Not Only How Much But How: The Importance Of Diversifying Funding Streams In A Reimagined Public Health System.

Revenue diversification may be a synergistic strategy for transforming public health, yet few national or trend data are available. This study quantified and identified patterns in revenue diversification in public health before and during the COVID-19 pandemic. We used National Association of County and City Health Officials' National Profile of Local Health Departments study data for 2013, 2016, 2019, and 2022 to calculate a yearly diversification index for local health departments. Respondents' revenue portfolios changed fairly little between 2016 and 2022. Compared with less-diversified local health departments, well-diversified departments reported a balanced portfolio with local, state, federal, and clinical sources of revenue and higher per capita revenues. Less-diversified local health departments relied heavily on local sources and saw lower revenues. The COVID-19 period exacerbated these differences, with less-diversified departments seeing little revenue growth from 2019 to 2022. Revenue portfolios are an underexamined aspect of the public health system, and this study suggests that some organizations may be under financial strain by not having diverse revenue portfolios. Practitioners have ways of enhancing diversification, and policy attention is needed to incentivize and support revenue diversification to enhance the financial resilience and sustainability of local health departments.

Current methodologies of greenspace exposure and mental health research-a scoping review.

Introduction: Greenspaces can provide an important resource for human mental health. A growing body of literature investigates the interaction and the influence of diverse greenspace exposures. In order to gain a comprehensive understanding of the complex connection between greenspace and mental health, a variety of perspectives and methodological combinations are needed. The aim of this review is to assess the current methodologies researching greenspace and mental health. Methods: A scoping review was conducted. Four electronic databases (Pubmed, Embase, PsycInfo, Web of Science) were searched for relevant studies. A wide range of greenspace and mental health keywords were included to provide a comprehensive representation of the body of research. Relevant information on publication characteristics, types of greenspaces, mental health outcomes, and measurements of greenspace exposure and mental health was extracted and assessed. Results: 338 studies were included. The included studies encompassed a multitude of methods, as well as outcomes for both greenspace and mental health. 28 combinations were found between seven categories each for greenspace and mental health assessment. Some pairings such as geoinformation systems for greenspace assessment and questionnaires investigating mental health were used much more frequently than others, implying possible research gaps. Furthermore, we identified problems and inconsistences in reporting of greenspace types and mental health outcomes. Discussion: The identified methodological variety is a potential for researching the complex connections between greenspace and mental health. Commonly used combinations can provide important insights. However, future research needs to emphasize other perspectives in order to understand how to create living environments with mental health benefits. For this purpose, interdisciplinary research is necessary.

Local public health under threat: Harassment faced by local health department leaders during the COVID-19 pandemic.

Background: Prior to the COVID-19 pandemic, local health departments (LHDs) faced several challenges including underfunding and understaffing. COVID-19 exacerbated these challenges and introduced new ones, including harassment of the agency, staff, and leadership. The objective of this study was to qualitatively understand the experiences and impact of harassment faced by LHDs during the pandemic and provide recommendations to prevent future harassment. Study design: A qualitative study was conducted utilizing focus groups for data collection. Methods: LHDs were sampled from the 2022 National Profile of Local Health Departments (Profile) study to ensure diversity in LHD size. Four virtual focus groups were conducted in Fall 2022 with a total of 16 LHD leaders surveyed in Profile, who were still in their positions. Focus group transcripts were then coded by two independent coders and analyzed using thematic analysis. Findings: Four common domains arose from the data: aggravating factors of harassment, content and formats of harassment, protective factors, and effects on individuals and on the workforce. Conclusion: Findings suggest that harassment was pervasive with many forms and impacts on the LHD leaders and workforce overall. Recommendations are proposed for the local as well as federal partners because the public health system is threatened without immediate, substantial, and coordinated solutions to address harassment and offer protection.

A qualitative analysis of public health officials' experience in California during COVID-19: priorities and recommendations.

Objectives: The aim of this study was to collect qualitative data regarding the violence faced by public health officials during the COVID-19 pandemic and create a guideline of recommendations to protect this population moving forward. Methods: Two focus groups were conducted virtually from April 2022 to May 2022. All nine participants were public health officials from across California. A grounded theory approach was used to analyze the data from these focus groups. Results: The main recurrent experiences among public health officials were harassment, psychological impact, systemic backlash, and burnout. Several recommendations for supporting public health officials were highlighted, including security and protection, mental health support, public awareness, and political/institutional support. Conclusion: Our study captures the violent experiences that health officials have faced during the COVID-19 pandemic. To maintain the integrity of the public health system, timely changes must be made to support and protect health officials. Our guideline of recommendations provides a multi-faceted approach to the urgent threats that officials continue to face. By implementing these solutions, we can strengthen our public health system and improve our response to future national emergencies.

The Role of Harassment in the Mental Well-being of Local Public Health Professionals and Its Relationship With an Intent to Leave Their Organization During the COVID-19 Pandemic.

Since the onset of the COVID-19 pandemic, news and nationwide survey efforts have reported harassment and bullying among local health officials, departments, and personnel, concurrent to a shortage of public health staff in the United States. We examined a nationally representative sample of local public health professionals (LPHPs) from the 2021 Public Health Workforce Interests and Needs Survey (PH WINS) data set to explore reported experiences with harassment, threats, and bullying; self-rated mental and emotional well-being; and intent to leave an organization. Results indicated that experience of harassment was negatively associated with ratings of mental and emotional health and positively associated with an intent to leave an organization. We discuss implications and recommendations to mitigate these risks for the nation's local public health workforce.

Disruptions to U.S. local public health's role in population-based substance use prevention and response during COVID-19.

BACKGROUND: COVID-19 dramatically limited the scale and scope of local health department (LHD) work, redirecting resources to the response. However, the need for essential public health services-including substance use prevention-was not reduced. METHODS: We examined six quantitative data sources, collected between 2016 and 2021, to explore the impact of the COVID-19 pandemic on LHD substance use-related services. RESULTS: Before the pandemic, the proportion of LHDs providing some level of substance use prevention services was increasing, and many were expanding their level of provision. During the pandemic, 65% of LHDs reduced their level of substance use-related service provision, but the proportion of LHDs providing some level of services remained steady from prior to COVID-19. CONCLUSION: We discuss policy recommendations to mitigate the risk of service disruptions during future public health emergencies, including direct and flexible funding for LHDs and federal directives declaring substance use prevention services as essential.

Physician Assistants' Training and Self-Perceived Competencies to Work with Survivors of Intimate Partner Violence.

INTRODUCTION: The purpose of this research was to assess physician assistant (PA) education and training on the diagnosis, management, and treatment of survivors of intimate partner violence (IPV), as well as perceived current vs. desired skills in tasks related to the management and treatment of IPV. METHODS: Participants in 2 studies included a convenience sample of attendees at an annual PA conference (study 1) and PAs in the United States who were randomly selected to be administered an online survey related to their PA practice (study 2). RESULTS: In 2 studies, PAs reported low perceived competence to treat and manage patients who are survivors of IPV. More than half of the respondents (51.2%) had received training to work with survivors of IPV. Almost 3 in 5 indicated that they felt adequately prepared, and almost 3 in 10 regularly asked patients about IPV. Gaps between current and desired perceived skills to treat and manage survivors of IPV were larger among PAs who had previous training related to IPV compared with PAs with no prior training. DISCUSSION: Guidance for PA educators may improve PA education and increase competencies among new PAs. Without more substantial guidance from an accrediting body, PA programs are left responsible for implementing IPV curriculum. Professional associations as well as constituent and specialty organizations that provide continuing medical education have an equally important role in strengthening skills and abilities among PAs.

Experiences Shared by the (Future) Public Health Workforce during the COVD-19 Pandemic in Germany: Results of a Survey on Workload, Work Content, and Related Challenges among Students and Young Professionals.

Although previous studies have focused on the adverse effects of the COVID-19 pandemic on various professional groups (particularly in the health and nursing care sector), this study aims to close a research gap by assessing perspectives of students and young professionals in epidemiology and public health in Germany in terms of shifts in workload, work content, and related challenges caused by the pandemic. We conducted a cross-sectional survey between mid-February and mid-March 2022. Quantitative data were analyzed via standardized mean differences. Qualitative data based on answers to open-ended questions were analyzed via a qualitative content analysis. Overall, 172 individuals participated in this survey. Results indicate that students felt burdened the most by lack of exchange with other students and lecturers. Study participants employed in public health experienced changes in their employment because they had changes in their work content- and administration, which was accompanied by a high burden due to the workload. Multiple demands that can have an impact on both acquired skills and mental health during the professional qualification phase were mentioned by the participants. Therefore, more in-depth analyses are needed to investigate the impact the pandemic will have on the (future) public health workforce in the long run.

Diversity in the Physician Assistant Pipeline: Experiences and Barriers in Admissions and PA School.

INTRODUCTION: The purpose of this study was to identify perceived barriers faced by physician assistant (PA) students who identified as an underrepresented minority in medicine (URM-med), sexual or gender minority (SGM), coming from low socioeconomic status (low SES), or a person with a disability (PWD). METHODS: More than 2700 PA students across the United States provided information regarding their PA school application process and program experiences. This study examined differences among URM-med, SGM, low SES, and PWD compared to those who were not in those groups to determine the relationship between these factors and student concerns about bias in the application process, as well as a variety of experiences in PA school. RESULTS: Using ordinal logistic regression analyses to examine the odds of experiencing a variety of barriers or experiences in applying to PA school and postmatriculation experiences, results suggested that, among disadvantaged groups within the PA student body, barriers include concerns about bias in the application process, lack of belonging, and the lack of academic and social support. DISCUSSION: PA students who identified as URM-med, SGM, low SES, and/or PWD faced barriers as they navigated the path to becoming a PA. To decrease these barriers, emphasis on raising awareness and interest in pursuing a career as a PA should occur early. Programs should work to identify biases within admissions processes, diversify faculty, and identify ways to support minority students once matriculated. Ultimately, increasing the diversity of healthcare providers has the potential to increase access to and quality of care for patients.

The Role of Interpersonal Toxicity on Healthcare Students' Well-Being.

INTRODUCTION: Nearly half of all medical students suffer from burnout, which not only has detrimental effects on the students themselves but can transfer into the clinical realm. Yet, studies exploring burnout and interpersonal toxicity in physician assistant (PA) students are rare. This study examined the role that interpersonal toxicity and abuse play in PA student burnout. METHODS: Nearly 2500 PA students in the United States responded to a survey about well-being, stress, and experiences with interpersonal toxicity in PA school as part of a larger cross-sectional study on PA student experiences in their didactic and clinical years. The present research focuses on overall measures among all PA students, as well as differences between didactic and clinical students, including the extent to which experiences of interpersonal toxicity predict symptoms associated with burnout. RESULTS: Overall, PA students reported high levels of satisfaction and happiness in school and life, but enthusiasm for school decreased for clinical students. More than two-thirds of students reported moderate to high levels of life stress, and more than 9 in 10 reported moderate to high levels of school stress. Symptoms of burnout were reported by many students, with clinical students reporting interpersonal toxicity exposure more often than didactic students. Experiencing interpersonal toxicity or abuse predicted symptoms of burnout. DISCUSSION: While PA students report high levels of life and school satisfaction, given the high levels of stress also reported, burnout metrics and well-being programs are needed. PA programs should work to create a supportive and engaging educational environment to ensure students' long-term career success.

PAs' skills in providing vision and ocular care.

OBJECTIVE: To evaluate characteristics, training, and self-reported skills and abilities in vision and ocular care among PAs not specializing in ophthalmology. METHODS: A survey on PA practice was administered to 5,763 randomly selected US-based PAs, and 537 respondents who completed the survey were invited to complete a separate vision and ocular care survey. Of those respondents, 382 completed the vision and ocular care survey. RESULTS: Among respondents, 23% of PAs were involved in eyecare by providing patient information, answering questions, and initiating discussions about vision care and ocular health more than once per month. More than 77% received vision and ocular care training in and/or outside PA training. PAs involved in eyecare had significantly greater odds of reporting higher desired and current skill and ability levels compared with PAs not involved in eyecare, in six of eight vision and ocular care domains. CONCLUSIONS: PAs who do not practice in ophthalmology provide vision and ocular care but have varying amounts of training and desire higher skill and ability levels. Ophthalmologists and PA institutions may develop vision and ocular care training for PA schools and continuing medical education.

Therapeutic Landscapes and Psychiatric Care Facilities: A Qualitative Meta-Analysis.

The environment in healthcare facilities can influence health and recovery of service users and furthermore contribute to healthy workplaces for staff. The concept of therapeutic landscapes seems to be a promising approach in this context. The aim of this qualitative meta-analysis is to review the effects of therapeutic landscapes for different stakeholders in psychiatric care facilities. A systematic literature search was conducted in the four data bases PubMed, PsycInfo, CINAHL, and Web of Science. Thirteen predominately qualitative studies were included in this qualitative meta-analysis. The methodological quality of these qualitative studies was assessed, using an adapted version of the Journal Article Reporting Standards for Qualitative Research, and a thematic analysis was conducted. The results were categorised into the three main themes of the physical (built and natural), social, and symbolic dimensions of the therapeutic landscape. Given the heterogeneity of the summarised data and an overall methodological quality of the included studies that can be rated as medium, the results should be interpreted with caution. Current findings are based almost exclusively on qualitative studies. Therefore, there is a need for quantitative study designs that investigate the relationship between specific environmental elements and mental health outcomes for different stakeholders in psychiatric facilities.

Depression, burnout, and professional outcomes among PAs.

OBJECTIVE: This study examined the effect of depression and burnout on PA professional fulfillment and medical errors. METHODS: Eight hundred eighty PAs completed an online survey containing the Professional Fulfillment Index, PHQ-2, GAD-7, and demographic questions. Two serial mediation models examined the relationship between depression, burnout, and professional outcomes. RESULTS: Burnout fully mediated the relationship between depression and outcomes in both models and the present research indicates that burnout plays a stronger role in job satisfaction than symptoms of depression. CONCLUSIONS: Understanding the underpinnings of professional satisfaction may mitigate clinician turnover, which in turn may lead to cost savings for the organization, better resilience and mental health for clinicians, and potentially better patient outcomes.

Reexamining the persisting wage gap between male and female PAs.

OBJECTIVE: To determine the magnitude of any difference in total compensation between male and female physician assistants (PAs) after controlling for personal and workplace factors related to compensation. METHODS: Using data from the 2019 AAPA Salary Survey, the authors conducted a sequential regression analysis to examine the relationship between a variety of personal and practice demographics and total compensation. RESULTS: After controlling for compensation-related factors, a wage gap between male and female PAs persisted: female PAs were paid almost $0.93 for every $1 male PAs were paid in the first year of work ($9,010 less). This wage gap widened by $201 for every year of work experience. CONCLUSIONS: A wage gap between male and female PAs persists even after including all compensation types and controlling for compensation-related factors that may differ between male and female PAs. Proposed policy implications could begin to mitigate the gap.

Physician Assistants in Ophthalmology: A National Survey.

PURPOSE: To evaluate the scope of practice and training of current physician assistants (PAs) in ophthalmology and gauge their interest in further training and involvement in ophthalmology. DESIGN: Cross-sectional survey study. METHODS: An anonymous survey on vision and ocular care in the PA profession was administered to PAs in ophthalmology within the American Academy of Physician Assistants member database. All survey questions were optional. RESULTS: A total response rate of 47/94 (50.0%) was obtained. Respondents reported an average of 9.8 years (SD = 9.0) of experience as a PA in ophthalmology. Over half of the respondents (59.5%) did not have previous experience in vision and ocular health before becoming a PA. Most respondents (79.5%) reported that they are able to provide their primary clinical responsibilities for ophthalmic care independently. In addition to providing clinical ophthalmic care, many of the respondents have duties that involve consenting patients for ophthalmic surgery and procedures (62.5%) and assisting in ophthalmic surgery and minor procedures (65.0%). Only a minority of respondents independently perform procedures, such as intravitreal injections (23.1%) and minor lid procedures (38.5%). Most respondents reported interest in additional training in providing vision and ocular care (69.0%), in continuing their career as a PA in ophthalmology (87.5%), and in joining a specialty organization for PAs in ophthalmology (88.1%). CONCLUSIONS: The PAs participating in this survey provide a range of clinical and some procedural ophthalmic care. The development of formal PA postgraduate training programs in ophthalmology may expand the pool of PAs qualified to practice ophthalmology.

Physician Assistant Students' Competency to Identify and Diagnose Autism Spectrum Disorder.

PURPOSE: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in communication and reciprocal social interactions. Little research has focused on the evaluation of developmental/behavioral pediatric education in the physician assistant (PA) curriculum. Therefore, the aims of this study were to evaluate whether PA students received training in identifying the red flags of ASD, using screening tests such as the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Additionally, the study sought to determine if PA students received education on the evaluation and management of children with ASD along with the methods to communicate effectively with their caretakers. METHODS: A survey open to PA students was administered by the American Academy of PAs. Demographic information along with questions on knowledge and perceptions related to ASD were asked. Perceptions of preparation to discuss ASD with patient caregivers were assessed, along with vaccination beliefs, and training information was collected. RESULTS: A total of 213 PA students answered the survey. Students received training regarding the red flags for ASD as well as ASD-related skills. Of note, 58.2% did not receive training on administration of the M-CHAT-(R/F) and 54.9% did not receive training to provide care to patients with ASD; 77.8% received training to understand pediatric developmental milestones. PA students overwhelmingly rejected the suggestion that there is a link between vaccines and ASD. CONCLUSION: The importance of diagnosing ASD as early as possible has been demonstrated by years of research; yet, this study concludes that many students still do not feel comfortable recognizing the red flags or using screening tools. Although the majority of PA students received training to understand developmental milestones, many did not know how to administer the M-CHAT-(R/F), which is key to making an early diagnosis.