Draw to Practice: A Qualitative Study Examining Factors Attracting Physicians to Rural Northern Ontario.

Introduction Physician shortages are a persisting issue in rural regions around the world, and rural Northern Ontario, Canada, is no exception. Even with significant government interventions, financial incentives, and rural-specific contracts, physician recruitment to the region remains an ongoing challenge. Refining recruitment strategies based on specific factors that attract physicians to rural practice could help address staffing shortages and, ultimately, enhance healthcare access and outcomes in rural communities. However, the draw to rural practice among physicians is poorly defined. Therefore, this study aims to bridge this knowledge gap and, in doing so, offers insight to better inform recruitment strategies for rural communities. Methodology As part of a larger qualitative study on physician retention and recruitment, semi-structured interviews were conducted with 12 physicians who had previously practiced in rural Northern Ontario communities. Interviews captured information about their individual experiences, including perspectives on factors that attracted them to establish a practice in rural Northern Ontario. Transcribed interviews were analyzed to identify recurring themes associated with the factors that affect the decision to practice in rural Northern Ontario. Results Participants described the draw to rural practice as being multifactorial and based on overlapping motivations. Key motivations described by participants could be categorized into three broad themes, including rural community connection and exposure, lifestyle and personal preferences, and career considerations. Specifically, participants emphasized the importance of pro-rural mentors and gaining firsthand experience in rural communities as important facilitators that created a connection with these areas. Interest in exploring new parts of the country, alignment with life plans, support of family, and the challenge of rural practice also played pivotal roles in the decision to pursue rural practice. Finally, the opportunity to have a broad scope of practice and serve a need in the healthcare system while receiving fair compensation within the framework of a flexible and supportive contract was also cited as a draw to practice. Conclusion The draw to rural practice is multifactorial and based on a wide array of motivations. As a result, recruitment strategies should move beyond single-pronged approaches and recognize the need to design strategies that address the multifaceted motivations and considerations that drive physicians towards rural practice. Designing and implementing recruitment approaches that consider the diverse factors influencing physicians interest in rural career paths is likely to enhance recruitment initiatives and more effectively address shortage of physicians in the region.

Relationship Between Residency Match Distance From Medical School and Virtual Application, School Characteristics, and Specialty Competitiveness.

INTRODUCTION: The COVID-19 pandemic has disrupted the residency match process by eliminating away rotations and changing from in-person to virtual interviews. In this study, we explore the impact of the COVID-19 pandemic on the geographic match distance of United States (US) senior medical students across all specialties. METHODS: We collected publicly available student match data between 2018 and 2021 from US allopathic medical schools and calculated match distance between medical school and residency training using a novel metric - the "match space." Match space was codified by whether the student matched at their home institution, home state, adjacent state, same or adjacent US census division (non-adjacent state) or skipped at least one US census division. Adjusting for covariates, ordinal logistic regression correlated school and specialty characteristics with match distance pre- and post-pandemic for all specialties. We defined and ranked specialty competitiveness using predictive values from factor analysis. RESULTS: A total of 34,672 students representing 66 medical schools from 28 states matched into 26 specialties in 50 states and Canada. Fifty-nine percent of students were from public institutions, and 27% of schools ranked in the top 40 for research. The mean percentage of in-state students by school was 60.3% (range 3-100%). Match space was lower after the pandemic (adjusted odds ratio (OR) 0.94, 95% CI 0.90-0.98; p=0.006), from schools with higher in-state percentages (OR 0.74, 95% CI 0.72-0.76), from top National Institutes of Health-funded institutions (OR 0.88, 95% CI 0.85-0.92), from the Northeast (OR 0.71, 95% CI 0.67-0.75; Midwest reference), and the West (OR 0.67, 95% 0.60-0.74). Match space was higher for students graduating from private schools (OR 1.11, 95% CI 1.05-1.19), from the South (OR 1.62, 95% CI 1.2-1.33), and matching into more competitive specialties (OR 1.08, 95% CI 1.02-1.14). The top five most competitive specialties were Plastic Surgery, Neurosurgery, Dermatology, Orthopedic Surgery, and Otolaryngology. Internal Medicine ranked eighth. CONCLUSIONS: After the COVID-19 pandemic, students graduating from US allopathic schools matched closer to their home institution. Students attending public schools, schools with more in-state matriculants, and schools with higher research rankings also matched closer to their home institutions. Specialty competitiveness and US census region also impacted match distance. Our study adds insight into how geographic match patterns were influenced by school, specialty choice, and the pandemic.

Factors influencing University of Papua New Guinea medical imaging science students considering rural radiography careers.

INTRODUCTION: The aim of this research was to explore factors influencing students at the University of Papua New Guinea (UPNG) Bachelor of Medical Imaging Science (BMIS) choice to pursue rural radiography careers. METHODS: A survey and focus groups of BMIS students at the UPNG were undertaken. The survey included questions related to sociodemographic variables including gender, age, education, rural background and previous employment; and Likert-type scale questions exploring motivation for rural practice, the promotion of radiography through rural practice and the influence of birthplace and incentives to practice. Focus groups comprising convenience samples of six students each from the second, third and fourth years of study explored the promotion of rural radiography, community-based training internships, the benefits of rural practice and the influence of undergraduate training on future rural practice. RESULTS: There were 54 responses (94.7%) to the survey with strong interest (88.9%) in rural radiography practice; 96.3% (n=52) agreed that undergraduate rural training would also act as a motivator. Rural training was a stronger incentive for females than for males (p=0.02). Not being trained in conventional non-digital film screen imaging at UPNG was a strong barrier to rural practice; while being able to give back to the community, increased professional responsibility, cheaper living, job satisfaction and cultural exchange were all viewed as positive aspects of rural practice. Most students reported a benefit to rural practice, while acknowledging a lack of contemporary imaging equipment in rural facilities. CONCLUSION: The study demonstrated that UPNG BMIS students would contemplate careers in rural practice and provides evidence to support dedicated undergraduate rural radiography placement. It also highlights the dichotomy in urban and rural services, which suggests the need for greater emphasis on conventional non-digital film screen radiography in the undergraduate program to best support graduates to work and, importantly, work effectively in rural communities. As most students were from rural areas these results must be tempered by the fact that students may simply be wanting to return home rather than reporting explicit rural intent. A more comprehensive study of the medical imaging profession in PNG should be undertaken to validate this study.

Perfil dos fonoaudiólogos com formação em motricidade orofacial no Brasil / Profile of speech therapists trained in orofacial myology in Brazil

RESUMO Objetivo Caracterizar o perfil do fonoaudiólogo brasileiro com formação especializada em motricidade orofacial (MO). Métodos Estudo descritivo e exploratório, transversal, de abordagem quantitativa, realizado entre setembro 2022 e fevereiro 2023, com parceria do Conselho Federal de Fonoaudiologia. Participaram 87 fonoaudiólogos com formação em MO. Resultados Evidenciou-se predominância feminina, faixa etária entre 41 e 50 anos e tempo de formação especializada em MO entre 16 e 20 anos; maioria com título de especialista e da Região Sudeste do Brasil, atuando em consultórios/ambulatórios e/ou clínicas, com ações interdisciplinares com Medicina e Odontologia, abrangendo adultos e crianças, principalmente na rede privada. Prevaleceram os domínios da MO quanto à reabilitação de estruturas moles e hábito oral e maior uso de tecnologias: leve - acolhimento e assistência; leve-dura - avaliação e terapia e dura - fotobiomodulação. Conclusão Os fonoaudiólogos brasileiros com formação especializada em MO, participantes do estudo, são, em sua maioria, mulheres com mais de 41 anos de idade, que detêm titulação de especialista, com práticas nos vários domínios e níveis de tecnologia da área, principalmente em diagnóstico e reabilitação dos distúrbios miofuncionais orofaciais.

ABSTRACT Purpose To characterize the profile of Brazilian speech therapists with specialized training in orofacial myology (OM). Methods Descriptive and exploratory, cross-sectional study, with a quantitative approach, carried out between September 2022 and February 2023, in partnership with CFFa. Eighty-seven speech therapists with specialized training in OM participated. Results showed female predominance, age between 41 and 50 years, and time of specialized training in OM between 16-20 years; most with specialist titles in the Southeast of Brazil. Most work in offices/outpatient clinics and/or clinics with interdisciplinary actions with Medicine and Dentistry; seeing adults and children, mainly in a private sector. As to OM domains there was a predominance of rehabilitation of soft structures and oral habits, and most use technologies: light - reception and assistance, light-hard - evaluation and therapy, and hard - photobiomodulation (40.2%). Conclusion The Brazilian speech therapists with specialized training in OM participating in the study are mostly women over 41 years old, who hold the title of specialists, and carry out practices in various domains and levels of technology in the area, with a predominance of diagnosis and rehabilitation of oromyofunctional disorders.

Banco de Leite Humano: possibilidades de atuação fonoaudiológica / Human Milk Bank: possibilities of speech therapy activities / Banco de leche humana: posibilidades de actuación fonoaudiológica

Introdução: os bancos de leite humano foram criados para apoiar e incentivar o aleitamento materno, atuando como estratégia de política pública na redução da mortalidade neonatal e proteção à saúde do binômio. Por se tratar de um espaço de atuação multidisciplinar, os bancos de leite tornam-se um ambiente ideal para a atuação do fonoaudiólogo, profissional que contribui no suporte às mães, especialmente durante o estabelecimento da amamentação exclusiva. Objetivo: relatar as possibilidades de atuação fonoaudiológica em um banco de leite humano. Descrição da experiência: estudo de abordagem qualitativa descritiva do tipo relato de experiência, realizado entre os meses de março e julho de 2020, em um Banco de Leite Humano de uma maternidade pública do Nordeste, credenciada na Iniciativa Hospital Amigo da Criança. A vivência compreendeu dois seguimentos: atuação técnica e atuação assistencial. As experiências foram apresentadas por meio da narração discursiva. O espaço de atuação da Fonoaudiologia em um banco de leite humano pode ser diversificado, pois abrange a atuação técnica e assistencial, desde o recebimento do leite humano doado à assistência a puérpera e ao recém-nascido. É necessário capacitação específica para que o profissional seja inserido dentro da equipe de um banco de leite humano. Considerações finais: Foi possível identificar, por meio da experiência, o papel do fonoaudiólogo no banco de leite humano, bem como compreender a necessidade da sua inserção na equipe deste setor no âmbito hospitalar.

Introduction: human milk banks were created to support and encourage breastfeeding, acting as a public policy strategy to reduce neonatal mortality and protect the health of the binomial. Because it is a space for multidisciplinary activities, milk banks become an ideal environment for the performance of the speech therapist, a professional who contributes to support mothers, especially during the establishment of exclusive breastfeeding. Objective: to report the possibilities of speech therapy activities in a human milk bank. Description of the experience: a qualitative descriptive study of an experience report type, carried out between March and July 2020, at a Human Milk Bank of a public maternity hospital in the Brazilian Northeast, accredited by the Baby Friendly Hospital Initiative. The experience comprised two segments: technical performance and assistance performance. The experiences were presented through discursive narration. The area of performance of Speech Therapy in a human milk bank can be diversified, as it covers technical and assistance activities, from the receipt of donated human milk to assistance to the puerperal woman and the newborn. Specific training is necessary for the professional to be inserted into the team of a human milk bank. Final considerations: It was possible to identify, through experience, the role of the speech therapist in the human milk bank, as well as to understand the need for his insertion in the team of this sector in the hospital environment.

Introducción: los bancos de leche humana fueron creados para apoyar e incentivar en el amamantamiento materno, actuando como estrategia de política pública en la reducción de la mortalidad neonatal y la protección de la salud del binomio. Por tratarse de un espacio de actuación multidisciplinar, los bancos de leche se convirtieron en un ambiente ideal para la actuación del fonoaudiólogo, profesional que contribuye en apoyo a las madres, especialmente durante el establecimiento del amamantamiento exclusivo. Objetivo: relatar las posibilidades de actuación fonoaudiológica en un banco de leche humana. Descripción de la experiencia: estudio de abordaje cualitativo descriptivo de tipo relato de experiencia, realizado entre los meses de marzo a julio del 2020, en un Banco de leche humana de una maternidad pública del Noroeste, bajo la iniciativa del Hospital Amigo de los Niños. La vivencia comprendió dos seguimientos: actuación técnica y actuación asistencial. Las experiencias fueron presentadas por medio de la narración discursiva. El espacio de actuación de la fonoaudiología en un banco del hecho humana puede ser diversificado, pues comprende tanto la actuación técnica como la asistencial, desde el recibimiento de la leche materna donada a la asistencia, la matrona y al recién nacido. Es necesario capacitación específica para que el profesional sea inserto dentro del equipo de un Banco de leche humana. Consideraciones finales: fue posible identificar, por medio de la experiencia del papel del fonoaudiólogo en el banco de leche humana, así como comprender la necesidad de su inserción en el equipo de este sector en el ámbito hospitalario.

Factors influencing medical radiation science graduates' early career principal place of practice: a retrospective cohort study.

INTRODUCTION: While studies have investigated influences on graduate practice locations of other health professionals, especially medicine, none have investigated practice locations of medical radiation science (MRS) graduates. This study aimed to explore factors influencing the registered principal place of practice (PPP) of diagnostic radiography, radiation therapy and nuclear medicine graduates from the University of Newcastle (UON), Australia, in their second post-graduate year. METHODS: Data were extracted from the UON enrolment and clinical placement databases and linked to Australian Health Practitioners Regulation Agency (Ahpra) registration data for PPP location in 2019 for 187 graduates who completed their studies in 2017. Explanatory variables included age at enrolment, gender, MRS discipline, location of origin, socio-economic index for location of origin, and locations and duration of undergraduate professional placements. Descriptive statistics, tests of association and logistic regression compared rural and non-rural origin, and professional placement locations with Ahpra PPP. RESULTS: Factors related to non-metropolitan PPP were location of origin (P = 0.002), number (P = 0.002) and duration (P = 0.007) of rural placements, and MRS discipline (P = 0.033). Controlling for other variables, location of origin and MRS discipline remained significant. Graduates of rural origin had up to 3.54 (95%CI = 1.51-8.28) times the odds of a rural PPP. Diagnostic radiography graduates had up to 5.46 (95%CI = 1.55-19.20) times the odds of nuclear medicine of a rural PPP. CONCLUSION: To help reduce the gap between rural and metropolitan medical radiation service availability, there is a need for targeted recruitment of rural origin students. Further investigation of the effect of rural undergraduate MRS placements is justified.

Family Physicians Working at Hospitals: A 20-Year Nationwide Trend Analysis in Taiwan.

Family physicians play an essential role as gatekeepers in primary health care. However, most studies in the past focused on the geographic maldistribution of family physicians, and few studies focused on the distribution of family physicians between private practices and hospitals. This study aims to analyze the trends in practice locations of family physicians in Taiwan between 1999 and 2018, using the databases of the Taiwan Association of Family Medicine and Taiwan Medical Association. Although the annual number of physicians registered as family physicians had steadily increased from 1876 in 1999 to 3655 in 2018, the ratio of family physicians practicing in hospitals to total family physicians remained stable around 40% in the study period. Even after eliminating the trainees who were entirely registered at hospitals, the proportion of hospital-based family physicians still accounted for about one-third of the total in each year. In conclusion, family physicians had been continuously demanded by hospitals in Taiwan. If the supply of primary care-oriented family physicians is insufficient outside hospitals, health manpower planning would require urgent adjustments.

Desafios e impactos da atuação de fonoaudiólogos recém-formados no Espírito Santo durante a pandemia de COVID-19 / Challenges and impacts of the performance of newly graduated speech-language pathologists in Espírito Santo during the COVID-19 pandemic / Retos e impactos del desempeño de los logopedas recién graduados en Espírito Santo durante la pandemia de COVID-19

Introdução: Os fonoaudiólogos recém-formados podem estar passando por um momento único para sua atuação por causa da pandemia de COVID-19. Além do aprendizado da graduação, há as Resoluções do Conselho Federal de Fonoaudiologia, que têm alertado e auxiliado os profissionais nessa prática. Objetivos: verificar como fonoaudiólogos recém-formados atuam durante a pandemia de COVID-19, quais os desafios da graduação que podem refletir nessa atuação e conhecimentos sobre Resoluções do Conselho Federal de Fonoaudiologia (CFFa). Métodos: estudo observacional e transversal. Aplicou-se um questionário em graduados em Fonoaudiologia dos últimos 24 meses por uma instituição do Espírito Santo, apresentando os dados de forma descritiva. Resultados: entrevistou-se 32 fonoaudiólogos, 93,7% mulheres, média de 25 anos. Destes, 81,2% exerciam a profissão durante a pandemia, a maioria de maneira presencial, porém, houve redução do salário para ⅓. Em média 40% alegaram que a graduação ajudou na preparação para o atendimento de casos COVID-19, mas apenas 28% para telefonoaudiologia. A Resolução do CFFa mais citada foi sobre a telefonoaudiologia, por 81%. A atuação fonoaudiológica em casos de COVID-19 foi classificada por 75% como "Desafiadora". Conclusão: a maioria dos fonoaudiólogos exerciam a profissão presencialmente, mas houve desemprego e redução do salário pela pandemia. Conheciam as Resoluções do CFFa, com destaque para a Resolução n. 580. Não houve consenso quanto à contribuição da graduação no atendimento desses casos, com desafios quanto a telefonoaudiologia e a urgência/emergência, que têm sido enfrentados pelos egressos, podendo impactar negativamente na vida profissional.

Introduction: Newly graduated speech-language pathologists (SLP) may be going through a unique moment for their performance because of the COVID-19 pandemic. In addition to undergraduate learning, there are the Resolutions of the Federal Council of Speech-Language Pathology, which have alerted and helped professionals in this practice. Objective: to verify how newly graduated speech-language pathologists act during the COVID-19 pandemic, what are the challenges of the graduation that may reflect in this performance and knowledge about Federal Council of Speech Therapy (CFFa) resolutions. Methods: observational, cross-sectional study. A questionnaire was applied to SLP graduates from the last 24 months by an institution of Espírito Santo state, presenting the data in a descriptive way. Results: 32 speech-language pathologists were interviewed, 93.7% women, mean of 25 years. 81.2% exercised their profession during the pandemic, the majority in person, with reduction in salary to ⅓. On average, 40% claimed that graduation helped them about treatment in COVID-19 cases, but only 28% for telehealth. The most cited CFFa resolution was on telehealth (81%). Speech-Language therapy performance in cases of COVID-19 was classified by 75% as "Challenging". Conclusion: most SLP performed the profession, but there was unemployment and reduced wages due to the pandemic. They knew CFFa resolutions, with emphasis on n. 580. There was no consensus regarding the contribution of the undergraduate course in the treatment of these cases, with challenges in terms of telehealth and urgency/emergency, which have been faced and may have a negative impact on professional life.

Introducción: Logopedas recién graduados pueden estar atravesando un momento único para su desempeño debido a la pandemia de COVID-19. Además del aprendizaje de pregrado, existen Resoluciones del Consejo Federal de Logopedia, que han alertado y ayudado a los profesionales en esta práctica. Objetivo: verificar cómo actúan logopedas recién graduados durante la pandemia de COVID-19, cuáles son los desafíos de la graduación que pueden reflejarse este desempeño y conocimiento sobre resoluciones del Consejo Federal de Logopedia (CFFa). Métodos: estudio observacional/transversal. Se aplicó un cuestionario a los egresados de Logopedia de los últimos 24 meses por una institución de Espírito Santo, presentando los datos de forma descriptiva. Resultados: se entrevistaron 32 logopedas, 93,7% mujeres, (media= 25 años). El 81,2% ejerció su profesión durante la pandemia, mayoría de forma presencial, con reducción de salario a ⅓. En promedio, 40% afirmó que la graduación les ayudó con el tratamiento en los casos de COVID-19, pero solo 28% para telesalud. La resolución de CFFa más citada fue sobre telesalud (81%). El rendimiento de la terapia del habla en los casos de COVID-19 se clasificó en un 75% como «Desafiante¼. Conclusión: la mayoría de los logopedas ejercen la profesión, pero hubo desempleo y reducción de salarios debido a la pandemia. Conocían las resoluciones CFFa, con énfasis en n. 580. No hubo consenso sobre la contribución de la carrera en el tratamiento de estos casos, con desafíos en telesalud y urgencia / emergencia, que se han enfrentado y pueden tener un impacto negativo en la vida profesional.

Factors Associated With Working in Remote Indonesia: A National Cross-Sectional Study of Early-Career Doctors.

Background: Doctor shortages in remote areas of Indonesia are amongst challenges to provide equitable healthcare access. Understanding factors associated with doctors' work location is essential to overcome geographic maldistribution. Focused analyses of doctors' early-career years can provide evidence to strengthen home-grown remote workforce development. Method: This is a cross-sectional study of early-career (post-internship years 1-5) Indonesian doctors, involving an online self-administered survey on demographic characteristics, and; locations of upbringing, medical clerkship (placement during medical school), internship, and current work. Multivariate logistic regression was used to test factors associated with current work in remote districts. Results: Of 3,176 doctors actively working as clinicians, 8.9% were practicing in remote districts. Compared with their non-remote counterparts, doctors working in remote districts were more likely to be male (OR 1.5,CI 1.1-2.1) or unmarried (OR 1.9,CI 1.3-3.0), have spent more than half of their childhood in a remote district (OR 19.9,CI 12.3-32.3), have completed a remote clerkship (OR 2.2,CI 1.1-4.4) or internship (OR 2.0,CI 1.3-3.0), currently participate in rural incentive programs (OR 18.6,CI 12.8-26.8) or have previously participated in these (OR 2.0,CI 1.3-3.0), be a government employee (OR 3.2,CI 2.1-4.9), or have worked rurally or remotely post-internship but prior to current position (OR 1.9,CI 1.2-3.0). Conclusion: Our results indicate that building the Indonesian medical workforce in remote regions could be facilitated by investing in strategies to select medical students with a remote background, delivering more remote clerkships during the medical course, deploying more doctors in remote internships and providing financial incentives. Additional considerations include expanding government employment opportunities in rural areas to achieve a more equitable geographic distribution of doctors in Indonesia.

O mercado de trabalho no contexto do lazer e da recreação: uma análise sobre o campo de atuação profissional / The labor market in the context of leisure and recreation: an analysis of the field of professional activity / El mercado laboral en el contexto del ocio y la recreación: un análisis sobre el campo de actuación profesional

Objetivo:Este trabalho teve como objetivo descrever e analisar as possibilidades de inserção do profissional de lazer e na recreação no mercado de trabalho, bem como identificar limites e potencialidades do trabalho desenvolvido.Metodologia:Combinamos as pesquisas bibliográfica e de campo para o desenvolvimento do estudo. Resultados:Como resultados foi possível identificar que as potencialidades do mercado de trabalho, estão relacionadas à possibilidade de inserção de profissionais oriundosde diferentes áreas de formação, podendo o profissional atuar tanto no setor público, privado e/ou terceiro setor e exercer uma multiplicidade de funções e/ou cargos. Conclusão:Com relação aos limites presentes neste mercado, eles estão relacionados com a insatisfação dos profissionais quanto à remuneração recebida e com a desvalorização da profissão.

Objective:This paper aimed to describe and analyze the possibilities of insertion of leisure and recreation professionals in the labor market, as well as to identify limits and potentialities of the developed work.Methodology: It is qualitative and quantitative research with an exploratory characteristic, which used the combination of bibliographical and field research. Results:It was possible to identify that the potentialities of the labor market are related to the possibility of insertion of professionals from differentareas of training, the professional can work in the public sector, private sector and/or third sector and perform a multiplicity of functions and/or positions. Conclusion: Regardingthe limits present in this market, they are related to the dissatisfaction of professionals regarding the remuneration received and the devaluation of the profession.

Objetivo:Este trabajo tiene como objetivo describir y analizar las posibilidades de inserción del profesional del ocio y la recreación en el mercado laboral, así como identificar los límites y las potencialidades del trabajo desarrollado.Metodología:Combinamos las investigaciones bibliográficas y de campo para el desarrollo del estudio. Resultados:Como resultados fue posible identificar que las potencialidades del mercado de trabajoestán relacionadas a la posibilidad de inserción de profesionales oriundos de diferentes áreas de formación, pudiendo el profesional actuar tanto en el sector público, privado y/o tercer sector y ejercer una multiplicidad de funciones y/o cargos. Conclusión:Con respecto a los límites presentes en este mercado, están relacionados con la insatisfacción de los profesionales en cuanto a la remuneración recibida y con la devaluación de la profesión.

Factors associated with increasing rural doctor supply in Asia-Pacific LMICs: a scoping review.

BACKGROUND: More than 60% of the world's rural population live in the Asia-Pacific region. Of these, more than 90% reside in low- and middle-income countries (LMICs). Asia-Pacific LMICs rural populations are more impoverished and have poorer access to medical care, placing them at greater risk of poor health outcomes. Understanding factors associated with doctors working in rural areas is imperative in identifying effective strategies to improve rural medical workforce supply in Asia-Pacific LMICs. METHOD: We performed a scoping review of peer-reviewed and grey literature from Asia-Pacific LMICs (1999 to 2019), searching major online databases and web-based resources. The literature was synthesized based on the World Health Organization Global Policy Recommendation categories for increasing access to rural health workers. RESULT: Seventy-one articles from 12 LMICs were included. Most were about educational factors (82%), followed by personal and professional support (57%), financial incentives (45%), regulatory (20%), and health systems (13%). Rural background showed strong association with both rural preference and actual work in most studies. There was a paucity in literature on the effect of rural pathway in medical education such as rural-oriented curricula, rural clerkships and internship; however, when combined with other educational and regulatory interventions, they were effective. An additional area, atop of the WHO categories was identified, relating to health system factors, such as governance, health service organization and financing. Studies generally were of low quality-frequently overlooking potential confounding variables, such as respondents' demographic characteristics and career stage-and 39% did not clearly define 'rural'. CONCLUSION: This review is consistent with, and extends, most of the existing evidence on effective strategies to recruit and retain rural doctors while specifically informing the range of evidence within the Asia-Pacific LMIC context. Evidence, though confined to 12 countries, is drawn from 20 years' research about a wide range of factors that can be targeted to strengthen strategies to increase rural medical workforce supply in Asia-Pacific LMICs. Multi-faceted approaches were evident, including selecting more students into medical school with a rural background, increasing public-funded universities, in combination with rural-focused education and rural scholarships, workplace and rural living support and ensuring an appropriately financed rural health system. The review identifies the need for more studies in a broader range of Asia-Pacific countries, which expand on all strategy areas, define rural clearly, use multivariate analyses, and test how various strategies relate to doctor's career stages.

As psicologias construídas no SUS: possibilidades e desafios profissionais no agreste pernambucano / The psychologies built in the SUS: professional possibilities and challenges in the Agreste Pernambucano

RESUMO O artigo aborda a atuação do psicólogo no Sistema Único de Saúde (SUS), sob a perspectiva de profissionais inseridos nos contextos da Atenção Primária à Saúde e da média complexidade. O objetivo foi investigar práticas psicológicas realizadas, discutindo possibilidades e desafios. A pesquisa utilizou-se do método qualitativo, buscando a construção de informações e reflexões a partir das narrativas de dez psicólogos atuantes em quatro municípios do agreste pernambucano. Após aprovação do projeto de investigação junto ao Comitê de Ética em Pesquisa, foram realizadas entrevistas individuais, semiestruturadas, que foram posteriormente transcritas e categorizados segundo as técnicas da Análise de Conteúdo. Constatou-se que a atuação do psicólogo no SUS tem sido refletida pelos profissionais, que apontam necessidade de revisão de propostas nos cursos universitários, uma vez que chegam despreparados para a atuação frente ao SUS. O resultado evidencia a ampliação de possibilidades de atuação, com experimentações e articulações multidisciplinares, ao mesmo tempo que se revela que esses psicólogos não dialogam entre si, numa construção coletiva de seus fazeres cotidianos. Por fim, defende-se que uma atuação profissional técnica, instrumentalizada e reconhecida é tão necessária quanto um fazer que se põe em abertura aos devires de um fazer da psicologia junto ao SUS.

ABSTRACT The article addresses the role of the psychologist in the Unified Health System (SUS), from the perspective of professionals inserted in the contexts of primary health care and medium complexity. The objective was to investigate psychological practices carried out, discussing possibilities and challenges. The research used the qualitative method, seeking the construction of information and reflections based on the narratives of ten psychologists working in four municipalities in the Agreste Pernambucano. After approval of the research project by the Research Ethics Committee, individual and semi-structured interviews were conducted, which were later transcribed and categorized according to the Content Analysis techniques. It was found that the psychologist's performance in the SUS has been reflected by the professionals, who point out the need to review proposals in university courses, since they arrive unprepared to perform on the SUS. The result shows the expansion of possibilities of action, with multidisciplinary experiments and articulations, at the same time that it is revealed that these psychologists do not dialogue with each other, in a collective construction of their daily activities. Finally, it is argued that a technical, instrumentalized, and recognized professional performance is as necessary as a task that opens itself up to the becoming of a Psychology practice with SUS.

Atendimento da doença inflamatória intestinal no Brasil: como é feito, os entraves e as demandas sob a ótica dos médicos / Inflammatory bowel disease care in brazil: how it is performed, obstacles and demands from the physicians' perspective

ABSTRACT BACKGROUND: Inflammatory bowel diseases (IBD) are chronic inflammatory affections of recurrent nature whose incidence and prevalence rates have increased, including in Brazil. In long term, they are responsible for structural damage that impacts quality of life, morbidity and mortality of patients. OBJECTIVE: To describe the profile of physicians who treat IBD patients as well as the characteristics of IBD care, unmet demands and difficulties. METHODS: A questionnaire containing 17 items was prepared and sent to 286 physicians from 101 Brazilian cities across 21 states and the Federal District, selected from the register of the State Commission of the "Study Group of Inflammatory Bowel Disease of Brazil" (GEDIIB). RESULTS: The majority of the physicians who answered the questionnaire were gastroenterologists and colorectal surgeons. More than 60% had up to 20 years of experience in the specialty and 53.14% worked at three or more locations. Difficulties in accessing or releasing medicines were evident in this questionnaire, as was referrals to allied healthy professionals working in IBD-related fields. More than 75% of physicians reported difficulties in performing double-balloon enteroscopy and capsule endoscopy, and 67.8% reported difficulties in measuring calprotectin. With regard to the number of patients seen by each physician, it was shown that patients do not concentrate under the responsibility of few doctors. Infliximab and adalimumab were the most commonly used biological medicines and there was a higher prescription of 5-ASA derivatives for ulcerative colitis than for Crohn's disease. Steroids were prescribed to a smaller proportion of patients in both diseases. The topics "biological therapy failure" and "new drugs" were reported as those with higher priority for discussion in medical congresses. In relation to possible differences among the country's regions, physicians from the North region reported greater difficulty in accessing complementary exams while those from the Northeast region indicated greater difficulty in accessing or releasing medicines. CONCLUSION: The data obtained through this study demonstrate the profile of specialized medical care in IBD and are a useful tool for the implementation of government policies and for the Brazilian society as a whole.

RESUMO CONTEXTO: As doenças inflamatórias intestinais (DII) são afecções inflamatórias crônicas de caráter recorrente, cujas taxas de incidência e prevalência têm aumentado, inclusive no Brasil. A longo prazo, são responsáveis por danos estruturais que impactam na qualidade de vida, morbidade e mortalidade dos pacientes. OBJETIVO: Avaliar o perfil dos médicos que atendem pacientes com DII, assim como as características deste atendimento, demandas não atendidas e dificuldades. MÉTODOS: Um questionário contendo 17 variáveis foi elaborado e enviado para médicos, selecionados a partir do cadastro da Comissão das Estaduais do Grupo de Estudos da Doença Inflamatória Intestinal do Brasil (GEDIIB), totalizando 286 médicos de 101 cidades brasileiras distribuídas por 21 estados e Distrito Federal. RESULTADOS: A maioria dos médicos que respondeu o questionário foram Gastroenterologistas e Coloproctologistas. Mais de 60% tinham até 20 anos de atuação na especialidade e 53,14% trabalhavam em três locais ou mais. A dificuldade no acesso ou liberação de medicamentos ficou evidenciada neste questionário, assim como a dificuldade no encaminhamento para profissionais não médicos que atuam em DII. Mais de 75% dos médicos relataram dificuldades para realização de enteroscopia por duplo balão e cápsula endoscópica, e 67,8% para realização da calprotectina. Em relação ao número de pacientes atendidos por cada médico, foi evidenciado que não há uma concentração de pacientes sob a responsabilidade de poucos médicos. O infliximabe e o adalimumabe foram os biológicos mais utilizados e ficou evidenciada prescrição maior de derivados de 5-ASA para retocolite ulcerativa quando comparada à doença de Crohn. Os corticoides foram prescritos para uma parcela menor de pacientes em ambas doenças. Os temas "falha a terapia biológica" e "novas drogas" foram referidos como aqueles com maior prioridade para discussão em eventos científicos. Em relação às possíveis diferenças entre cada região e o restante do país, os médicos da região Norte relataram maior dificuldade no acesso a exames complementares e os médicos da região Nordeste, maior dificuldade no acesso ou liberação de medicamentos. CONCLUSÃO: Os dados obtidos por meio deste estudo mostram o perfil do atendimento médico especializado em DII e podem se constituir em ferramenta útil para para elaboração de políticas governamentais e para sociedade brasileira como um todo.

[Meanings of the medical profession from the ideology of medical professionals]. / Significados de la profesión médica desde la ideología de las y los profesionales de la medicina.

This article deals with the ideology of medical professionals in order to understand the meanings attributed to their profession, taking Thompson's theory as a starting point and centering on the categories of autonomy, norms and values, and social recognition. Twenty-four semi-structured interviews were conducted with medical professionals in Amecameca, a municipality in the State of Mexico, from March to October 2019, in four sectors of service provision: public institutional, private institutional, private practice, and mixed practice. The analysis of meanings expressed by medical professionals with respect to each category of interest reveals that medical professionals are conditioned by the structure of state control and by the commodified economy, where private forms of medical practice are more highly regarded. In the ideological conformation of the medical profession, there remains a practical component imbued with a liberal romanticism in an extinct scenario that still exists today, without being articulated to more general social processes.

Se aborda la ideología de las y los profesionales de la medicina, desde la teoría de Thompson, para entender los significados de la profesión médica, a partir de las categorías: autonomía, normas y valores, y reconocimiento social. Se realizaron 24 entrevistas semiestructuradas a profesionales de la medicina en cuatro ámbitos de trabajo: institucional público, institucional privado, ejercicio privado y ejercicio mixto, en Amecameca, municipio del Estado de México, en el período comprendido de marzo a octubre de 2019. El análisis de los significados expresados por las y los profesionales de la medicina en cada una de las categorías de interés muestra una base condicionada por la estructura del control estatal y por la economía mercantilizada, que valora con mayor significación formas de práctica médica privada. En la conformación ideológica de la profesión médica subsiste un componente práctico inmerso en un romanticismo liberal en un escenario casi extinto que subsiste en la actualidad, sin articularlo a los procesos sociales más generales.

Do choque com a realidade à estabilização: justificativas para as intervenções da educação física nos centros de atenção psicossocial de Goiânia / From reality shock to stabilization: justifications for physical education interventions in Goiânia's psychosocial care centers / Del choque con la realidad a la estabilización: justificaciones para las intervenciones de la educación física en los centros de atención psicosocial de Goiânia

Este artigo analisa as justificativas das intervenções relacionadas com o núcleo da Educação Física relatadas por professores que trabalham nos Centros de Atenção Psicossocial (CAPS) de Goiânia. Trata-se de um estudo de abordagem qualitativa em que foram realizadas entrevistas semiestruturadas com 18 professores que trabalhavam nestes serviços. Para a análise dos dados foram utilizados procedimentos de análise de conteúdo. Os resultados indicaram que ao iniciarem seus trabalhos nos CAPS os professores dão sequência às atividades já existentes ou constroem propostas a partir das condições estruturais presentes. Na fase da estabilização e consolidação, estruturam suas ações com melhor fundamentação teórica e com maior interlocução com as necessidades dos usuários identificadas pela equipe ou por eles mesmos. Nesta fase, o professor se percebe integrado com a equipe e passa a ser mais reconhecido pelos outros profissionais.

This paper analyzes the justifications for interventions focused on Physical Education reported by teachers working at the Goiânia's Psychosocial Care Centers (CAPS). It is a qualitative study, and semi-structured interviews were conducted with 18 teachers. The data were examined through content analysis. The results indicated that, when teachers start working at the CAPS, they follow existing activities or create proposals based on structural conditions available. In the stabilization stage, they organize their actions with better theoretical foundation and greater communication with users' needs identified by the team or by themselves. Teachers see themselves integrated to the team and gain recognition from other professionals at this stage.

Este artículo analiza las justificaciones de las intervenciones relacionadas con el núcleo de Educación Física, reportadas por profesores que trabajan en los Centros de Atención Psicosocial (CAPS) de Goiânia. Se trata de un estudio cualitativo en el que se realizaron entrevistas semiestructuradas a 18 profesores que trabajaban en estos servicios. Se utilizaron procedimientos de análisis de contenido para el análisis de datos. Los resultados indicaron que cuando inician su trabajo en el CAPS los docentes mantienen las actividades existentes o construyen nuevos proyectos según las condiciones estructurales presentes. En la fase de estabilización y consolidación, estructuran sus acciones con mejor fundamento teórico y con mayor diálogo con las necesidades de los usuarios identificados por el equipo o por él mismo. En esta etapa, el docente se siente más integrado con el equipo y es más reconocido por los otros profesionales.

Significados de la profesión médica desde la ideología de las y los profesionales de la medicina / Meanings of the medical profession from the ideology of medical professionals

RESUMEN Se aborda la ideología de las y los profesionales de la medicina, desde la teoría de Thompson, para entender los significados de la profesión médica, a partir de las categorías: autonomía, normas y valores, y reconocimiento social. Se realizaron 24 entrevistas semiestructuradas a profesionales de la medicina en cuatro ámbitos de trabajo: institucional público, institucional privado, ejercicio privado y ejercicio mixto, en Amecameca, municipio del Estado de México, en el período comprendido de marzo a octubre de 2019. El análisis de los significados expresados por las y los profesionales de la medicina en cada una de las categorías de interés muestra una base condicionada por la estructura del control estatal y por la economía mercantilizada, que valora con mayor significación formas de práctica médica privada. En la conformación ideológica de la profesión médica subsiste un componente práctico inmerso en un romanticismo liberal en un escenario casi extinto que subsiste en la actualidad, sin articularlo a los procesos sociales más generales.

ABSTRACT This article deals with the ideology of medical professionals in order to understand the meanings attributed to their profession, taking Thompson's theory as a starting point and centering on the categories of autonomy, norms and values, and social recognition. Twenty-four semi-structured interviews were conducted with medical professionals in Amecameca, a municipality in the State of Mexico, from March to October 2019, in four sectors of service provision: public institutional, private institutional, private practice, and mixed practice. The analysis of meanings expressed by medical professionals with respect to each category of interest reveals that medical professionals are conditioned by the structure of state control and by the commodified economy, where private forms of medical practice are more highly regarded. In the ideological conformation of the medical profession, there remains a practical component imbued with a liberal romanticism in an extinct scenario that still exists today, without being articulated to more general social processes.

Where Do Pediatric Dental Residents Intend to Practice? Exploring the Influence of Loan Repayment Programs and Other Factors.

The high cost of dental education and consequent loan burdens contribute to the shortage of pediatric dental providers in rural areas (RAs). Economic incentives are meant to recruit practitioners to RAs. The aim of this study was to assess the ability of government subsidized loan repayment programs (GSLRPs) to recruit pediatric specialists to practice in RAs. A 26-item questionnaire was emailed to all 921 pediatric dental residents across the U.S. in 2015 for a cross-sectional study of factors influencing their choice of practice location. The instrument included information about GSLRPs, enabling the study to serve as a quasi-experiment on the level of funding needed to make GSLRPs effective. A total of 169 residents responded, for an 18% response rate; 74% of respondents were women and 86% had student loan debt. Among the respondents, 40.6% said they would like to practice in RAs, but only 4.1% actually intended to do so. Over one-third initially reported interest in GSLRPs for practicing in RAs. However, after being informed that the average GSLRP is $30,000 annually, one-third of those lost interest. Although 14.2% said no amount would convince them to consider practice in an RA, over half (53.3%) indicated willingness to consider it if the GSLRP were $40,000-$60,000. These results suggest that current GSLRP levels are insufficient to induce pediatric dentists to practice in RAs.

Os grupos de dança popular de Olinda e Recife: limites e fronteiras no século XXI / The popular dancing groups of Olinda and Recife: limits and borders in the XXI century / Los grupos de danza popular de Olinda y Recife: límites y fronteras en el siglo XXI

O estudo objetivou compreender os sentidos e significados de atuação dos Grupos de Dança Popular situados em Recife e Olinda e caracteriza-se por uma abordagem qualitativa do tipo fenomenológico a partir de uma análise de conteúdo, através de entrevistas semiestruturadas presenciais com os responsáveis pelos grupos. Os resultados apontaram para várias camadas de atuação dos grupos. A transmissão da cultura local foi o sentido mais atribuído pelos grupos quando se prontificam a divulgar e preservar a dança popular. A fronteira entre a atuação como motor/indutor/produtor da cultura popular reverbera e retorna como grupo cênico e teatral. O trânsito instalado propõe zonas de ebulição que ora multiplica, ora subtrai sua potência como ética, estética, arte e política.

The study aimed at the meanings of the acting of the Popular Dance Groups located in Recife and Olinda and is characterized by a qualitative approach of the phenomenological type based on a content analysis, through semi-structured interviews with those responsible for the groups. The results pointed to several layers of performance of the groups. The transmission of the local culture was the sense most attributed by the groups when they are ready to spread and preserve the popular dance. The boundary between acting as an engine / inductor / producer of popular culture reverberates and returns as a stage and theatrical group. The installed traffic proposes zones of boiling that sometimes multiplies, sometimes subtracting its power as ethics, aesthetics, art and politics.

El estudio objetivó los sentidos y significados de actuación de los Grupos de Danza Popular situados en Recife y Olinda y se caracteriza por un abordaje cualitativo del tipo fenomenológico a partir de un análisis de contenido a través de entrevistas semiestructuradas presenciales con los responsables por los grupos. Los resultados apuntaron a varias capas de actuación de los grupos. La transmisión de la cultura local fue el sentido más atribuido por los grupos cuando se pronuncia la divulgación y preservar la danza popular. La frontera entre una actuación como motor de la cultura popular reverbera y retorna como grupo escénico y teatral. El tránsito instalado propone zonas de ebullición que ora multiplica, ora sustrae su potencia como ética, estética, arte y política.

O papel do psicólogo na educação profissional e tecnológica: contribuições da Psicologia Escolar / The role of the psychologist in vocational and technological education: Contributions of school psychology

Os Institutos Federais de Educação, Ciência e Tecnologia oferecem cursos que vão do Ensino Médio Técnico à Pós-Graduação, voltados à formação profissional e tecnológica e à formação docente. As transformações no ensino profissionalizante, a oportunidade de os estudantes optarem por percursos diferentes na formação e o envolvimento da comunidade acadêmica nos processos educativos tornaram-se objetos de interesse da Psicologia Escolar. Este estudo, de caráter qualitativo, caracteriza a atuação de psicólogos escolares em um Instituto Federal do país. Os resultados revelaram que os participantes possuem uma formação inicial generalista, acompanhada de aperfeiçoamentos nas áreas da Psicologia e da Educação. Em virtude dessa formação, depreende-se que a atuação dos psicólogos escolares, em sua maioria, foi direcionada para ações de apoio aos processos de ensino e aprendizagem dos estudantes. Por outro lado, em alguns relatos foram identificados também os interesses dos psicólogos em propor uma intervenção que se aproxima das contribuições da Psicologia Escolar Crítica.

The Brazilian Federal Institutes of Education, Science and Technology offer courses for vocational training from secondary school to post graduation. And they also offer teacher training courses. In this context, the transformations on the vocational training, the students' opportunities to choose different trajectories in their training and the academic community's engagement in the educational process became subjects of the School Psychology. This study -a qualitative one- analyze school psychologists' performance at a specific Federal Institute. The results revealed that the research participants have a generalist background in Psychology and graduate studies in Psychology and Education. It can be concluded that, because of such background, the participants performance was generally focused on support to the teaching and learning processes. On the other hand, some reports showed the participants intention to propose actions related, to some extent, to the Critical School Psychology approach.

Perceptions of people with osteogenesis imperfecta about the interventions of the occupational therapy and its possibilities of care / Percepções de pessoas com osteogênese imperfeita acerca das intervenções terapêuticas ocupacionais e possibilidades de cuidado

Abstract Osteogenesis Imperfecta (OI) is a genetic disorder that compromises the collagen formation, which alters in a significant way the body structures causing osseous deformities. Faced with the different possibilities of care for people with OI, stand out the occupational therapy interventions, that even being poorly explored in the context of the national scientific production, show significant practices to compose a team of care for people with OI. Thus, this study aims to identifying the perceptions of people with OI about work of the occupational therapist. It was done a qualitative study based on the application of semi-structured interviews with five adults with OI. Interview data were analyzed by the technique of analysis of thematic content, allowing to cluster the results into three categories: "Knowing the participants: characterization of the sample"; "Living with osteogenesis imperfecta: possibilities and constructions"; and "Occupational therapy and osteogenesis imperfecta: perceptions, fragments, and experiences". The results lead to the conclusion that these professionals have a wide range of practices that still have to be better explored and points out an encouragement for more scientific production in the area.

Resumo A Osteogênese Imperfeita (OI) é um distúrbio genético que compromete a formação de colágeno, alterando de forma significativa estruturas do corpo e causando deformidades ósseas. Diante das diferentes possibilidades de cuidado para as pessoas com OI, enfatizam-se as intervenções terapêuticas ocupacionais, que embora sejam pouco exploradas no âmbito da produção cientifica nacional, apresentam práticas relevantes para compor a equipe de atenção à pessoa com OI. Assim, o presente estudo teve como objetivo identificar as percepções de pessoas com OI acerca da atuação do terapeuta ocupacional. Para tanto se realizou um estudo qualitativo a partir da aplicação de entrevistas semiestruturadas a cinco adultos com OI. Os dados provenientes das entrevistas foram analisados por meio da técnica de análise de conteúdo do tipo temática, possibilitando agrupar os resultados em três categorias: "Conhecendo os participantes: caracterização da amostra"; "Vivendo com osteogênese imperfeita: possibilidades e construções" e "A terapia ocupacional e a osteogênese imperfeita: percepções, fragmentos e vivências". Os resultados levam a concluir que os profissionais da área possuem um vasto campo de prática para ser mais bem explorado, e pontuam um incentivo para produções cientificas na área.