Dermatology workforce projections in the United States, 2021 to 2036.

BACKGROUND: There has been a growing imbalance between supply of dermatologists and demand for dermatologic care. To best address physician shortages, it is important to delineate supply and demand patterns in the dermatologic workforce. The goal of this study was to explore dermatology supply and demand over time. METHODS: We conducted a cross-sectional analysis of workforce supply and demand projections for dermatologists from 2021 to 2036 using data from the Health Workforce Simulation Model from the National Center for Health Workforce Analysis. Estimates for total workforce supply and demand were summarized in aggregate and stratified by rurality. Scenarios with status quo demand and improved access were considered. RESULTS: Projected total supply showed a 12.45% increase by 2036. Total demand increased 12.70% by 2036 in the status quo scenario. In the improved access scenario, total supply was inadequate for total demand in any year, lagging by 28% in 2036. Metropolitan areas demonstrated a relative supply surplus up to 2036; nonmetropolitan areas had at least a 157% excess in demand throughout the study period. In 2021 adequacy was 108% and 39% adequacy for metropolitan and nonmetropolitan areas, respectively; these differences were projected to continue through 2036. CONCLUSIONS: The findings suggest that the dermatology physician workforce is inadequate to meet the demand for dermatologic services in nonmetropolitan areas. Furthermore, improved access to dermatologic care would bolster demand and especially exacerbate workforce inadequacy in nonmetropolitan areas. Continued efforts are needed to address health inequities and ensure access to quality dermatologic care for all.

Children with palliative care needs - the landscape of the nordic countries.

BACKGROUND: To strengthen palliative care for children in the Nordic countries, an updated status of current needs, resources, clinical services, education, and research is necessary to align and consolidate future research. A Nordic research collaboration initiative for children with palliative care needs was assembled in 2023. Building on this initiative, this paper presents an overview of pediatric palliative care (PPC) in the Nordic countries' (a) population characteristics, (b) care models and setting of care, (c) education and training, and (d) research. METHODS: The Nordic initiative researchers collaboratively gathered and assessed available data on the characteristics of PPC within Denmark, Finland, Greenland, Iceland, Norway, the Faroe Islands, Sweden, and Åland. Data were compiled in a matrix with population characteristics, models- and setting of care, education and training, and areas of research in a Nordic context. The findings are narratively and descriptively presented, providing an overview of Nordic PPC. RESULTS: In total, the Nordic child population comprises around six million children (0-19 years), of which about 41.200 are estimated to be living with a life-limiting and/or life-threatening condition. Healthcare services are provided through various care models, ranging from specialized care to homecare settings. Overall, there remain few opportunities for education and training with some exceptions. Also, Nordic research within PPC has been shown to be a growing field although much remains to be done. CONCLUSION: This overview is the first outline of the current PPC in Nordic countries. Although some differences remain important to acknowledge, overall, the strengths and challenges faced within PPC in the Nordic countries are comparable and call for joint action to increase evidence, services, and education to better serve the children, families, and healthcare personnel within PPC. Despite the varying structural premises for PPC, research endeavors aiming to provide evidence in this field seem increasing, timely and relevant for the Nordic countries, as well as the international context.

Geographical accessibility of medical resources, health status, and demand of integrated care for older people: a cross-sectional survey from Western China.

BACKGROUND: The World Health Organization (WHO) published the Integrated Care for Older People (ICOPE) framework to help healthcare providers cope with the population aging crisis. However, the relevant evidence on the demands of older people and the compensatory capacity of the environment is limited. This study reports for the first time the level of the ICOPE demand in Western China that includes the impact of geographic accessibility of medical resources (GAMR) on ICOPE demand and the potential mechanism of health status. METHODS: A cross-sectional questionnaire survey was conducted among 1200 adults aged 60 years and older selected through multi-stage stratified cluster sampling to obtain relevant data, including ICOPE demand, health status, and GAMR. Propensity score matching (PSM) was used to analyze the impact of GAMR on ICOPE demand among older people and those with different health statuses. RESULTS: Among the prospective research participants, 1043 were eligible for the study. The mean score of ICOPE demand among all participants was 3.68 (standard deviation [SD] = 0.78). After adjusting for covariates between high and low GAMR groups (1:1 match), ICOPE demand was significantly higher in the low GAMR group than in the high GAMR group (average treatment effect on the treated [ATT] = 0.270, p < 0.05). For both good and poor self-rated health status, the ICOPE demand of the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.345, p < 0.05; ATT = 0.190, p < 0.05). For chronic diseases, the ICOPE demand of older people with multimorbidity in the low GAMR group was significantly higher than that in the high GAMR group (ATT = 0.318, p < 0.01). CONCLUSIONS: The older population in Western China has a relatively high demand for ICOPE. Low GAMR is a key factor in ICOPE demand growth in this region. It accelerates demand release for both older people with multimorbidity and self-perceptions of health.

National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020.

Importance: There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs. Objective: To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020. Design, Setting, and Participants: Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515). Main Outcomes and Measures: Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects. Results: From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001). Conclusions and Relevance: Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.

Medical rehabilitation of older employees with migrant background in Germany: Does the utilization meet the needs?

Due to demographic change with an ageing workforce, the proportion of employees with poor health and a need for medical rehabilitation is increasing. The aim was to investigate if older employees with migrant background have a different need for and utilization of medical rehabilitation than employees without migrant background. To investigate this, self-reported data from older German employees born in 1959 or 1965 of the first and second study wave of the lidA cohort study were exploratory analyzed (n = 3897). Subgroups of employees with migrant background were separated as first-generation, which had either German or foreign nationality, and second-generation vs. the rest as non-migrants. All subgroups were examined for their need for and utilization of medical rehabilitation with descriptive and bivariate statistics (chi-square, F- and post-hoc tests). Furthermore, multiple logistic regressions and average marginal effects were calculated for each migrant group separately to assess the effect of need for utilization of rehabilitation. According to our operationalizations, the foreign and German first-generation migrants had the highest need for medical rehabilitation while the German first- and second-generation migrants had the highest utilization in the bivariate analysis. However, the multiple logistic model showed significant positive associations between their needs and utilization of rehabilitation for all subgroups. Further in-depth analysis of the need showed that something like under- and oversupply co-exist in migrant groups, while the foreign first-generation migrants with lower need were the only ones without rehabilitation usage. However, undersupply exists in all groups independent of migrant status. Concluding, all subgroups showed suitable use of rehabilitation according to their needs at first sight. Nevertheless, the utilization does not appear to have met all needs, and therefore, the need-oriented utilization of rehabilitation should be increased among all employees, e.g. by providing more information, removing barriers or identifying official need with uniform standards.

Trends in US Ambulatory Care Patterns During the COVID-19 Pandemic, 2019-2021.

Importance: Following reductions in US ambulatory care early in the pandemic, it remains unclear whether care consistently returned to expected rates across insurance types and services. Objective: To assess whether patients with Medicaid or Medicare-Medicaid dual eligibility had significantly lower than expected return to use of ambulatory care rates than patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance. Design, Setting, and Participants: In this retrospective cohort study examining ambulatory care service patterns from January 1, 2019, through February 28, 2021, claims data from multiple US payers were combined using the Milliman MedInsight research database. Using a difference-in-differences design, the extent to which utilization during the pandemic differed from expected rates had the pandemic not occurred was estimated. Changes in utilization rates between January and February 2020 and each subsequent 2-month time frame during the pandemic were compared with the changes in the corresponding months from the year prior. Age- and sex-adjusted Poisson regression models of monthly utilization counts were used, offsetting for total patient-months and stratifying by service and insurance type. Exposures: Patients with Medicaid or Medicare-Medicaid dual eligibility compared with patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance, respectively. Main Outcomes and Measures: Utilization rates per 100 people for 6 services: emergency department, office and urgent care, behavioral health, screening colonoscopies, screening mammograms, and contraception counseling or HIV screening. Results: More than 14.5 million US adults were included (mean age, 52.7 years; 54.9% women). In the March-April 2020 time frame, the combined use of 6 ambulatory services declined to 67.0% (95% CI, 66.9%-67.1%) of expected rates, but returned to 96.7% (95% CI, 96.6%-96.8%) of expected rates by the November-December 2020 time frame. During the second COVID-19 wave in the January-February 2021 time frame, overall utilization again declined to 86.2% (95% CI, 86.1%-86.3%) of expected rates, with colonoscopy remaining at 65.0% (95% CI, 64.1%-65.9%) and mammography at 79.2% (95% CI, 78.5%-79.8%) of expected rates. By the January-February 2021 time frame, overall utilization returned to expected rates as follows: patients with Medicaid at 78.4% (95% CI, 78.2%-78.7%), Medicare-Medicaid dual eligibility at 73.3% (95% CI, 72.8%-73.8%), commercial at 90.7% (95% CI, 90.5%-90.9%), Medicare Advantage at 83.2% (95% CI, 81.7%-82.2%), and Medicare fee-for-service at 82.0% (95% CI, 81.7%-82.2%; P < .001; comparing return to expected utilization rates among patients with Medicaid and Medicare-Medicaid dual eligibility, respectively, with each of the other insurance types). Conclusions and Relevance: Between March 2020 and February 2021, aggregate use of 6 ambulatory care services increased after the preceding decrease in utilization that followed the onset of the COVID-19 pandemic. However, the rate of increase in use of these ambulatory care services was significantly lower for participants with Medicaid or Medicare-Medicaid dual eligibility than for those insured by commercial, Medicare Advantage, or Medicare fee-for-service.

Social Media Discussions Predict Mental Health Consultations on College Campuses.

The mental health of college students is a growing concern, and gauging the mental health needs of college students is difficult to assess in real-time and in scale. To address this gap, researchers and practitioners have encouraged the use of passive technologies. Social media is one such "passive sensor" that has shown potential as a viable "passive sensor" of mental health. However, the construct validity and in-practice reliability of computational assessments of mental health constructs with social media data remain largely unexplored. Towards this goal, we study how assessing the mental health of college students using social media data correspond with ground-truth data of on-campus mental health consultations. For a large U.S. public university, we obtained ground-truth data of on-campus mental health consultations between 2011-2016, and collected 66,000 posts from the university's Reddit community. We adopted machine learning and natural language methodologies to measure symptomatic mental health expressions of depression, anxiety, stress, suicidal ideation, and psychosis on the social media data. Seasonal auto-regressive integrated moving average (SARIMA) models of forecasting on-campus mental health consultations showed that incorporating social media data led to predictions with r = 0.86 and SMAPE = 13.30, outperforming models without social media data by 41%. Our language analyses revealed that social media discussions during high mental health consultations months consisted of discussions on academics and career, whereas months of low mental health consultations saliently show expressions of positive affect, collective identity, and socialization. This study reveals that social media data can improve our understanding of college students' mental health, particularly their mental health treatment needs.

Projecting Quarantine Utilization During a Pandemic.

Objectives. To develop an approach to project quarantine needs during an outbreak, particularly for communally housed individuals who interact with outside individuals. Methods. We developed a method that uses basic surveillance data to do short-term projections of future quarantine needs. The development of this method was rigorous, but it is conceptually simple and easy to implement and allows one to anticipate potential superspreading events. We demonstrate how this method can be used with data from the fall 2020 semester of a large urban university in Boston, Massachusetts, that provided quarantine housing for students living on campus in response to the COVID-19 pandemic. Our approach accounted for potentially infectious interactions between individuals living in university housing and those who did not. Results. Our approach was able to accurately project 10-day-ahead quarantine utilization for on-campus students in a large urban university. Our projections were most accurate when we anticipated weekend superspreading events around holidays. Conclusions. We provide an easy-to-use software tool to project quarantine utilization for institutions that can account for mixing with outside populations. This software tool has potential application for universities, corrections facilities, and the military. (Am J Public Health. 2022;112(2):277-283. https://doi.org/10.2105/AJPH.2021.306573).

A contemporary reassessment of the US surgical workforce through 2050 predicts continued shortages and increased productivity demands.

BACKGROUND: We aimed to predict practicing surgeon workforce size across ten specialties to provide an up-to-date, national perspective on future surgical workforce shortages or surpluses. METHODS: Twenty-one years of AMA Masterfile data (1997-2017) were used to predict surgeons practicing from 2030 to 2050. Published ratios of surgeons/100,000 population were used to estimate the number of surgeons needed. MGMA median wRVU/surgeon by specialty (2017) was used to determine wRVU demand and capacity based on projected and needed number of surgeons. RESULTS: By 2030, surgeon shortages across nine specialties: Cardiothoracic, Otolaryngology, General Surgery, Obstetrics-Gynecology, Ophthalmology, Orthopedics, Plastics, Urology, and Vascular, are estimated to increase clinical workload by 10-50% additional wRVU. By 2050, shortages in eight specialties are estimated to increase clinical workload by 7-61% additional wRVU. CONCLUSIONS: If historical trends continue, a majority of surgical specialties are estimated to experience workforce deficits, increasing clinical demands substantially.

Conhecendo as demandas de cuidado em saúde mental de jovens homoafetivos / Conociendo las demandas de cuidado en salud mental de jóvenes homoafectivos / Knowing the demands of mental health care of the young homoaffective

Objetivo: conhecer as demandas de cuidado em saúde mental de jovens homoafetivos. Método: pesquisa qualitativa, realizada com 18 jovens homoafetivos, estudantes universitários, em Santa Catarina. A produção de informações ocorreu em 2016, por meio de entrevista semiestruturada, com questões sobre percepções em relação à própria saúde mental, a homoafetividade e expectativas frente ao cuidado de saúde. As informações foram interpretadas mediante análise de conteúdo. Resultados: foram identificadas vulnerabilidades individuais, sociais e programáticas dos jovens homoafetivos, que podem interferir na saúde mental, levando-os a buscar suporte profissional. Foram relatadas fragilidades dos serviços de saúde para este cuidado. Considerações finais: os jovens homoafetivos vivenciam situações de vulnerabilidades, havendo demandas de cuidados que são negligenciadas nos serviços de saúde. Eles carecem de inovações, sobretudo em saúde mental, uma vez que sofrem agressões, opressões e estigmas, que colaboram para o uso de drogas. Ainda, questionam sobre atendimentos igualitários, resolutivos, livres de preconceitos e assistência humanizada.

Objetivo: conocer las demandas de cuidado en salud mental de jóvenes homoafectivos. Método: investigación cualitativa, realizada con 18 jóvenes homoafectivos, estudiantes universitarios, en Santa Catarina. La producción de información ocurrió en 2016, por medio de entrevista semiestructurada, con cuestiones sobre percepciones en relación a la propia salud mental, la homoafectividad y expectativas frente al cuidado de salud. La información se ha interpretado mediante análisis de contenido. Resultados: se identificaron vulnerabilidades individuales, sociales y programáticas de los jóvenes homoafectivos, que pueden interferir en la salud mental, llevándolos a buscar apoyo profesional. Se han reportado debilidades de los servicios de salud para este cuidado. Consideraciones finales: los jóvenes homoafectivos experimentan situaciones de vulnerabilidad, habiendo demandas de atención que son descuidadas en los servicios de salud. Carecen de innovaciones, sobre todo en salud mental, ya que sufren agresiones, opresiones y estigmas, que colaboran para el uso de drogas. Aún, cuestionan sobre atenciones igualitarias, resolutivos, libres de prejuicios y asistencia humanizada.

Objective: to know the demands of mental health care of young homosexuals. Method: qualitative research, conducted with 18 young homoaffective, university students in Santa Catarina. The production of information occurred in 2016, through semi-structured interviews, with questions about perceptions regarding mental health, homoaffectivity and expectations regarding health care. The information was interpreted through content analysis. Results: individual, social and programmatic vulnerabilities of young homosexuals were identified, which can interfere with mental health, leading them to seek professional support. Weaknesses of health services for this care were reported. Final considerations: young homosexuals experience situations of vulnerability, with demands for care that are neglected in health services. They lack innovations, especially in mental health, since they suffer aggression, oppression and stigma, which contribute to drug use. Still, they question about equal care, problem-solving, free of prejudice and humanized assistance.

COVID-19 and UK family carers: policy implications.

Informal (unpaid) carers are an integral part of all societies and the health and social care systems in the UK depend on them. Despite the valuable contributions and key worker status of informal carers, their lived experiences, wellbeing, and needs have been neglected during the COVID-19 pandemic. In this Health Policy, we bring together a broad range of clinicians, researchers, and people with lived experience as informal carers to share their thoughts on the impact of the COVID-19 pandemic on UK carers, many of whom have felt abandoned as services closed. We focus on the carers of children and young people and adults and older adults with mental health diagnoses, and carers of people with intellectual disability or neurodevelopmental conditions across different care settings over the lifespan. We provide policy recommendations with the aim of improving outcomes for all carers.