Dietary habits, traveling and the living situation potentially influence the susceptibility to SARS-CoV-2 infection: results from healthcare workers participating in the RisCoin Study.

PURPOSE: To explore occupational and non-occupational risk and protective factors for the coronavirus disease 2019 (COVID-19) in healthcare workers (HCWs). METHODS: Serum specimens and questionnaire data were obtained between October 7 and December 16, 2021 from COVID-19-vaccinated HCWs at a quaternary care hospital in Munich, Germany, and were analyzed in the RisCoin Study. RESULTS: Of 3,696 participants evaluated, 6.6% have had COVID-19 at least once. Multivariate logistic regression analysis identified working in patient care occupations (7.3% had COVID-19, 95% CI 6.4-8.3, Pr = 0.0002), especially as nurses, to be a potential occupation-related COVID-19 risk factor. Non-occupational factors significantly associated with high rates of the disease were contacts to COVID-19 cases in the community (12.8% had COVID-19, 95% CI 10.3-15.8, Pr < 0.0001), being obese (9.9% had COVID-19, 95% CI 7.1-13.5, Pr = 0.0014), and frequent traveling abroad (9.4% had COVID-19, 95% CI 7.1-12.3, Pr = 0.0088). On the contrary, receiving the basic COVID-19 immunization early during the pandemic (5.9% had COVID-19, 95% CI 5.1-6.8, Pr < 0.0001), regular smoking (3.6% had COVID-19, 95% CI 2.1-6.0, Pr = 0.0088), living with the elderly (3.0% had COVID-19, 95% CI 1.0-8.0, Pr = 0.0475), and frequent consumption of ready-to-eat meals (2.6% had COVID-19, 95% CI 1.1-5.4, Pr = 0.0045) were non-occupational factors potentially protecting study participants against COVID-19. CONCLUSION: The newly discovered associations between the living situation, traveling as well as dietary habits and altered COVID-19 risk can potentially help refine containment measures and, furthermore, contribute to new mechanistic insights that may aid the protection of risk groups and vulnerable individuals.

Sociodemographic and Geographic Variation in Access to Neuro-Ophthalmologists in the United States.

BACKGROUND: Neuro-ophthalmologists have expertise in rare and complex disorders, but the ability of patients to access neuro-ophthalmic care has not been examined at a nationwide level. METHODS: Using the 2020 directory of all 502 members of the North American Neuro-Ophthalmology Society as a reference, we found the practice locations of 461 confirmed practicing members and converted each street address to latitude and longitude coordinates. We calculated the travel distance and time from each census tract to the nearest practice location and calculated population-weighted averages by state, region, and other prespecified factors. Choropleth maps were used to visualize the distribution of travel distances and times across the United States. RESULTS: California had the most practicing neuro-ophthalmologists out of any state (50), whereas 4 states (DE, MT, SD, and WY) had none. Washington, DC and MA had the most neuro-ophthalmologists per capita. The average travel distance and time to the nearest neuro-ophthalmologists were found to be 40.90 miles and 46.50 minutes, respectively, although a large portion of western plains and mountain regions had travel times of over 120 minutes. Patients in rural areas had longer travel times than those in urban areas, and Native American patients had the longest travel times of any racial or ethnic group. CONCLUSION: The travel time to see a neuro-ophthalmologist varies widely by state, region, and rurality, with Native American patients and rural patients being disproportionately affected. By identifying the areas with the greatest travel burdens, future policies can work to alleviate these potential barriers to care.

[Decision-Making Behaviour in Physician-Rating Portals: Results of a Vignette Study in the New Federal States of Germany]. / Das Entscheidungsverhalten in Arztbewertungsportalen. Ergebnisse einer Vignettenstudie in den neuen Bundesländern.

BACKGROUND: The extent to which relevant information is taken into consideration in the decision process for or against the choice of certain physicians when searching for physicians via physician-rating portals is largely unknown. In particular, the question of whether longer travel distances to a doctor's office are accepted in favour of a good rating is investigated in this study. METHODS: In a vignette study, 192 respondents from new German states were shown ten hits each from a fictitious search for a primary care physician. A total of 1881 choice probabilities were evaluated with cluster-corrected regressions. RESULTS: A good rating and a short distance to the doctor's office were the most important determinants of a positive probability of choice. Longer distances were not accepted in favour of a good rating. Arabic-sounding names strongly reduced the probability of choice, although the respondents only assigned subordinate importance to the doctors' names as a basis for decision-making. CONCLUSION: The area served by physicians in private practice does not increase if they receive good grades on rating portals. Service quality is important, but not the most important factor in the rating score.

Toolkit for a Successful Nurse Educator Sabbatical.

ABSTRACT: This article provides evidence to support the need for nursing faculty to attain sabbaticals. In addition, a toolkit is provided that walks faculty through a step-by-step process to ensure a successful sabbatical. Future nurses are counting on strong, engaging, and visionary faculty. Thus, to foster resilience, nursing faculty are encouraged to embrace the sabbatical opportunity.

COVID-19 and doctor emigration: the case of Ireland.

BACKGROUND: Since the 2008 recession, Ireland has experienced large-scale doctor emigration. This paper seeks to ascertain whether (and how) the COVID-19 pandemic might disrupt or reinforce existing patterns of doctor emigration. METHOD: This paper draws on qualitative interviews with 31 hospital doctors in Ireland, undertaken in June-July 2020. As the researchers were subject to a government mandated work-from-home order at that time, they utilised Twitter™ to contact potential respondents (snowball sampling); and conducted interviews via Zoom™ or telephone. FINDINGS: Two cohorts of doctors were identified; COVID Returners (N = 12) and COVID Would-be Emigrants (N = 19). COVID Returners are Irish-trained emigrant doctors who returned to Ireland in March 2020, just as global travel ground to a halt. They returned to be closer to home and in response to a pandemic-related recruitment call issued by the Irish government. COVID Would-be Emigrants are hospital doctors considering emigration. Some had experienced pandemic-related disruptions to their emigration plans as a result of travel restrictions and border closures. However, most of the drivers of emigration mentioned by respondents related to underlying problems in the Irish health system rather than to the pandemic, i.e. a culture of medical emigration, poor working conditions and the limited availability of posts in the Irish health system. DISCUSSION/CONCLUSION: This paper illustrates how the pandemic intensified and reinforced, rather than radically altered, the dynamics of doctor emigration from Ireland. Ireland must begin to prioritise doctor retention and return by developing a coherent policy response to the underlying drivers of doctor emigration.

Genetics workforce: distribution of genetics services and challenges to health care in California.

PURPOSE: Access to genetics health-care services is often complicated by the distance to hospitals, workforce shortages, and insurance coverage. Despite technological advances and decreasing costs of genetic sequencing, the benefits of personalized medicine may be inaccessible to many patients. To assess potential disparities in care, we examined the genetics workforce in California and geographical issues that people encounter in seeking care. METHODS: Data on all board-certified genetics providers were analyzed including medical geneticists (MGs) and genetic counselors (GCs) in California. To assess distance traveled for care, we computed the distance patients traveled for n = 288 visits to University of California-San Francisco (UCSF) Medical Genetics. We performed geographic optimization to minimize the distance to genetics providers. RESULTS: The provider-to-patient ratio in California is 1:330,000 for MGs, 1:100,000 for GCs, and 1:1,520,000 for biochemical MGs. Genetics providers are concentrated in major metropolitan areas in California. People travel up to 386 miles for genetics care within the state (mean = 76.6 miles). CONCLUSION: There are substantial geographic barriers to genetics care that could increase disparities. Our findings highlight a challenging genetics workforce shortage. The shortage may be even greater due to care subspecialization or lack of full-time equivalency and staffing. We are currently promoting efforts to increase remote health-care options, training, and modified models of care.

Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks.

BACKGROUND: In July 2018, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid Managed Care (MMC) regulations that govern network and access standards for enrollees. There have been few published studies of whether there is accurate geographic information on primary care providers to monitor network adequacy. METHODS: We analyzed a sample of nurse practitioner (NP) and physician address data registered in the state labor, licensing, and regulation (LLR) boards and the National Provider Index (NPI) using employment location data contained in the patient-centered medical home (PCMH) data file. Our main outcome measures were address discordance (%) at the clinic-level, city, ZIP code, and county spatial extent and the distance, in miles, between employment location and the LLR/NPI address on file. RESULTS: Based on LLR records, address information provided by NPs corresponded to their place of employment in 5% of all cases. NP address information registered in the NPI corresponded to their place of employment in 64% of all cases. Among physicians, the address information provided in the LLR and NPI corresponded to the place of employment in 64 and 72% of all instances. For NPs, the average distance between the PCMH and the LLR address was 21.5 miles. Using the NPI, the distance decreased to 7.4 miles. For physicians, the average distance between the PCMH and the LLR and NPI addresses was 7.2 and 4.3 miles. CONCLUSIONS: Publicly available data to forecast state-wide distributions of the NP workforce for MMC members may not be reliable if done using state licensure board data. Meaningful improvements to correspond with MMC policy changes require collecting and releasing information on place of employment.

E-learning in medical education: the potential environmental impact.

Introduction There is a growing interest in the use of e-learning in medical education. However until recently there has been little interest in the potential environmental benefits of e-learning. This paper models various environmental outcomes that might emerge from the use of an e-learning resource (BMJ Learning) in CPD. Methods We modeled the use of e-learning as a component of CPD and evaluated the potential impact of this use on the learner's carbon footprint. We looked at a number of models - all from the perspective of a General Practitioner (GP). We assumed that all GPs completed 50 h or credits of CPD per year. Results High users of e-learning can reduce their carbon footprint - mainly by reducing their travel to face-to-face events (reducing printing also has a small beneficial effect). A high user of e-learning can reduce the carbon footprint that relates to their CPD by 18.5 kg. Discussion As global warming continues to pose a risk to human and environmental health, we feel that doctors have a duty to consider learning activities (such as e-learning) that are associated with a lower carbon footprint.

Report of the 2017 Arthroscopy Association of North America Traveling Fellowship-A Fellowship Odyssey.

It was an honor to be selected to participate in the 2017 Arthroscopy Association of North America Advanced Arthroscopy Traveling Fellowship. This year's group included Michael J. Alaia, M.D., Assistant Professor and Associate Sports Medicine Fellowship Director at NYU Hospital for Joint Diseases; Nathan K. Endres, M.D., Associate Professor at the University of Vermont; LCDR Patrick W. Joyner, M.D., Assistant Professor at Naval Medical Center Portsmouth, and Head Physician East Coast Navy Seals; and LTC Christopher J. Tucker, M.D., Assistant Professor at the Uniformed Services University and Chief of Sports Service at Fort Belvoir Community Hospital. This year, we were honored to have a true pioneer in sports medicine and arthroscopic surgery, Dr. Jack M. Bert, Past President of Arthroscopy Association of North America and Adjunct Clinical Professor at the University of Minnesota, serve as our Godfather.

Unchallenged good intentions: a qualitative study of the experiences of medical students on international health electives to developing countries.

BACKGROUND: Irish medical students have a long and proud history of embarking on international health electives (IHEs) to broaden their experience in the developing world. Although there are many opinions in the literature about IHEs, there is a dearth of empirical research that explores the experience and the value of these experiences to medical students. Most students who participate in these IHEs from Irish medical schools are members of student IHE societies, which are entirely run by students themselves. There are varying levels of preparation and interaction with the medical schools in planning these experiences. This study explores the experiences of a sample of students who completed IHEs in 2012. METHODS: This qualitative study used anonymized one-on-one interviews with medical students in Irish medical schools who completed IHEs to developing countries in 2012. Students were recruited using online noticeboards of student societies and e-mail. Purposive sampling was used to find students from different medical schools, some who had travelled with medical student IHE societies and others who had travelled independently. Seven male and seven female students participated. Interviews were conducted until saturation was reached. Data were then analyzed thematically. RESULTS: The main themes identified were the perceived benefits of IHEs, the difficulties experienced with the distribution of charitable donations, the emotional impact on the students of participating in the IHEs, awareness of scope of practice by students, and issues with the current structure of IHEs. CONCLUSIONS: The informal relationship that currently exists between student societies and the medical schools results in poor accountability and reporting requirements on IHEs. Clearer guidelines and identification of learning outcomes for students would be helpful. The findings are relevant to medical students internationally.

Internationally educated nurses' experiences in a hospital in England: an exploratory study.

BACKGROUND: The recruiting of internationally educated nurses (IENs) to work in the National Health Service (NHS) in the United Kingdom (UK) is not a new phenomenon. Such practices have its roots in the 1940s when the NHS was first incepted. OBJECTIVE: The aim of this study was to gain an understanding of IENs' experiences of working in the NHS in England. METHODS: Phenomenology in particular, Heidegger, was the approach adopted, and the study consisted of two phases in which twelve individuals' interviews were conducted in phase one. The findings from this phase informed the second phase where four focus group interviews were used. The data for both phases were thematically analysed. RESULTS: Six themes emerged following data analysis, namely Leaving a familiar world, Being thrown into an unfamiliar world, Encountering marginalisation and experiencing inequalities in the world, Surviving in an everyday world, Living in an everyday world and Making a new world. CONCLUSION: Internationally educated nurses encountered a number of challenges to their working practices in an English hospital, and there is a need for both IENs and home-grown nurses to adapt to each other cultural differences.

Fly-in/Fly-out nursing: is it for us? New graduate nurses' perspectives.

Fly-in/Fly-out models of health care for rural-remote communities are currently the focus of evaluation and debate, as the health inequalities of rural and remote communities continue to challenge both health service providers and healthcare consumers. At first glance, these models of health care may attract new graduate nurses transitioning to practice, because they appear to resolve some of the tensions in career planning and aspirations. However, FIFO models may also present significant tensions between healthcare services and the communities they serve. This article presents the thoughts and perceptions of new graduate nurses as they explore future career pathways in rural-remote nursing. It draws on the rural and remote health literature, in recognition of the enduring inequalities of rural and remote health in Australia.

A transcultural immersion experience: implications for nursing education.

This article is a synthesis and interpretation of field work from a transcultural nursing immersion experience in Italy. The main focus of the field work was to understand the cultural influences on health systems with interpretations related to nursing education. The major recommendations of the paper include strategies for nurse educators to promote cultural competence throughout curricula by providing students with meaningful clinical experiences and addressing healthcare needs of diverse populations in the U.S. and abroad.

[From Sherlock Holmes to Dr House. Analogies between medical thought and investigative method.] / Da Sherlock Holmes al Dr House. Analogie fra pensiero medico e metodo investigativo.

The analogies between clinical method and science of investigation are present in great measure in literature. Both the doctor and the detective have, as the main purpose of their action, the identification of the culprit of an abnormal and dangerous situation (the diagnosis of the disease on the one hand, the identification of the criminal on the other). Hence the idea of proposing the prototype of the modern investigator, Sherlock Holmes, as a travel companion in evidence-based medicine. Deduction, induction and abduction: these are the means available to investigators and doctors to solve the cases that arise before them.

Nurses without borders: the history of nursing as U.S. international history.

During World War I and its aftermath, thousands of U.S. nurses put their domestic careers on hold to work overseas. Many volunteered in the wake of war and disaster. Others worked as instructors in nursing schools and as the staff of fledgling public health agencies. This article charts the international travels of four especially mobile nurses, whose globetrotting careers took them to Europe, Asia, and the Caribbean. These women aspired to tackle world health issues, motivated by the conviction that the spread of U.S. professional nursing ideas stood to modernize the world. This article tells these nurses' stories and analyzes their ideologies of development and progress. In so doing, it demonstrates that professional women, working outside state channels, played a principal role in expanding U.S. influence in the world. Moreover, it makes the case for the centrality of nursing history to the history of U.S. foreign relations.