A disciplina psicologia do esporte nos cursos de psicologia e educação física / Sports psychology in psychology and physical education courses / La materia psicología del deporte en los cursos de psicología y educación física

Este discute a representatividade da disciplina Psicologia do Esporte nos cursos de Psicologia e Educação Física em instituições de ensino superior reconhecidas pelo MEC e situadas na região Sul do país. Foi realizado um estudo documental, com base nos currículos das Instituições. Os resultados revelaram que no Sul do Brasil 21,02% dos cursos de Psicologia, 41,96% dos cursos de bacharelado em Educação Física e apenas 14,83% dos cursos de licenciatura em Educação Física apresentam a disciplina Psicologia do Esporte em sua grade curricular. Observou-se que a disciplina é ofertada mais frequentemente em regime obrigatório nos cursos de bacharelado em Educação Física. Nos cursos de Psicologia, quando ofertada, costuma ser optativa. Os resultados evidenciam uma maior oferta da disciplina para os estudantes de Educação Física, em relação aos de Psicologia, o que pode estar relacionado ao próprio contexto de surgimento da disciplina e sua popularização no meio acadêmico. Para que esse panorama possa mudar e se possa oferecer uma formação adequada no curso de Psicologia para fomentar essa opção de carreira, há necessidade de se repensar o currículo e o próprio perfil do egresso, de forma a dar mais oportunidade aos estudantes para que conheçam as bases teóricas e os campos de aplicação da Psicologia do Esporte. Tal lacuna pode acarretar a fragilização da disseminação desse conhecimento aos estudantes de graduação e a consequente ocupação do mercado de trabalho.(AU)

This study discusses the representativeness of Sports Psychology in Psychology and Physical Education courses at higher education institutions from Southern Brazil. A documentary study was conducted based on the institutions' curricula. Results show that 21.02% of the Psychology major, 41.96% of the bachelor's in Physical Education, and only 14.83% of the license in Physical Education offer Sports Psychology in their curricula. Sports Psychology is most often offered as a compulsory subject in the bachelor's program in Physical Education, whereas Psychology courses offer it mainly as an elective. Physical Education students have greater contact with the discipline when compared with Psychology students, which may be explained by its context of development and popularization in the academic environment. To change this scenario and offer adequate education in the Psychology programs to foster this career option, institutions must rethink their curriculum and the graduate profile itself. This would give students better opportunity to get to know its theoretical bases and fields of application. Such a gap can hinder the dissemination of this knowledge to undergraduate students and the consequent labor market occupation.(AU)

El objetivo de este estudio es discutir la representatividad de la materia Psicología del Deporte en los cursos de Psicología y Educación Física en instituciones de educación superior de la región Sur de Brasil, reconocidas por el Ministerio de Educación (MEC). Se realizó un estudio documental, basado en los planes de estudio de las instituciones. Los resultados revelaron que, en el Sur de Brasil, el 21,02% de los cursos de Psicología, el 41,96% de los cursos de licenciatura en Educación Física y sólo el 14,83% de los cursos de profesorado en Educación tienen la materia Psicología del Deporte en sus planes de estudio. Se observó que la materia Psicología del Deporte se ofrece con mayor frecuencia como asignatura obligatoria en los cursos de licenciatura en Educación Física. Cuando se ofrece en los cursos de Psicología, es una materia optativa. Los resultados muestran una mayor oferta para los estudiantes de Educación Física en comparación con Psicología, lo que puede estar relacionado con el contexto del surgimiento de la Psicología del Deporte como materia y su popularización en el ámbito académico. Para que este escenario cambie y sea posible ofrecer una formación adecuada en el curso de Psicología con el fin de fomentar esta opción de carrera, es necesario repensar el plan de estudios y el perfil del egresado, así los estudiantes tendrán más oportunidades de conocer sus bases teóricas y sus campos de actuación. Tal brecha puede debilitar la difusión de este conocimiento a los estudiantes de grado y la consecuente ocupación en el mercado laboral.(AU)

A invenção de um setting on-line para atendimento psicológico remoto / The invention of an online environment for remote psychological care / La invención de un entorno en línea para la atención psicológica remota

Com o advento da covid-19, foi declarado estado de emergência de saúde pública e decretadas medidas de isolamento e distanciamento social para conter a propagação da doença. O Conselho Federal de Psicologia, considerando a importância do acolhimento seguro durante a pandemia, publicou a Resolução CFP nº 4/2020, permitindo que serviços psicológicos aconteçam de maneira remota. O presente estudo visa, através do Método da Cartografia, apresentar a construção de um setting on-line para intervenções grupais e os desafios na oferta de acolhimento e atendimento remoto. Foram ofertados grupos terapêuticos, por meio da plataforma Google Meet, para estudantes da Universidade Federal Rural do Rio de Janeiro. Um diário de bordo foi produzido para acompanhar as forças que atravessavam e constituíam o território e a experiência grupal remota. Compreendemos que o território-espaço-grupal-on-line era composto pelo espaço virtual em que nos reuníamos, pelos espaços individuais de cada integrante e pelas forças que os atravessavam. Observamos que nem sempre os participantes dispunham de um lugar privado, mas estiveram presentes no encontro com câmeras e áudios abertos e/ou fechados e/ou através do chat da videochamada. A participação no grupo funcionou como alternativa no momento de distanciamento social, sendo uma possibilidade para o atendimento psicológico em situações de dificuldade de encontros presenciais; entretanto, se mostrou dificultada em diversos momentos, pela falta de equipamentos adequados e instabilidade na internet, fatores que interferiram nas reuniões e impactaram na possibilidade de falar e escutar o que era desejado.(AU)

With the advent of COVID-19, a state of public health was declared, and measures of isolation and social distance to contain the spread of the disease was decreed. The Federal Council of Psychology, considering the importance of safe reception during the pandemic, published CFP Resolution No. 4/2020, allowing psychological services to happen remotely. This study narrates, via the Cartography Method, the experience of inventing an Online Setting for group reception. Therapeutic groups were offered, via Google Meet Platform, to students at the Federal Rural University of Rio de Janeiro. A logbook was produced to accompany the forces that crossed and constituted the territory and the remote group experience. We understand that the territoryspace-group-online was composed by the virtual-space that we gathered, by the individualspaces of each member and by the forces that crossed them. We observed that the participants did not always have a private place, but they were present at the meeting with open and/or closed cameras and audio and/or through the video call chat. Participation in the group worked as an alternative at the time of social distancing, being a possibility for psychological care in situations of difficulty in face-to-face meetings, however, it proved to be difficult at various times, due to the lack of adequate equipment and instability on the internet, factors that interfered in meetings and impacted the possibility of speaking and listening to what was desired.(AU)

La llegada de la COVID-19 produjo un estado de emergencia de salud pública, en el que se decretaron medidas de confinamiento y distanciamiento físico para contener la propagación de la enfermedad. El Consejo Federal de Psicología, considerando la importancia de la acogida segura durante la pandemia, publicó la Resolución CFP nº 4/2020, por la que se permite la atención psicológica remota. Este estudio tiene por objetivo presentar, mediante el método de la Cartografía, la elaboración de un escenario en línea para la intervención grupal y los desafíos en la oferta de acogida y atención remota. Grupos terapéuticos se ofrecieron, en la plataforma Google Meet, a estudiantes de la Universidad Federal Rural de Río de Janeiro. Se elaboró un diario para acompañar a las fuerzas que atravesaron y constituyeron el territorio y la experiencia remota del grupo. Entendemos que el territorio-espacio-grupo-en línea estaba compuesto por el espacio-virtual que reunimos, por los espacios individuales de cada integrante y por las fuerzas que los atravesaban. Observamos que los participantes no siempre tenían un lugar privado y que estaban presentes en la reunión con cámaras y audio abiertos y/o cerrados y/o por el chat de la videollamada. La participación en el grupo funcionó como una alternativa en el momento del distanciamiento físico y revela ser una posibilidad de atención psicológica en situaciones de dificultad en los encuentros presenciales, sin embargo, se mostró difícil en varios momentos, ya sea por la falta de medios adecuados o por inestabilidad en Internet, factores que interferían en las reuniones e impactaban en la posibilidad de hablar y escuchar lo que se deseaba.(AU)

Formação em psicologia escolar: implicações para a prática em equipe multiprofissional / The school psychology formation: implications for the practice in multidisciplinary team / Formación en psicología escolar: implicaciones para la práctica en equipo multiprofesional

O objetivo dessa pesquisa foi levantar o perfil sociodemográfico e formativo de psicólogos escolares, e discutir seu impacto nas práticas junto ao coletivo escolar e no trabalho em equipe. No município onde ocorreu a pesquisa, o psicólogo escolar é membro da equipe de especialistas em Educação. Participaram da pesquisa 62 psicólogos que atuam no Ensino Fundamental I, II, e na Educação de Jovens e Adultos. Os participantes responderam um questionário on-line com perguntas abertas e fechadas sobre dados sociodemográficos, de formação e atuação profissional. Realizou-se uma análise qualitativa a partir dos objetivos e itens do instrumento, quais sejam: caracterização do perfil sociodemográfico dos psicólogos escolares, formação acadêmica, atuação em psicologia escolar, atuação em outros campos/áreas da psicologia, e atuação em equipe de especialistas. A média de idade dos profissionais é de 47,46 anos, e apenas um é do sexo masculino. Possuem tempo de atuação de um a 36 anos, e a maioria não possui estágio supervisionado e pós-graduações no campo da psicologia escolar. Parte das equipes que trabalham nas escolas está incompleta, e há uma variabilidade nos dias e horários de reuniões. Reafirma-se que a formação de psicólogos escolares tem repercussões na atuação junto à equipe multidisciplinar, e a importância de intervenções pautadas na perspectiva crítica e psicossocial em Psicologia Escolar. Ademais, conhecer o perfil sociodemográfico e formativo destes profissionais possibilita obter um quadro atualizado sobre o grupo pesquisado e criar estratégias de intervenção que potencializem a atuação desses profissionais junto à equipe de especialistas e demais setores da escola.(AU)

The aim of this research is to identify the sociodemographic and training profile of school psychologists, and discuss their impact on practices within the school collective and the teamwork. In the city where the research took place, the school psychologist is a member of the council's expert team in Education. The research participants included 62 psychologists that work in elementary and intermediate school, and EJA. They answered an open and multiple choice online survey on sociodemographic, formation, and working data. A qualitative analysis was conducted considering its objectives and items, namely: sociodemographic profile, academic education, professional background on school psychology, other psychology fields/ areas, and participation on expert teams. The professionals are 47 and 46 years old, average, only one of them being male. They work in this position from one up to 36 years, and most of them do not have training experience and postgraduate studies in school psychology. Part of the teams working at schools are incomplete, and there is a variability concerning days and hours to team meetings. It is notable that the training profile of psychologists has repercussions in the performance with the multidisciplinary team, and in the importance of interventions based on critical and psychosocial perspectives in School Psychology. Moreover, knowing the sociodemographic and training profile of these professionals allowed us to have an updated chart about the researched group, as well as to create intervention strategies that enhance these professionals' performance within the expert team and other sectors of the school.(AU)

Esta investigación tuvo por objetivo levantar el perfil sociodemográfico y formativo de psicólogos escolares para discutir su impacto en las prácticas junto al colectivo escolar y al trabajo en equipo. En el municipio donde ocurrió la investigación, este profesional es miembro del equipo municipal de especialistas en Educación. Participaron 62 psicólogos que actúan en la educación primaria, secundaria y en la educación para jóvenes y adultos (EJA), y que respondieron a un cuestionario en línea con preguntas abiertas y de opción múltiple sobre datos sociodemográficos, de formación y de actuación profesional. Se realizó un análisis cualitativo según sus objetivos e ítems, o sea: perfil sociodemográfico, formación académica, actuación en Psicología Escolar, en otros campos/áreas de la Psicología o en equipo de especialistas. La edad mediana de los profesionales es de 46-47 años, y solo uno es del sexo masculino. El tiempo de actuación en el área varía entre 1 y 36 años, y la mayoría de los encuestados no tiene formación inicial y posgrado en el campo de la Psicología Escolar. Parte de los equipos que trabajan en las escuelas está incompleta, y existe una variabilidad en los días y horarios de reuniones. Se observó que la formación de los psicólogos escolares tiene repercusiones en la actuación con el equipo multidisciplinario y en la importancia de intervenciones basadas en la perspectiva crítica y psicosocial en Psicología Escolar. Además, conocer su perfil sociodemográfico y formativo posibilita obtener un cuadro actualizado sobre el grupo investigado, además de crear estrategias de intervención que potencialicen la actuación junto al equipo de especialistas y a los demás sectores de la escuela.(AU)

Rural Work and Specialty Choices of International Students Graduating from Australian Medical Schools: Implications for Policy.

Almost 500 international students graduate from Australian medical schools annually, with around 70% commencing medical work in Australia. If these Foreign Graduates of Accredited Medical Schools (FGAMS) wish to access Medicare benefits, they must initially work in Distribution Priority Areas (mainly rural). This study describes and compares the geographic and specialty distribution of FGAMS. Participants were 18,093 doctors responding to Medicine in Australia: Balancing Employment and Life national annual surveys, 2012-2017. Multiple logistic regression models explored location and specialty outcomes for three training groups (FGAMS; other Australian-trained (domestic) medical graduates (DMGs); and overseas-trained doctors (OTDs)). Only 19% of FGAMS worked rurally, whereas 29% of Australia's population lives rurally. FGAMS had similar odds of working rurally as DMGs (OR 0.93, 0.77-1.13) and about half the odds of OTDs (OR 0.48, 0.39-0.59). FGAMS were more likely than DMGs to work as general practitioners (GPs) (OR 1.27, 1.03-1.57), but less likely than OTDs (OR 0.74, 0.59-0.92). The distribution of FGAMS, particularly geographically, is sub-optimal for improving Australia's national medical workforce goals of adequate rural and generalist distribution. Opportunities remain for policy makers to expand current policies and develop a more comprehensive set of levers to promote rural and GP distribution from this group.

Demographic and Practice Characteristics of Physicians Who Care for Medically Underserved People: A National Survey.

OBJECTIVES: Few national studies have examined the influence of role models as a potential predictor for caring for medically underserved (MUS) patients. This study tested associations between previous physician role model exposure and caring for MUS populations, as well as examines the practice environments of these physicians. METHODS: Between October and December 2011, we mailed a confidential questionnaire to a representative sample of 2000 US physicians from various specialties. The primary criterion variable was "Is your patient population considered medically underserved?" We assessed demographic and other personal characteristics (calling, spirituality, and reporting a familial role model). We also asked about their practice characteristics, including a validated measure that assessed whether their work environment was considered chaotic/hectic or calm. RESULTS: The survey response rate was 64.5% (1289/2000). Female physicians and African American physicians were more likely to report working in MUS settings (multivariate odds ratio [OR] 1.32, confidence interval [CI] 1.00-1.76 and OR 2.65, CI 1.28-5.46, respectively). Physicians with high spirituality (OR 1.69, CI 1.02-2.79) and who reported familial role model exposure (OR 1.91, CI 1.11-3.30) also were associated with working with MUS populations. Physicians who worked in academic medical centers (OR 1.93, CI 1.45-2.56) and in chaotic work environments (OR 3.25, CI 1.64-6.44) also were more likely to report working with MUS patients. CONCLUSIONS: Familial role models may be influencing physicians to work with MUS patients, but the quality of their current work environments raises concerns about the long-term retention of physicians in MUS settings.

Comprehensive practice: Normative definition across 3 generations of alumni from a single family practice program, 1985 to 2012.

OBJECTIVE: To determine the range of services and procedures offered by family physicians who define themselves as comprehensive practitioners and compare responses across 3 generations of alumni of a single family practice program. DESIGN: Cross-sectional survey. SETTING: Western University in London, Ont. PARTICIPANTS: All graduates of the family medicine program between 1985 and 2012. MAIN OUTCOME MEASURES: Self-reported provision of the following types of care: in-office care, in-hospital care, intrapartum obstetrics, housecalls, palliative care, after-hours care, nursing home care, minor surgery, emergency department care, sport medicine, and walk-in care. Sex, training site (urban or rural), size of community of practice, practice model, and satisfaction with practice were also reported. RESULTS: Participants practised in 7 provinces and 1 territory across Canada, but principally in Ontario. A small number were located in the United States. There was a decline in the number of services provided across 3 generations of graduates, with newer graduates providing fewer services than the older graduates. Significant decreases across the 3 groups were observed in provision of housecalls (P = .004), palliative care (P = .028), and nursing home care (P < .001). Non-significant changes were seen in provision of intrapartum obstetrics across the 3 alumni groups, with an initial decline and then increase in reported activity. Most respondents were in a family health organization or family health network practice model and those in such models reported offering significantly more services than those in family health group or salary models (P < .001). CONCLUSION: The normative definition of comprehensive care varies across 3 generations of graduates of this family medicine program, with newer physicians reporting fewer overall services and procedures than older graduates. Greater understanding of the forces (institutional, regulatory, economic, and personal) that determine the meaning of comprehensive primary care is necessary if this foundational element of family medicine is to be preserved.

Impact of the workforce distribution on the viability of the osteopathic profession in Australia: results from a national survey of registered osteopaths.

Background: Workforce distribution has an important influence on the quality of healthcare delivered in a region, primarily because it impacts access to health services in the community and overall health equity in the population. Distribution of osteopaths in Australia does not appear to follow the Australian population with the majority of osteopaths located in Victoria. The implications of this imbalance on the osteopathic workforce have not yet been explored. Methods: A secondary analysis of data from a survey of 1531 members of Osteopathy Australia in 2013. The analysis focused on the practice and occupational characteristics associated with practice locality. Results: The survey was completed by a representative sample of 432 osteopaths. Respondents practicing outside Victoria were more likely to report higher income across all income brackets, and were less likely to report a preference for more patients. Conclusions: The Australian osteopathic profession should examine the issue of imbalanced workforce distribution as a priority. The results of this study are worth considering for all stakeholders as part of a coordinated approach to ensure the ongoing health of the Australian osteopathic workforce.

'Living the rural experience-preparation for practice': The future proofing of sustainable rural midwifery practice through midwifery education.

Rural practice presents unique challenges and skill requirements for midwives. New Zealand and Scotland face similar challenges in sustaining a rural midwifery workforce. This paper draws from an international multi-centre study exploring rural midwifery to focus on the education needs of student midwives within pre-registration midwifery programmes in order to determine appropriate preparation for rural practice. The mixed-methods study was conducted with 222 midwives working in rural areas in New Zealand (n = 145) and Scotland (n = 77). Midwives' views were gathered through an anonymous online survey and online discussion forums. Descriptive analysis was used for quantitative data and thematic analysis was conducted with qualitative data. 'Future proofing rural midwifery practice' using education was identified as the overarching central theme in ensuring the sustainability of rural midwives, with two associated principle themes emerging (i) 'preparation for rural practice' and (ii) 'living the experience and seeing the reality'. The majority of participants agreed that pre-registration midwifery programmes should include a rural placement for students and rural-specific education with educational input from rural midwives. This study provides insight into how best to prepare midwives for rural practice within pre-registration midwifery education, in order to meet the needs of midwives and families in the rural context.

Practice Area Intentions of Graduates of Colleges of Osteopathic Medicine: What Role Does Debt Play?

CONTEXT: Enrollment in colleges of osteopathic medicine continues to increase, as does the need for physicians practicing in underserved areas. The cost of osteopathic medical education is substantial, with students often incurring debt of $200,000 or more. It is unclear whether practice patterns of new graduates will be affected by debt-to-income ratios. OBJECTIVE: To determine whether the intended practice location of graduates of colleges of osteopathic medicine is associated with medical education debt. METHODS: Using data from the American Association of Colleges of Osteopathic Medicine's annual survey to graduates of colleges of osteopathic medicine, the authors focused on graduates' intention to practice in an underserved area, the amount of debt incurred, and plans to enter a loan-repayment program. Survey data from 2007, 2010, 2013, and 2016 were analyzed. RESULTS: From 2007 to 2016, the percentage of graduates who intended to practice in underserved areas increased (27.5% to 35.3%, respectively). Graduates with the most debt intended to practice in underserved areas at a higher percentage than those with the least amount of debt, and they also planned on using loan-repayment programs at a higher rate. CONCLUSION: There is a strong association among the intention to practice in an underserved area, high debt load, and intention to use a loan-repayment program. Therefore, the osteopathic medical community should support increased access to loan-repayment programs to help its graduates surmount economic and social barriers to providing care in underserved areas.

Indicações e tratamentos da laserterapia de baixa intensidade na odontologia: uma revisão sistemática da literatura / Indications and treatments of low level laser therapy in dentistry: a systematic review of the literature

Introdução: O laser de baixa intensidade (LLLT ­ Low Level Laser Therapy) possui efeitos anti-inflamatórios, analgésicos e trófico tecidual, podendo ser aplicado em uma grande variedade de condições clínicas na odontologia. Objetivo: este estudo teve como objetivo revisar as indicações e as possibilidades de tratamento de LLLT nas diversas especialidades odontológicas. Material e Métodos: Como estratégia de busca fez-se uma pesquisa bibliográfica nas bases de dados eletrônicas MEDLINE, BSV e SCIELO para identificar estudos relevantes de 2016 a 2018. Uma combinação das seguintes palavras-chaves foi utilizada: low level laser therapy e dentistry. Estas foram combinadas através do operador boleano "AND". Resultados: foram encontrados trinta e sete artigos com indicação de tratamento com laser de baixa intensidade na periodontia, ortodontia, cirurgia, odontopediatria, DTM, patologia, endodontia e dentística. Conclusão: LLLT é um tratamento seguro, sem efeitos colaterais que pode ser utilizado nas especialidades odontológicas como eficaz tratamento coadjuvante aos convencionais.

Introduction: The low level laser therapy (LLLT) has anti-inflammatory, analgesic and tissue-trophic effects, and can be applied in a wide variety of clinical conditions in dentistry. Objective: This study aimed to review indications and treatment possibilities with LLLT in the various dental specialties. Material and Methods: as a search strategy a bibliographic search was conducted in the electronic databases MEDLINE, BSV and SCIELO to identify relevant studies from 2016 to 2018. A combination of the following keywords was used: low level laser therapy and dentistry. These were combined through the Boolean operator "AND". Results: thirty seven articles were found with indication of low intensity laser treatment in periodontics, orthodontics, surgery, pediatric dentistry, TMD, pathology, endodontics and dentistry. Conclusion: LLLT is a safe treatment with no side effects that can be used in dental specialties as an effective adjunctive treatment to conventional ones.

Significado que profesionales de enfermería otorgan a educación en salud en un hospital público, Valparaíso - Chile / Meaning that nursing professionals give to Health Education in a public hospital, Valparaiso - Chile

Resumen Enmarcado en la Reforma Salud de Chile, la educación para la salud se ha transformado en una meta clave para fortalecer conductas que apoyen y complementen la prevención, recuperación y rehabilitación de la salud en la persona. Lo que implica una reflexión sobre cómo se desarrolla el proceso educativo en la atención cerrada. El objetivo propuesto es conocer el significado que le otorgan los profesionales de enfermería a la educación en salud, y cómo logran vivenciarlo en su ejercicio profesional. Estudio cualitativo, de orientación fenomenológica, que incluyó ocho enfermeras que desarrollan su ejercicio profesional en una Unidad de Mediana Complejidad Médica de un hospital alta complejidad. Se utilizó la entrevista fenomenológica, y los discursos se analizaron según los momentos de trayectoria metodológica. Se develan percepciones de los profesionales de enfermería, que pueden guiar a un cambio en el ejercicio profesional, permitiendo a las enfermeras brindar una educación en salud: holística y personalizada.

Abstract Enshrined in Chile's Health Reform, health education has become a key goal in strengthening behaviours that support and complement prevention, recuperation and rehabilitation. This implies a reflection on how the process of education can develop within an inpatient facility. Our proposed objective is to study the degree of importance that nurses ascribe to health education, and how they manage to incorporate health education into their professional practice. This is a qualitative research with a phenomenological orientation, which will include eight nurses who are developing their professional practice in a Medium Complexity Level Unit within a High Complexity Level Hospital. We will use phenomenological interviews, which we will analyse according to the moments of the methodological trajectory. The nurses' professional perceptions will be revealed and will be able to guide a change in professional practice, which will in turn enable the nurses to offer personalized and holistic health education.

Pennsylvania Otolaryngologists as a Model for the Implications of Practice Location of Osteopathic vs Allopathic Surgical Subspecialists.

BACKGROUND: Evidenced-based models should be used to predict future implications of the single accreditation system for graduate medical education. Compared with other states, Pennsylvania has a relatively high number of osteopathic physicians (ie, DOs) and may be used as a model for a health care system with an increased DO presence. OBJECTIVE: To compare the geographic distribution of otolaryngologist DOs with otolaryngologist allopathic physicians (ie, MDs) in Pennsylvania and identify differences in community size (urban, urbanized, and rural) in which these physicians practice. METHODS: A list of otolaryngologist practice locations in Pennsylvania was developed using Centers for Medicare and Medicaid Services data, the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery Masterfile, and the American Medical Association Physician Masterfile. The United States Census data were used to document the general population of those locations. The samples of individual otolaryngologist DOs and MDs were then analyzed by determining where each otolaryngologist practiced, identifying the type of community in which they practiced, and then comparing the percentage of otolaryngologist DOs and MDs who practiced in each community type (urbanized area, urban cluster, and rural). A χ2 analysis was used to determine whether a difference existed in practice location between otolaryngologist DOs and MDs. RESULTS: Of the 47 otolaryngologist DOs, 32 (70%) practiced in cities with a population of 49,999 or less. More than half (120 of 238) of the otolaryngologist MDs practiced in cities larger than 50,000, and 96 of 238 (40%) practiced in cities with a population of at least 200,000. χ2 analysis showed a significant difference in the geographic distribution of otolaryngologist DOs and MDs (P=.012). CONCLUSION: A correlation exists between the practice location of otolaryngologists in Pennsylvania and the medical degree they hold.

An examination of the causes, consequences, and policy responses to the migration of highly trained health personnel from the Philippines: the high cost of living/leaving-a mixed method study.

BACKGROUND: Dramatic increases in the migration of human resources for health (HRH) from developing countries like the Philippines can have consequences on the sustainability of health systems. In this paper, we trace the outflows of HRH from the Philippines, map out its key causes and consequences, and identify relevant policy responses. METHODS: This mixed method study employed a decentered, comparative approach that involved three phases: (a) a scoping review on health workers' migration of relevant policy documents and academic literature on health workers' migration from the Philippines; and primary data collection with (b) 37 key stakeholders and (c) household surveys with seven doctors, 329 nurses, 66 midwives, and 18 physical therapists. RESULTS: Filipino health worker migration is best understood within the context of macro-, meso-, and micro-level factors that are situated within the political, economic, and historical/colonial legacy of the country. Underfunding of the health system and un- or underemployment were push factors for migration, as were concerns for security in the Philippines, the ability to practice to full scope or to have opportunities for career advancement. The migration of health workers has both negative and positive consequences for the Philippine health system and its health workers. Stakeholders focused on issues such as on brain drain, gain, and circulation, and on opportunities for knowledge and technology transfer. Concomitantly, migration has resulted in the loss of investment in human capital. The gap in the supply of health workers has affected the quality of care delivered, especially in rural areas. The opening of overseas opportunities has commercialized health education, compromised its quality, and stripped the country of skilled learning facilitators. The social cost of migration has affected émigrés and their families. At the household level, migration has engendered increased consumerism and materialism and fostered dependency on overseas remittances. Addressing these gaps requires time and resources. At the same time, migration is, however, seen by some as an opportunity for professional growth and enhancement, and as a window for drafting more effective national and inter-country policy responses to HRH mobility. CONCLUSIONS: Unless socioeconomic conditions are improved and health professionals are provided with better incentives, staying in the Philippines will not be a viable option. The massive expansion in education and training designed specifically for outmigration creates a domestic supply of health workers who cannot be absorbed by a system that is underfunded. This results in a paradox of underservice, especially in rural and remote areas, at the same time as underemployment and outmigration. Policy responses to this paradox have not yet been appropriately aligned to capture the multilayered and complex nature of these intersecting phenomena.

Causes, consequences, and policy responses to the migration of health workers: key findings from India.

BACKGROUND: This study sought to better understand the drivers of skilled health professional migration, its consequences, and the various strategies countries have employed to mitigate its negative impacts. The study was conducted in four countries-Jamaica, India, the Philippines, and South Africa-that have historically been "sources" of health workers migrating to other countries. The aim of this paper is to present the findings from the Indian portion of the study. METHODS: Data were collected using surveys of Indian generalist and specialist physicians, nurses, midwives, dentists, pharmacists, dieticians, and other allied health therapists. We also conducted structured interviews with key stakeholders representing government ministries, professional associations, regional health authorities, health care facilities, and educational institutions. Quantitative data were analyzed using descriptive statistics and regression models. Qualitative data were analyzed thematically. RESULTS: Shortages of health workers are evident in certain parts of India and in certain specialty areas, but the degree and nature of such shortages are difficult to determine due to the lack of evidence and health information. The relationship of such shortages to international migration is not clear. Policy responses to health worker migration are also similarly embedded in wider processes aimed at health workforce management, but overall, there is no clear policy agenda to manage health worker migration. Decision-makers in India present conflicting options about the need or desirability of curtailing migration. CONCLUSIONS: Consequences of health work migration on the Indian health care system are not easily discernable from other compounding factors. Research suggests that shortages of skilled health workers in India must be examined in relation to domestic policies on training, recruitment, and retention rather than viewed as a direct consequence of the international migration of health workers.

Rural General Surgery: A 38-Year Experience with a Regional Network Established by an Integrated Health System in the Midwestern United States.

BACKGROUND: General surgeon (GS) workforce shortages are predicted to worsen, particularly in rural areas. We report on a sustainable model for delivery of GS services within a large rural region that includes an integrated health system. STUDY DESIGN: We conducted a longitudinal study of a rural GS network from 1978 to 2016. Employment data and rural GS survey results were reviewed to document methods of recruitment, retention, and case-volume development. RESULTS: During the 38-year study period, 19 rural GSs were employed by the health system. There were 3 practice acquisitions and 16 new hires. The rural GS network grew from 1 in 1978 to 10 in 2016. In 1996, the network consisted of 6 rural GSs at 6 different critical access hospitals (CAHs). Currently, 9 rural GSs practice at 1 of 4 CAHs. They provide outpatient general surgery and endoscopy at an additional 6 CAHs and cesarean section coverage at 4 CAHs. Four (21%) rural GSs have retired, 10 (53%) continue to practice in the network, and only 5 (26%) left before retirement. Six rural GSs have practiced in one location for more than 20 years. CONCLUSIONS: Successful recruitment of rural GSs depends on competitive salary, reasonable call and leave schedules, administrative support, and adequate case variety and volume. Case volume is enhanced by cooperative relationships with CAHs, health system assistance in performing appropriate procedures locally, co-management of complex cases, and development of outreach surgical locations. In addition to the recruitment principles mentioned, rural GS retention is optimized by connectivity with the main campus medical center.

Naturopaths in Ontario, Canada: geographic patterns in intermediately-sized metropolitan areas and integration implications.

Evaluating conventional medicine (CM) and complementary and alternative medicine (CAM) with respect to integration opportunities (such as patient referrals and professional knowledge sharing) and possible geographic implications is novel. This research utilizes nearest neighbour and local spatial autocorrelation statistical analyses and surveys directed towards Doctors of Naturopathic Medicine (NDs) and their patients to better understand the geographic patterns of NDs and potential integration qualities. While the statistical tests reveal that the offices of NDs and Doctors of Medicine (MDs) display clustered patterns in intermediately-sized census metropolitan areas in Ontario and that the majority of NDs are near MDs, proximity is not manifesting in discernible integration tendencies between NDs and MDs. The NDs polled were strongly in favour of greater integration with the CM sector (as were their patients) to: achieve better patient health outcomes and to gain efficiencies within the health care system. Yet, both surveys also indicate that the barriers to integration are substantial and, generally speaking, centre on the perception that many MDs lack respect for, and/or knowledge about, naturopathic approaches. It is speculated that as students in conventional medical schools are increasingly exposed to CAM approaches, perhaps more MDs in the future will be receptive to greater integration with CAM. Should this occur, then it is also possible that geographic proximity may be a catalyst for deeper CAM-CM integration; as it has been for CAM-CAM relationships.

Factors behind job preferences of Peruvian medical, nursing and midwifery students: a qualitative study focused on rural deployment.

BACKGROUND: Deployment of health workforce in rural areas is critical to reach universal health coverage. Students' perceptions towards practice in rural areas likely influence their later choice of a rural post. We aimed at exploring perceptions of students from health professions about career choice, job expectations, motivations and potential incentives to work in a rural area. METHODS: In-depth interviews and focus groups were conducted among medical, nursing and midwifery students from universities of two Peruvian cities (Ica and Ayacucho). Themes for assessment and analysis included career choice, job expectations, motivations and incentives, according to a background theory a priori built for the study purpose. RESULTS: Preference for urban jobs was already established at this undergraduate level. Solidarity, better income expectations, professional and personal recognition, early life experience and family models influenced career choice. Students also expressed altruism, willingness to choose a rural job after graduation and potential responsiveness to incentives for practising in rural areas, which emerged more frequent from the discourse of nursing and midwifery students and from all students of rural origin. Medical students expressed expectations to work in large urban hospitals offering higher salaries. They showed higher personal, professional and family welfare expectations. Participants consistently favoured both financial and non-financial incentives. CONCLUSIONS: Nursing and midwifery students showed a higher disposition to work in rural areas than medical doctors, which was more evident in students of rural origin. Our results may be useful to improve targeting and selection of undergraduate students, to stimulate the inclination of students to choose a rural job upon graduation and to reorient school programmes towards the production of socially committed health professionals. Policymakers may also consider using our results when planning and implementing interventions to improve rural deployment of health professionals.

Counseling on sexual side effects from TURP.

INTRODUCTION: We designed a pilot study to measure preoperative sexual dysfunction risk counseling between sexual medicine experts (SME) and general urologists between monopolar/bipolar transuretheral resection of the prostate (TURP) and laser TURP (LT). MATERIALS AND METHODS: An emailed electronic survey was distributed to members of the North Central Section (NCS) of the American Urologic Association and the Sexual Medicine Society of North America (SMSNA). Overall, 260 (12.3%) completed the survey. Counseling for ejaculatory disorder (EjD), erectile dysfunction (ED), stricture formation and incontinence was assessed. Additional subset analysis between those SME's versus general urologist was done. RESULTS: Overall, 82% (224) identified as general urologists and 18% (49) as SME. Two-thirds were in private practice versus academic. Over 90% of all practitioners 'almost always' counsel about the possibility of EjD, with varied risk rate for LT. Overall, 62%(140) for monopolar TURP (MBT) and 60% (110) for LT 'almost always' counsel about ED. There was no statistical difference between groups counseling on incontinence, strictures, EjD or ED between SME and general urologists. CONCLUSIONS: Sexual side effects of treatment for LUTS/BPH are appreciated by urologists. Most practitioners counsel about EjD, however the incidence varies between MBT and LT. Practitioners counsel their patients on ED less often than EjD. Counseling rates are not improved with those specializing in sexual medicine independent of TURP technique.