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1.
J Law Med ; 29(3): 725-739, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36056663

RESUMO

Rapid developments in biotechnology have brought questions regarding ownership of human genetic material to the forefront of the public conscience. This article aims to determine the current approach of Australian and United Kingdom courts to property disputes regarding human biological material and adjudicate its relevance in the context of human deoxyribonucleic acid (DNA) ownership. Following initial exploration of the question of whether DNA ought to be considered an object of property, it argues that the dominant approach established by the landmark decision of Doodeward v Spence (1908) 6 CLR 406 is weaker than the newer "guided discretion" basis in the DNA context. It concludes this latter approach is far better equipped to respond to key policy concerns associated with recognising property rights in DNA.


Assuntos
DNA , Propriedade , Austrália , Humanos , Reino Unido
2.
BMC Med Educ ; 22(1): 666, 2022 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-36076223

RESUMO

BACKGROUND: Patient care ownership (PCO) is crucial to enhancing accountability, clinical skills, and medical care quality among medical trainees. Despite its relevance, there is limited information on the association of personal or environmental factors with PCO, and thus, authors aimed to explore this association. METHODS: In 2021, the authors conducted a multicentered cross-sectional study in 25 hospitals across Japan. PCO was assessed by using the Japanese version of the PCO Scale (J-PCOS). To examine the association between personal (level of training, gender, and department) or environmental factors (hospital size, hospital type, medical care system, number of team members, number of patients receiving care, mean working hours per week, number of off-hour calls per month, and perceived level of the workplace as a learning environment) and PCO after adjusting for clustering within hospitals, the authors employed a linear mixed-effects model. RESULTS: The analysis included 401 trainees. After adjusting for clustering within hospitals, it was confirmed that the senior residents had significantly better J-PCOS total scores (adjusted mean difference: 8.64, 95% confidence interval [CI]: 6.18-11.09) than the junior residents and the perceived level of the workplace as a learning environment had a positive association with J-PCOS total scores (adjusted mean difference per point on a global rating of 0-10 points: 1.39, 95% CI: 0.88-1.90). Trainees who received calls after duty hours had significantly higher J-PCOS total scores than those who did not (adjusted mean difference: 2.51, 95% CI: 0.17-4.85). There was no clear trend in the association between working hours and PCO. CONCLUSIONS: Seniority and the perceived level of the workplace as a learning environment are associated with PCO. An approach that establishes a supportive learning environment and offers trainees a reasonable amount of autonomy may be beneficial in fostering PCO among trainees. The study findings will serve as a useful reference for designing an effective postgraduate clinical training program for PCO development.


Assuntos
Internato e Residência , Síndrome do Ovário Policístico , Estudos Transversais , Feminino , Humanos , Propriedade , Assistência ao Paciente
3.
Cad Saude Publica ; 38(8): e00040522, 2022.
Artigo em Português | MEDLINE | ID: mdl-36102384

RESUMO

Information about the prevalence of specific chronic diseases and the ownership of a health plan can help size and monitor care demands. This study aimed to estimate and compare the prevalence of chronic diseases among the elderly, according to the possession of a health plan in 2013 and 2019. This is a population-based cross-sectional study with data from elderly people (age ≥ 60 years) from the Brazilian National Health Survey (2013: n = 11,177; 2019: n = 22,728). The prevalence of self-reported chronic diseases and adjusted prevalence ratios were estimated, according to health plan ownership (medical and/or dental) and by year. In the period, increased prevalence was observed for hypertension (PR = 1.11; 95%CI: 1.06-1.16), diabetes (PR = 1.12; 95%CI: 1.01-1.24), heart disease (PR = 1.21; 95%CI: 1.05-1.39), stroke (PR = 1.27; 95%CI: 1.04-1.54), back pain (PR = 1.14; 95%CI: 1.05-1.23), hypercholesterolemia (PR = 1.09; 95%CI: 1.01-1.18), and depression (PR = 1.23; 95%CI: 1.05-1.43) among those without a health plan. In 2019, arthritis/rheumatism (PR = 1.21; 95%CI: 1,03-1,43), hypercholesterolemia (PR = 1.13; 95%CI: 1.01-1.26), and depression (PR = 1.26; 95%CI: 1.03-1.53) increased among elderly patients with a health plan. The findings showed differences in the prevalence of chronic diseases according to health plan ownership and an increase for some diseases in the period. Health promotion policies with an emphasis on reducing modifiable risk factors need to be maintained and intensified. Particularly for the elderly population, the importance of expanding actions focused on case tracking and early diagnosis, prevention and control of complications that favor equity in care is highlighted.


Informações sobre prevalências de doenças crônicas específicas e posse de plano de saúde podem contribuir para o dimensionamento e monitoramento de demandas assistenciais. O objetivo do estudo foi estimar e comparar as prevalências de doenças crônicas em pessoas idosas, conforme posse de plano de saúde em 2013 e 2019. Trata-se de um estudo transversal de base populacional com dados de pessoas idosas (idade ≥ 60 anos) da Pesquisa Nacional de Saúde (2013: n = 11.177; 2019: n = 22.728). Estimaram-se as prevalências das doenças crônicas autorreferidas e razões de prevalência ajustadas, segundo posse de plano de saúde (médico e/ou odontológico) e ano. No período, houve elevação das prevalências de hipertensão (RP = 1,11; IC95%: 1,06-1,16), diabetes (RP = 1,12; IC95%: 1,01-1,24), doença do coração (RP = 1,21; IC95%: 1,05-1,39), AVC (RP = 1,27; IC95%: 1,04-1,54), problema na coluna (RP = 1,14; IC95%: 1,05-1,23), hipercolesterolemia (RP = 1,09; IC95%: 1,01-1,18) e depressão (RP = 1,23; IC95%: 1,05-1,43) naqueles sem plano de saúde. Em 2019, artrite/reumatismo (RP = 1,21; IC95%: 1,03-1,43), hipercolesterolemia (RP = 1,13; IC95%: 1,01-1,26) e depressão (RP = 1,26; IC95%: 1,03-1,53) aumentaram nas pessoas idosas com plano. Os achados mostraram diferenças nas prevalências das doenças crônicas segundo posse de plano de saúde e aumento para algumas doenças no período. As políticas de promoção de saúde com ênfase na redução dos fatores de risco modificáveis precisam ser mantidas e intensificadas. Particularmente na população idosa, ressalta-se a importância da ampliação de ações voltadas para o rastreamento de casos e diagnóstico precoce, prevenção e controle de complicações que favoreçam a equidade no cuidado.


La información sobre las prevalencias de determinadas enfermedades crónicas y la posesión del plan de salud pueden contribuir a dimensionar y monitorear las demandas asistenciales. El objetivo del estudio fue estimar y comparar las prevalencias de enfermedades crónicas en las personas mayores, conforme la posesión del plan de salud en 2013 y 2019. Se trata de un estudio transversal de base poblacional con datos de personas mayores (edad ≥ 60 años) de la Encuesta Nacional de Salud brasileña (2013: n = 11.177; 2019: n = 22.728). Se estimaron las prevalencias de las enfermedades crónicas autoinformadas y razones de prevalencia ajustadas, según posesión de plan de salud (médico y/o odontológico) y año. En el periodo, se produjo un aumento de la prevalencia de la hipertensión (RP = 1,11; IC95%: 1,06-1,16), diabetes (RP = 1,12; IC95%: 1,01-1,24), enfermedad del corazón (RP = 1,21; IC95%: 1,05-1,39), AVC (RP = 1,27; IC95%: 1,04-1,54), problema en la columna (RP = 1,14; IC95%: 1,05-1,23), hipercolesterolemia (RP = 1,09; IC95%: 1,01-1,18) y depresión (RP = 1,23; IC95%: 1,05-1,43) en aquellos sin seguro de salud. En el 2019, artritis/reumatismo (RP = 1,21; IC95%: 1,03-1,43), hipercolesterolemia (RP = 1,13; IC95%: 1,01-1,26) y la depresión (RP = 1,26; IC95%: 1,03-1,53) aumentaron en las personas mayores con un plan. Los resultados mostraron diferencias en las prevalencias de las enfermedades crónicas según la posesión de plan de salud y un aumento para algunas enfermedades en el período. Es necesario mantener e intensificar las políticas de promoción de la salud con énfasis en la reducción de los factores de riesgo modificables. Particularmente en la población adulta mayor, se resalta la importancia de aumentar el seguimiento de casos y de diagnóstico precoz, prevención y control de complicaciones que favorezcan la equidad en el cuidado.


Assuntos
Hipercolesterolemia , Propriedade , Idoso , Brasil/epidemiologia , Doença Crônica , Estudos Transversais , Inquéritos Epidemiológicos , Humanos , Seguro Saúde , Pessoa de Meia-Idade , Prevalência
4.
N Z Med J ; 135(1559): 6-7, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35999777

RESUMO

Nil.


Assuntos
Propriedade , Humanos , Nova Zelândia
5.
J Med Life ; 15(6): 735-741, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35928362

RESUMO

Cord blood is a rich source of hematopoietic stem cells used to treat many diseases of blood origin. Thus, storage banks were created to store and provide umbilical cord cells. With the development of diagnostic and therapeutic technologies and techniques in medicine, ethical issues have also become more widespread and complex. After the creation of the cord blood banks, efforts were made to address the ethical issues associated with such banks. The present study attempts to identify the ethical challenges in these banks in the published studies. Databases including PubMed, Scopus, Web of Science (WOS), Embase, Proquest, and Google Scholar were searched from January 1996 to January 2021. Then, the ethical challenges of the cord blood bank were extracted from the results section using thematic content analysis. 22 studies were selected based on inclusion and exclusion criteria. The ethical challenges raised in the studies included private or public ownership of the bank, fair access to banking services, informed and voluntary consent, failure to provide sufficient information to individuals about the process, confidentiality of user's information, conflict of interest of bank founders (who are commonly doctors). The findings of this study indicated that there are serious ethical concerns regarding umbilical cord blood banks. Responding clearly to these ethical challenges calls for the attention of policymakers and medical ethics professionals; this will require a clear statement of the various aspects of these banks for society.


Assuntos
Bancos de Sangue , Sangue Fetal , Humanos , Propriedade
6.
Br J Dermatol ; 187(2): 133-134, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35912910

Assuntos
Propriedade , Humanos
7.
Soc Sci Med ; 309: 115216, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36029711

RESUMO

BACKGROUND: Previous studies have investigated the relationship between pet ownership and mental health in various populations, but few have targeted women around childbirth when they have heightened vulnerability to mental disorders. This study therefore examined this association in women around childbirth. METHODS: Data were obtained from 80,814 mothers in an ongoing nationwide birth cohort study in Japan. Pet ownership status-none, dog(s) only, cat(s) only, or both-was determined during the second/third trimester of pregnancy. Mental health was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Kessler Psychological Distress Scale (K6), with each score measured at two different time points around childbirth. Generalized linear models were used to derive adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for pet ownership, with no pet ownership as the reference. RESULTS: Dog ownership was associated with reduced risk of depressive symptoms at 1 month (aOR: 0.97, 95%CI: 0.95-0.98) and 6 months postpartum (aOR: 0.98, 95%CI: 0.96-0.99) and with psychological distress at 12 months postpartum (aOR: 0.96, 95%CI: 0.92-0.999). In contrast, cat ownership was associated with increased risk of depressive symptoms at 6 months postpartum (aOR: 1.04, 95% CI: 1.02-1.06) and psychological distress in the second/third trimester (aOR: 1.07, 95% CI: 1.02-1.12). Ownership of both cats and dogs was associated with increased risk of psychological distress in the second/third trimester (aOR: 1.12, 95% CI: 1.03-1.21) but was largely similar to that of the reference group. CONCLUSIONS: Dog ownership was a protective factor for maternal mental health problems, whereas cat ownership was a risk factor. These findings suggest that the type of pet owned, cat or dog, plays a differential role in maintaining mothers' mental health in the perinatal and postpartum periods.


Assuntos
Depressão Pós-Parto , Animais , Coorte de Nascimento , Gatos , Estudos de Coortes , Depressão Pós-Parto/psicologia , Cães , Feminino , Humanos , Japão/epidemiologia , Saúde Mental , Mães/psicologia , Propriedade , Período Pós-Parto , Gravidez
8.
Cad Saude Publica ; 38Suppl 2(Suppl 2): e00175820, 2022.
Artigo em Português | MEDLINE | ID: mdl-36043625

RESUMO

This study aims to analyze the shareholding dimension of changes in companies and corporate groups in the Brazilian health sector from 2008 to 2017. The idea was to understand the strategies of accumulation in a context of financialization, defined as a systemic pattern of wealth in contemporary capitalism. The shareholding changes were submitted to descriptive and exploratory analysis based on different sources. We studied 58 companies from the subsectors of health plans, pharmacies, hospitals, diagnostics, pharmaceutical industry, and social organizations. Data were collected on the legal structure, ownership, and control, equity operations, and economic and patient care activities. Despite the heterogeneity of the companies and their strategies, the results point to an increase in the presence of domestic and international investors, changes in internal organization, capital, financing, and diversification of activities. The companies that stood out were actively pursuing capitalization via foreign investments, purchase and share of assets and shares, and mergers and acquisitions, accelerating the process of expansion, accumulation, and shareholding and financial appreciation. The result is an increase in capital flows and growing integration of economic and patient care structures in the Brazilian health sector with financial circuits, thereby linking peripheral intermediate companies to an expanded process of accumulation under financial dominance. The findings corroborate striking aspects of corporate dynamics in financialization that increasingly influence health systems in Brazil and the world.


O objetivo deste trabalho é analisar a dimensão patrimonial de mudanças em empresas e grupos econômicos do setor saúde no Brasil entre 2008 e 2017. Busca-se compreender as estratégias de acumulação em um contexto de financeirização, compreendida como padrão sistêmico da riqueza no capitalismo contemporâneo. As mudanças patrimoniais foram analisadas de forma descritiva e exploratória a partir de diferentes fontes. Foram estudadas 58 empresas dos subsetores de planos de saúde, farmácias, hospitais, diagnóstico, indústria farmacêutica e organizações sociais. Foram coletados dados sobre forma jurídica, propriedade e controle; operações patrimoniais; atividades econômicas e assistenciais. A despeito da heterogeneidade das empresas e suas estratégias, os resultados apontam o aumento da presença de investidores nacionais e internacionais, mudanças na organização interna, na estrutura do capital, no financiamento e diversificação de atividades. As que mais se destacam buscaram ativamente a capitalização a partir de investimentos externos, compra e venda de ativos e ações, fusões e aquisições aceleram o processo de expansão, acumulação e valorização patrimonial-financeira. O resultado é o aumento do fluxo de capitais e a crescente integração das estruturas econômicas e assistenciais do setor saúde brasileiro aos circuitos financeiros, tornando as empresas intermediárias periféricas articuladas a um processo ampliado de acumulação sob dominância financeira. Os achados convergem com aspectos marcantes da dinâmica das corporações na financeirização, que influenciam cada vez mais os sistemas de saúde no Brasil e do mundo.


El objetivo de este trabajo es analizar la dimensión patrimonial de cambios en empresas y grupos económicos del sector salud en Brasil entre 2008 y 2017. Se busca comprender las estrategias de acumulación en un contexto de financiarización, comprendida como un patrón sistémico de la riqueza en el capitalismo contemporáneo. Los cambios patrimoniales fueron analizados de forma descriptiva y exploratoria a partir de diferentes fuentes. Se estudiaron 58 empresas de los subsectores de planes de salud, farmacias, hospitales, diagnóstico, industria farmacéutica y organizaciones sociales. Se recogieron datos sobre forma jurídica, propriedad y control; operaciones patrimoniales; actividades económicas y asistenciales. A pesar de la heterogeneidad de las empresas y sus estrategias, los resultados apuntan el aumento de la presencia de inversores nacionales e internacionales, cambios en la organización interna, estructura del capital, financiación y diversificación de actividades. Las que más se destacan buscaron activamente la capitalización a partir de inversiones externas, compra y venta de activos y acciones, fusiones y adquisiciones aceleraron el proceso de expansión, acumulación y valorización patrimonial-financiera. El resultado es el aumento del flujo de capitales y la creciente integración de las estructuras económicas y asistenciales del sector salud brasileño en los circuitos financieros, haciendo que las empresas intermediarias periféricas se coordinaran con un proceso ampliado de acumulación, auspiciado por el dominio financiero. Los resultados convergen con aspectos marcantes de la dinámica de las corporaciones en la financiarización, que influencian cada vez más los sistemas de salud en Brasil y en el mundo.


Assuntos
Investimentos em Saúde , Organizações , Brasil , Humanos , Internacionalidade , Propriedade
9.
JAMA Health Forum ; 3(5): e221012, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35977256

RESUMO

This cross-sectional study examines the prevalence and characteristics of real estate investment trust-owned health care properties in the US health care sector.


Assuntos
Atenção à Saúde , Investimentos em Saúde , Propriedade , Estudos Transversais , Estados Unidos
10.
BMJ ; 378: o2056, 2022 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-35981724

Assuntos
Propriedade , Humanos
11.
J Exp Child Psychol ; 224: 105519, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-35939871

RESUMO

The current study examined whether, for children and adults, behaviors that are considered violations of property rights in the case of physical property are likewise viewed as violations in the case of digital property. In this preregistered study (N = 156), 5- to 10-year-old children and adults heard a story about a person who downloaded a digital file (e.g., an e-book that she did not own) onto her personal computer (digital) versus a person who put a physical item (e.g., a book that she did not own) into her bag (physical). Participants were asked to evaluate how okay each behavior is. We found that from 5 years of age children evaluated taking a physical object more negatively than downloading a digital file, which was also the pattern observed in adults. Furthermore, by 9 years of age children were equivalent to adults in their evaluation of downloading digital files. The current study has implications for the development of ownership in children.


Assuntos
Livros , Propriedade , Adulto , Criança , Pré-Escolar , Feminino , Humanos
12.
JAMA ; 328(5): 451-459, 2022 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-35916847

RESUMO

Importance: Care of adults at profit vs nonprofit dialysis facilities has been associated with lower access to transplant. Whether profit status is associated with transplant access for pediatric patients with end-stage kidney disease is unknown. Objective: To determine whether profit status of dialysis facilities is associated with placement on the kidney transplant waiting list or receipt of kidney transplant among pediatric patients receiving maintenance dialysis. Design, Setting, and Participants: This retrospective cohort study reviewed the US Renal Data System records of 13 333 patients younger than 18 years who started dialysis from 2000 through 2018 in US dialysis facilities (followed up through June 30, 2019). Exposures: Time-updated profit status of dialysis facilities. Main Outcomes and Measures: Cox models, adjusted for clinical and demographic factors, were used to examine time to wait-listing and receipt of kidney transplant by profit status of dialysis facilities. Results: A total of 13 333 pediatric patients who started receiving maintenance dialysis were included in the analysis (median age, 12 years [IQR, 3-15 years]; 6054 females [45%]; 3321 non-Hispanic Black patients [25%]; 3695 Hispanic patients [28%]). During a median follow-up of 0.87 years (IQR, 0.39-1.85 years), the incidence of wait-listing was lower at profit facilities than at nonprofit facilities, 36.2 vs 49.8 per 100 person-years, respectively (absolute risk difference, -13.6 (95% CI, -15.4 to -11.8 per 100 person-years; adjusted hazard ratio [HR] for wait-listing at profit vs nonprofit facilities, 0.79; 95% CI, 0.75-0.83). During a median follow-up of 1.52 years (IQR, 0.75-2.87 years), the incidence of kidney transplant (living or deceased donor) was also lower at profit facilities than at nonprofit facilities, 21.5 vs 31.3 per 100 person-years, respectively; absolute risk difference, -9.8 (95% CI, -10.9 to -8.6 per 100 person-years) adjusted HR for kidney transplant at profit vs nonprofit facilities, 0.71 (95% CI, 0.67-0.74). Conclusions and Relevance: Among a cohort of pediatric patients receiving dialysis in the US from 2000 through 2018, profit facility status was associated with longer time to wait-listing and longer time to kidney transplant.


Assuntos
Instituições de Assistência Ambulatorial , Acesso aos Serviços de Saúde , Falência Renal Crônica , Transplante de Rim , Diálise Renal , Listas de Espera , Adolescente , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Administração de Instituições de Saúde/economia , Administração de Instituições de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Falência Renal Crônica/economia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Transplante de Rim/economia , Transplante de Rim/estatística & dados numéricos , Masculino , Organizações sem Fins Lucrativos/economia , Organizações sem Fins Lucrativos/organização & administração , Organizações sem Fins Lucrativos/estatística & dados numéricos , Propriedade/economia , Propriedade/estatística & dados numéricos , Diálise Renal/economia , Diálise Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo
13.
J Am Coll Surg ; 235(3): 539-543, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35972176

RESUMO

As surgical care continues to transition to an outpatient setting, ambulatory surgery centers (ASCs) present favorable options for physician investment. As of 2017, more than 90% of ASCs have at least some physician ownership, with 64% solely physician-owned. Yet, physician ownership creates an inherent conflict of interest known as dual agency, where clinicians have a personal financial stake in addition to their obligation towards patient well-being. Here, we assess the ethical considerations surrounding dual agency in the setting of ASCs through the lens of beneficence, nonmaleficence, autonomy, and justice. We further propose strategies for appropriate navigation of such situations, including disclosure of ownership status, instruction on unfamiliar techniques, and adherence to accepted clinical practice guidelines for materials selection and surgical indications.


Assuntos
Propriedade , Cirurgiões , Procedimentos Cirúrgicos Ambulatórios , Beneficência , Revelação , Humanos , Investimentos em Saúde , Autonomia Pessoal
14.
JAMA Health Forum ; 3(7): e221835, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35977220

RESUMO

Importance: The increase in rural hospital closures has strained access to inpatient care in rural communities. It is important to understand the association between hospital system affiliation and access to care in these communities to inform policy on this issue. Objective: To examine the association between affiliation and rural hospital closure. Design Setting and Participants: This cohort study used survival models with a time-dependent variable for affiliation vs independent status to assess risk of closure among a national cohort of US rural hospitals from January 2007 through December 2019. Data analysis was conducted from March to October 2021. Hospital affiliations were identified from the American Hospital Association Annual Survey and Irving Levin Associates and closures from the University of North Carolina Sheps Center (Chapel Hill). Additional covariates came from the Healthcare Cost and Utilization Project State Inpatient Databases and other national sources. Exposures: Affiliation with another hospital or multihospital health system. Main Outcomes and Measures: Closure was the main outcome. The models included hospital, market, and utilization characteristics and were stratified by financial distress in 2007. Results: Among 2237 rural hospitals operating in 2007, 140 (6.3%) had closed by 2019. The proportion of rural hospitals that were independent decreased from 68.9% in 2007 to 47.0% in 2019; the proportion that were affiliated increased from 31.1% to 46.7%. Among financially distressed hospitals in 2007, affiliation was associated with lower risk of closure compared with being independent (adjusted hazard ratio [aHR], 0.49; 95% CI, 0.26-0.92). Conversely, among hospitals that were financially stable in 2007, affiliation was associated with higher risk of closure compared with being independent (aHR, 2.36; 95% CI, 1.20-4.62). For-profit ownership was also strongly associated with closure for hospitals that were financially stable in 2007 (aHR, 4.08; 95% CI, 1.86-8.97). Conclusions and Relevance: The results of this cohort study suggest that affiliations may be associated with lower risk of closure for some rural hospitals in financial distress. However, among initially financially stable hospitals, an increased risk of closure for hospitals associated with affiliation and proprietary ownership raises concerns about the association of affiliation with closures in some circumstances. Policy interventions to stabilize inpatient care in rural areas should account for these findings.


Assuntos
Fechamento de Instituições de Saúde , Hospitais Rurais , American Hospital Association , Estudos de Coortes , Humanos , Propriedade , Estados Unidos/epidemiologia
15.
Soc Sci Med ; 309: 115234, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35969980

RESUMO

Processes of neighborhood change are important determinants of health. One salient dimension of the experience of neighborhood changes is a person's evolving sense of empowerment over the changes around them, such as development of new housing or shifts in economic opportunity. Community residents collaborating on a Participatory Action Research study developed the novel construct "ownership of change" to capture this psychosocial process, and hypothesized that it may help explain the relationship between neighborhood change and health. In this paper, we describe our participatory process for developing a way to measure ownership of change, explore the construct's validity, test the hypothesis that it is associated with health, and analyze qualitative data to understand the process through which one's sense of ownership of change is produced. We argue that the construct is useful for studying the role of neighborhood changes in shaping health, and that building ownership over neighborhood change must be a key dimension of urban planning and policy for health equity.


Assuntos
Equidade em Saúde , Propriedade , Habitação , Humanos , Características de Residência
16.
J Neurosci ; 42(37): 7131-7143, 2022 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-35940875

RESUMO

How do we come to sense that a hand in view belongs to our own body or not? Previous studies have suggested that the integration of vision and somatosensation in the frontoparietal areas plays a critical role in the sense of body ownership (i.e., the multisensory perception of limbs and body parts as our own). However, little is known about how these areas implement the multisensory integration process at the computational level and whether activity predicts illusion elicitation in individual participants on a trial-by-trial basis. To address these questions, we used functional magnetic resonance imaging and a rubber hand illusion-detection task and fitted the registered neural responses to a Bayesian causal inference model of body ownership. Thirty healthy human participants (male and female) performed 12 s trials with varying degrees of asynchronously delivered visual and tactile stimuli of a rubber hand (in view) and a (hidden) real hand. After the 12 s period, participants had to judge whether the rubber hand felt like their own. As hypothesized, activity in the premotor and posterior parietal cortices was related to illusion elicitation at the level of individual participants and trials. Importantly, activity in the posterior parietal cortex fit the predicted probability of illusion emergence of the Bayesian causal inference model based on each participant's behavioral response profile. Our findings suggest an important role for the posterior parietal cortex in implementing Bayesian causal inference of body ownership and reveal how trial-by-trial variations in neural signatures of multisensory integration relate to the elicitation of the rubber hand illusion.SIGNIFICANCE STATEMENT How does the brain create a coherent perceptual experience of one's own body based on information from the different senses? We examined how the likelihood of eliciting a classical bodily illusion that depends on vision and touch-the rubber hand illusion-is related to neural activity measured by functional magnetic resonance imaging. We found that trial-by-trial variations in the neural signal in the posterior parietal cortex, a well known center for sensory integration, fitted a statistical function that describes how likely it is that the brain infers that a rubber hand is one's own given the available visual and tactile evidence. Thus, probabilistic analysis of sensory information in the parietal lobe underlies our unitary sense of bodily self.


Assuntos
Ilusões , Percepção do Tato , Teorema de Bayes , Imagem Corporal , Feminino , Mãos/fisiologia , Humanos , Ilusões/fisiologia , Masculino , Propriedade , Lobo Parietal/fisiologia , Propriocepção/fisiologia , Tato/fisiologia , Percepção do Tato/fisiologia , Percepção Visual/fisiologia
17.
Acta Psychol (Amst) ; 229: 103672, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35870235

RESUMO

The sense of body ownership builds on proper multisensory integration mechanisms. The Rubber-Hand Illusion (RHI) paradigm exploits a visuo-tactile multisensory conflict to induce illusory body ownership toward a fake hand, assessed by multidimensional subjective ratings and univocal objective measurements. Considering the controversy as to whether viewing the rubber hand is necessary or not to induce the illusion, we investigated the effects of targeted manipulations of visibility on subjective and objective aspects of the RHI. To this aim, we collected questionnaire and proprioceptive drift data from thirty participants receiving visuo-tactile stimulation in a setup that allowed for increasing and decreasing the visibility (illumination) of the rubber hand. We found that specific subjective ratings (Movement and Loss of Ownership) were sensitive to the interaction between rubber hand's visibility and illusory ownership. The interaction was not significant for the Embodiment subjective component and for the objective one (proprioceptive drift). Since different degrees of visibility did not differentially affect the RHI, these findings highlight that relatively abrupt changes in the visibility of the rubber hand can differentially impact subjective versus objective components of body ownership. This understanding may be critical for neuroscientific theories on the relationship between multisensory integration and body consciousness.


Assuntos
Ilusões , Percepção do Tato , Imagem Corporal , Mãos , Humanos , Propriedade , Propriocepção , Percepção Visual
18.
Emerg Infect Dis ; 28(8): 1597-1605, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35850154

RESUMO

Human alveolar echinococcosis is caused by the parasite Echinococcus multilocularis, and dog ownership has been identified as a risk factor. We sought to specify the factors of dog ownership underlying this risk by conducting a case-control study among dog owners in Germany. The analysis revealed an increased odds ratio of ≈7-fold for dog owners whose dogs roam unattended in fields, 13-fold for dog owners who feed their dogs organic waste daily, 4-fold for dog owners who take their dog to a veterinarian only in case of illness, and 10-fold for dog owners who have never been informed by a veterinarian about the risk for infection. The results highlight the risk for infection associated with various factors of dog ownership and the value of veterinarians informing owners about prevention.


Assuntos
Doenças do Cão , Equinococose , Echinococcus multilocularis , Animais , Estudos de Casos e Controles , Doenças do Cão/epidemiologia , Doenças do Cão/parasitologia , Doenças do Cão/prevenção & controle , Cães , Equinococose/epidemiologia , Equinococose/parasitologia , Equinococose/transmissão , Equinococose/veterinária , Alemanha/epidemiologia , Humanos , Propriedade , Animais de Estimação
19.
Behav Processes ; 201: 104710, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35870551

RESUMO

The experiences that domestic dogs have with humans take many forms. We hypothesized that more experience with humans would lead to greater dependence on humans in problem-solving situations. We used the unsolvable task to compare persistence and gazing in dogs with differing degrees of experience with humans: 1) dogs living in a home for a year or more; 2) dogs living in a home for less than a year (including foster dogs); and 3) shelter dogs. Dogs first learned a solvable task; we then measured persistence as well as gazing at humans when the task was unsolvable. Dogs living in a home for a year or more gazed sooner and longer than shelter dogs. Formally trained dogs from breeders also gazed sooner than formally trained dogs from shelters. There were no differences in overall persistence among the three types of dog. However, shelter dogs spent more time biting the box and gazing at it than dogs in the home. Former shelter dogs, former strays, and dogs that had no formal training also spent more time biting the box. We conclude that ownership duration, background, and prior experiences with humans influence human-directed communication and persistence behaviors in dogs.


Assuntos
Comportamento Animal , Propriedade , Animais , Atenção , Comunicação , Cães , Humanos , Aprendizagem
20.
Med Care ; 60(9): 691-699, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35833416

RESUMO

BACKGROUND: Patient engagement strategies can equip patients with tools to navigate treatment decisions and improve patient-centered outcomes. Despite increased recognition about the importance of patient engagement, little is known about the extent of physician practice adoption of patient engagement strategies nationally. METHODS: We analyzed data collected from the National Survey of Healthcare Organizations and Systems (NSHOS) on physician practice adoption of patient engagement strategies. Stratified-cluster sampling was used to select physician practices operating under different organizational structures. Multivariable linear regression models estimated the association of practice ownership, health information technology functionality, use of screening activities, patient responsiveness, chronic care management processes, and the adoption of patient engagement strategies, including shared decision-making, motivational interviewing, and shared medical appointments. All regression models controlled for participation in payment reforms, practice size, Medicaid revenue percentage, and geographic region. RESULTS: We found modest and varied adoption of patient engagement strategies by practices of different ownership types, with health system-owned practices having the lowest adoption of ownership types. Practice capabilities, including chronic care management processes, routine screening of medical and social risks, and patient care dissemination strategies were associated with greater practice-level adoption of patient engagement strategies. CONCLUSIONS: This national study is the first to characterize the adoption of patient engagement strategies by US physician practices. We found modest adoption of shared decision-making and motivational interviewing, and low adoption of shared medical appointments. Risk-based payment reform has the potential to motivate greater practice-level patient engagement, but the extent to which it occurs may depend on internal practice capabilities.


Assuntos
Informática Médica , Médicos , Humanos , Medicaid , Propriedade , Participação do Paciente , Estados Unidos
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