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Feng R, Yang C, Zhang Y, Chen B. Decline in reproductive health and its transgenerational lag effect. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 945:173994. [PMID: 38879036 DOI: 10.1016/j.scitotenv.2024.173994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/23/2024]
Abstract
In the last two decades, there has been a fast-growing prevalence of infertility reported in China. Moreover, Chinese reproductive health has shown a clear decline. Thus, it is imperative to determine the precipitating causes and the root causes of this decline. Environmental and climate risks (ECRs) may cause the decline in reproductive health. Experimental findings have shown that the impact of ECRs on reproductive health can be passed down from both males and females to their offspring, demonstrating an intergenerational and transgenerational lag effect. We perceive that the declined reproductive health may lead to negative demographic consequences in China; therefore, we suggest the following five regulations be implemented: (i) prevent Chinese of childbearing age from exposure to ECRs; (ii) further develop and promote assisted reproductive technology and set up sperm and ovum banks on a national scale; (iii) quantitatively establish the causality between fathers and mothers who suffer from ECRs and the impaired reproductive health in their progeny; (iv) teach ECRs-health knowledge in psychotherapeutic training and continuing education; and (v) propagate and further promote common prosperity.
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Affiliation(s)
- Rui Feng
- School of engineering, Hangzhou Normal University, Hangzhou 311121, China; College of Environmental and Resource Sciences, Zhejiang University, Hangzhou 310058, China
| | - Cuiyu Yang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310020, China
| | - Yinli Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310020, China
| | - Bin Chen
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou 310020, China.
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Krane F, Heck VJ, Leyendecker J, Klug K, Klug A, Hackl M, Kircher J, Müller LP, Leschinger T. The Future of Total Elbow Arthroplasty: A Statistical Forecast Model for Germany. Healthcare (Basel) 2024; 12:1322. [PMID: 38998857 PMCID: PMC11241371 DOI: 10.3390/healthcare12131322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
This study provides a statistical forecast for the development of total elbow arthroplasties (TEAs) in Germany until 2045. The authors used an autoregressive integrated moving average (ARIMA), Error-Trend-Seasonality (ETS), and Poisson model to forecast trends in total elbow arthroplasty based on demographic information and official procedure statistics. They predict a significant increase in total elbow joint replacements, with a higher prevalence among women than men. Comprehensive national data provided by the Federal Statistical Office of Germany (Statistisches Bundesamt) were used to quantify TEA's total number and incidence rates. Poisson regression, exponential smoothing with Error-Trend-Seasonality, and autoregressive integrated moving average models (ARIMA) were used to predict developments in the total number of surgeries until 2045. Overall, the number of TEAs is projected to increase continuously from 2021 to 2045. This will result in a total number of 982 (TEAs) in 2045 of mostly elderly patients above 80 years. Notably, female patients will receive TEAs 7.5 times more often than men. This is likely influenced by demographic and societal factors such as an ageing population, changes in healthcare access and utilization, and advancements in medical technology. Our projection emphasises the necessity for continuous improvements in surgical training, implant development, and rehabilitation protocols.
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Affiliation(s)
- Felix Krane
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Vincent Johann Heck
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jannik Leyendecker
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Kristina Klug
- Department of Psychology, Goethe-University Frankfurt, Theodor-W.-Adorno Platz 6, PEG, 60629 Frankfurt am Main, Germany
| | - Alexander Klug
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389 Frankfurt am Main, Germany
| | - Michael Hackl
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jörn Kircher
- Department of Shoulder and Elbow Surgery, ATOS Klinik Fleetinsel Hamburg, Admiralitätstrasse 3-4, 20459 Hamburg, Germany
- Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40255 Düsseldorf, Germany
| | - Lars Peter Müller
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Tim Leschinger
- University Hospital Cologne, Department of Orthopedics, Trauma and Plastic Surgery, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Mburu G, Kiarie J, Allotey P. Towards a nuanced view and response to global fertility trends. Lancet 2024; 403:1953-1956. [PMID: 38521085 DOI: 10.1016/s0140-6736(24)00490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Gitau Mburu
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva 1211, Switzerland.
| | - James Kiarie
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva 1211, Switzerland
| | - Pascale Allotey
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva 1211, Switzerland
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Aitken RJ. What is driving the global decline of human fertility? Need for a multidisciplinary approach to the underlying mechanisms. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 6:1364352. [PMID: 38726051 PMCID: PMC11079147 DOI: 10.3389/frph.2024.1364352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/03/2024] [Indexed: 05/12/2024] Open
Abstract
An intense period of human population expansion over the past 250 years is about to cease. Total fertility rates are falling dramatically all over the world such that highly industrialized nations, including China and the tiger economies of SE Asia, will see their populations decline significantly in the coming decades. The socioeconomic, geopolitical and environmental ramifications of this change are considerable and invite a multidisciplinary consideration of the underlying mechanisms. In the short-term, socioeconomic factors, particularly urbanization and delayed childbearing are powerful drivers of reduced fertility. In parallel, lifestyle factors such as obesity and the presence of numerous reproductive toxicants in the environment, including air-borne pollutants, nanoplastics and electromagnetic radiation, are seriously compromising reproductive health. In the longer term, it is hypothesized that the reduction in family size that accompanies the demographic transition will decrease selection pressure on high fertility genes leading to a progressive loss of human fecundity. Paradoxically, the uptake of assisted reproductive technologies at scale, may also contribute to such fecundity loss by encouraging the retention of poor fertility genotypes within the population. Since the decline in fertility rate that accompanies the demographic transition appears to be ubiquitous, the public health implications for our species are potentially devastating.
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Affiliation(s)
- Robert John Aitken
- Priority Research Centre for Reproductive Science, Discipline of Biological Sciences, School of Environmental and Life Sciences, College of Engineering Science and Environment, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Carey JR, Eriksen B, Srinivasa Rao ASR. Congressional Symmetry: Years Remaining Mirror Years Served in the U.S. House and Senate. GENUS 2023; 79:5. [PMID: 38846561 PMCID: PMC11156217 DOI: 10.1186/s41118-023-00183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/13/2023] [Indexed: 02/15/2023] Open
Abstract
Our overarching goal in this paper was to both test and identify applications for a fundamental theorem of replacement-level populations known as the Stationary Population Identity (SPI), a mathematical model that equates the fraction of a population age x and the fraction with x years to live. Since true stationarity is virtually non-existent in human populations as well as in populations of non-human species, we used historical data on the memberships in both chambers of the U.S. Congress as population proxies. We conceived their fixed numbers (e.g., 100 Senators; 435 Representatives) as stationary populations, and their years served and years remaining as the equivalent of life lived and life remaining. Our main result was the affirmation of the mathematical prediction-i.e., the robust symmetry of years served and years remaining in Congress over the approximately 230 years of its existence (1789-2022). A number of applications emerged from this regularity and the distributional patterns therein including (1) new metrics such as Congressional half-life and other quantiles (e.g., 95% turnover); (2) predictability of the distribution of member's years remaining; (3) the extraordinary information content of a single number-the mean number of years served [i.e., derive birth (b) and death (d) rates; use of d as exponential rate parameter for model life tables]; (4) the concept of and metrics associated with period-specific populations (Congress); (5) Congressional life cycle concept with Formation, Growth, Senescence and Extinction Phases; and (6) longitudinal party transition rates for 100% Life Cycle turnover (Democrat/Republican) i.e., each seat from predecessor party-to-incumbent party and from incumbent party-to-successor party. Although our focus is on the use of historical data for Congressional members, we believe that most of the results are general and thus both relevant and applicable to most types of stationary or quasi-stationary populations including to the future world of zero population growth (ZPG).
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Affiliation(s)
- James R Carey
- Department of Entomology, University of California, Davis 95616, USA
- Center for the Economic and Demography of Aging, University of California, Berkeley 94720, USA
| | - Brinsley Eriksen
- London School of Economics and Political Science, Houghton St, London WC2A 2AE, United Kingdom
| | - Arni S R Srinivasa Rao
- Medical College of Georgia, Augusta University, GA, USA
- Laboratory for Theory and Mathematical Modeling, Division of Infectious Diseases, Department of Mathematics, Augusta University, Georgia, GA, USA
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Heck VJ, Klug K, Prasse T, Oikonomidis S, Klug A, Himpe B, Egenolf P, Lenz M, Eysel P, Scheyerer MJ. Projections From Surgical Use Models in Germany Suggest a Rising Number of Spinal Fusions in Patients 75 Years and Older Will Challenge Healthcare Systems Worldwide. Clin Orthop Relat Res 2023; 481:1610-1619. [PMID: 36779601 PMCID: PMC10344528 DOI: 10.1097/corr.0000000000002576] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/06/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Spinal fusion is a well-established procedure in the treatment of degenerative spinal diseases. Previous research shows that the use of this operative treatment has been growing in recent decades in industrialized countries and has become one of the most cost-intensive surgical procedures. It seems that in some countries such as Germany-with its large, industrialized, European population-this increase is mainly driven by demographic changes with low fertility rates, increasing life expectancy, and an aging population. Based on current projections, however, Germany faces a population trend that many other countries are likely to follow within a few decades. An increasingly shrinking and aging working population may eventually put the healthcare system under enormous pressure, with greater demands for spinal fusions and associated higher costs. Thus, we aimed to provide reliable projections regarding the future demand for posterior spinal fusion procedures including age- and gender-related trends up to 2060, which will be necessary for future resource planning and possible improvements in actual treatment strategies. QUESTIONS/PURPOSES (1) How is the use of posterior spinal fusions in Germany expected to change from 2019 through 2060, if currents trends continue? (2) How is the use of posterior spinal fusions in Germany expected to change depending on patients' age and gender during this time period? METHODS Comprehensive nationwide data provided by the Federal Statistical Office, the official institution for documenting all data on operations and procedures performed in Germany, were used to quantify posterior spinal fusion rates as a function of calendar year, age, and gender. Because there is a lack of evidence regarding future trends in the use of posterior spinal fusions, an autoregressive integrated moving average model on historical procedure rates from 2005 to 2019 in relation to official population projections from 2020 to 2060 was chosen to forecast future absolute numbers and incidence rates of this procedure in Germany. Long-term forecasting is more prone to unexpected disruptions than forecasting over short-term periods; however, longer spans facilitate estimates of how trends may challenge future healthcare systems if those trends continue, and thus are useful for research and planning. RESULTS The incidence rate of posterior spinal fusion was projected to increase by approximately 83% (95% CI 28% to 139%) to 102% per 100,000 inhabitants (95% CI 71% to 133%) in 2060, with a 1.3-fold higher rate of women undergoing surgery in terms of absolute numbers. The highest increase identified by the model occurred in patients 75 years and older with 38,974 (95% CI 27,294 to 50,653) posterior spinal fusions in 2060, compared with 14,657 in 2019. This trend applied for both women and men, with a 246% (95% CI 138% to 355%) increase in the total number of posterior spinal fusions for women 75 years and older and a 296% (95% CI 222% to 370%) increase for men 75 years and older. At the same time, posterior spinal fusions in all age groups younger than 55 years were projected to follow a constant or even negative trend up to 2060. CONCLUSION Our findings suggest that increasing use of posterior spinal fusion, particularly in patients 75 years and older, will challenge healthcare systems worldwide if current trends persist. This study may serve as a model for many other industrialized countries facing similar demographic and procedure-specific developments in the future. This emphasizes the need to focus on frailty research as well as appropriate financial and human resource management. Effective perioperative medical management, multidisciplinary treatment, and interinstitutional protocols are warranted, especially in older patients as we attempt to manage these trends in the future. LEVEL OF EVIDENCE Level III, economic and decision analysis.
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Affiliation(s)
- Vincent J. Heck
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Kristina Klug
- Goethe-University Frankfurt, Department of Psychology, Frankfurt am Main, Germany
| | - Tobias Prasse
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Stavros Oikonomidis
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Alexander Klug
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Bastian Himpe
- Center for Spinal Surgery, St. Elisabethen-Krankenhaus Frankfurt, Frankfurt am Main, Germany
| | - Philipp Egenolf
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Maximilian Lenz
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Peer Eysel
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Max J. Scheyerer
- Faculty of Medicine and University Hospital Cologne, Department of Orthopedics and Trauma Surgery, University of Cologne, Cologne, Germany
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
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Bal PM, Chudzikowski K, Jansen P, Wawoe K. Individualized work arrangements and socio-economic factors in relation to motivation to continue working: a multilevel study of municipal influences. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2022. [DOI: 10.1080/09585192.2021.1928730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- P. Matthijs Bal
- Lincoln International Business School, University of Lincoln, Lincoln, United Kingdom of Great Britain and Northern Ireland
| | - Katharina Chudzikowski
- School of Management, University of Bath, Bath, United Kingdom of Great Britain and Northern Ireland
| | - Paul Jansen
- Department of Management and Organization, VU University Amsterdam, Amsterdam, Netherlands
| | - Kilian Wawoe
- Department of Social and Organizational Psychology, VU University Amsterdam, Amsterdam, Netherlands
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Calvo-Sotomayor I, Atutxa E. Reviewing the Benefits of Aging Populations: Care Activities Provided by the Older People as a Commons. Front Public Health 2022; 10:792287. [PMID: 35462814 PMCID: PMC9021500 DOI: 10.3389/fpubh.2022.792287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
This research reviews the commons paradigm as a framework for understanding the positive contribution of older cohorts to society. The commons, thought as instituting praxis that provide social goods based on autonomy and reciprocity, can help in understanding the role of this age group in providing care to the rest of society. This approach overturns the way economic literature approaches the aging phenomenon. What is understood as a “common evil”—or a problem that needs to be solved—can be analyzed as a “common good.” From this perspective, older people (population aged 65 and over) are essential to European society and the economy to carry out informal care activities that enable and facilitate the “productive” activities of working people.
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Affiliation(s)
- Iñigo Calvo-Sotomayor
- Department of Management, University of Deusto, Bilbao, Spain
- *Correspondence: Iñigo Calvo-Sotomayor
| | - Ekhi Atutxa
- Department of Finance and Economics, University of Deusto, Bilbao, Spain
- Ekhi Atutxa
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Klug A, Pfluger DH, Gramlich Y, Hoffmann R, Drees P, Kutzner KP. Future burden of primary and revision hip arthroplasty in Germany: a socio-economic challenge. Arch Orthop Trauma Surg 2021; 141:2001-2010. [PMID: 33837811 DOI: 10.1007/s00402-021-03884-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/27/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Total hip arthroplasty (THA) rates have increased dramatically in the recent decades worldwide, with Germany being one of the leading countries in the prevalence of THA. Simultaneously, a rising number of revision procedures is expected, which will put an enormous economic burden on future health care systems. METHODS Nationwide data provided by the Federal Statistical Office of Germany were used to quantify primary and revision arthroplasty rates as a function of age and gender. Projections were performed with use of Negative Binomial and Poisson regression models on historical procedure rates in relation to population projections from 2020 to 2060. RESULTS A 62% increase in the incidence rate of primary THAs is projected until 2060. At the same time, the annual total number of revision procedures is forecast to rise about 40% by the year 2060. The highest numbers of revision arthroplasties were calculated around year 2043. The greatest proportions of revision surgery will be observed in women and in those aged 70 years or older. The revision burden is projected to stabilize around 15% by 2060. CONCLUSIONS The present projections allow a quantification of the increasing economic burden that (revision) THA will place on the German health care system in the upcoming decades. This study may serve as a model for other countries with similar demographic development as the country-specific approach predicts a substantial increase in the number of these procedures. This highlights the need for appropriate financial and human resource management in the future.
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Affiliation(s)
- Alexander Klug
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany.
| | | | - Yves Gramlich
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Karl Philipp Kutzner
- Department of Orthopedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,Department of Orthopaedic Surgery and Traumatology, St. Josefs Hospital Wiesbaden, Beethovenstr. 20, 65189, Wiesbaden, Germany
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Klug A, Herrmann E, Fischer S, Hoffmann R, Gramlich Y. Projections of Primary and Revision Shoulder Arthroplasty until 2040: Facing a Massive Rise in Fracture-Related Procedures. J Clin Med 2021; 10:jcm10215123. [PMID: 34768643 PMCID: PMC8585038 DOI: 10.3390/jcm10215123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022] Open
Abstract
Although the demand for shoulder arthroplasties has reached its highest number worldwide, there remains a lack of epidemiologic data regarding recent and future trends. In this study, data for all shoulder arthroplasties (hemiarthroplasty, reverse/anatomic shoulder arthroplasty) from the nationwide inpatient statistics of Germany (2010–2019) and population forecasts until 2040 were gathered. A Poisson and a negative binomial approach using monotone B-splines were modeled for all types of prostheses to project the annual number and incidence of primary and revision arthroplasty. Additionally, trends in main indicators were also gathered and expected changes were calculated. Overall, the number of primary shoulder replacements is set to increase significantly by 2040, reaching at least 37,000 (95% CI 32,000–44,000) procedures per year. This trend is mainly attributable to an about 10-fold increased use of fracture-related reverse shoulder arthroplasty in patients over 80 years of age, although the number of procedures in younger patients will also rise substantially. In contrast, hemiarthroplasties will significantly decrease. The number of revision procedures is projected to increase subsequently, although the revision burden is forecast to decline. Using these country-specific projection approaches, a massive increase of primary and revision shoulder arthroplasties is expected by 2040, mainly due to a rising number of fracture-related procedures. These growth rates are substantially higher than those from hip or knee arthroplasty. As these trends are similar in most Western countries, this draws attention to the international issue, of: if healthcare systems will be able to allocate human and financial resources adequately, and if future research and fracture-prevention programs may help to temper this rising burden in the upcoming decades.
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Affiliation(s)
- Alexander Klug
- Abteilung für Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (S.F.); (R.H.); (Y.G.)
- Correspondence: ; Tel.: +49-69-475-1594
| | - Eva Herrmann
- Institut für Biostatistik und Mathematische Modellierung, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany;
| | - Sebastian Fischer
- Abteilung für Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (S.F.); (R.H.); (Y.G.)
| | - Reinhard Hoffmann
- Abteilung für Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (S.F.); (R.H.); (Y.G.)
| | - Yves Gramlich
- Abteilung für Unfallchirurgie und Orthopädische Chirurgie, BG Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstrasse 430, 60389 Frankfurt am Main, Germany; (S.F.); (R.H.); (Y.G.)
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Ageing Urban Population Prognostic between 2020 and 2050 in Transylvania Region (Romania). SUSTAINABILITY 2021. [DOI: 10.3390/su13179940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Population ageing represents a dramatic scenario and a progressive process inducing major changes in the dynamics of the population and especially in the age structure. The ageing population process is a phenomenon relevant to define not only demographic but also social, cultural, and territorial transformations in relation to the urban settlements. In this article, we present a case study regarding the ageing process persistent in urban areas from the counties of the Transylvania region. The present study emphasizing the evolution of the older adults age group between 2015 and 2019, drawing a forecast model for the prognosis period 2020–2050. The tendencies of the population decline process are revealed by the outcomes of the ageing index, outlining some long-term effects of population ageing over the years. The study of this phenomenon reveals an important framework at the regional level of Transylvania and points out the means to determine its existence in other regions or countries, since it affects the urban population evolution and its dynamics.
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The Social Economy as a Factor of Economic Development and Resilience of Population in Rural Areas. A Study of Mediating Effects in Castilla-La Mancha (Spain). SUSTAINABILITY 2021. [DOI: 10.3390/su13105544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Depopulation is a serious problem facing developed countries, among them Spain. It is especially severe in rural areas, where some vicious circles emerge, nourished by reduced infrastructures and services, deteriorated quality of life, the low inflow of new inhabitants, low local development and an aged population. In this context, social economy institutions may be a key factor in the fight against population decline, having a leading role in reactivating economic dynamism through the creation of stable, high-quality jobs, promoting the local endogenous development of rural areas, helping enhance income in those spaces, encouraging the arrival of people and impacting positively on social cohesion, and enabling sustainable growth. This paper focuses on Castilla-La Mancha, an eminently rural region, which is among the areas most severely impacted by the loss of population in Spain. The aim is to analyze the factors that affect the settlement of population, and to demonstrate that social economy institutions may be a resilience factor of rural population. A partial least squares model, composed of 8 constructs related to 21 variables extracted from data for 2017 and 2018 on the 613 municipalities, allows us to demonstrate that the existence of social economy entities helps to anchor population and increase the resilience of this territory.
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Abstract
In 2020, a special issue titled “Sustainable Rural Development: Strategies, Good Practices and Opportunities” was launched, in which 16 papers were published [...]
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Economic Aspects of Shrinking Cities in Poland in the Context of Regional Sustainable Development. SUSTAINABILITY 2021. [DOI: 10.3390/su13063104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two trends are observed in contemporary cities around the world: whereas some urban areas develop rapidly and experience population growth, a steady population decline is noted in other cities. Demographic changes in urban areas are also accompanied by economic changes. These changes constitute a very serious challenge for sustainable regional growth. However, these problems have not been sufficiently investigated to date, including in Poland. The aim of this study was to identify shrinking cities in Poland and the phenomena that are related to the economic aspects of urban shrinkage in Poland. Empirical research relied on analysis of the population growth rate in Polish urban municipalities, and the phenomena related to the economic aspects of urban shrinkage were identified by multiple linear regression analysis. The period of research was 2003–2019. Thirty-three Polish cities experienced a steady population decline. The economic phenomena related to urban shrinkage included changes in own-source revenues, proportions of government transfers in municipal budgets, unemployment, migration, municipal spending on education, transport, communications, and social welfare. Population decline was not related to changes in the age-dependency ratio, public spending on housing, the number of companies, or the number of vacant homes in cities. The research results can be a source of important information for regional sustainable growth policies used not only in cities and regions in Poland, but also in other Central and Eastern European countries where this phenomenon occurs.
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Abstract
This study estimates demographic resilience in local socioeconomic systems of Southern Europe using long-term population dynamics. We assume attractive places with a continuously expanding (resident) population as ‘demographically resilient’, and locations experiencing a persistent decline of population as more fragile to external shocks. Based on these premises, a comprehensive assessment of demographic resilience in more than 1000 municipalities along the urban–rural gradient in Greece, a Mediterranean country with marked regional disparities, was carried out between 1961 and 2011. Municipalities were considered representative of homogeneous local communities, especially in rural areas. The results of non-parametric correlations suggest how basic geographical gradients (coastal–inland and urban–rural) have significantly influenced the demographic resilience of Greek municipalities. These findings outline two contrasting spatial patterns that reflect (i) continuous expansion of peri-urban local communities and (ii) a particularly intense rural shrinkage, linking depopulation to land abandonment and scarce accessibility of inland districts. While long-term population growth in Greece has progressively re-shaped the intrinsic divide in urban and rural areas, the traditional gap in central and peripheral districts is still reflected in the spatial polarization between the ‘demographically resilient’, socially dynamic coastal locations and the ‘demographically fragile’ inland, economically marginal places. These results indicate the persistence of a center–periphery model characterizing long-term settlement expansion in Greece, with spatial patterns delineating ‘resilient’ and ‘fragile’ districts based essentially on infrastructures, accessibility, and amenities.
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van Dalen HP, Henkens K. When is fertility too low or too high? Population policy preferences of demographers around the world. Population Studies 2020; 75:289-303. [PMID: 32697143 DOI: 10.1080/00324728.2020.1784986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
When does fertility in a country become so low or so high that a government needs to intervene? This paper sheds light on this population policy question, based on a worldwide survey among demographers. We examine how professionals' policy preferences regarding fertility levels are affected by their views on the impacts of population growth/decline and by fertility in their country of residence. The median respondent suggests intervention once fertility goes below 1.4 children or above 3.0. Three results stand out: first, demographers who are concerned about the carrying capacity of the earth are more willing to intervene than those who are less concerned. Second, the context of decision-making matters: experts living in high-fertility countries are more set on intervention than those living in low-fertility countries, but their threshold fertility level is also higher. Third, political orientation matters: right-leaning demographers are more set on government intervention than left-leaning demographers.
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Affiliation(s)
| | - Kène Henkens
- Netherlands Interdisciplinary Demographic Institute.,University Medical Center Groningen.,University of Amsterdam
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Who Is Afraid of Population Aging? Myths, Challenges and an Open Question from the Civil Economy Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155277. [PMID: 32707851 PMCID: PMC7432602 DOI: 10.3390/ijerph17155277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/09/2020] [Accepted: 07/19/2020] [Indexed: 11/20/2022]
Abstract
Population aging is a great human achievement, but the economic literature normally addresses its effects in a narrow way and as a “problem” to be solved. The objective of this paper is to provide a more balanced approach to aging by calling into question some widespread ideas in the economic literature on aging, such as its supposed negative influence on economic growth, its impact on labor productivity or the assumption that aging societies are incapable of applying reforms. The paper adopts the renewed civil economy framework and takes as a reference the existing literature about beliefs and wrong assumptions on aging. The innovative contribution of this analysis lies in its effort to foster a positive perspective in the population aging field of research and in challenging negative associations regarding old-age stereotypes.
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Abstract
BACKGROUND Future projections for both TKA and THA in the United States and other countries forecast a further increase of already high numbers of joint replacements. The consensus is that in industrialized countries, this increase is driven by demographic changes with more elderly people being less willing to accept activity limitations. Unlike the United States, Germany and many other countries face a population decline driven by low fertility rates, longer life expectancy, and immigration rates that cannot compensate for population aging. Many developing countries are likely to follow that example in the short or medium term amid global aging. Due to growing healthcare expenditures in a declining and aging population with a smaller available work force, reliable predictions of procedure volume by age groups are requisite for health and fiscal policy makers to maintain high standards in arthroplasty for the future population.Questions/purposes (1) By how much is the usage of primary TKA and THA in Germany expected to increase from 2016 through 2040? (2) How is arthroplasty usage in Germany expected to vary as a function of patient age during this time span? METHODS The annual number of primary TKAs and THAs were calculated based on population projections and estimates of future healthcare expenditures as a percent of the gross domestic product (GDP) in Germany. For this purpose, a Poisson regression analysis using age, gender, state, healthcare expenditure, and calendar year as covariates was performed. The dependent variable was the historical number of primary TKAs and THAs performed as compiled by the German federal office of statistics for the years 2005 through 2016. RESULTS Through 2040, the incidence rate for both TKA and THA will continue to increase annually. For TKA, the incidence rate is expected to increase from 245 TKAs per 100,000 inhabitants to 379 (297-484) (55%, 95% CI 21 to 98). The incidence rate of THAs is anticipated to increase from 338 to 437 (357-535) per 100,000 inhabitants (29% [95% CI 6 to 58]) between 2016 and 2040. The total number of TKAs is expected to increase by 45% (95% CI 14 to 8), from 168,772 procedures in 2016 to 244,714 (95% CI 191,920 to 312,551) in 2040. During the same period, the number of primary THAs is expected to increase by 23% (95% CI 0 to 50), from 229,726 to 282,034 (95% CI 230,473 to 345,228). Through 2040, the greatest increase in TKAs is predicted to occur in patients aged 40 to 69 years (40- to 49-year-old patients: 269% (95% CI 179 to 390); 50- to 59-year-old patients: 94% (95% CI 48 to 141); 60- to 69-year-old patients: 43% (95% CI 13 to 82). The largest increase in THAs is expected in the elderly (80- to 89-year-old patients (71% [95% CI 40 to 110]). CONCLUSIONS Although the total number of TKAs and THAs is projected to increase in Germany between now and 2040, the increase will be smaller than that previously forecast for the United States, due in large part to the German population decreasing over that time, while the American population increases. Much of the projected increase in Germany will be from the use of TKA in younger patients and from the use of THA in elderly patients. Knowledge of these trends may help planning by surgeons, hospitals, stakeholders, and policy makers in countries similar to Germany, where high incidence rates of arthroplasty, aging populations, and overall decreasing populations are present. LEVEL OF EVIDENCE Level III, economic and decision analysis.
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Abstract
Although a widespread management approach, diversity management is far from being a well-defined and unambiguous one. This article outlines how this management practice emerged, and how it is enacted, and it identifies and critically discusses the two crucial areas of dissent or ambivalence within the diversity management discourse: first, the dimensionality of diversity management, and second, its legitimacy. The first issue addresses the prioritization of certain dimensions, the difficulty of clearly demarcating one dimension from another, and the unequal consideration of specific manifestations of each dimension. Taking into account the fact that everyone embodies at least one manifestation of every dimension of diversity, the aspect of intersectionality also belongs to the dimensionality of diversity. The legitimacy issue includes legitimate starting points, operating ranges, and desired outcomes of diversity management practices. The article concludes by looking toward possible future directions in diversity management research and diversity management practice.
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Aging Human Populations: Good for Us, Good for the Earth. Trends Ecol Evol 2018; 33:851-862. [PMID: 30340868 DOI: 10.1016/j.tree.2018.08.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 12/18/2022]
Abstract
As the nations of the world grapple with the task of creating sustainable societies, ending and in some cases reversing population growth will be necessary to succeed. Yet stable or declining populations are typically reported in the media as a problem, or even a crisis, due to demographic aging. This is misguided, as economic analyses show that the costs connected with aging societies are manageable, while the economic, social, and environmental benefits of smaller populations are substantial. Earth's human-carrying capacity has been exceeded; hence, population growth must end and aging societies are unavoidable. They should be embraced as part of a just and prosperous future for people and the other species with whom we share our planet.
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POST-TRANSITIONAL FERTILITY: THE ROLE OF CHILDBEARING POSTPONEMENT IN FUELLING THE SHIFT TO LOW AND UNSTABLE FERTILITY LEVELS. J Biosoc Sci 2018; 49:S20-S45. [PMID: 29160188 DOI: 10.1017/s0021932017000323] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study discusses fertility trends and variation in countries that completed the transition from high to around-replacement fertility in the 1950s to 1980s, especially in Europe, East Asia and North America, and summarizes the key relevant findings for those countries with a more recent experience of fertility decline towards replacement level. A central finding is that there is no obvious theoretical or empirical threshold around which period fertility tends to stabilize. Period fertility rates usually continue falling once the threshold of replacement fertility is crossed, often to very low levels. While cohort fertility rates frequently stabilize or change gradually, period fertility typically remains unstable. This instability also includes marked upturns and reversals in Total Fertility Rates (TFRs), as experienced in many countries in Europe in the early 2000s. The long-lasting trend towards delayed parenthood is central for understanding diverse, low and unstable post-transitional fertility patterns. In many countries in Europe this shift to a late childbearing pattern has negatively affected the TFR for more than four decades. Many emerging post-transitional countries and regions are likely to experience a similar shift over the next two to three decades, with a depression of their TFRs to very low levels.
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Depopulation and the Aging Population: The Relationship in Italian Municipalities. SUSTAINABILITY 2018. [DOI: 10.3390/su10041004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Franklin RS, van Leeuwen ES. For Whom the Bells Toll: Alonso and a Regional Science of Decline. INTERNATIONAL REGIONAL SCIENCE REVIEW 2018; 41:134-151. [PMID: 29622853 PMCID: PMC5881950 DOI: 10.1177/0160017616675917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In his presidential address to the Regional Science Association over thirty years ago, William Alonso presented the case for "Five Bell Shapes in Development" and argued that "the developed countries will enter fully in to the realm of the right-hand tail of these curves" (p. 16) and that this transition might result in several surprises. He proposed, therefore, that we should study the right tail of these "curves" as well as interactions among them. Much of what Alonso suggested has come to pass, although his prognostications were not always exact. And although he touched on several issues of relevance to regional scientists, the discipline has been slow to move away from a growth-centered paradigm. The strength of regional science-the capacity to consider economic, demographic, and geographical aspects of an issue simultaneously-has yet to be focused on some of the "right-hand" challenges that have arisen, population loss, for example. In this article, we provide a review of regional science research within the context of Alonso's five bells and hypothesize how Alonso's propositions might differ in today's world. We then focus more specifically on one particular area: population loss. Using these examples allows us to highlight how regional science might contribute to the conceptualization of "right-hand tail" development challenges, especially where theory, issues of spatial scale, and interregional dependencies are concerned.
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Affiliation(s)
- Rachel S. Franklin
- Spatial Structures in the Social Sciences (S4)/Population Studies and Training Center (PSTC), Brown University, Providence, RI, USA
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Jackson N, Cameron MP. The Unavoidable Nature of Population Ageing and the Ageing-Driven End of Growth – an Update for New Zealand. JOURNAL OF POPULATION AGEING 2017. [DOI: 10.1007/s12062-017-9180-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aassve A, Billari FC, Pessin L. Trust and Fertility Dynamics. SOCIAL FORCES; A SCIENTIFIC MEDIUM OF SOCIAL STUDY AND INTERPRETATION 2016; 95:663-692. [PMID: 28003707 PMCID: PMC5167372 DOI: 10.1093/sf/sow080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We argue that the divergence in fertility trends in advanced societies is influenced by the interaction of long-standing differences in generalized trust with the increase in women's educational attainment. Our argument builds on the idea that trust enhances individuals' and couples' willingness to outsource childcare to outside their extended family. This becomes critically important as women's increased education enhances the demand for combining work and family life. We test our hypothesis using data from the World Values Survey and European Values Study on 36 industrialized countries between the years 1981 and 2009. Multilevel statistical analyses reveal that the interaction between national-level generalized trust and cohort-level women's education is positively associated with completed fertility. As education among women expands, high levels of generalized trust moderate fertility decline.
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Affiliation(s)
- Arnstein Aassve
- Carlo F. Dondena, Centre for Research on Social Dynamics and, Department of Policy Analysis and Public Management, Università Bocconi, Via Guglielmo Röntgen 1, 20136 Milan, Italy, , Tel. + 39. 02.5836. 5657, Fax. + 39.02.5836.2798
| | | | - Léa Pessin
- Population Research Institute, The Pennsylvania Research Institute
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Basten S, Verropoulou G. A Re-Interpretation of the 'Two-child Norm' in Post-Transitional Demographic Systems: Fertility Intentions in Taiwan. PLoS One 2015; 10:e0135105. [PMID: 26291083 PMCID: PMC4546404 DOI: 10.1371/journal.pone.0135105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 07/16/2015] [Indexed: 11/17/2022] Open
Abstract
Taiwan currently has one of the lowest fertility rates in the world, leading to projections of rapid population ageing and decline. In common with other territories in Pacific Asia, policies designed to support childbearing have recently been introduced. Some optimism for the future success of these policies has been drawn from the fact that the ‘ideal’ number of children stated in Taiwanese surveys is over two. In this way, Taiwan appears to fit the ‘two-child norm’ model identified for Europe and North America. Furthermore, this feature has led commentators to state that Taiwan is not in a ‘low fertility trap’–where positive feedback mechanisms emanating from the normalisation of small families, slow economic growth and ageing/declining population mean attempts to increase fertility become ever less likely to succeed. Using a recent national representative survey, and arguing that ‘intentions’ are a more reliable guide to understanding the circumstances of family formation, this paper explores fertility intentions in Taiwan with a special focus on women at parity one and parity two. This will form the first full-length examination of fertility intentions in Taiwan published in English and one of the few studies of Pacific Asia that reports a micro-level analysis. We argue that using intentions should provide a better ‘barometer’ of attitudes towards childbearing in Taiwan, and that through micro-level analysis, we can better identify the predictors of intentions that could, in turn, provide useful clues both for projections as well as shaping policy responses. While we found some evidence for a ‘two-child norm’ among childless women, this could be an unrealistic ideal. This is supported by the fact that a majority of women with one child do not intend to have another.
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Affiliation(s)
- Stuart Basten
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Georgia Verropoulou
- Department of Statistics and Insurance Science, University of Piraeus, Piraeus, Greece
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Ashraf QH, Weil DN, Wilde J. The Effect of Fertility Reduction on Economic Growth. POPULATION AND DEVELOPMENT REVIEW 2013; 39:97-130. [PMID: 25525283 PMCID: PMC4267474 DOI: 10.1111/j.1728-4457.2013.00575.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We assess quantitatively the effect of exogenous reductions in fertility on output per capita. Our simulation model allows for effects that run through schooling, the size and age structure of the population, capital accumulation, parental time input into child-rearing, and crowding of fixed natural resources. The model is parameterized using a combination of microeconomic estimates, data on demographics and natural resource income in developing countries, and standard components of quantitative macroeconomic theory. We apply the model to examine the effect of a change in fertility from the UN medium-variant to the UN low-variant projection, using Nigerian vital rates as a baseline. For a base case set of parameters, we find that such a change would raise output per capita by 5.6 percent at a horizon of 20 years, and by 11.9 percent at a horizon of 50 years.
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Ceobanu AM, Koropeckyj-Cox T. Should International Migration Be Encouraged to Offset Population Aging? A Cross-Country Analysis of Public Attitudes in Europe. POPULATION RESEARCH AND POLICY REVIEW 2012. [DOI: 10.1007/s11113-012-9260-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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European Regional Populations: Current Trends, Future Pathways, and Policy Options. EUROPEAN JOURNAL OF POPULATION-REVUE EUROPEENNE DE DEMOGRAPHIE 2012; 28:385-416. [PMID: 23162180 PMCID: PMC3496551 DOI: 10.1007/s10680-012-9268-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 07/12/2012] [Indexed: 10/26/2022]
Abstract
Europe is currently experiencing an ageing population and slowing population growth of both the total and working-age populations. These trends are likely to continue. Even though population ageing will affect all European regions, different regions will be affected in different ways. Even under favorable conditions, 35-40 % of all NUTS2 regions will face a labor force decline. If economic conditions are poor, some regions may continue to grow, but 55-70 % of the regions will see a labor force decline by 10 % or more. In most regions of Eastern Europe, the labor force may decrease by more than 30 %. To keep regions prosperous (maintaining competitiveness) and to avoid worse inequality (maintaining cohesion), policy-makers must find ways to cope with these challenges through new fiscal and social policies, though policies directly affecting demographic and migratory trends may also be needed.
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