Understanding COVID-19 Vaccine Acceptance among Latin American Health Workers: Implications for Designing Interventions.

Health workers (HWs) have a key role in promoting vaccine acceptance. This study draws on the Behavioral and Social Drivers of Vaccination (BeSD) model and our team's investigation of vaccine hesitancy in a sample of 1197 HWs across 14 Caribbean countries in 2021. We conducted a cross-sectional Internet survey of 6718 HWs across 16 countries in Latin America in spring 2022, after the COVID-19 vaccine had recently become widely available in the region. The survey assessed HWs' attitudes regarding COVID-19 vaccines and vaccines in general. As a proxy measure of COVID-19 vaccine acceptance, we used the willingness to recommend the COVID-19 vaccine to eligible people. Ninety-seven percent of respondents were COVID-19 vaccine acceptant. Although nearly all respondents felt that the COVID-19 vaccine was safe and effective, 59% expressed concerns about potential adverse effects. Despite uniformly high acceptance of the COVID-19 vaccine overall and across Latin American subregions, acceptance differed by sex, HW profession, and COVID-19 history. Social processes, including actions and opinions of friends, family, and colleagues; actions and opinions of religious leaders; and information seen on social networks shaped many respondents' opinions of vaccines, and the magnitude of these effects differed across both demographic and geographic subgroups. Information campaigns designed for HWs should underscore the importance of vaccine safety. Messages should be tailored to specific audiences according to the information source each is most likely to consult and trust.

COVID-19 and human resources for health: analysis of planning, policy responses and actions in Latin American and Caribbean countries.

BACKGROUND: The COVID-19 pandemic led to worldwide health service disruptions, due mainly to insufficient staff availability. To gain insight into policy responses and engage with policy-makers, the World Health Organization (WHO) developed a global approach to assess and measure the impact of COVID-19 on the health workforce. As part of this, WHO, together with the Pan American Health Organization (PAHO), supported an impact analysis of COVID-19 on health workers and policy responses, through country case studies in Latin America and the Caribbean (LAC). METHODS: We sought to identify lessons learned from policies on human resources for health (HRH) during health emergencies, to improve HRH readiness. First, we performed a rapid literature review for information-gathering. Second, we used the WHO interim guidance and impact measurement framework for COVID-19 and HRH to systematically organize that information. Finally, we used the Health Labour Market Framework to guide the content analysis on COVID-19 response in eight LAC countries and identify lessons learned to improve HRH readiness. RESULTS: Planning and implementing the COVID-19 response required strengthening HRH governance and HRH data and information systems. The results suggest two main aspects for HRH governance crucial to enabling an agile response: (1) aligning objectives among ministries to define and produce regulation and policy actions; and (2) agreeing on the strategy for HRH management between the public and private sectors, and between central and local governments. We identified three areas for improvement: (a) HRH information systems; (b) methodologies to estimate HRH needs; and (c) teams to analyse information for decision-making. Three key actions were identified during countries monitored, reviewed, and updated their response stages: (i) strengthening response through primary health care; (ii); planning HRH needs to implement the vaccination plan; and (iii) securing long-term HRH availability. CONCLUSION: Countries coordinated and articulated with different stakeholders to align objectives, allocate resources, and agree on policy actions to implement the COVID-19 response. Data and information for HRH preparedness and implementation were key in enabling an agile COVID-19 response and are key areas to explore for improved pandemic preparedness.

Addressing the move toward universal health in the Caribbean through strengthening the health workforce.

This article describes the human resources for health (HRH) policy and action plan development in Barbados, Grenada, and St. Vincent and the Grenadines, the supporting role of the PAHO/WHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, and sub-regional action for supporting continuing country-level HRH strengthening. A policy development process, comprising document/literature review and stakeholder consultations, was used to conduct a situational analysis, which informed the HRH policy and action plan. The policies and action plans centered on HRH priority areas of leadership and governance, HRH planning capacity, strengthening primary health care, optimization of pre- and post-licensure education/training, retention and recruitment, deployment and utilization, inter-sectoral and external partnerships for sustainability, health information systems, and HRH research. A cross-sectional analysis of the findings found that HRH challenges and priority areas were consistent across the countries, resulting in similar policy priority actions that are aligned with the regional lines of action for strengthening HRH for universal access to health and universal health coverage. The results support the value-add in collaborating on a regional level to build capacity for needs-based HRH planning within member countries. The Caribbean-Community (CARICOM), with facilitation by Pan American Health Organization (PAHO) Caribbean Subregional Programme, has established the Human Resources for Health Action Task Force for the Caribbean. The expertise of the Dalhousie University PAHO/WHO Collaborating Centre, provided through the technical assistance, supported the three countries in this important initiative and provides for further opportunities to support PAHO, the Task Force, and countries as they work to achieve their HRH strengthening objectives.

En este artículo se describe la elaboración de políticas y planes de acción sobre los recursos humanos para la salud en Barbados, Granada y San Vicente y las Granadinas, el apoyo brindado por la Universidad de Dalhousie (centro colaborador de la OPS/OMS para la planificación y la investigación sobre el personal de salud) y las medidas subregionales para apoyar el fortalecimiento continuo de los recursos humanos para la salud a nivel de país. Se llevó a cabo un proceso de elaboración de políticas, que incluyó la revisión de documentos y artículos, así como consultas con las partes interesadas, para realizar un análisis de la situación, que documentó las políticas y los planes de acción sobre recursos humanos para la salud. Las políticas y los planes de acción se centraron en las áreas prioritarias de liderazgo y gobernanza de los recursos humanos para la salud; la capacidad de planificación de los recursos humanos para la salud; el fortalecimiento de la atención primaria de salud; la optimización de la educación y la capacitación previas y posteriores al otorgamiento de licencias, así como la retención y el reclutamiento, el despliegue y la utilización; las asociaciones intersectoriales y externas para la sostenibilidad; los sistemas de información de salud; y la investigación en el ámbito de los recursos humanos para la salud. En un análisis transversal de los resultados se concluyó que los retos y las áreas prioritarias en el ámbito de los recursos humanos para la salud coincidieron en todos los países, por lo que las medidas prioritarias establecidas en las políticas son congruentes con las líneas de acción regionales para fortalecer los recursos humanos respecto del acceso universal a la salud y la cobertura universal de salud. Los resultados respaldan el valor agregado que tiene la colaboración a nivel regional encaminada a crear capacidad para la planificación de los recursos humanos para la salud basada en las necesidades dentro de los Estados Miembros. La Comunidad del Caribe (CARICOM), con la facilitación del Programa Subregional del Caribe de la Organización Panamericana de la Salud (OPS), ha creado el grupo de trabajo de recursos humanos para la salud en el Caribe. La experiencia de la Universidad de Dalhousie como centro colaborador de la OPS/OMS, en forma de la asistencia técnica prestada, brindó apoyo a los tres países en esta importante iniciativa y ofrece nuevas oportunidades para apoyar a la OPS, el grupo de trabajo y los países en su labor para lograr sus objetivos en cuanto al fortalecimiento de los recursos humanos para la salud.

Este artigo descreve a política de recursos humanos para a saúde (RHS) e o desenvolvimento de planos de ação em Barbados, Granada e São Vicente e Granadinas, o papel de apoio do Centro Colaborador da OPAS/OMS sobre Planejamento e Pesquisa da Força de Trabalho da Saúde (Universidade Dalhousie) e a ação sub-regional para apoiar o fortalecimento contínuo dos RHS nesses países. Para fazer uma análise da situação visando a subsidiar a política e o plano de ação de recursos humanos para a saúde foi utilizado um processo de desenvolvimento de políticas, incluindo revisão de documentos/literatura e consultas às partes interessadas. As políticas e os planos de ação concentraram-se em áreas prioritárias de liderança e governança de RHS, capacidade de planejamento de RHS, fortalecimento da atenção primária à saúde, otimização da educação/treinamento pré e pós-licenciamento, retenção e recrutamento, implantação e utilização, parcerias intersetoriais e externas para sustentabilidade, sistemas de informação de saúde e pesquisa sobre RHS. Uma análise transversal das conclusões constatou que os desafios e as áreas prioritárias de RHS eram consistentes entre os países, resultando em ações prioritárias de políticas similares que estão alinhadas com as ações regionais de fortalecimento de RHS para o acesso universal e a cobertura universal de saúde. Os resultados apontam a vantagem da colaboração em nível regional para construir capacidade de planejamento de RHS com base nas necessidades dentro dos países-membros. A Comunidade do Caribe (CARICOM), com facilitação do Programa Sub-Regional do Caribe da Organização Pan-Americana da Saúde (OPAS), estabeleceu a Força Tarefa de Ação em Recursos Humanos para a Saúde no Caribe. A experiência da Universidade Dalhousie, um centro colaborador da OPAS/OMS, disponibilizada por meio da assistência técnica, apoiou os três países nesta importante iniciativa e oferece mais oportunidades para apoiar a OPAS, a força tarefa e os países enquanto trabalham para alcançar seus objetivos de fortalecer os RHS.

Addressing the move toward universal health in the Caribbean through strengthening the health workforce

[ABSTRACT]. This article describes the human resources for health (HRH) policy and action plan development in Barbados, Grenada, and St. Vincent and the Grenadines, the supporting role of the PAHO/WHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, and sub-regional action for supporting continu- ing country-level HRH strengthening. A policy development process, comprising document/literature review and stakeholder consultations, was used to conduct a situational analysis, which informed the HRH policy and action plan. The policies and action plans centered on HRH priority areas of leadership and governance, HRH planning capacity, strengthening primary health care, optimization of pre- and post-licensure education/ training, retention and recruitment, deployment and utilization, inter-sectoral and external partnerships for sustainability, health information systems, and HRH research. A cross-sectional analysis of the findings found that HRH challenges and priority areas were consistent across the countries, resulting in similar policy priority actions that are aligned with the regional lines of action for strengthening HRH for universal access to health and universal health coverage. The results support the value-add in collaborating on a regional level to build capacity for needs-based HRH planning within member countries. The Caribbean-Community (CARICOM), with facilitation by Pan American Health Organization (PAHO) Caribbean Subregional Programme, has estab- lished the Human Resources for Health Action Task Force for the Caribbean. The expertise of the Dalhousie University PAHO/WHO Collaborating Centre, provided through the technical assistance, supported the three countries in this important initiative and provides for further opportunities to support PAHO, the Task Force, and countries as they work to achieve their HRH strengthening objectives.

[RESUMEN]. En este artículo se describe la elaboración de políticas y planes de acción sobre los recursos humanos para la salud en Barbados, Granada y San Vicente y las Granadinas, el apoyo brindado por la Universidad de Dalhousie (centro colaborador de la OPS/OMS para la planificación y la investigación sobre el personal de salud) y las medidas subregionales para apoyar el fortalecimiento continuo de los recursos humanos para la salud a nivel de país. Se llevó a cabo un proceso de elaboración de políticas, que incluyó la revisión de do- cumentos y artículos, así como consultas con las partes interesadas, para realizar un análisis de la situación, que documentó las políticas y los planes de acción sobre recursos humanos para la salud. Las políticas y los planes de acción se centraron en las áreas prioritarias de liderazgo y gobernanza de los recursos humanos para la salud; la capacidad de planificación de los recursos humanos para la salud; el fortalecimiento de la atención primaria de salud; la optimización de la educación y la capacitación previas y posteriores al otorga- miento de licencias, así como la retención y el reclutamiento, el despliegue y la utilización; las asociaciones intersectoriales y externas para la sostenibilidad; los sistemas de información de salud; y la investigación en el ámbito de los recursos humanos para la salud. En un análisis transversal de los resultados se concluyó que los retos y las áreas prioritarias en el ámbito de los recursos humanos para la salud coincidieron en todos los países, por lo que las medidas prioritarias establecidas en las políticas son congruentes con las líneas de acción regionales para fortalecer los recursos humanos respecto del acceso universal a la salud y la cober- tura universal de salud. Los resultados respaldan el valor agregado que tiene la colaboración a nivel regional encaminada a crear capacidad para la planificación de los recursos humanos para la salud basada en las necesidades dentro de los Estados Miembros. La Comunidad del Caribe (CARICOM), con la facilitación del Programa Subregional del Caribe de la Organización Panamericana de la Salud (OPS), ha creado el grupo de trabajo de recursos humanos para la salud en el Caribe. La experiencia de la Universidad de Dalhousie como centro colaborador de la OPS/OMS, en forma de la asistencia técnica prestada, brindó apoyo a los tres países en esta importante iniciativa y ofrece nuevas oportunidades para apoyar a la OPS, el grupo de trabajo y los países en su labor para lograr sus objetivos en cuanto al fortalecimiento de los recursos humanos para la salud.

[RESUMO]. Este artigo descreve a política de recursos humanos para a saúde (RHS) e o desenvolvimento de planos de ação em Barbados, Granada e São Vicente e Granadinas, o papel de apoio do Centro Colaborador da OPAS/OMS sobre Planejamento e Pesquisa da Força de Trabalho da Saúde (Universidade Dalhousie) e a ação sub-regional para apoiar o fortalecimento contínuo dos RHS nesses países. Para fazer uma análise da situação visando a subsidiar a política e o plano de ação de recursos humanos para a saúde foi utilizado um processo de desenvolvimento de políticas, incluindo revisão de documentos/literatura e consultas às partes interessadas. As políticas e os planos de ação concentraram-se em áreas prioritárias de liderança e gover- nança de RHS, capacidade de planejamento de RHS, fortalecimento da atenção primária à saúde, otimização da educação/treinamento pré e pós-licenciamento, retenção e recrutamento, implantação e utilização, par- cerias intersetoriais e externas para sustentabilidade, sistemas de informação de saúde e pesquisa sobre RHS. Uma análise transversal das conclusões constatou que os desafios e as áreas prioritárias de RHS eram consistentes entre os países, resultando em ações prioritárias de políticas similares que estão alinha- das com as ações regionais de fortalecimento de RHS para o acesso universal e a cobertura universal de saúde. Os resultados apontam a vantagem da colaboração em nível regional para construir capacidade de planejamento de RHS com base nas necessidades dentro dos países-membros. A Comunidade do Caribe (CARICOM), com facilitação do Programa Sub-Regional do Caribe da Organização Pan-Americana da Saúde (OPAS), estabeleceu a Força Tarefa de Ação em Recursos Humanos para a Saúde no Caribe. A experiência da Universidade Dalhousie, um centro colaborador da OPAS/OMS, disponibilizada por meio da assistência técnica, apoiou os três países nesta importante iniciativa e oferece mais oportunidades para apoiar a OPAS, a força tarefa e os países enquanto trabalham para alcançar seus objetivos de fortalecer os RHS.

Addressing the move toward universal health in the Caribbean through strengthening the health workforce / Abordar el avance hacia la salud universal en el Caribe mediante el fortalecimiento del personal de salud / Considerações para o avanço rumo à saúde universal no Caribe por meio do fortalecimento da força de trabalho da saúde

ABSTRACT This article describes the human resources for health (HRH) policy and action plan development in Barbados, Grenada, and St. Vincent and the Grenadines, the supporting role of the PAHO/WHO Collaborating Centre on Health Workforce Planning and Research, Dalhousie University, and sub-regional action for supporting continuing country-level HRH strengthening. A policy development process, comprising document/literature review and stakeholder consultations, was used to conduct a situational analysis, which informed the HRH policy and action plan. The policies and action plans centered on HRH priority areas of leadership and governance, HRH planning capacity, strengthening primary health care, optimization of pre- and post-licensure education/training, retention and recruitment, deployment and utilization, inter-sectoral and external partnerships for sustainability, health information systems, and HRH research. A cross-sectional analysis of the findings found that HRH challenges and priority areas were consistent across the countries, resulting in similar policy priority actions that are aligned with the regional lines of action for strengthening HRH for universal access to health and universal health coverage. The results support the value-add in collaborating on a regional level to build capacity for needs-based HRH planning within member countries. The Caribbean-Community (CARICOM), with facilitation by Pan American Health Organization (PAHO) Caribbean Subregional Programme, has established the Human Resources for Health Action Task Force for the Caribbean. The expertise of the Dalhousie University PAHO/WHO Collaborating Centre, provided through the technical assistance, supported the three countries in this important initiative and provides for further opportunities to support PAHO, the Task Force, and countries as they work to achieve their HRH strengthening objectives.

RESUMEN En este artículo se describe la elaboración de políticas y planes de acción sobre los recursos humanos para la salud en Barbados, Granada y San Vicente y las Granadinas, el apoyo brindado por la Universidad de Dalhousie (centro colaborador de la OPS/OMS para la planificación y la investigación sobre el personal de salud) y las medidas subregionales para apoyar el fortalecimiento continuo de los recursos humanos para la salud a nivel de país. Se llevó a cabo un proceso de elaboración de políticas, que incluyó la revisión de documentos y artículos, así como consultas con las partes interesadas, para realizar un análisis de la situación, que documentó las políticas y los planes de acción sobre recursos humanos para la salud. Las políticas y los planes de acción se centraron en las áreas prioritarias de liderazgo y gobernanza de los recursos humanos para la salud; la capacidad de planificación de los recursos humanos para la salud; el fortalecimiento de la atención primaria de salud; la optimización de la educación y la capacitación previas y posteriores al otorgamiento de licencias, así como la retención y el reclutamiento, el despliegue y la utilización; las asociaciones intersectoriales y externas para la sostenibilidad; los sistemas de información de salud; y la investigación en el ámbito de los recursos humanos para la salud. En un análisis transversal de los resultados se concluyó que los retos y las áreas prioritarias en el ámbito de los recursos humanos para la salud coincidieron en todos los países, por lo que las medidas prioritarias establecidas en las políticas son congruentes con las líneas de acción regionales para fortalecer los recursos humanos respecto del acceso universal a la salud y la cobertura universal de salud. Los resultados respaldan el valor agregado que tiene la colaboración a nivel regional encaminada a crear capacidad para la planificación de los recursos humanos para la salud basada en las necesidades dentro de los Estados Miembros. La Comunidad del Caribe (CARICOM), con la facilitación del Programa Subregional del Caribe de la Organización Panamericana de la Salud (OPS), ha creado el grupo de trabajo de recursos humanos para la salud en el Caribe. La experiencia de la Universidad de Dalhousie como centro colaborador de la OPS/OMS, en forma de la asistencia técnica prestada, brindó apoyo a los tres países en esta importante iniciativa y ofrece nuevas oportunidades para apoyar a la OPS, el grupo de trabajo y los países en su labor para lograr sus objetivos en cuanto al fortalecimiento de los recursos humanos para la salud.

RESUMO Este artigo descreve a política de recursos humanos para a saúde (RHS) e o desenvolvimento de planos de ação em Barbados, Granada e São Vicente e Granadinas, o papel de apoio do Centro Colaborador da OPAS/OMS sobre Planejamento e Pesquisa da Força de Trabalho da Saúde (Universidade Dalhousie) e a ação sub-regional para apoiar o fortalecimento contínuo dos RHS nesses países. Para fazer uma análise da situação visando a subsidiar a política e o plano de ação de recursos humanos para a saúde foi utilizado um processo de desenvolvimento de políticas, incluindo revisão de documentos/literatura e consultas às partes interessadas. As políticas e os planos de ação concentraram-se em áreas prioritárias de liderança e governança de RHS, capacidade de planejamento de RHS, fortalecimento da atenção primária à saúde, otimização da educação/treinamento pré e pós-licenciamento, retenção e recrutamento, implantação e utilização, parcerias intersetoriais e externas para sustentabilidade, sistemas de informação de saúde e pesquisa sobre RHS. Uma análise transversal das conclusões constatou que os desafios e as áreas prioritárias de RHS eram consistentes entre os países, resultando em ações prioritárias de políticas similares que estão alinhadas com as ações regionais de fortalecimento de RHS para o acesso universal e a cobertura universal de saúde. Os resultados apontam a vantagem da colaboração em nível regional para construir capacidade de planejamento de RHS com base nas necessidades dentro dos países-membros. A Comunidade do Caribe (CARICOM), com facilitação do Programa Sub-Regional do Caribe da Organização Pan-Americana da Saúde (OPAS), estabeleceu a Força Tarefa de Ação em Recursos Humanos para a Saúde no Caribe. A experiência da Universidade Dalhousie, um centro colaborador da OPAS/OMS, disponibilizada por meio da assistência técnica, apoiou os três países nesta importante iniciativa e oferece mais oportunidades para apoiar a OPAS, a força tarefa e os países enquanto trabalham para alcançar seus objetivos de fortalecer os RHS.

Use of gamma radiation and artificial neural network techniques to monitor characteristics of polyduct transport of petroleum by-products.

This study presents a methodology based on the dual-mode gamma densitometry technique in combination with artificial neural networks to simultaneously determine type and quantity of four different fluids (Gasoline, Glycerol, Kerosene and Fuel Oil) to assist operators of a fluid transport system in pipelines commonly found in the petrochemical industry, as it is necessary to continuously monitor information about the fluids being transferred. The detection system is composed of a 661.657 keV (137Cs) gamma-ray emitting source and two NaI(Tl) scintillation detectors to record transmitted and scattered photons. The information recorded in both detectors was directly applied as input data for the artificial neural networks. The proposed intelligent system consists of three artificial neural networks capable of predicting the fluid volume percentages (purity level) with 94.6% of all data with errors less than 5% and MRE of 1.12%, as well as identifying the pair of fluids moving in the pipeline with 95.9% accuracy.

Prevalencia de lactancia materna en la Zona Básica de Purullena (Granada). Caminando hacia la acreditación IHAN / Prevalence of breastfeeding in the Basic Zone of Purullena (Granada). Walking towards IHAN accreditation

Introducción: se realizó un estudio descriptivo observacional con el objetivo de conocer la prevalencia, duración y características de la lactancia materna en nuestra área sanitaria, como punto de partida para la implantación de mejoras en las prácticas de atención perinatal según la Iniciativa para la Humanización de la Asistencia al Nacimiento y la lactancia (IHAN) y monitorizar resultados a largo plazo; así como comparar con otras áreas de España. Material y métodos: se realizó una encuesta de alimentación infantil a niños de 0-2 años, con un total de 82 lactantes para conocer los indicadores de lactancia materna exclusiva antes de los seis meses, lactancia materna continuada al año y dos años de vida e índice de alimentación complementaria entre 6-8 meses. Además, se obtuvo información sobre la alimentación recibida en el día anterior de cada uno de 25 recién nacidos consecutivos que acudieron al centro, para obtener el indicador de lactancia materna exclusiva en lactantes de 0-15 días. Resultados: se obtuvo un índice de lactancia materna exclusiva en lactantes de 0-15 días de 68%, lactancia materna exclusiva antes de los seis meses de 37%, lactancia materna continuada al año y dos años de vida de 24 y 21% respectivamente. En cuanto al índice de alimentación complementaria, un 100% de niños entre 6-8 meses consumían otros sólidos, semisólidos o purés. Conclusiones: los datos de nuestro estudio se asemejan a otros datos nacionales publicados, pero distan aún mucho de las recomendaciones de la Organización Mundial de la Salud (AU)

Introduction: we conducted an observational and descriptive study with the aim of determining the prevalence, duration and characteristics of breastfeeding in our health district to establish a baseline for the implementation of improvements in perinatal care practices in adherence with the IHAN initiative, to monitor long-term results and to compare outcomes with other areas of Spain.Material and methods: we carried out a survey of nutrition in a sample of 82 children aged 0 to 2 years to calculate the indicators of exclusive breastfeeding up to 6 months; continued breastfeeding at ages 1 and 2 years and the prevalence of complementary feeding at age 6-8 months. We also collected information on the nutrition received the previous day in 25 neonates that attended the primary care centre to calculate the indicator of exclusive breastfeeding in infants aged 0 to 15 days.Results: we found a prevalence of exclusive breastfeeding of 68% in infants aged 0 to 15 days and 37% in infants aged 6 months, and a prevalence of continued BF of 24% at age 1 year and 21% at age 2 years. The proportion of infants that consumed other solid, semisolid or soft foods at ages 6 to 8 months was 100%.Conclusions: the findings of our study were similar to those of other studies in Spain, but were still far from the targets recommended by the World Health Organization. (AU)

Concerns, attitudes, and intended practices of Caribbean healthcare workers concerning COVID-19 vaccination: A cross-sectional study.

BACKGROUND: The Caribbean has a long history of being a global leader in immunization, and one factor contributing to this success has been the commitment of healthcare workers in promoting the benefits of vaccines. Healthcare workers play a critical role in building trust between the public and the immunization program and are generally cited as the most trusted source of information on vaccination. Healthcare workers themselves, therefore, must be confident in vaccination as a public health good and able to transmit this confidence to those who trust them. However, just as with the general public, healthcare workers develop confidence at different rates and may be susceptible to misinformation about vaccines. METHODS: During April and May 2021, the Pan American Health Organization (PAHO) conducted a mixed-methods survey to assess vaccination attitudes, opinions, and reasoning of 1197 healthcare workers across 14 Caribbean countries. FINDINGS: Seventy-seven percent of respondents expressed clear intention to be vaccinated for COVID-19 as soon as possible. Intention to be vaccinated as soon as possible was expressed by lower proportions of nurses (66%) and allied health professionals (62%) than physicians (85%) and by younger respondents than older ones (64% vs. 85%, respectively; p < 0.001 for all these comparisons). Across 32 questions about attitudes and opinions, vaccine hesitancy was consistently expressed by higher proportions of nurses and allied health professionals than physicians and by younger respondents than older ones. INTERPRETATION: Insights from the survey are helping PAHO address healthcare worker concerns with informative messages and supporting countries in policy development to increase vaccine confidence and coverage among Caribbean healthcare workers. FUNDING: This work has been sponsored by the World Health Organization/Pan American Health Organization, the Government of Germany and The Gavi Alliance.

68Ga-PSMA-11 PET/CT in patients with occult biochemical recurrence of prostate carcinoma and negative 18F-Choline PET/CT. Preliminary assessment of its clinical use.

OBJECTIVE: To assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18 F-Choline PET/CT imaging studies. MATERIAL AND METHODS: Retrospective descriptive study. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (<3 ng/mL) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT. All patients were referred to 68 Ga-PSMA-11 PET/CT. PROTOCOL: Dose 2.2 M Bq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 h if needed. RESULTS: The 68 Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them. Four patients (28.5%) obtained a negative or inconclusive 68 Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/mL). One of the 68 Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. CONCLUSION: 68 Ga-PSMA-11 PET/CT allows an early diagnosis, with low PSA values, of occult biochemical recurrence of prostate carcinoma, even in patients with negative 18 F-Choline PET/CT.

Ga-PSMA-11 PET/TC en la recidiva bioquímica oculta del carcinoma de próstata, con 18F-Colina PET/TC negativa. Valoración preliminar de su uso clínico / Ga-PSMA-11 PET/CT in patients with occult biochemical recurrence of prostate carcinoma and negative 18F-Choline PET/CT. Preliminary assessment of its clinical use

Objetivo: Valorar la utilidad de los estudios 68Ga-PSMA PET/TC en la práctica clínica de los pacientes con recidiva bioquímica oculta de carcinoma de próstata, con estudios de imagen radiológicos y 18F-Colina PET/TC negativos o no concluyentes.Material y métodosobservacional retrospectivo y de exactitud diagnóstica. Se seleccionaron los primeros 14 pacientes con antecedentes de carcinoma de próstata, tratados con intención curativa y que presentaban sospecha de recidiva bioquímica con valores bajos de antígeno prostático específico (PSA) (< 3 ng/mL). Los estudios de imagen, ecografía prostática, tomografía computarizada (TC) y/o resonancia magnética (RM) pélvica eran negativos, y todos ellos tenían un 18F-Colina PET/TC negativo o no concluyente. Se derivó a todos los pacientes para realizarse un 68Ga-PSMA-11 PET/TC. Protocolo: Dosis 2,2 MBq/kg, 20 mg de furosemida en el minuto 0. Imágenes PET/TC desde calota craneal hasta el tercio proximal de muslos a los 60 min, e imágenes tardías a las tres horas, si precisara.ResultadosEn nueve de los 14 pacientes (64,2%) el 68Ga-PSMA-11 PET/TC consiguió localizar la recidiva bioquímica oculta, y en todos ellos hubo cambios en la actitud terapéutica. En cuatro de los 14 pacientes (28,5%) el 68Ga-PSMA-11 PET/TC resultó negativo o no concluyente, se prosiguió con la actitud vigilante con controles de PSA y estudios de imagen, según los protocolos habituales. Estos pacientes presentaban los valores más bajos de PSA (inferiores a 1 ng/mL). Uno de los estudios 68Ga-PSMA-11 PET/TC fue no concluyente, informándose la presencia de una dudosa adenopatía iliaca derecha. (AU)

Objective: To assess the clinical usefulness of 68Ga-PSMA PET/CT studies in patients with occult biochemical recurrence of prostate carcinoma, with negative or inconclusive radiologic and 18F-Choline PET/CT imaging studies.Material and methodsRetrospective observational and diagnostic accuracy. The first 14 patients with a history of prostate carcinoma, treated with curative intent and presenting suspicion of biochemical recurrence with low PSA values (< 3 ng/ml) were selected. Imaging studies, prostate ultrasound, pelvic CT and/or MRI were negative, and all of them had a negative or inconclusive 18F-Choline PET/CT.All patients were referred to 68Ga-PSMA-11 PET/CT. Protocol: Dose 2.2 MBq/kg. 20 mg furosemide at start. PET/CT images from skull base to proximal third of thighs at 60 min, and late images at 3 hours if needed.ResultsThe 68Ga-PSMA-11 PET/CT was able to localize the occult biochemical recurrence in 9 of the 14 patients (64.2%), and it affected the therapeutic attitude in all of them.Four patients (28.5%) obtained a negative or inconclusive 68Ga-PSMA-11 PET/CT and continued under vigilant approach with PSA controls and imaging studies according to the clinical guidelines. These patients had the lowest PSA values (less than 1 ng/ml).One of the 68Ga-PSMA-11 PET/CT studies was inconclusive, reporting the presence of a doubtful right iliac adenopathy. (AU)

Career choice in primary care: pre- and post-comparison of Honduran physicians completing social service

[ABSTRACT]. Objective. To describe and compare patterns of specialty choice among physicians in Honduras before and after completing mandatory social service; and to identify and compare salary perceptions and factors that may influence their career choice. Methods. A quantitative methods approach was used on a cross-sectional questionnaire survey applied to 106 physicians completing social service in September 2015. Statistical analysis was performed using chi-square and factor analysis. Results. Interest in family medicine was low and declined from 2.2% before social service to 0.9% after. Median annual expected income was 19.5% lower overall compared to the beginning of social service, and in particular, for primary care specialties (US$ 17 733), it was significantly lower than for other specialties (US$ 27 281). Participants reported that the most important factors influencing career choice were: income potential (23.3%), making a positive difference in people´s lives (19.4%), challenging work (10.7%), and perceived prestige (7.8%). Two factors were significantly associated with a preference for specialties other than primary care: the opportunity to teach (P= 0.008) and “makes positive difference in people´s lives” (P = 0.005). When all categories were compared, “makes positive difference in people´s lives” (P = 0.043), and opportunities to practice with independence (P = 0.036) were factors significantly associated to career decision. Conclusion. Since interest in primary care among physicians decreased during social service and salary perception increased in favor of non-primary care careers, offering greater incentives for this specialty should be explored. Additional research to identify factors that might support the choice of a career in primary care are recommended.

[RESUMEN]. Objetivo. Describir y comparar los patrones de elección de especialidad de los médicos hondureños antes y después de completar el servicio social obligatorio. Establecer y comparar las percepciones sobre el salario y los factores que pueden influir en esa elección. Método. Se aplicaron métodos cuantitativos a un cuestionario transversal administrado a 106 médicos que terminaron el servicio social en septiembre de 2015. El análisis estadístico se realizó mediante ji cuadrado y análisis factorial. Resultados. El interés por la medicina familiar era escaso y descendió de 2,2% antes del servicio social a 0,9% después. La mediana de ingresos anuales previstos fue, en general, 19,5% inferior que al comienzo del servicio social y, en particular, fue significativamente inferior para las especialidades de atención primaria (US$ 17 733) que para otras especialidades (US$ 27 281). Los participantes informaron que los factores más importantes que influían en la elección de especialidad eran: posibles ingresos (23,3%), posibilidad de cambiar para mejor la vida de las personas (19,4%), trabajo estimulante (10,7%) y prestigio que pudiera otorgar (7,8%). Dos factores se asociaron significativamente con la preferencia por una especialidad fuera de la atención primaria: la oportunidad de enseñar (P= 0,008) y la posibilidad de “cambiar para mejor la vida de las personas” (P = 0,005). Cuando se compararon todas las categorías, “cambiar para mejor la vida de las personas” (P = 0,043) y la oportunidad de ejercer de forma independiente (P = 0,036) fueron factores que se asociaron significativamente con la decisión sobre la especialidad. Conclusión. Como el interés por la atención primaria entre los médicos disminuyó durante el servicio social y la percepción sobre el salario inclinó la balanza en favor de especialidades distintas a la atención primaria, se debe explorar la posibilidad de ofrecer mayores incentivos para esta especialización. Se recomienda realizar nuevas investigaciones para determinar los factores que podrían apoyar la elección de la especialidad de atención primaria.

[RESUMO]. Objetivo. Descrever e comparar os padrões de escolha da área de especialidade entre médicos hondurenhos antes e depois da prestação do serviço social obrigatório e identificar e comparar a percepção salarial e de outros potenciais determinantes da escolha profissional. Métodos. Estudo transversal com metodologia quantitativa conduzido com a aplicação de um questionário em uma amostra de 106 médicos que concluíram a prestação do serviço social obrigatório em setembro de 2015. A análise estatística foi realizada com o uso do teste de qui-quadrado e análise fatorial. Resultados. Verificou-se baixo grau de interesse em medicina da família, com redução do interesse de 2,2% a 0,9% após o serviço social. Houve, em geral, uma redução de 19,5% na mediana anual prevista de remuneração comparada ao início do serviço social, sendo particularmente significativa nas especialidades de atenção primária (US$ 17.733) e relação às outras especialidades (US$ 27.281). Os participantes informaram os seguintes principais determinantes da escolha da carreira profissional: ter potencial de remuneração (23,3%), contribuir para melhorar a vida das pessoas (19,4%), ser um trabalho estimulante (10,7%) e prestígio percebido (7,8%). Observou-se uma associação significativa entre os seguintes fatores e a preferência por especialidades fora da atenção primária: oportunidade de ensinar (P = 0,008) e contribuir para melhorar a vida das pessoas (P = 0,005). Quando se compararam todas as categorias, contribuir para melhorar a vida das pessoas (P = 0,043) e oportunidade de exercer a medicina de forma autônoma (P = 0,036) foram os fatores significativamente associados à escolha da carreira. Conclusão. Diante da perda de interesse por parte dos médicos pela área de atenção primária durante o serviço social e uma percepção salarial maior favorecendo carreiras fora da atenção primária, deve ser dado maior incentivo para que os profissionais optem por esta especialidade. Recomenda-se conduzir outros estudos para identificar os fatores que poderiam estimular a escolha de uma carreira profissional em atenção primária.

Career choice in primary care: pre- and post-comparison of Honduran physicians completing social service.

OBJECTIVE: To describe and compare patterns of specialty choice among physicians in Honduras before and after completing mandatory social service; and to identify and compare salary perceptions and factors that may influence their career choice. METHODS: A quantitative methods approach was used on a cross-sectional questionnaire survey applied to 106 physicians completing social service in September 2015. Statistical analysis was performed using chi-square and factor analysis. RESULTS: Interest in family medicine was low and declined from 2.2% before social service to 0.9% after. Median annual expected income was 19.5% lower overall compared to the beginning of social service, and in particular, for primary care specialties (US$ 17 733), it was significantly lower than for other specialties (US$ 27 281). Participants reported that the most important factors influencing career choice were: income potential (23.3%), making a positive difference in people's lives (19.4%), challenging work (10.7%), and perceived prestige (7.8%). Two factors were significantly associated with a preference for specialties other than primary care: the opportunity to teach (P= 0.008) and "makes positive difference in people's lives" (P = 0.005). When all categories were compared, "makes positive difference in people's lives" (P = 0.043), and opportunities to practice with independence (P = 0.036) were factors significantly associated to career decision. CONCLUSION: Since interest in primary care among physicians decreased during social service and salary perception increased in favor of non-primary care careers, offering greater incentives for this specialty should be explored. Additional research to identify factors that might support the choice of a career in primary care are recommended.

Career choice in primary care: pre- and post-comparison of Honduran physicians completing social service / Elección de especialidad en atención primaria: comparación entre médicos hondureños antes y después de completar el servicio social / Escolha da carreira profissional em atenção primária: comparação entre médicos hondurenhos antes e depois da prestação do serviço social

ABSTRACT Objective To describe and compare patterns of specialty choice among physicians in Honduras before and after completing mandatory social service; and to identify and compare salary perceptions and factors that may influence their career choice. Methods A quantitative methods approach was used on a cross-sectional questionnaire survey applied to 106 physicians completing social service in September 2015. Statistical analysis was performed using chi-square and factor analysis. Results Interest in family medicine was low and declined from 2.2% before social service to 0.9% after. Median annual expected income was 19.5% lower overall compared to the beginning of social service, and in particular, for primary care specialties (US$ 17 733), it was significantly lower than for other specialties (US$ 27 281). Participants reported that the most important factors influencing career choice were: income potential (23.3%), making a positive difference in people's lives (19.4%), challenging work (10.7%), and perceived prestige (7.8%). Two factors were significantly associated with a preference for specialties other than primary care: the opportunity to teach (P= 0.008) and "makes positive difference in people's lives" (P = 0.005). When all categories were compared, "makes positive difference in people's lives" (P = 0.043), and opportunities to practice with independence (P = 0.036) were factors significantly associated to career decision. Conclusion Since interest in primary care among physicians decreased during social service and salary perception increased in favor of non-primary care careers, offering greater incentives for this specialty should be explored. Additional research to identify factors that might support the choice of a career in primary care are recommended.

RESUMEN Objetivo Describir y comparar los patrones de elección de especialidad de los médicos hondureños antes y después de completar el servicio social obligatorio. Establecer y comparar las percepciones sobre el salario y los factores que pueden influir en esa elección. Método Se aplicaron métodos cuantitativos a un cuestionario transversal administrado a 106 médicos que terminaron el servicio social en septiembre de 2015. El análisis estadístico se realizó mediante ji cuadrado y análisis factorial. Resultados El interés por la medicina familiar era escaso y descendió de 2,2% antes del servicio social a 0,9% después. La mediana de ingresos anuales previstos fue, en general, 19,5% inferior que al comienzo del servicio social y, en particular, fue significativamente inferior para las especialidades de atención primaria (US$ 17 733) que para otras especialidades (US$ 27 281). Los participantes informaron que los factores más importantes que influían en la elección de especialidad eran: posibles ingresos (23,3%), posibilidad de cambiar para mejor la vida de las personas (19,4%), trabajo estimulante (10,7%) y prestigio que pudiera otorgar (7,8%). Dos factores se asociaron significativamente con la preferencia por una especialidad fuera de la atención primaria: la oportunidad de enseñar (P= 0,008) y la posibilidad de "cambiar para mejor la vida de las personas" (P = 0,005). Cuando se compararon todas las categorías, "cambiar para mejor la vida de las personas" (P = 0,043) y la oportunidad de ejercer de forma independiente (P = 0,036) fueron factores que se asociaron significativamente con la decisión sobre la especialidad. Conclusión Como el interés por la atención primaria entre los médicos disminuyó durante el servicio social y la percepción sobre el salario inclinó la balanza en favor de especialidades distintas a la atención primaria, se debe explorar la posibilidad de ofrecer mayores incentivos para esta especialización. Se recomienda realizar nuevas investigaciones para determinar los factores que podrían apoyar la elección de la especialidad de atención primaria.

RESUMO Objetivo Descrever e comparar os padrões de escolha da área de especialidade entre médicos hondurenhos antes e depois da prestação do serviço social obrigatório e identificar e comparar a percepção salarial e de outros potenciais determinantes da escolha profissional. Métodos Estudo transversal com metodologia quantitativa conduzido com a aplicação de um questionário em uma amostra de 106 médicos que concluíram a prestação do serviço social obrigatório em setembro de 2015. A análise estatística foi realizada com o uso do teste de qui-quadrado e análise fatorial. Resultados Verificou-se baixo grau de interesse em medicina da família, com redução do interesse de 2,2% a 0,9% após o serviço social. Houve, em geral, uma redução de 19,5% na mediana anual prevista de remuneração comparada ao início do serviço social, sendo particularmente significativa nas especialidades de atenção primária (US$ 17.733) e relação às outras especialidades (US$ 27.281). Os participantes informaram os seguintes principais determinantes da escolha da carreira profissional: ter potencial de remuneração (23,3%), contribuir para melhorar a vida das pessoas (19,4%), ser um trabalho estimulante (10,7%) e prestígio percebido (7,8%). Observou-se uma associação significativa entre os seguintes fatores e a preferência por especialidades fora da atenção primária: oportunidade de ensinar (P = 0,008) e contribuir para melhorar a vida das pessoas (P = 0,005). Quando se compararam todas as categorias, contribuir para melhorar a vida das pessoas (P = 0,043) e oportunidade de exercer a medicina de forma autônoma (P = 0,036) foram os fatores significativamente associados à escolha da carreira. Conclusão Diante da perda de interesse por parte dos médicos pela área de atenção primária durante o serviço social e uma percepção salarial maior favorecendo carreiras fora da atenção primária, deve ser dado maior incentivo para que os profissionais optem por esta especialidade. Recomenda-se conduzir outros estudos para identificar os fatores que poderiam estimular a escolha de uma carreira profissional em atenção primária.

Genetic ACE I/D and ACTN3 R577X polymorphisms and adolescent idiopathic scoliosis.

The etiology of adolescent idiopathic scoliosis remains unknown. Angiotensin-converting enzyme and α-actinin-3 polymorphisms influence the characteristics of muscle fibers. The aim of this study was to examine the association between idiopathic scoliosis and genetic polymorphism of angiotensin-converting enzyme and α-actinin-3. Ninety-seven females with scoliosis, and 137 healthy, age-matched control females were studied. The presence of polymorphisms was determined by PCR. A χ2 test was used to analyze differences, and odds ratios were estimated. The frequencies of ACE genotypes in the scoliotic group were 46.4% DD, 45.4% ID, and 8.2% II, while in the control group they were 40.1% DD, 43.8% ID, and 16.1% II (P = 0.197). The D allele had a frequency of 69.1% in patients with idiopathic scoliosis and 62% in the control group (P = 0.116). The frequencies of ACTN3 genotypes in females with scoliosis were 31.8% RR, 49.4% RX, and 18.8% XX, while in the control group they were 35% RR, 49% RX, and 16% XX (P = 0.810). The frequency of the R allele was 56.4% in the scoliotic group and 59.6% in the control group (P = 0.518). There was no statistically significant association between angiotensin-converting enzyme or α-actinin-3 polymorphisms and the presence of adolescent idiopathic scoliosis in females.

Factors that influence career choice in primary care among medical students starting social service in Honduras / Factores que influyen en la elección de especialidades de atención primaria por los estudiantes de medicina que comienzan el servicio social

Objective. To 1) describe patterns of specialty choice; 2) investigate relationships between career selection and selected demographic indicators; and 3) identify salary perception, factors that influence career choice in primary care, and factors that influence desired location of future medical practice. Methods. The study used a mixed-methods approach that included a cross-sectional questionnaire survey applied to 234 last-year medical students in Honduras (September 2014), and semi-structured interviews with eight key informants (October 2014). Statistical analysis included chi-square and factor analysis. An alpha level of 0.05 was used to determine significance. Results. In the qualitative analysis, several codes were associated with each other, and five major themes emerged. Primary care careers were the preferred choice for 8.1% of students, who preferred urban settings for future practice location. The perceived salary of specialties other than primary care was significantly higher than those of general practitioners, family practitioners, and pediatricians (P < 0.001). Participants considered “making a difference,” income, teaching, prestige, and challenging work the most important factors influencing career choice. Practice in ambulatory settings was significantly associated with a preference for primary care specialties (P = < 0.05). Logistic regression analysis found that factors related to patient-based care were statistically significant for selecting primary care (P = 0.006). The qualitative analysis further endorsed the survey findings, identifying additional factors that influence career choice (future work option; availability of residency positions; and social factors, including violence). Rationales behind preference of a specialty appeared to be based on a combination of ambition and prestige, and on personal and altruistic considerations. Conclusions. Most factors that influence primary care career choice are similar to those found in the literature. There are several factors distin

Objetivo. El objetivo del estudio fue: 1) describir los modelos de elección del área de especialidad; 2) investigar las relaciones entre la elección de carrera y algunos indicadores demográficos seleccionados, y 3) establecer otros elementos como el sueldo esperado, factores que influyen en la elección de carrera en atención primaria y factores que influyen en la localización deseada para la práctica médica futura. Métodos. En el estudio se utilizó un enfoque metodológico mixto que incluyó una encuesta transversal mediante un cuestionario que respondieron 234 estudiantes del último año de la carrera de medicina en Honduras (septiembre del 2014) y entrevistas semiestructuradas a ocho informantes clave (octubre del 2014). El análisis estadístico incluyó la prueba de ji cuadrada y el análisis factorial. Para determinar la significación estadística, se utilizó usó un nivel de alfa de 0,05. Resultados. En el análisis cualitativo, varios códigos se asociaron entre sí y surgieron cinco temas principales. Las carreras de atención primaria fueron la elección preferida por el 8,1% de los estudiantes que preferían los entornos urbanos para su práctica futura. El sueldo esperado en las especialidades diferentes de la atención primaria fue significativamente mayor que el sueldo esperado en especialidades como médico general, médico de familia y pediatra (P < 0,001). Los participantes consideraron que los factores que más influían en su elección de carrera eran: “marcar la diferencia”, los ingresos, la enseñanza, el prestigio y el trabajo estimulante. La práctica en entornos ambulatorios se asoció significativamente con la preferencia por las áreas de especialidad de la atención primaria (P = < 0,05). En el análisis de regresión logística se observó que los factores relacionados con la atención centrada en el paciente fueron estadísticamente significativos para la elección de la atención primaria (P = 0,006). El análisis cualitativo respaldó aún más los resultados de la encuesta y determinó otros factores que influyen en la elección de carrera (opciones de trabajo futuras, posibilidad de puestos de médico residente y factores sociales, incluida la violencia). Aparentemente, las razones para la preferencia de una especialidad se basaban en una combinación de ambición y prestigio, y en consideraciones personales y altruistas. Conclusiones. La mayor parte de los factores que influyen en la elección de especialidades de atención primaria detectados son similares a los que figuran en la bibliografía. Hay varios factores distintivos en relación con los estudiantes de medicina hondureños, que en su mayor parte son obstáculos para la elección de especialidades de atención primaria.

Factors that influence career choice in primary care among medical students starting social service in Honduras / Factores que influyen en la elección de especialidades de atención primaria por los estudiantes de medicina que comienzan el servicio social en Honduras

ABSTRACT Objective To 1) describe patterns of specialty choice; 2) investigate relationships between career selection and selected demographic indicators; and 3) identify salary perception, factors that influence career choice in primary care, and factors that influence desired location of future medical practice. Methods The study used a mixed-methods approach that included a cross-sectional questionnaire survey applied to 234 last-year medical students in Honduras (September 2014), and semi-structured interviews with eight key informants (October 2014). Statistical analysis included chi-square and factor analysis. An alpha level of 0.05 was used to determine significance. Results In the qualitative analysis, several codes were associated with each other, and five major themes emerged. Primary care careers were the preferred choice for 8.1% of students, who preferred urban settings for future practice location. The perceived salary of specialties other than primary care was significantly higher than those of general practitioners, family practitioners, and pediatricians (P < 0.001). Participants considered “making a difference,” income, teaching, prestige, and challenging work the most important factors influencing career choice. Practice in ambulatory settings was significantly associated with a preference for primary care specialties (P = < 0.05). Logistic regression analysis found that factors related to patient-based care were statistically significant for selecting primary care (P = 0.006). The qualitative analysis further endorsed the survey findings, identifying additional factors that influence career choice (future work option; availability of residency positions; and social factors, including violence). Rationales behind preference of a specialty appeared to be based on a combination of ambition and prestige, and on personal and altruistic considerations. Conclusions Most factors that influence primary care career choice are similar to those found in the literature. There are several factors distinctive to medical students in Honduras—most of them barriers to primary care career choice.

RESUMEN Objetivo El objetivo del estudio fue: 1) describir los modelos de elección del área de especialidad; 2) investigar las relaciones entre la elección de carrera y algunos indicadores demográficos seleccionados, y 3) establecer otros elementos como el sueldo esperado, factores que influyen en la elección de carrera en atención primaria y factores que influyen en la localización deseada para la práctica médica futura. Métodos En el estudio se utilizó un enfoque metodológico mixto que incluyó una encuesta transversal mediante un cuestionario que respondieron 234 estudiantes del último año de la carrera de medicina en Honduras (septiembre del 2014) y entrevistas semiestructuradas a ocho informantes clave (octubre del 2014). El análisis estadístico incluyó la prueba de ji cuadrada y el análisis factorial. Para determinar la significación estadística, se utilizó usó un nivel de alfa de 0,05. Resultados En el análisis cualitativo, varios códigos se asociaron entre sí y surgieron cinco temas principales. Las carreras de atención primaria fueron la elección preferida por el 8,1% de los estudiantes que preferían los entornos urbanos para su práctica futura. El sueldo esperado en las especialidades diferentes de la atención primaria fue significativamente mayor que el sueldo esperado en especialidades como médico general, médico de familia y pediatra (P < 0,001). Los participantes consideraron que los factores que más influían en su elección de carrera eran: “marcar la diferencia”, los ingresos, la enseñanza, el prestigio y el trabajo estimulante. La práctica en entornos ambulatorios se asoció significativamente con la preferencia por las áreas de especialidad de la atención primaria (P = < 0,05). En el análisis de regresión logística se observó que los factores relacionados con la atención centrada en el paciente fueron estadísticamente significativos para la elección de la atención primaria (P = 0,006). El análisis cualitativo respaldó aún más los resultados de la encuesta y determinó otros factores que influyen en la elección de carrera (opciones de trabajo futuras, posibilidad de puestos de médico residente y factores sociales, incluida la violencia). Aparentemente, las razones para la preferencia de una especialidad se basaban en una combinación de ambición y prestigio, y en consideraciones personales y altruistas. Conclusiones La mayor parte de los factores que influyen en la elección de especialidades de atención primaria detectados son similares a los que figuran en la bibliografía. Hay varios factores distintivos en relación con los estudiantes de medicina hondureños, que en su mayor parte son obstáculos para la elección de especialidades de atención primaria.

Factors that influence career choice in primary care among medical students starting social service in Honduras.

OBJECTIVE: To 1) describe patterns of specialty choice; 2) investigate relationships between career selection and selected demographic indicators; and 3) identify salary perception, factors that influence career choice in primary care, and factors that influence desired location of future medical practice. METHODS: The study used a mixed-methods approach that included a cross-sectional questionnaire survey applied to 234 last-year medical students in Honduras (September 2014), and semi-structured interviews with eight key informants (October 2014). Statistical analysis included chi-square and factor analysis. An alpha level of 0.05 was used to determine significance. RESULTS: In the qualitative analysis, several codes were associated with each other, and five major themes emerged. Primary care careers were the preferred choice for 8.1% of students, who preferred urban settings for future practice location. The perceived salary of specialties other than primary care was significantly higher than those of general practitioners, family practitioners, and pediatricians (P < 0.001). Participants considered "making a difference," income, teaching, prestige, and challenging work the most important factors influencing career choice. Practice in ambulatory settings was significantly associated with a preference for primary care specialties (P = < 0.05). Logistic regression analysis found that factors related to patient-based care were statistically significant for selecting primary care (P = 0.006). The qualitative analysis further endorsed the survey findings, identifying additional factors that influence career choice (future work option; availability of residency positions; and social factors, including violence). Rationales behind preference of a specialty appeared to be based on a combination of ambition and prestige, and on personal and altruistic considerations. CONCLUSIONS: Most factors that influence primary care career choice are similar to those found in the literature. There are several factors distinctive to medical students in Honduras-most of them barriers to primary care career choice.

Factors that influence a career choice in primary care among medical students from high-, middle-, and low-income countries: a systematic review / Factores que influyen en la elección de una carrera en atención primaria entre estudiantes de medicina de países de ingresos altos, medianos y bajos: una revisión sistemática

OBJECTIVE: To determine which factors influence a medical student's decision to choose a career in primary care; and to establish if these factors are similar or different among students in high-, middle- and low-income countries. METHODS: An extensive search was done of PubMed, Google Scholar, and Virtual Library of Health for articles on primary care careers published in 2003-2013 in English, Spanish, and/or Portuguese. Initially, 600 records were identified; 74 full-text articles were assessed for eligibility and 55 were selected (42 from high-income countries; 13 from middle- and low-income). These were assessed to identify intrinsic and extrinsic factors that influence career choice among medical students from high-, middle-, and low-income countries. RESULTS: A comparison framework with common and specific factors that influence career choice in primary care among medical students from high-, middle- and low-income was developed. Factors were classified as extrinsic or intrinsic, and as facilitators or barriers. Several factors common to all countries were identified: facilitators were exposure to rural location, role models, working conditions; barriers were low income, prestige, and medical school environment. Some factors specific to middle- and low-income countries were: understanding of rural needs and intellectual challenge. Other factors specific to high-income countries were: attitude towards social problems, voluntary work, influence of family, and length of residency. CONCLUSIONS: Further studies on the subject are needed, especially in low- and middle-income countries. Identifying factors as barriers or facilitators for career choice will promote a better understanding of the reasons behind the shortage of primary care professionals and will contribute to policy building, improved training, and recruitment and retention of these professionals.

OBJETIVO: Determinar los factores que influyen en la decisión de un estudiante de medicina de dedicarse profesionalmente a la atención primaria; y establecer si estos factores son similares o diferentes entre estudiantes de países de ingresos altos, medianos y bajos. MÉTODOS: Se llevó a cabo una extensa búsqueda en PubMed, en Google Académico y en la Biblioteca Virtual en Salud de artículos sobre selección de carrera en atención primaria publicados entre 2003 y 2013 en inglés, español o portugués. Inicialmente, se seleccionaron 600 registros; se evaluó la idoneidad de 74 artículos de texto completo, y de estos se seleccionaron 55 (42 de países de ingresos altos, 13 de países de ingresos medianos y bajos). Se evaluaron los artículos con el objeto de determinar cuáles eran los factores intrínsecos y extrínsecos que influían en la elección profesional de los estudiantes de medicina de países de ingresos altos, medianos y bajos. RESULTADOS: Se elaboró un marco de comparación de los factores comunes y específicos que influyen en la elección profesional de atención primaria por parte de los estudiantes de medicina de países de ingresos altos, medianos y bajos. Los factores se clasificaron como extrínsecos o intrínsecos, y como facilitadores o barreras. Se determinaron varios factores comunes a todos los países: la exposición a un entorno rural, los modelos a imitar y las condiciones laborales actuaban como facilitadores; los ingresos bajos, el escaso prestigio y el entorno propio de las facultades de medicina actuaban como barreras. Algunos factores específicos de países de ingresos medianos y bajos fueron la comprensión de las necesidades rurales y el desafío intelectual. Otros factores específicos de países de ingresos altos fueron la actitud hacia los problemas sociales, el haber trabajado como voluntario, la influencia de la familia y la duración del período de residencia. CONCLUSIONES: Se requieren nuevos estudios sobre el tema, especialmente en países de ingresos medianos y bajos. Determinar si estos factores actúan como barreras o facilitadores de la elección profesional ayudará a comprender los motivos de la escasez de profesionales de atención primaria y contribuirá a la elaboración de políticas, a mejorar la capacitación, y a captar a estos profesionales y garantizar su permanencia.

Factors that influence a career choice in primary care among medical students from high-, middle-, and low-income countries: a systematic review.

OBJECTIVE: To determine which factors influence a medical student's decision to choose a career in primary care; and to establish if these factors are similar or different among students in high-, middle- and low-income countries. METHODS: An extensive search was done of PubMed, Google Scholar, and Virtual Library of Health for articles on primary care careers published in 2003-2013 in English, Spanish, and/or Portuguese. Initially, 600 records were identified; 74 full-text articles were assessed for eligibility and 55 were selected (42 from high-income countries; 13 from middle- and low-income). These were assessed to identify intrinsic and extrinsic factors that influence career choice among medical students from high-, middle-, and low-income countries. RESULTS: A comparison framework with common and specific factors that influence career choice in primary care among medical students from high-, middle- and low-income was developed. Factors were classified as extrinsic or intrinsic, and as facilitators or barriers. Several factors common to all countries were identified: facilitators were exposure to rural location, role models, working conditions; barriers were low income, prestige, and medical school environment. Some factors specific to middle- and low-income countries were: understanding of rural needs and intellectual challenge. Other factors specific to high-income countries were: attitude towards social problems, voluntary work, influence of family, and length of residency. CONCLUSIONS: Further studies on the subject are needed, especially in low- and middle-income countries. Identifying factors as barriers or facilitators for career choice will promote a better understanding of the reasons behind the shortage of primary care professionals and will contribute to policy building, improved training, and recruitment and retention of these professionals.