BACKGROUND: The equitable distribution of medical specialists in Indonesia\'s remote areas remains a challenge. This study investigated the preferences of medical specialists regarding retention programs aimed at addressing this issue.
METHODS: A Discrete Choice Experiment (DCE) was utilized to collect stated preferences from 341 medical specialist working in district general hospitals across 10 Indonesian provinces. The DCE retention questionnaire focused on eight key characteristics: location, medical facilities, net income, continuing professional development program, security, length of commitment, source of incentives, and caseload.
RESULTS: The study found that the most influential factors for retention in remote areas were security guarantees from the local government (OR = 6.11), fully funded continuing professional development programs (OR = 2.84), and access to advanced medical facilities (OR = 2.35).
CONCLUSIONS: The findings indicate that a comprehensive intervention package, with a particular emphasis on security provisions, is necessary to retain medical specialists in remote areas. Financial incentives are also recommended to improve retention. However, it is crucial to acknowledge that no single intervention will suffice, as the factors influencing specialist retention in remote areas of Indonesia are complex and multifaceted.

BACKGROUND: Cancer remains the second most common cause of death in Germany. Performance management and specialization concepts in medicine have the potential to positively influence the care and chances of survival of patients.
OBJECTIVE: From the perspective of the University Hospital Freiburg (UKF), the legislative initiative within the framework of the Hospital Treatment Improvement Act (KHVVG) results in a number of medical strategic implications. This article explains and discusses the background, objectives and contents of the reform project \"Occasional surgical oncology\" and provides perspectives on strategic fields of action.
METHODS: Analysis and interpretation of the draft of the Act for improvement of the treatment quality in hospitals and on the reform of the remuneration structures (Federal Government draft act).
RESULTS: From the point of view of the UKF hospitals should engage in cooperative discussions with neighboring hospitals at the earliest opportunity to shape regional healthcare with the goals of mapping the local allocation of oncology patients for optimal treatment, mitigating the loss of patients at affected locations and preparing for patient growth at facilities that will continue to provide treatment in surgical oncology.
CONCLUSIONS: The ongoing legislative process and the fact that a reliable analysis of relevant treatment areas will be possible for hospitals in the first half of 2025, presents particular challenges for hospitals and the strategic planning of activities. The gaps in the bill presented in this article should be urgently addressed to avoid undermining the project\'s goals and to support the hospitals remaining in the healthcare system in their preparations.
UNASSIGNED: HINTERGRUND: Nach wie vor stellen Krebsleiden die zweithäufigste Todesursache in Deutschland dar. Leistungssteuerung und Spezialisierungskonzepte in der Medizin bergen Potenziale, die Versorgung und die Überlebenschancen von Patientinnen und Patienten positiv zu beeinflussen.
UNASSIGNED: Aus der Gesetzesinitiative im Rahmen des KHVVG resultiert aus der Perspektive des UKF eine ganze Reihe medizinstrategischer Implikationen. Diese Arbeit erläutert und diskutiert die Hintergründe, Ziele und Inhalte des Reformvorhabens „Gelegenheits-Onkochirurgie“ und gibt Perspektiven auf strategische Handlungsfelder.
METHODS: Analyse und Interpretation des Entwurfs eines Gesetzes zur Verbesserung der Versorgungsqualität im Krankenhaus und zur Reform der Vergütungsstrukturen (Gesetzentwurf der Bundesregierung).
UNASSIGNED: Aus Sicht des UKF sollten Krankenhäuser frühestmöglich und proaktiv Kooperationsgespräche mit benachbarten Krankenhäusern zur Gestaltung der regionalen Gesundheitsversorgung führen mit den Zielen, die lokale Allokation onkologischer Patientinnen und Patienten im Sinne einer bestmöglichen Behandlung abzubilden, den Verlust von Patienten an den betroffenen Standorten abzufedern sowie den Patientenaufwuchs bei den Einrichtungen, die weiterhin onkochirurgisch versorgen werden, vorzubereiten.
CONCLUSIONS: Das noch laufende Gesetzgebungsverfahren sowie der Umstand, dass eine belastbare Analyse der relevanten Leistungsbereiche erst im ersten Halbjahr 2025 für Krankenhäuser möglich sein wird, stellt die Einrichtungen vor besondere Herausforderungen in der strategischen Planung ihrer Aktivitäten. Die im Rahmen dieser Arbeit dargestellten Lücken im Gesetzesvorhaben sollten dringend geschlossen werden, um die Ziele des Vorhabens nicht zu konterkarieren und die im System verbleibenden Leistungserbringer bei ihren Vorbereitungen zu unterstützen.

OBJECTIVE: To identify the perceptions of veterinary students interested in specialization regarding veterinary anesthesiology.
METHODS: Cross-sectional, multi-institutional, voluntary, anonymous, nonrandomized survey.
METHODS: Veterinary students (303 of 557 total respondents) from 10 veterinary schools.
METHODS: Quantitative data were obtained via 5-point Likert scale questions about anesthesia-related topics. Open-ended questions were used to obtain qualitative data. A multivariate logistic regression model assessed the likelihood of choosing a career as an anesthesiologist. Spearman\'s rank correlation coefficient was used to assess the relationship between \'anesthesia is interesting\' and other variables.
RESULTS: Of the respondents, 14 (6%) indicated veterinary anesthesia as their chosen specialty. There was a significant positive relationship between \'anesthesia is interesting\' and the following variables: age, enjoyment in anesthesia class, belief in the importance of anesthesia for their career, belief in the importance of analgesia for their career, belief that anesthesia and analgesia have a large impact on patient care, interest in pharmacology, interest in physiology, interest in learning technical skills, belief that anesthesiologists are respected by their colleagues and belief that anesthesiologists are an important part of the health care team. More weeks on the anesthesia clinical rotation was positively and significantly associated with increased rotation enjoyment. Enjoyment in the anesthesia class [p = 0.001, Exp(β) = 2.1, 95% confidence interval (CI): 1.3-3.4] and belief that anesthesia is interesting [p = 0.013, Exp(β) = 2.6, 95% CI: 1.2-5.4] were predictors that respondents would be more likely to consider a career as a veterinary anesthesiologist.
CONCLUSIONS: Those veterinary students with an interest in pharmacology and who enjoyed their anesthesia course were more likely to consider a career as a veterinary anesthesiologist. If students indicated no interest in specializing in veterinary anesthesia, they appreciated the value the specialty brings to animal care and believed that veterinary anesthesiologists are respected by their peers.

UNASSIGNED: The purpose of this study was to compare the knowledge and practices of specialist and experienced nonspecialist physical therapists in performing patient education about physical activity with patients with heart failure (HF).
UNASSIGNED: Responses on a nationwide anonymous online survey were used to compare specialist and experienced nonspecialist physical therapists on knowledge and frequency of providing physical activity related education to patients hospitalized with acutely decompensated HF. Responses to survey items were scored on 5-point scales ranging from \"Strongly agree\" to \"Strongly disagree\" or \"Always\" to \"Never.\" Mann-Whitney U statistics were used to compare specialist and experienced nonspecialist responses and Wilcoxon signed-ranks tests were used to examine the gap between knowledge and practice.
UNASSIGNED: Twenty-seven specialists and 43 experienced nonspecialists completed the survey. Both groups were similar in age, and experience treating patients hospitalized with acutely decompensated HF. Both groups \"strongly agree\" that they had the required knowledge and skills to educate patients with HF on the physical activity topics. However, specialists more often than experienced nonspecialists provided education on topics such as how to monitor vital signs during physical activity (\"most of the time\" vs. \"about half of the time\") that promoted patient confidence and safety during exercise. Specialists demonstrated a smaller gap between knowledge and frequency of providing patient education than experienced nonspecialists on three of the four patient education topics.
UNASSIGNED: Specialist physical therapists treating patients with HF in the inpatient hospital setting provided patient education on physical activity at a level more closely matching their skills and the clinical practice guideline than did experienced nonspecialists. Physical therapy clinical specialists practicing in the inpatient hospital setting may improve patient outcomes and lower costs to the health care system by improving physical activity adherence and thereby may reduce avoidable hospital readmissions.

This article examines the development of urology as an independent medical discipline in Germany, with a particular focus on professionalization and specialization in the 19th and 20th centuries. Based on historical sources, the text illuminates the importance of the German medical profession\'s further training regulations as an instrument of medical self-administration and the classification of urology as a medical specialty in the Bremen guidelines of 1924, which established board certification in diseases of the urinary organs (urology).
UNASSIGNED: Dieser Artikel untersucht die Entwicklung der Urologie als eigenständige medizinische Disziplin in Deutschland mit besonderem Fokus auf die Professionalisierung und Spezialisierung im 19. und 20. Jahrhundert. Basierend auf historischen Quellen beleuchtet der Text die Bedeutung der Weiterbildungsordnungen der deutschen Ärzteschaft als Instrument der ärztlichen Selbstverwaltung und die Einordnung der Urologie als Sonderfach der Medizin in den Bremer Richtlinien von 1924, welche den Facharzt für Erkrankungen der Harnorgane (Urologie) etablierten.

暂无摘要。

Race and ethnic difference in delinquency are examined using the National Longitudinal Study of Adolescent Health. It is argued that crime theories that attempt to explain race and ethnic differences imply consistent effects for different offenses and common mediating processes. Analyses suggest some degree of group consistency in delinquent behaviors for Mexican-Americans, Puerto Ricans, Native Americans, and some Asian groups, but not for African-Americans. Black youth have higher rates of violent offenses than white youth, lower rates of substance use, and similar rates of property offending. Some variables are consistent mediators while others are not. Crime theories can account for the low rates of delinquency among Asian Americans while theories of violence and substance use are needed to understand differences between black and white youth. The findings are inconsistent with the idea that group differences among youth are due to the socioeconomic status of their families or neighborhoods. The race patterns are also inconsistent with the stereotype of high crime rates in black communities.

BACKGROUND: Recent research highlighting a shortage of pediatric subspecialists in the United States has shown wide variations in the distance from children to the nearest subspecialists but has not accounted for subspecialty outreach clinics, in which specialists may improve access in rural areas by periodically staffing clinics there. This study aimed to determine the impact of pediatric subspecialty outreach clinics on the driving times to the nearest pediatric subspecialists for children in Maine.
METHODS: This cross-sectional study utilized administrative data on the schedule and location of pediatric subspecialty clinics in Maine in 2022 to estimate the driving time from each ZIP-code tabulation area to the nearest subspecialist, with and without the inclusion of outreach clinics. Using 2020 census data, we calculated the median and interquartile ranges of driving times for the state\'s overall child population, as well as for children living in urban and rural areas.
RESULTS: Of 207,409 individuals under 20 years old in Maine, 68% were located closer to an outreach location than to a clinical hub. Across the seven subspecialties offering outreach clinics, outreach clinics decreased median driving times to the nearest pediatric subspecialist by 5 to 26 minutes among all children, and by 16 to 46 minutes among rural children.
CONCLUSIONS: Pediatric subspecialty outreach clinics can substantially reduce the driving time to the nearest pediatric subspecialist , especially for children living in rural areas. The use of outreach clinics should be accounted for in research describing the geographic access or barriers to care. Expanding the number of outreach clinics should be considered by policymakers hoping to improve access.

UNASSIGNED: The Global Specialist Digital Health Workforce Census is the largest workforce survey of the specialist roles that support the development, use, management, and governance of health data, health information, health knowledge, and health technology.
UNASSIGNED: This paper aims to present an analysis of the roles and functions reported by respondents in the 2023 census.
UNASSIGNED: The 2023 census was deployed using Qualtrics and was open from July 1 to August 13, 2023. A broad definition was provided to guide respondents about who is in the specialist digital health workforce. Anyone who self-identifies as being part of this workforce could undertake the survey. The data was analyzed using descriptive statistical analysis and thematic analysis of the functions respondents reported in their roles.
UNASSIGNED: A total of 1103 respondents completed the census, with data reported about their demographic information and their roles. The majority of respondents lived in Australia (n=870, 78.9%) or New Zealand (n=130, 11.8%), with most (n=620, 56.3%) aged 35-54 years and identifying as female (n=720, 65.3%). The top four occupational specialties were health informatics (n=179, 20.2%), health information management (n=175, 19.8%), health information technology (n=128, 14.4%), and health librarianship (n=104, 11.7%). Nearly all (n=797, 90%) participants identified as a manager or professional. Less than half (430/1019, 42.2%) had a formal qualification in a specialist digital health area, and only one-quarter (244/938, 26%) held a credential in a digital health area. While two-thirds (502/763, 65.7%) reported undertaking professional development in the last year, most were self-directed activities, such as seeking information or consuming online content. Work undertaken by specialist digital health workers could be classified as either leadership, functional, occupational, or technological.
UNASSIGNED: Future specialist digital health workforce capability frameworks should include the aspects of leadership, function, occupation, and technology. This largely unqualified workforce is undertaking little formal professional development to upskill them to continue to support the safe delivery and management of health and care through the use of digital data and technology.

Parasites comprise a substantial portion of global biodiversity and play critical roles in shaping ecosystems by modulating trophic networks and affecting their hosts\' abundance and distribution. The dynamics of host migration introduce new complexity to these relationships. From the host perspective, migratory behavior can either act as a defense mechanism or augment exposure to a broader spectrum of pathogens. Conversely, for parasites, host migration represents a mechanism for their dispersion and an opportunity to infect new host species. This study investigates the complex interplay between migration and parasite-host interactions, focusing on the interaction between hosts and avian malaria and malaria-like parasites in the Brazilian Atlantic Rain Forest. We captured 1466 birds representing 70 different species, uncovering 322 infections with Plasmodium/Haemoproteus parasites. We observed variations in migration timing and fluctuations in host abundance across months. By comparing the observed patterns of interaction of migratory and non-migratory birds to patterns of interaction expected at random, we show that migration affects the roles hosts take in the parasite-host network. Interestingly, despite the fact migratory species hosted more exclusive and distinct parasites, migrants did not occupy central network positions, which are mostly occupied by resident birds. Overall, we highlight the role of resident birds as a key species within parasite-host communities and the high specialization among avian haemosporidians and their hosts.