Development and piloting of a Community of Practice to support learning and improvement in health promotion practice within NSW local health district.

OBJECTIVES: Health Promotion Units within New South Wales (NSW) local health districts (LHDs) frequently collaborate and test innovations to address priority health issues or approaches to support the implementation of a health promotion program in a way that is consistent with the needs, resources, and contexts of their regions. Compatible with learning health system approaches, mechanisms to facilitate the exchange of evidence and expertise across districts could improve the collective impact of health promotion services across the state. This study aimed to assess the use of a health promotion Community of Practice (CoP) model as a strategy to achieve this. Type of program or service: This paper describes and shares experiences from the development and piloting process of a CoP model to develop, evaluate and exchange learnings to improve approaches to support the adoption of an effective healthy lunchbox program ('SWAP IT') across three LHDs. RESULTS: The functioning of the CoP was supported by key activities, funding and infrastructure over a 2-year period, including: planning workshops, implementation check-ins, and knowledge exchange meetings. A particularly novel aspect of the CoP was the harmonised evaluation of different, locally developed strategies to facilitate program adoption across the three LHDs. The alignment of the CoP with local and state priorities, as well as the operation of the CoP in a way that did not impose significant time demands, was seen as important for the sustainability of the CoP. LESSONS LEARNT: Findings from the piloting process suggest that a formalised CoP shows promise as an effective model to enhance health promotion collaboration, information sharing and practice across LHDs, which may be suitable for broader application across the state.

Prospective 5-Year Analysis of the United States Radiation Oncology Job Market Using the ASTRO Career Center Website.

PURPOSE: We provide 5-year results of prospectively collected radiation oncology (RO) job opportunities and a longitudinal assessment of RO graduate numbers within the United States. METHODS AND MATERIALS: Full-time domestic RO job opportunities were collected and categorized using the American Society for Radiation Oncology (ASTRO) Career Center from July 1, 2016 to June 30, 2021. A chi-square test was used to compare regional job availability by city size and position type. The corresponding number of graduating United States (US) RO residents (2017-2021) was collected. US census and Medicare database resources were used as comparators for population and workforce estimates. Pearson's correlation coefficients were used to examine changes in data over time and a 2-tailed t test was used to assess for statistical significance. RESULTS: Over the 5-year study period, 819 unique job offers were posted, compared with 935 RO graduates (0.88 total jobs-to-graduates ratio). Most jobs were nonacademic (57.6%), located in populated areas >1 million (57.1%; median: 1.57M), with the largest proportion of jobs seen in the South region (32.4%). One-third of academic jobs were located at satellites. Regional differences were seen between academic versus nonacademic job availability (P < .01), with the highest proportion of academic jobs seen in the Northeast (60.3%) and the lowest in the Midwest (34.5%). Differences between regions were also observed for jobs in areas >1 million versus ≤1 million (P < .01), with the most jobs in areas >1 million seen in the West (64.6%) and the least in the South (51.3%). Regional job availability over time did not differ by position type (academic vs nonacademic) or population area size (P = .11 and P = .27, respectively). Annual graduate numbers increased with time (P = .02), with the highest percentage of graduates trained in the South (30.8%). Regional distribution of jobs versus graduates significantly differed (P < .01) with the lowest jobs-to-graduates ratio observed in the Northeast (0.67) and highest ratio in the West (1.07). Regional RO workforce estimates based on the 4336 radiation oncologists who were Medicare providers in 2020 were compared with total jobs and graduates by region with no difference observed between the distributions of the workforce and jobs (P = .39), but comparisons between the workforce and graduates were proportionally different (P < .01). The number of total jobs (vs graduates) per 10 million population in the Northeast, South, Midwest, and West were 30.2 (45.1), 21.0 (22.7), 30.6 (33.4), and 22.6 (21.2), respectively. CONCLUSIONS: This multiyear quantitative assessment of the RO job market and graduates identified fewer job opportunities than graduates overall in most regions, most notably in the Northeast. Regional differences were seen between available job type (academic vs nonacademic) and population size (>1 million vs ≤1 million). The findings are worrisome for trainee oversupply and geographic maldistribution. The number and distribution of RO trainees and residency programs across the US should be evaluated to minimize job market imbalance for future graduates, promote workforce stability, and continue to meet the future societal needs of patients with cancer.

US Primary Care vs Specialty Care Trainee Positions and Physician Incomes: Trends From 2001 to 2019.

BACKGROUND: Much of the Affordable Care Act (ACA) and subsequent US health care policies were designed to address deficiencies in health care access and enhance primary care services. How residency positions and physician incomes have changed in the post-ACA era is not well characterized. OBJECTIVE: We evaluated the growth of US trainee positions and physician income, in the pre- vs post-ACA environment by specialty and among primary care vs specialty care. METHODS: Total resident complement by specialty and year was extracted from the National Graduate Medical Education (GME) Census and stratified into primary care vs specialty care. Median incomes were extracted from Medical Group Management Association surveys. Piecewise linear regression with interaction terms (pre-ACA, 2001-2010, vs post-ACA, 2011-2019) assessed growth rate by specialty and growth rate differences between primary care and specialty care. Sensitivity analyses were performed by focusing on family medicine and excluding additional GME positions contributed by the introduction of the 2015 single GME accreditation system. RESULTS: Resident complements increased for primary care (+0.16%/year pre-ACA to +2.06%/year post-ACA, P < .001) and specialty care (+1.49%/year to +2.07%/year, P = .005). Specialty care growth outpaced primary care pre-ACA (P < .001) but not post-ACA (P = .10). Family medicine had the largest increase in the pre- vs post-ACA era (-0.77%/year vs +2.09%/year, P < .001). Excluding positions contributed by the single GME accreditation system transition did not result in any statistically significant changes to the findings. Income growth increased for primary care (+0.84%/year to +1.37%/year, P = .044), but decreased for specialty care (+1.44%/year to +0.49%/year, P = .011). Specialty care income growth outpaced primary care pre-ACA (P < .001), but not post-ACA (P = .22). CONCLUSIONS: We found significant growth differences in resident complement and income among primary care versus specialty care in the pre-/post-ACA eras.

Quantitative DTI assessment in human lumbar stabilization muscles at 3 T.

OBJECTIVES: To characterize diffusion tensor imaging (DTI) tensor eigenvalues (λ1, λ2, λ3), fractional anisotropy, mean diffusivity, and radial diffusivity in healthy lumbar musculature. METHODS: Seventeen healthy subjects (10 men, 7 women; mean age, 28 ± 7 years) were scanned using a 3.0-T magnetic resonance imaging. Axial DTI was performed using 15 diffusion directions (b = 400 mm/s) at the L4 level. Oswestry Low Back Pain and Godin Physical Activity questionnaires were administered to rule out underlying lower back problems. RESULTS: Skeletal muscle DTI metrics were similar to those previously published. All measurements showed low coefficients of variation, except for quadratus lumborum. Laterality was not significant. Significant sex differences were observed in the quadratus lumborum (P < 0.05). Significant correlations were found between subjects' weight and body mass index with fractional anisotropy and λ1 of the multifidus muscles. CONCLUSIONS: The DTI metrics in paraspinal muscles can be reliably measured and are influenced by body mass index and weight but not by age or physical activity.

Population and development beyond the first demographic transition: a focus on the experience of east and southeast Asian countries / População e desenvolvimento além da primeira transição demográfica: discussão da experiência de países do leste e sudeste da Ásia / Población y desarrollo más allá de la primera transición demográfica: discusión sobre la experiencia de países del este y sudeste asiático

This paper covers a wide scope, focusing on some trends in East and Southeast Asia that may be of interest to Latin America. The first demographic transition has essentially been completed in both regions. The issue is what should now be the focus of our consideration of population and development? East Asian countries are now stressing issues of ultra-low fertility, and policies to raise fertility. They are not comfortable with the prospect of making up future deficits through international migration. The paper also deals briefly with studies of dynamics of change in mega-urban regions, and argues that comparative studies on Latin America and Asia could be valuable. Issues of poverty, development, and equity are then addressed, with particular emphasis on the role of education as a key to equality and development. One dilemma is that in East Asia, the generally commendable obsession with education is one factor making for very low levels of fertility. Finally, the paper touches on population and environmental issues.

Este artigo é bastante abrangente e se concentra em algumas tendências do Leste e Sudeste da Ásia que podem ser de interesse para a América Latina. A primeira transição demográfica foi concluída em essência em ambas as regiões. A questão atual é qual deve ser o foco de nossa atenção em população e desenvolvimento? Atualmente, os países da Ásia Oriental estão enfatizando as questões de fecundidade ultrabaixa e políticas para fomentar a fecundidade. Esses países não se sentem à vontade com a perspectiva de compensar déficits futuros por meio de migração internacional. Este artigo também discute de forma resumida os estudos de dinâmica de mudança em regiões megaurbanas, e defende a ideia de que estudos comparando a América Latina e a Ásia poderiam ser de grande importância. Em seguida, são discutidas as questões da pobreza, desenvolvimento e equidade, com especial ênfase no papel da educação como fator-chave para a equidade e o desenvolvimento. Um dos dilemas é que a obsessão, em geral admirável, da Ásia Oriental com educação é um dos fatores que determinam os índices muito baixos de fecundidade. Por fim, o artigo aborda questões populacionais e ambientais.

Este artículo es bastante englobador, y se concentra en algunas tendencias del Este y Sudeste asiático que pueden resultar de interés para América Latina. La primera transición demográfica concluyó en esencia en ambas regiones. La cuestión actual es cuál debe ser el foco de nuestra atención en población y desarrollo. Actualmente, los países de Asia Oriental están dando énfasis a las cuestiones de fertilidad ultrabaja y políticas para fomentar la fertilidad. Esos países no se sienten a gusto con la perspectiva de compensar déficits futuros a través de la migración internacional. Este artículo también discute de forma resumida los estudios de dinámica de cambios en regiones megaurbanas, y defiende la idea de que estudios comparando América Latina y Asia podrían ser de gran importancia. A continuación, se discuten las cuestiones de pobreza, desarrollo y equidad, con especial énfasis en el papel de la educación como factor clave para la equidad y el desarrollo. Uno de los dilemas es que la obsesión, en general admirable, de Asia Oriental con la educación es uno de los factores que determina los índices tan bajos de fertilidad. Finalmente, el artículo aborda cuestiones poblacionales y ambientales.

East Asian childbearing patterns and policy developments.

Childbearing behavior in East Asian countries has changed rapidly during the past half century from an average of five to seven children per family, to replacement-level fertility, and subsequently to unprecedentedly low levels, the lowest in the world. This article analyzes fertility trends in Hong Kong, Japan, singapore, south Korea, and Taiwan using cohort fertility data and methods, then examines social and economic causes of the childbearing trends, and surveys policies pursued to reverse the fertility trends. Postponement of childbearing started in the 1970s with continuously fewer delayed births being "recuperated," which resulted in ultra-low fertility. A rapid expansion of education and employment among women in a patriarchal environment has generated a stark dilemma for women who would like to combine childbearing with a career. Policy responses have been slow, with a more serious attempt to address issues in recent years. Thus far public and private institutions are not devoting sufficient attention to generating broad social change supportive of parenting.

Asia's family planning programs as low fertility is attained.

The dramatic demographic changes in Asia during the three decades from 1970 to the end of the twentieth century were matched by major changes in government population policies and programs. Fertility declines occurred in widely different economic, sociocultural, and political settings. The extent to which they were attributable to family planning programs, established in most countries of the region by 1970, is hotly debated. The 1970s were the heyday of family planning programs, which were created in a climate of urgency because of concerns over the "population explosion." Issues faced by programs at that time are discussed. Over time, programs generally have moved to a simpler "service" approach. As increasing numbers of countries reach replacement-level fertility, and as policies are formed against the background of the 1994 International Conference on Population and Development held in Cairo, the role of family planning programs is increasingly debated and questioned. This article examines the responses of Asian countries and the population challenges that remain.