Reducing Neurologist Burnout and Improving Career Satisfaction.

Objective-Persons with severe mental illness have higher rates of chronic general medical illness compared with the general population.Similarly, compared with the general population, incarcerated persons have higher rates of chronic medical illness; however, there is little information about the synergy between severe mental illness and incarceration and the general medical problems of consumers.To address this gap in the literature this study addresses the following question: are consumers with a history of incarceration at greater risk of general medical problems compared with consumers without such a history?Methods-Administrative data were used to compare the medical problems of 3,690 persons with severe mental illness with a history of incarceration and 2,042 persons with severe mental illness with no such history.Results-Consumers with a history of incarceration were more likely than those with no such history to have infectious, blood, and skin diseases and a history of injury.Furthermore, when analyses controlled for gender, race, age, and substance use disorders, consumers with an incarceration history were 40% more likely to have any general medical problem and 30% more likely to have multiple medical problems.Conclusions-The findings presented here call for better communication among local public health and mental health providers and jails and better integration of primary care and behavioral health care among community mental health providers.Also, research on evidence-based interventions designed to divert persons with severe mental illness from the criminal justice system and facilitate community reentry for persons with severe mental illness who are released from jails and prisons should be accelerated.

Health services are the first and most important demand for the affected people after disasters. Hospitals and staff of health centers are directly affected by disasters, and this issue is more critical due to the hospital conditions, such as the presence of patients, medical facilities, and equipment. Therefore, it is necessary to make hospitals retrofit against disasters. This study was conducted qualitatively to extract experts' opinions about the factors affecting the retrofitting of health-care facilities in 2021. Semi-structured interviews were the basis of the data. In addition, to obtain data from different sources (triangulation), a focus group discussion (FGD) was held after the interviews. The findings of this study were extracted from interviewees and FGD in the form of 2 categories, 6 subcategories, and 23 codes. Main categories included external and internal factors. The subcategories of external factors were General government policies to reduce risk, The Programs of the Ministry of Health, and medical universities for retrofitting and Uncontrollable external factors. The subcategories of internal factors were Exposure of managers and staff of health-care organizations to various disasters, determining the types of vulnerabilities in health-care facilities, and Factors related to managerial actions. Retrofitting health-care facilities is one of the requirements for designing and constructing these facilities. The role of governments in this issue is more than other stakeholders because governments are the trustee of the health system and are responsible for the people's health. Therefore, governments must plan for the retrofitting of health facilities according to the disaster risk analysis and prioritization and their resources. Although, external factors play a very important role in influencing retrofitting policies, the role of internal factors should not be neglected. None of the internal and external factors alone can have a significant effect on retrofitting activities. For this purpose, a suitable combination of factors should be determined and the goal of the system should be to achieve resistant and resilient facilities against disasters.

The goal of this American Heart Association Guide for Improving Cardiovascular Health at the Community Level (AHA Community Guide) is to provide a comprehensive inventory of evidence-based goals, strategies, and recommendations for cardiovascular disease (CVD) and stroke prevention that can be implemented on a community level. This guide advances the 2003 AHA Community Guide1 and the 2005 AHA statement on guidance for implementation2 by incorporating new evidence for community interventions gained over the past decade, expanding the target audience to include a broader range of community advocates, aligning with the concepts and terminology of the AHA 2020 Impact Goals, and recognizing the contributions of new public and private sector programs involving community interventions. In recent years, expanding arrays of programs and policies have been implemented in increasingly diverse communities to provide tools, strategies, and other best practices to potentially reduce the incidence of initial and recurrent cardiovascular events. The AHA Community Guide complements the AHA statement entitled “Population Approaches to Improve Diet, Physical Activity, and Smoking Habits”3 and supports the AHA 2020 goal4 to “improve the cardiovascular health of all Americans by 20%, while reducing deaths from CVDs and stroke by 20%.” The present AHA Community Guide supports the AHA 2020 goal by identifying exemplary regional or national programs that encourage cardiovascular health behaviors and health factors (formerly addressing risk behaviors and risk factors) from which communities might acquire proven strategies, expertise, and technical assistance for improving cardiovascular health. The AHA Community Guide seeks to prevent the onset of disease (primary prevention) and to maintain optimal cardiovascular health (primordial prevention) among broader segments of the population. Prior research indicates that using public health strategies such as sodium reduction in processed foods to lower blood pressure,5–8 tobacco laws to promote smoking cessation,9–11 and modification of …

The scope and emphasis of a public health program are necessarily influenced by the changing characteristics of the population it serves. The rate of population growth affects long-range planning of community health and medical facilities. Alterations in age composition, internal migration of racial or industrial groups, changes in population density and urban-rural movement require current adaptation of the health program to solve the new problems thus created. Among the various characteristics of recent population trends, aging of the population is one of the most fundamental in its bearing on national health. The social and economic effects of an aging population have long been recognized. Dr. Louis I. Dublin appraised the problem of old age in some detail in 1926, when the provision of economic security for the aged was the dominant theme of contemporary discussion.1 The passage of the Social Security Act in 1935 represented the fruits of the efforts of this early period. Adjustment of national policy with respect to the health problems associated with aging of the population has been slower in development. Under the terms of the Social Security Act, a limited expansion of activities designed to promote the health of older adults—control of cancer and pneumonia, and industrial hygiene services—has been made possible in the cooperating States. However, the Act makes no provision for the solution of such fundamental problems as invalidity insurance and medical care of the aged. During the past five years, the health aspects of old age have received increasing attention in the discussions of public health administrators. It therefore seems appropriate to resurvey this general problem, and to consider, in particular, the nature of future trends in mortality, morbidity, and the receipt of medical care which may be expected solely as a result of changing age structure of the population.

Sex workers must not be forgotten in the COVID-19 response

Regional Public Health Training Centers: An Essential Partner in Workforce Development.

Firmly establishing oral health care professionals’ roles as vaccinators within the health care system

Introduction The residential neighbourhood is thought to affect residents because of presumed neighbourhood effects; the independent effects of a neighbourhood’s characteristics on the life chances of its residents. An enormous body of research has tried to measure neighbourhood effects, however, there are no clear conclusions on how much, if any, effect the neighbourhood has on its residents. There is non-random selection of people into neighbourhoods which causes a bias in the modelling of neighbourhood effects. Any correlation found between neighbourhood characteristics and individual outcomes might be explained by selection bias and can therefore not prove the existence of a causal neighbourhood effect. The question is; do poor neighbourhoods make people poor, or do poor people live in unattractive neighbourhoods because they cannot afford to live elsewhere (Cheshire, 2007). Therefore, insight in selection is important to gain more insight in neighbourhood effects (Van Ham and Manley, 2012). For neighbourhood effects research it is important to study selective mobility and neighbourhood choice and to combine neighbourhood effects research with neighbourhood selection research (Doff, 2010a; Van Ham and Manley, 2012; Van Ham et al., 2012; Galster, 2003; Hedman, 2011). The aim of this thesis therefore is to gain more insight in both the causes and the consequences of segregation and thus to study both individual residential mobility and neighbourhood selection and neighbourhood effects. Besides the neighbourhood effects literature, also the segregation literature will benefit from better insights in selective residential mobility because selective residential mobility is one of the main driving forces of segregation. There are two main research questions for this thesis. Firstly, I try to give insight in selective mobility and neighbourhood choice and thus to study where, when and why which people move. What is the effect of personal characteristics, neighbourhood characteristics and macro level housing market developments on individual neighbourhood satisfaction, moving wishes, moving behaviour and neighbourhood selection and on macro level selective mobility patterns and segregation? Secondly, I will test presumed neighbourhood effect mechanisms. Concentration areas of ethnic minorities are seen as undesirable, because their residents are thought to have less contact with the native majority which might hamper their integration and their life chances. It is, however, unclear to what extent social contact is affected by the residential neighbourhood. The second research question therefore asks whether ethnic minorities have less contact with the native majority if they live in minority concentration neighbourhoods. Segregation Segregation is defined as the population composition of neighbourhoods in relation to each other; that is, the concentration or underrepresentation of population groups in neighbourhoods compared to a city or national level average. Selective residential mobility is one of the main driving forces of segregation. Households move to a certain neighbourhood, either because they choose to live there, or because they are constrained in their choice options. Therefore segregation can be both voluntary and involuntary. This thesis focuses on selective residential mobility as cause of segregation, therefore it tries to understand why and where people move. According to residential mobility theory, personal characteristics determine residential preferences and if the residential situation is not in line with these preferences this will lead to dissatisfaction and a desire to move (Brown and Moore, 1970). Whether a dissatisfied household succeeds in moving to a dwelling and neighbourhood more in line with their preferences, depends on their personal resources and restrictions and macro level opportunities and constraints (Mulder and Hooimeijer, 1999). Successful households will move to a neighbourhood more in line with their preferences. There are, however, differences between households in which neighbourhoods are open to choice. Low income households will only be able to select neighbourhoods in which inexpensive dwellings are available. Similarly, households who depend on the social housing sector, or on the owner-occupied sector will only be able to select neighbourhoods where dwellings of this tenure are available. In addition, there are differences between households in which neighbourhood is (deemed) most attractive. People prefer to live among others who are similar to themselves and also facilities directed towards specific groups will make especially concentration neighbourhoods of the own ethnic or income group attractive. Besides residential preferences, also other factors will affect neighbourhood selection; population groups will differ in access to information on neighbourhood attractiveness or housing opportunities and discrimination, or fear of discrimination, can limit the opportunities of minority groups on the housing market. Neighbourhood effects It is typically assumed in European and American urban policy and academic research that spatial concentrations of low income households or ethnic minorities have negative effects on their inhabitants (Friedrichs et al., 2003). An enormous body of research has tried to measure neighbourhood effects; the independent effect of a neighbourhood on its residents when controlling for individual characteristics (see for a review Dietz, 2002; Ellen and Turner, 1997; Sharkey and Faber, 2014; Van Ham et al., 2012). The research attention for neighbourhood effects started with the seminal work of Wilson (1987). He argued that living in concentration areas of the jobless lowest class, isolated from role models, mainstream values and norms, and informal job networks and social contacts with employed, has a negative effect on your life chances. Neighbourhoods can affect their residents via a number of mechanisms (Ellen and Turner, 1997; Erbring and Young, 1979; Galster, 2012). Firstly, the geographical location determines job access and thereby labour market opportunities. Secondly, pollution, noise and disturbance affect health and (thereby) life chances via environmental mechanisms . In addition, neighbourhood stigmatisation can reduce life chances because others have prejudiced ideas and low expectations of the residents of stigmatised neighbourhoods. Also, the quality of institutions such as schools, museums, libraries and sport facilities will generally be lower in disadvantaged neighbourhoods, thereby reducing the life chances of residents. Finally, neighbourhood effects can transpire via social interactions with neighbours. Through collective socialisation and peer pressure people are thought to conform to local social norms (Jencks and Mayer, 1990). Positive role models and social network contacts with individuals with more social capital can help people advance in their work or educational career (Ellen and Turner, 1997). For ethnic minorities it can be important to have social interactions with the native majority to have the opportunity to learn the majority language, standards and values (Lazear, 1999) and to have bridging network ties that can provide access to valuable information not present within the own ethnic network (Buck, 2001). Many neighbourhood effect researchers believe that living in concentrated poverty has negative effects on individuals, and policymakers try to create mixed neighbourhoods to prevent these negative neighbourhood effects. However, although “it is perfectly plausible that poor people are made poorer by the characteristics of the neighbourhoods in which they live” (…) “a close examination of the best research available does not reveal any clear evidence to support it” (Cheshire, 2007: p. ix). Almost all neighbourhood effect studies struggle with selection bias (Cheshire, 2007). Any relation found between neighbourhood characteristics and individual outcomes might be a selection effect and therefore cannot prove the existence of a causal neighbourhood effect. Neighbourhood effects researchers have tried to reduce or eliminate selection bias. Firstly this is done by using quasi-experimental study designs, using households whose residential neighbourhood is determined by external factors (Sampson et al., 2002). Secondly, advanced statistical methods such as sibling studies, fixed effects studies, instrumental variables and propensity score matching are used to reduce selection bias or to control for selection (Harding, 2003). These advancements in methodology have improved our insight in selection bias and in neighbourhood effects, however, since there are no methods that can completely eliminate selection bias, there is still no clear evidence of causal neighbourhood effects. Generally, methods that apply more controls for selection bias find smaller neighbourhood effects. Instead of trying to eliminate selection bias, this thesis tries to provide insight in selection, in why and where which people move. In addition, this thesis tests presumed neighbourhood effect mechanisms. Social interactive mechanisms assume that neighbourhood effects transpire because the population composition of the residential neighbourhood affects with whom you interact (Ellen and Turner, 1997; Galster, 2012). Therefore I test whether the ethnic composition of the neighbourhood affects interethnic contact. Individual differences in determinants of residential satisfaction<

Though sufficient and stable funds are critical to effective public health systems, existing literature on public health system financing is limited. This study aimed to address this gap by uncovering the salient factors influencing public health system financial decision-making. We conducted a qualitative case study of public health system financing in British Columbia, consisting of a jurisdictional review of academic and grey literature, and semi-structured interviews with 14 participants influential in public health budget-setting. Taking an inductive analytical approach, we constructed a conceptual model of the political, structural, and external factors influencing public health funding trends. Building on insight from participants, we identified promising policy considerations for improving the sustainability of public health funding. Participants identified that external factors such as public health crises and major sociopolitical events create windows of opportunity for investments or cuts. They reported that structurally separating public health budgets from other health service budgets seems to protect public health funding. Political priorities of top decision-makers were highlighted as the most influential political factor, though advocacy has been successful in bringing public health issues onto the political agenda. Strong relationships between public health actors and decision-makers such as senior executives are seen as important for promoting investment in public health programs. This study sheds light on some of the possible policy strategies for sustaining public health funding, such as inclusion of public health experts in financial decision-making and developing public health performance indicators, which may inform current public health system strengthening efforts.

Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

Healthcare workers’ stress, burnout, and job dissatisfaction were exacerbated by the COVID-19 pandemic, whose mid-term negative effects are still present. The aim of this work was to consider the effects of burnout (psychophysical exhaustion, relational deterioration, and professional inefficacy) on the career satisfaction of healthcare workers. These relationships were evaluated by considering the direct and mediated effects of disillusion. For these purposes, the Link Burnout Questionnaire (LBQ) and the Career Satisfaction Scale (Occupational Stress Indicator—OSI) were administered to 295 healthcare professionals working at three Italian public hospitals in Cagliari, Italy. The analyses were conducted using the Partial Least Square Structural Equation Model (PLS-SEM) method. Outcomes highlighted that healthcare workers were in a condition of work distress, high risk of burnout, and career dissatisfaction. Also recognized was the direct negative effect of burnout dimensions on career satisfaction. Finally, the mediated negative effect of disillusion in the relationship between burnout and career satisfaction was identified. This study underlines the relevance of the dimension of disillusion, and its “bright side” fulfilment, in healthcare workers, specifically referring to the disregarded relationship between burnout and career satisfaction.

Creating a framework towards integrated health syndromic surveillance and response in Africa

WHO Director-General announces senior team

Betel quid (BQ) chewing, tobacco smoking and alcohol drinking are risk factors of oral cancer, thus, BQ chewing is the main cause in Taiwan. Moreover, male oral cancer incidence rate is 42.74/10^6 which topped the fourth leading causes of cancers. Most studies indicated that construction employees have higher prevalence in betel quid (BQ) chewing, tobacco smoking and alcohol drinking than other. Moreover, these workers had lower opportunities and capabilities to access, understand, process and use health information and considered as low health literacy disadvantaged groups. Individuals' health behaviors have complex interaction with workplaces, thus, an integrated approach for workplace health literate could empower individuals, managers, and public health providers to deliver tailored health information and services. Taiwan Health Promotion Administration aims to develop a health literacy workplace to provide a tailored health information and services within construction. This study was a participatory action research. A stakeholder analysis was conducted to establish the connections and relationships for a collaborative approach to plan and implement health programs in health sectors. This step aims to recruitment of construction industry, local governments, and health sectors. Taichung and Yilan have the public health planning capacity and could horizontal coordination within their governments. Furthermore, two counties were the first one which initiated collaboration with the Construction Bureau and the Public Health Bureau to establish the strategies for health literacy workplaces. Through these collaborations partnership, public health services based on a tailed program included BQ free logo, proving oral cancer screening service in workplace, conducting quitting betel quid contests, encouraging supervisor join betel quid cessation workplace policy. A media announcement strategy is to encourage other construction industries which could lead the potential ally. In conclusion, an intersectoral cooperation health literacy approach which tailored local government could provide health services to the health risk groups.