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PubMed1996

Evaluation in the Health Resources and Services Administration. Improving program performance.

The mission of the Health Resources and Services Administration (HRSA) in the U.S. Department of Health and Human Services is to improve the health of the nation by assuring quality health care to underserved and vulnerable populations and by promoting a primary care and public health workforce. This article provides an overview of HRSA's prior work in performance measurement and highlights a current initiative designed to help the agency improve its performance measurement efforts in the context of the Government Performance and Results Act. This initiative began with an agencywide assessment of capacity to measure performance at program, bureau, and agency levels. Based on the findings, HRSA is moving forward both with technical assistance to individual bureaus in developing performance indicators and data sources and with activities to coordinate performance measurement for the agency as a whole.

Budgets↗
PubMed2026

Integrated molecular, epidemiological, and bioinformatics perspectives on the Mpox virus: Implications for surveillance and Global Health preparedness.

Mpox has re-emerged as a significant global zoonotic threat, driven mainly by two large waves the 2022 worldwide Clade IIb outbreak and the 2024 Clade Ib epidemic in Central Africa. This review examines the challenges of interpreting this evolving virus from molecular, epidemiological, and bioinformatics perspectives, with a focus on global health workforce preparedness. Clade IIb largely moved through sexual transmission across countries, but Clade Ib has appeared in a wider population-women, children, and individuals infected through household spread without any sexual contact. Early case series suggest that Clade Ib may cause a more severe disease burden, but more research is needed to directly compare severity and fatality rates with Clade IIb due to the limited number of current studies. The review examines the virus's strategies for evading the host's immune defenses throughout its ∼197 kbp genome, including how it disrupts interferon signaling and creates decoy receptors. This review summarizes the clinical findings of PALM007 and STOMP, noting that neither trial achieved its main efficacy endpoint making routine tecovirimat use less compelling-while leaving open whether it helps particular high-risk groups. A further point is that immunity from the MVA-BN vaccine wanes with time, leading to the growing adoption of booster vaccinations. In conclusion, the review calls for a One Health approach pairing genomic tracking with ecological intelligence and including wastewater surveillance to fill existing gaps in knowledge and enhance the global handling of new orthopoxvirus threats.

Animals↗
PubMed2004

Equal opportunity for all? Trends in flexible training 1995-2001.

This paper describes current patterns and trends in flexible training in the UK. It is a descriptive study based on (1) survey data on the number of flexible trainees from the annual survey of UK deaneries from 1995 to 2001; (2) Department of Health workforce figures on numbers of consultants and specialist registrars in England; (3) survey data from UK deaneries on the destination of those leaving flexible training schemes from 1999 to 2001. The absolute number and percentage of flexible SpRs in England increased from 389 (3.5%) in 1995 to 1067 (8.4%) in 2001. There is substantial variation by region, with only 4% of SpRs in Mersey being flexible compared with 11% in South Western and Oxford in 2000, and by specialty, with 2% in general surgery compared with 22% in psychiatry and 19% in paediatrics. There was a continued increase in the number and percentage of flexible SpRs over the period 1995-2001. The rate slowed in 2001 and fell in three regions, suggesting a possible adverse effect of the New Pay Deal for junior doctors. Substantial geographical and specialty inequities in access to flexible training appear to exist. If skills and talents of female doctors required to achieve the medical workforce needed in the future are to be retained, these issues need to be urgently addressed.

Education, Medical↗
PubMed2002

Outcomes of combined internal medicine-pediatrics residency programs: a review of the literature.

PURPOSE: To evaluate the outcomes of combined internal medicine and pediatrics (IMP) residency programs using the published literature. METHOD: A literature search was conducted using Medline. Published articles were categorized as research or non-research (commentary, program requirements, program descriptions). Research articles were summarized and the results grouped under ten outcome variables. RESULTS: Of the 32 articles located, 18 were research articles, of which only four had been published since 1993. All the research conducted was cross-sectional and most involved surveys of program directors (seven studies) or graduates (four studies). At the time the studies were conducted, 20-33% of IMP residents did not complete their combined training; attrition rates have not been documented recently. Approximately 80% of IMP graduates achieved certification in both specialties, one third subspecialized to some degree, and 80% provided care to both adults and children. One fourth of the graduates felt that more training was needed in ambulatory settings and less was needed in intensive care. Very few studies of the outcomes of IMP physicians were found. CONCLUSION: The outcomes of IMP residency programs are important for health workforce policy, and this study documents a need for more extensive research on the outcomes of training programs for primary care physicians.

Adult↗
PubMed2006

Training competent and effective Primary Health Care Workers to fill a void in the outer islands health service delivery of the Marshall Islands of Micronesia.

BACKGROUND: Human resources for health are non-existent in many parts of the world and the outer islands of Marshall Islands in Micronesia are prime examples. While the more populated islands with hospital facilities are often successful in recruiting qualified health professionals from overseas, the outer islands generally have very limited health resources, and are thus less successful. In an attempt to provide reasonable health services to these islands, indigenous people were trained as Health Assistants (HA) to service their local communities. In an effort to remedy the effectiveness of health care delivery to these islands, a program to train mid-level health care workers (Hospital Assistants) was developed and implemented by the Ministry of Health in conjunction with the hospital in Majuro, the capital city of the Marshall Islands. METHODS: A physician instructor with experience and expertise in primary health care in these regions conducted the program. The curriculum included training in basic health science, essentials of endemic disorders and their clinical management appropriate to the outer islands. Emphasis was given to prevention and health promotion as well as to the curative aspects. For clinical observation, the candidates were assigned to clinical departments of the Majuro hospital for 1 year during their training, as assistants to the nursing staff. This paper discusses the details of the training, the modalities used to groom the candidates, and an assessment of the ultimate effectiveness of the program. RESULTS: Out of 16 boys who began training, 14 candidates were successful in completing the program. In 1998 a similar program was conducted exclusively for women under the auspices of Asian Development Bank funding, hence women were not part of this program. CONCLUSION: For developing countries of the Pacific, appropriately trained human resources are an essential component of economic progress, and the health workforce is an important part of human resources for sustainable progress and development.

Journal Article↗
PubMed2003

Gonorrhoea, chlamydia and syphilis incidence in the Kimberley.

The Kimberley region in far-north Western Australia has some of the highest reported incidences of sexually transmitted infections (STIs) in the nation. This report documents the region's incidence rates of gonorrhoea and syphilis from 1997 to 2001 and of chlamydia from 1993 to 2001. Chlamydia rates have been increasing since 1993 when genital chlamydia became a notifiable disease. By contrast, gonorrhoea rates remained stable from 1997 to 2001. Syphilis rates, which plateaued between 1996 and 2000 following a steep decrease in the previous decade, rose in 2001 in association with a regional syphilis outbreak. Factors important in interpreting changes in STI rates over time include the increased accuracy of more recent census data, the introduction of new and more sensitive diagnostic techniques and the influence of health workforce numbers and skills on STI diagnosis.

Chlamydia Infections↗
PubMed2000

"Elder" physician assistants and their practices.

UNLABELLED: Physician assistants (PAs) in American medicine are aging. After 30 years of having PAs enter the US health care system, it seems an appropriate time to examine where they are in their careers. This study describes the phenomenon of a rising number of elder PAs in the ranks of the nation's health providers and their patterns of practice. METHOD: A subpopulation cohort of practicing PAs 60 years and older was compared to all PAs. Age range, gender, practice setting, specialty, and other demographic variables were analyzed using established methods. Differences between elder PAs and all other PAs and services provided by the two groups were examined. RESULTS: Elder PAs constituted about 1.6% of full-time PAs in practice in 1998. Average age of elder PAs is 64 years (range, 60 years to 74 years) compared to 41 years (range, 21 years to 60 years) for all full-time practicing PAs. Analysis of several variables--gender, ethnicity, geographic distribution, number of patients seen in a week, and hours worked in a week--revealed few differences between the cohorts. On average, older PAs were in practice longer than all PAs (18.3 years and 9.2 years, respectively), had been with their current employer for 7.7 years, and worked one job. Elder PAs had an associate degree at twice the rate of all PAs, but three times as many of them had a doctorate. Elder PAs are more likely to be taking care of older patients, working in a rural area, and remaining in a rural area longer than PAs overall. INTERPRETATION: America's corps of PAs continues to work into and beyond the usual retirement age for most workers, and is caring for a greater percentage of older persons than all PAs are. Most elder PAs practice in family or general medicine and prefer to practice in a rural area. These practice preferences mirror results of previous studies of the practices of elder physicians in the United States and Canada. The aging of PAs has important implications for clinical practice and health workforce planning. If PAs were encouraged to take early retirement, more elderly patients would be shifted to younger providers--with the potential to affect delivery of primary care services in rural communities.

Age Factors↗
PubMedDate not supplied

[Medical doctors in Italy: a situation analysis].

In 1999, there are 336,000 medical doctors in Italy, as compared to 86,000 in 1964. The present-day ratio is 583 physicians per 100,000 population. Italy has probably the highest level of medical staffing in the world. The medical school intake has been controlled since the early 90's and the annual number of new graduates has recently decreased. However, the number of active doctors has not yet been stabilized. After the recent statistics, nearly 39,000 medical doctors cannot find a job in the various medical fields, i.e. more than 11% of the profession. Furthermore, a great number of doctors have not a full-time job. Surprisingly, the physician/population ratio is lower in the northern provinces where the per capita GDP is much higher than in the South. The feature evidences the importance of non-economic factors in shaping the geographic distribution of health workforce.

Adult↗
PubMed2004

Some legal implications of the Precautionary Principle: improving information-generation and legal protections.

In creating a legal agenda in service of the Precautionary Principle, the idea of precaution requires more inventories and better monitoring of the condition of public and workforce health than at present. Rectifying problems of the past to better serve the aims of precaution will require more affirmative pre-market and much more post-market knowledge-generation by those who create and use potentially toxic substances, improved pre-market review of substances, better responses to early warnings, and quicker protective post-market responses to evidence of toxicity. This paper conceptualizes a model pre-market screening law to highlight the need for primary prevention measures and to provide philosophic ideas for improving post-market laws and addressing a large universe of existing substances that have been poorly characterized. Although retrospective personal injury law does not have good mechanisms for precaution, even this can be more protective than it is at present by enhancing causes of action for reasonable fear of disease and medical monitoring, and moving to create new causes of action for failure to develop and disseminate information needed to assess the toxicity of substances.

California↗
PubMed2006

Academic performance and scientific involvement of final year medical students coming from urban and rural backgrounds.

INTRODUCTION: The aim of this study was to evaluate the academic performance and research involvement of students coming from urban and rural backgrounds. To our knowledge, this is the first such study of undergraduate medical students in Croatia. METHOD: We surveyed the final (sixth) year medical students from Medical School, University of Zagreb, Croatia. Students were surveyed during the academic year 2004/2005, several months prior to their graduation. We analysed students' academic performance (grade point average, which is the most important academic success indicator in Croatia, and the number of failed study years) and research involvement (involvement in research projects and the possible subsequent publication of scientific articles). Additionally, we investigated the extent of extracurricular activities, and students' workplace preferences. Data were analysed using chi2 test, Fisher's exact test, and Kruskal-Wallis test, due to non-normal data distribution. RESULTS: A total of 204 students (out of 240 enrolled, with a response rate of 85%) were surveyed, and divided into three groups: (1) those coming from the highly urbanised background (capital and other highly urbanised areas; n = 100, 49%); (2) mid-urban (towns; n = 75, 37%); and (3) rural and remote backgrounds (n = 29, 14%). There was no indication of gender gap or age difference among the three groups. However, significant differences were recorded in most academic and research indicators. Students from highly urbanised backgrounds reported the best grade point average (p = 0.022). Students from rural and remote backgrounds most commonly reported a study year failure (p = 0.032), with 17 (59%) cases, compared with 32 (32%) and 31 (42%) cases in high and mid-urban ones, respectively. Rural and remote students were also the most likely to experience multiple years failure (p = 0.030), were the least often involved in research projects (p = 0.002), and reported the least interest in career supplemented with scientific research (p = 0.015). Finally, students from rural and remote backgrounds were the least commonly involved in extracurricular activities, such as membership in student organizations (p = 0.005), or various hobbies (p = 0.009). However, 12 (41%) of rural and remote students were likely to seek employment in rural and remote areas, compared with a much lower percent among high and mid-urban students, with 16 (16%) and 16 (21%) students, respectively (p = 0.014). CONCLUSION: This study exhibited significant differences in the academic performance and research involvement of students coming from urban and rural backgrounds. Students from highly urbanised background reported the best academic indicators, while students from rural and remote backgrounds reported the poorest. Implementation of a rural students' support program should be strategically planned and carried out, because students from rural backgrounds in more than half the cases experienced a study year failure. Because students from rural and remote backgrounds were the most likely to prefer employment in rural and remote areas, they present a valuable resource for reduction of disparities in health workforce geographical distribution.

Adult↗
PubMed1980

Labor-force participation patterns of older self-employed workers.

Self-employed persons work in a less constrained environment than do most wage-and-salary employees. Generally they are not subject to compulsory retirement nor are they affected by institutional rules concerning labor supply. Data from the 1969 and 1971 interviews of the Retirement History Study show that the labor supply and retirement patterns of the self-employed are distinct from those of other workers. The self-employed (espeically "career" self-employed) nearing retirement age are less likely to be out of the labor force, and those who continue in the labor force have a wider variation in the number of hours worked per year. Downward flexibility in hours (the option for gradual retirement) may be an extremely valuable aspect of self-employed status, and one wonders whether other older workers would also choose this pattern if more flexible opportunities were available. Despite these differences, labor-supply decisions of the self-employed are found to be influenced by many of the same factors that affect the rest of the workforce--health, eligibility for social security and pension benefits, the wage rate, and the flow of asset.

Cross-Sectional Studies↗
PubMed1990

Workforce diversity in health care: managing the melting pot.

Management journals and business magazines are abuzz with discussions of how the changing makeup of the American workforce will affect business operations. Many health care executives are already making the transition to a workforce dominated by women, minorities, and immigrants. Managing the great American melting pot is a big challenge, according to executives, but with proper planning it can be done.

Communication Barriers↗
PubMedDate not supplied

The registered nurse workforce: infrastructure for health care reform.

As of March 1992, 83 percent of America's more than 2.2 million licensed registered nurses (RNs) were actively employed in nursing. RNs are the largest group of U.S. health care professionals and constitute a major part of the infrastructure necessary to any health care reform agenda. Therefore, it is critical to assess the extent to which the current nurse workforce is adequately prepared for its future role in a reformed health care system. Two central trends in the composition of the nurse workforce are noteworthy. First, while the number of RNs is large and continues to grow, cyclical, demand-driven shortages have occurred nationally since World War II. Further, hospital cost containment strategies periodically depress nurses' relative wages, contributing to the substitution of RNs for other workers. Second, there is concern in nursing, as in medicine, that the RN workforce is not optimally trained to meet future needs. While two-year associate degree programs now produce a majority of nursing graduates, the greatest need is for advanced practice nurses. Demand for such nurses is high and is expected to increase as more of the population gains access to health care services. The incentives put forth in the health care reform debate--expanded health insurance coverage, integrated health care delivery systems, and cost-effective practice--create the potential for expanded roles and increased job opportunities for nurses. Realizing this potential will depend largely on the profession's responsiveness to the changes confronting it under health care reform.

Adult↗