When Trying Hard Isn’t Natural Smith, Jessi L.; Lewis, Karyn L.; Hawthorne, Lauren ...
Personality & social psychology bulletin,
02/2013, Letnik:
39, Številka:
2
Journal Article
Recenzirano
Feeling like one exerts more effort than others may influence women’s feelings of belonging with science, technology, engineering, and math (STEM) and impede their motivation. In Study 1, women STEM ...graduate students perceived they exerted more effort than peers to succeed. For women, but not men, this effort expenditure perception predicted a decreased sense of belonging, which in turn decreased motivation. Study 2 tested whether the male-dominated status of a field triggers such effort expectations. We created a fictional “eco-psychology” graduate program, which when depicted as male-dominated resulted in women expecting to exert relatively more effort and decreased their interest in pursuing the field. Study 3 found emphasizing effort as expected (and normal) to achieve success elevated women’s feelings of belonging and future motivation. Results suggest effort expenditure perceptions are an indicator women use to assess their fit in STEM. Implications for enhancing women’s participation in STEM are discussed.
L'économie islandaise se redresse après avoir traversé une grave récession liée au COVID-19. Les exportations de produits de la pêche et de services intellectuels sont en hausse, et les touristes ...étrangers commencent à revenir en Islande parallèlement à l'assouplissement progressif des restrictions de déplacement.
Primary Care — Will It Survive? Bodenheimer, Thomas
The New England journal of medicine,
08/2006, Letnik:
355, Številka:
9
Journal Article
Recenzirano
Dr. Thomas Bodenheimer writes that primary care is facing a confluence of factors that could spell disaster. Patients are increasingly dissatisfied, many primary care physicians are unhappy, and ...fewer and fewer U.S. medical students are choosing to enter the field.
The American College of Physicians recently warned that “primary care, the backbone of the nation's health care system, is at grave risk of collapse.”
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And indeed, primary care is facing a confluence of factors that could spell disaster. Patients are increasingly dissatisfied with their care and with the difficulty of gaining timely access to a primary care physician; many primary care physicians, in turn, are unhappy with their jobs, as they face a seemingly insurmountable task; the quality of care is uneven; reimbursement is inadequate; and fewer and fewer U.S. medical students are choosing to enter the field.
The great . . .
Right-to-work? Dutta, Puja; Murgai, Rinku; Ravallion, Martin ...
The World Bank eBooks,
2014., 2014, 2-27-2014, 2014-02-26
eBook, Book
Odprti dostop
In 2006, India embarked on an ambitious attempt to fight poverty by attempting to introduce a wage floor in a setting in which many unskilled workers earn less than the minimum wage. The 2005 ...national rural employment guarantee act (NREGA) creates a justiciable "right to work" by promising 100 days of wage employment in every financial year to all rural households whose adult members volunteer to do unskilled manual work. In attempting to fight poverty in poor places with weak administrative capabilities, the idea of "rights" has often been invoked. This book aims to contribute to the understanding of the efficacy of poor states in fighting poverty using an ambitious rights-based program - the largest antipoverty public employment program in India, and possibly anywhere in the world. The program authors study is India's Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS), which was launched to implement the NREGA. This book presents survey-based estimates for India as a whole as well as results for Bihar. Results for India are based on the 2009-10 national sample survey. Two surveys were carried out in 2009 and 2010 and spanned 150 villages spread across all 38 districts in Bihar. These data are supplemented by qualitative research in six districts to better understand supply-side challenges. A distinctive feature of the methodology is that the authors identify the key counterfactual outcomes of interest - that is, what Bihar Rural Employment Guarantee Scheme (BREGS) participants will have done in the absence of the program - by directly asking individual BREGS participants. The advantage of this approach is that it produces an individual-specific estimate of impact - exploiting the information available for each participant - rather than delivering only a mean impact. The authors find compelling evidence that the scheme is reaching relatively poor families. It is important that reform efforts for MGNREGS work on both of these aspects - a stronger, more capable, local administration, plus more effective participation by civil society.
Americans claim a strong attachment to the work ethic and regularly profess support for government policies to promote employment. Why, then, have employment policies gained only a tenuous foothold ...in the United States? To answer this question, Margaret Weir highlights two related elements: the power of ideas in policymaking and the politics of interest formation.
Abstract Objectives This investigation aimed to document surgical capacity at public medical centers in a middle-income Latin American country using the Surgeons OverSeas (SOS) Personnel, ...Infrastructure, Procedures, Equipment, and Supplies (PIPES) survey tool. Materials and methods We applied the PIPES tool at six urban and 25 rural facilities in Santa Cruz, Bolivia. Outcome measures included the availability of items in five domains (Personnel, Infrastructure, Procedures, Equipment, and Supplies) and the PIPES index. PIPES indices were calculated by summing scores from each domain, dividing by the total number of survey items, and multiplying by 10. Results Thirty-one of the 32 public facilities that provide surgical care in Santa Cruz were assessed. Santa Cruz had at least 7.8 surgeons and 2.8 anesthesiologists per 100,000 population. However, these providers were unequally distributed, such that nine rural sites had no anesthesiologist. Few rural facilities had blood banking (4/25), anesthesia machines (11/25), postoperative care (11/25), or intensive care units (1/25). PIPES indices ranged from 5.7–13.2, and were significantly higher in urban (median 12.6) than rural (median 7.8) areas ( P < 0.01). Conclusions This investigation is novel in its application of a Spanish-language version of the PIPES tool in a middle-income Latin American country. These data document substantially greater surgical capacity in Santa Cruz than has been reported for Sierra Leone or Rwanda, consistent with Bolivia’s development status. Unfortunately, surgeons are limited in rural areas by deficits in anesthesia and perioperative services. These results are currently being used to target local quality improvement initiatives.
Anesthetic Care in Mozambique Lyon, Camila B; Merchant, Amina I; Schwalbach, Teresa ...
Anesthesia and analgesia
122, Številka:
5
Journal Article
Recenzirano
BACKGROUND:The World Bank and Lancet Commission in 2015 have prioritized surgery in Low-Income Countries (LIC) and Lower-Middle Income Countries (LMICs). This is consistent with the shift in the ...global burden of disease from communicable to noncommunicable diseases over the past 20 years. Essential surgery must be performed safely, with adequate anesthesia monitoring and intervention. Unfortunately, a huge barrier to providing safe surgery includes the paucity of an anesthesia workforce. In this study, we qualitatively evaluated the anesthesia capacity of Mozambique, a LIC in Africa with limited access to anesthesia and safe surgical care. Country-based solutions are suggested that can expand to other LIC and LMICs.
METHODS:A comprehensive review of the Mozambique anesthesia system was conducted through interviews with personnel in the Ministry of Health (MOH), a school of medicine, a public central referral hospital, a general first referral hospital, a private care hospital, and leaders in the physician anesthesia community. Personnel databases were acquired from the MOH and Maputo Central Hospital.
RESULTS:Quantitative results reveal minimal anesthesia capacity (290 anesthesia providers for a population of >25 million or 0.01:10,000). The majority of physician anesthesiologists practice in urban settings, and many work in the private sector. There is minimal capacity for growth given only 1 Mozambique anesthesia residency with inadequate resources. The most commonly perceived barriers to safe anesthesia in this critical shortage are lack of teachers, lack of medical student interest in and exposure to anesthesia, need for more schools, low allocation to anesthesia from the list of available specialist prospects by MOH, and low public payments to anesthesiologists. Qualitative results show assets of a good health system design, a supportive environment for learning in the residency, improvement in anesthetic care in past decades, and a desire for more educational opportunities and teachers.
CONCLUSIONS:Mozambique has a strong health system design but few resources for surgery and safe anesthesia. At present, similar to other LICs, human resources, access to essential medicines, and safety monitoring limit safe anesthesia in Mozambique.
There has been attention on the job market recently and on radiology's supply/demand calculus. Supply is influenced by the number of trained radiologists, while demand is driven by demographics and ...technological innovation. We analyze the supply of radiologists historically and compare to other labor markets-medical and non-medical, domestic and foreign.
We review National Resident Matching Program data in radiology and several other specialties from 1991 to 2015. We also review surveys, physician recruitment data, and peer-reviewed commentaries on medical specialty job markets. Trends are compared across specialties. The regulation of American medical training is compared to that in the United Kingdom and to a nonmedical labor market, unionized theatrical stage employees.
Radiology residency positions have increased since 1998 despite a downturn in the job market. This expansion coincides with a decreasing percentage of positions filled by domestic graduates. A similar trend has been seen in pathology, a notoriously oversupplied specialty. Conversely, other specialties have maintained their proportion of domestic graduates by way of limited supply or implicit demand.
The radiology job market is currently oversupplied, primarily a result of increasing residency positions despite indicators of decreasing demand. The percentage of residency positions filled by domestic graduates has decreased during the same period, suggesting that medical student interest is responsive to the market. Other specialties, particularly pathology, demonstrate the dangers of chronic oversupply. We advocate a reduction of radiology residency positions such that supply closely approximates demand without exceeding it. Additional measures may be taken, if necessary, to restore market equilibrium in the event of a mild undersupply.
IMPORTANCE Although early detection and treatment of colorectal cancer has been shown to improve outcomes, geographic proximity may influence access to these services. OBJECTIVE To examine the ...disparities that may exist in colorectal cancer screening and treatment by comparing the distribution of providers of these services in rural and urban counties in the United States. DESIGN, SETTING, AND PARTICIPANTS A retrospective population-based study using data obtained from the 2009 Area Resource File for the entire US population within each county. MAIN OUTCOMES AND MEASURES Counties in the United States were categorized as rural or urban using rural-urban continuum codes as our primary exposure. The proportion of gastroenterologists, general surgeons, and radiation oncologists per 100 000 people in each county was estimated as primary outcomes. Multivariate linear regression analysis adjusted for county-level socioeconomic variables, such as percentages of females, blacks, population without insurance, those with a high school diploma, and median household income, to estimate the relative density of each category of these providers between urban and rural counties. RESULTS In total, 3220 counties were identified, comprising 1807 rural and 1413 urban counties. An unadjusted analysis showed an increased density of gastroenterologists, general surgeons, and radiation oncologists per 100 000 people in urban vs rural counties. A multivariable analysis revealed a significantly higher density of gastroenterologists (1.63; 95% CI, 1.40-1.85; P < .001), general surgeons (2.01; 95% CI, 1.28-2.73; P < .001), and radiation oncologists (0.68; 95% CI, 0.59-0.77; P < .001) per 100 000 people living in urban vs rural counties. CONCLUSIONS AND RELEVANCE A rural-urban disparity exists in the density of gastroenterologists, general surgeons, and radiation oncologists who traditionally provide colorectal cancer screening services and treatment. This might affect access to these services and may negatively influence outcomes for colorectal cancer in rural areas.
Nurse Staffing and Inpatient Hospital Mortality Needleman, Jack; Buerhaus, Peter; Pankratz, V. Shane ...
The New England journal of medicine,
03/2011, Letnik:
364, Številka:
11
Journal Article
Recenzirano
Odprti dostop
In this analysis of data on nurse staffing and patient mortality for nearly 200,000 admissions to a large academic medical center, actual nurse staffing below target levels was associated with ...increased mortality.
Evidence from an increasing number of studies has shown an association between the level of in-hospital staffing by registered nurses (RNs) and patient mortality,
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adverse patient outcomes,
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and other quality measures.
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Quality measures that are related to nurse staffing have been adopted by the National Quality Forum,
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the Agency for Healthcare Research and Quality (AHRQ),
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and the Joint Commission.
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Some private payers have followed the lead of the Centers for Medicare and Medicaid Services in no longer paying hospitals for the costs associated with certain nursing-sensitive, hospital-acquired “never” events, such as pressure ulcers and catheter-associated infections. . . .
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