Changing demographic trends among South African occupational therapists: 2002 to 2018.

BACKGROUND: South Africa's quadruple burden of disease, coupled with health system challenges and other factors, predicts a high burden of disability within the population. Human Resources for Health policy and planning need to take account of this challenge. Occupational therapists are part of the health rehabilitation team, and their supply and status in the workforce need to be better understood. METHODS: The study was a retrospective record-based review of the Health Professions Council of South Africa database from 2002 to 2018. The data obtained from the Health Professions Council of South Africa was analysed for the following variables: geographical location, population groups, age, practice type and sex. Data was entered on a Microsoft Excel spreadsheet and analysed using the Statistical Package for the Social Sciences (SPSS version 22.0). RESULTS: In 2018, there were 5180 occupational therapists registered with the Health Professions Council of South Africa with a ratio of 0.9 occupational therapists per 10 000 population. There has been an average annual increase of 7.1% over the time period of 2002-2018. The majority of occupational therapists are located in the more densely populated and urbanised provinces, namely Gauteng, Western Cape and KwaZulu-Natal. Most of the registered occupational therapists are under the age of 40 years (67.7%). The majority (66%) are classified as white followed by those classified as black and coloured. Females make up 95% of the registered occupational therapists. Nationally, 74.8% of occupational therapists are deployed in the private sector catering for 16% of the population while approximately 25.2% are employed in the public sector catering for 84% of the population. CONCLUSIONS: Under-resourcing and disparities in the profile and distribution of occupational therapy human resources remain an abiding concern which negatively impacts on rehabilitation service provision and equitable health and rehabilitation outcomes.

Trend in unequal geographical distribution of doctors by age and sex in Japan from 2004 to 2014.

OBJECTIVES: In Japan, the proportion of female doctors and elderly doctors is increasing as in other countries. We investigated the relationship between doctors' demographic changes and their geographical distribution. STUDY DESIGN: A national database study. METHODS: We assessed trends in unequal geographical distribution of the number of doctors by sex and age from 2004 to 2014 in Japan. RESULTS: The Gini coefficient values for the number of female doctors (0.18) were larger than those for male doctors across all generations (0.13-0.14). The Gini coefficient values for the number of elderly doctors aged 60 years and older (male: 0.12, female: 0.18-0.23) were larger than those for majority age groups aged 40-59 years (male: 0.10, female: 0.16-0.17). CONCLUSION: The persisting geographical maldistribution of doctors may be associated with demographic changes, such as increase in the number of female doctors.

Capacity evaluation for general practitioners in Pudong new area of Shanghai: an empirical study.

BACKGROUND: Building highly qualified General Practitioners (GPs) is key to the development of primary health care. It's therefore urgent to ensure the GPs' quality service under the background of the new round of health care system reforms in China. A new model of GP qualification examination was originally implemented in Pudong New Area of Shanghai, China, which aimed to empirically evaluate the GPs' capability in terms of clinical performance and social recognition. In the current study, an analysis was made of the first two years (2014-2015) of such theoretical and practical examinations on the GPs there with a view to getting a deep insight into the GP community so as to identify the barriers to such a form of GP qualification examination. METHODS: The agency survey method was applied to the two-year database of the GP examinees, the formative research conducted to explore the key elements for developing the examination model. The data analysis was performed with SPSS for Windows (Version 19.0) to describe the GPs' overall characteristics, and to make comparisons between different groups. RESULTS: In 2015, the total number of GPs was 1264 in the area, in different districts of which, statistically significant differences were found in sex, age, professional title and employment span (P < 0.05). Such results were found to be similar to those in 2014. The examinees' theoretical scores were statistically different (F = 7.76; P < 0.05), showing a sloping trend from the urban district to the suburban, to the rural and then to the farther rural, as indicated by LSD-t test (P < 0.05). From the theoretical examinations the scores were higher on the western medicine than on the traditional Chinese medicine (F = 22.11; P < 0.05). CONCLUSIONS: As suggested by the current study on the GPs' qualification examination, which was pioneered in Pudong New Area of Shanghai, the construction of GP community was far from sufficient. It was a preliminary study and further studies are merited along the construction and development in terms of continuing medical education, performance appraisal and incentive mechanism.

Strengthening the Engagement of Provinces in Health Workforce Planning and Management: A Case Study From Lao PDR.

The purpose of this health workforce plan is to provide guidance for the staffing of the Bolikhamxay. Province health services and the training of health service personnel to the year 2020. It must be stressed, however, that this plan is in its first iteration and does not provide all the solutions. Rather, it identifies issues that need to be further investigated and resolved at the local level. For example, the provincial health department (PHD) will need to further investigate the reasons for the significant variability in the utilization of services in different facilities and in the different ratios of staff in relation to the activities performed. The accuracy of the data must be validated and specific interventions must be determined. For Bolikhamxay, particular attention by PHD and district health authorities should be given to the following issues identified in the analysis:• Shortage of clinical staff, particularly in the age group 30 to 40 years old, to provide supervision, guidance, and support for junior staff in coming years;• The existence of health centers with less than minimum staffing level (<3), including a midwife and/or staff capable of properly addressing emergencies with particular reference to maternal and child health.• The median number of activities per staff per year is around 470 (Nakoun/Bolikhan), which means that, on average, a health worker will participate in fewer than two activities per day. The situation in some district hospitals and most health centers is even worse, with an annual average number of activities per staff of only 163, which means that, on average, one staff participates in one activity every 3 days, hardly enough to maintain skills and justify deployment.• This low level of staff activity raises questions about the need for further increase of staff supply to health centers and districts unless effective interventions are implemented to increase the demand and utilization of services in these facilities.• It is also necessary to document all relevant activities, including outreach activities and home visits, in order to give appropriate weight in the calculation of utilization and productivity.• Development of the provincial health workforce development plan requires validated human resources for health information and engagement of local health authorities, as well as strong collaboration with the national authorities and development partners, to ensure adequate support and resourcing.

Trends in pharmacist participation in the workforce, 2009 to 2014.

OBJECTIVES: To examine changes from 2009 to 2014 in variables related to whether, how much, and where licensed pharmacists worked as pharmacists. Comparisons were made separately for men and women pharmacists. DESIGN: Data were obtained from 2 cross-sectional, descriptive surveys of licensed pharmacists and represented 1394 pharmacists in 2009 and 2446 pharmacists in 2014. The useable response rates to the surveys were 52.3% and 48.2%, respectively. SETTING: United States. MAIN OUTCOME MEASURES: We examined the work status, the work setting, work position, and age distribution of actively practicing pharmacists. We studied the proportion of pharmacists working part-time overall and by age group and determined full-time equivalents (FTEs) by age group. RESULTS: From 2009 to 2014, the proportion of licensed pharmacists that reported actively practicing pharmacy decreased for both men and women pharmacists. A significantly larger proportion of men pharmacists reported being retired in 2014 compared with 2009. In 2014, women represented a majority of actively practicing pharmacists and pharmacists in management positions. The proportion of actively practicing women pharmacists that worked part-time decreased from 2009 to 2014, and the FTE contribution of women pharmacists was approximately equal to men pharmacists in 2014. The proportion of pharmacists working in community practice settings decreased from 2009 to 2014. CONCLUSION: The period 2009 to 2014 appears to have been a time of great change in the pharmacist workforce and for work participation by pharmacists, reinforcing the need to continue to monitor changes that affect work participation by pharmacists.

Retirement Financial Planning and the RN: An Integrative Literature Review.

This integrative literature review examined the current research on RN retirement. The review identified 3 critical gaps in knowledge: (a) minimal knowledge regarding the economic impact on RN retirement, (b) incomplete information regarding the demographics of RN retirement, and (c) a scarcity of prospective longitudinal RN workforce studies. Future research must address these gaps to better address RN workforce sustainability.

[Strategies to Cope with the Shortage of Technologists: Facing the Mass-Retirement of the 'Baby-Boomer' Generation].

In Japan, the primary 'baby-boomer' generation, born between 1947 and 1949, is now in its retirement. This has caused a marked shortage of human resources nationwide. Clinical laboratory technologists are no exception, and many clinical laboratories in Japanese healthcare facilities are struggling with management because the number of new graduates, i.e., newly licensed technologists, is mostly fixed and, therefore, their recruitment is becoming more and more competitive. Our laboratory is now facing a wave of mass-retirement associated with our history. In addition, in the early 2000s, there was almost no position for new graduates replacing those retiring because of the change in the social healthcare system as well as our hospital's policy. This resulted in uneven numbers of technologists in generations, and it seemed to be getting worse. Fortunately, five years ago, the direction of social health care was changed and lots of positions became available as a result. We have been trying to recruit new graduates and experienced technologists as well, and were able to hire 18 people. Among them, 8 were non-freshmen. The generation gap has been mostly resolved. We will continue to make our laboratory more attractive not just to new graduates but also to experienced technologists, especially those who wish to return to work after a several-year absence to raise their children. We believe that this will energize our laboratory.

[Inequality and inequity in the use of medical services in Chile, by age group, 2000-2011]. / Desigualdad e inequidad en la utilización de servicios médicos según grupos etarios en Chile, 2000-2011.

OBJECTIVE: To calculate indices of inequality and inequity in the use of medical services for children, adults, and older adults in Chile from 2000 to 2011. METHODS: Based on the CASEN survey (2000-2011), the concentration index (CI) was calculated to measure inequality and the horizontal inequity index (HI) was calculated to measure inequity in the use of medical services. Four groups were studied: children under 5, children aged 6-18 years, adults, and older adults. RESULTS: The results indicate higher levels of inequality in the use of specialized physician services in the child groups, and higher levels of inequity in the adult group. In the use of dental services, the greatest inequality and inequity is found among older adults. For visits to emergency services in the last two years for which data are available (2009 and 2011), the adult group shows a higher level of inequality. CONCUSIONS: In terms of levels of inequity and inequality, there are differences among children, adults, and older adults over the years in at least three of the six variables studied.

Public insurance is increasingly crucial to American families even as employer-sponsored health insurance coverage ends its steady decline.

Americans under age 65 rely on a healthy labor market for almost all facets of economic security. While 2012 marked the first year in more than a decade that the employer-sponsored health insurance (ESI) coverage rate for the under-65 population did not decline, employer-sponsored health insurance continues to fail American families. If the coverage rate had not fallen 10.8 percentage points as it did from 2000 to 2012, as many as 29 million more people under age 65 would have had ESI in 2012. Even with the end of its longstanding decline, ESI coverage rates among men and women, white and non-white, high and low income, white and blue collar, young and old remain far lower than they were in 2000. Over this period, the increase in uninsured Americans was not as steep as the fall in ESI because of increases in public coverage, including Medicaid, the Children's Health Insurance Program, and Medicare. These programs were particularly effective in reducing the share of children uninsured over the 2000s. Additionally, key components in the Patient Protection and Affordable Care Act shielded young adults from further coverage losses.

Fire deaths in Cape Town, South Africa: A retrospective review of medico-legal and toxicological findings (2006 - 2018).

BACKGROUND: In South Africa, fire-related deaths are common, particularly within dense informal housing settlements. Published data on deaths from fire incidents in Cape Town is sparse. Additionally, little emphasis has been placed on the role of toxicological investigations in these deaths, despite the known risk of alcohol and drug impairment to burn injury. METHODS: A retrospective, descriptive analysis of post-mortem case reports from Salt River Mortuary was conducted to investigate all deaths in which fires were involved in the west metropole of Cape Town, between 2006 to 2018. Demographic, circumstantial, and toxicological data were analyzed using R software. RESULTS: In total 1370 fire deaths occurred over 13 years, with a mean of 106 (SD ± 18) cases per annum (≈3% of the annual caseload and a mortality rate of 5.5 per 100,000). Males (70.4%), adults (mean=30.7 years), and toddlers (1-4 years old) were notably at risk. Deaths typically occurred in the early morning (00h00 - 06h00) (45.7%), during winter (32.1%), and in lower socioeconomic areas with highly dense informal settlements (65.6%), with 29% of deaths occurring in multi-fatality incidents. Ethanol was detected (≥0.01 g/100 mL) in 55.1% of cases submitted for analysis (71.5%), with a mean of 0.18 g/100 mL, and with 93.8% of positive cases > 0.05 g/100 mL. Carboxyhaemoglobin (COHb) analysis was requested in 76.4% of cases, with 57% of cases having a %COHb of ≥ 20%. Toxicology results (for drugs other than ethanol) from the national laboratory were outstanding in 34.4% of the cases at the conclusion of the study. BAC and %COHb were significantly higher in deaths from burns and smoke inhalation (usually accidents) than deaths from combined trauma and burns (typically homicides). Fire deaths with high COHb levels were more likely to display cherry-red discoloration (OR=3.1) and soot in the airways (OR=2.7) at autopsy. CONCLUSION: This article provides an updated description of fire deaths in the west metropole of Cape Town. The importance of BAC and COHb testing in these cases was noted, and the authors call for an investigation of the role of drug impairment (specifically frequently misused drugs methamphetamine and methaqualone) as a risk factor in these deaths. Areas of high-density informal settlements, where open flames are used to heat, light, and cook, were noted as high risk.

[Demography and labor shortage. Future challenges of labor market policy]. / Demografie und Fachkräftemangel. Die künftigen arbeitsmarktpolitischen Herausforderungen.

For demographic reasons, the German labor force will decrease dramatically and it will be much older on average. However, labor demand, especially for qualified workers, is expected to remain high. This paper focuses on the possibilities of expanding the labor force by increasing the participation rates of women and older persons. Herein, the change in the labor force is decomposed with respect to population and labor participation and, moreover, the effects of higher participation rates are simulated. The decomposition and simulation scenarios are based on data published by the Institute for Employment Research. The analysis clearly reveals that the effect of a considerably higher labor participation of women and older workers will disappear over time when the working-age population shrinks more and more. In addition, individuals who are currently unemployed or out of the labor force are not skilled enough. Since it seems difficult to get more qualified workers in the short and even in the medium term, improving the conditions for women and older people to take up jobs should be tackled soon. This includes investments in education and health care.

[Impact of demographic changes - analysis and possible implications for the example of a specialist hospital]. / Auswirkungen des demografischen Wandels - Analyse und Handlungsansätze am Beispiel eines Fachkrankenhauses.

The ongoing demographic development creates distinctive challenges for the management of hospitals. Due to the demographic change hospitals will be more and more dependent on the work ability and performance of an aging workforce. Therefore, age-specific work design and interventions are inevitable to create a work environment that sustainably promotes health and well-being. This study reports the work conditions, health impairments (work ability, musculoskeletal complaints), and turnover intentions (intentions to leave the organisation within the previous year, intentions to leave before official retirement age) of N=210 employees working in a specialist hospital. Age-specific analyses show that correlations between working conditions, health, and turnover intention differ substantially across the age groups. From the results an exemplary approach for the analysis and management of demography-related challenges for hospital employees has been deduced. With it, this study presents a promising strategy to identify age-related work stressors and health complaints and to promote health and well-being of hospital employees in different age groups.

Sources of health insurance and characteristics of the uninsured: analysis of the March 2012 Current Population Survey.

HEALTH COVERAGE RATE INCREASED, UNINSURED DOWN: The percentage of the nonelderly population (under age 65) with health insurance coverage increased to 82 percent in 2011, notable since increases in health insurance coverage have been recorded in only five years since 1994. EMPLOYMENT-BASED COVERAGE REMAINS DOMINANT SOURCE OF HEALTH COVERAGE, BUT CONTINUES TO ERODE: Employment-based health benefits remain the most common form of health coverage in the United States, though it represents a declining share. In 2011, 58.4 percent of the nonelderly population had employment-based health benefits, down from the peak of 69.3 percent in 2000, during the 1994-2011 period. PUBLIC PROGRAM COVERAGE IS EXPANDING: Public program health coverage expanded as a percentage of the population in 2011, accounting for 22.5 percent of the nonelderly population. Enrollment in Medicaid and the State Children's Health Insurance Program (S-CHIP) also increased to a combined 46.9 million in 2011, covering 17.6 percent of the nonelderly population, significantly above the 10.2 percent level of 1999. INDIVIDUAL COVERAGE STABLE: The percentage represented by individually purchased health coverage was unchanged in 2011 and has basically hovered in the 6-7 percent range since 1994. WHAT TO EXPECT IN 2012: The unemployment rate in 2012 has been about 8 percent since the beginning of the year, and remains high amidst a still-sluggish economy. As a result, the nation is likely to see a corresponding erosion of employment-based health benefits when the data for 2012 are released next year. Until the economy gains enough strength to have a substantial impact on the labor market, a rebound in employment-based coverage is unlikely.

General practice - workforce gaps now and in 2020.

BACKGROUND: The general practice workforce required for Australia in the future will depend on many factors, including geographic areas and patient utilisation of general practice services. OBJECTIVE: This article examines the current and future general practice workforce requirements by way of an analysis of geographic areas accounting for differing patient utilisation. DISCUSSION: The results showed that, compared with major cities, inner regional areas had 24.4% higher expected patient general practice utilisation per general practitioner, outer regional 33.2%, and remote/very remote 21.4%. Balanced distribution would mean 1129 fewer GPs in major cities: 639 more in inner regional, 423 more in outer regional and 66 more in remote/very remote. With the population projected to increase 18.6-26.1% by 2020, expected general practice utilisation will increase by 27.0-33.1%. Initiatives addressing general practice workforce shortages should account for increasing general practice utilisation due to the aging population, or risk exacerbating the unequal distribution of general practice services.

A closer look at Ontario's northern and southern rural physician demographics.

INTRODUCTION: In Ontario, Canada, there is a tendency to conflate rural and northern issues and although much of northern Ontario is rural, this is not exclusively the case. In this study, data were utilized from the licensing and regulatory body of physicians in Ontario to provide a more nuanced understanding of the distribution of the physician population across varying degrees of rurality in northern and southern regions. METHODS: This is a report on the geographic distribution of the 22 688 GPs, and specialists certified by the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada who had their primary practice address in Ontario. Descriptive statistics were produced to determine differences in distribution of physician numbers, age, sex, international medical graduates (IMGs), and certification for physicians with primary practices coded as northern versus southern across varying degrees of rurality. RESULTS: Differences were found in the Ontario physician population with regard to age, sex and IMG status between rural and urban areas and also from the northern versus southern perspective. There were more younger and male physicians in northern and rural areas. Female physicians were more frequently found in the south with decreasing proportions of females with increasing rurality. In the northern areas of the province, although the proportion of female physicians was lower than in the south, there was a slight increase in the proportion of female physicians as rurality increased. The largest proportions of IMGs were found in urban areas and the proportions of IMGs decreased with increasing rurality. However, northern rural regions did tend to have a higher proportion of IMG physicians than in corresponding rural areas in the south. CONCLUSIONS: The results indicate that although there are similarities in physician demographics in rural and urban areas, there are clear differences between the rural north and the rural south. Likewise, although some patterns distinguish the south from the north, these areas are not homogeneous regions where the urban north is clearly different from the rural north.

Sources of health insurance and characteristics of the uninsured: analysis of the March 2011 current population survey.

LATEST CENSUS DATA: This Issue Brief provides historical data through 2010 on the number and percentage of nonelderly individuals with and without health insurance. Based on EBRI estimates from the U.S. Census Bureau's March 2011 Current Population Survey (CPS), it reflects 2010 data. It also discusses trends in coverage for the 1994-2010 period and highlights characteristics that typically indicate whether an individual is insured. HEALTH COVERAGE RATE CONTINUES TO DECREASE, UNINSURED INCREASE: The percentage of the nonelderly population (under age 65) with health insurance coverage decreased to 81.5 percent in 2010. Increases in health insurance coverage have been recorded in only three years since 1994, when 36.5 million nonelderly individuals were uninsured. The percentage of nonelderly individuals without health insurance coverage was 18.5 percent in 2010, up from 18.3 percent in 2009, and its highest level during the 1994-2010 period. EMPLOYMENT-BASED COVERAGE REMAINS DOMINANT SOURCE OF HEALTH COVERAGE, BUT CONTINUES TO ERODE: Employment-based health benefits remain the most common form of health coverage in the United States. In 2010, 58.7 percent of the nonelderly population had employment-based health benefits, down from 69.3 percent in 2000. SHIFTING COMPOSITION OF EMPLOYMENT-BASED COVERAGE: Between 2007 and 2010, the percentage of individuals under age 65 with employment-based coverage in their own name has dropped. In 2007, 54.2 percent had coverage in their own name. By 2010, it was down to 51.5 percent. Dependent coverage during this time period fell slightly from 17.5 percent to 17.1 percent, and increased slightly from 16.8 percent to 17.1 percent between 2009 and 2010. PUBLIC PROGRAM COVERAGE IS GROWING: Public program health coverage expanded as a percentage of the population in 2010, accounting for 21.6 percent of the nonelderly population. Enrollment in Medicaid and the State Children's Health Insurance Program increased, reaching a combined 45 million in 2010, and covering 16.9 percent of the nonelderly population, significantly above the 10.2 percent level of 1999. INDIVIDUAL COVERAGE STABLE: Individually purchased health coverage was unchanged in 2010 and has basically hovered in the 6-7 percent range since 1994. WHAT TO EXPECT IN 2011: 2010 is the most recent year for data on sources of health coverage. Unemployment in 2011 has been about 9 percent since the beginning of the year. While down from the 2010 average of 9.6 percent, it remains high and there is a continued threat of a double-dip recession increasing it even further. As a result, the nation is likely to see continued erosion of employment-based health benefits when the data for 2011 are released in 2012. Fewer working individuals translates into fewer individuals with access to health benefits in the work place, especially after COBRA subsidies have been exhausted.

[Population density, age distribution and urbanisation as factors influencing the frequency of home visits--an analysis for Mecklenburg-West Pomerania]. / Bevölkerungsdichte, Altersverteilung und Urbanität als Einflussfaktoren der Hausbesuchshäufigkeit - eine Analyse für Mecklenburg-Vorpommern.

BACKGROUND: This study examines and compares the frequency of home visits by general practitioners in regions with a lower population density and regions with a higher population density. The discussion centres on the hypothesis whether the number of home visits in rural and remote areas with a low population density is, in fact, higher than in urbanised areas with a higher population density. The average age of the population has been considered in both cases. METHODOLOGY: The communities of Mecklenburg West-Pomerania were aggregated into postal code regions. The analysis is based on these postal code regions. The average frequency of home visits per 100 inhabitants/km2 has been calculated via a bivariate, linear regression model with the population density and the average age for the postal code region as independent variables. The results are based on billing data of the year 2006 as provided by the Association of Statutory Health Insurance Physicians of Mecklenburg-Western Pomerania. In a second step a variable which clustered the postal codes of urbanised areas was added to a multivariate model. RESULTS: The hypothesis of a negative correlation between the frequency of home visits and the population density of the areas examined cannot be confirmed for Mecklenburg-Western Pomerania. Following the dichotomisation of the postal code regions into sparsely and densely populated areas, only the very sparsely populated postal code regions (less than 100 inhabitants/km2) show a tendency towards a higher frequency of home visits. Overall, the frequency of home visits in sparsely populated postal code regions is 28.9% higher than in the densely populated postal code regions (more than 100 inhabitants/km2), although the number of general practitioners is approximately the same in both groups. In part this association seems to be confirmed by a positive correlation between the average age in the individual postal code regions and the number of home visits carried out in the area. As calculated on the basis of the data at hand, only the very sparsely populated areas with a still gradually decreasing population show a tendency towards a higher frequency of home visits. CONCLUSION: According to the data of 2006, the number of home visits remains high in sparsely populated areas. It may increase in the near future as the number of general practitioners in these areas will gradually decrease while the number of immobile and older inhabitants will increase.