Users and Suppliers of Physician Services: A Tale of Two Populations

Physician shortages and their implications for required increases in the physician population are matters of considerable interest in many health care systems, in light especially of the widespread phenomenon of population ageing. To determine the extent to which shortages exist one needs to study the population of users of physician services as well as that of the physicians themselves. In this paper we study both, using the province of Ontario, Canada, as an example. The user population is projected and the implications for requirements calculated, conditional on given utilization rates. On the supplier side, the age and other characteristics of the (active) physician population are examined and patterns of withdrawal investigated. The necessary future growth of supply is calculated, assuming alternative levels of present shortages. The effects of population change on requirements are found to be smaller in the future than in the decade 1981- 1991, in the aggregate, not far from the effects in 1991-2001, but highly variable among different categories of physicians.physician shortages, physician requirements, population aging

Users and Suppliers of Physician Services: A Tale of Two Populations

Physician shortages and their implications for required increases in the physician population are matters of considerable interest in many health care systems, in light especially of the widespread phenomenon of population ageing. To determine the extent to which shortages exist one needs to study the population of users of physician services as well as that of the physicians themselves. In this paper we study both, using the province of Ontario, Canada, as an example. The user population is projected and the implications for requirements calculated, conditional on given utilization rates. On the supplier side, the age and other characteristics of the (active) physician population are examined and patterns of withdrawal investigated. The necessary future growth of supply is calculated, assuming alternative levels of present shortages. The effects of population change on requirements are found to be smaller in the future than in the decade 1981- 1991, in the aggregate, not far from the effects in 1991-2001, but highly variable among different categories of physicians.physician shortages, physician requirements, population aging

Pengaruh Minyak Cumi Pada Umpan Bubu Dasar Terhadap Hasil Tangkapan Ikan-ikan Karang

Bottom trap have been used widely by coastal communities in North Sulawesi to catch coral fishes, since it simple in design, cheaper and easy to manage with a small boat. Unfortunately, the fishing practice of the traditional trap is usually conducted in destructive way, where fishermen cover the gear with live coral to attract fishing target. Although the gear\u27s design has evolved over centuries, there is still potential for improving its catching efficiency and selectivity. An attempt to understand the fishing process of bottom trap should therefore be focused on bait and how its chemical composition, visual and physical properties may stimulate target species to attack the bait and captured. Addition of squid liver oil to the bait could increase the fishing power of bottom trap gear. But scientific information\u27s about its applications are not available yet. Therefore, the objective of this research was to study the effect of squid liver oil on bait of bottom trap toward the capture of coral fishes. This research was done in Bangka Strait North of Minahasa, based on experimental method. Six units of bottom trap (bamboo) were operated ten nights in collecting data; where tree units of them used scad mackerel bait that injected by squid liver oil, and tree other units just used scad mackerel bait without squid liver oil; and the capture data were analyzed by ttest. The catch was 117 fish in total consist of 2 genera; 74 fish was caught by scad mackerel bait with squid liver oil, and 43 fish was caught by bait without squid liver oil. Analysis of ttest show that t0= 8.908>t0.05; 5= 3.250; which means that the addition of squid liver oil on bait could increase the catch of bottom trap

Time preference, the discounted utility model and health

The constant rate discounted utility model is commonly used to represent intertemporal preferences in health care program evaluations. This paper examines the appropriateness of this model, and argues that the model fails both normatively and descriptively as a representation of individual intertemporal preferences for health outcomes. Variable rate discounted utility models are more flexible, but still require restrictive assumptions and may lead to dynamically inconsistent behaviour. The paper concludes by considering two ways of incorporating individual intertemporal preferences in health care program evaluations that allow for complementarity of health outcomes in different time periods

Lo que sabemos acerca de la toma de decisiones en cáncer ovárico

Objectives: To describe what is known about the three stages of treatment decision making (TDM) in the medical encounter: (1) information exchange, (2) deliberation, and (3) making the treatment decision for ovarian cancer (OC). Methods: A literature search was completed including original research on TDM as it pertained to the disease continuum of OC. Results: Information exchange shows that patients and physicians feel that life expectancy is the most important issue. Physicians report that they do not discuss this at initial diagnosis. Decision aids could be used as a tool to ensure that information. The deliberation stage is the least researched. There is no information on the role that patients and physicians take. With the exception of one internet based tool, there is no research on how to elicit patient preferences. During making the treatment decision, women do not perceive that they have treatment options yet they feel they are making the decision. “No treatment” is not considered to be an option. Conclusions: TDM in OC is increasingly being evaluated. The stage of information exchange has been assessed in greater depth compared to that of the other stages.Objetivos: exponer lo que se conoce acerca de tres niveles de toma de decisión sobre tratamiento en el encuentro medico: (1) intercambio de información, (2) deliberación, y (3) toma de decisión en el cáncer ovárico. Métodos: Se completó una búsqueda bibliográfica que incluía investigación original acerca de la toma de decisión del tratamiento médico sobre el proceso de enfermedad del cáncer de ovario. Resultados: el intercambio de información mostró que los pacientes y los médicos sienten que la expectativa de vida es el tema más importante. Los médicos informan que no discuten esto en el diagnóstico inicial. Las ayudas a la decisión pueden emplearse como una herramienta para asegurar la información. El nivel de deliberación es el menos investigado. No hay información sobre el rol que los pacientes y médicos toman. Con la excepción de una herramienta basada en Internet, no hay investigación sobre como elicitar las preferencias del paciente. Durante la toma de decisión del tratamiento, las mujeres no perciben que ellas tengan opciones de tratamiento aunque sienten que están tomando una decisión. El “no tratamiento” no se considera una opción. Conclusiones: la toma de decisión sobre los tratamientos en cáncer de ovario esta progresivamente siendo valorada. El nivel de intercambio de información ha sido evaluado en mayor profundidad comparado con otros niveles

Empirical relationships between health literacy and treatment decision making : A scoping review of the literature

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. Acknowledgements This research was supported by a Joseph Armand Bombardier Doctoral Scholarship awarded to Leslie J. Malloy-Weir by the Social Sciences and Humanities Research Council of Canada. The authors would like to thank Maureen Rice for her help with the literature search strategy and Dr. Malcolm Weir for his help with the relevance screening.Peer reviewedPostprin

Implementing shared treatment decision making and treatment decision aids: a cautionary tale

El interés en la toma de decisión médica compartida y en las ayudas a la toma de decisión se desarrollaron en los años ochenta y noventa con un foco inicial en pacientes con cáncer, y en particular, en mujeres con cáncer de mama. Este interés con el tiempo ha experimentado un cambio en énfasis desde la curiosidad acerca del significado de estos conceptos y su potencial para mejorar la participación del paciente en la toma de decisión a una promoción a gran escala, intentos de expansión, implementación en una variedad de situaciones clínicas, medición de resultados múltiples en niveles clínicos y de política pública y el desarrollo de criterios estandarizados para evaluar las ayudas a la toma de decisión. En este artículo planteamos la cuestión: ¿estamos moviéndonos demasiado rápido en la promoción de la decisión médica compartida y de la ayuda a la toma de decisión antes de resolver los importantes desafíos que todavía existen acerca del significado y los méritos de estas iniciativas? Discutimos cuatro desafíos: i) ambigüedad e inconsistencia en la definición de la decisión médica compartida; ii) variaciones en las preferencias de médicos y pacientes sobre la decisión médica compartida; iii) el incremento en el número y rango de metas definidas para lograr con la toma de decisión compartida y/o la ayuda a la decisión; iv) la carencia de apoyo teórico y empírico bien documentado para los criterios usados en la evaluación de la calidad de las ayudas a la decisión, y potencialmente para los propósitos de la certificación de la ayuda a la decisión. Estos hallazgos sugieren la necesidad de precaución, un análisis más meditado e investigación adicional en los desafíos mencionados previamente a la promoción a gran escala de la decisión compartida y las ayudas a la decisión en la práctica clínica habitual.Clinical and research interest in shared treatment decision making (STDM) and decision aids (DA) evolved in the 1980’s and 1990’s with an initial focus on patients with cancer, and particularly, women with breast cancer. This interest has undergone a shift in emphasis over time from curiosity about the meaning of these concepts and their potential to improve patient participation in treatment decision making to wide scale endorsement, attempts to expand implementation in a variety of clinical settings, measurement of multiple outcomes at the clinical and public policy level, and the development of standardized criteria for evaluating DA. In this chapter we raise the question: are we moving too fast to promote implementation of STDM and DA before resolving important challenges that still exist about the meaning and merits of these initiatives? We discuss four such challenges: i) ambiguity and inconsistency in the definition of STDM, ii) variations in patient and physician preferences for STDM, iii) the increase in the number and range of goals defined for STDM and /or DA to achieve, and iv) the lack of well documented theoretical and empirical support for criteria to be used in evaluating DA quality, and potentially for purposes of DA certification. These findings suggest the need for caution, for more thoughtful analysis, and additional research on the challenges raised above prior to wide scale endorsement of STDM and DA in routine clinical practice

COLECCIÓN AÑOS 50 Y 60 [Material gráfico]

Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte, 201

Describing Disability among High and Low Income Status Older Adults in Canada

The purpose of this study was to determine the prevalence, types, and severity of disabilities, as well as the medical conditions that may have caused disabilities among non-institutionalized older adults by high and low income. Disabled individuals aged 55 years and older were identified from the 1986 and 1991 Health and Activity Limitation Surveys. The overall unweighted sample sizes for each survey were 132,337 in 1986 and 91,355 in 1991. Approximately 40% of senior men and women reported having at least one disability, with women just slightly more likely than men to report being disabled. Almost twice as many senior women had low income compared with senior men. Mobility and agility disabilities were the most common types of disabilities reported by older adults. Arthritis/rheumatism was the medical condition most often reported as the primary cause of a disability among women. Men most often reported diseases of the ear and mastoid processes, with differences reported by low and high income respondents. Among 55-64 year olds, low income respondents were generally less likely to be categorized as mildly disabled and more likely to be categorized as severely disabled compared with high income respondents. In an effort to postpone or prevent disabilities in an ever-growing older population, public health initiatives are required to educate older adults about medical conditions and impairments that often lead to disability, particularly among low income seniors.disability; income; seniors

Describing Disability among High and Low Income Status Older Adults in Canada

The purpose of this study was to determine the prevalence, types, and severity of disabilities, as well as the medical conditions that may have caused disabilities among non-institutionalized older adults by high and low income. Disabled individuals aged 55 years and older were identified from the 1986 and 1991 Health and Activity Limitation Surveys. The overall unweighted sample sizes for each survey were 132,337 in 1986 and 91,355 in 1991. Approximately 40% of senior men and women reported having at least one disability, with women just slightly more likely than men to report being disabled. Almost twice as many senior women had low income compared with senior men. Mobility and agility disabilities were the most common types of disabilities reported by older adults. Arthritis/rheumatism was the medical condition most often reported as the primary cause of a disability among women. Men most often reported diseases of the ear and mastoid processes, with differences reported by low and high income respondents. Among 55-64 year olds, low income respondents were generally less likely to be categorized as mildly disabled and more likely to be categorized as severely disabled compared with high income respondents. In an effort to postpone or prevent disabilities in an ever-growing older population, public health initiatives are required to educate older adults about medical conditions and impairments that often lead to disability, particularly among low income seniors.disability; income; seniors