Reshaping internationalization of medical education in 2023.

The global COVID-19 pandemic has shown the need for internationalization of medical education, in order to facilitate global collaborative problem solving in healthcare. In 2023, it is time to reshape IoME within the context of our time, and share new visions, ideas, and formats. This collection of articles reports on theories and actions in IoME.

Implementing a Virtual Team Model in the Acute Care Setting.

Health care has forever changed in early 2021. Three years after the beginning of the COVID-19 world pandemic, we must seriously look at the role of the nurses and the model we deploy to ensure our health system's viability. In this article, the authors offer insights into the journey of deconstructing the nurses' role and planning for a Co-Caring Model where virtual and bedside nurses practice and unlicensed assisting personnel work as a team to care for those in need of health care. We also provide a list of actions for nurse leaders to consider. Finally, we aim to spark an international conversation on how we can bring back the joy of practice to ensure we create the best possible places to give and get care.

Switching from offline to online health consultation in the post-pandemic era: the role of perceived pandemic risk.

Introduction: Due to its effectiveness and various benefits, the use of online health consultation (OHC) has dramatically increased in recent years, especially since the outbreak of the COVID-19 pandemic. However, underlying mechanism whereby the pandemic impacted OHC usage is still unclear. Methods: Via an online survey (N=318), the present paper measures the users' perceptions towards both offline and online services, their intention to switch to OHC, and the perceived pandemic risks. The relationships among these factors are conceptualized by the push-pull-mooring framework, and tested via structural equation modelling. Results: Dissatisfaction with offline service (process inefficiency and consultation anxiety), the attractiveness of OHC (perceived benefits and perceived ease of use), and users' behavioral inertia (switching cost and habit) jointly influence the intention to switching to OHC. The significant role of the perceived pandemic risk of going to medical facilities is particularly addressed. On the one hand, the perceived pandemic risk is found with an indirect impact on the switching intention by enlarging the dissatisfaction with offline service and the attractiveness of OHC. On the other hand, a high perceived pandemic risk induces more actual switching behavior and also amplifies the transition from switching intention to behavior. Discussion: The study provides novel insights into the understanding of OHC usage in the post-pandemic era, and also informs medical facilities, OHC platforms, and policymakers on managing and balancing the online and offline healthcare provision.

The Prevalence of mRNA Related Discussions During the Post-COVID-19 Era.

Vaccinations are one of the most significant interventions to public health, but vaccine hesitancy and skepticism are raising serious concerns for a portion of the population in many countries, including Sweden. In this study, we use Swedish social media data and structural topic modeling to automatically identify mRNA-vaccine related discussion themes and gain deeper insights into how people's refusal or acceptance of the mRNA technology affects vaccine uptake. Our point of departure is a scientific study published in February 2022, which seems to once again sparked further suspicion and concern and highlight the necessity to focus on issues about the nature and trustworthiness in vaccine safety. Structural topic modelling is a statistical method that facilitates the study of topic prevalence, temporal topic evolution, and topic correlation automatically. Using such a method, our research goal is to identify the current understanding of the mechanisms on how the public perceives the mRNA vaccine in the light of new experimental findings.

Why we should care about moral foundations when preparing for the next pandemic: Insights from Canada, the UK and the US.

Health behaviors that do not effectively prevent disease can negatively impact psychological wellbeing and potentially drain motivations to engage in more effective behavior, potentially creating higher health risk. Despite this, studies linking "moral foundations" (i.e., concerns about harm, fairness, purity, authority, ingroup, and/or liberty) to health behaviors have generally been limited to a narrow range of behaviors, specifically effective ones. We therefore explored the degree to which moral foundations predicted a wider range of not only effective but ineffective (overreactive) preventative behaviors during the COVID-19 pandemic. In Study 1, participants from Canada, the United Kingdom, and the United States reported their engagement in these preventative behaviors and completed a COVID-specific adaptation of the Moral Foundations Questionnaire during the pandemic peak. While differences occurred across countries, authority considerations consistently predicted increased engagement in both effective preventative behaviors but also ineffective overreactions, even when controlling for political ideology. By contrast, purity and liberty considerations reduced intentions to engage in effective behaviors like vaccination but had no effect on ineffective behaviors. Study 2 revealed that the influence of moral foundations on U.S participants' behavior remained stable 5-months later, after the pandemic peak. These findings demonstrate that the impact of moral foundations on preventative behaviors is similar across a range of western democracies, and that recommendations by authorities can have unexpected consequences in terms of promoting ineffective-and potentially damaging-overreactive behaviors. The findings underscore the importance of moral concerns for the design of health interventions that selectively promote effective preventative behavior.

Evaluation of COVID-19 pandemic management in Türkiye.

Three years since the first cases were identified and 2 years since an effective vaccine was developed, COVID-19 continues to claim lives and impact people's health and wellbeing, both socially and economically. While the world has been waiting for its leaders to come together to form a collective response to end the pandemic, we still have not seen a multisectoral response, nor any whole-of-society approach. Like many other countries around the globe, Türkiye was caught unprepared by the pandemic. This was exacerbated by the unsuccessful management of the pandemic by the authorities. The reasoning and/or scientific explanations for enforcing or lifting public health measures have never shared with the public. Throughout the pandemic, no epidemiological details have been released on cases and deaths, other than the numbers of these two measures. Civil society organizations, professional associations, and the public in general have been kept out from policy formulation and decision making. As a result, community engagement has never been properly put into practice. In this paper, we analyzed Türkiye's pandemic management response through the continuum of the response cycle to emergencies: prevention, preparedness, readiness, response, and recovery.

Strategies to maintain recovery from alcohol problems during the COVID-19 pandemic: Insights from a mixed-methods national survey of adults in the United States.

The COVID-19 pandemic has been associated with poorer mental health and, in some cases, increased alcohol consumption; however, little is known about the pandemic's effects on people in recovery from alcohol use disorder (AUD), especially how they have coped with novel stressors. Our mixed-methods study investigated strategies used to maintain recovery during the pandemic, with attention to variation by gender. We analyzed data obtained in fall 2020 from an online US national survey of adults with resolved AUD (n = 1,492) recruited from KnowledgePanel, a probability-based cohort of non-institutionalized adults maintained by Ipsos for internet-based research. Participants endorsed possible coping strategies on a 19-item choose-all-that-apply list, which were analyzed using chi-square tests. In addition, 1,008 participants provided text responses to an open-ended question about their strategies to maintain recovery during the pandemic, which were coded and analyzed using an inductive, thematic approach. The majority of our sample met criteria for severe lifetime AUD (72.9%), reported being in recovery more than five years (75.5%), and had never used specialty AUD services or mutual-help groups (59.7%). The ordering of the coping strategies was quite similar for women and men; however, the top strategy (talking with family and friends by phone, text, or video) was endorsed more frequently by women than men (49.7% vs. 36.1%; p < .001). Among qualitative themes, "staying connected" was the most common. It was dominated by statements about family, with women mentioning children more often than men. Among other themes, "cognitive strategies" mirrored established therapeutic modalities, and "active pursuits" aligned with many recent recommendations for service providers working with substance-using populations during the pandemic. A minority of participants invoked "willpower" for recovery or stated that pandemic restrictions helped by reducing exposure to relapse risks. These findings shed light on recovery mechanisms during the COVID-19 pandemic and suggest potential intervention targets to support recovery during other catastrophic events, such as natural disasters.

The wisdom of many in few: Finding individuals who are as wise as the crowd.

Is forecasting ability a stable trait? While domain knowledge and reasoning abilities are necessary for making accurate forecasts, research shows that knowing how accurate forecasters have been in the past is the best predictor of future accuracy. However, unlike the measurement of other traits, evaluating forecasting skill requires substantial time investment. Forecasters must make predictions about events that may not resolve for many days, weeks, months, or even years into the future before their accuracy can be estimated. Our work builds upon methods such as cultural consensus theory and proxy scoring rules to show talented forecasters can be discriminated in real time, without requiring any event resolutions. We define a peer similarity-based intersubjective evaluation method and test its utility in a unique longitudinal forecasting experiment. Because forecasters predicted all events at the same points in time, many of the confounds common to forecasting tournaments or observational data were eliminated. This allowed us to demonstrate the effectiveness of our method in real time, as time progressed and more information about forecasters became available. Intersubjective accuracy scores, which can be obtained immediately after the forecasts are made, were both valid and reliable estimators of forecasting talent. We also found that asking forecasters to make meta-predictions about what they expect others to believe can serve as an incentive-compatible method of intersubjective evaluation. Our results indicate that selecting small groups of, or even single forecasters, based on intersubjective accuracy can yield subsequent forecasts that approximate the actual accuracy of much larger crowd aggregates. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Understanding Connections between Nature and Stress among Conservation-Engaged Adolescents Using Photovoice Methodology.

While the literature supports positive associations between nature and adolescent mental health, mechanisms are not well understood, and assessment of nature varies widely among existing studies. To partner with the most insightful informants, we enrolled eight adolescent participants from a conservation-informed summer volunteer program, applying qualitative photovoice methodology to understand their use of nature to relieve stress. Across five group sessions, participants identified four themes: (1) Nature shows us different aspects of beauty; (2) nature helps us relieve stressful experiences by balancing our senses; (3) nature gives us space to find solutions; and (4) we want to find time to enjoy nature. At the conclusion of the project, youth participants reported that the research experience was overwhelmingly positive, enlightening, and inspired appreciation of nature. We found that, while our participants unanimously reported that nature relieved their stress, prior to this project, they were not always intentional in seeking time in nature for this purpose. Through the photovoice process, these participants noted the usefulness of nature for stress relief. We conclude with recommendations for leveraging nature to decrease adolescent stress. Our findings are relevant for families, educators, students, healthcare professionals, and anyone who works with or cares for adolescents.

Determinants of people's motivations to approach COVID-19 vaccination centers.

This paper presents the results of a survey exploring the determinants of vacinees' confidence in COVID-19 vaccines and their motivations to become vaccinated. At the threatening rise of the highly infectious Omicron variant, in December 2021, we interviewed people in waiting lines of vaccination centers. Our results identify risk-averse and social-distancing-compliant people as showing high confidence in the vaccine, which motivates them to receive it for reasons of protecting themselves and others. By contrast, policy incentives, such as "3G/2G" restrictions, motivate risk-tolerant people who opted for vaccination to get access to public areas. Trusting people who regularly vote are little afraid of vaccines' side effects. Our findings offer insights for policymakers in societies and firms that help to tailor policies promoting vaccination based on people's economic preferences.

The untapped potential of Games for Health in times of crises. A critical reflection.

Given its promising role in public health to address hard to reach population groups, game-based interventions (i.e., Games for Health, G4H) have experienced growing interest in recent years. Therefore, it is surprising that they have played only a minor role during the COVID-19 pandemic. Hence, the aim of this paper is to reflect the opportunities and challenges of G4H especially during the pandemic but also with regard to future health crises. As commercial video games (i.e., those that primarily aim to entertain its users) were often used to deal with the containment measures during the COVID-19 pandemic, we call for greater cooperation with commercial game makers to distribute health-related messages via entertainment games. With regard to G4H we see a need to (i) strengthen the intervention theory underlying game-based applications, (ii) to enhance the appeal of games in order to maintain the interest of users in the long term, and (iii) to improve the evidence base using appropriate study designs. Finally, we argue for (iv) greater user involvement, both in terms of developing game-based approaches and as co-researchers in solving complex health problems.

Introducing second-year medical students to diagnostic reasoning concepts and skills via a virtual curriculum.

OBJECTIVES: Curriculum for clinical reasoning in the preclinical years is sparse and the COVID-19 pandemic heightened the need for virtual curriculums. METHODS: We developed, implemented and evaluated a virtual curriculum for preclinical students scaffolding key diagnostic reasoning concepts: dual process theory, diagnostic error, problem representation and illness scripts. Fifty-five second-year medical students participated in four 45-min virtual sessions led by one facilitator. RESULTS: The curriculum led to increased perceived understanding and increased confidence in diagnostic reasoning concepts and skills. CONCLUSIONS: The virtual curriculum was effective in introducing diagnostic reasoning and was well-received by second-year medical students.

A Thematic Review on Using Food Delivery Services during the Pandemic: Insights for the Post-COVID-19 Era.

The food delivery service is the most typical and visible example of online-to-offline (O2O) commerce. More consumers are using food delivery services for various reasons during the COVID-19 pandemic, making this business model viral worldwide. In the post-pandemic era, offering food delivery services will become the new normal for restaurants. Although a growing number of publications have focused on consumer behavior in this issue, no review paper has addressed current research and industry trends. Thus, this paper aims to review the literature published from 2020 to the present (October 2022) on consumers' use of food delivery services during the pandemic. A thematic review was conducted, with 40 articles searched from Scopus and Web of Science being included. Quantitative findings showed current research trends, and thematic analyses formed eight themes of factors influencing consumer behavior: (1) technical and utilitarian factors, (2) system-related attributes, (3) emotional and hedonic factors, (4) individual characteristics, (5) service quality, (6) risk-related factors, (7) social factors, and (8) food-related attributes. The paper also emphasizes COVID-19-related influences and suggests promising future research directions. The results offer insights into industry practices and starting points for future research.

Supporting Health and Medical Decision Making: Findings and Insights from Fuzzy-Trace Theory.

HIGHLIGHTS: Fuzzy-trace theory (FTT) supports practical approaches to improving health and medicine.FTT differs in important respects from other theories of decision making, which has implications for how to help patients, providers, and health communicators.Gist mental representations emphasize categorical distinctions, reflect understanding in context, and help cue values relevant to health and patient care.Understanding the science behind theory is crucial for evidence-based medicine.

Optimizing COVID-19 vaccine allocation considering the target population.

Vaccine allocation strategy for COVID-19 is an emerging and important issue that affects the efficiency and control of virus spread. In order to improve the fairness and efficiency of vaccine distribution, this paper studies the optimization of vaccine distribution under the condition of limited number of vaccines. We pay attention to the target population before distributing vaccines, including attitude toward the vaccination, priority groups for vaccination, and vaccination priority policy. Furthermore, we consider inventory and budget indexes to maximize the precise scheduling of vaccine resources. A mixed-integer programming model is developed for vaccine distribution considering the target population from the viewpoint of fairness and efficiency. Finally, a case study is provided to verify the model and provide insights for vaccine distribution.

A qualitative study of behavioral and social drivers of COVID-19 vaccine confidence and uptake among unvaccinated Americans in the US April-May 2021.

INTRODUCTION: Around one-third of Americans reported they were unwilling to get a COVID-19 vaccine in April 2021. This focus group study aimed to provide insights on the factors contributing to unvaccinated adults' hesitancy or refusal to get vaccinated with COVID-19 vaccines. METHOD: Ipsos recruited 59 unvaccinated US adults who were vaccine hesitant (i.e., conflicted about or opposed to receiving a COVID-19 vaccination) using the Ipsos KnowledgePanel. Trained facilitators led a total of 10 focus groups via video-conference in March and April 2021. Two coders manually coded the data from each group using a coding frame based on the focus group discussion guide. The coding team collaborated in analyzing the data for key themes. RESULTS: Data analysis of transcripts from the focus groups illuminated four main themes associated with COVID-19 vaccine hesitancy: lack of trust in experts and institutions; concern about the safety of COVID-19 vaccines; resistance towards prescriptive guidance and restrictions; and, despite personal reluctance or unwillingness to get vaccinated, acceptance of others getting vaccinated. DISCUSSION: Vaccine confidence communication strategies should address individual concerns, describe the benefits of COVID-19 vaccination, and highlight evolving science using factural and neutral presentations of information to foster trust.

Responding to the times: Adapting an evaluation study during a dual pandemic.

This paper is a critical essay to discuss an original methodological design for an equity school evaluation in diverse-by-design schools. The evaluation was to gather a broad swathe of data necessary to provide detailed insights on diverse-by-design schools in diversity, equity, and inclusion (DEI) practices. We chronicle and critically explore the methodological pivots generated by the research team as we conducted this research against the backdrop of both the COVID-19 pandemic and US nationwide protests in response to the murder of George Floyd and countless other Black people at the hands of the police. We challenge our own use of equity in our research design by centering school communities through agency of partnership.

Jeelo Dobara (Live Life Again): a cross-sectional survey to understand the use of social media and community experience and perceptions around COVID-19 vaccine uptake in three low vaccine uptake districts in Karachi, Pakistan.

OBJECTIVE: To gather preliminary insights through formative research on social media usage, and experiences, attitudes and perceptions around COVID-19 and COVID-19 vaccination in three high-risk, underserved districts in Karachi, Pakistan. DESIGN: Cross-sectional mixed-method design. PARTICIPANTS: 392 adults (361 surveys and 30 in-depth interviews (IDI)) from districts South, East and Korangi in Karachi, Pakistan. MAIN OUTCOME MEASURES: Social media usage and knowledge, perception and behaviour towards COVID-19 infection and vaccination. RESULTS: Using social media was associated with an increased probability of getting vaccinated by 1.61 units. Most of the respondents (65%) reported using social media, mainly to watch videos and/or keep in touch with family/friends. 84.76% knew of COVID-19 while 88.37% knew about the COVID-19 vaccination, with 71.19% reported vaccine receipt; reasons to vaccinate included belief that vaccines protect from the virus, and vaccination being mandatory for work. However, only 56.7% of respondents believed they were at risk of disease. Of the 54 unvaccinated individuals, 27.78% did not vaccinate as they did not believe in COVID-19. Despite this, 78.38% of respondents scored high on vaccine confidence. In IDIs, most respondents knew about COVID-19 vaccines: 'This vaccine will create immunity in your body. Therefore, I think we should get vaccinated', and over half knew how COVID-19 spreads. Most considered COVID-19 a serious public health problem and thought it important that people get vaccinated. However, there was a low-risk perception of self as only a little over half felt that they were at risk of contracting COVID-19. CONCLUSION: With our conflicting results regarding COVID-19 vaccine confidence, that is, high vaccine coverage but low perception of risk to self, it is likely that vaccine coverage is more a result of mandates and coercion than true vaccine confidence. Our findings imply that interactive social media could be valuable in fostering provaccine sentiment.