Population Ageing as a Sociodemographic Problem in the Baltic Region

Population ageing is a major problem of European development in the 21st cen­tury. Rapid population ageing in most developed countries will continue to drive the dependency ratio up. This research aims to forecast dependency ratio in the Baltic region until the end of the century. A more detailed population analysis and forecast is provided for the case of the Baltic States — Estonia, Latvia, and Lithuania. The authors use Bayesian probabilistic predictions based on data from the Pop­ulation Division of the United Nations Department of Economic and Social Affairs. Principle research methods include multi-factor simulation modelling; some find­ings are presented on schematic maps. The study shows that by the end of the century the highest dependency ratio in the Baltic region will be observed in Poland, while Finland, Estonia, Denmark, Norway, and Sweden will also face significant challenges. The authors put forward demographic policy recommendations for those Baltic region states that will reach the highest dependency ratio by the second half of the 21st century

Старение населения как социально-демографическая проблема Балтийского региона=Population Ageing as a Sociodemographic Problem in the Baltic Region

Population ageing is a major problem of European development in the 21st cen­tury. Rapid population ageing in most developed countries will continue to drive the dependency ratio up. This research aims to forecast dependency ratio in the Baltic region until the end of the century. A more detailed population analysis and forecast is provided for the case of the Baltic States — Estonia, Latvia, and Lithuania. The authors use Bayesian probabilistic predictions based on data from the Pop­ulation Division of the United Nations Department of Economic and Social Affairs. Principle research methods include multi-factor simulation modelling; some find­ings are presented on schematic maps. The study shows that by the end of the century the highest dependency ratio in the Baltic region will be observed in Poland, while Finland, Estonia, Denmark, Norway, and Sweden will also face significant challenges. The authors put forward demographic policy recommendations for those Baltic region states that will reach the highest dependency ratio by the second half of the 21st century

Population ageing as a sociodemographic problem in the Baltic region

Population ageing is a major problem of European development in the 21st century. Rapid population ageing in most developed countries will continue to drive the dependency ratio up. This research aims to forecast the dependency ratio in the Baltic region until the end of the century. A more detailed population analysis and projections are provided for the case of the Baltic States - Estonia, Latvia, and Lithuania. The authors use Bayesian probabilistic predictions based on data from the Population Division of the United Nations Department of Economic and Social Affairs. Principle research methods include multi-factor simulation modelling; some findings are presented on schematic maps. The study shows that by the end of the century the highest dependency ratio in the Baltic region will be observed in Poland, while Finland, Estonia, Denmark, Norway, and Sweden will also face significant challenges. The authors put forward demographic policy recommendations for those Baltic region states that will reach the highest dependency ratio by the second half of the 21st centuryVytauto Didžiojo universitetasŠvietimo akademij

A multifaceted primary care practice-based intervention to reduce ED visits and hospitalization for complex medical patients: A mixed methods study.

BackgroundThe management of complex, multi-morbid patients is challenging for solo primary care providers (PCPs) with limited access to resources. The primary objective of the intervention was to reduce the overall rate of Emergency Department (ED) visits among patients in participating practices.Methods and findingsAn interrupted time series design and qualitative interviews were used to evaluate a multifaceted intervention, SCOPE (Seamless Care Optimizing the Patient Experience), offered to solo PCPs whose patients were frequent users of the ED. The intervention featured a navigation hub (nurse, homecare coordinator) to link PCPs with hospital and community resources, a general internist on-call to provide phone advice or urgent assessments, and access to patient results on-line. Continuous quality improvement (QI) strategies were employed to optimize each component of the intervention. The primary outcome was the relative pre-post intervention change in ED visit rate for patients of participating practices compared with that for a propensity-matched control group of physicians over the contemporaneous period. Themes were identified from semi-structured interviews on PCP's experiences and influential factors in their engagement. Twenty-nine physicians agreed to participate and were provided access to the intervention over an 18-month time period. There were a total of 1,525 intervention contacts over the 18-months (average: 50.6±60.8 per PCP). Both intervention and control groups experienced a trend towards lower rates of ED use by their patients over the study time period. The pre-post difference in trend for the intervention group compared to the controls was not significant at 1.4% per year (RR = 1.014; p = 0.59). Several themes were identified from qualitative interviews including: PCPs felt better supported in the care of their patients; they experienced a greater sense of community, and; they were better able to provide shared primary-specialty care.ConclusionsThis multifaceted intervention to support solo PCPs in the management of their complex patients did not result in a reduced rate of ED visits compared to controls, likely related to variable uptake among PCPs. It did however result in more comprehensive and coordinated care for their patients. Future directions will focus on increasing uptake by improving ease of use, increasing the range of services offered and expanding to a larger number of PCPs

Cohort recruitment flow chart.

<p>Cohort recruitment flow chart.</p

Results of multivariable survival analysis: effect of baseline osteoarthritis (OA) pain and disability on risk for composite cardiovascular (CVD) outcome after adjusting for covariates and censoring on death.

<p>Model R-square  = 0.381.</p