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1.
Pan Afr Med J ; 37: 28, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33062129

RESUMO

COVID-19 is a rapidly growing pandemic that has grown from a few cases in Wuhan, China to millions of infections and hundreds of thousands of deaths worldwide within a few months. Sub-Saharan Africa is not spared. Radiology has a key role to play in the diagnosis and management of COVID-19 as literature from Wuhan and Italy demonstrates. We therefore share some critical knowledge and practice areas for radiological suspicion and diagnosis. In addition, emphasis on how guarding against healthcare acquired infections (HAIs) by applying "red" and "green" principle is addressed. Given that pandemics such as COVID-19 can worsen the strain on the scantily available radiological resources in this region, we share some practical points that can be applied to manage these precious resources also needed for other essential services. We have noted that radiology does not feature in many main COVID-19 guidelines, regionally and internationally. This paper therefore suggests areas of collaboration for radiology with other clinical and management teams. We note from our local experience that radiology can play a role in COVID-19 surveillance.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Área de Atuação Profissional/tendências , Radiologia/organização & administração , África ao Sul do Saara/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Surtos de Doenças/ética , Surtos de Doenças/prevenção & controle , Recursos em Saúde , Humanos , Conhecimento , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia
2.
J Grad Med Educ ; 12(4): 507-511, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32879697

RESUMO

Background: The start of a new academic year in graduate medical education will mark a transition for postgraduate year 1 (PGY-1) residents from medical school into residency. The relocation of individuals has significant implications given the COVID-19 pandemic and variability of the outbreak across the United States, but little is known about the extent of the geographic relocation taking place. Objective: We reported historical trends of PGY-1 residents staying in-state and those starting residency from out-of-state to quantify the geographic movement of individuals beginning residency training each year. Methods: We analyzed historical data collected by the Accreditation Council for Graduate Medical Education in academic years 2016-2017, 2017-2018, and 2018-2019, comparing the locations of medical school and residency programs for PGY-1 residents to determine the number of matriculants from in-state medical schools and out-of-state medical schools. International medical school graduates (IMGs) were shown separately in the analysis and then combined with out-of-state matriculants. US citizens who trained abroad were counted among IMGs. Results: The total number of PGY-1s increased by 10.3% during the 3-year time period, from 29 338 to 32 348. When combined, IMGs and USMGs transitioning from one state or country to another state accounted for approximately 72% of PGY-1s each year. Approximately 63% of USMGs matriculated to a residency program in a new state, and IMGs made up 24.6% to 23.1% of PGY-1s over the 3-year period. Conclusions: Each year brings a substantial amount of movement among PGY-1s that highlights the need for policies and procedures specific to the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Internato e Residência , Pandemias , Pneumonia Viral , Área de Atuação Profissional , Betacoronavirus , Infecções por Coronavirus/virologia , Educação Médica , Educação de Graduação em Medicina , Médicos Graduados Estrangeiros , Humanos , Pneumonia Viral/virologia , Estados Unidos , Local de Trabalho
3.
Semin Arthritis Rheum ; 50(5): 1049-1054, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32911282

RESUMO

OBJECTIVE: To investigate the perceptions and behaviors of rheumatologists in the United States (US) regarding the risk of COVID-19 for their autoimmune patients and the subsequent management of immunosuppressive and anti-inflammatory medications. METHODS: We administered an online survey to a convenience sample of rheumatologists in the US from 4/8/20-5/4/20 via social media and group emails. Survey respondents provided demographic information such as, age, gender, state of practice, and practice type. We asked questions about COVID-19 risk in rheumatic patients, as well as their medication management during the pandemic. We conducted descriptive analysis and Multivariable regression models. RESULTS: 271 respondents completed the survey nationally. 48% of respondents either agreed or strongly agreed with the statement "Patients with rheumatic diseases are at a higher risk of COVID-19 irrespective of their immunosuppressive medications". 50% disagreed or strongly disagreed with the statement "The pandemic has led you to reduce the use/dosage/frequency of biologics", while 56% agreed or strongly agreed with the statement "The pandemic has led you to reduce the use/dosage/frequency of steroids". A third of respondents indicated that at least 10% of their patients had self-discontinued or reduced at least one immunosuppressive medication to mitigate their risk of COVID-19. Responses to these questions as well as to questions regarding NSAID prescription patterns were significantly different in the Northeast region of US compared to other regions. CONCLUSION: In this national sample of rheumatologists, there are variations regarding perceptions of patients' risk of COVID-19, and how to manage medications such as NSAIDs, biologics and steroids during the pandemic. These variations are more pronounced in geographical areas where COVID-19 disease burden was high.


Assuntos
Infecções por Coronavirus , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Pandemias , Pneumonia Viral , Doenças Reumáticas , Reumatologistas/estatística & dados numéricos , Risco Ajustado/métodos , Adulto , Atitude do Pessoal de Saúde , Betacoronavirus , Produtos Biológicos/uso terapêutico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/tendências , Feminino , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Área de Atuação Profissional/estatística & dados numéricos , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/terapia , Medição de Risco , Percepção Social , Estados Unidos/epidemiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-32605246

RESUMO

Strategies are urgently needed to foster rural general practitioners (GPs) with the skills and professional support required to adequately address healthcare needs in smaller, often isolated communities. Australia has uniquely developed two national-scale faculties that target rural practice: the Fellowship in Advanced Rural General Practice (FARGP) and the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM). This study evaluates the benefit of rural faculties for supporting GPs practicing rurally and at a broader scope. Data came from an annual national survey of Australian doctors from 2008 and 2017, providing a cross-sectional design. Work location (rurality) and scope of practice were compared between FACRRM and FARGP members, as well as standard non-members. FACRRMs mostly worked rurally (75-84%, odds ratio (OR) 8.7, 5.8-13.1), including in smaller rural communities (<15,000 population) (41-54%, OR 3.5, 2.3-5.3). FARGPs also mostly worked in rural communities (56-67%, OR 4.2, 2.2-7.8), but fewer in smaller communities (25-41%, OR 1.1, 0.5-2.5). Both FACRRMs and FARGPs were more likely to use advanced skills, especially procedural skills. GPs with fellowship of a rural faculty were associated with significantly improved geographic distribution and expanded scope, compared with standard GPs. Given their strong outcomes, expanding rural faculties is likely to be a critical strategy to building and sustaining a general practice workforce that meets the needs of rural communities.


Assuntos
Clínicos Gerais , Serviços de Saúde Rural , Austrália , Estudos Transversais , Docentes , Humanos , Área de Atuação Profissional
5.
BMC Health Serv Res ; 20(1): 476, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460778

RESUMO

BACKGROUND: Day care is an important service for many people with dementia and their carers. In Ireland, day care services for people with dementia are delivered by a mix of dementia-specific day care centres as well as generic day care centres that cater for people with dementia to various degrees. In this paper we examine the geographic distribution of day care services for people with dementia relative to potential need. METHODS: Using a national survey of day care centres, we estimate the current availability of day care services for people with dementia in the country. We use geographic information systems (GIS) to map day care provision at regional and sub-regional levels and compare this to the estimated number of people with dementia in local areas. RESULTS: There is significant variation across the country in the existing capacity of day care centres to cater for people with dementia. The number of places per 100 persons with dementia in the community varies from 14.2 to 21.3 across Community Health Organisation areas. We also show that 18% of people with dementia do not live within 15kms of their nearest day care centre. CONCLUSION: Currently, day care centres, in many parts of the country, have limited capacity to provide a service for people with dementia who live in their catchment area. As the number of people with dementia increases, investment in day care centres should be targeted to areas where need is greatest. Our GIS approach provides valuable evidence that can help inform decisions on future resource allocation and service provision in relation to day care.


Assuntos
Hospital Dia , Demência , Acesso aos Serviços de Saúde , Área de Atuação Profissional , Área Programática de Saúde , Sistemas de Informação Geográfica , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Irlanda , Alocação de Recursos , Inquéritos e Questionários
6.
Pesqui. prát. psicossociais ; 15(1): 1-18, jan.-abr. 2020.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1098427

RESUMO

A existência de pessoas em situação de rua (PSRs) é um fenômeno social relacionado com a organização das cidades, especialmente nos centros urbanos industrializados, e com desigualdades historicamente construídas. Nesse contexto, a Psicologia também tem se mostrado um campo de saber-fazer conectado com os desafios dessa população, ainda que desafiada em sua forma tradicional de exercício profissional. A presente pesquisa objetivou compreender as práticas de psicólogos no trabalho com as PSRs na cidade de Fortaleza-CE. Orientando-se a partir da metodologia qualitativa crítica-compreensiva, a pesquisa evidenciou que, na perspectiva psicossocial, a atuação no contexto de rua dá lugar a processos de produção de saúde e subjetividades, construindo novas linguagens e novos territórios mediante as realidades específicas e as singularidades dos sujeitos. A Psicologia tem sido convocada a instalar-se como instrumento de saber-fazer peripatético e a rearranjar os settings a cada ato criativo de produção de vida, buscando superar a tecnificação do cuidado.


The existence of homeless population is a social phenomenon related to the organization of cities, especially in industrialized urban centers, and historical inequalities. In this context, Psychology has demonstrated to be a field of know-how connected with the challenges of this population, although it has been challenged in its traditional professional practice. The present research aimed to understand the practices of psychologists in the work with homeless population in the city of Fortaleza-CE, Brazil. Based on the critical-understanding qualitative methodology, the research pointed that, in the psychosocial perspective, the professional practice in this context gives place to processes of health production and subjectivities, constructing new languages and new territories through the specific realities and the singularities of individuals. Psychology has claimed to establish itself as an instrument of peripatetic know-how and to rearrange the "psychological settings" to each creative act of life production, seeking to overcome the technification of care.


La existencia de personas en situación de calle (PSRs) es un fenómeno social relacionado con la organización de las ciudades, especialmente en los centros urbanos industrializados, y con desigualdades históricamente construidas. En este contexto, la psicología también se ha mostrado un campo de saber hacer conectado con los desafíos de esa población. La presente investigación objetivó comprender las prácticas de psicólogos en el trabajo con las PSRs en la ciudad de Fortaleza-CE. Orientándose de la metodología cualitativa crítico-comprensiva, la investigación evidenció que, en la perspectiva psicosocial, la actuación en el contexto de calle da lugar a procesos de producción de salud y subjetividades, construyendo nuevos lenguajes y nuevos territorios mediante las realidades específicas y las singularidades de los sujetos. La psicología ha sido convocada a instalarse como instrumento de saber hacer peripatético ya reajustar los ajustes a cada acto creativo de producción de vida, buscando superar la tecnificación del cuidado.


Assuntos
Prática Profissional , Pessoas em Situação de Rua , Área de Atuação Profissional , Psicologia , Apoio Social , Fatores Socioeconômicos , Saúde Mental , Redução do Dano , Capacitação Profissional
7.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32213648

RESUMO

BACKGROUND: Pediatricians are less frequently sued than other physicians. When suits are successful, however, the average payout is higher. Little is known about changes in the risk of litigation over time. We sought to characterize malpractice lawsuit trends for pediatricians over time. METHODS: The Periodic Survey is a national random sample survey of American Academy of Pediatrics members. Seven surveys between 1987 and 2015 asked questions regarding malpractice (n = 5731). Bivariate and multivariable analyses examined trends and factors associated with risk and outcome of malpractice claims and lawsuits. Descriptive analyses examined potential change in indemnity amount over time. RESULTS: In 2015, 21% of pediatricians reported ever having been the subject of any claim or lawsuit, down from a peak of 33% in 1990. Report of successful outcomes in the most-recent suit trended upward between 1987 and 2015, greatest in 2015 at 58%. Median indemnity was unchanged, averaging $128 000 in 2018 dollars. In multivariate analysis, male sex, hospital-based subspecialty (neonatology, pediatric critical care, pediatric emergency medicine, and hospital medicine), longer career, and more work hours were associated with a greater risk of malpractice claim. CONCLUSIONS: From 1987 to 2015, the proportion of pediatricians sued has decreased and median indemnity has remained unchanged. Male pediatricians and hospital-based subspecialists were more likely to have been sued. Greater knowledge of the epidemiology of malpractice claims against pediatricians is valuable because it can impact practice arrangements, advise risk-management decisions, influence quality and safety projects, and provide data to guide advocacy for appropriate tort reform and future research.


Assuntos
Imperícia/tendências , Pediatria/tendências , Adulto , Análise de Variância , Competência Clínica/estatística & dados numéricos , Feminino , Humanos , Masculino , Imperícia/economia , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Pessoa de Meia-Idade , Pediatras/estatística & dados numéricos , Pediatras/tendências , Pediatria/economia , Pediatria/estatística & dados numéricos , Área de Atuação Profissional/estatística & dados numéricos , Risco , Viés de Seleção , Fatores Sexuais , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
8.
Am J Surg ; 220(2): 256-261, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32184008

RESUMO

BACKGROUND: A gender pay gap has been reported across many professions, including medicine. METHODS: Surgeons employed at complex Veterans Affairs Medical Centers (VAMC) nationwide in 2016 were identified. Data on salary, gender, years since medical school graduation, professorship status, h-index, and geographic location were collected. RESULTS: Of 1993 surgeons nationwide, 23% were female. On average, female surgeons had significantly lower salaries compared to male surgeons ($268,429 ± 41,339 versus $287,717 ± 45,379, respectively; p < 0.001). Among each surgical specialty, there were no significant differences in salary on univariate analysis. Women were underrepresented in higher paying specialties and more heavily represented in lower paying specialties. On multivariate analysis, gender (p < 0.001), time since medical school graduation (p < 0.001), surgical specialty (p = 0.031), h-index (p < 0.001), and geographic location (p < 0.001) were significant predictors of salary. CONCLUSION: Female gender significantly predicted lower salary among VAMC surgeons, however within each surgical specialty, there was no significant gender pay gap. SENTENCE SUMMARY: Independent predictors of salary included gender, surgical specialty, experience, h-index, and geographic location. Although female surgeons had lower overall salaries compared to male surgeons in the Veterans Health Administration (VHA), there were no significant gender differences in salary among each surgical specialty. Pay transparency, unique to the VHA, along with the use of rational and objective criteria to establish and adjust salaries, may play a role in reducing the gender pay gap among VHA surgeons.


Assuntos
Médicas/economia , Salários e Benefícios/estatística & dados numéricos , Especialidades Cirúrgicas/economia , Cirurgiões/economia , United States Department of Veterans Affairs , Adulto , Feminino , Humanos , Masculino , Área de Atuação Profissional , Fatores Sexuais , Estados Unidos
9.
Am J Surg ; 219(4): 557-562, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32007235

RESUMO

BACKGROUND: The "white-flight" phenomenon of the mid-20th century contributed to the perpetuation of residential segregation in American society. In light of recent reports of racial segregation in our healthcare system, could a contemporary "white-flight" phenomenon also exist? METHODS: The New York Statewide Planning and Research Cooperative System was used to identify all Manhattan and Bronx residents of New York city who underwent elective cardiothoracic, colorectal, general, and vascular surgeries from 2010 to 2016. Primary outcome was borough of surgical care in relation to patient's home borough. Multivariable analyses were performed. RESULTS: White patients who reside in the Bronx are significantly more likely than racial minorities to travel into Manhattan for elective surgical care, and these differences persist across different insurance types, including Medicare. CONCLUSIONS: Marked race-based differences in choice of location for elective surgical care exist in New York city. If left unchecked, these differences can contribute to furthering racial segregation within our healthcare system.


Assuntos
Comportamento de Escolha , Grupos de Populações Continentais/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Área de Atuação Profissional/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Participação do Paciente , Fatores Raciais , Estados Unidos
10.
Public Health ; 181: 168-170, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32062171

RESUMO

OBJECTIVES: The objective of the study was to clarify the reasons why students who graduated from a Master's programme in international health were joining the programme. Another objective was to document how the Master's degree had influenced the careers of the graduates. STUDY DESIGN: An online survey of students who graduated from a Master's programme in international health, including oral science, between 2010 and 2015. METHOD: The study used an anonymous questionnaire that contained 28 items. Topics included information such as demographics, questions about the reasons for joining the Master's programme and the benefits and influence of the programme on the career of the students. RESULTS: Of the 102 alumni who were invited to participate, 70 responded. The response rate was 69%, and we have no information about the non-responders. The results showed that the main reasons for students enrolling in the programme were to improve their competence and develop their career. Around 63% of the respondents reported that the programme had increased their competencies in the jobs they had, whereas 24% answered that their increased qualifications had enabled them to acquire new positions. Thus successfully completing the programme had a positive influence on the graduates' careers in international health. Most of the graduates, who were working, were typically employed at hospitals and universities. Several graduates had proceeded to gain further qualifications by now being enrolled in a PhD programme. CONCLUSIONS: Among the 70% of responders in this survey, the master's programme had benefitted the alumni and the programme had fulfilled their expectations. The programme had a positive influence on the alumni in areas such as increased competency, development of their careers, new positions and better salaries.


Assuntos
Educação de Pós-Graduação , Educação Profissional em Saúde Pública , Saúde Global/educação , Estudantes/psicologia , Emprego , Objetivos , Humanos , Noruega , Área de Atuação Profissional , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Universidades
11.
BMC Fam Pract ; 21(1): 25, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32024480

RESUMO

BACKGROUND: A well-functioning general practice sector that has a strong research component is recognised as a key foundation of any modern health system. General practitioners (GPs) are more likely to collaborate in research if they are part of an established research network. The primary aims of this study are to describe Ireland's newest general practice-based research network and to analyse the perspectives of the network's members on research engagement. METHOD: A survey was sent to all GPs participating in the network in order to document practice characteristics so that this research network's profile could be compared to other national profiles of Irish general practice. In depth interviews were then conducted and analysed thematically to explore the experiences and views of a selection of these GPs on research engagement. RESULTS: All 134 GPs responded to the survey. Practices have similar characteristics to the national profile in terms of location, size, computerisation, type of premises and out of hours arrangements. Twenty-two GPs were interviewed and the resulting data was categorised into subthemes and four related overarching themes: GPs described catalysts for research in their practices, the need for coherence in how research is understood in this context, systems failures, whereby the current health system design is prohibitive of GP participation and aspirations for a better future. CONCLUSION: This study has demonstrated that the research network under examination is representative of current trends in Irish general practice. It has elucidated a better understanding of factors that need to be addressed in order to encourage more GPs to engage in the research process.


Assuntos
Atitude do Pessoal de Saúde , Pesquisa Biomédica , Clínicos Gerais , Medicina Geral , Prática de Grupo , Humanos , Irlanda , Prática Profissional , Área de Atuação Profissional , Pesquisa Qualitativa , Inquéritos e Questionários
12.
Healthc Q ; 22(4): 48-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32073391

RESUMO

Recruitment and retention of physicians, especially in rural communities, are severe public health policy problems in Canadian hospitals. This characterizes the situation in Nova Scotia. This study explored the Eastern Zone of the Nova Scotia Health Authority to determine ways to overcome the physician shortage. Six participants, all working in physician recruitment in Nova Scotia, were asked semi-structured, in-depth questions about the current recruitment process in their respective zones. The research participants presented many parallel perspectives on problems and solutions. It was determined that the biggest obstacles faced by recruiters are bureaucracy, a lack of clear communication channels, failure to track return on investment, a lack of community integration (including spousal employment supports) and a lack of clearly defined roles and responsibilities within the Eastern Zone. This study is timely given the salience of the subject, especially on the Canadian public agenda.


Assuntos
Seleção de Pessoal/métodos , Médicos/provisão & distribução , Área de Atuação Profissional , Médicos Graduados Estrangeiros , Humanos , Nova Escócia , População Rural
13.
BMC Med Educ ; 20(1): 18, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948434

RESUMO

BACKGROUND: Up to 60% of preventable mortality is attributable to social determinants of health (SDOH), yet training on SDOH competencies is not widely implemented in residency. The objective of this study was to assess internal and family medicine residents' competence at identifying and addressing SDOH. METHODS: Residents' perceived competence at identifying, discussing, and addressing SDOH in outpatient settings was assessed using a single questionnaire administered in March 2017. In this cross-sectional analysis, bivariate associations of resident characteristics with the following outcomes were examined: identifying, discussing, and addressing patients' challenges related to SDOH through referrals. RESULTS: The survey was completed by 129 (84%) residents. Twenty residents (16%) reported an annual income of less than $50,000 during childhood. Overall, 108 residents (84%) reported previous SDOH training. Two-thirds had outpatient practices in Veterans Affairs or safety-net clinics. Thirty-nine (30%) intended to pursue a career in primary care. The following numbers of residents reported high levels of competence for performing these outcomes: identifying patients' challenges related to SDOH: 37 (29%); discussing them with patients: 18 (14%); and addressing these challenges through referrals to internal and external resources: 13 (10%) and 11 (9%), respectively. Factors associated with higher competence included older age, lower childhood household income, prior education about SDOH, primary practice site and intention to practice primary care. CONCLUSIONS: Most residents had previous SDOH training, yet only a small proportion of residents reported being highly competent at identifying or addressing SDOH. Providing opportunities for practical training may be a key component in preparing medical residents to identify and address SDOH effectively in outpatient practice.


Assuntos
Assistência Ambulatorial , Competência Clínica , Medicina de Família e Comunidade/educação , Medicina Interna/educação , Internato e Residência , Determinantes Sociais da Saúde , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Fatores Etários , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Escolha da Profissão , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Medicina de Família e Comunidade/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Renda , Medicina Interna/estatística & dados numéricos , Internato e Residência/economia , Internato e Residência/estatística & dados numéricos , Masculino , Atenção Primária à Saúde/estatística & dados numéricos , Área de Atuação Profissional , Encaminhamento e Consulta/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Serviços de Saúde para Veteranos Militares/estatística & dados numéricos
15.
Acad Med ; 95(3): 442-449, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31517681

RESUMO

PURPOSE: To examine the potential impact of Health Resources and Services Administration (HRSA) funding (predoctoral [PD] and postdoctoral [PDD] programs) on dentists' practice location in the United States. METHOD: The authors linked 2011-2015 data from HRSA's Electronic Handbooks to 2015 data from the American Dental Association Masterfile, dental health professional shortage areas, and rural-urban commuting area codes. They examined the associations between PD and PDD funding and dentists' practice location between 2004 and 2015 using a difference-in-differences analysis and multiple logistic regressions, adjusting for covariates. RESULTS: From 2004 to 2015, 21.2% (1,588/7,506) of dentists graduated from institutions receiving PD funding and 26.8% (2,014/7,506) graduated from institutions receiving PDD funding. Among dentists graduating from institutions receiving PDD funding, after adjusting for covariates, those graduating between 2011 and 2015 were more likely to practice in a rural area than those graduating between 2004 and 2010 (odds ratio [OR] = 1.98; 95% confidence interval [CI] = 1.04-3.76). The difference-in-differences approach showed that PD and PDD funding significantly increased the odds that a dentist would practice in a rural area (respectively, OR = 2.70; 95% CI = 1.31-5.79/OR = 2.84; 95% CI = 1.40-5.77). CONCLUSIONS: HRSA oral health training program funding had a positive effect on dentists choosing to practice in a rural area. By increasing the number of dentists practicing in rural communities, HRSA is improving access to, and the delivery of, oral health care services to underserved and vulnerable rural populations.


Assuntos
Unidade Hospitalar de Odontologia/estatística & dados numéricos , Odontólogos/estatística & dados numéricos , Financiamento Governamental/legislação & jurisprudência , Área de Atuação Profissional/legislação & jurisprudência , Área de Atuação Profissional/estatística & dados numéricos , Recursos Humanos/legislação & jurisprudência , Recursos Humanos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Estudos Retrospectivos , Serviços de Saúde Rural , Estados Unidos
16.
Br J Gen Pract ; 70(690): e64-e70, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31594773

RESUMO

BACKGROUND: There is widespread concern over the recruitment and retention of GPs in England. Income is a fundamental consideration affecting the attractiveness of working in general practice. AIM: To report on trends in average incomes earned by GPs in England, adjusted for inflation and contracted time commitment. DESIGN AND SETTING: Postal surveys of random samples of GPs working in England in 2008, 2010, 2012, 2015, and 2017. METHOD: Trends in average reported incomes of partner and salaried GPs were directly standardised for the reported number of sessions worked per week and adjusted for inflation. RESULTS: Data were obtained from between 1000 and 1300 responders each year, representing response rates between 25% and 44%. Almost all responders (96%) reported the income they earned from their job as a GP. Mean nominal annual income decreased by 1.1% from £99 437 in 2008 to £98 373 in 2017 for partner GPs and increased by 4.4% from £49 061 to £51 208 for salaried GPs. Mean sessions worked decreased from 7.7 to 7.0 per week for partner GPs and decreased from 5.6 to 5.3 per week for salaried GPs. Mean income adjusted for sessions worked and inflation decreased by 10.0% for partner GPs and by 7.0% for salaried GPs, between 2008 and 2017. CONCLUSION: The decrease in GP income adjusted for sessions worked and inflation over the last decade may have contributed to the current problems with recruitment and retention.


Assuntos
Medicina Geral/economia , Clínicos Gerais/economia , Salários e Benefícios/estatística & dados numéricos , Atitude do Pessoal de Saúde , Escolha da Profissão , Inglaterra/epidemiologia , Clínicos Gerais/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Renda , Satisfação no Emprego , Área de Atuação Profissional , Estudos Retrospectivos
17.
J Robot Surg ; 14(1): 95-99, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30830569

RESUMO

A social media group, the International Hernia Collaboration (IHC), facilitates professional development among surgeons interested in hernia disease. The purpose of this study was to assess practice pattern differences among IHC surgeon members regarding a ventral incisional hernia (VIH) scenario. A single multiple-choice question, posted for 1 month on the IHC, assessed which operation was preferred for a healthy patient with a symptomatic, reducible primary VIH (5 × 6 cm). Responses were compared by surgeon practice location (US vs. World). In total, 371 IHC surgeons completed the survey. More respondents practicing in the US completed the survey (57.1% vs. 42.9%, P < 0.01). Respondents in the US cohort would select a robotic-assisted approach more frequently than World colleagues (47.6% vs. 8.8%, P < 0.01). More IHC surgeons in the US cohort would offer a robotic-assisted approach for primary VIH repair compared to World colleagues. Studies are warranted to investigate practice pattern differences related to VIH repair.


Assuntos
Hérnia Incisional/cirurgia , Procedimentos Cirúrgicos Robóticos , Humanos , Cooperação Internacional , Padrões de Prática Médica , Área de Atuação Profissional , Procedimentos Cirúrgicos Robóticos/métodos , Inquéritos e Questionários
18.
Cancer ; 126(5): 1068-1076, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31702829

RESUMO

BACKGROUND: Persistent rural-urban disparities for colorectal and cervical cancers raise concerns regarding access to treatment providers. To the authors knowledge, little is known regarding rural-urban differences in residential proximity to cancer specialists. METHODS: Using the 2018 Physician Compare data concerning physician practice locations and the 2012 to 2016 American Community Survey, the current study estimated the driving distance from each residential zip code tabulation area (ZCTA) centroid to the nearest cancer provider of the following medical specialties involved in treating patients with colorectal and cervical cancer: medical oncology, radiation oncology, surgical oncology, general surgery, gynecological oncology, and colorectal surgery. Using population-weighted multivariable logistic regression, the authors analyzed the associations between ZCTA-level characteristics and driving distances >60 miles to each type of specialist. ZCTA-level residential rurality was defined using rural-urban commuting area codes. RESULTS: Nearly 1 in 5 rural Americans lives >60 miles from a medical oncologist. Rural-urban differences in travel distances to the nearest cancer care provider(s) increased substantially for cancer surgeons; greater than one-half of rural residents were required to travel 60 miles to reach a gynecological oncologist, compared with 8 miles for their urban counterparts. Individuals residing within ZCTAs with a higher poverty rate, those of American Indian/Alaska Native ethnicity, and/or were located in the South and West regions were more likely than their counterparts to be >60 miles away from any of the aforementioned providers. CONCLUSIONS: The substantial travel distances required for rural, low-income residents to reach a cancer specialist should prompt a policy action to increase access to specialized cancer care for millions of rural residents.


Assuntos
Neoplasias Colorretais/terapia , Pessoal de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Especialização/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Neoplasias do Colo do Útero/terapia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Geografia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Área de Atuação Profissional/estatística & dados numéricos , Prognóstico , Viagem/estatística & dados numéricos , Estados Unidos , Adulto Jovem
19.
Phys Ther ; 100(4): 591-599, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-31800062

RESUMO

BACKGROUND: The growing student debt of physical therapists entering the workforce, coupled with the growth in projected need, raises concerns about where and how entry-level physical therapists will practice and if these choices will be affected by their debt burden. OBJECTIVE: The purpose of this study was to identify the debt profile of entry-level physical therapists and explore relationships between student debt and clinical practice setting choices. METHODS: This study utilized a cross-sectional survey design to identify debt profiles and explore relationships between student debt and the clinical practice choices of entry-level physical therapists. RESULTS: The mean debt-to-income ratio based on the total reported educational debt was 197% (93%). The most frequently reported debt range for doctor of physical therapy (DPT) debt and total educational debt was $100,000 to $124,999. Despite the setting itself being rated as the most important factor (83%), 28% of participants reported debt as a barrier to their desired practice setting. In addition, when considering job choice overall, 57% of the participants reported that their student debt has had an effect on their decision. LIMITATIONS: This study is limited by its small sample size, originating from 1 state, and being taken by convenience from a special interest group. Data were collected via an anonymous survey, which increases the risk of selection bias. In addition, there are further personal, family, and institutional characteristics that were not collected in this study, which may influence the interaction between student debt and clinical practice choices. CONCLUSION: The results of this study suggest that practice setting choice may be affected by physical therapist student debt, and student debt may be a barrier overall to practice and career choices in physical therapy.


Assuntos
Renda , Fisioterapeutas/economia , Área de Atuação Profissional/economia , Apoio ao Desenvolvimento de Recursos Humanos/economia , Adulto , Escolha da Profissão , Estudos Transversais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho da Amostra , Inquéritos e Questionários , Adulto Jovem
20.
Community Dent Oral Epidemiol ; 48(2): 152-162, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31851397

RESUMO

OBJECTIVES: To investigate the association between dentists' geographic density and perceptions of market competition with clinical decision-making among a representative sample of dentists in Ontario, Canada's most populated province. METHODS: Competition was quantified using dentist density, defined as the number of dental clinics lying within a one kilometre radius around the respondents' clinic address and by self-reported perceived pressure from other dental clinics. The outcome (clinical decision-making or treatment intensity) was measured using a set of clinical scenarios, which categorized dentists as either relatively aggressive or conservative. Associations were assessed using bivariate analysis and logistic and linear regression. RESULTS: Dentists who perceived large competitive pressure from other dentists (OR = 1.63, 95% CI: 1.07-2.49) were relatively more aggressive in their treatment choices. Interestingly, dentists located in very low dentist density areas (OR = 1.31, 95% CI: 1.03-1.68) were also relatively more aggressive in their treatment choices. CONCLUSION: This study is the first to explore the impact of competition on the clinical decision-making of dentists in a Canadian context. It presents a valuable addition to the competition literature and helps to understand current dynamics in the Canadian dental care market.


Assuntos
Tomada de Decisão Clínica , Odontólogos/psicologia , Padrões de Prática Odontológica , Área de Atuação Profissional , Ansiedade , Atitude do Pessoal de Saúde , Canadá , Humanos , Inquéritos e Questionários
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