Training Public Health Professionals on Adaptive Challenges-An Innovative Approach Using Remote Learning Modalities.

The COVID-19 and Children with Medical Complexity (CMC) Extension for Community Healthcare Outcomes (ECHO) was developed as a "just in time" learning format to respond to the vast number of challenges faced by health care clinicians, public health professionals, and families/caregivers of CMC during the coronavirus disease 2019 (COVID-19) pandemic. A unique aspect of the ECHO was the meaningful integration of family leaders who participated as faculty, learners, case study presenters, and guest lecturers. Another distinguishing feature of this ECHO was its inclusion within a Collaborative Improvement and Innovation Network. A mixed methods analysis found that the COVID-19 and CMC ECHO was associated with significant gains in knowledge and confidence in caring for CMC and their families during the COVID-19 pandemic. This article provides an overview of the results of the COVID-19 and CMC ECHO and provides recommendations related to utilizing the ECHO model as a rapid response mechanism for systems improvement, clinical practice improvement, and education during a public health emergency.

Project ECHO (Extension for Community Healthcare Outcomes) is an evidence-based telementoring approach to connect often siloed school nurses with a network of expert clinical and academic faculty, as well as school nurse colleagues throughout the country by engaging in case-based learning. Managing Students with Seizures ECHO: The Importance of School Nurses (MSwS ECHO) provided two cohorts of school nurses with an interactive, bidirectional educational program focused on various aspects of seizures and epilepsy relevant to school nurse practice. MSwS ECHO enhanced school nurses’ confidence in caring and advocating for students with seizures and epilepsy, expanded school nurses’ access to resources and professional networks, and provided the opportunity to collaborate with experts and colleagues to problem solve challenging real-life cases. The ECHO Model is a unique and effective teaching modality that can be applied to a variety of school health topics and chronic conditions. School nurses are encouraged to participate in forthcoming ECHO-based learning opportunities.

The literature on recruiting and/or retaining health professionals in rural areas focuses primarily on the development of recruitment and retention strategies and assessing whether such strategies are effective. The objective of this article is to argue that it is important for all stakeholders involved in rural recruitment and/or retention processes to consider their decisions and actions from an ethics perspective. Recruitment and/or retention processes are not value neutral and it is important to understand their ethical dimensions. From the literature, elements of the recruitment and/or retention strategies that have been employed were identified and organised in respect of levels of governance (namely, the levels of health system/government, community, and individual health professionals). The elements identified in these levels were subjected to analysis to identify their ethical dimensions and to determine whether a clash or complement of values arose at each level of governance or between governance levels. There is very little literature in this area that considers the ethical dimensions of rural recruitment and/or retention processes. However, all policies and practices have ethical dimensions that need to be identified and understood as they may have significant implications for recruitment and/or retention processes. This article recommends the application of an ethics perspective when reflecting on rural recruitment and/or retention strategies. The collective decisions of all involved in rural recruitment and/or retention processes may fundamentally influence the 'health' (broadly understood) of rural communities.

There is some evidence that the problem of illicit drug use (IDU) is increasing in rural areas of Australia. Lack of access to harm minimization (HM) strategies is potentially exacerbated by a shortage of health care facilities and health care professionals in rural areas. This study was conducted to determine barriers to implementation, access to, and success of HM strategies, as seen by health professionals presently working in rural Australia. Four hundred rural pharmacists Australia-wide and 425 doctors in rural Victoria and Tasmania were sent postal surveys to assess their opinions on the level of IDU in their area, the types of drugs commonly used, the adequacy of HM strategies and facilities, and the barriers faced by doctors, pharmacists and clients. The overall response rate was almost 50%. Slightly less than half of surveyed health professionals felt that IDU was increasing in their area, with heroin perceived to be the most prevalent drug used in all States except Tasmania and the Northern Territory. Both methadone prescribers and dispensers believed the methadone maintenance programmes were highly valuable to the community, but not without problems (e.g. risk of overdose). A lack of time or staff was the greatest influence on doctors not participating in the methadone programmes, whereas safety concerns were prominent with pharmacists. The majority of doctors felt HM facilities were inadequate, with needle-syringe exchange being the most frequently nominated HM strategy lacking. Despite best intentions, there are still problems with HM strategies in these areas. Improving the number and expertise of health professionals in rural areas, and providing adequate support for them, would address some of these problems.

It is argued that each country of South Eastern Europe should have its own school of public health. However, a basic prerequisite of modern public health training is the comprehensiveness of the programme and a worldview approach. Most of the countries of South Eastern Europe face the same difficulties to adapt their inherited communist structures of public health training to Western standards. A regional collaboration would facilitate the process of establishing schools of public health in all countries of the region and support the training of public health professionals at all levels. South East Europe includes Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Macedonia, Moldavia, Romania, Serbia and Montenegro, and Slovenia. Public health institutions in South East Europe face similar difficulties to adapt their inherited teaching structures to Western standards. Public health institutions in South East Europe should make a joint effort towards establishing regional training programmes. A regional approach in public health training would enable an efficient use of resources in countries of South East Europe.

The shortage of health professionals in rural areas contributes towards a discriminatory health care delivery. Accessibility of health services is a multidimensional concept that refers to geographical, economic (affordability), organizational and cultural (acceptability) factors that can facilitate and/or, hinder the use of services in rural areas. Oral health is an integral part of general health. Though highly preventable, oral diseases are the most common chronic diseases amongst all age groups. Furthermore, accessing dental services is particularly hard for people from the underserved and rural areas. Thus, the impact of dental care crisis has been and continues to be greater in rural areas. To add to this, paucity of dentists practicing in rural areas with the preference of dentists to locate their practices in urban areas does not bode well for the future of dental care for the rural population in the near future, too. Attitude of dental students plays an important role in determining the future dental work force in rural areas. With this background, the present study attempted to evaluate the attitude of dental students towards rural dental practice based on gender and year of education. Materials and Methods: The present study was based on a cross-sectional study design with 30-item questionnaire survey instrument employed and distributed amongst the undergraduate and postgraduate dental students. The questionnaire comprised of four parts including the first part which focused on information regarding the demographic details and opinion about the rural dental practice, the second part dealt with the professional concerns perceived regarding rural dental practice while the third and fourth parts dealt with the personal and general concerns of the dental students regarding the rural dental practice respectively. Anonymity and confidentiality of the respondents was given utmost importance while participation in the study was kept voluntary. Statistical Analysis Used: Statistical analysis was done using SPSS version 12.0 (SPSS Inc., Chicago, IL, USA). The said data was analyzed for descriptive and inferential statistics. Independent student's t-test and One Way Analysis of Variance (ANOVA) were used for comparison among the variables while chisquare test was used to determine association between the variables. The level of significance was set at 0.05. Results: From a total of 550 dental students, 428 respondents completed the questionnaire (Response Rate: 77.8%). No significant difference was observed in the attitude of the students based on gender (p = 0.43) while a statistically significant difference was observed in the attitude of students based on the year of their education with a positive attitude towards rural dental practice generally noted in the first year Bachelor of Dental Surgery (BDS) students which significantly declined with the increasing level of education (p = 0.01). Conclusion: Dental students are more influenced by the negative aspects of rural dental practice though they have, in their mind, a positive approach for the same at the beginning of their education but this significantly declined with the increasing level of their education. Also, many dental students have a poor understanding of the fact what the term 'rural' actually means and of the rural health issues, in general. The present study, actually, adds to the understanding of the challenges that are faced by the dental professionals in rural dental practice.

Abstract: Policy analysts have long been concerned that the reduced availability of mental health professionals in rural areas prohibits rural individuals from getting the care they need for serious psychiatric conditions like bipolar disorder. Through a community‐based telephone survey, the researchers recruited 54 subjects with bipolar disorder who were currently experiencing depressive episodes. Forty‐six (85.1%) of them were reinterviewed one year after the first survey. Multivariate models indicate that while rural subjects were just as likely to receive nonacute services for mental health problems as their urban counterparts, the rural residents had 22.1 times the odds (95% confidence interval 2.5 to 198.3, P=0.006) of receiving such services exclusively from a general medical provider. Rural subjects had 5.8 times the odds (95% confidence interval 0.8 to 40.7, P=0.07) of using hospital or emergency room services and 4 times the odds (95% confidence interval 0.8 to 20.5, P=0.10) of experiencing a manic episode during the year following baseline. While rural individuals with bipolar disorder have a comparable likelihood of receiving care for their mental health problems, they utilize more acute services and experience worse outcomes. Further research is warranted to deter‐mine what causes these differences before developing cost‐effective ways to improve the care delivered to individuals with this serious illness.

Failure to retain health professionals in rural areas contributes to the poor health status of these communities through an inability to deliver reliable and consistent services. Considerable attention has focused on factors affecting recruitment of health professionals. Far less is known about factors affecting the retention of occupational therapists. In this study ethnographic interviews were conducted with 10 occupational therapists to explore their experiences related to leaving rural practice. Six themes emerged from the participants' experiences and gave rise to a framework that suggests retention can be improved by addressing the imbalance between incentives to leave and to stay in rural practice. The findings can be used by occupational therapists contemplating rural practice, as well as by health services managers responsible for service delivery in rural areas.

Peer support program for veterans in rural areas.

Developing countries currently face internal and external migration of their health workforce and interventions are needed to attract and retain health professionals in rural areas. Evidence of multidimensional interventions, however, is scarce. This study explores a long-standing strategy to attract and retain doctors to rural areas in Chile: the Rural Practitioner Programme. The main objective is to describe the programme, characterize its multidimensional set of incentives and appraise preliminary programme outcomes.Retrospective national data were employed to examine recruitment, retention and incentives provided to extend the length of stay and motivate non-clinical work. The programme has successfully recruited a large number of applicants, with acceptance rates close to 100%. Retention rates are nearly 100% (drop-outs are exceptional), but only 58% of participants stay for the maximum period. Areas with greater work difficulty are attracting the best-ranked applicants, but incentives to engage in community projects, management responsibilities, continuous medical education and research have achieved mixed results. Rural doctors are satisfied with their experience and 70% plan to practise as specialists in a referral hospital.The programme has successfully matched the interests of physicians in specialization with the country's need for rural doctors. However, a gap might be forming between the demand for certain specialties and what the programme can offer. There is a need to conciliate both parties, which will require a more refined strategy than before. This should be grounded in robust knowledge based on programme outcomes and evidence of the interests and motivations of health professionals.

Background There is a critical shortage of health workers globally, which is not just a problem for low- and middle-income countries, but needs to be tackled through shared action. At the same time, public policy around the world is responding to changing health needs, social trends and technological possibilities by placing ever greater emphasis on primary care and public health, the interconnections between them and their relationships with other disciplines. All these themes mean that a new approach to the education and training of health workers is required. Setting Global, but with relevance to the UK. Question The education and training of professionals in public health and primary care need to adapt to the changing epidemiological, social, technological and policy environment, as well as to health worker shortages and resource constraints. Methods This article brings together the results of reviews undertaken by the Global Health Workforce Alliance taskforce on scaling up the education and training of the health workforce and the Lancet Commission 'Health professionals for a new century - transforming education to strengthen health systems in an interdependent world' (of both of which the author was a member) with the author's own experiences working in Africa, Asia and North America as well as in the UK. Results There are obvious differences in the needs and capabilities of health systems in different countries, but whatever the context - and whether they are high-, low- or middle-income countries - there are many similarities in the approach that is needed to educate and train professional and non-professional health workers, and a great deal that all countries can learn from each other. Conclusion/discussion As the NHS enters a new phase in the continuing development of general practitioners as commissioners and providers there is a need to look for insights from around the world and to develop a new approach to educating and training primary care and public health professionals which takes account of this global perspective and global learning.

In an emergency, the needs of women of reproductive age, particularly pregnant and postpartum women, introduce unique challenges for public health and clinical care. Incorporating reproductive health issues and considerations into emergency preparedness and response is a relatively new field. In recent years, several resources and tools specific to reproductive health have been developed. However, there is still a need for training about the effects of emergencies on women of reproductive age. In an effort to train medical and public health professionals about these topics, the CDC Division of Reproductive Health developed Reproductive Health in Emergency Preparedness and Response, an online course that is available across the United States.

A person receiving public health services should not receive a lesser standard of service because of his/her race, gender, age, colour, national origin, disability status, occupation or any other extraneous characteristics. However, sometimes our perception based on these hidden linkages (unconscious, irrepressible, or irrational connotations) may influence our judgements resulting in unfairness which are referred as implicit biases. Such biases can result in poorer quality of care. In public health, where the ultimate motive is to ensure social justice, these implicit biases are thus quite deleterious. The purpose of this article was to examine the implicit biases in public health practice and develop recommendations for education, training and research in this discipline using the application of a novel behavioural theory, multi-theory model (MTM) of health behaviour change. A review of literature in the MEDLINE, CINAHL, Google Scholar, and ERIC databases was performed to prepare this article. The constructs of participatory dialogue in which advantages outweigh disadvantages, behavioural confidence, and changes in physical environment were discussed to initiate behaviour change devoid of implicit biases. The constructs of emotional transformation, practice for change and changes in social environment were discussed to sustain behaviour change devoid of implicit biases. Educational interventions based on MTM need to be adopted by Schools of Public Health in education of public health students and training of public health professionals. Such efforts will reduce implicit biases in the discipline of public health and improve quality of care.

Field Epidemiology Training Programs (FETPs) are competency-based training programs aiming to strengthen the epidemiologic capacity of the public health workforce. This study aimed to evaluate the impact of the advanced FETPs in the Eastern Mediterranean region (EMR) and ascertain whether the expected objectives of the programs are met. A descriptive study was conducted based on Kirkpatrick's model for evaluating training programs. Data were collected from FETP graduates and FETP technical advisers on the practices of FETP graduates, their engagement in key areas of field epidemiology, and their perceived skills and capacity to perform such activities. A total of 166 FETP graduates responded to the online survey. Almost two-thirds of FETP graduates reported that they are often engaged in managing public health surveillance systems (n = 119, 71.7%), analyzing the surveillance data (n = 116, 69.9%), training public health professionals (n = 113, 68.1%), investigations on and response to outbreaks (n = 109, 65.7%), and managing staff and resources (n = 106, 63.9%). However, only 28.3% reported that they are often engaged in writing scientific research articles. More than two-thirds of graduates reported that the FETP helped them to perform most of the field epidemiology activities and rate their skills as good. In conclusion, the FETP graduates in the EMR were well engaged in many field epidemiology activities including managing public health surveillance systems, surveillance data analysis, training public health professionals, and investigations on and response to outbreaks. Therefore, the FETPs should continue supporting the graduates to work toward strengthening surveillance systems and investigating outbreaks and to participate in regional and global efforts as part of the Global Health Security.

Important advances occurred in ethics and epidemiology in the closing decades of the twentieth century [1, 2]. These advances include explications of the societal importance of epidemiologic research and practice, clarifications of the ethical duties of epidemiologists, and the increasing integration of ethics into the professional life of epidemiologists [3–12]. These developments in ethics are not isolated events. Rather, they have occurred in conjunction with historical events: improvements in institutional and regulatory safeguards for protecting human subjects, rising public concern over the privacy and confidentiality of medical records, the onset of the AIDS epidemic, and the emergence of molecular epidemiology, to name a few. One sign of the increased attention to ethics and values in epidemiology in recent years is the development of ethics guidelines for epidemiologists and policy statements on data sharing, privacy and confidentiality protection, deoxyribonucleic acid (DNA) testing for disease susceptibility, and other issues [6–10, 13–15]. Courses on ethics in epidemiology and public health have also been initiated at several institutions that train public health professionals [16–19]. In addition, the number of publications on ethical issues in epidemiology has increased [20–23]. Indeed, all these developments have likely contributed to the increasing recognition of epidemiology as a distinct profession [2, 12].