Thriving in neuroscience careers: Three lessons from 12+ years of the BRAINS Program.

The NINDS-funded BRAINS Program for neuroscientists from underrepresented and marginalized groups has positively impacted its participants and the field. We discuss three lessons to advance excellence and diversity: center relationships, provide ongoing engagement, and leverage programmatic expertise.

Dermatology workforce projections in the United States, 2021 to 2036.

BACKGROUND: There has been a growing imbalance between supply of dermatologists and demand for dermatologic care. To best address physician shortages, it is important to delineate supply and demand patterns in the dermatologic workforce. The goal of this study was to explore dermatology supply and demand over time. METHODS: We conducted a cross-sectional analysis of workforce supply and demand projections for dermatologists from 2021 to 2036 using data from the Health Workforce Simulation Model from the National Center for Health Workforce Analysis. Estimates for total workforce supply and demand were summarized in aggregate and stratified by rurality. Scenarios with status quo demand and improved access were considered. RESULTS: Projected total supply showed a 12.45% increase by 2036. Total demand increased 12.70% by 2036 in the status quo scenario. In the improved access scenario, total supply was inadequate for total demand in any year, lagging by 28% in 2036. Metropolitan areas demonstrated a relative supply surplus up to 2036; nonmetropolitan areas had at least a 157% excess in demand throughout the study period. In 2021 adequacy was 108% and 39% adequacy for metropolitan and nonmetropolitan areas, respectively; these differences were projected to continue through 2036. CONCLUSIONS: The findings suggest that the dermatology physician workforce is inadequate to meet the demand for dermatologic services in nonmetropolitan areas. Furthermore, improved access to dermatologic care would bolster demand and especially exacerbate workforce inadequacy in nonmetropolitan areas. Continued efforts are needed to address health inequities and ensure access to quality dermatologic care for all.

"I Like the Feeling of Connecting With People": A Mixed-Methods Study of Nursing Assistants Experiences Across the Care Continuum.

Nursing assistants (NAs) are critical professionals across the long-term care continuum. Despite the demands of NAs, these frontline personnel experience workplace challenges and turnover at a disproportionate rate compared to other professionals. Much research has explored the experiences of nursing assistants using federal survey data and national datasets. Guided by a socio-ecological model and the job-demands resource model, this study utilized a sequential mixed-methods approach to uncover a more nuanced understanding of NA workplace experience. Results from this combined qualitative (N = 17) and quantitative (N = 354) study found that there are several workplace aspects, such as organizational culture and supervisor relationships, that contribute to NA experiences across system levels. Further exploration of direct care tasks directly from nursing assistants is necessary to understand full intentions.

The Relationship between Dietary Patterns and Metabolic Phenotypes: A Cross-Sectional Study in a Representative Sample of Iranian Industrial Employees.

Background and Aim: There is limited evidence to support the relationship between dietary patterns and metabolic phenotypes. Therefore, this study aimed to assess the association of dietary patterns with metabolic phenotypes among a large sample of Iranian industrial employees. Methods: This cross-sectional study was conducted among 3,063 employees of Esfahan Steel Company, Iran. Using exploratory factor analysis, major dietary patterns were obtained from a validated short form of food frequency questionnaire. The metabolic phenotypes were defined according to Adult Treatment Panel III guidelines. The independent-sample t-test, one-way analysis of variance, χ2 test, and multivariable logistic regression were applied to analyze data. Results: Three major dietary patterns were identified by factor analysis: the Western dietary pattern, the healthy dietary pattern, and the traditional dietary pattern. After controlling for potential confounders, subjects in the highest tertile of Western dietary pattern score had a higher odds ratio (OR) for metabolically healthy obese (MHO; OR 1.58, 95% confidence interval [CI]: 1.29-1.94), metabolically unhealthy normal weight (OR 1.93, 95% CI 1.08-3.45), and metabolically unhealthy obese (MUHO) phenotypes (OR 2.87, 95% CI 2.05-4.03) than those in the lowest tertile. Also, higher adherence to traditional dietary pattern was positively associated with a higher risk of MHO (OR 1.91, 95% CI 1.56-2.34) and MUHO phenotypes (OR 2.33, 95% CI 1.69-3.22) in the final model. Conclusion: There were significant associations between dietary patterns and metabolic phenotypes, suggesting the necessity of nutritional interventions in industrial employees to improve metabolic phenotype, health outcomes, and, therefore, job productivity in the workforce population.

Equity and justice in health.

BACKGROUND: While justice is promised to all U.S. citizens, the truth is that the pathway to equity and justice in health is riddled with obstacles for many marginalized and minoritized groups. The United States ranks lower on crucial health measures than its high-income peer countries, reflecting differences in health outcomes for marginalized and minoritized populations. PURPOSE: Promoting equity and justice in health is vital as health shapes the daily experiences of individuals and communities, specifically those from marginalized and minoritized backgrounds. METHOD: This paper highlights the health care system and sociopolitical factors contributing to the longstanding structural barriers that impede health and the need for structural competence, advocacy, and activism in the nursing workforce. DISCUSSION: Understanding systemic issues underlying health inequities provides an opportunity to develop targeted strategies to eliminate practices perpetuating inequities and pave the way for everyone to have a fair and just opportunity to be as healthy as possible. CONCLUSION: Specific education, practice, research, and policy recommendations can advance equity and justice in health.

Social accountability in a medical school: is it sufficient? A regional medical school curriculum and approaches to equip graduates for rural and remote medical services.

BACKGROUND: Social accountability is increasingly integral to medical education, aligning health systems with community needs. Universitas Pattimura's Faculty of Medicine (FMUP) enhances this through a curriculum that prepares graduates for rural and remote (RR) medical practice, exceeding national standards. The impact of this curriculum on graduate readiness in actual work settings remains unassessed. OBJECTIVE: This study was conducted to capture the perspectives of FMUP medical graduates in a rural-centric curriculum, focusing on the teaching and learning opportunities afforded to them during their medical education. These insights are crucial for evaluating the accountability of regional medical schools in delivering quality service, particularly in underserved areas. METHODS: Semistructured interviews were conducted with nine FMUP graduates employed in the RR areas of Maluku Province. A qualitative analysis was employed to examine graduates' views on the curriculum concerning medical school accountability. RESULTS: The FMUP curriculum, informed by social accountability principles, partially prepares graduates to work under Maluku's RR conditions. However, it was reported by participants that their skills and preparedness often fall short in the face of substandard working environments. CONCLUSIONS: The FMUP curriculum supports the government's aim to develop an RR medical workforce. However, the curriculum's social accountability and rural emphasis fall short of addressing community health needs amid inadequate practice conditions. Political investment in standardizing medical facilities and equipment is essential for enhancing graduates' effectiveness and health outcomes in RR communities.

Nurses' Personality Traits and Perceived Work Environments During Public Health Emergencies: Implications for Nursing Workforce Planning.

Background: The nursing workforce faces substantial challenges, particularly in the aftermath of the COVID-19 era. Developing an effective strategy for workforce maintenance and the strategic deployment of nurses is crucial. Purpose: This study aimed to explore and categorize nurses' personality traits, with a focus on analyzing differences in their perceptions of the nursing work environment. Participants and Methods: Between January 2023 and February 2023, a multi-center cross-sectional study was carried out involving nurses from 12 tertiary hospitals actively engaged in frontline COVID-19 response duties. Through cluster sampling, surveys were distributed among eligible nursing staff, comprising a general information questionnaire, the Chinese Big Five Personality Questionnaire-Short Form, subjective evaluations of emergency nursing management, and the Chinese Nursing Work Environment Scale for Public Health Emergencies. Various statistical analyses, such as descriptive analysis, cluster analysis, non-parametric tests, and general linear model analysis, were employed to investigate the correlation between personality types and the perception of nursing work environments. Results: The analysis encompassed 1059 valid questionnaires, reflecting the experiences of frontline nurses. The majority of these nurses possessed 1-5 years of experience, held junior professional titles, volunteered for their roles, and served as attending nurses. Categorization based on personality traits revealed three groups: resilient (35.60%), ordinary (16.15%), and distressed (48.25%) types. Significantly distinct perceptions of nursing work environments emerged among these categories, with resilient and ordinary types expressing notably higher satisfaction compared to the distressed group (H value = 256.487, p < 0.001). Conclusion: This study illustrates the connection between nurses' perceived working environment and their personality traits. Nursing managers should factor in nurses' personality traits when choosing and deploying frontline responders during public health emergencies. Prioritizing resilient-type nurses and crafting a supportive work environment that aligns with nurses' characteristics is indispensable for an effective emergency response.

Organizational Cynicism and Turnover Intention Among Nurses: Do Perceived Organizational Support Moderates the Relationship.

Introduction: Understanding work dynamics is imperative for organizational efficiency in the healthcare industry. Therefore, achieving such a feat is akin to knowing the interplay between organizational cynicism, organizational support and turnover among nurses in the healthcare sector in Nigeria. Aim: This present study aimed to examine the moderating role of perceived organizational support on the association between organizational cynicism (cognitive, affective, and behavioral dimensions) and turnover intention among Nigerian nurses. Methods: The study is a descriptive cross-sectional survey research conducted on a sample of 515 nurses, aged between 29-55 years, with mean age = 34.3 and SD = 9.4 drawn across different government-owned hospitals from the southeast geographical region of Nigeria through snowball sampling method. Three instruments, the Turnover Intention Scale, Organizational Cynicism Scale and Survey of Perceived Organizational Support Scale were used for data collection, while the Hayes PROCESS Macro for SPSS version 23 was used for data analysis. Results: The results showed that organizational cynicism dimensions were positively associated with turnover intention among nurses, whereas organizational support negatively associated with turnover intention of Nigerian nurses. In addition, perceived organizational support moderated the association between organizational cynicism (affective and behavioral dimensions) and turnover intention among nurses. The study evidenced a strong association between organizational cynicism and turnover intention among nurses in their work setting. The study observed that organizational cynicism is a recipe for nurses' turnover intention and that organizational support decreased the extent to which nurses experience turnover intention. Conclusion: The results showed that organizational cynicism dimensions positively associated with turnover intention among nurses in Nigeria. In addition, the association between organizational cynicism (affective and behavioral) dimensions were moderated by perceived organizational support. The study suggests that perceived organizational support mitigates the positive relationship between organizational cynicism and turnover intention. The result provided further evidence of how perceived organizational support can influence motivation and morale in the workplace.

Enhancing Patient Safety Through Effective Interprofessional Communication: A Focus on Medication Error Prevention.

BACKGROUND: Medication errors significantly impact patient safety and healthcare costs. This study investigates the influence of interprofessional communication on medication error rates, with a focus on identifying actionable strategies to improve communication efficacy among healthcare professionals. METHODS: Utilizing a quantitative approach, this research distributed a detailed online questionnaire to a broad cohort of healthcare workers in various settings within Saudi Arabia. The survey encompassed sections on demographics, the frequency and quality of interprofessional communication, perceived barriers and facilitators to effective communication, and personal experiences with medication errors. Statistical analysis was performed using SPSS to derive descriptive and inferential statistics, alongside thematic analysis for qualitative responses. RESULTS: The survey attracted 1165 respondents, predominantly aged 20-30 (68.58%) and female (65.49%). Pharmacists constituted the largest professional group (40.34%). We identified a notable positive correlation (r = 0.16) between high-quality interprofessional communication and employment in hospital environments or having 5-20 years of experience. In contrast, negative correlations were observed with employment in non-traditional healthcare settings (r = -0.19) and professionals with less than five years of experience (r = -0.13), indicating communication challenges. The analysis also highlighted a concerning frequency of prescription and dispensing errors, with 52.70% of participants reporting prescription errors as the most common issue encountered. CONCLUSION: Effective interprofessional communication is pivotal in mitigating medication errors within healthcare settings. The study illuminates specific areas for improvement, including the need for targeted communication training, particularly for less experienced professionals and those in non-traditional settings. Enhancing communication channels and fostering an environment conducive to open, interdisciplinary dialogue are essential steps towards advancing patient safety and reducing medication errors.

Holistic Review of Applicants by the United States Postgraduate Training Programs Is Not Associated With the Percentage of Female Residents.

Introduction Given the underrepresentation of female physicians in most specialties and the aim of holistic review in residency applications to improve the diversity of matriculating resident physicians in the United States (US) postgraduate medical training programs, we examined the association between holistic review and female resident representation among US postgraduate training programs. Methods We conducted a cross-sectional survey of US postgraduate training programs to inquire about their use of holistic review for resident applications (independent variable). The primary outcome was the percentage of female residents in each program, which was obtained along with other program-level characteristics from the Fellowship and Residency Electronic Interactive Database Access (FREIDA) catalog in April 2023. We limited the analysis to the 10 specialties with the most training spots in 2022, including anesthesiology, emergency medicine, family medicine, internal medicine, neurology, obstetrics and gynecology, orthopedic surgery, pediatrics, psychiatry, and surgery (general). We also examined the interactions between holistic review and specialty and the percentage of female faculty using model comparison and simple slopes analyses.  Results Of the 3,364 total programs surveyed from the 10 specialties, 222 (6.6%) responded. Responders and nonresponders had similar program-level characteristics, including program type (e.g., university, community), specialty, and reported minimum board examination scores. Of the 222 responders, 179 (80.6%) reported performing holistic review. The percentage of female residents was 49.0% (interquartile range 37.5 to 66.7) in the no holistic review group and 47.8% (35.4 to 65.0) in the holistic review group (median difference 0.9%, 95% confidence interval -6.7 to 8.3). Furthermore, there was no evidence of interaction between holistic review and either the specialty or the percentage of female faculty on the outcome of the percentage of female residents. Conclusions Holistic review of residency applications in this limited sample of US postgraduate training programs was not associated with the percentage of female residents. The role of holistic review in addressing the imbalance of male and female physicians in the healthcare workforce, particularly between specialties, remains unknown.

Prioritization criteria in policies and management of human resources for health: a proposal for a validated methodology.

Objective: To create and validate criteria for prioritizing problems related to policies and management of the health workforce. Methods: This methodological study was divided into three stages. First, the criteria were elaborated by means of a systematized literature review. Second, the criteria were evaluated online by a committee of judges comprised of eight specialists. In the third stage, an evaluation was carried out by the target audience in a hybrid workshop. The participants evaluated the material using the Suitability Assessment of Materials instrument, adapted for the research. Results: Three prioritization criteria (relevance, window of opportunity and acceptability) and a scoring scale were developed based on the literature review. In the evaluation by the committee of judges, the approval percentage of the criteria and prioritization method was 84%. Modifications were made based on suggestions in relation to the material presented to the specialists. In the pre-test stage, the approval percentage varied by item, with six of them reaching a maximum approval of 100% (corresponding to approximately 46% of the items), four reaching 92% and three achieving 83% each, indicating positive results. Conclusions: The developed criteria were considered valid for use in the context of policies and management in the area of human resources for health.

[Dual practice in the Spanish health system: problem or solution? SESPAS Report 2024]. / La práctica dual público-privada en la sanidad española. ¿Solución o problema? Informe SESPAS 2024.

The Spanish public health system is overburdened. As a result, heath care professionals are showing symptoms of burnout, while private health services are expanding more than ever. As revealed by numerous strikes in recent years, health care professionals want better pay and work conditions and feel frustrated by their inability to give proper time and care to their patients. The institutional response from regional governments in Spain has been to remove the exclusivity clause that provided a salary bonus for physicians who worked entirely in the public sector; now all physicians receive this bonus, effectively promoting dual (public and private) practice. Although dual practice may increase the income of physicians and other health professionals, it poses several challenges that are analyzed in this paper. We also discuss alternative and more far-reaching policies that we believe should be implemented by the government in order to deal with the current crisis of the health system.

Risk factors for resignation from work during pregnancy among Japanese women: a cross-sectional, multicenter questionnaire survey.

This study was to investigate the employment status of pregnant women in Japan and identify risk factors associated with resigning from work during pregnancy. We conducted a cross-sectional survey with 975 postpartum women in Tokyo and its suburbs, focusing on those who were employed during pregnancy. Women who were employed when they became pregnant were selected and divided into two groups: those who did not resign and those who resigned; the groups were analyzed separately. Multiple logistic regression analyses were performed to examine associations between employment resignation and risk factors. The analysis revealed that 79% continued working, while 8.1% resigned. Risk factors for resignation included non-regular employment (OR: 13.1, 95% CI: 6.6-25.9), fewer employees (OR: 3.4, 95% CI: 1.8-6.4), and shorter employee tenure (OR: 2.4, 95% CI: 1.1-5.2). Non-regular employment status, a smaller number of employees, and shorter employee tenure were identified as risk factors for working women resigning from their job during pregnancy. In work situations and work environments that encourage pregnant women to leave the workforce, developing systems to improve these conditions for pregnant employees may help women to progress in the labor force.

Children and adolescents with type 1 diabetes in Aotearoa New Zealand: An online survey of workforce and outcomes 2021.

AIMS: To survey the national workforce that manages children and adolescents with type 1 diabetes (T1D) in Aotearoa New Zealand and compare with glycaemic outcomes for 2021. METHODS: A representative from each tertiary and regional diabetes service in Aotearoa New Zealand was asked to participate in an online survey assessing health-care professional (HCP) workforce numbers operating for the 2021 calendar year. Regional full-time-equivalent (FTE), glycaemic outcomes and population demographics were compared to a previously reported workforce surveys (2015 and 2019). RESULTS: Seventeen sites responded - including all four large tertiary centres - serving >99% of children and adolescents with T1D in Aotearoa New Zealand. HCP resourcing varied across sites, with median (range) HCP/100 patient ratios of: doctors: 0.40 (0.16-1.11), nurses: 1.19 (0.29-5.56), dietitians: 0.25 (0-1.11) and psychologist/social workers: 0 (0-0.26). No site met all of the International Society of Paediatric and Adolescent Diabetes (ISPAD) recommendations of HCP/100 patient ratios. Measures of socio-economic deprivation predicted HbA1c, rather than the diabetes clinic attended. Overall, only 15.1% (240/1585) of patients had an HbA1c less than the recommended 53 mmol/mol. CONCLUSIONS: The Aotearoa New Zealand workforce for children and adolescents with T1D is under-resourced and no site meets the ISPAD recommendations. There has been no significant increase in HCP/100 patient ratios compared to previous workforce surveys over the last decade. Few children and adolescents with T1D meet the recommended HbA1c. Resourcing according to recommended clinical need is required if equity in outcomes for young people with T1D is to be addressed.

Public School Nurses in the United States: National School Nurse Workforce Study 2.0.

The National School Nurse Workforce Study 2.0 describes the demographic characteristics and distribution patterns, school nursing models and activities, and practice environment among self-reported public school nurses in the United States. A random sample of U.S. public schools was surveyed, stratified by region, school level, and urban/rural locale. A total of 2,827 schools responded, yielding a 38.1% response rate. Using these data, we estimate 78,869 full-time equivalents of school nurses, with 65,052 registered nurses (RN) and 13,817 licensed practical/vocational nurses (LPN/LVN). Findings indicate school nurse distribution differences by region, locale, and income. The predominant model of school nursing practice was the RN only, followed by the RN and LPN model. In general, school nurse respondents felt supported by school staff and parents. Less than half of survey respondents stated they were supervised by an RN. Research, policy, and school nursing practice implications are discussed.

Encouraging entrepreneurship in dietetics: A qualitative exploration of the experiences of new graduate dietitians participating in an entrepreneurship mentoring circle.

AIMS: Healthcare needs of the Australian population are changing, providing an opportunity for dietitians to embrace innovation and entrepreneurship to meet evolving demands. This study explored the expectations and experiences of participants in a 12-month mentoring circle designed to provide entrepreneurship learning and formal mentoring for the Provisional Accredited Practising Dietitians Program. METHODS: A qualitative study design was employed. New graduate dietitians (<2 years) participating in the Entrepreneurial Dietetics Mentoring Circle in 2019, 2020 or 2021 were invited to participate. Baseline demographic and employment data were collected via survey. Semi-structured interviews were conducted before mentoring circle session 1 (baseline) and after the final session (completion), exploring insights into participant expectations and experiences in entrepreneurship. Thematic analysis, using methods outlined by Braun and Clark, was conducted to identify themes and subthemes. RESULTS: Twenty-eight dietitians participated (85% of mentees). Participants were mostly female (89%), less than 12 months post-graduation (75%), registered as Provisional Accredited Practising Dietitians (82%) and employed at least part-time (55%). Forty five interviews were conducted (28 baseline, 18 completion). Themes developed were: (1) entrepreneurial career path as a deliberate choice; (2) the value of being prepared for entrepreneurial careers; and (3) the importance of networks to support entrepreneurship. CONCLUSION: The mentoring circle at this single university was seen by participants as supporting their transition into entrepreneurial careers, while meeting their requirement to be formally mentored through their Provisional status. Future research could consider the applicability of the mentoring circle model across a wider graduate population to support innovative practice.

Private practice dietetics: A scoping review of the literature.

AIM: Private practice is one of the most rapidly growing, but under-researched employment sectors for graduate dietitians in Australia, limiting evidence-based workforce development. This scoping review examines existing international literature to gain an understanding of the current private practice workforce size, distribution, demography and workforce development considerations, including competencies, supply and demand, remuneration and professional development activities. METHODS: The databases MEDLINE, EMBASE, CINAHL, EMCARE, PsycInfo (Ovid) and grey literature were systematically searched in August 2023 using key search terms to identify studies for inclusion. Articles were included if they related to private practice dietetics and described an aspect of workforce. Original research, government and organisational reports, statements of practice and websites providing governmental or organisational statistics were included. A directed content analysis and qualitative constant comparison technique were used to deductively map intelligence sources against a workforce development framework. A gap analysis was also conducted to provide a focus for future workforce development research. RESULTS: A total of 72 peer-reviewed and grey literature sources were included, with 65% of the studies being Australian-based publications. Private practice dietetics research interest has increased in the last decade. Despite a breadth of published sources, this review found little published data on workforce size, distribution, demography, supply, demand, continued professional development and remuneration, indicating a significant gap in the evidence base. Existing literature focuses on workforce challenges and barriers, the work of private practice dietitians, with limited exploration of competency requirements for graduate private practitioners. CONCLUSIONS: The literature on the private practice dietetics workforce is lacking worldwide, which constrains evidenced-based workforce development initiatives. Workforce development research across all workforce aspects is warranted to address current evidence gaps.

2024 Alzheimer's disease facts and figures.

This article describes the public health impact of Alzheimer's disease (AD), including prevalence and incidence, mortality and morbidity, use and costs of care and the ramifications of AD for family caregivers, the dementia workforce and society. The Special Report discusses the larger health care system for older adults with cognitive issues, focusing on the role of caregivers and non-physician health care professionals. An estimated 6.9 million Americans age 65 and older are living with Alzheimer's dementia today. This number could grow to 13.8 million by 2060, barring the development of medical breakthroughs to prevent or cure AD. Official AD death certificates recorded 119,399 deaths from AD in 2021. In 2020 and 2021, when COVID-19 entered the ranks of the top ten causes of death, Alzheimer's was the seventh-leading cause of death in the United States. Official counts for more recent years are still being compiled. Alzheimer's remains the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2021, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 140%. More than 11 million family members and other unpaid caregivers provided an estimated 18.4 billion hours of care to people with Alzheimer's or other dementias in 2023. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $346.6 billion in 2023. Its costs, however, extend to unpaid caregivers' increased risk for emotional distress and negative mental and physical health outcomes. Members of the paid health care and broader community-based workforce are involved in diagnosing, treating and caring for people with dementia. However, the United States faces growing shortages across different segments of the dementia care workforce due to a combination of factors, including the absolute increase in the number of people living with dementia. Therefore, targeted programs and care delivery models will be needed to attract, better train and effectively deploy health care and community-based workers to provide dementia care. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are almost three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 22 times as great. Total payments in 2024 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $360 billion. The Special Report investigates how caregivers of older adults with cognitive issues interact with the health care system and examines the role non-physician health care professionals play in facilitating clinical care and access to community-based services and supports. It includes surveys of caregivers and health care workers, focusing on their experiences, challenges, awareness and perceptions of dementia care navigation.