Quantification of Oversupply of Chronic Disease Medications among Patients Aged ≥55 Years in Japan.

Medication waste may be caused by medication oversupply; however, the degree of medication oversupply in Japan is unclear. This study aimed to quantify the degree of oversupply of chronic disease medications per patient, the proportion of oversupplied patients, and the excess days and costs of the oversupplied medications in Japan. This retrospective nationwide cohort study using a large insurance claims database from Japan was conducted in patients aged ≥55 years who received one or a combination of the following five classes of medications dispensed in FY 2019: third-generation calcium antagonists, angiotensin 2 receptor blockers, statins, dipeptidyl peptidase-4 inhibitors, and biguanides. Medications with the same ingredient having the same specification were treated as the same medication. Medication oversupply was defined as a medication possession ratio (MPR) during persistence >1.0. The proportions of oversupplied patients and excessively oversupplied patients with ≥30 excess days/year were approximately 16 and 1-2% for all drug classes, respectively. Three-quarters of the oversupplied patients had fewer excess day (≤14/year), and the median oversupplied medication cost was less than 1000 yen/year for all classes. However, there was a patient with oversupplied medication estimated as 983 excess days per year and a patient with oversupplied medication costs of nearly 90000 yen per year. Using the MPR and excess days as indicators, it is necessary to accelerate estimation of the oversupply per patient, as well as the development of patient intervention strategies and a national system to reduce medication oversupply.

Age at school entry and reported symptoms of attention-deficit/hyperactivity in first graders: results of the prospective cohort study ikidS.

Young age at school entry (ASE) is related to attention-deficit/hyperactivity disorder in higher grades. The reason for this association is unclear, but medical oversupply and stress-related factors are discussed. We aimed to investigate whether ASE is associated with reported symptoms of attention-deficit/hyperactivity (ADH) already in first grade. Data of a population-based prospective cohort study (N = 2003; Mainz-Bingen region; Rhineland-Palatinate; Germany) with baseline assessments prior to school entry and two follow-ups during first grade were analysed. ADH symptoms were assessed by parent and teacher versions of the Strengths and Difficulties Questionnaire. Associations between ASE and scores of the hyperactivity/inattention subscale (range 0-10) were investigated by regression analysis and adjusted for potential confounders and baseline symptoms prior to school entry. In total, 1633 children (52% boys, mean ASE 6.5 years) were included. There were no relationships between ASE and parent-reported scores of the hyperactivity/inattention subscale prior to school entry and 3 months thereafter. However, at the end of first grade, ASE was negatively associated with the hyperactivity/inattention subscale in parent (- 0.7 subscale points per year ASE, standard error = 0.16, p < 0.0001) and teacher reports (- 1.2 subscale points per year ASE, standard error = 0.25, p < 0.0001). This ASE effect appeared more pronounced in girls than in boys. Young ASE is related to more reported symptoms of ADH at the end of first grade, but not before. The evolvement of this effect during first grade may be a clue to ASE-related stress factors.

Quantifying spatial accessibility of general practitioners by applying a modified huff three-step floating catchment area (MH3SFCA) method.

BACKGROUND: It is necessary to ensure sufficient healthcare. The use of current, precise and realistic methods to model spatial accessibility to healthcare and thus improved decision-making is helping this process. Generally, these methods-which include the family of floating catchment area (FCA) methods-incorporate a number of criteria that address topics like access, efficiency, budget, equity and the overall system utilization. How can we measure spatial accessibility? This paper investigates a sophisticated approach for quantifying the spatial accessibility of general practitioners. (GPs). Our objective is the investigation and application of a spatial accessibility index by an improved Huff three-step floating catchment area (MH3SFCA) method. METHODS: We modify and implement the huff model three-step floating catchment area (MH3SFCA) method and exemplary calculation of the spatial accessibility indices for the test study area. The method is extended to incorporate a more realistic way to model the distance decay effect. To that end, instead of a binary approach, a continuous approach is employed. Therefore, each distance between a healthcare site and the population is incorporated individually. The study area includes Swabia and the city of Augsburg, Germany. The data for analysis is obtained from following data sources: (1) Acxiom Deutschland GmbH (2020) provided a test dataset for the locations of general practitioners (GPs); (2) OpenStreetMap (OSM) data is utilized for road networks; and (3) the Statistische Ämter des Bundes und der Länder (German official census 2011) provided a population distribution dataset stemming from the 2011 Census. RESULTS: The spatial accessibility indices are distributed in an inhomogeneous as well as polycentric pattern for the general practitioners (GPs). Differences in spatial accessibility are found mainly between urban and rural areas. The transitions from lower to higher values of accessibility or vice versa in general are smooth rather than abrupt. The results indicate that the MH3SFCA method is suited for comparing the spatial accessibility of GPs in different regions. The results of the MH3SFCA method can be used to indicate over- and undersupplied areas. However, the absolute values of the indices do not inherently define accessibility to be too low or too high. Instead, the indices compare the spatial relationships between each supply and demand location. As a result, the higher the value of the accessibility indices, the higher the opportunities for the respective population locations. The result for the study area are exemplary as the test input data has a high uncertainty. Depending on the objective, it might be necessary to further analyze the results of the method. CONCLUSIONS: The application of the MH3SFCA method on small-scale data can provide an overview of accessibility for the whole study area. As many factors have to be taken into account, the outcomes are too complex for a direct and clear interpretation of why indices are low or high. The MH3SFCA method can be used to detect differences in accessibility on a small scale. In order to effectively detect over- or undersupply, further analysis must be conducted and/or different (legal) constraints must be applied. The methodology requires input data of high quality.

Does an 'oversupply' of ovules cause pollen limitation?

Lifetime seed production can be constrained by shortfalls of pollen receipt ('pollen limitation'). The ovule oversupply hypothesis states that, in response to unpredictable pollen availability, plants evolve to produce more ovules than they expect to be fertilized, and that this results in pollen limitation of seed production. Here, we present a cartoon model and a model of optimal plant reproductive allocations under stochastic pollen receipt to evaluate the hypothesis that an oversupply of ovules leads to increased pollen limitation. We show that an oversupply of ovules has two opposing influences on pollen limitation of whole-plant seed production. First, ovule oversupply increases the likelihood that pollen receipt limits the number of ovules that can be fertilized ('prezygotic pollen limitation'). Second, ovule oversupply increases the proportion of pollen grains received that are used to fertilize ovules ('pollen use efficiency'). As a result of these opposing influences, ovule oversupply has only a modest effect on the degree to which lifetime seed production is constrained by pollen receipt, producing a small decrease in the incidence of pollen limitation. Ovule oversupply is not the cause of the pollen limitation problem, but rather is part of the evolutionary solution to that problem.

Refill adherence and self-reported adverse drug reactions and sub-therapeutic effects: a population-based study.

PURPOSE: To assess refill adherence to dispensed oral long-term medications among the adult population and to investigate whether the percentages of self-reported adverse drug reactions (ADRs) and sub-therapeutic effects (STEs) differed for medications with adequate refill adherence, oversupply, and undersupply. METHOD: Survey responses on self-reported ADRs and STEs were linked to the Swedish Prescribed Drug Register in a cross-sectional population-based study. Refill adherence to antihypertensive, lipid-lowering, and oral anti-diabetic medications was measured using the continuous measure of medication acquisition (CMA). The percentages of self-reported ADRs and STEs were compared between medications with adequate refill adherence (CMA 0.8-1.2), oversupply (CMA > 1.2), and undersupply (CMA < 0.8). RESULTS: The study included 1827 persons, and the refill adherence was measured for 3014 antihypertensive, 839 lipid lowering, and 253 oral anti-diabetic medications. Overall, 65.7% of the medications had adequate refill adherence, 21.9% oversupply, and 12.4% undersupply. The percentages of self-reported ADRs and STEs were respectively 2.6%, 2.7%, and 2.1% (p > 0.5) for ADRs and 1.1%, 1.6%, and 1.5% (p > 0.5) for STEs. CONCLUSIONS: Adequate refill adherence was found in two thirds of the medication therapies. ADRs and STEs were unexpectedly equally commonly reported for medications with adequate refill adherence, oversupply, and undersupply. These results suggest that a better understanding of patients' refill behaviors and their perceived medication adverse outcomes is needed and should be considered in improving medication management. The impact of individual and healthcare factors that may influence the association between refill adherence and reported medication adverse outcomes should be investigated in future studies.

Downregulation of mTORC1 and Mcl-1 by lipid-oversupply contributes to islet ß-cell apoptosis and dysfunction.

Pancreatic ß-cell apoptosis is a key feature of diabetes and can be induced by chronic exposure to saturated fatty acids (FAs). However, the underlying mechanisms remain poorly understood. We presently evaluated the role of Mcl-1 and mTOR in mice fed with high-fat-diet (HFD) and ß-cells exposed to the overloaded palmitic acid (PA). Compared with normal-chow-diet (NCD)-fed mice, HFD group showed impaired glucose tolerance after two months. Along with the diabetes progression, pancreatic islets first became hypertrophic and then atrophic, the ratio of ß-cell:α-cell increased in the islets of four months HFD-fed mice while decreased after six months. This process was accompanied by significantly increased ß-cell apoptosis and AMPK activity, and decreased Mcl-1 expression and mTOR activity. Consistently, glucose-induced insulin secretion dropped. In terms of mechanism, PA with lipotoxic dose could activate AMPK, which in turn inhibited ERK-stimulated Mcl-1Thr163 phosphorylation. Meanwhile, AMPK blocked Akt activity to release Akt inhibition on GSK3ß, followed by GSK3ß-initiated Mcl-1Ser159 phosphorylation. The context of Mcl-1 phosphorylation finally led to its degradation by ubiquitination. Also, AMPK inhibited the activity of mTORC1, resulting in a lower level of Mcl-1. Suppression of mTORC1 activity and Mcl-1 expression positively related to ß-cell failure. Alteration of Mcl-1 or mTOR expression rendered different tolerance of ß-cell to different dose of PA. In conclusion, lipid oversupply-induced dual modulation of mTORC1 and Mcl-1 finally led to ß-cell apoptosis and impaired insulin secretion. The study may help further understand the pathogenesis of ß-cell dysfunction in case of dyslipidemia, and provide promising therapeutic targets for diabetes.

Addressing Surgical Instrument Oversupply: A Focused Literature Review and Case-Study in Orthopedic Hand Surgery.

BACKGROUND: Instrument oversupply drives cost in the operating room (OR). We review previously reported methodologies for surgical instrument reduction and report a pilot methodology for optimizing instrument supply via ethnographic instrument tracking of thumb carpometacarpal (CMC) arthroplasties. Additionally, we report a cost analysis of instrument oversupply and potential savings of tray optimization methods. METHODS: Instrument utilization was tracked over 8 CMC arthroplasties conducted by 2 surgeons at an ambulatory surgery center of a large academic hospital. An optimized supply methodology was designed. A cost analysis was conducted using health-system-specific data and previously published research. RESULTS: After tracking instrument use in 8 CMC arthroplasties, a cumulative total of 59 out of the 120 instruments in the Hand & Foot (H&F) tray were used in at least 1 case. Two instruments were used in all cases, and another 20 instruments were used in at least 50% of the cases. Using a reduced tray with 59 instruments, potential cost savings for tray reduction in 60 cases were estimated to be $2086 without peel-packing and $2356 with peel-packing. The estimated cost savings were lower than those reported in literature due to a reduced scope and exclusion of OR time cost in the analysis. CONCLUSIONS: Instrument oversupply drives cost at our institution's ambulatory surgery center. Ethnography is a cost-effective method to track instrument utilization and determine optimal tray composition for small services but is not scalable to large health systems. The time and cost required to observe sufficient surgeries to enable supply reduction to motivate the need for more efficient methods to determine instrument utility.

Distributions of dentists and physicians in Taiwan during the Japanese colonial period from 1923 to 1924.

BACKGROUND/PURPOSE: In 1896, the first dentist opened his dental clinic in Taipei City and this also opened a new era of Taiwan's dentistry. This study tried to assess the dentist manpower in Taiwan during the Japanese colonial period from 1923 to 1924, and hence to explore the appearance of Taiwan's early dentistry. MATERIALS AND METHODS: This study utilized the secondary data analysis to evaluate the numbers and distributions of dentists, physicians, and local practitioners in Taiwan from 1923 to 1924, to find the relationship among them, and further to explore the development of dentists in Taiwan at that period. RESULTS: The total numbers of dentists and physicians increased from 87 to 882 in 1923 to 97 and 927 in 1924, respectively. Moreover, the total number of local practitioners decreased from 583 in 1923 to 558 in 1924. Their Gini coefficients for dentists, physicians, and local practitioners were 0.18, 0.16 and 0.20 in 1923 and 0.27, 0.05 and 0.19 in 1924, respectively. From 1923 to 1924, dentists and physicians were mainly concentrated in the northern and southern regions of Taiwan, and dentists had more serious uneven distribution problem. CONCLUSION: We conclude that the uneven distribution of dentist in Taiwan is an old problem. After a hundred years of development, the number of dentists increases at a higher rate than the number of physicians and there is no shortage of dentists to date in Taiwan. However, the problem of uneven distribution of dentists still exists and is even more serious now.

Growth of for-profit involvement in emergency medicine graduate medical education and association between for-profit affiliation and resident salary.

Background: Following projections of an emergency medicine (EM) physician oversupply, the growth of EM residency programs affiliated with for-profit hospitals has been subject to increased attention and speculation. However, essentially no literature exists regarding these programs. Resident pay is one area where these programs could differ from nonprofit-affiliated programs, as investor obligations could make for-profit corporations more likely to reduce resident salaries to increase profit margins. Here, we aim to quantify the growth of EM for-profit affiliated residency programs from 2001-2021 and determine if PGY1 salaries differ between these program types. Methods: Medicare and ACGME accreditation data were used to determine the profit status of hospitals affiliated with EM residency programs. ACGME new accreditation data from 2001-2021 were used to quantify the growth of both for-profit and nonprofit affiliated programs over this period. We searched program websites and called programs to determine 2021-2022 PGY1 salary. Multiple regression was used to model the relationship between profit status and salary using program characteristic covariates to control for confounding variables. Results: The number of EM programs increased from 117 to 276 from 2001-2021 while the number of for-profit affiliated EM residency programs increased from 1 to 29 during this period. Most (85.7%, [24/29]) for-profit affiliated programs were accredited from 2016-2021. Mean for-profit affiliated program salary ($55,658, n  = 24) was $3840 lower than mean nonprofit affiliated program salary ($59,498, n  = 203). For-profit affiliation was a significant predictor of lower 2021-2022 PGY1 salary after controlling for other program characteristics using multiple regression ( ß  = -1919.88, P = 0.010). Conclusions: We found a substantial growth of newly ACGME accredited for-profit affiliated EM residency programs from 2016-2021. We also found for-profit affiliated programs pay lower PGY1 salaries than nonprofit-affiliated programs after controlling for potential confounding variables, which suggests more oversight over the salary determination process could be necessary to prevent resident underpayment.

Dentist manpower development and geographical distribution of dentists in Taiwan.

BACKGROUND/PURPOSE: The development of dentists in Taiwan has been over a century. This study tried to explore the dentist manpower development and the current status of geographical distribution of dentists in Taiwan. MATERIALS AND METHODS: This study used the secondary data analysis to survey the changes of total dentist number from 1986 to 2018 and the geographic distribution of dentists in different levels of dental institutions in 2019. RESULTS: The total number of dentists increased from 3739 in 1986 to 14,717 in 2018. The total number of hospital dentists increased from 809 in 1986 to 2121 in 2018. However, the proportion of hospital dentists in the total number of dentists decreased from 21.64% in 1986 to 14.41% in 2018. On the contrary, the total number of dental clinic dentists increased from 2930 in 1986 to 12,596 in 2018. The proportion of dental clinic dentists in the total number of dentists increased from 78.36% in 1986 to 85.59% in 2018. The northern region of Taiwan and Taipei City had 52.81% (7829/14,825) and 22.29% (3304/14,825) of the total number of dentists in 2019, respectively. Hospital dentists showed a significantly greater imbalance in geographic distribution than overall dentists. CONCLUSION: Our results indicate that Taiwan has the problems of oversupply of dentists and imbalance in geographical distribution of dentists. Because continuation of the current dentist manpower development may accelerate the oversupply and geographical imbalance of dentists, a mechanism for controlling the total dentist manpower should be implemented to prevent the deterioration of the problems.

The status of hospital dentistry in Taiwan in October 2019.

BACKGROUND/PURPOSE: Dental care has been officially incorporated into the hospital accreditation system in Taiwan since 2015. The geographical distribution of dentist manpower still remains in an unbalanced status as shown by the dentist-to-population ratio. This study tried to assess the dental manpower issue in terms of the status of hospital dentistry, and hence provided two organizational-level suggestions with their policy implications. MATERIALS AND METHODS: This study utilized the secondary data analysis to evaluate the dental manpower in dental departments of medical centers, regional hospitals, and district hospitals in different regions of Taiwan in October 2019. RESULTS: Our results found that the dental manpower including the numbers of general dentists and dental specialists was highest in medical centers, followed by regional hospitals and district hospitals. Moreover, the dental resources and manpower were mostly concentrated in the northern region of Taiwan, followed by the central and southern regions of Taiwan, the eastern region of Taiwan, and offshore islands. CONCLUSION: The hospital dentistry in Taiwan develops toward large-scale and specialization. Both hospital general dentists and dental specialists are concentrated in the medical centers, especially the medical centers in the northern region of Taiwan, indicating the problem of oversupply in the northern Taiwan and unbalanced distribution of dentists among the regions in Taiwan. Therefore, the responsibilities of the hospitals in metropolitan areas are to develop the elderly and disabled dentistry and to assist with oral health promotion and oral disease prevention in remote areas to reduce the urban-rural gap in dental resources in Taiwan.

Provision of health care services and regional diversity in Germany: insights from a Bayesian health frontier analysis with spatial dependencies.

The German health care system is among the most patient-oriented systems in Europe. Nevertheless, distinct utilisation patterns, access barriers due to socio-economic profiles, and potentials of misallocation of medical resources lead to disparities in the provision of health care services. We analyse how a possible over- and undersupply of services and the utilisation of and the access to the health care system relate to regional variations in the population's well-being. For this purpose, we employ a recent Bayesian stochastic frontier approach that allows for spatial dependence structures. Our results indicate that patient migration plays an important role in contributing to regional differences in the utilisation of the medical infrastructure. As a consequence, policy should take spatial patterns of health care utilisation into account to improve the allocation of medical resources.

Comparative Metabolomics Unravel the Effect of Magnesium Oversupply on Tomato Fruit Quality and Associated Plant Metabolism.

In general, greenhouse cultivation involves the rampant application of chemical fertilizers, with the aim of achieving high yields. Oversaturation with mineral nutrients that aid plant growth, development, and yield may lead to abiotic stress conditions. We explore the effects of excess magnesium on tomato plant metabolism, as well as tomato fruit quality using non-targeted mass spectrometry (MS)-based metabolomic approaches. Tomato plants were subjected to three different experiments, including high magnesium stress (MgH), extremely high magnesium stress (MgEH), and a control with optimal nutrient levels. Leaves, roots, and fruits were harvested at 16 weeks following the treatment. A metabolic pathway analysis showed that the metabolism induced by Mg oversupply was remarkably different between the leaf and root. Tomato plants allocated more resources to roots by upregulating carbohydrate and polyamine metabolism, while these pathways were downregulated in leaves. Mg oversupply affects the fruit metabolome in plants. In particular, the relative abundance of threonic acid, xylose, fucose, glucose, fumaric acid, malic acid, citric acid, oxoglutaric acid, threonine, glutamic acid, phenylalanine, and asparagine responsible for the flavor of tomato fruits was significantly decreased in the presence of Mg oversupply. Altogether, we concluded that Mg oversupply leads to drastically higher metabolite transport from sources (fully expanded leaves) to sinks (young leaves and roots), and thus, produces unfavorable outcomes in fruit quality and development.

The combined effects of Cr(III) propionate complex supplementation and iron excess on copper and zinc status in rats.

It is suggested that both iron overload and chromium(III) deficiency may be risk factors of diabetes. It seems that both Fe and Cr(III) metabolism as well as copper and zinc metabolism are interrelated. However, the direction of these changes may depend on mutual proportions of these elements in the diet and organism. The aim of the study was to evaluate the combined effects of Cr(III) supplementation with Fe excess on the Cu and Zn status in female rats. Thirty-six healthy rats were divided into 6 experimental groups with different Fe levels in the diet. Groups marked with C (control) contained Fe at the recommended level (45 mg kg-1). The excess groups (E) contained Fe at 180 mg kg-1. At the same time the animals were supplemented with Cr(III) of doses 1, 50 and 500 mg kg-1 of diet. The Cr, Fe, Cu and Zn dietary and tissular contents were measured with the AAS method.The excess Fe in the diet significantly decreased the Cu content in the liver and kidneys, but it increased the spleen Cu level. The Cr(III) supplementary did not affect the tissular Cu levels, regardless of Fe supply with diet. The experimental factors did not have significant interactional effect on the Cu status parameters under study.The Fe excess in the diet reduced the renal and splenic Zn content, but increased the heart Zn content. The Cr(III) supplementation decreased the Zn content in the kidneys. The Zn content in the liver and spleen tended to decrease as the Cr(III) supply in the diet increased. There was no significant interactional effect of Cr(III) supplementation and the Fe excessive supply in diet on the parameters of Zn metabolism in Wistar rats. Iron oversupply disturbed the rat's Cu and Zn status. However, Cr(III) supplementation did not affect the tissular levels of these elements, except the kidney Zn content. Simultaneous supplementation with the Cr(III) propionate complex did not deepen changes in tissular Cu and Zn levels caused by the Fe excess in the diet.

Sustainable applications utilizing sulfur, a by-product from oil and gas industry: A state-of-the-art review.

This paper presents a review of current routes to utilize sulfur and sulfuric acid. Sulfur is a by-product from sour gas and crude oil processing and the precursor of sulfuric acid. As an oversupply is projected for the near-term future, it is prudent to investigate new sulfur applications and market domains that may facilitate a balancing of supply and demand. This consideration is especially relevant for the UAE, and the Middle East in general, due to the requirement to develop sulfur-rich sour gas resources to meet increasing energy needs. The goal of this review is to understand current sulfur oversupply, not as a problem, but as an opportunity to develop more sustainable technologies. Current routes are reviewed, and possible new applications and their potential as a sulfur sink and a sustainable alternative to existing technologies are discussed. Although sulfur is currently in oversupply, less than 5% positive balance according to Harrisson (2016), it must be noted that it is also a critical component in fertilizer production, having a direct impact on the food supply for the world's growing population. Should the world find itself in a sulfur shortage in the future (which could be possible in the long-term (beyond 2030) as a result of growth in renewable energies, shale gas/oil proliferation and population growth), this would be a much greater problem than the current slight oversupply situation, thus making it important to consider sulfur recoverability as a key factor for any sulfur sink technologies explored.

Management of Breast Milk Oversupply in Traditional Persian Medicine.

Comprehensive explanation about milk oversupply is not available in the current literature because few studies have been done on this topic. In traditional Persian medicine, milk oversupply and its management have been described. The aim of this study was to investigate milk oversupply from the perspective of medieval Persian practitioners. In this study, some main medical resources of traditional Persian medicine such as Al-Havi and the Canon of Medicine were studied to extract valuable information about milk oversupply. Etiology of milk overproduction according to traditional Persian medicine is based on humors theory and cannot be easily compared with current medical concepts. Diet modifications and natural remedies have been applied for managing this condition but the majority of traditional Persian medicine interventions for reducing milk oversupply have not been scientifically investigated in modern medicine. The knowledge of milk oversupply in traditional Persian medicine may be helpful to conduct further related studies.

Supply/Demand in Radiology: A Historical Perspective and Comparison to other Labor Markets.

RATIONALE AND OBJECTIVES: There has been attention on the job market recently and on radiology's supply/demand calculus. Supply is influenced by the number of trained radiologists, while demand is driven by demographics and technological innovation. We analyze the supply of radiologists historically and compare to other labor markets-medical and non-medical, domestic and foreign. MATERIALS AND METHODS: We review National Resident Matching Program data in radiology and several other specialties from 1991 to 2015. We also review surveys, physician recruitment data, and peer-reviewed commentaries on medical specialty job markets. Trends are compared across specialties. The regulation of American medical training is compared to that in the United Kingdom and to a nonmedical labor market, unionized theatrical stage employees. RESULTS: Radiology residency positions have increased since 1998 despite a downturn in the job market. This expansion coincides with a decreasing percentage of positions filled by domestic graduates. A similar trend has been seen in pathology, a notoriously oversupplied specialty. Conversely, other specialties have maintained their proportion of domestic graduates by way of limited supply or implicit demand. CONCLUSIONS: The radiology job market is currently oversupplied, primarily a result of increasing residency positions despite indicators of decreasing demand. The percentage of residency positions filled by domestic graduates has decreased during the same period, suggesting that medical student interest is responsive to the market. Other specialties, particularly pathology, demonstrate the dangers of chronic oversupply. We advocate a reduction of radiology residency positions such that supply closely approximates demand without exceeding it. Additional measures may be taken, if necessary, to restore market equilibrium in the event of a mild undersupply.

Medication oversupply in patients with diabetes.

BACKGROUND: Studies in integrated health systems suggest that patients often accumulate oversupplies of prescribed medications, which is associated with higher costs and hospitalization risk. However, predictors of oversupply are poorly understood, with no studies in Medicare Part D. OBJECTIVE: The aim of this study was to describe prevalence and predictors of oversupply of antidiabetic, antihypertensive, and antihyperlipidemic medications in adults with diabetes managed by a large, multidisciplinary, academic physician group and enrolled in Medicare Part D or a local private health plan. METHODS: This was a retrospective cohort study. Electronic health record data were linked to medical and pharmacy claims and enrollment data from Medicare and a local private payer for 2006-2008 to construct a patient-quarter dataset for patients managed by the physician group. Patients' quarterly refill adherence was calculated using ReComp, a continuous, multiple-interval measure of medication acquisition (CMA), and categorized as <0.80 = Undersupply, 0.80-1.20 = Appropriate Supply, >1.20 = Oversupply. We examined associations of baseline and time-varying predisposing, enabling, and medical need factors to quarterly supply using multinomial logistic regression. RESULTS: The sample included 2519 adults with diabetes. Relative to patients with private insurance, higher odds of oversupply were observed in patients aged <65 in Medicare (OR = 3.36, 95% CI = 1.61-6.99), patients 65+ in Medicare (OR = 2.51, 95% CI = 1.37-4.60), patients <65 in Medicare/Medicaid (OR = 4.55, 95% CI = 2.33-8.92), and patients 65+ in Medicare/Medicaid (OR = 5.73, 95% CI = 2.89-11.33). Other factors associated with higher odds of oversupply included any 90-day refills during the quarter, psychotic disorder diagnosis, and moderate versus tight glycemic control. CONCLUSIONS: Oversupply was less prevalent than in previous studies of integrated systems, but Medicare Part D enrollees had greater odds of oversupply than privately insured individuals. Future research should examine utilization management practices of Part D versus private health plans that may affect oversupply.

Vacant hospitals and under-employed nurses: a qualitative study of the nursing workforce management situation in Nepal.

It is vital for all healthcare systems to have a sufficient number of suitably trained health professionals including nurses at all levels of health services to deliver effective healthcare. An ethnographic, qualitative method was chosen for this study, which included open-ended, in-depth interviews with a range of stakeholders including student nurses, qualified nurses, nurse managers and lecturers, and the human resource co-ordinator in the Ministry of Health and Population. Available records and policy documents were also analysed. Study findings suggest that there is a severe mal-distribution of the nursing workforce in rural and urban healthcare centres in Nepal. Although there is an oversupply of newly qualified nurses in hospitals in Kathmandu, the staffing situation outside the valley is undesirable. Additionally, the turnover of junior nursing staff remains high in major urban hospitals. Most qualified nurses aspire to work in developed countries, such as the UK, North America, Australia and New Zealand. Between 2000 and 2008, as many as 3000 nurses have left Nepal for jobs in the developed west. There is no effective management strategy in place to retain a nursing workforce, particularly in rural Nepal. This article concludes by proposing some suggestions for a nursing workforce retention policy to address this critical issue.

Desde la Admisión Hasta el Ejercicio Profesional. Una Revisión de las Carreras de Odontología en Chile / From Admission to Professional Practice, A Review of Dental Programs in Chile

RESUMEN: Al año 1991 sólo existían tres carreras de odontología en Chile: Universidad de Chile (1911), Universidad de Concepción (1919) y la Universidad de Valparaíso (1955 como sede de la U. de Chile). Actualmente, existen 21 universidades que dictan un total de 32 carreras de odontología, titulando aproximadamente 1500 nuevos profesionales cada año, lo cual, aparte de disparar las cifras de profesionales en nuestro sistema, levanta la duda de cuantos estudiantes se encuentran en formación y cuál es el perfil de admisión que se establece en estas instituciones. El objetivo de este artículo es conocer las cifras de los procesos de admisión, matrícula financiamiento y acreditación universitarios y discutirlas en base a la cantidad de profesionales habilitados para trabajar en nuestro sistema para así reflejar la situación actual que vive la Odontología en Chile. Se realizó un estudio descriptivo de corte transversal realizado en base a la revisión de las bases estadísticas públicas. A pesar de sus altos costos asociados a la implementación de espacios y materiales, la carrera sigue siendo altamente postulada. Los nuevos ingresos rondan en alrededor de 2.20 0 para primer año, llegando aproximadamente a 14.300 estudiantes en todos los niveles para el 2019. El Estado de Chile debería abordar los problemas que se desprenden de estos indicadores, a través de una discusión seria y sistemática, incorporando diversos actores y basándose en información sobre la real necesidad de atención en salud de la población y la disponibilidad estructural del sistema de salu d público y privado para soportar determinado número de profesionales. La apertura de nuevas carreras de odontología se visualiza como un problema, mientras el país avanza a pasos lentos en una regulación que es requerida de manera urgente.

ABSTRACT: In 1991 there were only three dental programs in Chile: Universidad de Chile (1911), Universidad de Concepción (1919) and Universidad de Valparaíso (1955, as campus of U. de Chile). Currently, there are 21 universities that teach a total of 32 dental programs, graduating approximately 1500 new professionals each year, which, in addition to increasing the number of dentists in our system, raises the question as to how many students are in training, and what is the admission profile established by these institutions. The aim of this article is to know the number of admissions, registration, financing, and university accreditation process, based on the number of qualified professionals working in our system, in order to reflect the current situation of dentistry in Chile. A descriptive cross-sectional study was carried out based on the review of the public statistical resources. Despite the high cost of the program, associated with the implementation and materials, the program has many applicants. The number of enrolled students each year in the first semester is around 2200. Therefore, a high number of students are currently enrolled in all semesters, totalling approximately 14,300 in 2019. The Chilean government should address this problem based on information about the real need for healthcare of the population, within the framework of the public and private health system to support a certain number of professionals. The opening of new dental programs is viewed as a problem, while the country is advancing slowly in a regulation that is urgently required.