Percent In Urban Areas Research Articles

A Cross-Sectional Study on Quality of Life of Patients with Coronary Artery Disease Attending Out Patient Cardiology Department of a Tertiary Care Hospital, Kolkata

Introduction: Developing countries like India prevalence of coronary artery disease (CAD) is increasing day to day from 1.6 percent to 7.6 percent in rural areas and 1.0 percent to 13.6 percent in urban areas in last few decades and it is going to be a double burden near 2035. Indians are known to have the highest coronary artery disease (CAD) rates.Objective: To find out the socio-demographic characteristics and clinical profile of the patients suffering from coronary artery disease (CAD) attending a tertiary care hospital. This study also assessed the health-related quality of life (HRQOL) of patients.Method: A hospital based cross sectional study was done in Patients more than 18 years of age with coronary artery disease attending Cardiology OPD SSKM Hospital in Kolkata. The study was done from the year August 2020 to September 2022. The study was done on 220 patients by using a structured pretested Mac New HRQOL questionnaire. Results: The median age of coronary artery disease patients was 56 (50-62) years. Around one-third portion (34.1%) of the study participants achieved a primary level of education. The Median (IQR) of per capita income (Rs/month) of the study participants was 2000 (1250-3938). Nearly three fourth (71.4%) participants had various types of co-morbidities. Clinically, 88.2% had normal heart rates, 51.4% had normal blood pressure and 43.6% had low ejection fraction. MacNew HRQOL score among participants were 4.7,4.8,4.4 in social, emotional and physical domain, respectively. Conclusion: Male gender, lower socio-economic conditions, low level of education, inadequate dietary diversity patterns and substance user outnumbered their counterpart. The HRQOL was found satisfactory but lacking in physical domain.

Legal Issues Involved in Electronic Payments System in India

The Indian economy has developed rapidly after the induction of digital interfaces in commerce, trade, and industry particularly after the popularisation of electronic payment systems or digital banking. Since 2016 when the Government of India announced demonetization, electronic payments have been rising and are expected to continue in the future because the government has promoted these types of payments. Internet penetration in India was 47 percent in 2022 and it was more than 100 percent in urban areas as compared to rural areas, now with the expansion of the information technology-enabled generation which is using digital modes of payments more in their daily transactions has resulted in more than 140 crore rupees each day through various methods of digital prevailing in India. State Governments are also prioritizing and making more efforts to ensure that the unprivileged people should have to be provided access to web services so that they may also make payments conciliatory through this method. Resultantly, there are 103 billion digital transactions worth Indian rupee 166 trillion in the financial year 2023. It is also expected that digital transactions will also rise to 411 trillion by the year 2027. Consequently, on advent of high tech system of fund transfer and its enormous use several cases of fraud have also been taking place on daily basis. The legislation has enacted various laws in connivance with the global laws, to resolve the problem, but they are still prevailing. The present study has been conducted to identify the legal issues and the results arising from these issues and to recommend some pathways to recover from these obstacles. This study further explains the further way to improvement in fund transfer and making payments using digital mode. Consequently, it is found that the present legal system does not have sufficient provisions to stop such fraud, and blockage of money with the UPI, payment gateways, banks, and merchants. There is no single online solution to these problems. The banking ombudsman is working on resolving some of the issues, but due to the red tapism, such transactions of payment failure and fraud websites could not be resolved. Sufficient amendments dealing with such transactions have not been incorporated in the present Consumer Protection Act. Hence, it is recommended that there should be a virtual hearing in the office of the ombudsman as well as in the court of President Consumers Protection.

Impact of Soot on the Environment, Livestock and the Well Being of Inhabitants of the Niger Delta Region, Nigeria

This study was carried out to review the impact of soot on the environment, livestock and the well being of inhabitants of the Niger Delta Region, Nigeria. The study revealed that the environmental hazards caused by soot have become so alarming with the increase in artisanal refining of crude oil in the Niger Delta region of Nigeria. According to sources, the first observation of a high concentration of soot in parts of Port Harcourt was in November 2016. The soot first appears as clouds laden with dark particulate matter on the skyline in various parts of the state. The black soot accumulates in homes and makes everywhere appear dirty, even when cleaned thoroughly and regularly. It is visible on window nets, streets, walls, floors, and bedsheets, both private and public places, even on children’s feet, innocently playing. Residents frequently wake up to toxic hydrocarbon emissions from nearby creeks and waterways that remain in the air for hours. A visitor could easily conclude that heavy rain was on the way. Still, for the residents who have grown accustomed to the situation, it’s a sobering reminder of an environmental problem that refuses to go away. From this review, it is observed that soot pollution has contributed significantly to the unavailability of safe drinking water—76–80 percent in rural areas and 50–55 percent in urban areas lack access to safe drinking water. This supports the April 2018 ranking of Port Harcourt as one of the most polluted cities in the world, with an air index of 188. Similarly, Air Visual ranked Port Harcourt as “very unhealthy” for sensitive groups, having attained an air index of 207.817 in December 2020. Different impact of soot on temperature variability and the well being of inhabitants of Rivers State, Nigeria were identified that call for urgent attention.

Household’s Willingness to Pay for Safe Drinking Water: A Case Study of Abbottabad District

Drinking water is the basic need of human life. Safe drinking water is an essential component of primary health care and have vital role in poverty alleviation. There is positive correlation between increased national income and the proportion of population with access to improved water supply. An increase of 0.3 percent investment in household access to safe drinking water generates one percent increase in GDP. Whereas, provision of safe drinking water supply is an effective health intervention reduces the mortality caused by water-borne diseases by an average 70 percent. Inadequate drinking water not only resulted in more sickness and deaths, but also augments health costs, lower worker productivity and school enrolment [World Bank (1994)]. The World Health Organisation (WHO) estimate 1.8 million people in developing countries die every year from diarrhea and cholera, Out of these 90 percent are children under the age of five years. While 88 percent of diarrhoeal diseases are attributed to unsafe water supply, inadequate sanitation and hygiene [WHO (2004)]. The situation is not very different in Pakistan; the access to safe drinking water is estimated to be available to 23.5 percent of population in rural areas and 30 percent in urban areas. While every year 0.2 million children die due to diarrhoeal diseases [Rosemann (2005)].

Nature, pattern, and changes in alcohol consumption among men in India: Insights from NFHS-4 and NFHS-5

The consumption pattern of alcohol varies between cultures and different communities. Moreover, alcohol consumption pattern depends on age, religion, education, type of drink, and other socio-economic parameters. Alcohol use has reportedly declined in most developed counties, but developing countries still witnessed an increasing trend. The study investigated socio-economic drivers, nature, and patterns of alcohol use among adult men in India. We have also investigated the state-level alcohol prevalence in India better to understand the impact of state-level alcohol prohibition policies. We have retrieved the data from the National Family Health survey’s fourth and fifth-round, which was conducted in 2015–2016 and 2020–2021, respectively. We used the bi-variate technique to estimate that percentage of men who consume alcohol. Furthermore, a multivariate logistic regression model was applied to assess the association of each background characteristic with alcohol consumption. It is observed that 19 percent of men aged 15 and above currently drink alcohol, including 20 percent in rural and 17 percent in urban areas. The consumption of tadi/madi/country liquor/homemade liquor was high in rural areas than in urban areas in both rounds of the survey. Additionally, beer or wine consumption is higher in urban areas than in rural areas in NFHS-4 and NFHS-5. Among the 35–49 years of age group, around 6 and 8 times more likely to consume alcohol in NFHS-4 and NFHS-5, respectively. Rural men were 18 and one percent less likely to consume alcohol in NFHS-4 & 5 compared to urban (OR: 0.82 and 0.99 in NFHS-4 & 5 respectively). Despite an overall reduction in alcohol consumption among men, lowering alcohol consumption remains the main priority of policymakers. There is a need to target the most vulnerable socio-economic segments where alcohol consumption is still a problem, one of the primary reasons for violence against women.

Micro-ECG-monitoring system based on arduino with bluetooth feature

Cardiovascular disease (CVD) is one of India's most deadly diseases, with a 4.77 million annual death rate in 2020 [1]. CVD rates have risen from 1.6 percent to 7.4 percent in rural areas and from 1 percent to 13.2 percent in urban areas [1]. Electrocardiogram (ECG) devices, which monitor the heart's activity, are far too expensive to be used for personal care. In this project, we created a low-cost device using an Arduino (UNO/MEGA) microprocessor and a Real-time ECG graph display feature. The main instrument for measuring the pulse is the AD8232 sensor, which converts the sense-voltage obtained from ECG electrodes placed on the body. Integrating Arduino microcontroller (Uno/Mega) and Bluetooth module HC-05, the ECG readout may be presented on a mobile phone's monitor in real-time 24x7. The ECG simul externally attached can provide the accurate 12-lead ECG that depicts the patients' current health status in real time. This portable ECG has produced a satisfactory outcome in terms of production costs.

Socioeconomic Study on the Prevalence and Pattern of Various Neurological Disorders in Urban and Rural Areas

Introduction: Neurological disorders are defined as problems that affect the brain as well as the nerves located throughout the human body and the spinal cord. Underlying, metabolic or electrical imbalances in the brain, spinal cord, or other nerves can cause a variety of adverse effects. Aim of the study: The Socio-Economical on The Prevalence and Pattern of Various Disorders Regarding Neurology in Urban and Rural Areas of kpk was studied in this study. Methodology: The research was carried out in the Department of Neurology at dhq Hospital Timergira on the urban and rural populations of the KPK district of Peshawar. In a two-phase design, each area received a proportional representation in sample size allocation, and the probability proportional to size (PPS) technique was applied. An individual's case of neurological illness was only confirmed after a professional evaluation. A total of 260 patients (out of 7800 samples) tested positive for neurological diseases, yielding a 2.6 percent crude prevalence. The crude frequency in rural regions was 2.28 percent, whereas it was 5.4 percent in urban areas. Migraine was the most common disorder. Conclusion: Given the increasing occurrence of serious neurological illnesses, there is a need for healthcare personnel to be trained in their treatment.

Pinpointing optimized air quality model performance over the Beijing-Tianjin-Hebei region: Mosaic approach

Mosaic approach, with certain number of tiles representing land use (LU) types in each grid cell, had been implemented into WRF-Noah model. Previous studies found mosaic approach had a better performance on meteorological parameters than only considering dominant LU in dominant approach. In this study, the impacts of mosaic approach on meteorological parameters and air quality were investigated in WRF-CMAQ over Beijing-Tianjin-Hebei (BTH) region in China in 2020. Results showed that mosaic approach improved the simulation results of WS10 (surface wind speed at 10 m), T2 (temperature at 2 m), and RH (relative humidity) especially in nighttime in winter and were available for all stations with different percent of urban area. “MOS_TOPO” scenario, which coupled with mosaic approach and “topo-wind” schemes, obtained best simulation results of WS10 and T2 in January among six scenarios, with the lower average Root Mean Square Error of WS10 (1.18 m/s) and Mean Bias of T2 (0.55 °C) for all stations. Meanwhile, mosaic approach obtained lower |NMB| of PM2.5 than dominant approach in more than 69% cities in BTH region. Cities in southern Hebei province, especially Xingtai city, were identified as the most sensitive area for PM2.5 simulation affected by mosaic approach. Although the mosaic approach has improved the simulation results of meteorological parameters, especially the nighttime simulation results of WS10, there is still some deviation in the simulation results of PM2.5. Accurate emission inventory, suitable physics option in numerical weather model and rational chemical mechanism in air quality model are the important factors for WRF-CMAQ.

Relationship between chewing tobacco, smoking, consuming alcohol and cognitive impairment among older adults in India: a cross\u2010sectional study

BackgroundPhysical aging increases the sensitivity to the effects of substance use, elevating the risk for cognitive impairment among older adults. Since studies on the association of substance use with cognitive ability in later years are scant in India, we aimed to explore the factors associated with cognitive impairment especially, alcohol consumption, smoking, and chewing tobacco later in life.MethodsThe present research used nationally representative data from Building a Knowledge Base on Population Aging in India (BKPAI) that was conducted in 2011, across seven states of India (N=9,453). Sample distribution along with percentage distribution was calculated for cognitive impairment over explanatory variables. For finding the association between cognitive impairment over explanatory variables, binary logistic regression models were estimated.ResultsAbout 16.5 percent of older adults in rural areas consumed smoked tobacco compared to 11.7 percent in urban areas. Nearly, 23.7 percent of rural older adults consumed smokeless tobacco in comparison to 16 percent in urban areas. Alcohol consumption was high among rural residents (7.9%) than urban counterparts (6.7%). The prevalence of cognitive impairment was 62.8% and 58% among older adults from rural and urban areas respectively. Older adults who smoked tobacco had a 24 percent significantly higher likelihood to have cognitive impairment with reference to older adults who did not smoke [OR: 1.24, CI: 1.02-1.49]. Moreover, older adults who consumed alcohol had a 30 percent significantly higher likelihood to have cognitive impairment [OR: 1.02, 1.65]. It was also found that older adults who had smoked along with consuming alcohol were at risk of worse cognitive outcomes than those who neither smoke nor drink alcohol [OR: 1.56, CI: 1.21-2.00] or consumed either of them unlike consuming smokeless tobacco only.ConclusionThe encouragement of older people to stop smoking and smokeless tobacco use could be considered as part of a strategy to reduce the incidence of cognitive impairment. Further, appropriate measures should be taken for the detection of early stages of cognitive decline in older individuals and efforts should be made to improve the availability and quality of care for dementing older adults.

Measurement and Analysis of Multidimensional Poverty Using Fuzzy Set Approach

The study was carried out to measure and analyse aspect based multidimensional poverty in rural and urban Haryana using a fuzzy set approach. The necessary data for the study was obtained from the 69th round conducted in 2012 by the NSSO on drinking water, sanitation, hygiene, and housing conditions. The Totally Fuzzy and Relative Approach was used. The fuzzy multidimensional poverty index for rural, urban and overall Haryana was calculated based on drinking water, sanitation, and housing conditions. The results revealed that 33.28 percent of households in Haryana overall were multidimentionally poor, with 36.64 percent of households in rural and 30.46 percent in urban areas. The government should lay the water connections and water pipes, construction of individual household latrines, sanitary complex for women, school, and sanitation housing schemes for all BPL families under schemes initiated by the government to overcome poverty based on these aspects.

District-level analysis of climate vulnerability and household nutrition status among rural communities in Odisha, India

Good nutrition is the foundation of human well-being that leads to better health, effective engagement of the workforce, and productive lifestyle, resulting in higher income and an integrated development trajectory. This paper attempts to comprehend the impact of climate vulnerability on household nutrition status through agriculture production systems in Odisha, India. This study using secondary data estimates a composite index of climate vulnerability on the agriculture ecosystem in Odisha at the district scale. Results suggest that among all the districts in Odisha, Bhadrak (0.193) is the most vulnerable district followed by Sonepur (0.191) and Baudh (0.190). On the other hand, Mayurbhanj (0.099) is the least vulnerable district followed by Ganjam (0.103) and Sundargarh (0.105). The fi ndings also suggest that there is a wide variation in vulnerability indicators among the districts in Odisha (0.099 – the lowest district value vs. 0.193 – the highest). The results of multivariate analysis evince that in households (both women and children) nutritional status, the composite value of “climate vulnerability” has a greater role in predicting the predictors in Odisha through the agriculture production system. The climate vulnerability has a positive and signifi cant relationship with forest area (r=0.403*), gross cropped area (r=0.489**), percent of scheduled caste population (r=0.510**), percent of urban area (r=0.427*), and per-capita income (r=0.712**). The fi ndings also signify that district-wise gross cropped area (t=3.01), average annual rainfall (t=4.05), area under irrigation (t=3.36), cropping intensity (t=3.60), and forest areas (t=1.81) play a more predictive role to determine the household nutritional status along with socioeconomic and health factors such as per-capita income (t=1.8), urbanization (t=1.91), and women’s anemic status (t=2.74). Drawing inferences from the empirical evidence, the study suggests that climate vulnerability has a much greater role in influencing household nutrition status, particularly with women and child nutrition through the agriculture production system. Appropriate policy level measures for climate-sensitive and adaptive action are the need of the hour to make agriculture production ecosystem contributes positively to nutrition status.

Food insecurity dynamics in India: A synthetic panel approach

Abstract This study examines food (in)security dynamics for India since the year 2000 using National Sample Survey data on household consumer expenditure. In the absence of true panel data, a synthetic panel approach has been applied to analyse food security transitions, in order to examine the movement of households both into and out of food security. The overall findings revealed that the maximum chronically food insecure households were 50.4 percent in rural and 46.1 percent in urban areas whereas the households which remained food secure were 39.8 percent in rural and 42.2 percent in urban areas. The maximum percentage of people who escape from food insecurity was 19.4 percent in rural and 18.6 percent in urban areas whereas the fall into the food insecurity in the rural was 29.2 percent and 30.2 percent in urban areas. The paper additionally evaluates food insecurity dynamics by income decile groups and different household identities, such as within the caste, religion, and gender of the households, which indicated that forward castes and Islam religion noticed a higher degree of food insecurity transition within the different caste and religious identities, respectively. Between the genders of the household head, the larger transition was observed for male and female-headed households, where male-headed shows inward and female-headed witnessed outward transition. The higher income groups are facing more inward and outward food insecurity transition in rural and urban areas. The results were robust to the under-reporting. This study provided a better understanding of food insecurity dynamics in India, which will help in effective policy design.

Association of household income and female labour force participation rate in income generating activities in hill rural areas of Uttarakhand

As per 2011 Census, about 70 per cent of population in Uttarakhand state resides in rural areas and the ten hill districts out of total 13 districts of the State comprises 48.1 per cent of its entire population. Difficult terrain, lack of transport, lack of employment due to non availability of industrial sector along with small farm sizes and low farm incomes has fuelled large migration from these hill rural areas of the Uttarakhand to the urban regions across the country. The various studies reflect upon the importance of women in the economy of the hill areas as they share the burden of their families and their participation in employment and subsistence cum income generating activities mainly in the rural regions is much higher than the males. The importance of women further enhances amidst the severe problem of migration of males and mainly of the youths from these regions to the urban areas. The women are left back to work in most tough conditions further taking care of the domestic chores. The females labour force participation is higher in rural areas of the state, as per National Sample Survey Office, 68th Round, the female labour force participation rate in rural areas was 31.5 percent and 10.8 percent in urban areas of the state. In this context it is very important to understand the nature of female labour force participation i.e. , whether it is in non-income generating sector like agriculture or in purely income generating sector which mainly comprises of both i.e., agriculture and non-agriculture sector. The present study analyses this distribution of female labour force participation and depicts the association between the female labour force participation in income generating activities and the total household income.

Schooling and Labor Market Impacts of Bolivia's Bono Juancito Pinto Program

Schooling and Labor Market Impacts of Bolivia's <i>Bono Juancito Pinto</i> Program

An Educational Programme of Sanitation in India: A Mirage to Reality

Sanitation is the need of the present era. It is the basis of disease free, clean environment and healthy aspect of a hygienic and decent life style. According to the World Bank data the 2.3 billion people in the world live without an access to a toilet and almost 892 million people practice open defecation. Only 69% of world’s population have an access to toilets and 38% have managed to go for safe and germs free defecation. It represents a high categorical underprivileged section of a society deprived of basic amenities. The Indian Ministry of Statistics and Programme implementation (MOPS) in its published 2016 report says that usage of toilet is 95.6 percent in rural region and 98.8 percent in urban areas which shows a considerable level of hygienic defecation process practices in Indian households. India has implemented Swacha Bharat Abhiyan (SBA) or Swacha Bharat Mission (SBM) with an objective of cleanliness drive and making India open defecation free. An NSSO survey reveals that 42.5 percent people in rural areas and 87.9 percent in urban areas have access to water facility in toilets. An educational drive or a comprehensive programme is implemented in India with wider application and coverage.

People’s perception and awareness on air pollution in rural and urban areas of Mymensingh Sadar upazila

The present study was conducted to investigate peoples’ perception level and awareness of air pollution in some selected areas of Mymensingh sadar upazila. The relationship of independent variables (age, educational qualification, family size, residence and communication exposure) with the peoples’ perception level and awareness of air pollution (dependent variable) was done to understand the objectives of the study. Six Hundreds (600) respondents were selected randomly from six study sites under Mymensingh sadar upazila for collecting data during the period of Jan 2016-April, 2017. Pearson’s product-moment correlation coefficients were computed to examine the relationship between the concerned variables. The findings revealed that about half (46.67 percent) of the peoples had medium perception and awareness, 31.67 percent had low and 21.67 percent had high perception and awareness about air pollution. In rural areas, 43.33 percent respondents had low, 50.00 percent had medium and only 6.67 percent had high perception and awareness of air pollution. In urban areas, 20.00 percent respondents had low, 43.33 percent had medium and 36.67 percent had high perception and awareness of air pollution. Majority of the respondents (93.33 percent) were lacking of proper awareness of air pollution in rural areas while 63.33 percent in urban areas. Out of five independent variables, three variables such as educational qualification, residence and communication exposure had positive and significant relationship, age had negative and significant relationship and family size had no relationship with their perception and awareness of air pollution.Progressive Agriculture 29 (1): 22-32, 2018

Declining urban and community tree cover in the United States

Paired aerial photographs were interpreted to assess recent changes (c. 2009–2014) in tree, impervious and other cover types within urban/community and urban land in all 50 United States and the District of Columbia. National results indicate that tree cover in urban/community areas of the United States is on the decline at a rate of about 175,000 acres per year, which corresponds to approximately 36 million trees per year. Estimated loss of benefits from trees in urban areas is conservatively valued at $96 million per year. Overall, for both urban and the broader urban/community areas, 23 states/districts had statistically significant declines in tree cover, 25 states had non-significant decreases or no change in tree cover, and three states showed a non-significant increase in tree cover. The most intensive change occurred within urban areas, with tree cover in these areas dropping one percent over the 5-year period, compared to a 0.7 percent drop in urban/community areas. States/districts with the greatest statistically significant annual decline in percent urban tree cover were: Oklahoma (−0.92%/yr), District of Columbia (−0.44%/yr), Rhode Island (−0.40%/yr), Oregon (−0.38%/yr) and Georgia (−0.37%/yr). Coinciding with the loss of tree cover was a gain in impervious cover, with impervious cover increasing 0.6 percent in urban/community areas and 1.0 percent in urban areas over the 5-year period. Such changes in cover types affect the benefits derived from urban forests and consequently the health and well-being of urban residents.

Deadly Cities? Spatial Inequalities in Mortality in sub‐Saharan Africa

We investigate whether sub‐Saharan African countries are affected by an “urban mortality penalty” repeating the history of industrialized countries during the nineteenth century. We analyze Demographic and Health Surveys from several sub‐Saharan African countries for differences in child and adult mortality between rural and urban areas. For the first decade of the 2000s, our findings indicate that child mortality is higher in rural than in urban areas for all countries. On average, child mortality rates are 13.6 percent in rural areas and 10.8 percent in urban areas. In contrast, average urban adult mortality rates (14.1 percent) have exceeded rural adult mortality rates (12.4 percent). Child mortality rates are on average 65 percent higher in urban slums than in formal settlements. Child mortality rates in slum areas are, however, still lower than or equal to those in rural areas for most countries in our sample.

Public Perceptions Of Private Health Care In Socialist China

We present the findings of a United Nations Development Programme-World Health Organization study commissioned by China's Ministry of Health on use of public and private ambulatory care services in three Chinese provinces. We found much unmet medical need (16 percent), attributed mainly to the perceived high cost of care. Seventy-one percent had no health insurance (90 percent in rural and 51 percent in urban areas). For 33 percent, the last consultation was with a private practitioner. Widespread dissatisfaction with public providers (mainly high user fees and poor staff attitudes) is driving patients to seek cheaper but lower-quality care from poorly regulated private providers.

The contribution of nurse practitioners and physician assistants to generalist care in Washington State.

To quantify the total contribution to generalist care made by nurse practitioners (NPs) and physician assistants (PAs) in Washington State. State professional licensure renewal survey data from 1998-1999. Cross-sectional. Data on medical specialty, place of practice, and outpatient visits performed were used to estimate productivity of generalist physicians, NPs, and PAs. Provider head counts were adjusted for missing specialty and productivity data and converted into family physician full-time equivalents (FTEs) to facilitate estimation of total contribution to generalist care made by each provider type. Nurse practitioners and physician assistants make up 23.4 percent of the generalist provider population and provide 21.0 percent of the generalist outpatient visits in Washington State. The NP/PA contribution to generalist care is higher in rural areas (24.7 percent of total visits compared to 20.1 percent in urban areas). The PAs and NPs provide 50.3 percent of generalist visits provided by women in rural areas, 36.5 percent in urban areas. When productivity data were converted into family physician FTEs, the productivity adjustments were large. A total of 4,189 generalist physicians produced only 2,760 family physician FTEs (1 FTE = 105 outpatient visits per week). The NP and PA productivity adjustments were also quite large. Accurate estimates of available generalist care must take into account the contributions of NPs and PAs. Additionally, simple head counts of licensed providers are likely to result in substantial overestimates of available care. Actual productivity data or empirically derived adjustment factors must be used for accurate estimation of provider shortages.