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Results from the 2008 National Survey on Drug Use and Health: National findings

ContextTwo important areas of medicine, care of the critically ill and management
of pulmonary disease, are likely to be influenced by the aging of the US population.ObjectiveTo estimate current and future requirements for adult critical care
and pulmonary medicine physicians in the United States.Design, Setting, and ParticipantsAnalysis of existing population, patient, and hospital data sets and
prospective, nationally representative surveys of intensive care unit (ICU)
directors (n = 393) and critical care specialists (intensivists) and pulmonary
specialists (pulmonologists) (n = 421), conducted from 1996 to 1999.Main Outcome MeasuresInfluence of patient, physician, regional, hospital, and payer characteristics
on current practice patterns; forecasted future supply of and demand for specialist
care through 2030. Separate models for critical care and pulmonary disease.
Base-case projections with sensitivity analyses to estimate the impact of
future changes in training and retirement, disease prevalence and management,
and health care reform initiatives.ResultsIn 1997, intensivists provided care to 36.8% of all ICU patients. Care
in the ICU was provided more commonly by intensivists in regions with high
managed care penetration. The current ratio of supply to demand is forecast
to remain in rough equilibrium until 2007. Subsequently, demand will grow
rapidly while supply will remain near constant, yielding a shortfall of specialist
hours equal to 22% of demand by 2020 and 35% by 2030, primarily because of
the aging of the US population. Sensitivity analyses suggest that the spread
of current health care reform initiatives will either have no effect or worsen
this shortfall. A shortfall of pulmonologist time will also occur before 2007
and increase to 35% by 2020 and 46% by 2030.ConclusionsWe forecast that the proportion of care provided by intensivists and
pulmonologists in the United States will decrease below current standards
in less than 10 years. While current health care reform initiatives and modification
of existing practice patterns may temporarily forestall this problem, most
anticipated effects are minor in comparison with the growing disease burden
created by the aging US population.

https://jamanetwork.com/journals/jama/articlepdf/193318/JCE00009.pdf

Current and Projected Workforce Requirements for Care of the Critically Ill and Patients With Pulmonary Disease: Can We Meet the Requirements of an Aging Population?

This study examined the relationship between three variables, compassion fatigue (CF), compassion satisfaction (CS), and burnout, and provider and setting characteristics in a sample of 1,121 mental health providers in a rural southern state. Respondents completed the Professional Quality of Life Scale as part of a larger survey of provider practice patterns. Female gender was associated with higher levels of CF, and therapists with specialized training in trauma work reported higher levels of CS than nonspecialists. Provider discipline proved to be an important factor, with psychiatrists reporting higher levels of CF than their non-medicalcounterparts. When providers were compared using rural, urban, and rural with urban influence classifications, the most rural providers reported increased levels of burnout but could not be distinguished from their colleagues on the CF and CS subscales. Important practice, education, and policy implications are noted for a multidisciplinary audience.

/pdf/compassion-fatigue-compassion-satisfaction-and-burnout-vd8qq4i8gm.pdf

Compassion Fatigue, Compassion Satisfaction, and Burnout: Factors Impacting a Professional's Quality of Life

It is increasingly recognized that families and communities are important in helping youths develop the knowledge and skills they need to obtain technologically sophisticated jobs, which are an emerging part of the global economy. In this paper we adopt social capital as a frame- work for examining the influence of family and community on promoting educational achievement among public school students. We explore more fully the role of community social capital in influencing educational per- formance beyond that attributed to family social capital. Using data from the National Education Longitudinal Survey (NELS), we find that both process and structural attributes of family social capital are key factors af- fecting high school students' educational achievement. Process and struc- tural attributes of community social capital also help youths to excel, though they contribute less strongly to achievement. These findings sug- gest that policies designed to promote educational achievement must ex- tend beyond the school and must seek to strengthen social capital in the family and the community. Increasing evidence indicates that our nation's economic well-being is linked directly to three factors: our capability to be participate ac- tively in the global economy, our ability to incorporate information technology into the workplace, and our capacity to develop a labor force with the knowledge and skills necessary to operate in an in- creasingly complex and dynamic work environment ( Judy and D'Amico 1997; Katz 1992:30-35). Probably the last of these three elements, an educated and skilled pool of workers, is the key fea- ture supporting our nation's effort to progress in the technologi- cally sophisticated global environment.

/pdf/the-influence-of-family-and-community-social-capital-on-2qsbthe9f5.pdf

The Influence of Family and Community Social Capital on Educational Achievement

Objectives:To describe the organization and distribution of intensive care unit (ICU) patients and services in the United States and to determine ICU physician staffing before the publication and dissemination of the Leapfrog Group ICU physician staffing recommendations.Design and Setting:Stratified

Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations.

This report provides a one-digit code for each of 10 classifications for all U.S. counties. The classifications describe a county by degree of urbanization and nearness to a metro area. These codes allow researchers to break county data into finer residential groups than the standard metro-nonmetro classification of the Bureau of the Census.

Rural-urban continuum codes for metro and nonmetro counties

This report examines the possibilities of improving the economic prospects of rural communities and regions through the provision of business assistance. Several specific approaches to business assistance are discussed: a focus on small business, industrial targeting, retention and expansion programs, seed and venture capital programs, industrial parks, business incubators, and enterprise zones. The authors stress that the success of any specific business assistance approach will depend upon the context, and that the strength of an overall economic development strategy for a rural community or region is likely to come from the thoughtful combination of several elements, often including some business assistance, rather than the selection of a single "perfect" ingredient.

Rural Economy Division

Papers

Rural-urban continuum codes for metro and nonmetro counties

Business assistance and rural development