Doctor Retention in Ireland - What it may mean for the Global Health Workforce Reform Agenda Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

BackgroundThe unmet burden of surgical care is high in low-income and middle-income countries. The Lancet Commission on Global Surgery (LCoGS) proposed six indicators to guide the development of national plans for improving and monitoring access to essential surgical care. This study aimed to characterise the Somaliland surgical health system according to the LCoGS indicators and provide recommendations for next-step interventions.MethodsIn this cross-sectional nationwide study, the WHO’s Surgical Assessment Tool–Hospital Walkthrough and geographical mapping were used for data collection at 15 surgically capable hospitals. LCoGS indicators for preparedness was defined as access to timely surgery and specialist surgical workforce density (surgeons, anaesthesiologists and obstetricians/SAO), delivery was defined as surgical volume, and impact was defined as protection against impoverishment and catastrophic expenditure. Indicators were compared with the LCoGS goals and were stratified by region.ResultsThe healthcare system in Somaliland does not meet any of the six LCoGS targets for preparedness, delivery or impact. We estimate that only 19% of the population has timely access to essential surgery, less than the LCoGS goal of 80% coverage. The number of specialist SAO providers is 0.8 per 100 000, compared with an LCoGS goal of 20 SAO per 100 000. Surgical volume is 368 procedures per 100 000 people, while the LCoGS goal is 5000 procedures per 100 000. Protection against impoverishing expenditures was only 18% and against catastrophic expenditures 1%, both far below the LCoGS goal of 100% protection.ConclusionWe found several gaps in the surgical system in Somaliland using the LCoGS indicators and target goals. These metrics provide a broad view of current status and gaps in surgical care, and can be used as benchmarks of progress towards universal health coverage for the provision of safe, affordable, and timely surgical, obstetric and anaesthesia care in Somaliland.

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What do young doctors know of Palliative Care; how do they expect the concept to work?

10.21203/rs.2.10199/v2 ◽

2019 ◽

Author(s):

GVM Chamath Fernando ◽

Shamini Prathapan

Keyword(s):

Palliative Care ◽

Sri Lanka ◽

De Novo ◽

Cross Sectional Study ◽

Service Organization ◽

Average Score ◽

Health Coverage ◽

Cross Sectional ◽

Medical Graduates ◽

On Line

Abstract Objectives Discipline of palliative care is still evolving in developed parts of the world while it remains at an infantile stage in Sri Lanka which has not been formally assessed as of today. We aimed at evaluating the level of palliative care knowledge and opinions among young medical graduates. A descriptive cross-sectional study was carried out among pre-residency medical graduates of Sri Lanka through a social media based on-line survey. The pre-tested questionnaire assessed the level of knowledge on general principles, service organization, clinical management and ethical considerations while it also evaluated their opinions. Results Response rate was 35.8% (n=351). The average score among the respondents was 37.25% (standard deviation (SD) = 11.975). Specific knowledge on “general principles” was adequate (score>=50%) with an average of 62.61%, SD=24.5 while “ethics” was observed to be the area with poorest knowledge (average score=19.55%, SD=22). Average scores for “service organization” and “managerial aspects” were 34.54%, SD=17.6 and 32.26%, SD=22.3 respectively. The majority (>90%) believed that de-novo establishment of hospice, hospital and community-based palliative services would sustainably improve holistic patient care. Measures must be taken to optimize basic palliative care knowledge among the undergraduates in view of achieving Universal Health Coverage in the long term.

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Evaluation of a multidisciplinary global health online course in Mexico

Global Health Research and Policy ◽

10.1186/s41256-020-00179-8 ◽

2020 ◽

Vol 5 (1) ◽

Author(s):

Héctor Carrasco ◽

Patricia Fuentes ◽

Itzel Eguiluz ◽

Cesar Lucio-Ramírez ◽

Sandra Cárdenas ◽

...

Keyword(s):

Global Health ◽

Health Systems ◽

Cross Sectional Study ◽

Cross Sectional ◽

Middle Income ◽

Exact Test ◽

Health Course ◽

Development Goals ◽

Strongly Agree ◽

The Impact

Abstract Background Global Health Education (GHE) focuses on training proactive global citizens to tackle health challenges in an increasingly interconnected and interdependent world. Studies show that health professionals in training have reported that GHE has improved their teamwork, responsiveness to contextual factors that impact health, and understanding of health systems; however, there is little research on the impact of GHE courses in undergraduate settings, especially in low and middle-income countries (LMICs). Methods Our study analyzes a multidisciplinary online global health course at Tecnologico de Monterrey, México. We conducted a cross-sectional study with pre- and post-design. Students who took the multidisciplinary course of Global Health for Leaders in the Fall of 2019 (n = 153) and Spring of 2020 (n = 348) were selected for this study. Using a five-point Likert scale (strongly agree to strongly disagree), the survey assessed seven competencies as well as questions about course expectations, takeaways, and recommendations to improve the course. We performed descriptive statistical analyses comparing the combined pre-tests (from Fall and Spring cohorts) to the combined post-tests. Fisher’s exact test was used to compare the samples. Results Of the 501 pre-course surveys administered, 456 responses were completed in the pre-course and 435 in the post-course (91% overall response rate). Only 8.7% of the respondents in the pre-course survey strongly agreed that they could describe fundamental aspects of global health such as the Millennium Development Goals or Sustainable Development Goals, in contrast to a 56% of the students who strongly agreed in the post-course survey (p < 0.001). Similar differences were captured in understanding the global burden of disease, social determinants of health, the effects of globalization in health, health systems’ goals and functions, and human rights. 38% felt that the course helped them develop a more empathetic perception of the suffering of others experiencing global health-related issues. Conclusion In this study, we have presented our experience in teaching an online global health course for multidisciplinary undergraduates in a LMIC. The competencies reported by our students indicate that the course prepared them to confront complex global health issues.

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What do young doctors know of Palliative Care; how do they expect the concept to work?

10.21203/rs.2.10199/v1 ◽

2019 ◽

Author(s):

GVM Chamath Fernando ◽

Shamini Prathapan

Keyword(s):

Palliative Care ◽

Sri Lanka ◽

De Novo ◽

Cross Sectional Study ◽

Service Organization ◽

Average Score ◽

Health Coverage ◽

Cross Sectional ◽

Medical Graduates ◽

On Line

Abstract Objectives Discipline of palliative care is still evolving in developed parts of the world while it remains at an infantile stage in Sri Lanka which has not been formally assessed as of today. We aimed at evaluating the level of palliative care knowledge and opinions among young medical graduates. A descriptive cross-sectional study was carried out among pre-residency medical graduates of Sri Lanka through a social media based on-line survey. The pre-tested questionnaire assessed the level of knowledge on general principles, service organization, clinical management and ethical considerations while it also evaluated their opinions. Results Response rate was 35.8% (n=351). The average score among the respondents was 37.25% (standard deviation (SD) = 11.975). Specific knowledge on “general principles” was adequate (score>=50%) with an average of 62.61%, SD=24.5 while “ethics” was observed to be the area with poorest knowledge (average score=19.55%, SD=22). Average scores for “service organization” and “managerial aspects” were 34.54%, SD=17.6 and 32.26%, SD=22.3 respectively. The majority (>90%) believed that de-novo establishment of hospice, hospital and community-based palliative services would sustainably improve holistic patient care. Measures must be taken to optimize basic palliative care knowledge among the undergraduates in view of achieving Universal Health Coverage in the long term.

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Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.54 ◽

2020 ◽

Author(s):

Ruairi Brugha ◽

Nicholas Clarke ◽

Louise Hendrick ◽

James Sweeney

Keyword(s):

Online Survey ◽

Multivariable Analysis ◽

National Sample ◽

Cross Sectional Study ◽

Junior Doctors ◽

Cross Sectional ◽

Middle Income ◽

Retention Strategy ◽

Medical Graduates ◽

Training Costs

Background: The failure of some high-income countries to retain their medical graduates is one driver of doctor immigration from low- and middle-income countries. Ireland, which attracts many international medical graduates, implemented a doctor retention strategy from early 2015. This study measures junior doctors’ migration intentions, the reasons they leave and likelihood of them returning. The aim is to identify the characteristics and patterns of doctors who plan to emigrate to inform targeted measures to retain these doctors. Methods: A national sample of 1148 junior hospital doctors completed an online survey in early 2018, eliciting their experiences of training and working conditions. Respondents were asked to choose between the following career options: remain in Ireland, go and return, go and stay away, or quit medicine. Bivariate analyses and a two-stage multivariable analysis were used to model the factors associated with these outcomes. Results: 45% of respondents planned to remain in Ireland, 35% leave but return later, 17% leave and not return; and 3% to quit medicine. An intention to go abroad versus remain in Ireland was independently associated (P<.05) with the doctor being under 30 years (odds ratio [OR]=1.09 per year under 30), a non-European Union (EU) national (OR=1.54), a trainee (OR=1.50), and with hospital specialization, especially in Anesthesiology (OR=5.09). Respondents were more likely to remain if they had experienced improvements in supervision and training costs. Intention to go abroad and not return versus go and return was independently associated (P<.05) with: age over 30 years (OR=1.16 per year over 30); being a non-EU (OR=9.85) or non-Irish EU (OR=3.42) national; having trained through a graduate entry pathway (OR=2.17), specializing in Psychiatry (OR=4.76) and reporting that mentoring had become worse (OR=5.85). Conclusion: Ireland’s doctor retention strategy has not addressed the root causes of poor training and working experiences in Irish hospitals. It needs a more diversified retention strategy that addresses under-staffing, facilitates circular migration by younger trainees who choose to train abroad, identifies and addresses specialty-specific factors, and builds mentoring linkages between trainees and senior specialists.

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Prevalence of MDR organism (MDRO) carriage in children and their household members in Siem Reap Province, Cambodia

JAC-Antimicrobial Resistance ◽

10.1093/jacamr/dlaa097 ◽

2020 ◽

Vol 2 (4) ◽

Author(s):

Shweta R Singh ◽

Bunsoth Mao ◽

Konstantin Evdokimov ◽

Pisey Tan ◽

Phana Leab ◽

...

Keyword(s):

Final Analysis ◽

Cross Sectional Study ◽

Cross Sectional ◽

Middle Income ◽

E Coli ◽

Middle Income Countries ◽

Siem Reap ◽

High Prevalence ◽

Significant Public Health ◽

History Of

Abstract Background The rising incidence of infections caused by MDR organisms (MDROs) poses a significant public health threat. However, little has been reported regarding community MDRO carriage in low- and middle-income countries. Methods We conducted a cross-sectional study in Siem Reap, Cambodia comparing hospital-associated households, in which an index child (age: 2–14 years) had been hospitalized for at least 48 h in the preceding 2–4 weeks, with matched community households on the same street, in which no other child had a recent history of hospitalization. Participants were interviewed using a survey questionnaire and tested for carriage of MRSA, ESBL-producing Enterobacterales (ESBL-E) and carbapenemase-producing Enterobacterales (CPE) by culture followed by antibiotic susceptibility testing. We used logistic regression analysis to analyse associations between collected variables and MDRO carriage. Results Forty-two pairs of households including 376 participants with 376 nasal swabs and 290 stool specimens were included in final analysis. MRSA was isolated from 26 specimens (6.9%). ESBL-producing Escherichia coli was detected in 269 specimens (92.8%) whereas ESBL-producing Klebsiella pneumoniae was isolated from 128 specimens (44.1%), of which 123 (42.4%) were co-colonized with ESBL-producing E. coli. Six (2.1%) specimens tested positive for CPE (4 E. coli and 2 K. pneumoniae). The prevalence ratios for MRSA, ESBL-producing E. coli and ESBL-producing K. pneumoniae carriage did not differ significantly in hospital-associated households and hospitalized children compared with their counterparts. Conclusions The high prevalence of ESBL-E across both household types suggests that MDRO reservoirs are common in the community. Ongoing genomic analyses will help to understand the epidemiology and course of MDRO spread.

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Global Prevalence and Drivers of Dental Students’ COVID-19 Vaccine Hesitancy

Vaccines ◽

10.3390/vaccines9060566 ◽

2021 ◽

Vol 9 (6) ◽

pp. 566

Author(s):

Abanoub Riad ◽

Huthaifa Abdulqader ◽

Mariana Morgado ◽

Silvi Domnori ◽

Michal Koščík ◽

...

Keyword(s):

International Association ◽

Cross Sectional Study ◽

Dental Students ◽

Vaccine Hesitancy ◽

Online Questionnaire ◽

Cross Sectional ◽

Middle Income ◽

Related Attitude ◽

The Media ◽

Acceptance Levels

Background: Acceleration of mass vaccination strategies is the only pathway to overcome the COVID-19 pandemic. Healthcare professionals and students have a key role in shaping public opinion about vaccines. This study aimed to evaluate the attitudes of dental students globally towards COVID-19 vaccines and explore the potential drivers for students’ acceptance levels. Methods: A global cross-sectional study was carried out in February 2021 using an online questionnaire. The study was liaised by the scientific committee of the International Association of Dental Students (IADS), and data were collected through the national and local coordinators of IADS member organizations. The dependent variable was the willingness to take the COVID-19 vaccine, and the independent variables included demographic characteristics, COVID-19-related experience, and the drivers of COVID-19 vaccine-related attitude suggested by the WHO SAGE. Results: A total of 6639 students from 22 countries, representing all world regions, responded to the questionnaire properly. Their mean age was 22.1 ± 2.8 (17–40) years, and the majority were females (70.5%), in clinical years (66.8%), and from upper-middle-income economies (45.7%). In general, 22.5% of dental students worldwide were hesitant, and 13.9% rejected COVID-19 vaccines. The students in low- and lower-middle-income (LLMI) economies had significantly higher levels of vaccine hesitancy compared to their peers in upper-middle- and high-income (UMHI) economies (30.4% vs. 19.8%; p < 0.01). Conclusions: The global acceptance level of dental students for COVID-19 vaccines was suboptimal, and their worrisome level of vaccine hesitancy was influenced by the socioeconomic context where the dental students live and study. The media and social media, public figures, insufficient knowledge about vaccines, and mistrust of governments and the pharmaceutical industry were barriers to vaccination. The findings of this study call for further implementation of epidemiology (infectious diseases) education within undergraduate dental curricula.

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The Influence of Universal Health Coverage on Life Expectancy at Birth (LEAB) and Healthy Life Expectancy (HALE): A Multi-Country Cross-Sectional Study

Frontiers in Pharmacology ◽

10.3389/fphar.2018.00960 ◽

2018 ◽

Vol 9 ◽

Cited By ~ 22

Author(s):

Chhabi L. Ranabhat ◽

Joel Atkinson ◽

Myung-Bae Park ◽

Chun-Bae Kim ◽

Mihajlo Jakovljevic

Keyword(s):

Life Expectancy ◽

Universal Health Coverage ◽

Cross Sectional Study ◽

Healthy Life Expectancy ◽

Health Coverage ◽

Sectional Study ◽

Cross Sectional ◽

Healthy Life ◽

Life Expectancy At Birth ◽

Universal Health

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Depression and its associated factors among pregnant women in central Vietnam

Health Psychology Open ◽

10.1177/2055102920988445 ◽

2021 ◽

Vol 8 (1) ◽

pp. 205510292098844

Author(s):

Bao-Yen Luong-Thanh ◽

Lan Hoang Nguyen ◽

Linda Murray ◽

Manuel Eisner ◽

Sara Valdebenito ◽

...

Keyword(s):

Pregnant Women ◽

Associated Factors ◽

Mental Health Problems ◽

Cross Sectional Study ◽

Cross Sectional ◽

Middle Income ◽

Middle Income Countries ◽

Prevalence Of Depression ◽

Patient Health ◽

Quota Sampling

To date, little attention has been given to prenatal depression, especially in low and middle-income countries. The aim of this research was to assess the prevalence of depression and its associated factors amongst pregnant women in a central Vietnamese city. This cross-sectional study included 150 pregnant women from 29 to 40 weeks of gestation, from eight wards of Hue city, via quota sampling from February to May 2019. We employed the Patient Health Questionnaire (PHQ-9) to assess depression. Findings suggest the need to provide routine screening of pregnant women in primary care for depressive symptoms and other mental health problems.

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