; Hernández-Cruz, Blanca; Campos, José; Rosas, José; García-Llorente, José Francisco; Gómez-Centeno, Antonio; Cáliz, Rafael; Sanmartí, Raimon; Bermúdez, Alberto; Abasolo-Alcázar, Lydia; Fernández-Nebro, Antonio; Rodríguez-Rodríguez, Luis; Marras, Carlos; González-Gay, Miguel Ángel; Hmamouchi, Ihsane; Martín-Mola, Emilio

    2017-07-12

    To describe the prevalence of comorbidities in patients with RA in Spain and discuss their management and implications using data from the Spanish cohort of the multinational study on COMOrbidities in Rheumatoid Arthritis (COMORA). This is a national sub-analysis of the COMORA study. We studied the demographics and disease characteristics of 200 adults patients diagnosed with RA (1987 ACR), and routine practices for screening and preventing the following selected comorbidities: cardiovascular, infections, cancer, gastrointestinal, pulmonary, osteoporosis and depression. Patients had a mean age of 58 years and a mean RA duration of 10 years. Mean DAS28 score was 3.3 and approximately 25% of patients were in remission (DAS28 20% (51%), hypercholesterolemia (46%) or hypertension (41%) and smoking (25%) were the most common CV risk factors. For prostate, colon and skin cancers, only 9%, 10% and 18% of patients, respectively, were optimally monitored. Infections were also inadequately managed, with 7% and 17% of patients vaccinated against influenza and pneumococcal, respectively, as was osteoporosis, with 47% of patients supplemented with vitamin D and 56% with a bone densitometry performed. In Spain, the prevalence of comorbidities and CV risk factors in RA patients with established and advanced disease is relatively high, and their management in clinical daily practice remains suboptimal. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  20. Analysis of effectiveness, safety and optimization of tocilizumab in a cohort of patients with rheumatoid arthritis in clinical practice.

    Science.gov (United States)

    Mena-Vázquez, Natalia; Manrique-Arija, Sara; Rojas-Giménez, Marta; Ureña-Garnica, Inmaculada; Jiménez-Núñez, Francisco G; Fernández-Nebro, Antonio

    2017-07-01

    To evaluate the effectiveness and safety of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) in clinical practice, establishing the optimized regimen and switching from intravenous (IV) to subcutaneous (SC) therapy. Retrospective observational study. We included 53 RA patients treated with TCZ. The main outcome was TCZ effectiveness at week 24. Secondary outcome variables included effectiveness at week 52, therapeutic maintenance, physical function and safety. The effectiveness of optimization and the switch from IV to SC was evaluated at 3 and 6 months. The efficacy was measured with the Disease Activity Score. Paired t-tests or Wilcoxon were used to evaluate effectiveness and survival time using Kaplan-Meier. The proportion of patients who achieved remission or low disease activity at weeks 24 and 52 was 75.5% and 87.3%, respectively. The mean retention time (95% confidence interval [95% CI] was 81.7 months [76.6-86.7]). Twenty-one of 53 patients (39.6%) optimized the TCZ dose and 35 patients switched from IV TCZ to SC, with no changes in effectiveness. The adverse event rate was 13.6 events/100 patient-years. Tocilizumab appears to be effective and safe in RA in clinical practice. The optimized regimen appears to be effective in most patients in remission, even when they change from IV to SC. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

  1. Data Access and Usage Practices Across a Cohort of Researchers at a Large Tertiary Pediatric Hospital: Qualitative Survey Study.

    Science.gov (United States)

    Ho, Hoi Ki Kiki; Görges, Matthias; Portales-Casamar, Elodie

    2018-05-14

    Health and health-related data collected as part of clinical care is a foundational component of quality improvement and research. While the importance of these data is widely recognized, there are many challenges faced by researchers attempting to use such data. It is crucial to acknowledge and identify barriers to improve data sharing and access practices and ultimately optimize research capacity. To better understand the current state, explore opportunities, and identify barriers, an environmental scan of investigators at BC Children's Hospital Research Institute (BCCHR) was conducted to elucidate current local practices around data access and usage. The Clinical and Community Data, Analytics and Informatics group at BCCHR comprises over 40 investigators with diverse expertise and interest in data who share a common goal of facilitating data collection, usage, and access across the community. Semistructured interviews with 35 of these researchers were conducted, and data were summarized qualitatively. A total impact score, considering both frequency with which a problem occurs and the impact of the problem, was calculated for each item to prioritize and rank barriers. Three main themes for barriers emerged: the lengthy turnaround time before data access (18/35, 51%), inconsistent and opaque data access processes (16/35, 46%), and the inability to link data (15/35, 43%) effectively. Less frequent themes included quality and usability of data, ethics and privacy review barriers, lack of awareness of data sources, and efforts required duplicating data extraction and linkage. The two main opportunities for improvement were data access facilitation (14/32, 44%) and migration toward a single data platform (10/32, 31%). By identifying the current state and needs of the data community onsite, this study enables us to focus our resources on combating the challenges having the greatest impact on researchers. The current state parallels that of the national landscape. By

  2. Prostate-specific antigen (PSA) testing of men in UK general practice: a 10-year longitudinal cohort study.

    Science.gov (United States)

    Young, Grace J; Harrison, Sean; Turner, Emma L; Walsh, Eleanor I; Oliver, Steven E; Ben-Shlomo, Yoav; Evans, Simon; Lane, J Athene; Neal, David E; Hamdy, Freddie C; Donovan, Jenny L; Martin, Richard M; Metcalfe, Chris

    2017-10-30

    Cross-sectional studies suggest that around 6% of men undergo prostate-specific antigen (PSA) testing each year in UK general practice (GP). This longitudinal study aims to determine the cumulative testing pattern of men over a 10-year period and whether this testing can be considered equivalent to screening for prostate cancer (PCa). Patient-level data on PSA tests, biopsies and PCa diagnoses were obtained from the UK Clinical Practice Research Datalink (CPRD) for the years 2002 to 2011. The cumulative risks of PSA testing and of being diagnosed with PCa were estimated for the 10-year study period. Associations of a man's age, region and index of multiple deprivation with the cumulative risk of PSA testing and PCa diagnosis were investigated. Rates of biopsy and diagnosis, following a high test result, were compared with those from the programme of PSA testing in the Prostate Testing for Cancer and Treatment (ProtecT) study. The 10-year risk of exposure to at least one PSA test in men aged 45 to 69 years in UK GP was 39.2% (95% CI 39.0 to 39.4%). The age-specific risks ranged from 25.2% for men aged 45-49 years to 53.0% for men aged 65-69 years (p for trend PSA level ≥3, a test in UK GP was less likely to result in a biopsy (6%) and/or diagnosis of PCa (15%) compared with ProtecT study participants (85% and 34%, respectively). A high proportion of men aged 45-69 years undergo PSA tests in UK GP: 39% over a 10-year period. A high proportion of these tests appear to be for the investigation of lower urinary tract symptoms and not screening for PCa. ISRCTN20141297,NCT02044172. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Impact of insurance carrier, prior authorization, and socioeconomic status on appropriate use of SPECT myocardial perfusion imaging in private community-based office practice.

    Science.gov (United States)

    Doukky, Rami; Hayes, Kathleen; Frogge, Nathan; Nazir, Noreen T; Collado, Fareed M; Williams, Kim A

    2015-05-01

    The impact of health insurance carrier and socioeconomic status (SES) on the adherence to appropriate use criteria (AUC) for radionuclide myocardial perfusion imaging (MPI) is unknown. Health insurance carrier's prior authorization and patient's SES impact adherence to AUC for MPI in a fee-for-service setting. We conducted a prospective cohort study of 1511 consecutive patients who underwent outpatient MPI in a multi-site, office-based, fee-for-service setting. The patients were stratified according to the 2009 AUC into appropriate/uncertain appropriateness and inappropriate use groups. Insurance status was categorized as Medicare (does not require prior authorization) vs commercial (requires prior authorization). Socioeconomic status was determined by the median household income in the ZIP code of residence. The proportion of patients with Medicare was 33% vs 67% with commercial insurance. The rate of inappropriate use was higher among patients with commercial insurance vs Medicare (55% vs 24%; P impact AUC determination (odds ratio: 1.06, 95% confidence interval: 0.62-1.82, P = 0.82). The mean annual household income in the residential areas of patients with inappropriate use as compared to those with appropriate/uncertain use was $72 000 ± 21 000 vs $68 000 ± 20 000, respectively (P impact AUC determination, SES (top vs bottom quartile income area) was not independently predictive of inappropriate MPI use (odds ratio: 0.9, 95% confidence interval: 0.53-1.52, P = 0.69). Insurance carriers prior authorization and SES do not seem to play a significant role in determining physicians adherence to AUC for MPI. © 2015 Wiley Periodicals, Inc.

  4. Prática de privação de liberdade em adolescentes: um enfoque psicossociológico Practice of freedom privation in teenagers: a psychosocial approach

    Directory of Open Access Journals (Sweden)

    Maria da Penha de Lima Coutinho

    2011-03-01

    en relación a la socializadora. Los actores sociales demostraron que, si la práctica socioeducativa de privación de libertad sea justa y humanizada, podrá obtener éxito en la resocialización del adolescente y en la superación de su condición de exclusión.The Statute of Children and Adolescents ( a Brazilian law related to children and adolescents, contains articles regulating the practice of the infraction act and the socioeducational procedures leading the adolescent to reflect on the offense committed and its subsequent return to the familial interaction. The objective was to understand the social representations of adolescents in conflict with the law about socioeducative practice with privation of liberty. The study included 50 adolescents who completed interviews with depth which, thereafter, were subjected to content analysis. The results showed seven empirical categories: conception of the practice socioeducative of privation of freedom, description of the institution, professional image, perception of self-image, life experience, demonstrations and biopsycognitve life project. Social representations indicated that the practice presented a non-socialization primacy in relation to socialization. The social actors have shown that if the practice of socioeducative which is related with the privation of liberty is just and humane, they can be succeed in re-socialization of these adolescents and in overcoming their excluded condition.

  5. Is immunising all patients with chronic lung disease in the community against influenza cost effective? : Evidence from a general practice based clinical prospective cohort study in Utrecht, The Netherlands

    NARCIS (Netherlands)

    Hak, E; van Essen, G A; Buskens, E; Stalman, W; de Melker, R A

    STUDY OBJECTIVE: There is little information on the potential benefit of immunising all patients with chronic lung disease in the community against influenza. The clinical effectiveness and economic benefit was established of the influenza vaccination programme in a general practice based cohort of

  6. Pharmaceutical Public-Private Partnerships

    DEFF Research Database (Denmark)

    Bagley, Constance; Tvarnø, Christina D.

    2014-01-01

    This article provides a game theory and law-and-management analysis of for- profit pharmaceutical public-private partnerships, a complex type of legal arrangement in the highly regulated pharmaceutical industry. A pharmaceutical public-private partnership (PPPP) agreement is a legally binding...... and a practical perspective on how properly crafted PPPP arrangements can promote innovation more efficiently than traditional self-optimizing contracts. In particular, a properly framed binding contract, coupled with respect for positive incentives, can move the parties away from an inefficient prisoners...... systems to build and share innovation. When coupled with appropriate attention to the difficult task of coordinating the actions of interdependent actors, a PPPP arrangement can enhance the likelihood of successful commercialization of pharmacological discoveries by flipping the par- ties’ incentives...

  7. Privatization Framework: Political Economy Perspective

    OpenAIRE

    Bastian, Indra

    2009-01-01

    Privatization has been recognized as a worldwide phenomenon. In this pa-per, a political economy approach is developed to analyze privatization. The ap-proach assumes that political economy and privatization overlap in people’s need. So, the framework of political economy in privatization is based on the ‘need’ phi-losophy. Government and private sectors are contrasted in this respect, leading to a conclusion on privatization as a method to manage the economy. Keywords: privatization, politic...

  8. Public private partnerships

    NARCIS (Netherlands)

    Miranda Sarmento, J.J.

    2014-01-01

    Public-private partnerships (PPPs) are increasing in number worldwide and are used to build and manage large public infrastructure projects. In PPPs, the private sector plays a role in developing and maintaining public infrastructure and services, which is usually a public sector responsibility.

  9. Women and Private Pensions.

    Science.gov (United States)

    Benson, Helene A.

    This speech focuses on women and private pension plans, such as private pension coverage and smaller benefit amounts. Pension issues affecting women as employees include participation in plans, vesting, break-in service, benefit accruals, integration with Social Security, sex-based actuarial tables, portability, inflation, and individual…

  10. Private pensions for Europe

    NARCIS (Netherlands)

    Bovenberg, L.; van Ewijk, C.

    2011-01-01

    Private pensions can enhance international and intergenerational risk-sharing and create a deeper European capital market, which allows for better diversification of country-specific risks and facilitates economic growth. Private funding of pensions creates a more integrated European capital market

  11. Serial private infrastructures

    NARCIS (Netherlands)

    van den Berg, V.A.C.

    2013-01-01

    This paper investigates private supply of two congestible infrastructures that are serial, where the consumer has to use both in order to consume. Four market structures are analysed: a monopoly and 3 duopolies that differ in how firms interact. It is well known that private supply leads too high

  12. Retention of the rural allied health workforce in New South Wales: a comparison of public and private practitioners.

    Science.gov (United States)

    Keane, Sheila; Lincoln, Michelle; Rolfe, Margaret; Smith, Tony

    2013-01-27

    Policy initiatives to improve retention of the rural health workforce have relied primarily on evidence for rural doctors, most of whom practice under a private business model. Much of the literature for rural allied health (AH) workforce focuses on the public sector. The AH professions are diverse, with mixed public, private or combined practice settings. This study explores sector differences in factors affecting retention of rural AH professionals. This study compared respondents from the 2008 Rural Allied Health Workforce (RAHW) survey recruiting all AH professionals in rural New South Wales. Comparisons between public (n = 833) and private (n = 756) groups were undertaken using Chi square analysis to measure association for demographics, job satisfaction and intention to leave. The final section of the RAHW survey comprised 33 questions relating to retention. A factor analysis was conducted for each cohort. Factor reliability was assessed and retained factors were included in a binary logistic regression analysis for each cohort predicting intention to leave. Six factors were identified: professional isolation, participation in community, clinical demand, taking time away from work, resources and 'specialist generalist' work. Factors differed slightly between groups. A seventh factor (management) was present only in the public cohort. Gender was not a significant predictor of intention to leave. Age group was the strongest predictor of intention to leave with younger and older groups being significantly more likely to leave than middle aged.In univariate logistic analysis (after adjusting for age group), the ability to get away from work did not predict intention to leave in either group. In multivariate analysis, high clinical demand predicted intention to leave in both the public (OR = 1.40, 95% CI = 1.08, 1.83) and private (OR = 1.61, 95% CI = 1.15, 2.25) cohorts. Professional isolation (OR = 1.39. 95% CI = 1.11, 1.75) and Participation in community (OR = 1

  13. Restrictions on the use of e-cigarettes in public and private places-current practice and support among adults in Great Britain.

    Science.gov (United States)

    Brose, Leonie S; McNeill, Ann; Arnott, Deborah; Cheeseman, Hazel

    2017-08-01

    Debates around policies regulating e-cigarette use make it important to obtain an overview of current practice, people's attitudes and correlates of policy support. Aims were to assess (i) current practices for e-cigarette use in homes and workplaces; (ii) characteristics associated with allowing e-cigarette use in the home; and (iii) level of, and characteristics associated with, support for extending smoke-free legislation to include e-cigarettes. Online survey in 2016, n = 11 389 adults in Great Britain. Descriptives for all measures; multivariable logistic regressions assessed correlates of allowing e-cigarette use and support for extension of legislation. Most (79%) reporting on workplace policies reported some level of restrictions on e-cigarette use. Small majorities would not allow e-cigarette use in their home (58%) and supported an extension of smoke-free legislation (52%; 21% opposed). Allowing use was less likely and supporting an extension more likely among men, respondents from a higher socio-economic status, ex-smokers, never-smokers, non-users of e-cigarettes and respondents with increased perceived harm of e-cigarettes or nicotine (all P e-cigarette use. Over half of adults would not allow use of e-cigarettes in their home and support prohibiting the use of e-cigarettes in smoke-free places. Adjusting for socio-demographics, more restrictive attitudes are more common among never-smokers, never-users and those with increased perception of relative harms of e-cigarettes or nicotine as cause of smoking-related illness. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  14. Setting up virtual private network

    International Nuclear Information System (INIS)

    Huang Hongmei; Zhang Chengjun

    2003-01-01

    Setting up virtual private network for business enterprise provides a low cost network foundation, increases enterprise's network function and enlarges its private scope. The text introduces virtual private network's principal, privileges and protocols that use in virtual private network. At last, this paper introduces several setting up virtual private network's technologies which based on LAN

  15. Setting up virtual private network

    International Nuclear Information System (INIS)

    Huang Hongmei; Zhang Chengjun

    2003-01-01

    Setting up virtual private network for business enterprise provides a low cost network foundation, increases enterprise network function and enlarges its private scope. This text introduces virtual private network principal, privileges and protocols applied in virtual private network. At last, this paper introduces several setting up virtual private network technologies which is based on LAN

  16. Parental practices predict psychological well-being in midlife: life-course associations among women in the 1946 British birth cohort.

    Science.gov (United States)

    Huppert, F A; Abbott, R A; Ploubidis, G B; Richards, M; Kuh, D

    2010-09-01

    Certain parenting styles are influential in the emergence of later mental health problems, but less is known about the relationship between parenting style and later psychological well-being. Our aim was to examine the association between well-being in midlife and parental behaviour during childhood and adolescence, and the role of personality as a possible mediator of this relationship. Data from 984 women in the 1946 British birth cohort study were analysed using structural equation modelling. Psychological well-being was assessed at age 52 years using Ryff's scales of psychological well-being. Parenting practices were recollected at age 43 years using the Parental Bonding Instrument. Extraversion and neuroticism were assessed at age 26 years using the Maudsley Personality Inventory. In this sample, three parenting style factors were identified: care; non-engagement; control. Higher levels of parental care were associated with higher psychological well-being, while higher parental non-engagement or control were associated with lower levels of psychological well-being. The effects of care and non-engagement were largely mediated by the offspring's personality, whereas control had direct effects on psychological well-being. The psychological well-being of adult women was at least as strongly linked to the parenting style of their fathers as to that of their mothers, particularly in relation to the adverse effects of non-engagement and control. This study used a prospective longitudinal design to examine the effects of parenting practices on psychological well-being in midlife. The effects of parenting, both positive and negative, persisted well into mid-adulthood.

  17. Patient factors influencing the prescribing of lipid lowering drugs for primary prevention of cardiovascular disease in UK general practice: a national retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Jianhua Wu

    Full Text Available Guidelines indicate eligibility for lipid lowering drugs, but it is not known to what extent GPs' follow guidelines in routine clinical practice or whether additional clinical factors systematically influence their prescribing decisions.A retrospective cohort analysis was undertaken using electronic primary care records from 421 UK general practices. At baseline (May 2008 patients were aged 30 to 74 years, free from cardiovascular disease and not taking lipid lowering drugs. The outcome was prescription of a lipid lowering drug within the next two years. The proportions of eligible and ineligible patients prescribed lipid lowering drugs were reported and multivariable logistic regression models were used to investigate associations between age, sex, cardiovascular risk factors and prescribing.Of 365,718 patients with complete data, 13.8% (50,558 were prescribed lipid lowering drugs: 28.5% (21,101/74,137 of those eligible and 10.1% (29,457/291,581 of those ineligible. Only 41.7% (21,101/50,558 of those prescribed lipid lowering drugs were eligible. In multivariable analysis prescribing was most strongly associated with increasing age (OR for age ≥ 65 years 4.21; 95% CI 4.05-4.39; diabetes (OR 4.49; 95% CI 4.35-4.64; total cholesterol level ≥ 7 mmol/L (OR 2.20; 95% CI 2.12-2.29; and ≥ 4 blood pressure measurements in the past year (OR 4.24; 95% CI 4.06-4.42. The predictors were similar in eligible and ineligible patients.Most lipid lowering drugs for primary prevention are prescribed to ineligible patients. There is underuse of lipid lowering drugs in eligible patients.

  18. Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer.

    Science.gov (United States)

    Holtedahl, Knut; Vedsted, Peter; Borgquist, Lars; Donker, Gé A; Buntinx, Frank; Weller, David; Braaten, Tonje; Hjertholm, Peter; Månsson, Jörgen; Strandberg, Eva Lena; Campbell, Christine; Ellegaard, Lisbeth; Parajuli, Ranjan

    2017-06-01

    Abdominal symptoms are diagnostically challenging to general practitioners (GPs): although common, they may indicate cancer. In a prospective cohort of patients, we examined abdominal symptom frequency, initial diagnostic suspicion, and actions of GPs in response to abdominal symptoms. Over a 10-day period, 493 GPs in Norway, Denmark, Sweden, Belgium, the Netherlands, and Scotland, recorded consecutive consultations: sex, date of birth and any specified abdominal symptoms. For patients with abdominal symptoms, additional data on non-specific symptoms, GPs' diagnostic suspicion, and features of the consultation were noted. Data on all cancer diagnoses among all included patients were requested from the GPs eight months later. Consultations with 61802 patients were recorded. Abdominal symptoms were recorded in 6264 (10.1%) patients. A subsequent malignancy was reported in 511 patients (0.8%): 441 (86.3%) had a new cancer, 70 (13.7%) a recurrent cancer. Abdominal symptoms were noted in 129 (25.2%) of cancer patients ( P GPs noted a suspicion of cancer for 85 (65.9%) versus 1895 (30.9%) when there was no subsequent cancer ( P GPs' diagnostic thinking and referral practices.

  19. A prospective cohort study to assess seroprevalence, incidence, knowledge, attitudes and practices, willingness to pay for vaccine and related risk factors in dengue in a high incidence setting

    Directory of Open Access Journals (Sweden)

    Ruth Aralí Martínez-Vega

    2016-11-01

    Full Text Available Abstract Background Dengue is one of the most important vector-borne diseases in the world, causing significant morbidity and economic impact. In Colombia, dengue is a major public health problem. Departments of La Guajira, Cesar and Magdalena are dengue endemic areas. The objective of this research is to determine the seroprevalence and the incidence of dengue virus infection in the participating municipalities from these Departments, and also establish the association between individual and housing factors and vector indices with seroprevalence and incidence. We will also assess knowledge, attitudes and practices, and willingness-to-pay for dengue vaccine. Methods A cohort study will be assembled with a clustered multistage sampling in 11 endemic municipalities. Approximately 1000 homes will be visited to enroll people older than one year who living in these areas, who will be followed for 1 year. Dengue virus infections will be evaluated using IgG indirect ELISA and IgM and IgG capture ELISA. Additionally, vector indices will be measured, and adult mosquitoes will be captured with aspirators. Ovitraps will be used for continuous estimation of vector density. Discussion This research will generate necessary knowledge to design and implement strategies with a multidimensional approach that reduce dengue morbidity and mortality in La Guajira and other departments from Colombian Caribbean.

  20. Gonorrhoea and Syphilis Epidemiology in Flemish General Practice 2009–2013: Results from a Registry-based Retrospective Cohort Study Compared with Mandatory Notification

    Directory of Open Access Journals (Sweden)

    Christoph Schweikardt

    2016-09-01

    Full Text Available Background: The number of newly diagnosed gonorrhoea and syphilis cases has increased in Flanders in recent years. Our aim was to investigate, to which extent these diagnoses were registered by general practitioners (GPs, and to examine opportunities and limits of the Intego database in this regard. Methods: Data from a retrospective cohort study based on the Flemish Intego general practice database was analyzed for the years 2009–2013. Case definitions were applied. Due to small case numbers obtained, cases were pooled and averaged over the observation period. Frequencies were compared with those calculated from figures of mandatory notification. Results: A total of 91 gonorrhoea and 23 syphilis cases were registered. The average Intego annual frequency of gonorrhoea cases obtained was 11.9 (95% Poisson confidence interval (CI 9.6; 14.7 per 100,000 population, and for syphilis 3.0 (CI 1.9; 4.5, respectively, while mandatory notification was calculated at 14.0 (CI: 13.6, 14.4 and 7.0 (CI: 6.7, 7.3, respectively. Conclusion: In spite of limitations such as small numbers and different case definitions, comparison with mandatory notification suggests that the GP was involved in the large majority of gonorrhoea cases, while the majority of new syphilis cases did not come to the knowledge of the GP.

  1. [Changes of medico-pharmaceutical profession and private practice from the late 19th century to the early 20th century: ebb and flow of western pharmacies and clinics attached to pharmacy].

    Science.gov (United States)

    Lee, Heung-Ki

    2010-12-31

    This article examined i) how traditional medico-pharmaceutical custom from the late 19th century influenced such changes, ii) how medical laws of Daehan Empire and early colonial period influenced the differentiation of medico-pharmaceutical profession, and iii) what the responses of medico-pharmaceutical professionals were like, and arrived at following conclusions. First, in late Chosun, there was a nationwide spread of pharmacies (medicine room, medicine store) as general medical institutions in charge of prescription and medication as well as diagnosis. Therefore, Koreans' perception of Western medicine was not very different from that of traditional pharmacy. Second, Western pharmacies were established by various entities including oriental doctors, Western doctors and drug manufacturers.Their business ranged from medical consultation, prescription, medication and drug manufacture. This was in a way the extension of traditional medico-pharmaceutical custom, which did not draw a sharp line between medical and pharmaceutical practices. Also, regulations on medical and pharmaceutical business of Daehan Empire did not distinguish oriental and Western medicine. Third, clinics attached to pharmacy began to emerge after 1908, as some Western pharmacies that had grown their business based on selling medicine began to hire doctors trained in Western medicine. This trend resulted from Government General's control over medico-pharmaceutical business that began in 1908, following a large-scale dismissal of army surgeons trained in medical schools in 1907. Fourth, as specialization increased within medico-pharmaceutical business following the colonial medical law in early 1910s, such comprehensive business practices as Western pharmacy disappeared and existing businesses were differentiated into dealers of medical ingredients, drug manufacturer, patent medicine businessmen and herbalists. And private practice gradually became the general trend by establishment of medical

  2. Private healthcare quality: applying a SERVQUAL model.

    Science.gov (United States)

    Butt, Mohsin Muhammad; de Run, Ernest Cyril

    2010-01-01

    This paper seeks to develop and test the SERVQUAL model scale for measuring Malaysian private health service quality. The study consists of 340 randomly selected participants visiting a private healthcare facility during a three-month data collection period. Data were analyzed using means, correlations, principal component and confirmatory factor analysis to establish the modified SERVQUAL scale's reliability, underlying dimensionality and convergent, discriminant validity. Results indicate a moderate negative quality gap for overall Malaysian private healthcare service quality. Results also indicate a moderate negative quality gap on each service quality scale dimension. However, scale development analysis yielded excellent results, which can be used in wider healthcare policy and practice. Respondents were skewed towards a younger population, causing concern that the results might not represent all Malaysian age groups. The study's major contribution is that it offers a way to assess private healthcare service quality. Second, it successfully develops a scale that can be used to measure health service quality in Malaysian contexts.

  3. Inviting In the Private Sector

    Science.gov (United States)

    2002-10-01

    private sector . After all, corruption does not just involve government. Business people and lawyers and citizens pay the bribes, even as they condemn bribery. They should be invited to become part of the solution. But how? The first point to note is that business people and citizens know where corruption exists and how corrupt systems work. Citizens understand how bribery shapes the services they receive or don’t receive. Accountants know the illicit games played with audits and taxes. Lawyers understand corrupt legal practices. Business people know all about corrupt

  4. Relationship between initial therapy and blood pressure control for high-risk hypertension patients in the UK: a retrospective cohort study from the THIN general practice database.

    Science.gov (United States)

    Weir, Sharada; Juhasz, Attila; Puelles, Jorge; Tierney, Travis S

    2017-07-28

    To examine the UK practice patterns in treating newly diagnosed hypertension and to determine whether subgroups of high-risk patients are more or less likely to follow particular therapeutic protocols and to reach blood pressure goals. Retrospective cohort study. This study examined adults in The Health Improvement Network (THIN) UK general practice medical records database who were initiated on medication for hypertension. 48 131 patients with essential hypertension diagnosed between 2008 and 2010 who were registered with a participating practice for a minimum of 13 months prior to, and 6 months following, initiation of therapy. We excluded patients with gestational hypertension or secondary hypertension. Patients were classified into risk groups based on blood pressure readings and comorbid conditions. Odds of receiving single versus fixed or free-drug combination therapy and odds of achieving blood pressure control were assessed using multivariable logistic regression. The vast majority of patients (95.8%) were initiated on single drug therapy. Patients with high cardiovascular risk (patients with grade 2-3 hypertension or those with high normal/grade 1 hypertension plus at least one cardiovascular condition pretreatment) had a statistically significant benefit of starting immediately on combination therapy when blood pressure control was the desired goal (OR: 1.23; 95% CI: 1.06 to 1.42) but, surprisingly, were less likely than patients with no risk factors to receive combination therapy (OR: 0.53; 95% CI: 0.47 to 0.59). Our results suggest that combination therapy may be indicated for patients with high cardiovascular risk, who accounted for 60.6% of our study population. The National Institute for Health and Care Excellence guideline CG34 of 2006 (in effect during the study period) recommended starting with single drug class therapy for most patients, and this advice does seem to have been followed even in cases where a more aggressive approach might

  5. "Private Views" Ungaris

    Index Scriptorium Estoniae

    1999-01-01

    9. juulist Dunaujvarosi Kaasaegse Kunsti Instituudis eesti ja briti kunstnike ühisnäitus "Private Views. Ruum taasavastatud eesti ja briti kaasaegses kunstis". Kuraatorid Pam Skelton, Mare Tralla. Osalejad.

  6. "Private Views" Ungaris

    Index Scriptorium Estoniae

    1999-01-01

    9. juulist Dunaujvarosi Kaasaegse Kunsti Instituudis eesti ja briti kunstnike ühisnäitus "Private Views. Ruum taasavastatud eesti ja briti kaasaegses kunstis" Kuraatorid Pam Skelton, Mare Tralla. Osalejad

  7. Private sector development

    International Development Research Centre (IDRC) Digital Library (Canada)

    Small businesses can be an important vehicle for .... Small and medium enterprises make up most of private businesses in the. Middle East ... Small businesses can drive more equi- table growth. ... patterns affect job creation and the demand ...

  8. Private Web Browsing

    National Research Council Canada - National Science Library

    Syverson, Paul F; Reed, Michael G; Goldschlag, David M

    1997-01-01

    .... These are both kept confidential from network elements as well as external observers. Private Web browsing is achieved by unmodified Web browsers using anonymous connections by means of HTTP proxies...

  9. Does Private Tutoring Payoff?

    OpenAIRE

    Gurun, Ayfer; Millimet, Daniel L.

    2008-01-01

    We assess the causal effect of private tutoring on the probability of university placement in Turkey. We find that tutoring increases the probability of being placed in a university when non-random selection is ignored. Moreover, among those utilizing private tutoring, greater expenditure on tutoring is also positively associated with university placement. However, we find evidence of positive selection into tutoring, but negative selection into greater expenditures among those receiving tuto...

  10. Areva's privatization uncertainties

    International Nuclear Information System (INIS)

    Jemain, A.

    2004-01-01

    The French nuclear public group Areva (the fusion of CEA-Industrie, Framatome and Cogema companies) will actively prepare its privatization and stock exchange introduction before the end of the first half of 2005, in order to re-launch its acquisitions and associations policy. However, the advantages of this privatization with a preponderant public share-holding will depend on the intentions of the French government. Short paper. (J.S.)

  11. Privatizing electricity: Pt. 2

    International Nuclear Information System (INIS)

    Bindon, F.J.L.

    1991-01-01

    In February 1988, the Government announced their intention of privatizing the electricity supply industry of England, Wales and Scotland. The Government's proposals were outlined in two White Papers. Cm 322 covered the proposals for England and Wales and Cm 327 the proposals for Scotland. This article deals with the events covering the stages of the privatization process from just before passing of the Electricity Bill in July 1989 to December 1990. (author)

  12. Career intentions of medical students in the setting of Nepal's rapidly expanding private medical education system.

    Science.gov (United States)

    Huntington, Ian; Shrestha, Suvash; Reich, Nicholas G; Hagopian, Amy

    2012-08-01

    The number of medical students trained in Nepal each year has increased nearly fifty-fold in the last 15 years, primarily through the creation of private medical schools. It is unknown where this expanding cohort of new physicians will ultimately practice. We distributed an anonymous survey to students in their last 2 years of medical school at four medical schools in Nepal to examine two dimensions of career intention: the intention to practice in Nepal and the intention to practice in rural areas. Eighty-five per cent of the eligible study population participated, for a total of 469 medical students. Of these, 88% thought it was likely they would practice in Nepal and 88% thought it likely they would practice in urban areas. Those students who indicated a greater likelihood of practicing abroad came from families with higher incomes, were more likely to think earning a good salary was very important to their decision to become a physician, and were less likely to think they could earn a good salary in Nepal. Students whose tuition was paid by the government were no more likely to indicate an intention to practice in Nepal than students paying their own tuition at private medical schools. Students who indicated a greater likelihood of practicing in rural areas were more likely to be male, to have gone to a government secondary school, to have been born in a village, or to have received a scholarship from the Ministry of Education that requires rural service. Based on our findings, we suggest the following policy changes: (1) medical schools consider selecting for students from rural backgrounds or government secondary schools who are more likely to intend to practice in rural areas, and (2) increase the number of post-graduate positions--weighted toward rural health needs--to retain students in Nepal.

  13. Private health insurance and access to healthcare.

    Science.gov (United States)

    Duggal, Ravi

    2011-01-01

    The health insurance business in India has seen a growth of over 25% per annum in the last few years with the expansion of the private health insurance sector. The premium incomes of health insurance have crossed the Rs 8,000 crore mark with the share of private companies increasing to over 41%. This is despite the fact that from the perspective of patients, health insurance is not a good deal, especially when they need it most. This raises a number of ethical issues regarding how the health insurance business runs and how medical practice adjusts to it for profiteering. This article uses the personal experience of the author to argue that health insurance in an unregulated environment can only lead to unethical practices, further victimising the patient. Further, publicly financed healthcare which operates in an environment regulating both public and private healthcare provisioning is the only way to assure access to ethical and equitable healthcare to people.

  14. Protocol for a multicentre, prospective, population-based cohort study of variation in practice of cholecystectomy and surgical outcomes (The CholeS study).

    Science.gov (United States)

    Vohra, Ravinder S; Spreadborough, Philip; Johnstone, Marianne; Marriott, Paul; Bhangu, Aneel; Alderson, Derek; Morton, Dion G; Griffiths, Ewen A

    2015-01-12

    Cholecystectomy is one of the most common general surgical operations performed. Despite level one evidence supporting the role of cholecystectomy in the management of specific gallbladder diseases, practice varies between surgeons and hospitals. It is unknown whether these variations account for the differences in surgical outcomes seen in population-level retrospective data sets. This study aims to investigate surgical outcomes following acute, elective and delayed cholecystectomies in a multicentre, contemporary, prospective, population-based cohort. UK and Irish hospitals performing cholecystectomies will be recruited utilising trainee-led research collaboratives. Two months of consecutive, adult patient data will be included. The primary outcome measure of all-cause 30-day readmission rate will be used in this study. Thirty-day complication rates, bile leak rate, common bile duct injury, conversion to open surgery, duration of surgery and length of stay will be measured as secondary outcomes. Prospective data on over 8000 procedures is anticipated. Individual hospitals will be surveyed to determine local policies and service provision. Variations in outcomes will be investigated using regression modelling to adjust for confounders. Research ethics approval is not required for this study and has been confirmed by the online National Research Ethics Service (NRES) decision tool. This novel study will investigate how hospital-level surgical provision can affect patient outcomes, using a cross-sectional methodology. The results are essential to inform commissioning groups and implement changes within the National Health Service (NHS). Dissemination of the study protocol is primarily through the trainee-led research collaboratives and the Association of Upper Gastrointestinal Surgeons (AUGIS). Individual centres will have access to their own results and the collective results of the study will be published in peer-reviewed journals and presented at relevant

  15. Breastfeeding Progression in Preterm Infants Is Influenced by Factors in Infants, Mothers and Clinical Practice: The Results of a National Cohort Study with High Breastfeeding Initiation Rates

    Science.gov (United States)

    Maastrup, Ragnhild; Hansen, Bo Moelholm; Kronborg, Hanne; Bojesen, Susanne Norby; Hallum, Karin; Frandsen, Annemi; Kyhnaeb, Anne; Svarer, Inge; Hallström, Inger

    2014-01-01

    Background and Aim Many preterm infants are not capable of exclusive breastfeeding from birth. To guide mothers in breastfeeding, it is important to know when preterm infants can initiate breastfeeding and progress. The aim was to analyse postmenstrual age (PMA) at breastfeeding milestones in different preterm gestational age (GA) groups, to describe rates of breastfeeding duration at pre-defined times, as well as analyse factors associated with PMA at the establishment of exclusive breastfeeding. Methods The study was part of a prospective survey of a national Danish cohort of preterm infants based on questionnaires and structured telephone interviews, including 1,221 mothers and their 1,488 preterm infants with GA of 24–36 weeks. Results Of the preterm infants, 99% initiated breastfeeding and 68% were discharged exclusively breastfed. Breastfeeding milestones were generally reached at different PMAs for different GA groups, but preterm infants were able to initiate breastfeeding at early times, with some delay in infants less than GA 32 weeks. Very preterm infants had lowest mean PMA (35.5 weeks) at first complete breastfeed, and moderate preterm infants had lowest mean PMA at the establishment of exclusive breastfeeding (36.4 weeks). Admitting mothers to the NICU together with the infant and minimising the use of a pacifier during breastfeeding transition were associated with 1.6 (95% CI 0.4–2.8) and 1.2 days (95% CI 0.1–2.3) earlier establishment of exclusive breastfeeding respectively. Infants that were small for gestational age were associated with 5.6 days (95% CI 4.1–7.0) later establishment of exclusive breastfeeding. Conclusion Breastfeeding competence is not developed at a fixed PMA, but is influenced by multiple factors in infants, mothers and clinical practice. Admitting mothers together with their infants to the NICU and minimising the use of pacifiers may contribute to earlier establishment of exclusive breastfeeding. PMID:25251690

  16. Cohort profile

    DEFF Research Database (Denmark)

    Tollånes, Mette C; Strandberg-Larsen, Katrine; Forthun, Ingeborg

    2016-01-01

    PURPOSE: The purpose of MOthers and BAbies in Norway and Denmark cerebral palsy (MOBAND-CP) was to study CP aetiology in a prospective design. PARTICIPANTS: MOBAND-CP is a cohort of more than 210 000 children, created as a collaboration between the world's two largest pregnancy cohorts-the Norweg......PURPOSE: The purpose of MOthers and BAbies in Norway and Denmark cerebral palsy (MOBAND-CP) was to study CP aetiology in a prospective design. PARTICIPANTS: MOBAND-CP is a cohort of more than 210 000 children, created as a collaboration between the world's two largest pregnancy cohorts......-the Norwegian Mother and Child Cohort study (MoBa) and the Danish National Birth Cohort. MOBAND-CP includes maternal interview/questionnaire data collected during pregnancy and follow-up, plus linked information from national health registries. FINDINGS TO DATE: Initial harmonisation of data from the 2 cohorts...... has created 140 variables for children and their mothers. In the MOBAND-CP cohort, 438 children with CP have been identified through record linkage with validated national registries, providing by far the largest such sample with prospectively collected detailed pregnancy data. Several studies...

  17. Public Supervision over Private Relationships : Towards European Supervision Private Law?

    NARCIS (Netherlands)

    Cherednychenko, O.O.

    2014-01-01

    The rise of public supervision over private relationships in many areas of private law has led to the development of what, in the author’s view, could be called ‘European supervision private law’. This emerging body of law forms part of European regulatory private law and is made up of

  18. Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin-angiotensin system blockade: a UK general practice-based cohort study.

    Science.gov (United States)

    Schmidt, Morten; Mansfield, Kathryn E; Bhaskaran, Krishnan; Nitsch, Dorothea; Sørensen, Henrik Toft; Smeeth, Liam; Tomlinson, Laurie A

    2017-01-09

    To examine adherence to serum creatinine and potassium monitoring and discontinuation guidelines following initiation of treatment with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs); and whether high-risk patients are monitored. A general practice-based cohort study using electronic health records from the UK Clinical Practice Research Datalink and Hospital Episode Statistics. UK primary care, 2004-2014. 223 814 new ACEI/ARB users. Proportion of patients with renal function monitoring before and after ACEI/ARB initiation; creatinine increase ≥30% or potassium levels >6 mmol/L at first follow-up monitoring; and treatment discontinuation after such changes. Using logistic regression models, we also examined patient characteristics associated with these biochemical changes, and with follow-up monitoring within the guideline recommendation of 2 weeks after treatment initiation. 10% of patients had neither baseline nor follow-up monitoring of creatinine within 12 months before and 2 months after initiation of an ACEI/ARB, 28% had monitoring only at baseline, 15% only at follow-up, and 47% both at baseline and follow-up. The median period between the most recent baseline monitoring and drug initiation was 40 days (IQR 12-125 days). 34% of patients had baseline creatinine monitoring within 1 month before initiating therapy, but creatinine increase ≥30% (n=567, 1.2%) or potassium level >6 mmol/L (n=191, 0.4%), 80% continued treatment. Although patients with prior myocardial infarction, hypertension or baseline potassium >5 mmol/L were at high risk of ≥30% increase in creatinine after ACEI/ARB initiation, there was no evidence that they were more frequently monitored. Only one-tenth of patients initiating ACEI/ARB therapy receive the guideline-recommended creatinine monitoring. Moreover, the vast majority of the patients fulfilling postinitiation discontinuation criteria for creatinine and potassium increases continue on treatment

  19. Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin–angiotensin system blockade: a UK general practice-based cohort study

    Science.gov (United States)

    Schmidt, Morten; Bhaskaran, Krishnan; Nitsch, Dorothea; Sørensen, Henrik Toft; Smeeth, Liam; Tomlinson, Laurie A

    2017-01-01

    Objectives To examine adherence to serum creatinine and potassium monitoring and discontinuation guidelines following initiation of treatment with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs); and whether high-risk patients are monitored. Design A general practice-based cohort study using electronic health records from the UK Clinical Practice Research Datalink and Hospital Episode Statistics. Setting UK primary care, 2004–2014. Subjects 223 814 new ACEI/ARB users. Main outcome measures Proportion of patients with renal function monitoring before and after ACEI/ARB initiation; creatinine increase ≥30% or potassium levels >6 mmol/L at first follow-up monitoring; and treatment discontinuation after such changes. Using logistic regression models, we also examined patient characteristics associated with these biochemical changes, and with follow-up monitoring within the guideline recommendation of 2 weeks after treatment initiation. Results 10% of patients had neither baseline nor follow-up monitoring of creatinine within 12 months before and 2 months after initiation of an ACEI/ARB, 28% had monitoring only at baseline, 15% only at follow-up, and 47% both at baseline and follow-up. The median period between the most recent baseline monitoring and drug initiation was 40 days (IQR 12–125 days). 34% of patients had baseline creatinine monitoring within 1 month before initiating therapy, but creatinine increase ≥30% (n=567, 1.2%) or potassium level >6 mmol/L (n=191, 0.4%), 80% continued treatment. Although patients with prior myocardial infarction, hypertension or baseline potassium >5 mmol/L were at high risk of ≥30% increase in creatinine after ACEI/ARB initiation, there was no evidence that they were more frequently monitored. Conclusions Only one-tenth of patients initiating ACEI/ARB therapy receive the guideline-recommended creatinine monitoring. Moreover, the vast majority of the patients fulfilling postinitiation

  20. Post-Graduate Training in Private Practice

    DEFF Research Database (Denmark)

    Petersen, Birgitte; Jacobsen, Claus Haugaard

    2010-01-01

    is mainly theoretical. Thus, the clinical training is to be obtained after graduation. In order to obtain authorization as a psychologist the candidates must receive 160 hours of clinical supervision during fulltime occupation in at least two years. Until recently, this postgraduate training was mainly...... to research of evaluating. Thus, the present study is the first one focusing on the specific conditions in this context, i.e. being intimate together in a small unit; the need to make a living; dual or multiple relationships, etc. The status of this project; The research data (interviews) is currently being...

  1. Abdominal symptoms in general practice: frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer.

    NARCIS (Netherlands)

    Holtedahl, K.; Vedsted, P.; Borgquist, L.; Donker, G.A.; Buntinx, F.; Weller, D.; Braaten, T.; Hjertholm, P.; Mansson, J.; Strandberg, E.L.; Campbell, C.; Ellegaard, L.; Parajuli, R.

    2017-01-01

    Background: Abdominal symptoms are diagnostically challenging to general practitioners (GPs): although common, they may indicate cancer. In a prospective cohort of patients, we examined abdominal symptom frequency, initial diagnostic suspicion, and actions of GPs in response to abdominal

  2. Public Private Partnerships: deciphering meaning message and phenomenon

    NARCIS (Netherlands)

    E-H. Klijn (Erik-Hans)

    2010-01-01

    markdownabstract__Abstract__ There is no doubt that Public private partnerships have been a dominant issue in governmental rhetoric’s but also in governmental practice. In many countries governments have turned to the idea of public private partnerships, or partnerships in general, as a vehicle

  3. Obstetric risk avoidance: Will anyone be offering obstetrics in private ...

    African Journals Online (AJOL)

    By the end of the decade indemnifying obstetric risk will probably be too expensive for doctors in private practice. Non-indemnified doctors will be unable or unwilling to do private deliveries; however, women will still fall pregnant and require delivery. These women will inevitably be forced to deliver in provincial facilities, ...

  4. Practice management.

    Science.gov (United States)

    Althausen, Peter L; Mead, Lisa

    2014-07-01

    The practicing orthopaedic traumatologist must have a sound knowledge of business fundamentals to be successful in the changing healthcare environment. Practice management encompasses multiple topics including governance, the financial aspects of billing and coding, physician extender management, ancillary service development, information technology, transcription utilization, and marketing. Some of these are universal, but several of these areas may be most applicable to the private practice of medicine. Attention to each component is vital to develop an understanding of the intricacies of practice management.

  5. Private Sector Savings

    Directory of Open Access Journals (Sweden)

    Pitonáková Renáta

    2018-03-01

    Full Text Available The majority of household savings are in the form of bank deposits. It is therefore of interest for credit institutions to tailor their deposit policy for getting finances from non-banking entities and to provide the private sector with the loans that are necessary for investment activities and consumption. This paper deals with the determinants of the saving rate of the private sector of Slovakia. Economic, financial and demographic variables influence savings. Growth of income per capita, private disposable income, elderly dependency ratio, real interest rate and inflation have a positive impact on savings, while increases in public savings indicate a crowding out effect. The inflation rate implies precautionary savings, and dependency ratio savings for bequest. There are also implications for governing institutions deciding on the implementation of appropriate fiscal and monetary operations.

  6. PRIVATE SECURITY IN SPORT

    Directory of Open Access Journals (Sweden)

    Dragan Vukasović

    2011-09-01

    Full Text Available Given the importance of sport for international integration, affirmation, a sense of belonging and other values of general interest, in order to maintain and open new prospects of development, it is necessary to form the private security system along with state security system, with a view to creating conditions for development sports athletes to achieve better results both in domestic and international competitions. Private security is only one element of an integrated security system which, with its efficient organization with the use of adequate means and measures should provide answers to new challenges, risks and threats. Private security in line with the new understanding of the concept of security has an important role in providing athletes.

  7. Private Tutoring: Evidence from India

    OpenAIRE

    Azam, Mehtabul

    2015-01-01

    Drawing on the nationally representative "Participation and Expenditure in Education" surveys, we document the incidence and cost of private tutoring at different stages of schooling over the last two decades in India. As private tutoring involve two decisions: a) whether to take private tuition or not, and b) how much to spend on private tutoring conditional on positive decision in (a), we analyze the determinants of the two decisions separately using a Hurdle model. We find that private tut...

  8. Peruvian projects, privatization proceeding

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This paper reports that Petroleos del Peru is forging ahead on several fronts despite Peru's political turmoil and uncertainty over where government ordered-privatization will take it. The state oil company: is expected to sign contract soon related to development of Chambira oil field in the northern jungle; let contract to a group of Peruvian and Brazilian companies for construction of an oil terminal at Talara on the Pacific coast; and received expressions of interest in participating in an operating contract on an offshore block operated by its Petromar SA offshore subsidiary under the government's privatization program

  9. Peruvian projects, privatization proceeding

    Energy Technology Data Exchange (ETDEWEB)

    1992-10-19

    This paper reports that Petroleos del Peru is forging ahead on several fronts despite Peru's political turmoil and uncertainty over where government ordered-privatization will take it. The state oil company: is expected to sign contract soon related to development of Chambira oil field in the northern jungle; let contract to a group of Peruvian and Brazilian companies for construction of an oil terminal at Talara on the Pacific coast; and received expressions of interest in participating in an operating contract on an offshore block operated by its Petromar SA offshore subsidiary under the government's privatization program.

  10. At private den

    DEFF Research Database (Denmark)

    Winther, Ida

    2006-01-01

    ?To go private? As an object the cell phone is a diminutive phenomenon, but its power and importance in the social space is infinite. What happens in the social space when the cell phone is used and when it is turned off? As a point of departure observations from a field study conducted in a youth...... club (teens between 12-16 years) in Denmark will be presented. The teens are always situated end located when they use the cell phone. When they use it, temporary personal reserves are created, in which they do territorial demands. As the most obvious they forget themselves and ?go private?. It has...

  11. Integrating an Interprofessional Education Model at a Private University

    Science.gov (United States)

    Parker, Ramona Ann; Gottlieb, Helmut; Dominguez, Daniel G.; Sanchez-Diaz, Patricia C.; Jones, Mary Elaine

    2015-01-01

    In 2012, a private University in South Texas sought to prepare eight cohorts of 25 nursing, optometry, pharmacy, physical therapy, and health care administration students with an interprofessional education activity as a model for collaborative learning. The two semester interprofessional activity used a blended model (Blackboard Learn®,…

  12. Water privatization, water source, and pediatric diarrhea in Bolivia: epidemiologic analysis of a social experiment.

    Science.gov (United States)

    Tornheim, Jeffrey A; Morland, Kimberly B; Landrigan, Philip J; Cifuentes, Enrique

    2009-01-01

    Water and sanitation services are fundamental to the prevention of pediatric diarrhea. To enhance both access to water and investment, some argue for the privatization of municipal water networks. Water networks in multiple Bolivian cities were privatized in the 1990s, but contracts ended following popular protests citing poor access. A population-based retrospective cohort study was conducted in two Bolivian cities. Data were collected on family water utilization and sanitation practices and on the prevalence of diarrhea among 596 children. Drinking from an outdoor water source (OR, 2.08; 95%CI, 1.25-3.44) and shorter in-home water boiling times (OR, 1.99; 95%CI, 1.19-3.34) were associated with prevalence of diarrhea. Increased prevalence was also observed for children from families using private versus public water services, using off-network water from cistern trucks, or not treating their water in-home. Results suggest that water source, water provider, and in-home water treatment are important predictors of pediatric diarrhea.

  13. Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database

    Directory of Open Access Journals (Sweden)

    Reed C

    2013-01-01

    Full Text Available Catherine Reed,1 Jihyung Hong,2 Diego Novick,1 Alan Lenox-Smith,3 Michael Happich41Global Health Outcomes, Eli Lilly and Company, Windlesham, Surrey, UK; 2Personal Social Services Research Unit, London School of Economics and Political Science, London, UK; 3Eli Lilly UK, Basingstoke, UK; 4Eli Lilly and Company, Bad Homburg, GermanyPurpose: To assess the impact of pain severity and time to diagnosis of depression on health care costs for primary care patients with pre-existing unexplained pain symptoms who subsequently received a diagnosis of depression.Patients and methods: This retrospective cohort study analyzed 4000 adults with unexplained pain (defined as painful physical symptoms [PPS] without any probable organic cause and a subsequent diagnosis of depression, identified from the UK General Practice Research Database using diagnostic codes. Patients were categorized into four groups based on pain severity (milder or more severe; based on number of pain-relief medications and use of opioids and time to diagnosis of depression (≤1 year or >1 year from PPS index date. Annual health care costs were calculated (2009 values and included general practitioner (GP consultations, secondary care referrals, and prescriptions for pain-relief medications for the 12 months before depression diagnosis and in the subsequent 2 years. Multivariate models of cost included time period as a main independent variable, and adjusted for age, gender, and comorbidities.Results: Total annual health care costs before and after depression diagnosis for the four patient groups were higher for the groups with more severe pain (£819–£988 versus £565–£628; P < 0.001 for all pairwise comparisons and highest for the group with more severe pain and longer time to depression diagnosis in the subsequent 2 years (P < 0.05. Total GP costs were highest in the group with more severe pain and longer time to depression diagnosis both before and after depression diagnosis (P

  14. Small public private partnerships

    DEFF Research Database (Denmark)

    Koch, Christian; Jensen, Jesper Ole

    2009-01-01

    Public Private Partnerships (PPP) are frequently mobilized as a purchasing form suitable for large infrastructure projects. And it is commonly assumed that transaction costs linked to the establishment of PPP make them prohibitive in small sizes. In a Danish context this has been safeguarded by t...

  15. Secure quantum private comparison

    International Nuclear Information System (INIS)

    Yang Yuguang; Cao Weifeng; Wen Qiaoyan

    2009-01-01

    We propose a two-party quantum private comparison protocol using single photons, in which two distrustful parties can compare whether their secrets are equal with the help of a third party (TP). Any information about the values of their respective secrets will not be leaked out even with a compromised TP. Security is also discussed.

  16. Secure quantum private comparison

    Energy Technology Data Exchange (ETDEWEB)

    Yang Yuguang [College of Computer Science and Technology, Beijing University of Technology, Beijing 100124 (China); Cao Weifeng [College of Electric and Information Engineering, Zhengzhou University of Light Industry, Zhengzhou 450002 (China); Wen Qiaoyan [State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing 100876 (China)], E-mail: yangyang7357@bjut.edu.cn

    2009-12-15

    We propose a two-party quantum private comparison protocol using single photons, in which two distrustful parties can compare whether their secrets are equal with the help of a third party (TP). Any information about the values of their respective secrets will not be leaked out even with a compromised TP. Security is also discussed.

  17. Future Of Privatized Warfare

    Science.gov (United States)

    2016-05-26

    including Bosnia, Ukraine, Chile , and others made up the largest portion of private contractors in Iraq.43 Mercenary...56 movements, schools are now advocating “diversity rather than unity” and make “little effort to inculcate immigrants in American culture...identities are becoming increasingly important as a result of failures to assimilate new immigrants . Huntington highlights that immigrants from Mexico

  18. Strategy in the Public and Private Sectors

    DEFF Research Database (Denmark)

    Alford, John; Greve, Carsten

    2017-01-01

    Strategic concepts and practices first evolved in the private sector, so they evoked much controversy when they migrated to the public sector from the late 1970s onwards. Partly this was about their (in)applicability to the distinctive features of government organizations, in particular their focus...... on public as well as private value, their situation in a political rather than a market environment, their almost exclusive capacity to use legal authority to achieve purposes, and the extent to which they often need to share power over personnel and resources with other public sector agencies....... These and other factors complicated efforts to apply New Public Management and similar frameworks in strategy concepts in a governmental context. Partly also the traditional private-sector focus on single organizations did not resonate with the growth of network governance from the 1990s. The authors argue...

  19. HRM in private and public organizations in Serbia

    Directory of Open Access Journals (Sweden)

    Berber Nemanja

    2016-01-01

    Full Text Available Human resource management (HRM is a management concept which obtains many practices and activities. Although there is a substantial literature on HRM in the private sector, the practice of HRM in the public sector is still scarce. In the private sector, HRM is found as a factor for gaining competitive advantage, especially if HR practices are implemented in the way of high-performing working practice (HPWP. In the public sector, HRM is seen as paternalistic management, with the standardization of employment practices, collective bargaining and working practices that emphasize equal opportunities for employees. The goal of this research is to explore the characteristics and differences between HRM practice in organizations from the private and public sector. The subject of the research is HRM practice (staffing, training and development, compensation and benefits, and industrial relation and communication in the private and public organizations in the Republic of Serbia. The methodology of the paper includes exploration of the available literature on the theme and statistical analysis of the differences between HR practices in organizations from the private and public sector. The research is based on the HR data gathered in the second CRANET research round in Serbia, performed in 2015.

  20. Birth weight ratio as an alternative to birth weight percentile to express infant weight in research and clinical practice: a nationwide cohort study

    NARCIS (Netherlands)

    Voskamp, Bart Jan; Kazemier, Brenda M.; Schuit, Ewoud; Mol, Ben Willem J.; Buimer, Maarten; Pajkrt, Eva; Ganzevoort, Wessel

    2014-01-01

    Objective. To compare birth weight ratio and birth weight percentile to express infant weight when assessing pregnancy outcome. Study Design. We performed a national cohort study. Birth weight ratio was calculated as the observed birth weight divided by the median birth weight for gestational age.

  1. Cohort Profile

    DEFF Research Database (Denmark)

    Jespersen, Sanne; Hønge, Bo Langhoff; Oliveira, Inés

    2014-01-01

    The West African country Guinea-Bissau is home to the world’s highest prevalence of HIV-2, and its HIV-1 prevalence is rising. Other chronic viral infections like human T-lymphotropic virus type 1 (HTLV-1) and hepatitis B virus are common as well. The Bissau HIV Cohort was started in 2007 to gain...... new insights into the overall effect of introducing antiretroviral treatment in a treatment-naı ̈ve population with concomitant infection with three retroviruses (HIV-1, HIV-2 and HTLV-1) and tuberculosis. The cohort includes patients from the HIV clinic at Hospital Nacional Sima ̃ o Mendes, the main...

  2. Valuing Private Equity

    DEFF Research Database (Denmark)

    Sørensen, Morten; Wang, Neng; Yang, Jinqiang

    2014-01-01

    We investigate whether the performance of private equity (PE) investments is sufficient to compensate investors (LPs) for risk, long-term illiquidity, management, and incentive fees charged by the general partner (GP).We analyze the LPs’ portfolio-choice problem and find that management fees, car....... On average, LPs may just break even, net of management fees, carry, risk, and costs of illiquidity.......We investigate whether the performance of private equity (PE) investments is sufficient to compensate investors (LPs) for risk, long-term illiquidity, management, and incentive fees charged by the general partner (GP).We analyze the LPs’ portfolio-choice problem and find that management fees......, carried interest, and illiquidity are costly, and GPs must generate substantial alpha to compensate LPs for bearing these costs. Debt is cheap and reduces these costs, potentially explaining the high leverage of buyout transactions. Conventional interpretations of PE performance measures appear optimistic...

  3. The influence of early feeding practices on healthy diet variety score among pre-school children in four European birth cohorts.

    Science.gov (United States)

    Jones, Louise; Moschonis, George; Oliveira, Andreia; de Lauzon-Guillain, Blandine; Manios, Yannis; Xepapadaki, Paraskevi; Lopes, Carla; Moreira, Pedro; Charles, Marie Aline; Emmett, Pauline

    2015-07-01

    The present study examined whether maternal diet and early infant feeding experiences relating to being breast-fed and complementary feeding influence the range of healthy foods consumed in later childhood. Data from four European birth cohorts were studied. Healthy Plate Variety Score (HPVS) was calculated using FFQ. HPVS assesses the variety of healthy foods consumed within and across the five main food groups. The weighted numbers of servings consumed of each food group were summed; the maximum score was 5. Associations between infant feeding experiences, maternal diet and the HPVS were tested using generalized linear models and adjusted for appropriate confounders. The British Avon Longitudinal Study of Parents and Children (ALSPAC), the French Etude des Déterminants pre et postnatals de la santé et du développement de L'Enfant study (EDEN), the Portuguese Generation XXI Birth Cohort and the Greek EuroPrevall cohort. Pre-school children and their mothers. The mean HPVS for each of the cohorts ranged from 2.3 to 3.8, indicating that the majority of children were not eating a full variety of healthy foods. Never being breast-fed or being breast-fed for a short duration was associated with lower HPVS at 2, 3 and 4 years of age in all cohorts. There was no consistent association between the timing of complementary feeding and HPVS. Mother's HPVS was strongly positively associated with child's HPVS but did not greatly attenuate the relationship with breast-feeding duration. Results suggest that being breast-fed for a short duration is associated with pre-school children eating a lower variety of healthy foods.

  4. Privatization in Turkey

    OpenAIRE

    Kjellstrom, Sven B.

    1990-01-01

    State capitalism has been a basic tenet of the developing strategy for Turkey for half a century, with import-substituting industrialization through state economic enterprises (SEEs) as a guiding principle. By 1980 a serious economic and political crisis called for a reassessment of economic policies. Policy reorientation was radical : from import substitution to export promotion, from interventionism to market forces, and from promotion of SEEs to promotion of the private sector. The state's...

  5. Privatized multipurpose reactor initiative

    International Nuclear Information System (INIS)

    Davis, G.A.

    1995-01-01

    ABB Combustion Engineering (ABB CE) and seven other companies have submitted a plan to the DOE for deploying a multipurpose reactor at the Savannah River Plant. The facility would consume excess plutonium as fuel, irradiate tritium producing targets, and generate electricity. The plan proposes to establish a consortium that would privately finance and own two System 80+ nuclear units and a mixed oxide fuel fabrication facility

  6. Privatized Military Operations

    Science.gov (United States)

    2006-01-01

    environment such as that in Abu Grahib prison , where military personnel tasked with similar duties to that of contractors have been held legally accountable... Grahib Prison . The Washington Post. Office of Management and Budget Circular A-76. (August 4, 1988. Revised 1999). Performance of Commercial...downsizes the military after the Global War on Terror as it did after the Cold War. Private contractors depend largely upon former service members to

  7. Agriculture and private sector

    DEFF Research Database (Denmark)

    Sahin, Sila; Prowse, Martin Philip; Weigh, Nadia

    and this looks set to remain for the next two decades at least. The agriculture and growth evidence paper series has been developed to cover a range of issues that are of most relevance to DFID staff. The paper is not intended to be a comprehensive overview of all issues relating to agriculture and the private...... sector. It concentrates on those areas that are of particular focus for DFID policy and strategy....

  8. Privatize Candu (question mark)

    International Nuclear Information System (INIS)

    Kelly, Thomas.

    1981-01-01

    A report sponsored by a group of nuclear suppliers and the Royal Bank suggested that the Candu reactor system would sell better if it were owned by a private company. Licensing of a Candu reactor in the U.S.A. was also suggested. The author of this article agrees with these points, but disagrees with the suggestion that safeguards should be relaxed. He suggests that contracts should stipulate that instrumentation should be supplied as much as possible from Canadian sources

  9. Apaches push privatization

    International Nuclear Information System (INIS)

    Daniels, S.

    1994-01-01

    Trying to drum up business for what would be the first private temporary storage facility for spent nuclear fuel rods, the Mescalero Apaches are inviting officials of 30 utilities to convene March 10 at the tribe's New Mexico reservation. The state public utilities commission will also attend the meeting, which grew from an agreement the tribe signed last month with Minneapolis-based Northern States Power Co

  10. Public-Private Partnerships

    DEFF Research Database (Denmark)

    Lehmann, Martin; Jeppesen, S.

    2006-01-01

    Public-private partnerships in the environmental field have emerged as one option in the pursuit of sustainable development. So-called ‘Green Networks’, ‘Cleaner Production Centres’, ‘Waste Minimisation Clubs’ are among others highlighted as alternatives to governmental regulation. While being...... these initiatives in an institutional framework and suggest how the experiences can be understood in their own rights....

  11. Virtual private network (VPN)

    International Nuclear Information System (INIS)

    Caskey, Susan

    2006-01-01

    A virtual private network (VPN) is the essential security feature that allows remote monitoring systems to take advantage of the low communications cost of the internet. This paper introduces the VPN concept and summarizes the networking and security principles. The mechanics of security, for example, types of encryption and protocols for exchange of keys between partners, are explained. Important issues for partners in different countries include the interoperability and mutual accreditations of systems. (author)

  12. Financial Private Regulation and Enforcement

    OpenAIRE

    MILLER, Geoffrey

    2011-01-01

    This paper has been delivered within the context of the research project "Transnational Private Regulatory Regimes: Constitutional foundations and governance design". This paper considers the topic of private regulation and enforcement for internationally active financial services firms. The paper documents the following types of regulation and enforcement that involve significant private input: house rules, contracts, internal compliance, management-based regulation, private standard-sett...

  13. From Social to Private Ownership

    DEFF Research Database (Denmark)

    Gregoric, Aleksandra; Masten, Arjana Brezigar; Zajc, Katarina

    2011-01-01

    of the multiple blockholder structures that these firms were assigned at privatization. We observe significant path dependence: patterns of ownership and control are in part determined by the persistence of the initial privatization owners (state funds, privatization investment funds, employees, and managers...

  14. Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study

    OpenAIRE

    Gubbels, Jessica S; Kremers, Stef PJ; Stafleu, Annette; de Vries, Sanne I; Goldbohm, R Alexandra; Dagnelie, Pieter C; de Vries, Nanne K; van Buuren, Stef; Thijs, Carel

    2011-01-01

    Abstract Background Insights into the effects of energy balance-related parenting practices on children's diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of energy balance-related parenting practices at age 5, as well as the associations of these practices with children's diet, activity behavior, and body mass index (BMI) development. Methods ...

  15. Detecting referral and selection bias by the anonymous linkage of practice, hospital and clinic data using Secure and Private Record Linkage (SAPREL: case study from the evaluation of the Improved Access to Psychological Therapy (IAPT service

    Directory of Open Access Journals (Sweden)

    Parry Glenys

    2011-10-01

    Full Text Available Abstract Background The evaluation of demonstration sites set up to provide improved access to psychological therapies (IAPT comprised the study of all people identified as having common mental health problems (CMHP, those referred to the IAPT service, and a sample of attenders studied in-depth. Information technology makes it feasible to link practice, hospital and IAPT clinic data to evaluate the representativeness of these samples. However, researchers do not have permission to browse and link these data without the patients' consent. Objective To demonstrate the use of a mixed deterministic-probabilistic method of secure and private record linkage (SAPREL - to describe selection bias in subjects chosen for in-depth evaluation. Method We extracted, pseudonymised and used fuzzy logic to link multiple health records without the researcher knowing the patient's identity. The method can be characterised as a three party protocol mainly using deterministic algorithms with dynamic linking strategies; though incorporating some elements of probabilistic linkage. Within the data providers' safe haven we extracted: Demographic data, hospital utilisation and IAPT clinic data; converted post code to index of multiple deprivation (IMD; and identified people with CMHP. We contrasted the age, gender, ethnicity and IMD for the in-depth evaluation sample with people referred to IAPT, use hospital services, and the population as a whole. Results The in IAPT-in-depth group had a mean age of 43.1 years; CI: 41.0 - 45.2 (n = 166; the IAPT-referred 40.2 years; CI: 39.4 - 40.9 (n = 1118; and those with CMHP 43.6 years SEM 0.15. (n = 12210. Whilst around 67% of those with a CMHP were women, compared to 70% of those referred to IAPT, and 75% of those subject to in-depth evaluation (Chi square p Conclusions The sample studied in-depth were older, more likely female, and less deprived than people with CMHP, and fewer had recorded ethnic minority status. Anonymous

  16. Cohort profile

    DEFF Research Database (Denmark)

    Kreiberg, Michael; Bandak, Mikkel; Lauritsen, Jakob

    2018-01-01

    The cohort was set up in order to analyze late effects in long-term testicular cancer survivors (TCS) and to contribute to the design of future follow-up programs addressing and potentially preventing late effects. Data for this cross-sectional study were collected between January 1, 2014, and De...

  17. Private political archives

    Directory of Open Access Journals (Sweden)

    Waldemar Chorążyczewski

    2010-12-01

    Full Text Available "Private political archives" are understood by me as all acts collected intently by a private person. These acts are connected with the person's participation in political life and gathered in order to be used in public activity as the source of argumentation and information about factors and mechanisms of political processes. Private political archives of the first half of the XVI century were mainly created by royal servants, often with reference to their job duties. These duties could inspire to collect political acts for private purposes. During the reign of Sigismund Augustus, archives of gentry activists were developed to small extent and they mainly focused on parliamentary life. Private political archives were created outside the executionist movement, namely in the community gathered around the royal court. After 1572, Crown and Lithuanian magnates greatly influenced the creation of political archives. Archives of lesser gentry, scarce and poor, did not disappear completely. However, they became difficult for identification. Therefore, developmental process concerned exclusively documentary "treasure troves" created by magnates. They had the financial means and possibilities to create truly valuable political archives. The same as in the previous period the dynamisms of executionist movement was reflected in political archival documentation, now the creation of patronage system and clientele, or traditionally understood magnate oligarchy, (depending on the point of view corresponded best to archives development. The heritage of previous generations was the treasure trove of patterns and solutions. However, this trove was used selectively, on one hand giving up patterns and rights that were uncomfortable, and, on the other, giving the value of precedence to unexpected acts that gained more importance or even new content in changed political conditions. The application of interpretation principle raised interest in old acts and patterns

  18. Use of atomoxetine and suicidal ideation in children and adolescents: Results of an observational cohort study within general practice in England.

    Science.gov (United States)

    Davies, M; Coughtrie, A; Layton, D; Shakir, S A S

    2017-01-01

    To investigate the association between atomoxetine, a drug used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), and suicidal ideation, within a cohort of 2-18-year-old patients in England. The study was conducted using the observational cohort technique of Modified prescription event monitoring (M-PEM). Patients prescribed atomoxetine were identified from dispensed prescriptions issued by primary care physicians. A customised postal GP questionnaire was used to capture outcome data for suicidal ideation. A matched pair cohort analysis was performed within patients to compare the risk of suicidal ideation in the period after starting atomoxetine with the risk prior to starting atomoxetine; this was stratified by age and concomitant use of methylphenidate. Additional information on patient characteristics, and events of interest was also collected; individual cases of suicidal ideation were qualitatively assessed for drug relatedness. Of the final cohort (n=4509); 85.5% male (n=3857), median age 11 years (IQR: 9,14). Primary prescribing indication for atomoxetine was ADHD (n=4261, 94.6%). Almost a quarter of the cohort had been co-prescribed methylphenidate. Results of the matched pair cohort analysis indicated that the period after starting atomoxetine was not associated with an increase in the incidence of suicidal ideation compared to the period prior to starting treatment (RR: 0.71; CI: 0.48-1.07; P-value: 0.104). Individual case assessment of suicidal ideation suggested a causal association within a number of cases. This study found no evidence of an increased risk of suicidal ideation during treatment with atomoxetine, compared to the period prior to starting treatment. Amongst age specific subgroups, this risk may change. Nonetheless, individual case assessment suggested a causal relationship in some patients, hence physicians need to be aware of the possibility of developing this event, and furthermore consider how best to detect it in

  19. A public private partnership to fight against malaria along the Chad-Cameroon pipeline corridor: I. Baseline data on socio-anthropological aspects, knowledge, attitudes and practices of the population concerning malaria.

    Science.gov (United States)

    Moyou-Somo, Roger; Essomba, Paul; Songue, Eva; Tchoubou, Natacha Nsiewe; Ntambo, Anita; Hiol, Huguette Ngo; Kemajou, Jacques Pokam; Essi, Marie-José; Millet, Pascal

    2013-10-29

    Malaria is ranked as the major public health problem in Cameroon, representing 50% of illness in less than five year old children, 40-45% of medical consultation and 40% of the annual home income spent on health. The Cameroon Oil Transportation Company (COTCO) that exploits the Chad-Cameroon pipeline in Cameroon territory, initiated in 2010, a public private partnership project to control malaria along the pipeline corridor. A research component was included in the project so as to guide and evaluate the control measures applied in this pipeline corridor. This study presents the baseline socio-anthropological data as well as the knowledge, attitudes and practices of the local population concerning malaria, its transmission, management and prevention. A descriptive cross-sectional survey was undertaken in four sentinel sites (one site per ecological zone) along the Chad-Cameroon pipeline corridor. Three structured questionnaires were used for the survey. Two of them were addressed to the heads of households (one for census and the other to collect information concerning the characteristics of houses and living conditions in households as well as their knowledge, attitudes and practices concerning malaria). The last questionnaire was used to collect information on malaria management and prevention. It was addressed to women who had delivered a living child within the past three years. Interviewers were recruited from each village and trained for two consecutive days on how to fill the different questionnaires. All data were analysed at 5% significant level using Epi-Info, SPSS and Cs PRO 4.0 STATA. Values of p ≤ 0.05 were considered statistically significant. Interviews were conducted in 2597 households (Bipindi 399, Bélabo 835, in Meidougou 820 and Dompta 543). Whatever the study site, 50% of the heads of household were workers of the agro-pastoral sector. Most of the heads of household were men (average 77.4% for men and 22.6% for females). The walls of

  20. Privatization an a national business

    Directory of Open Access Journals (Sweden)

    Andrzej Tokarski

    2009-12-01

    Full Text Available Privatization is a very complicated process that builds a market economy. It entails numerous problems, the overcoming of which depends on the pace and scale of privatization in a particular country. The privatization process of the Polish economy is assessed differently, and still raises a lot of controversy and debate, not only for the economy, but also politics. This is particularly the privatization of state assets. Privatization was one of the foundations for political transformation in Poland and other Central- and Eastern European countries. Some say that was a great success, while for others it was a field for plunder and affairs. Who is right? Is privatization a success or a failure? This paper aims to present the arguments posed by both supporters and opponents of the privatization in Poland.

  1. Effectiveness of Cetuximab as First-Line Therapy for Patients With Wild-Type KRAS and Unresectable Metastatic Colorectal Cancer in Real-Life Practice: Results of the EREBUS Cohort.

    Science.gov (United States)

    Rouyer, Magali; François, Eric; Cunha, Antonio Sa; Monnereau, Alain; Noize, Pernelle; Robinson, Philip; Droz-Perroteau, Cécile; Le Monies de Sagazan, Alise; Jové, Jérémy; Lassalle, Régis; Moore, Nicholas; Fourrier-Réglat, Annie; Smith, Denis

    2018-01-31

    Few real-life data are available on cetuximab benefit. The EREBUS cohort was performed to assess metastases resection rate, use, safety, and survival outcomes in wild-type KRAS (Kirsten rat sarcoma viral oncogene) patients with initially unresectable metastatic colorectal cancer (mCRC) treated by cetuximab in real practice. The study cohort comprised patients initiating cetuximab between January 2009 and December 2010 in 65 French centers, with initially unresectable mCRC and wild-type KRAS. Kaplan-Meier analysis estimated 24-month probability of metastases resection and progression-free survival, and 36-month overall survival (OS). Cox proportional hazards models investigated factors associated with survival outcomes. Among the 389 patients included, median age was 64 years, 67.4% were male, 77.9% had Eastern Cooperative Oncology Group performance status ≤ 1, and hepatic metastases were most frequent at baseline (n = 146 exclusively, n = 149 not exclusively, n = 94 nonliver only). Median duration of cetuximab use was 4.8 months. Metastases resection was performed in 106 patients (27.2%) (n = 60 liver exclusively, n = 33 not exclusively, n = 13 nonliver only). The 24-month probability (95% confidence interval) of metastases resection occurrence was 33.6% (28.5-39.3). Median progression-free survival was 9.2 (8.5-9.8) months for the total cohort and 13.0 (11.6-15.1) for those resected; median OS was 23.0 (20.6-26.3) months for the total cohort and was not reached after 36 months for those who were resected. The strongest factor associated with higher OS was metastases resection with complete remission (hazard ratio, 0.41; 95% confidence interval, 0.19-0.88). This cohort study highlights in French real-life practice the benefit of cetuximab in first-line mCRC therapy, notably in case of metastases resection with complete remission. Copyright © 2018 Elsevier Inc. All rights reserved.

  2. Balancing Public and Private Regulation

    Directory of Open Access Journals (Sweden)

    Martijn Scheltema

    2016-01-01

    Full Text Available Voluntary Sustainability Standards (VSS might develop into a viable alternative to public regulation. However, it turns on the (regulatory circumstances whether that holds true in practice. If public regulation on CSR topics is lacking, governments are unable to agree upon certain topics on a global level or diverging public regulation exists, VSS can be helpful to set global standards. Obviously, private standards will especially be helpful if they are commensurate with local public legislation (and e.g. treaties and/or are accepted by local governments. If one neglects this, numerous domestic structures might exist that frustrate VSS. Furthermore, governments have to remain vigilant as to whether these private regimes do not result in market disruption, consumer detriment or hamper trade. VSS might also compete with public arrangements which might limit the uptake of VSS. However, if public regulation exists VSS might be a viable alternative if compliance with not too compelling public norms by market participants is rather poor and the public policymaker is aiming to incentivize the better performing part of the market to embark on higher standards and thus only desires to regulate the less performing part of the market. However, of paramount importance is the effectiveness of VSS in order to be a viable alternative to public regulation. The effectiveness of VSS should be assessed using an integrated multi-disciplinary (comparative approach entailing legal, impact-assessment, legitimacy, governance and behavioural aspects. Only effective VSS in the aforementioned sense are a true alternative to public regulation.Beyond that, the legal perspective in connection with (the effectiveness of VSS is discussed, featuring FSC and UTZ Certified as an example. It is important from this perspective that VSS have a clear and sufficiently selective objective and sufficiently specific norms, are regularly evaluated, entail ‘conflict of law rules’ and

  3. Mobile Virtual Private Networking

    Science.gov (United States)

    Pulkkis, Göran; Grahn, Kaj; Mårtens, Mathias; Mattsson, Jonny

    Mobile Virtual Private Networking (VPN) solutions based on the Internet Security Protocol (IPSec), Transport Layer Security/Secure Socket Layer (SSL/TLS), Secure Shell (SSH), 3G/GPRS cellular networks, Mobile IP, and the presently experimental Host Identity Protocol (HIP) are described, compared and evaluated. Mobile VPN solutions based on HIP are recommended for future networking because of superior processing efficiency and network capacity demand features. Mobile VPN implementation issues associated with the IP protocol versions IPv4 and IPv6 are also evaluated. Mobile VPN implementation experiences are presented and discussed.

  4. Private Sector Involvement

    DEFF Research Database (Denmark)

    Hansen, Annette Skovsted

    New and independent donors are adding their own twist to the experiences of receiving ODA and their examples are already inspiring the DAC, UN, and other multiple- and bilateral aid relationships. Rather than competition among development paradigms, I see negotiations of ideas of development and ...... and a co-existence of a multiplicity of approaches. I will argue that a trend of new and old actors inspiring each other will continue and the explicit focus on private sector development is just a first outcome....

  5. Private information retrieval

    CERN Document Server

    Yi, Xun; Bertino, Elisa

    2013-01-01

    This book deals with Private Information Retrieval (PIR), a technique allowing a user to retrieve an element from a server in possession of a database without revealing to the server which element is retrieved. PIR has been widely applied to protect the privacy of the user in querying a service provider on the Internet. For example, by PIR, one can query a location-based service provider about the nearest car park without revealing his location to the server.The first PIR approach was introduced by Chor, Goldreich, Kushilevitz and Sudan in 1995 in a multi-server setting, where the user retriev

  6. Corruption in Romanian Forestry - Morality and Local Practice in the Context of Privatization (Corupţia în domeniul forestier din România - moralitate şi practici locale în contextul privatizării

    Directory of Open Access Journals (Sweden)

    MONICA VASILE

    2009-02-01

    Full Text Available I believe that recent theoretical developments on corruption from the field of social anthropology can shed light on various processes that communities confront in different areas. This paper focuses on practices related to forestry, trying to show different mechanisms by which corruption might be performed, as well as the way in which the villagers' definitions of a corrupt act relate to morality. In Romania, 50% of the forests were privatized and a huge number ofcommunity-based institutions were established in the forest areas. A dense net of forestry institutions is beginning to work in rural Romania for managing and regulating forest-related issues in a decentralized way. Parallel with this process, storytelling about illegal logging and forest depletion is becoming a routine. How is it possible to perform corruption in the context of privatization and decentralization, which are among the anticorruption panacea promoted by international development agencies? - this is a question which will be answered in the article.

  7. Do Catalan private hospitals enjoy financial health?

    Directory of Open Access Journals (Sweden)

    Judit Creixans Tenas

    2016-02-01

    Full Text Available Purpose: The present study reflects the economic and financial analysis of  private hospitals with non-charitable character in Catalonia 2008-2013. The private health sector is considered to be a service activity that develops an important social role. The study positions these analysed centers in the Catalan and Spanish health sector and presents the main economic and financial indicators to diagnose the situation of these companies during the period indicated by analysing short and long-term results and analysis of changes in equity and cash flows of the wineries. Design/methodology/approach: The data used comes from the statements of the Catalan hospital centers in the period 2008-2013 and in particular, it contains a sample of 94 Catalan private hospitals, that mostly are considered large-level accounting (according to the General Accounting Plan. The economic and financial  analysis has carried out using descriptive statistics and analysis results and conclusions have been reached. Findings: The study noted that enables private hospitals in this period have a healthy economic and financial status, although it should improve the management of assets. Most sales are concentrated with a small number of hospitals and, regarding the evolution of the results, produces two distinct stages, the first period of decrease (2008-2010 and the second period of growth and recovery from 2011.. Research limitations/implications: It would be desirable to perform the same study by the Spanish private hospitals in order to compare the economic and financial analysis of the Catalan private sector with the Spanish private sector. Practical implications: It allows us to assess the projection of this sector in recent years in Catalonia in order to take the appropriate economic decisions in this regard. Social implications: The results show the changes that have occurred over the years in the economic crisis of the period analysed. Originality / value: For

  8. [Comparison on Endoscopic Hemoclip and Hemoclip Combination Therapy in Non-variceal Upper Gastrointestinal Bleeding Patients Based on Clinical Practice Data: Is There Difference between Prospective Cohort Study and Randomized Study?].

    Science.gov (United States)

    Lee, Su Hyun; Jung, Jin Tae; Lee, Dong Wook; Ha, Chang Yoon; Park, Kyung Sik; Lee, Si Hyung; Yang, Chang Heon; Park, Youn Sun; Jeon, Seong Woo

    2015-08-01

    Endoscopic hemoclip application is an effective and safe method of endoscopic hemostasis. We conducted a multicenter retrospective study on hemoclip and hemoclip combination therapy based on prospective cohort database in terms of hemostatic efficacy not in clinical trial but in real clinical practice. Data on endoscopic hemostasis for non-variceal upper gastrointestinal bleeding (NVUGIB) were prospectively collected from February 2011 to December 2013. Among 1,584 patients with NVUGIB, 186 patients treated with hemoclip were enrolled in this study. Subjects were divided into three groups: Group 1 (n = 62), hemoclipping only; group 2 (n = 88), hemoclipping plus epinephrine injection; and group 3 (n = 36), hemocliping and epinephrine injection plus other endoscopic hemostatic modalities. Primary outcomes included rebleeding, other therapeutic management, hospitalization period, fasting period and mortality. Secondary outcomes were bleeding associated mortality and overall mortality. Active bleeding and peptic ulcer bleeding were more common in group 3 than in group 1 and in group 2 (p bleeding associated mortality and total mortality) were not different among groups. Combination therapy of epinephrine injection and other modalities with hemoclips did not show advantage over hemoclipping alone in this prospective cohort study. However, there is a tendency to perform combination therapy in active bleeding which resulted in equivalent hemostatic success rate, and this reflects the role of combination therapy in clinical practice.

  9. Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: The KOALA Birth Cohort Study.

    NARCIS (Netherlands)

    Gubbels, J.S.; Kremers, S.P.J.; Stafleu, A.; Vries, S.I. de; Goldbohm, R.A.; Dagnelie, P.C.; Vries, N.K. de; Buuren, S. van; Thijs, C.

    2011-01-01

    Background: Insights into the effects of energy balance-related parenting practices on children’s diet and activity behavior at an early age is warranted to determine which practices should be recommended and to whom. The purpose of this study was to examine child and parent background correlates of

  10. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review.

    Directory of Open Access Journals (Sweden)

    Sanjay Basu

    Full Text Available INTRODUCTION: Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. METHODS AND FINDINGS: Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive

  11. Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

    Science.gov (United States)

    Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

    2012-01-01

    Introduction Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Methods and Findings Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of “private sector” included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. “Competitive dynamics” for

  12. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

    2012-01-01

    Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive dynamics" for funding appeared between the two sectors, such

  13. Postoperative radiotherapy dose requirement in standard combined-modality practice for head and neck squamous cell carcinoma: Analysis of salient surgical and radiotherapy parameters in 2 cohorts.

    Science.gov (United States)

    Mohanti, Bidhu K; Thakar, Alok; Kaur, Jaspreet; Bahadur, Sudhir; Malik, Monica; Gandhi, Ajeet K; Bhasker, Suman; Sharma, Atul

    2017-09-01

    This study compared 2 sequential cohorts to identify the postoperative radiotherapy (PORT) dose requirement for head and neck squamous cell carcinoma (HNSCC). Two distinct PORT dose regimens were prescribed over 11 years; group 1 received 56 Gy or less, and group 2 received 60 Gy or more. The 2D and 3D techniques were used. Two sequential cohorts consisted of 478 patients, with mean and median follow-up for group 1 and 2 as: 37.0 versus 28.5 months and 13.8 versus 13.1 months, respectively. Grades 3-4 mucosal toxicities (11.4% vs 28.3%), hospitalization (3.2% vs 17.4%), and nasogastric feeding (11.9% vs 29.7%) were higher in group 2. The 2-year disease-free survival (DFS) was higher with PORT >60 Gy for the following factors: age ≤ 50 years (P = .041); ≥ 4 positive nodes (P = .029); and overall treatment time (OTT) ≥ 100 days (P = .042). Except for the benefit of doses >60 Gy for limited parameters, a lower PORT dose did not compromise the results and can potentially reduce the morbidities and healthcare costs. © 2017 Wiley Periodicals, Inc.

  14. Prevalence of Ischemic Heart Disease and Management of Coronary Risk in Daily Clinical Practice: Results from a Mediterranean Cohort of HIV-Infected Patients

    Directory of Open Access Journals (Sweden)

    Patricia Echeverría

    2014-01-01

    Full Text Available Background. There are conflicting data on the prevalence of coronary events and the quality of the management of modifiable cardiovascular risk factors (CVRF in HIV-infected patients. Methods. We performed a retrospective descriptive study to determine the prevalence of coronary events and to evaluate the management of CVRF in a Mediterranean cohort of 3760 HIV-1-infected patients from April 1983 through June 2011. Results. We identified 81 patients with a history of a coronary event (prevalence 2.15%; 83% of them suffered an acute myocardial infarction. At the time of the coronary event, CVRF were highly prevalent (60.5% hypertension, 48% dyslipidemia, and 16% diabetes mellitus. Other CVRF, such as smoking, hypertension, lack of exercise, and body mass index, were not routinely assessed. After the coronary event, a significant decrease in total cholesterol P=0.025 and LDL-cholesterol P=0.004 was observed. However, the percentage of patients who maintained LDL-cholesterol > 100 mg/dL remained stable (from 46% to 41%, P=0.103. Patients using protease inhibitors associated with a favorable lipid profile increased over time P=0.028. Conclusions. The prevalence of coronary events in our cohort is low. CVRF prevalence is high and their management is far from optimal. More aggressive interventions should be implemented to diminish cardiovascular risk in HIV-infected patients.

  15. Regional cost information for private timberland conversion and management.

    Science.gov (United States)

    Lucas S Bair; Ralph J. Alig

    2006-01-01

    Cost of private timber management practices in the United States are identified, and their relationship to timber production in general is highlighted. Costs across timber-producing regions and forest types are identified by forest type and timber management practices historically applied in each region. This includes cost estimates for activities such as forest...

  16. Transnational mediation: a practical approach in the treatment of private international relationships / Mediación transnacional: una aproximación práctica en el ámbito de las relaciones privadas internacionales

    Directory of Open Access Journals (Sweden)

    Carmelo Hernández Ramos

    2015-10-01

    Full Text Available Conflict resolution through mediation, in the course of private international relationships and in the context of multiculturalism, particularly when it involves individuals from other countries or cultures requires robust tools for conflict management and efficient negotiation skills. In the resolution of civil or commercial conflicts and, in general, in the camp of international private mediation, is necessary to know and apply strategies and specific skills to resolve conflicts that must be addressed having in mind his legal aspects, along with his interdisciplinary characteristics and specially his intercultural nature. Why then is good to use mediation as a tool to solve a conflict in this so complex area? Because it aims to solve disputes avoiding lengthy and costly procedures for the persons, which involves the incorporation of conflict management techniques, together with negotiation skills and communication strategies and extrajudicial settlement of disputes raised.

  17. Private Equity and Industry Performance

    DEFF Research Database (Denmark)

    Bernstein, Shai; Lerner, Josh; Sørensen, Morten

    2017-01-01

    The growth of the private equity industry has spurred concerns about its impact on the economy. This analysis looks across nations and industries to assess the impact of private equity on industry performance. We find that industries where private equity funds invest grow more quickly in terms...... of total production and employment and appear less exposed to aggregate shocks. Our robustness tests provide some evidence that is consistent with our effects being driven by our preferred channel....

  18. Exploring Responsibility. Public and Private in Human Rights Protection

    OpenAIRE

    Bexell, Magdalena

    2005-01-01

    The theory and practice of international relations are replete with dilemmas related to the distribution of responsibility for human rights protection. Institutionalized notions of public and private empower and shape knowledge of what the spheres of responsibility signify for different kinds of actors. This study examines how the public-private distinction is manifested in controversy concerning the character of corporate social responsibility. The study develops a conceptual framework cente...

  19. Contractual Obligations under the Private International Law in Albania.

    Directory of Open Access Journals (Sweden)

    Ervis Çela

    2014-07-01

    This work as based on the ex-positio sinkronik system aims at giving a minimum contribution in the application of the international private law and clarifies the omission, collision and legal problematic aspects in practice. At the end of this work, there are our conclusions which serve as a deduction over the analysis and studies done to this part of the private international law.

  20. TWRS privatization bibliography

    International Nuclear Information System (INIS)

    1996-02-01

    The purpose of this bibliography is to present a select set of documents that may be of interest to the Offeror, covering a variety of subject areas related to the TWRS Privatization Project. The organization of this bibliography is by subject area. Some of the documents overlap subject areas, and may be presented in more than one. Additionally, assignment of a document to one subject area does not necessarily preclude that document from containing information relevant to other subject areas not identified. The subject areas include, in order of presentation:. Waste Characterization; Pre-treatment; High-level Waste Immobilization; Low-level Waste Immobilization; Low-level Waste Melter Test Program; Performance Assessment; and General Safety

  1. TWRS privatization bibliography

    International Nuclear Information System (INIS)

    1996-03-01

    The purpose of this bibliography is to present a select set of documents that may be of interest to the Offeror, covering a variety of subject areas related to the TWRS Privatization Project. This bibliography is not, nor is intended to be, exhaustive or complete. It was prepared with the intent of providing a sampling of representative documents potentially helpful to Offerors. The documents referenced herein have been identified as representative of those potentially helpful to Offerors. This list of documents does not represent the full extent of available and potentially helpful information, nor should it be taken as a representation of documents determined to be of greater importance than other documents not referenced herein. There are numerous documents available to the public that are NOT cited in this bibliography; the Offeror is encouraged to perform searches for alternate sources of information

  2. Heating plant privatization stagnates

    International Nuclear Information System (INIS)

    Janoska, J.; Benka, M.; Sobinkovic, B.; Haluza, I.

    2005-01-01

    The state has been talking about privatization of 6 municipal heating plants since 2001. The tenders were to start last year. But nothing has happened and the future is uncertain. The city councils would prefer to receive, if not 100%, then at least a majority stake in the heating plants free of charge. But the Cabinet has decided to sell 51% to investors. The privatization agency - the National Property Fund (FNM) is preparing a proposal to increase the stake offered for sale to 67%. According to information provided by the FNM the sale will begin after Cabinet approval. The Fund intends to apply the same model to the sale of all the heating plants. Last year, a major German company Verbundnetz Gas declared its interest in purchasing large municipal heating plants in Slovakia. But it has been waiting for a response ever since. The French company - Dalkia, which has 10-years' experience of doing business in Slovakia, is interested in all the heating plants to be offered for sale. The Austrian company - Stefe is not new to the business either, it is interested mainly in the regions where it has already established itself - Central and Eastern Slovakia. Strategic investors expect financial groups to show interest too. The Penta Group has not hid its ambitions - it has already privatised a company which represents the key to the future development of heat management in Bratislava - Paroplynovy cyklus. Whereas Penta is not new to the heat production business another financial group - Slavia Capital is still surveying the sector. Should it not succeed, it plans several projects that would allow it to take a stake in the sector

  3. Industry structures in private dental markets in Finland.

    Science.gov (United States)

    Widström, E; Mikkola, H

    2012-12-01

    To use industrial organisation and organisational ecology research methods to survey industry structures and performance in the markets for private dental services and the effect of competition. Data on practice characteristics, performance, and perceived competition were collected from full-time private dentists (n = 1,121) using a questionnaire. The response rate was 59.6%. Cluster analysis was used to identify practice type based on service differentiation and process integration variables formulated from the questionnaire. Four strategic groups were identified in the Finnish markets: Solo practices formed one distinct group and group practices were classified into three clusters Integrated practices, Small practices, and Loosely integrated practices. Statistically significant differences were found in performance and perceived competitiveness between the groups. Integrated practices with the highest level of process integration and service differentiation performed better than solo and small practices. Moreover, loosely integrated and small practices outperformed solo practises. Competitive intensity was highest among small practices which had a low level of service differentiation and was above average among solo practises. Private dental care providers that had differentiated their services from public services and that had a high number of integrated service production processes enjoyed higher performance and less competitive pressures than those who had not.

  4. Inflammatory eye reactions in patients treated with bisphosphonates and other osteoporosis medications - cohort analysis using a national prescription database

    DEFF Research Database (Denmark)

    Pazianas, Michael; Clark, Emma M; Eiken, Pia Agnete

    2013-01-01

    Ocular inflammatory reactions have been described in patients on bisphosphonate treatment. We estimated the incidence rate of ocular inflammation at 3 and 12 months in patients treated for osteoporosis using a register based cohort linked to prescription data (hospitals and private practice.......4%) of patients on osteoporosis therapy filled one or more prescriptions for TES. TES treatment rates (per 1000 patient years) in the first year of osteoporosis treatment were 44 (95% confidence interval (CI) 42-46) for alendronate, 40 (95% CI 38-43) for etidronate, 45 (95% CI 35-57) for risedronate, 32 (95% CI...

  5. A Policy-into-Practice Intervention to Increase the Uptake of Evidence-Based Management of Low Back Pain in Primary Care: A Prospective Cohort Study

    Science.gov (United States)

    Slater, Helen; Davies, Stephanie Joy; Parsons, Richard; Quintner, John Louis; Schug, Stephan Alexander

    2012-01-01

    Background Persistent non-specific low back pain (nsLBP) is poorly understood by the general community, by educators, researchers and health professionals, making effective care problematic. This study evaluated the effectiveness of a policy-into-practice intervention developed for primary care physicians (PCPs). Methods To encourage PCPs to adopt practical evidence-based approaches and facilitate time-efficient, integrated management of patients with nsLBP, we developed an interdisciplinary evidence-based, practical pain education program (gPEP) based on a contemporary biopsychosocial framework. One hundred and twenty six PCPs from primary care settings in Western Australia were recruited. PCPs participated in a 6.5-hour gPEP. Self-report measures recorded at baseline and at 2 months post-intervention included PCPs' attitudes, beliefs (modified Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS), evidence-based clinical practices (knowledge and skills regarding nsLBP management: 5-point Likert scale with 1 =  nil and 5 =  excellent) and practice behaviours (recommendations based on a patient vignette; 5-point Likert scale). Results Ninety one PCPs participated (attendance rate of 72%; post-intervention response rate 88%). PCP-responders adopted more positive, guideline-consistent beliefs, evidenced by clinically significant HC-PAIRS score differences (mean change  = −5.6±8.2, ppain education program set within a framework that aligns health policy and practice, encourages PCPs to adopt more self-reported evidence-based attitudes, beliefs and clinical behaviours in their management of patients with nsLBP. However, further research is required to determine cost effectiveness of this approach when compared with other modes of educational delivery and to examine PCP behaviours in actual clinical practice. PMID:22662264

  6. Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study

    DEFF Research Database (Denmark)

    Prompers, L.; Huijberts, M.; Apelqvist, J.

    2008-01-01

    Aims To determine current management and to identify patient-related factors and barriers that influence management strategies in diabetic foot disease. Methods The Eurodiale Study is a prospective cohort study of 1232 consecutive individuals presenting with a new diabetic foot ulcer in 14 centres...... suggest that current guidelines are too general and that healthcare organizational barriers and personal beliefs result in underuse of recommended therapies. Action should be undertaken to overcome these barriers and to guarantee the delivery of optimal care for the many individuals with diabetic foot...... across Europe. We determined the use of management strategies: referral, use of offloading, vascular imaging and revascularization. Results Twenty-seven percent of the patients had been treated for > 3 months before referral to a foot clinic. This varied considerably between countries (6-55%). At study...

  7. Socioeconomic differences in the association between sickness absence and mortality: The prospective DREAM study of Danish private sector employees

    DEFF Research Database (Denmark)

    Lund, Thomas; Kivimäki, Mika; Christensen, Karl Bang

    2008-01-01

    OBJECTIVES: To examine duration of sickness absence as a risk marker for future mortality by socioeconomic position among all private sector employees in Denmark 1998-2004. Design, SETTING AND PARTICIPANTS: This prospective cohort study studied all residents in Denmark employed in the private sec...

  8. Advanced practice nurses: starting an independent practice.

    Science.gov (United States)

    Lambert, V A; Lambert, C E

    1996-01-01

    Independent or private practice is the delivery of nursing services provided by nurses over which nurses have full control. With a changing healthcare system, nurses are in a prime position to negotiate the delivery of appropriate, acceptable, and cost-effective health care as independent practitioners. This article addresses the mission and goals of independent practice, community need, business structure of the practice, housing the practice, legal considerations, financing the practice, marketing issues, clientele, record keeping, and reimbursement.

  9. Social Security privatization in Latin America.

    Science.gov (United States)

    Kritzer, B E

    2000-01-01

    The new, partially privatized social security system adopted by Chile in 1981 has attracted attention in many parts of the world. Since then, a number of Latin American countries have implemented the Chilean model, with some variations: either with a single- or multi-tier system, or with a period of transition to take care of those in the labor force at the time of the change. The single-tier version consists of a privatized program with individual accounts in pension fund management companies. Multi-tier systems have a privatized component and retain some form of public program. This article describes each of the new programs in Latin America, their background, and similarities and differences among them. Much more information is available for Chile than for the other countries (in part because Chile has the oldest system), enough to be able to evaluate what, in most cases, is the most accurate information. That is often not the case for the other countries, especially when dealing with subjects such as transition costs and net rates of return (rates of return minus administrative fees). No country has copied the Chilean system exactly. Bolivia, El Salvador, and Mexico have closed their public systems and set up mandatory individual accounts. Argentina has a mixed public/private system with three tiers. In Colombia and Peru, workers have a choice between the public and private programs. Uruguay created a two-tier mixed system. Costa Rica has a voluntary program for individual accounts as a supplement to the pay-as-you-go program and has just passed a law setting up mandatory accounts containing employer contributions for severance pay. All of the countries continue to face unresolved issues, including: High rates of noncompliance--the percentage of enrollees who do not actively and regularly contribute to their accounts--which could lead to low benefits and greater costs to the governments that offer a guaranteed minimum benefit; Proportionately lower benefits for

  10. Advanced Introduction to Private Law

    NARCIS (Netherlands)

    Smits, Jan

    2017-01-01

    In this Advanced Introduction, the reader is taken on an intellectual journey through the different facets and dimensions of private law, from the family home to Kuta Beach and from Thomas Piketty to Nina Hagen. This concise book provides an accessible and fresh introduction to private law,

  11. The structure of privatization plans

    NARCIS (Netherlands)

    Perotti, E.C.; Guney, S.E.

    1992-01-01

    In recent years a vast transfer of state-owned assets to the private sector has taken place in many countries, irrespective of their level of development or the political affiliation of their government. Privatization is believed to improve economic incentives; attract managerial and technological

  12. Is Nordic Private Equity Different?

    DEFF Research Database (Denmark)

    Spliid, Robert

    2013-01-01

    Most research on private equity is based on American theory, tested on American empirical data. Nevertheless, the private equity concept has gained a solid foothold in the Nordic region, especially in Sweden. This article analyzes whether American-biased assumptions prevail in the Nordic countries...

  13. Entrepreneurial Crowdfunding without Private Claims

    DEFF Research Database (Denmark)

    Boudreau, Kevin J.; Jeppesen, Lars Bo; Reichstein, Toke

    Today's crowdfunding raises funds for tiny, private entrepreneurial ventures without granting funders private claims to a project's future value. Rather than “investments,” these are “contributions.” This paper argues that for such crowdfunding neither producer nor consumer surplus – i.e., project...

  14. Private Military and Security Contractors

    DEFF Research Database (Denmark)

    In Private Military and Security Contractors: Controlling the Corporate Warrior a multinational team of 16 scholars and a practitioner from political science, sociology, and law address a developing phenomenon: controlling the use of privatized force by states in international politics. Robust...

  15. Private Loans: Facts and Trends

    Science.gov (United States)

    Institute for College Access & Success, 2014

    2014-01-01

    Private loans are one of the riskiest ways to finance a college education. Like credit cards, they typically have variable interest rates. Both variable and fixed rates are higher for those who can least afford them--as high as 13% in June 2014. Private loans are not eligible for the important deferment, income-based repayment, or loan forgiveness…

  16. Cohort description

    DEFF Research Database (Denmark)

    Dantoft, Thomas Meinertz; Ebstrup, Jeanette Frost; Linneberg, Allan

    2017-01-01

    -76 years from the general population examined from 2011 to 2015. The survey comprises screening questionnaires for five types of FSS, ie, fibromyalgia, whiplash-associated disorder, multiple chemical sensitivity, irritable bowel syndrome, and chronic fatigue syndrome, and for the unifying diagnostic......The Danish study of Functional Disorders (DanFunD) cohort was initiated to outline the epidemiology of functional somatic syndromes (FSS) and is the first larger coordinated epidemiological study focusing exclusively on FSS. FSS are prevalent in all medical settings and can be defined as syndromes...... category of bodily distress syndrome. Additional data included a telephone-based diagnostic interview assessment for FSS, questionnaires on physical and mental health, personality traits, lifestyle, use of health care services and social factors, and a physical examination with measures...

  17. Public Sector Unions and Privatization

    DEFF Research Database (Denmark)

    Foged, Søren Kjær; Aaskoven, Lasse

    2016-01-01

    Privatization varies considerably among local governments. One of the oft-listed explanations is the ability of public employees to block privatization. However, many studies on the influence of public employees on privatization do not use very precise measures of the influence of public employees...... Danish municipalities in 2012, we are able to measure the strength of the public eldercare union as well as the number of the public eldercare workers relative to the number of local voters. We find that the increased union strength measured in terms of union density at the municipal level leads...... to substantially and significantly less privatization through the voucher market. By comparison, the estimated relationship between the relative number of public workers and privatization does not reach statistical significance. Features of the voucher market and qualitative evidence suggest that the union...

  18. State Government, Its Relationship to Private Schools.

    Science.gov (United States)

    Cronin, Joseph M.; Kenyon, Regan

    1982-01-01

    In examining the state's role in private education, this article discusses court cases bearing on state services to private schools, state regulation of different types of private schools, collaborative efforts between public and private schools, and emerging state attitudes toward private education. (Author/WD)

  19. Privatization and the allure of franchising: a Zambian feasibility study.

    Science.gov (United States)

    Fiedler, John L; Wight, Jonathan B

    2003-01-01

    Efforts to privatize portions of the health sector have proven more difficult to implement than had been anticipated previously. One common bottleneck encountered has been the traditional organizational structure of the private sector, with its plethora of independent, single physician practices. The atomistic nature of the sector has rendered many privatization efforts difficult, slow and costly-in terms of both organizational development and administration. In many parts of Africa, in particular, the shortages of human and social capital, and the fragile nature of legal institutions, undermine the appeal of privatization. The private sector is left with inefficiencies, high prices and costs, and a reduced effective demand. The result is the simultaneous existence of excess capacity and unmet need. One potential method to improve the efficiency of the private sector, and thereby enhance the likelihood of successful privatization, is to transfer managerial technology--via franchising--from models that have proven successful elsewhere. This paper presents a feasibility analysis of franchizing the successful Bolivian PROSALUD system's management package to Zambia. The assessment, based on PROSALUD's financial model, demonstrates that technology transfer requires careful adaptation to local conditions and, in this instance, would still require significant external assistance.

  20. The pattern of physical comorbidity and the psychosocial determinants of depression: a prospective cohort study on a representative sample of family practice attendees in Slovenia.

    Science.gov (United States)

    Selič, Polona; Svab, Igor; Rifel, Janez; Pavlič, Danica Rotar; Cerne, Anja; King, Michael; Nazareth, Irwin

    2011-09-01

    Objectives This study aims to present the patterns of physical comorbidity in depressed patients and factors strongly associated with depression in a representative sample of Slovenian family practice attendees.Methods Medical data was obtained for 911 general practice attendees. Of them, 221 (24.3%) were diagnosed as depressed. The depressive states of the subjects were evaluated using the Composite International Diagnostic Interview (CIDI). Physical comorbidity was assessed with a questionnaire covering the most common health problems in the Slovenian adult population. Several psycho-social factors were also analysed.Results Those variables significantly related to ICD depression were included in multivariate binary logistic regression analysis, adjusted by age, gender and education. The calculation included the chi-square, odds ratio (OR) with confidence interval (95% CI) and P-value. A P-value financial situation were strongly associated with depression. The impact of concurrent incontinence and chronic bowel disease was also important, though somewhat weaker.

  1. Public-private interactions in global food safety governance.

    Science.gov (United States)

    Lin, Ching-Fu

    2014-01-01

    In response to an apparent decline in global food safety, numerous public and private regulatory initiatives have emerged to restore public confidence. This trend has been particularly marked by the growing influence of private regulators such as multinational food companies, supermarket chains and non-governmental organizations (NGOs), who employ private standards, certification protocols, third-party auditing, and transnational contracting practices. This paper explores how the structure and processes of private food safety governance interact with traditional public governance regimes, focusing on Global Good Agricultural Practices (GlobalGAP) as a primary example of the former. Due to the inefficiency and ineffectiveness of public regulation in the face of global problems, private governance in food safety has gradually replaced states' command-and-control regulation with more flexible, market-oriented mechanisms. The paper concludes by emphasizing the importance of constructive regime interaction instead of institutional boundary building to global food safety governance. Public and private ordering must each play a role as integral parts of a larger, dynamic and evolving governance complex.

  2. A set of vertically integrated inquiry-based practical curricula that develop scientific thinking skills for large cohorts of undergraduate students.

    Science.gov (United States)

    Zimbardi, Kirsten; Bugarcic, Andrea; Colthorpe, Kay; Good, Jonathan P; Lluka, Lesley J

    2013-12-01

    Science graduates require critical thinking skills to deal with the complex problems they will face in their 21st century workplaces. Inquiry-based curricula can provide students with the opportunities to develop such critical thinking skills; however, evidence suggests that an inappropriate level of autonomy provided to underprepared students may not only be daunting to students but also detrimental to their learning. After a major review of the Bachelor of Science, we developed, implemented, and evaluated a series of three vertically integrated courses with inquiry-style laboratory practicals for early-stage undergraduate students in biomedical science. These practical curricula were designed so that students would work with increasing autonomy and ownership of their research projects to develop increasingly advanced scientific thinking and communication skills. Students undertaking the first iteration of these three vertically integrated courses reported learning gains in course content as well as skills in scientific writing, hypothesis construction, experimental design, data analysis, and interpreting results. Students also demonstrated increasing skills in both hypothesis formulation and communication of findings as a result of participating in the inquiry-based curricula and completing the associated practical assessment tasks. Here, we report the specific aspects of the curricula that students reported as having the greatest impact on their learning and the particular elements of hypothesis formulation and communication of findings that were more challenging for students to master. These findings provide important implications for science educators concerned with designing curricula to promote scientific thinking and communication skills alongside content acquisition.

  3. Constructing Private Governance

    International Development Research Centre (IDRC) Digital Library (Canada)

    It is an evidence-based treaty that sets out objectives and principles that parties ... The articles of the convention include demand reduction measures like tax ... the direct economic costs attributable to tobacco use in Malaysia, estimated at .... The analytical framework used in Chapter 1, based on the established practice of ...

  4. Study protocol: Transition from localized low back pain to chronic widespread pain in general practice: Identification of risk factors, preventive factors and key elements for treatment – A cohort study

    Directory of Open Access Journals (Sweden)

    Viniol Annika

    2012-05-01

    Full Text Available Abstract Background Chronic localized pain syndromes, especially chronic low back pain (CLBP, are common reasons for consultation in general practice. In some cases chronic localized pain syndromes can appear in combination with chronic widespread pain (CWP. Numerous studies have shown a strong association between CWP and several physical and psychological factors. These studies are population-based cross-sectional and do not allow for assessing chronology. There are very few prospective studies that explore the predictors for the onset of CWP, where the main focus is identifying risk factors for the CWP incidence. Until now there have been no studies focusing on preventive factors keeping patients from developing CWP. Our aim is to perform a cross sectional study on the epidemiology of CLBP and CWP in general practice and to look for distinctive features regarding resources like resilience, self-efficacy and coping strategies. A subsequent cohort study is designed to identify the risk and protective factors of pain generalization (development of CWP in primary care for CLBP patients. Methods/Design Fifty-nine general practitioners recruit consecutively, during a 5 month period, all patients who are consulting their family doctor because of chronic low back pain (where the pain is lasted for 3 months. Patients are asked to fill out a questionnaire on pain anamnesis, pain-perception, co-morbidities, therapy course, medication, socio demographic data and psychosomatic symptoms. We assess resilience, coping resources, stress management and self-efficacy as potential protective factors for pain generalization. Furthermore, we raise risk factors for pain generalization like anxiety, depression, trauma and critical life events. During a twelve months follow up period a cohort of CLBP patients without CWP will be screened on a regular basis (3 monthly for pain generalization (outcome: incident CWP. Discussion This cohort study will be the largest

  5. SWOT analysis & privatization in Croatia

    Directory of Open Access Journals (Sweden)

    Družić Ivo

    2006-01-01

    Full Text Available Legal framework for privatization in Croatia was based on two key laws: the Transformation Act of 1991, and the Privatization Act of 1993, amended in 1996. Early start of privatization process in 1990s in Croatia was marked by the transformation of socially-owned companies into stock holding companies or limited liability companies. The first step (1991-1993 of this process of almost 2700 companies which entered privatization was their evaluation and transformation into private ownership entities. The second step (1994- 1997 consisted of privatization of CPF portfolio. The portfolios change constantly, not only as a result of privatization but also because companies themselves change, as does their position in the market. The third step (1998 in the privatization process was voucher privatization. Privatization of large infrastructure and utility companies designated as public enterprises began in 1999 (Croatian Telecom and INA in 2002 (public enterprises are privatized on the basis of separate laws. Attempts to discuss privatization in Croatia in terms of SWOT analysis have been motivated by the stark difference among Croatian professional economists in an appraisal of Croatia's performance during the transition process in general and of the privatization process in particular. Therefore we considered the elements of SWOT analysis to be an acceptable way to delve into the confusing world of bickering arguments on the state and perspective of the Croatia's privatization process. In this paper we have tried to provide an impartial approach by employing two criteria i.e. strength and weaknesses in judging the events and results of the privatization process in Croatia. Strength of the overall privatization process can be mostly ascribed to the institutional swiftness on micro as well as on macro level. On the micro level 80% of the companies were formally privatized in the first two years despite unfavorable external conditions comprising the

  6. Implications of private sector Hib vaccine coverage for the introduction of public sector Hib-containing pentavalent vaccine in India: evidence from retrospective time series data.

    Science.gov (United States)

    Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Hasan Farooqui, Habib; Zodpey, Sanjay P

    2015-02-23

    Haemophilus influenzae type b (Hib) vaccine has been available in India's private sector market since 1997. It was not until 14 December 2011 that the Government of India initiated the phased public sector introduction of a Hib (and DPT, diphtheria, pertussis, tetanus)-containing pentavalent vaccine. Our objective was to investigate the state-specific coverage and behaviour of Hib vaccine in India when it was available only in the private sector market but not in the public sector. This baseline information can act as a guide to determine how much coverage the public sector rollout of pentavalent vaccine (scheduled April 2015) will need to bear in order to achieve complete coverage. 16 of 29 states in India, 2009-2012. Retrospective descriptive secondary data analysis. (1) Annual sales of Hib vaccines, by volume, from private sector hospitals and retail pharmacies collected by IMS Health and (2) national household surveys. State-specific Hib vaccine coverage (%) and its associations with state-specific socioeconomic status. The overall private sector Hib vaccine coverage among the 2009-2012 birth cohort was low (4%) and varied widely among the studied Indian states (minimum 0.3%; maximum 4.6%). We found that private sector Hib vaccine coverage depends on urban areas with good access to the private sector, parent's purchasing capacity and private paediatricians' prescribing practices. Per capita gross domestic product is a key explanatory variable. The annual Hib vaccine uptake and the 2009-2012 coverage levels were several times higher in the capital/metropolitan cities than the rest of the state, suggesting inequity in access to Hib vaccine delivered by the private sector. If India has to achieve high and equitable Hib vaccine coverage levels, nationwide public sector introduction of the pentavalent vaccine is needed. However, the role of private sector in universal Hib vaccine coverage is undefined as yet but it should not be neglected as a useful complement to

  7. Private Finance 2 (PF2): Re-inventing the Wheel?

    Science.gov (United States)

    Zawawi, N. A. W. A.; Abdul-Aziz, A. R.; Khamidi, M. F.; Othman, I.; Idrus, A.; Umar, A. A.

    2013-06-01

    The Procurement policy of any government is the most influential factor in determining the efficiency of infrastructure and service provision like roads, water supply and energy. The UK's HM Treasury released its new guidelines on private involvement in infrastructures provision and services towards reforming the popular Private Finance Initiatives (PFI) policy. This new approach, it now refers to as the Private Finance 2 (PF2) is meant to correct the imperfections which have bedeviled the older version-PFI. However, the 'new guidelines' contained nothing really new in the area of private financing and operation of public infrastructures, at best it is akin to 're-inventing the wheel' rather than being 'new'. While dwelling extensively on issues relating to cheaper financing sources, risks transfer, counterpart funding by government and improving public sector procurement skills, this paper argues that some countries in the developing world have long recognised these issues and taken practical steps to correct them.

  8. Private Finance 2 (PF2): Re-inventing the Wheel?

    International Nuclear Information System (INIS)

    Zawawi, N A W A; Khamidi, M F; Othman, I; Umar, A A; Abdul-Aziz, A R; Idrus, A

    2013-01-01

    The Procurement policy of any government is the most influential factor in determining the efficiency of infrastructure and service provision like roads, water supply and energy. The UK's HM Treasury released its new guidelines on private involvement in infrastructures provision and services towards reforming the popular Private Finance Initiatives (PFI) policy. This new approach, it now refers to as the Private Finance 2 (PF2) is meant to correct the imperfections which have bedeviled the older version-PFI. However, the 'new guidelines' contained nothing really new in the area of private financing and operation of public infrastructures, at best it is akin to 're-inventing the wheel' rather than being 'new'. While dwelling extensively on issues relating to cheaper financing sources, risks transfer, counterpart funding by government and improving public sector procurement skills, this paper argues that some countries in the developing world have long recognised these issues and taken practical steps to correct them.

  9. Risk factors of falls in inpatients and their practical use in identifying high-risk persons at admission: Fukushima Medical University Hospital cohort study.

    Science.gov (United States)

    Hayakawa, Takehito; Hashimoto, Shigeatsu; Kanda, Hideyuki; Hirano, Noriko; Kurihara, Yumi; Kawashima, Takako; Fukushima, Tetsuhito

    2014-01-01

    To clarify the risk factors for falls in hospital settings and to propose the use of such factors to identify high-risk persons at admission. Prospective cohort study. Fukushima Medical University Hospital, Japan, from August 2008 and September 2009. 9957 adult consecutive inpatients admitted to our hospital. Information was collected at admission from clinical records obtained from a structured questionnaire conducted in face-to-face interviews with subjects by nurses and doctors and fall events were collected from clinical records. The proportion of patients who fell during follow-up was 2.5% and the incidence of falls was 3.28 per 100 person-days. There were significant differences in age, history of falling, cognitive dysfunction, planned surgery, wheelchair use, need for help to move, use of a remote caring system, rehabilitation, use of laxative, hypnotic or psychotropic medications and need for help with activities of daily living (ADL) between patients who did and did not fall. Multivariable adjusted ORs for falls showed that age, history of falls and need for help with ADL were common risk factors in both men and women. Using psychotropic medication also increased the risk of falling in men while cognitive dysfunction and use of hypnotic medication increased the risk of falling in women. Planned surgery was associated with a low risk of falls in women. To prevent falls in inpatients it is important to identify high-risk persons. Age, history of falling and the need for help with ADL are the most important pieces of information to be obtained at admission. Care plans for patients including fall prevention should be clear and considered.

  10. Treatment and outcomes of an Australian cohort of outpatients with bipolar I or schizoaffective disorder over twenty-four months: implications for clinical practice

    Directory of Open Access Journals (Sweden)

    Kulkarni Jayashri

    2012-12-01

    Full Text Available Abstract Background The Bipolar Comprehensive Outcomes Study (BCOS is a 2-year, prospective, non-interventional, observational study designed to explore the clinical and functional outcomes associated with ‘real-world’ treatment of participants with bipolar I or schizoaffective disorder. All participants received treatment as usual. There was no study medication. Methods Participants prescribed either conventional mood stabilizers (CMS; n = 155 alone, or olanzapine with, or without, CMS (olanzapine ± CMS; n = 84 were assessed every 3 months using several measures, including the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale, Clinical Global Impressions Scale – Bipolar Version, and the EuroQol Instrument. This paper reports 24-month longitudinal clinical, pharmacological, functional, and socioeconomic data. Results On average, participants were 42 (range 18 to 79 years of age, 58%; were female, and 73%; had a diagnosis of bipolar I. Polypharmacy was the usual approach to pharmacological treatment; participants took a median of 5 different psychotropic medications over the course of the study, and spent a median proportion of time of 100%; of the study on mood stabilizers, 90%; on antipsychotics, 9%; on antidepressants, and 5%; on benzodiazepines/hypnotics. By 24 months, the majority of participants had achieved both symptomatic and syndromal remission of both mania and depression. Symptomatic relapse rates were similar for both the CMS alone (65%; and the olanzapine ± CMS (61%; cohorts. Conclusions Participants with bipolar I or schizoaffective disorder in this study were receiving complex medication treatments that were often discordant with recommendations made in contemporary major treatment guidelines. The majority of study participants demonstrated some clinical and functional improvements, but not all achieved remission of symptoms or syndrome.

  11. Private benefits and board size: International evidence

    Directory of Open Access Journals (Sweden)

    Shinya Shinozaki

    2011-04-01

    Full Text Available In our analyses of 10,390 companies from 51 countries, we find that in countries that have small capital markets free cash flow is positively related to board size. However, this positive relation becomes significantly weak for companies in large securities markets. This result suggests that managers in underdeveloped capital markets have an incentive to construct less effective boards to extract private benefits. However, the distorted managerial incentive is alleviated in developed countries that have various disciplinary mechanisms to ensure good governance practices. We do not find clear evidence that legal protection of shareholder rights mitigates the managerial incentive to construct less effective boards.

  12. Peru turnaround tied to privatization

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    Petroleos del Peru predicts a 10% increase in Peru's oil production this year and a further increase in 1994. Petroperu also forecasts a sharp increase in drilling in Peru this year. After several years of declining oil production, a gradual turnaround in the cash strapped country's petroleum industry is largely tied to its progress in privatization. The government last year began a campaign to privatize all state owned companies by the end of July 1995. The paper discusses forecasts by Petroperu; the contract of Occidental del Amazonas Inc.; the Petromar privatization; Great Western's contract; development of the Aguaytia gas field; and refinery contracts

  13. The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry.

    Science.gov (United States)

    Gwon, Hyeon-Cheol; Jeon, Dong Woon; Kang, Hyun-Jae; Jang, Jae-Sik; Park, Duk-Woo; Shin, Dong-Ho; Moon, Keon-Woong; Kim, Jung-Sun; Kim, Juhan; Bae, Jang-Whan; Hur, Seung-Ho; Kim, Byung Ok; Choi, Donghoon; Han, Kyoo-Rok; Kim, Hyo-Soo

    2017-05-01

    Appropriate use criteria (AUC) was developed to improve the quality of percutaneous coronary intervention (PCI). However, these criteria should consider the current practice pattern in the country where they are being applied. The algorithm for the Korean PCI practice pattern (KP3) was developed by modifying the United States-derived AUC in expert consensus meetings. KP3 class A was defined as any strategy with evidence from randomized trials that was more conservative for PCI than medical therapy or coronary artery bypass graft (CABG). Class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or CABG. Class B was defined as a strategy that was partly class A and partly class C. We applied the KP3 classification system to the Korean PCI registry. The KP3 class A was noted in 67.7% of patients, class B in 28.8%, and class C in 3.5%. The median proportion of class C cases per center was 2.0%. The distribution of KP3 classes varied significantly depending on clinical and angiographic characteristics. The proportion of KP3 class C cases per center was not significantly dependent on PCI volume, but rather on the percentage of ACS cases in each center. We report the current PCI practice pattern by applying the new KP3 classification in a nationwide PCI registry. The results should be interpreted carefully with due regard for the complex relationships between the determining variables and the healthcare system in Korea.

  14. Role of the private sector in vaccination service delivery in India: evidence from private-sector vaccine sales data, 2009-12.

    Science.gov (United States)

    Sharma, Abhishek; Kaplan, Warren A; Chokshi, Maulik; Zodpey, Sanjay P

    2016-09-01

    India's Universal Immunization Programme (UIP) provides basic vaccines free-of-cost in the public sector, yet national vaccination coverage is poor. The Government of India has urged an expanded role for the private sector to help achieve universal immunization coverage. We conducted a state-by-state analysis of the role of the private sector in vaccinating Indian children against each of the six primary childhood diseases covered under India's UIP. We analyzed IMS Health data on Indian private-sector vaccine sales, 2011 Indian Census data and national household surveys (DHS/NFHS 2005-06 and UNICEF CES 2009) to estimate the percentage of vaccinated children among the 2009-12 birth cohort who received a given vaccine in the private sector in 16 Indian states. We also analyzed the estimated private-sector vaccine shares as function of state-specific socio-economic status. Overall in 16 states, the private sector contributed 4.7% towards tuberculosis (Bacillus Calmette-Guérin (BCG)), 3.5% towards measles, 2.3% towards diphtheria-pertussis-tetanus (DPT3) and 7.6% towards polio (OPV3) overall (both public and private sectors) vaccination coverage. Certain low income states (Uttar Pradesh, Rajasthan, Madhya Pradesh, Orissa, Assam and Bihar) have low private as well as public sector vaccination coverage. The private sector's role has been limited primarily to the high income states as opposed to these low income states where the majority of Indian children live. Urban areas with good access to the private sector and the ability to pay increases the Indian population's willingness to access private-sector vaccination services. In India, the public sector offers vaccination services to the majority of the population but the private sector should not be neglected as it could potentially improve overall vaccination coverage. The government could train and incentivize a wider range of private-sector health professionals to help deliver the vaccines, especially in the low

  15. 76 FR 71329 - Request for Information Regarding Private Education Loans and Private Educational Lenders

    Science.gov (United States)

    2011-11-17

    ... Regarding Private Education Loans and Private Educational Lenders AGENCY: Bureau of Consumer Financial... Justice and the Federal Trade Commission, to prepare a Report on Private Education Loans and Private... Justice and the Federal Trade Commission, to prepare a Report on Private Education Loans and Private...

  16. Defense Inventory Management: Expanding Use of Best Practices for Hardware Items Can Reduce Logistics Costs

    National Research Council Canada - National Science Library

    1998-01-01

    ...) logistics practices with those of the private sector. We are continuously examining DOD'S inventory management practices to identify areas where costs can be reduced and problems can be avoided by using leading private sector practices...

  17. Private sector in public health care systems

    OpenAIRE

    Matějusová, Lenka

    2008-01-01

    This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...

  18. Laboratory Diagnosis and Characterization of Fungal Disease in Patients with Cystic Fibrosis (CF): A Survey of Current UK Practice in a Cohort of Clinical Microbiology Laboratories.

    Science.gov (United States)

    Boyle, Maeve; Moore, John E; Whitehouse, Joanna L; Bilton, Diana; Downey, Damian G

    2018-03-02

    There is much uncertainty as to how fungal disease is diagnosed and characterized in patients with cystic fibrosis (CF). A 19-question anonymous electronic questionnaire was developed and distributed to ascertain current practice in clinical microbiology laboratories providing a fungal laboratory service to CF centres in the UK. Analyses of responses identified the following: (1) current UK laboratory practice, in general, follows the current guidelines, but the scope and diversity of what is currently being delivered by laboratories far exceeds what is detailed in the guidelines; (2) there is a lack of standardization of fungal tests amongst laboratories, outside of the current guidelines; (3) both the UK CF Trust Laboratory Standards for Processing Microbiological Samples from People with Cystic Fibrosis and the US Cumulative Techniques and Procedures in Clinical Microbiology (Cumitech) Guidelines 43 Cystic Fibrosis Microbiology need to be updated to reflect both new methodological innovations, as well as better knowledge of fungal disease pathophysiology in CF; (4) there is a need for clinical medicine to decide upon a stratification strategy for the provision of new fungal assays that will add value to the physician in the optimal management of CF patients; (5) there is also a need to rationale what assays should be performed at local laboratory level and those which are best served at National Mycology Reference Laboratory level; and (6) further research is required in developing laboratory assays, which will help ascertain the clinical importance of 'old' fungal pathogens, as well as 'emerging' fungal pathogens.

  19. Relationship between parent knowledge of child sleep, and child sleep practices and problems: A pilot study in a children's hospital cohort.