Dataset Information

Internal migration of physicians who graduated in Brazil between 1980 and 2014.

ABSTRACT: BACKGROUND:The internal migration of physicians from one place to another in the same country can unbalance the supply and distribution of these professionals in national health systems. In addition to economic, social and demographic issues, there are individual and professional factors associated with a physician's decision to migrate. In Brazil, there is an ongoing debate as to whether opening medicine programmes in the interior of the country can induce physicians to stay in these locations. This article examines the migration of physicians in Brazil based on the location of the medical schools from which they graduated. METHODS:A cross-sectional design based on secondary data of 275,801 physicians registered in the Regional Councils of Medicine (Conselhos Regionais de Medicina-CRMs) who graduated between 1980 and 2014. The evaluated outcome was migration, which was defined as moving away from the state where they completed the medicine programme to another state where they currently work or live. RESULTS:57.3% of the physicians in the study migrated. The probability of migration ratio was greater in small grouped municipalities and lower in state capitals. 93.4% of the physicians who trained in schools located in cities with less than 100,000 inhabitants migrated. Fewer women (54.2%) migrated than men (60.0%). More than half of the physicians who graduated between 1980 and 2014 are in federative units different from the unit in which they graduated. Individual factors, such as age, gender, time of graduation and specialty, vary between the physicians who did or did not migrate. CONCLUSIONS:The probability of migration ratio was greater in small municipalities of the Southeast region and strong in the states of Tocantins, Acre and Santa Catarina. New studies are recommended to deepen understanding of the factors related to the internal migration and non-migration of physicians to improve human resource for health policies.

SUBMITTER: Scheffer MC

PROVIDER: S-EPMC5930743 | biostudies-literature | 2018 May

REPOSITORIES: biostudies-literature

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Internal migration of physicians who graduated in Brazil between 1980 and 2014.

Scheffer Mario Cesar MC Cassenote Alex Jones Flores AJF Guilloux Aline Gil Alves AGA Dal Poz Mario Roberto MR

Human resources for health 20180502 1

<h4>Background</h4>The internal migration of physicians from one place to another in the same country can unbalance the supply and distribution of these professionals in national health systems. In addition to economic, social and demographic issues, there are individual and professional factors associated with a physician's decision to migrate. In Brazil, there is an ongoing debate as to whether opening medicine programmes in the interior of the country can induce physicians to stay in these lo ...[more]

PMID: 29716607

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Project description:BACKGROUND:Schistosomiasis is highly debilitating and related to poverty, leading to chronic health problems. This disease is important for public health due to the high prevalence, severity of clinical forms and heterogeneous spatial and temporal patterns. In Brazil, about 1.5 million people are at risk of infection with Schistosoma mansoni, with an annual average of 500 deaths. In this study, the temporal change in mortality was evaluated in relation to the effects of age, period and birth cohort, in Brazil and regions, from 1980 to 2014. METHODS:In this study, we analyzed the influence of age, period and birth cohort (APC effects) on the temporal evolution of schistosomiasis mortality in Brazil from 1980 to 2014, according to sex and geographic regions of the country. The death records were extracted from the SIM (Mortality Information System) of the DATASUS website (Department of National Health Informatics) of the Ministry of Health of Brazil. The temporal effects were estimated using Bayesian models and the INLA (Integrated Nested Laplace Approximations) method for parameter inference. RESULTS:More than 24 thousand deaths were registered in the analyzed period, mainly in men from the Northeast region. In Brazil, children under 14 years of age had protection against death from schistosomiasis. There was no significant effect for others ages. From 1990 to 1999, there was a protective effect for death from schistosomiasis and a null effect in the other periods. There was a decreasing trend in the risk of death among birth cohorts. The greatest risk was among people born from 1903 to 1912. There was a protective effect for death among people born after 1968. Men were at risk of death between 25 and 54 years old, while women were at risk after seventy years of age. The southern and central-western regions had a risk of death until 1989 and had a protective effect between1995 and 1999. The northern region had a risk of death between 1985 and 1994, and a protective effect after 2005. The northeast and Southeast regions had protective effects for death between the years 1990 and 1999, and after 2000, respectively. People born until 1952 and 1957 were at risk of dying in the South and North regions, respectively, and a protective effect among people born after 1968, in both regions. In the Northeast region, there was a protective effect among people born after 1963. In the other regions, there was a risk of death among people born until 1962 and a protective effect among people born after 1973. The Central-West region had the least declining trend in risk of death among birth cohorts. CONCLUSIONS:The birth cohorts had a great influence on the decreasing trend of schistosomiasis mortality in Brazil. This result may be due to the interaction between demographic changes and greater access to health and sanitation services, in addition to the impact of schistosomiasis control measures experienced by younger cohorts.

Project description:BackgroundDescribing the prevalence and trends of cardiometabolic risk factors that are associated with non-communicable diseases (NCDs) is crucial for monitoring progress, planning prevention, and providing evidence to support policy efforts. We aimed to analyse the transition in body-mass index (BMI), obesity, blood pressure, raised blood pressure, and diabetes in the Americas, between 1980 and 2014.MethodsWe did a pooled analysis of population-based studies with data on anthropometric measurements, biomarkers for diabetes, and blood pressure from adults aged 18 years or older. A Bayesian model was used to estimate trends in BMI, raised blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg), and diabetes (fasting plasma glucose ≥7·0 mmol/L, history of diabetes, or diabetes treatment) from 1980 to 2014, in 37 countries and six subregions of the Americas.Findings389 population-based surveys from the Americas were available. Comparing prevalence estimates from 2014 with those of 1980, in the non-English speaking Caribbean subregion, the prevalence of obesity increased from 3·9% (95% CI 2·2-6·3) in 1980, to 18·6% (14·3-23·3) in 2014, in men; and from 12·2% (8·2-17·0) in 1980, to 30·5% (25·7-35·5) in 2014, in women. The English-speaking Caribbean subregion had the largest increase in the prevalence of diabetes, from 5·2% (2·1-10·4) in men and 6·4% (2·6-10·4) in women in 1980, to 11·1% (6·4-17·3) in men and 13·6% (8·2-21·0) in women in 2014). Conversely, the prevalence of raised blood pressure has decreased in all subregions; the largest decrease was found in North America from 27·6% (22·3-33·2) in men and 19·9% (15·8-24·4) in women in 1980, to 15·5% (11·1-20·9) in men and 10·7% (7·7-14·5) in women in 2014.InterpretationDespite the generally high prevalence of cardiometabolic risk factors across the Americas, estimates also showed a high level of heterogeneity in the transition between countries. The increasing prevalence of obesity and diabetes observed over time requires appropriate measures to deal with these public health challenges. Our results support a diversification of health interventions across subregions and countries.FundingWellcome Trust.

Project description:ImportanceIncreasing diversity in the physician workforce is a fulcrum for reducing health disparities. Efforts to increase the diversity in the internal medicine (IM) workforce may improve health equity among an increasingly diverse population with increasing prevalence of chronic disease.ObjectivesTo assess diversity trends in the academic IM workforce and evaluate how well these trends reflected medical student diversity and the changing demographic composition of the general population.Design, setting, and participantsThis secondary analysis of a cross-sectional study analyzed data from January 1, 1980, to December 31, 2018, from the Association of American Medical Colleges Faculty Roster and Applicant Matriculant File, which capture full-time US medical school faculty and matriculants, respectively, and population data through 2017 from the US Census Bureau.Main outcomes and measuresThe study calculated the proportions of women and individuals from racial/ethnic groups that are traditionally underrepresented in medicine (URM) among IM faculty and faculty in all other clinical departments. These data were compared with the proportions of female and URM matriculants in US medical schools and the proportions of women and individuals from underrepresented racial/ethnic groups in the population. The analysis was stratified by sex, race/ethnicity, and intersections of sex and race/ethnicity.ResultsFrom 1980 to 2018, the absolute number of full-time IM faculty increased from 10 964 to 42 547. Although IM was the department classification with the most women faculty, in 2018 it continued to have a lower proportion of women (n = 17 165 [40.3%]) compared with all other clinical departments (n = 48 936 [43.2%]). Among IM faculty, the percentage of URM faculty members more than doubled during the study period (from 4.1% to 9.7%) but still made up only a small portion of faculty members. The percentage of female matriculants among medical school matriculants increased steadily (from 28.7% in 1980 to 51.6% in 2018) and was nearly identical to their population representation in 2017 (50.7% compared with 50.8%). Although the percentage of URM matriculants had nearly doubled since 1980 (from 11.3% to 18.1%), it still lagged far behind the proportion of individuals in the US population who are members of underrepresented racial/ethnic groups (18.1% vs 31.5% in 2017).Conclusions and relevanceThis cross-sectional study found that progress has been made in diversifying academic IM faculty; however, it does not yet reflect the diversity of medical students or the US population. Continued efforts to increase the diversity of the academic IM workforce are needed.

Project description:IntroductionCancer is a leading cause of morbidity and mortality in the United States and results in a high economic burden.ObjectiveTo estimate age-standardized mortality rates by US county from 29 cancers.Design and settingDeidentified death records from the National Center for Health Statistics (NCHS) and population counts from the Census Bureau, the NCHS, and the Human Mortality Database from 1980 to 2014 were used. Validated small area estimation models were used to estimate county-level mortality rates from 29 cancers: lip and oral cavity; nasopharynx; other pharynx; esophageal; stomach; colon and rectum; liver; gallbladder and biliary; pancreatic; larynx; tracheal, bronchus, and lung; malignant skin melanoma; nonmelanoma skin cancer; breast; cervical; uterine; ovarian; prostate; testicular; kidney; bladder; brain and nervous system; thyroid; mesothelioma; Hodgkin lymphoma; non-Hodgkin lymphoma; multiple myeloma; leukemia; and all other cancers combined.ExposureCounty of residence.Main outcomes and measuresAge-standardized cancer mortality rates by county, year, sex, and cancer type.ResultsA total of 19 511 910 cancer deaths were recorded in the United States between 1980 and 2014, including 5 656 423 due to tracheal, bronchus, and lung cancer; 2 484 476 due to colon and rectum cancer; 1 573 593 due to breast cancer; 1 077 030 due to prostate cancer; 1 157 878 due to pancreatic cancer; 209 314 due to uterine cancer; 421 628 due to kidney cancer; 487 518 due to liver cancer; 13 927 due to testicular cancer; and 829 396 due to non-Hodgkin lymphoma. Cancer mortality decreased by 20.1% (95% uncertainty interval [UI], 18.2%-21.4%) between 1980 and 2014, from 240.2 (95% UI, 235.8-244.1) to 192.0 (95% UI, 188.6-197.7) deaths per 100 000 population. There were large differences in the mortality rate among counties throughout the period: in 1980, cancer mortality ranged from 130.6 (95% UI, 114.7-146.0) per 100 000 population in Summit County, Colorado, to 386.9 (95% UI, 330.5-450.7) in North Slope Borough, Alaska, and in 2014 from 70.7 (95% UI, 63.2-79.0) in Summit County, Colorado, to 503.1 (95% UI, 464.9-545.4) in Union County, Florida. For many cancers, there were distinct clusters of counties with especially high mortality. The location of these clusters varied by type of cancer and were spread in different regions of the United States. Clusters of breast cancer were present in the southern belt and along the Mississippi River, while liver cancer was high along the Texas-Mexico border, and clusters of kidney cancer were observed in North and South Dakota and counties in West Virginia, Ohio, Indiana, Louisiana, Oklahoma, Texas, Alaska, and Illinois.Conclusions and relevanceCancer mortality declined overall in the United States between 1980 and 2014. Over this same period, there were important changes in trends, patterns, and differences in cancer mortality among US counties. These patterns may inform further research into improving prevention and treatment.

Project description:ObjectiveTo evaluate the association between self-rated evidence-based medicine (EBM) competencies and the prescription of drugs without scientific evidence against mild COVID-19 (present with any of the signs and symptoms of COVID-19 but who do not have shortness of breath, dyspnea, or abnormal chest imaging) among recently graduated physicians in Peru.MethodsWe conducted an analytical cross-sectional study where we evaluated a non-probability sample of recently graduated physicians during June and July 2021 (end of second wave of COVID-19 in Peru). Self-rated EBM competencies were assessed by four domains (formulation of a clinical question, search, analysis, and application) using a Likert scale with scores from zero to four ("Very inadequate" = 0, to "Very Adequate" = 4), it was considered as "Adequate" if the score was three or four. In addition, the variable "General competence on EBM" was rated as "Adequate" if in all domains evaluated it presented an adequate self-rating. For the outcome, drug prescription, we considered the use of ivermectin, azithromycin, other antibiotics, hydroxychloroquine, dexamethasone, and anticoagulants (drugs with no efficacy demonstrated for patients with mild COVID-19). To assess the association, we used Poisson regression models with robust variances and obtaining crude (cPR) and adjusted (aPR) prevalence ratios with their 95% confidence intervals (95%CI).ResultsOf a total of 239 physicians included 70.7% prescribed at least one drug without scientific evidence. A total of 51.1% reported adequate ratings in all evaluated domains of EBM. Self-rating the "Clinical Question Formulation" competency as adequate was associated with a lower frequency of prescribing medications for mild COVID-19 (aPR: 0.93; 95% CI: 0.91-0.95). While self-rating as adequate the competency of "Identify possible implications of investigations" was associated with an increase in the prescription of such drugs (aPR: 1.14; 95% CI: 1.09-1.20). Additionally, self-rating all domains as adequate were associated with less prescription (aPR: 0.93; 95% CI: 0.90-0.96).ConclusionSeven out of ten recently graduated physicians prescribed some type of medication without scientific evidence to treat patients with mild COVID-19. Having adequate self-perceived EBM competencies was associated with a lower frequency of prescribing medications without scientific evidence to manage patients with mild COVID-19.

Project description:In the United States, regional variation in cardiovascular mortality is well-known but county-level estimates for all major cardiovascular conditions have not been produced.To estimate age-standardized mortality rates from cardiovascular diseases by county.Deidentified death records from the National Center for Health Statistics and population counts from the US Census Bureau, the National Center for Health Statistics, and the Human Mortality Database from 1980 through 2014 were used. Validated small area estimation models were used to estimate county-level mortality rates from all cardiovascular diseases, including ischemic heart disease, cerebrovascular disease, ischemic stroke, hemorrhagic stroke, hypertensive heart disease, cardiomyopathy, atrial fibrillation and flutter, rheumatic heart disease, aortic aneurysm, peripheral arterial disease, endocarditis, and all other cardiovascular diseases combined.The 3110 counties of residence.Age-standardized cardiovascular disease mortality rates by county, year, sex, and cause.From 1980 to 2014, cardiovascular diseases were the leading cause of death in the United States, although the mortality rate declined from 507.4 deaths per 100?000 persons in 1980 to 252.7 deaths per 100?000 persons in 2014, a relative decline of 50.2% (95% uncertainty interval [UI], 49.5%-50.8%). In 2014, cardiovascular diseases accounted for more than 846?000 deaths (95% UI, 827-865 thousand deaths) and 11.7 million years of life lost (95% UI, 11.6-11.9 million years of life lost). The gap in age-standardized cardiovascular disease mortality rates between counties at the 10th and 90th percentile declined 14.6% from 172.1 deaths per 100?000 persons in 1980 to 147.0 deaths per 100?000 persons in 2014 (posterior probability of decline >99.9%). In 2014, the ratio between counties at the 90th and 10th percentile was 2.0 for ischemic heart disease (119.1 vs 235.7 deaths per 100?000 persons) and 1.7 for cerebrovascular disease (40.3 vs 68.1 deaths per 100?000 persons). For other cardiovascular disease causes, the ratio ranged from 1.4 (aortic aneurysm: 3.5 vs 5.1 deaths per 100?000 persons) to 4.2 (hypertensive heart disease: 4.3 vs 17.9 deaths per 100?000 persons). The largest concentration of counties with high cardiovascular disease mortality extended from southeastern Oklahoma along the Mississippi River Valley to eastern Kentucky. Several cardiovascular disease conditions were clustered substantially outside the South, including atrial fibrillation (Northwest), aortic aneurysm (Midwest), and endocarditis (Mountain West and Alaska). The lowest cardiovascular mortality rates were found in the counties surrounding San Francisco, California, central Colorado, northern Nebraska, central Minnesota, northeastern Virginia, and southern Florida.Substantial differences exist between county ischemic heart disease and stroke mortality rates. Smaller differences exist for diseases of the myocardium, atrial fibrillation, aortic and peripheral arterial disease, rheumatic heart disease, and endocarditis.

Dataset Information

Internal migration of physicians who graduated in Brazil between 1980 and 2014.

Publications

Internal migration of physicians who graduated in Brazil between 1980 and 2014.

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