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PubMed1990

Forecasting chronic disease risks in developing countries.

Declining fertility and infant mortality has caused the population in many developing countries to age. Population ageing can produce a rapid shift in the predominant public health problems from infant mortality and infectious diseases to chronic disease mortality at later ages. Designing public health strategies to deal with the health consequences of population ageing in developing countries is difficult both because of a remaining burden of infectious diseases and because of changes in life style associated with economic development that may raise chronic disease risks. Because there are few longitudinal studies of chronic disease risks in developing countries, we investigate the use of a planning and forecasting model, which combines data from multiple sources, in six developing countries.

Adolescent↗

PubMed1991

Increased hip-fracture incidence in the county of Ostergötland, Sweden, 1940-1986, with forecasts up to the year 2000: an epidemiological study.

The incidence of hip fractures in the county of Ostergötland in Sweden has increased dramatically from 1940 to 1986, mainly due to an increase in age-specific incidence of trochanteric fractures. The increase is most pronounced in people over 80 but is present even in age groups down to 50 years. If the age-specific incidence rates continue to increase, and the population of the elderly grows in accordance with the forecast, there will be 70% more hip fractures in the year 2000 than in 1985.

Age Factors↗

PubMed1995

Forecasting requirements for physical therapists.

In response to the existing undersupply of physical therapists and the projected changes of the health care reform era, it is prudent for the profession to consider implementing a training strategy that would bring the supply of physical therapists in line with requirements. Before such a training strategy could be developed, however, the physical therapy community would need to produce a requirements forecast. This article compares the uses and limitations of the two major methods for generating health professions requirements--the "need-based" and "demand-based" approaches--and recommends a pragmatic, tailored approach to determining physical therapist requirements that uses easily obtainable data on staffing patterns of managed care plans. The proposed method draws from both need-based and demand-based models to produce complementary data on which to base policy formation.

Forecasting↗

PubMed2004

Indoor radon concentration forecasting in South Tyrol.

In this paper a modern statistical technique of multivariate analysis is applied to an indoor radon concentration data base. Several parameters are more or less significant in determining the radon concentration inside a building. The elaboration of the information available on South Tyrol makes it possible both to identify the statistically significant variables and to build up a statistical model that allows us to forecast the radon concentration in dwellings, when the values of the same variables involved are given. The results confirm the complexity of the phenomenon.

Air Pollutants, Radioactive↗

PubMed1975

Forecasting and medical education.

The ability to render more accurate predictions of the future will enable medical educators and administrators to make more advantageous policy and program decisions. Modern forecasting techniques and criteria to evaluate prognostic endeavors are described. Examples of how these methods can be applied to medical education are provided.

Decision Making↗

PubMed2005

Forecasting residents' performance--partly cloudy.

The authors offer a practical guide for improving the appraisal of a resident's performance. They identify six major factors that compromise the process of observing, measuring, and characterizing a resident's current performance, forecasting future performance, and making decisions about the resident's progress. Factors that compromise any of these steps lead to individual and collective uncertainty and decrease faculty confidence when making decisions on a resident's progress. The six factors, addressed in order of importance, are inaccuracies due to (1) incomplete sampling of performance, (2) rater memory constraints, (3) hidden performance deficits of the resident, (4) lack of performance benchmarks, (5) faculty members' hesitancy to act on negative performance information, and (6) systematic rater error. The description of each factor is followed by a number of specific suggestions on what residency programs can do to eliminate or minimize the impact of these factors. While this article is couched in the context of the performance evaluation of residents, everything included pertains to measuring and appraising medical students' and practicing physicians' clinical performance as well.

Academic Medical Centers↗

PubMed1987

Assessing a methodology for physician requirement forecasting. Replication of GMENAC's need-based model for the pediatric specialty.

Methodologies for determining levels of U.S. physician requirement are as complex as they are controversial. One long-standing controversy surrounds the advantages of an epidemiologic need-based forecasting model over an economic demand-based model. This paper examines the need-based requirement approach as recently developed by the Graduate Medical Education National Advisory Committee (GMENAC). This approach is assessed for the pediatric specialty by replicating the original model using data derived from three large HMOs. These data were empirically obtained from the computerized visit records of more than 10,000 children at each of the three plans and normatively from Delphi panels consisting of pediatric practitioners at those same sites. Results indicate that if U.S. pediatrician requirement was estimated on the basis of HMO practice data, rather than GMENAC's national ideals, fewer physicians would be needed. The pediatric requirement based on local Delphi panel judgments was lower still, due in great part to the suggestion of increased delegation rates to nonphysician providers. Implications of this comparative analysis for the GMENAC need-based methodology and future physician requirement modeling efforts are discussed.

Boston↗

PubMed1991

CRNA (certified registered nurse anesthetist) manpower forecasts: 1990-2010.

The delivery of anesthesia services is at a crossroads in the United States. In 1967, there were two certified registered nurse anesthetists (CRNAs) for every anesthesiologist providing anesthetics, and the numbers are nearly equal today. A CRNA manpower forecasting model is developed in this article that shows CRNA supply and requirements from 1990 through 2010. Two estimates of CRNA shortage are presented, one based on the current trend of anesthesiologists replacing CRNAs and another assuming that CRNAs are involved in every anesthetic under anesthesiologist supervision. The results imply that more than a twofold increase in CRNA school enrollments is needed just to fill conservative baseline needs given the predicted growth in operations in all settings. Limiting anesthesiologists to a supervisory role, at the other extreme, would require a doubling of CRNAs by 2010 and an even greater expansion of CRNA schools. However, it is estimated that reversing CRNA manpower trends could save society between $750 million and $1.2 billion annually.

Anesthesia, Obstetrical↗

PubMed2005

Long-term forecasting of internet backbone traffic.

We introduce a methodology to predict when and where link additions/upgrades have to take place in an Internet protocol (IP) backbone network. Using simple network management protocol (SNMP) statistics, collected continuously since 1999, we compute aggregate demand between any two adjacent points of presence (PoPs) and look at its evolution at time scales larger than 1 h. We show that IP backbone traffic exhibits visible long term trends, strong periodicities, and variability at multiple time scales. Our methodology relies on the wavelet multiresolution analysis (MRA) and linear time series models. Using wavelet MRA, we smooth the collected measurements until we identify the overall long-term trend. The fluctuations around the obtained trend are further analyzed at multiple time scales. We show that the largest amount of variability in the original signal is due to its fluctuations at the 12-h time scale. We model inter-PoP aggregate demand as a multiple linear regression model, consisting of the two identified components. We show that this model accounts for 98% of the total energy in the original signal, while explaining 90% of its variance. Weekly approximations of those components can be accurately modeled with low-order autoregressive integrated moving average (ARIMA) models. We show that forecasting the long term trend and the fluctuations of the traffic at the 12-h time scale yields accurate estimates for at least 6 months in the future.

Algorithms↗

PubMed2006

Loss aversion is an affective forecasting error.

Loss aversion occurs because people expect losses to have greater hedonic impact than gains of equal magnitude. In two studies, people predicted that losses in a gambling task would have greater hedonic impact than would gains of equal magnitude, but when people actually gambled, losses did not have as much of an emotional impact as they predicted. People overestimated the hedonic impact of losses because they underestimated their tendency to rationalize losses and overestimated their tendency to dwell on losses. The asymmetrical impact of losses and gains was thus more a property of affective forecasts than a property of affective experience.

Adult↗

PubMed2005

Forecasting Spanish natural life expectancy.

Knowledge of trends in life expectancy is of major importance for policy planning. It is also a key indicator for assessing future development of life insurance products, substantiality of existing retirement schemes, and long-term care for the elderly. This article examines the feasibility of decomposing age-gender-specific accidental and natural mortality rates. We study this decomposition by using the Lee and Carter model. In particular, we fit the Poisson log-bilinear version of this model proposed by Wilmoth and Brouhns et al. to historical (1975-1998) Spanish mortality rates. In addition, by using the model introduced by Wilmoth and Valkonen we analyze mortality-gender differentials for accidental and natural rates. We present aggregated life expectancy forecasts compared with those constructed using nondecomposed mortality rates.

Aged↗

PubMed1984

Mathematical description and use in forecasting of the caries curve.

Caries curves drawn from empirical prevalences (DMFT counts) of US and Hungarian males as well as females, and British male-female combined samples were satisfactorily described by the transformed truncated Cauchy function: y = 1 + c [-1/2 + 1/pi arc tan (a x + b)]. The parameters a, b, and c, respectively, were determined by a computer with the least squares' method. Of these descriptive models, prevalences at specified ages (covered in the original reports) were read, and additionally the half-life values and maximum yearly relative increments of decay (with the age of their occurrence). The mean deviation of all individual readings in the five models from the observed prevalences was 3.6% only. In each sample, thereafter, relying upon empirical DMF counts in only five juvenile cohorts, analogous models, referred to as predictory, were constructed by the computer, and their extrapolated right tails were compared both with the empirical DMF counts and with the descriptive models. Slight deviations were experienced, the mean deviation of all readings from the empirical counts being 4.5%. Accordingly, predictions of future caries prevalence (in later adolescence in the US samples, and adulthood in all five ones) were feasible relying on DMFT counts. By the predictory models a trend to improving dental health was demonstrated in the American samples (based on the 1971-74 survey) whereas for the other three populations a further rise of caries prevalence was forecast in adults. Merits and limitations of such predictions as well as an improved new procedure used in the comparisons ("penalty points method"), taking into account clinical requirements, were discussed.

Adolescent↗

PubMed1982

Use of prediction models to forecast and analyse airborne spread during the foot-and-mouth disease outbreaks in Brittany, Jersey and the Isle of Wight in 1981.

Between March 4 and 26, 1981 the French veterinary authorities reported a series of 14 outbreaks of disease due to type O foot-and-mouth (FMD) virus, 13 in Brittany and one in Normandy. The United Kingdom reported FMD type O in Jersey on March 19 and in the Isle of Wight on March 22. The field and laboratory investigations on the farm in the Isle of Wight are outlined. The way in which short and long range numerical models were used to forecast the airborne spread of FMD from Brittany to the UK and then to assess the risk of further airborne spread within the UK is described.

Air Microbiology↗

PubMed1984

Professional certification procedures: a developmental forecast for the year 2000.

This paper presents the technique of future forecasting through the development of a scenario based on the process of certification. The paper focuses on the demands of consumer groups. influence of world events, actions taken by Government, and developments within medicine, nursing and occupational therapy through the presentation of a scenario which spans the years 1983-2000. No claim is made that the contents of the scenario will become reality. Rather, the technique is presented as another tool that could be used by the profession in the development of future plans and policies.

Canada↗

PubMed1983

A dialysis need-forecasting model. A retrospective evaluation.

A model to forecast the need for dialysis beds, currently used by the Massachusetts Department of Public Health (DPH), is evaluated after ten years of availability and two years of formal use. The model was originally developed in 1972 to accommodate some informal planning needs of dialysis providers in Massachusetts. In 1978 the model was formally adopted by the DPH for its end stage renal disease planning. The model was designed to be and proved to be flexible in accommodating parameters and inputs specific to a given region, changes due to medical and technological innovations, and the acquisition of new data. This paper evaluates the model in terms of its accuracy, its financial impact, and the impact it has had on the allocation of dialysis resources in Massachusetts. The usefulness of the model as a planning tool is evaluated along several criteria. Two case studies are presented to illustrate how the model has been used to evaluate requests for dialysis facility development or expansion.

Bed Occupancy↗

PubMed2005

The future prospects of Lithuanian family physicians: a 10-year forecasting study.

BACKGROUND: When health care reform was started in 1991, the physician workforce in Lithuania was dominated by specialists, and the specialty of family physician (FP) did not exist at all. During fifteen years of Lithuania's independence this specialty evolved rapidly and over 1,900 FPs were trained or retrained. Since 2003, the Lithuanian health care sector has undergone restructuring to optimize the network of health care institutions as well as the delivery of services; specific attention has been paid to the development of services provided by FPs, with more health care services shifted from the hospital level to the primary health care level. In this paper we analyze if an adequate workforce of FPs will be available in the future to take over new emerging tasks. METHODS: A computer spreadsheet simulation model was used to project the supply of FPs in 2006-2015. The supply was projected according to three scenarios, which took into account different rates of retirement, migration and drop out from training. In addition different population projections and enrollment numbers in residency programs were also considered. Three requirement scenarios were made using different approaches. In the first scenario we used the requirement estimated by a panel of experts using the Delphi technique. The second scenario was based on the number of visits to FPs in 2003 and took into account the goal to increase the number of visits. The third scenario was based on the determination that one FP should serve no more than 2,000 inhabitants. The three scenarios for the projection of supply were compared with the three requirement scenarios. RESULTS: The supply of family physicians will be higher in 2015 compared to 2005 according to all projection scenarios. The largest differences in the supply scenarios were caused by different migration rates, enrollment numbers to training programs and the retirement age. The second supply scenario, which took into account 1.1% annual migration rate, stable enrollment to residency programs and later retirement, appears to be the most probable. The first requirement scenario, which was based on the opinion of well-informed key experts in the field, appears to be the best reflection of FP requirements; however none of the supply scenarios considered would satisfy these requirements. CONCLUSION: Despite the rapid expansion of the FP workforce during the last fifteen years, ten-year forecasts of supply and requirement indicate that the number of FPs in 2015 will not be sufficient. The annual enrollment in residency training programs should be increased by at least 20% for the next three years. Accurate year-by-year monitoring of the workforce is crucial in order to prevent future shortages and to maintain the desired family physician workforce.

Adult↗

PubMed2005

Limits to forecasting precision for outbreaks of directly transmitted diseases.

BACKGROUND: Early warning systems for outbreaks of infectious diseases are an important application of the ecological theory of epidemics. A key variable predicted by early warning systems is the final outbreak size. However, for directly transmitted diseases, the stochastic contact process by which outbreaks develop entails fundamental limits to the precision with which the final size can be predicted. METHODS AND FINDINGS: I studied how the expected final outbreak size and the coefficient of variation in the final size of outbreaks scale with control effectiveness and the rate of infectious contacts in the simple stochastic epidemic. As examples, I parameterized this model with data on observed ranges for the basic reproductive ratio (R0) of nine directly transmitted diseases. I also present results from a new model, the simple stochastic epidemic with delayed-onset intervention, in which an initially supercritical outbreak (R0 > 1) is brought under control after a delay. CONCLUSION: The coefficient of variation of final outbreak size in the subcritical case (R0 < 1) will be greater than one for any outbreak in which the removal rate is less than approximately 2.41 times the rate of infectious contacts, implying that for many transmissible diseases precise forecasts of the final outbreak size will be unattainable. In the delayed-onset model, the coefficient of variation (CV) was generally large (CV > 1) and increased with the delay between the start of the epidemic and intervention, and with the average outbreak size. These results suggest that early warning systems for infectious diseases should not focus exclusively on predicting outbreak size but should consider other characteristics of outbreaks such as the timing of disease emergence.

Communicable Disease Control↗

PubMedDate not supplied

Forecast of acute respiratory infections: expected nonepidemic morbidity in Cuba.

A forecast of nonepidemic morbidity due to acute respiratory infections were carry out by using time series analysis. The data consisted of the weekly reports of medical patient consultation from ambulatory facilities from the whole country. A version of regression model was fitted to the data. Using this approach, we were able to detect the starting data of the epidemic under routine surveillance conditions for various age groups. It will be necessary to improve the data reporting system in order to introduce these procedures at the local health center level, as well as on the provincial level.

Adolescent↗