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2.
Community Dent Health ; 37(1): 3-4, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32112675

RESUMO

On Friday, 20 December 2019, after three and a half years of discussion the Parliament of the United Kingdom (UK) voted decisively that this country should leave the European Union (EU). For many of us this was a sad day. However, this political decision has been made and intensive negotiations will now take place between the UK and the EU's negotiating teams to agree the details for the UK's future relationship with the EU. It is still far from clear exactly what the consequences of the resulting deal will be for both parties. A number of previous articles and editorials have speculated on the possible consequences for health and oral health in the UK. Key areas include workforce, research and regulations for medicines and medical and dental equipment. This editorial will consider the implications for the UK's Oral healthcare workforce.


Assuntos
Mão de Obra em Saúde , Saúde Bucal , União Europeia , Humanos , Reino Unido , Recursos Humanos
3.
Lancet ; 395(10228): 940, 2020 03 21.
Artigo em Inglês | MEDLINE | ID: mdl-32199482
5.
Nurse Pract ; 45(2): 38-47, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31977621

RESUMO

Workforce and reimbursement data were collected from a 2018 survey of Washington state advanced registered nurse practitioners (ARNPs). Survey results will be used to improve workforce planning and advocate for payment parity legislation requiring health plans to pay ARNPs the same as physicians for the same service.


Assuntos
Prática Avançada de Enfermagem/economia , Seguro Saúde/economia , Médicos/economia , Mecanismo de Reembolso/legislação & jurisprudência , Estudos Transversais , Mão de Obra em Saúde/organização & administração , Humanos , Mecanismo de Reembolso/estatística & dados numéricos , Inquéritos e Questionários , Washington
7.
World Neurosurg ; 133: 8-9, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31610426

RESUMO

BACKGROUND: Nepal has a critical shortage of health workers for achieving its projected sustainable development goals pertaining to its health sector. METHODS: To counteract this crisis and reduce the morbidity and mortality associated with untreated brain injuries secondary to inadequate access, it is pivotal to generate solutions through the establishment of improved educational and training objectives. Objectives must align themselves with achieving equitable access to neurologic health. To that end, the cadre of health professionals able to treat neurologic disease should be sharply skilled and increased in number. We outline potential sustainable solutions at the training level to address this public health problem. RESULTS: Demanding and limitless working hours, burnout, social stressors, and minimal monthly stipend likely contribute to limited applications for neurosurgery residency programs. Measures should be taken to improve participation and access to extracurricular nonwork activities so as to improve resident well-being and avoid burnout. Moreover, gender inequality has also become a matter of concern as there were no females among 31 new specialist registrations in neurosurgery in 2017 and only 5 female neurosurgeons in practice to date in Nepal as per the NMC registration. CONCLUSIONS: Every effort should be directed toward honing the "value of neurosurgeon" among residents and promoting and nurturing their capabilities thereby maximizing sustainability in our health care system.


Assuntos
Mão de Obra em Saúde/estatística & dados numéricos , Internato e Residência , Neurocirurgiões/provisão & distribução , Neurocirurgia/educação , Humanos , Nepal
8.
J Surg Res ; 246: 93-99, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31562991

RESUMO

BACKGROUND: Ninety-four percent of congenital anomalies occur in low- and middle-income countries. In Uganda, only three pediatric surgeons and three pediatric anesthesiologists serve more than 20 million children. This study estimates burden, outcomes, coverage, and economic benefit of neonatal surgical conditions in Uganda. METHODS: A prospectively collected database was reviewed for neonatal surgical admissions from January 1, 2012, to December 31, 2017, at the only two sites with specialist pediatric surgical coverage. Outcomes were compared with high-income countries. Met and unmet need were estimated using disability-adjusted life years. Economic benefit was estimated using a value of statistical life-year approach. RESULTS: For 1313 neonatal admissions, the median age of presentation was 3 d, overall mortality was 36%, and median distance traveled was 40 km. Anorectal malformations were most common (18%). Postoperative mortality was 24%. Mortality was significantly associated with surgical intervention (P < 0.0001). Met need was 4181 disability-adjusted life years per year, which corresponds to a $3.5 million net economic benefit to Uganda, with a potential additional benefit of $153 million if unmet need were fully addressed. Approximately 2% of the total need is met by the health care system. CONCLUSIONS: Neonatal surgery is associated with improved survival for most conditions. Despite increases in workforce and infrastructure, a limited proportion of the need for neonatal surgery is currently being met. This is multifactorial, including lack of access to surgical care and severe shortages of workforce and infrastructure. Current and potential economic benefit to Uganda appears substantial.


Assuntos
Efeitos Psicossociais da Doença , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Doenças do Recém-Nascido/cirurgia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Pediátricos/economia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/economia , Doenças do Recém-Nascido/epidemiologia , Masculino , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Procedimentos Cirúrgicos Operatórios/economia , Taxa de Sobrevida , Uganda/epidemiologia
9.
Sports Health ; 12(1): 94-98, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31665613

RESUMO

BACKGROUND: Mixed results exist regarding the benefit of orthobiologic injections. The purpose of this study was to assess the variability in costs for platelet-rich plasma (PRP) and stem cell (SC) injections and evaluate for variables that influence pricing. HYPOTHESIS: There will be significant variability in the cost of PRP and SC injections throughout the United States. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. METHODS: Calls were made to 1345 orthopaedic sports medicine practices across the United States inquiring into the availability of PRP or SC knee injections and associated costs. In addition to pricing, the practice type, number of providers, and population and income demographics were recorded. Univariate statistical analyses were used to identify differences in availability and cost between variables. RESULTS: Of the contacted offices that provided information on both PRP and SC availability (n = 1325), 268 (20.2%) offered both treatments, 550 (41.5%) offered only PRP injections, 20 (1.5%) offered only SC injections, and 487 (36.8%) did not offer either treatment. The mean ± SD cost of a PRP injection was $707 ± $388 (range, $175-$4973), and the mean cost of an SC injection was $2728 ± $1584 (range, $300-$12,000). Practices offering PRP and SC injections tended to be larger (PRP, 12.0 physicians per practice vs. 8.1 [P < 0.001]; SC, 13.6 vs 9.7 [P < 0.001]). Practices that offered PRP injections were located in areas with higher median household income (P = 0.047). Variables associated with higher cost of PRP injections included city population (P < 0.001) and median income of residents (P < 0.001). CONCLUSION: While the majority of sports medicine practices across the United States offer some type of orthobiologic injection, there exists significant variability in the cost of these injections. CLINICAL RELEVANCE: This study demonstrates the significant variability in costs of orthobiologic injections throughout the country, which will allow sports medicine physicians to appreciate the value of these injections when counseling patients on available treatment options.


Assuntos
Custos de Cuidados de Saúde , Traumatismos do Joelho/economia , Traumatismos do Joelho/terapia , Plasma Rico em Plaquetas , Células-Tronco , Mão de Obra em Saúde , Humanos , Renda , Injeções Intra-Articulares , Traumatismos do Joelho/epidemiologia , Cirurgiões Ortopédicos/estatística & dados numéricos , Estados Unidos/epidemiologia
11.
J Surg Res ; 245: 587-592, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31499364

RESUMO

BACKGROUND: Surgical disease increasingly contributes to global mortality and morbidity. The Lancet Commission on Global Surgery found that global cost-effectiveness data are lacking for a wide range of essential surgical procedures. This study helps to address this gap by defining the cost-effectiveness of exploratory laparotomies in a regional referral hospital in Uganda. MATERIALS AND METHODS: A time-and-motion analysis was utilized to calculate operating theater personnel costs per case. Ward personnel, administrative, medication, and supply costs were recorded and calculated using a microcosting approach. The cost in 2018 US Dollars (USD, $) per disability-adjusted life year (DALY) averted was calculated based on age-specific life expectancies for otherwise fatal cases. RESULTS: Data for 103 surgical patients requiring exploratory laparotomy at the Soroti Regional Referral Hospital were collected over 8 mo. The most common cause for laparotomy was small bowel obstruction (32% of total cases). The average cost per patient was $75.50. The postoperative mortality was 11.7%, and 7.8% of patients had complications. The average number of DALYs averted per patient was 18.51. The cost in USD per DALY averted was $4.08. CONCLUSIONS: This investigation provides evidence that exploratory laparotomy is cost-effective compared with other public health interventions. Relative cost-effectiveness includes a comparison with bed nets for malaria prevention ($6.48-22.04/DALY averted), tuberculosis, tetanus, measles, and polio vaccines ($12.96-25.93/DALY averted), and HIV treatment with multidrug antiretroviral therapy ($453.74-648.20/DALY averted). Given that the total burden of surgically treatable conditions in DALYs is more than that of malaria, tuberculosis, and HIV combined, our findings strengthen the argument for greater investment in primary surgical capacity in low- and middle-income countries.


Assuntos
Análise Custo-Benefício , Países em Desenvolvimento/economia , Laparotomia/economia , Centros de Atenção Terciária/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Países em Desenvolvimento/estatística & dados numéricos , Equipamentos e Provisões Hospitalares/economia , Feminino , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Laparotomia/estatística & dados numéricos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Regionalização/economia , Centros de Atenção Terciária/estatística & dados numéricos , Uganda , Adulto Jovem
13.
Z Psychosom Med Psychother ; 65(4): 341-352, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801441

RESUMO

Objectives: Description of the qualifications of psychotherapy-training candidates in Austria at the beginning of their training. Methods: Psychotherapists in training in Austria were interviewed at the beginning of their training concerning their socio-demographic background and prior education. These background data were collected using the Trainee Background Information Form (TBIF), which was designed by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (SPRISTAD). Results: The group of 197 psychotherapy trainees from Austria consists largely of women, of persons with high school education and with a satisfactory, financially secure life situation. One-third of them show a "second career" pattern, which is in line with the predominantly part-time training programs in Austria. A high percentage of the candidates have previous professional experience in the psychosocial field. Conclusions: As this is a pilot study, results can be seen as a starting point for further research in psychotherapy training and competence development. In discussing the findings, both national conditions and opportunities for future interdisciplinary research are considered.


Assuntos
Mão de Obra em Saúde/estatística & dados numéricos , Psicoterapia/educação , Psicoterapia/estatística & dados numéricos , Áustria , Demografia , Feminino , Humanos , Masculino , Projetos Piloto
15.
BMC Health Serv Res ; 19(1): 998, 2019 Dec 26.
Artigo em Inglês | MEDLINE | ID: mdl-31878913

RESUMO

BACKGROUND: Deficits in the rural medical workforce is an international issue. In Australia, The Rural Clinical School intervention is effective for initial recruitment of rural doctors. However, the extent of survival is not yet established. This paper summarises rural survival over a 10-year period. METHODS: Rural Clinical School graduates of Western Australia were surveyed annually, 2006-2015, and post Graduate Years (PGY) 3-12 included. Survival was described as "tours of service", where a tour was either a period of ≥1 year, or a period of ≥2 weeks, working rurally. A tour ended with a rural work gap of ≥52 weeks. Considering each exit from urban as an event, semi-parametric repeated measures survival models were fitted. RESULTS: Of 468 graduates, using the ≥2 weeks definition, 239 PGY3-12 graduates spent at least one tour rurally (average 61.1, CI 52.5-69.7 weeks), and a total length of 14,607 weeks. Based on the tour definition of ≥1 year, 120 graduates completed at least one tour (average 1.89, 1.69-2.10 years), and a total of 227 years' rural work. For both definitions, the number of tours increased from one to four by PGY10/11, giving 17,786 total weeks (342 years) across all PGYs for the ≥2 weeks tour definition, and 256 years total for ≥1 year. Significantly more graduates exited from urban work for the 2007-09 middle cohort compared with 2010-11 (HR 1.876, p = 0.022), but no significant difference between 2002 and 06 and 2010-11. Rural origin, age and gender were not statistically significant. CONCLUSIONS: PGY3-12 RCS graduates contributed substantially to the rural workforce: 51% did so by short rotations, while 26% contributed whole years of service. There was an apparent peak in entry and survival for the middle cohort and decline thereafter, likely attributable to lack of advanced/specialist vocational training. These data indicate a real commitment to rural practice by RCS graduates, and the need for rural vocational training as a key element of a successful rural survival strategy.


Assuntos
Mão de Obra em Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/estatística & dados numéricos , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Inquéritos e Questionários , Austrália Ocidental , Adulto Jovem
18.
Neurology ; 93(23): 1002-1008, 2019 12 03.
Artigo em Inglês | MEDLINE | ID: mdl-31690682

RESUMO

Neurology faces an increasing shortage of neurologists in the United States due to a growing demand for neurologic services. A 7% increase in the supply of neurologists is predicted from 2012 to 2025, whereas the demand will rise by 16%. An increase in the neurology workforce is critical to meet the demands, and a significant gender gap remains within the workforce that must be addressed to further ease the discrepancy between supply and demand. Individual, institutional, and societal factors contribute to this gender discrepancy and potentially result in the burnout or soft attrition of women from neurology. These factors, including earning disparity between male and female neurologists, one of the largest gaps in pay for any medical specialty, and the lack of representation at higher academic levels with only 12% (14 of 113) of neurology department chairs at academic medical centers being women, could lead to increased attrition of women from neurology. Identifying and mitigating these factors may help narrow the gender gap and increase the supply of neurologists to better meet future demand.


Assuntos
Esgotamento Profissional , Mão de Obra em Saúde , Neurologistas/provisão & distribução , Neurologia , Distribuição por Sexo , Feminino , Mão de Obra em Saúde/estatística & dados numéricos , Mão de Obra em Saúde/tendências , Humanos , Masculino , Neurologistas/psicologia
19.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31740501

RESUMO

This technical report reviews education, training, competency requirements, and scopes of practice of the different neonatal care providers who work to meet the special needs of neonatal patients and their families in the NICU. Additionally, this report examines the current workforce issues of NICU providers, offers suggestions for establishing and monitoring quality and safety of care, and suggests potential solutions to the NICU provider workforce shortages now and in the future.


Assuntos
Competência Clínica/normas , Pessoal de Saúde/normas , Mão de Obra em Saúde/normas , Unidades de Terapia Intensiva Neonatal/normas , Equipe de Assistência ao Paciente/normas , Feminino , Pessoal de Saúde/educação , Humanos , Recém-Nascido , Doenças do Recém-Nascido/terapia , Masculino
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