Suchergebnisse

In this article some questions of legislative providing of functioning of rural medicine in USSR in 1920-1930 are considered. The research is conducted for the legal politic, state control in a sphere of rural medicine and for it realization in difficult political and economic situation.

The use of pesticides has rapidly increased in Japan since the end of World War II, significantly reducing work burdens and boosting food production. In the meantime, pesticides, responsible for poisoning and environmental pollution, have for many years posed grave issues that have had to be tackled by scientists of rural medicine for a long period. The Japanese Association of Rural Medicine, founded by the late Toshikazu Wakatsuki, has grappled with those issues for many years. Above all, the association has fulfilled its social obligations, such as by bringing the toxicity of organic mercury to light in animal tests to prompt the government to prohibit its use, and by casting light on birth defects caused by defoliants aerially sprayed during the Vietnam War to urge U.S. military forces to break off herbicide warfare. As it has become possible to make less toxic pesticides available for farm work in recent years, death-inducing accidents have seldom occurred during the spraying of pesticides, and the association's activities are now at a low ebb. Now that pesticides, which after all are biologically toxic compounds, are openly used on farms, there is the need to pay constant attention to their impacts on the human body and the environment. In the future, it is necessary to epidemiologically probe into chronic impacts on the human body and contribute to the prevention of pesticide poisoning in Southeast Asia.

Objective: This study investigated Pakistani physicians' decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad. Methods: This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as 'stayers', 'leavers' and 'resettlers' were interviewed via telephone to explore their lived experience in 2008-2009. Results: Results show a dynamic nature of the physicians' career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians' can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity. Conclusions: The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals.

Background Rural medical workforce shortage contributes to health disadvantage experienced by rural communities worldwide. This study aimed to determine the regional results of an Australian Government sponsored national program to enhance the Australian rural medical workforce by recruiting rural background students and establishing rural clinical schools (RCS). In particular, we wished to determine predictors of graduates' longer-term rural practice and whether the predictors differ between general practitioners (GPs) and specialists. Methods A cross-sectional cohort study, conducted in 2012, of 729 medical graduates of The University of Queensland 2002–2011. The outcome of interest was primary place of graduates' practice categorised as rural for at least 50% of time since graduation ('Longer-term Rural Practice', LTRP) among GPs and medical specialists. The main exposures were rural background (RB) or metropolitan background (MB), and attendance at a metropolitan clinical school (MCS) or the Rural Clinical School for one year (RCS-1) or two years (RCS-2). Results Independent predictors of LTRP (odds ratio [95% confidence interval]) were RB (2.10 [1.37–3.20]), RCS-1 (2.85 [1.77–4.58]), RCS-2 (5.38 [3.15–9.20]), GP (3.40 [2.13–5.43]), and bonded scholarship (2.11 [1.19–3.76]). Compared to being single, having a metropolitan background partner was a negative predictor (0.34 [0.21–0.57]). The effects of RB and RCS were additive—compared to MB and MCS (Reference group): RB and RCS-1 (6.58[3.32–13.04]), RB and RCS-2 (10.36[4.89–21.93]). Although specialists were less likely than GPs to be in LTRP, the pattern of the effects of rural exposures was similar, although some significant differences in the effects of the duration of RCS attendance, bonded scholarships and partner's background were apparent. Conclusions Among both specialists and GPs, rural background and rural clinical school attendance are independent, duration-dependent, and additive, predictors of longer-term rural practice. Metropolitan-based medical ...

Networks are everywhere. Health systems and public health settings are experimenting with multifarious forms. Governments and providers are heavily investing in networks with an expectation that they will facilitate the delivery of better services and improve health outcomes. Yet, we lack a suitable conceptual framework to evaluate the effectiveness and sustainability of clinical and health networks. This paper aims to present such a framework to assist with rigorous research and policy analysis. The framework was designed as part of a project to evaluate the effectiveness and sustainability of health networks. We drew on systematic reviews of the literature on networks and communities of practice in health care, and on theoretical and evidence-based studies of the evaluation of health and non-health networks. Using brainstorming and mind-mapping techniques in expert advisory group sessions, we assessed existing network evaluation frameworks and considered their application to extant health networks. Feedback from stakeholders in network studies that we conducted was incorporated. The framework encompasses network goals, characteristics and relationships at member, network and community levels, and then looks at network outcomes, taking into account intervening variables. Finally, the short-term, medium-term and long-term effectiveness of the network needs to be assessed. The framework provides an overarching contribution to network evaluation. It is sufficiently comprehensive to account for many theoretical and evidence-based contributions to the literature on how networks operate and is sufficiently flexible to assess different kinds of health networks across their life-cycle at community, network and member levels. We outline the merits and limitations of the framework and discuss how it might be further tested.

© 2019, Society of Teachers of Family Medicine. All rights reserved. BACKGROUND AND OBJECTIVES: Family medicine rural training track (RTT) residency programs produce a higher proportion of graduates who choose rural practice than other programs, yet RTTs face continuing threats to their existence. This study sought to understand threats to RTT sustainability and resilience factors that enable RTTs to thrive. METHODS: In 2014 and 2015, the authors conducted semistructured interviews of 21 RTT leaders representing two closed programs and 22 functioning programs. Interview topics included program strengths providing resilience and sustainability, risk factors for closure or vulnerabilities threatening sustainability, and advice for other RTTs. The authors performed a content analysis, coding pertinent themes in all interview data. RESULTS: From the top three assets, risks, and advice that respondents offered, the following nine themes emerged, in order from most to least mentioned: leadership, faculty and teaching resources, program support, finances, resident recruitment, program attributes, program mission, political and environmental context, and patient-related clinical experiences. Interviewees frequently reported multifactorial causes for RTT sustainability or closure. CONCLUSIONS: Numerous factors identified, such as distance, can operate as positive or negative influences for program resilience, depending on place and context. Resilience depends on multiple forms of social capital, including robust networks among individuals and various communities: the local population and patients, local health care providers, residency faculty, and RTTs in general. The small size and remoteness of RTTs make them vulnerable to multiple challenges in finances, regulations, and accreditation, requiring program adaptability and suggesting the need for flexibility in the policies that govern them.

1.4.1 Training for Healthcare Practitioners1.4.2 Training Full-time Agriculture Health and Safety Specialists ; 1.5 Demographics of the Agricultural Workforce; 1.6 The Evolution of Production Agricultural, Workforce, and Types of Farms; 1.6.1 Family Farms; 1.6.2 Principal Operator; 1.6.3 Farm Family Members; 1.6.4 Farm Workers; 1.6.5 Indigenous Farm Workers; 1.6.6 Migrant and Seasonal Farm Workers; 1.6.7 Large Farms and Industrial-style Farms ; 1.6.8 Family Corporations; 1.7 Other Occupations Exposed to the Agricultural Environment; 1.8 General Health Status of the Agricultural Population.

The primary aim of the research project was to develop conceptual models of rural ambulance service delivery based on different worldviews or philosophical positions, and then to compare and contrast these new and emerging models with existing organisational policy and practice. Four research aims were explored: community expectations of pre-hospital care, the existing organization of rural ambulance services, the measurement of ambulance service performance, and the comparative suitability of different pre-hospital models of service delivery. A unique feature was the use of soft systems methodology to develop the models of service delivery. It is one of the major non-traditional systems approaches to organisational research and lends itself to problem solving in the real world. The classic literature-hypothesis-experiment-results-conclusion model of research was not followed. Instead, policy and political analysis techniques were used as counter-points to the systems approach. The program of research employed a triangulation technique to adduce evidence from various sources in order to analyse ambulance services in rural Victoria. In particular, information from questionnaires, a focus group, interviews and performance data from the ambulance services themselves were used. These formed a rich dataset that provided new insight into rural ambulance services. Five service delivery models based on different worldviews were developed, each with its own characteristics, transformation processes and performance criteria. The models developed are titled: competitive; sufficing; community; expert; and practitioner. These conceptual models are presented as metaphors and in the form of holons and rich pictures, and then transformed into patient pathways for operational implementation. All five conceptual models meet the criteria for systemic desirability and were assessed for their political and cultural feasibility in a range of different rural communities. They provide a solid foundation for future discourse, debate and ...