South African Chiropractic Students' Intentions, Motivations, and Considerations for Emigration: A Cross-Sectional Study.

Objective: The purpose of this study was to investigate the emigration intentions of South African senior chiropractic students upon graduation, emphasizing motivations and considerations guiding migration decisions. Methods: A cross-sectional, quantitative, and exploratory approach was employed, utilizing an anonymous and adapted online survey administered to chiropractic students at 2 South African institutions (n = 177) between March 15 and May 19, 2021. Data were analyzed using frequencies, descriptions, and cross-tabulations to identify trends and interrelationships related to students' intentions to emigrate postqualification. Results: Findings indicate that 75.5% of South African chiropractic senior students intend to emigrate. Motivations for emigration include improved quality of life and seeking of opportunities. Economic instability in South Africa (SA) (82.7%) and concern for the National Health Insurance implementation (57.7%) serve as a significant push factor, whereas economic stability abroad (85.7%) emerged as a key pull factor. Preferred emigration destinations are primarily developed countries with established chiropractic communities. Conclusion: High emigration intentions among students were driven by diverse push factors in SA, including economic decline, socio-political climates, and safety concerns, contrasting with pull factors abroad, such as better opportunities, living conditions, and economic stability. Concerns regarding healthcare reforms, particularly the National Health Insurance, are also highlighted. Destinations in order of preference such as the United Kingdom, Canada, and Australia offer valuable insights for policy interventions. Understanding these dynamics is crucial for developing effective retention strategies and addressing socio-economic challenges.

Education and Career Advancement Opportunities in Polish and English Nursing-A Comparative Study of Intensive Care Unit Nurses.

The aim of this study was to comparatively investigate education, job, and professional development satisfaction among intensive care unit nurses in Poland and England. A total of 258 ICU nurses from both countries were interviewed (72 Polish nurses working in Poland and 186 of various national backgrounds in England, including 50 of Polish origin). We used an 11-item structured survey followed by an open-ended qualitative interview retrospectively coded for statistical analysis. Regardless of national origin, nurses in England report significantly higher education satisfaction, attributed to better theoretical knowledge gain but not to other dimensions (such as practical knowledge or personal satisfaction). They also express greater satisfaction with job conditions regarding professional development, a state-of-the-art work environment, teamwork, and finance. The UK system is also considered significantly superior in promotion opportunities and participation in post-graduation training. In conclusion, systemic factors play a crucial role in career satisfaction and advancement in nursing, with the British band system having a clear advantage over the Polish one.

The hospital emigration to another region in the light of the environmental, social and governance model in Italy during the period 2004-2021.

The following article presents an analysis of the impact of the Environmental, Social and Governance-ESG determinants on Hospital Emigration to Another Region-HEAR in the Italian regions in the period 2004-2021. The data are analysed using Panel Data with Random Effects, Panel Data with Fixed Effects, Pooled Ordinary Least Squares-OLS, Weighted Least Squares-WLS, and Dynamic Panel at 1 Stage. Furthermore, to control endogeneity we also created instrumental variable models for each component of the ESG model. Results show that HEAR is negatively associated to the E, S and G component within the ESG model. The data were subjected to clustering with a k-Means algorithm optimized with the Silhouette coefficient. The optimal clustering with k=2 is compared to the sub-optimal cluster with k=3. The results suggest a negative relationship between the resident population and hospital emigration at regional level. Finally, a prediction is proposed with machine learning algorithms classified based on statistical performance. The results show that the Artificial Neural Network-ANN algorithm is the best predictor. The ANN predictions are critically analyzed in light of health economic policy directions.

Analysis of Iranian health workforce emigration based on a system dynamics approach: a study protocol.

BACKGROUND: Emigration of health workers has emerged as a significant obstacle in Iran, compelling policymakers to implement a diverse range of interventions and reforms to enhance healthcare services. It is imperative to comprehend the efficacy of emigration control interventions. To explore the intricate dynamics of elite emigration, this study employs a system dynamics modeling approach. The objective is to scrutinize Iranian health workers' emigration, examine the relationships, and evaluate the impact of various factors involved. OBJECTIVES: The general purpose of this study is to analyze the policy interventions affecting the emigration of human resources in the field of health in Iran based on the system's dynamic approach. METHOD: The research consists of four phases including analyzing the emigration status of health workers in developing countries, studying health personnel emigration in Iran, developing a System Dynamics (SD) model, and determining evidence-based policy interventions to address health worker emigration. These phases involve realist review, document analysis, qualitative interviews, data integration, and policy scenario planning. The primary objective is to gain a profound understanding of the underlying causes, mechanisms, and consequences of migration, as well as assess the impact of policies, in order to prioritize effective interventions. RESULTS: It seems that the SD model developed in this study can highlight the interconnectedness of various factors that influence health worker emigration, including demographic changes, economic conditions, and characteristics of healthcare systems. CONCLUSION: This study uses a systems dynamics approach to analyze health worker emigration from Iran, focusing on policies that promote retention and explore the implications of emigration on the healthcare system. By examining interrelationships and feedback loops within the healthcare system and socioeconomic factors, the study aims to identify effective policy interventions that can mitigate the negative effects of emigration.

Main findings: The study reveals a complex web of factors driving the emigration of Iranian health workers, and along with the Investigating the effectiveness of different interventions, the aim of this research is to develop sustainable solutions to deal with the emigration of health workers.Added knowledge: This research adds to the existing literature by employing a system dynamics approach to model the multifaceted nature of health workforce emigration in Iran, offering a novel perspective on policy intervention analysis.Global health impact for policy and action: The findings underscore the necessity for comprehensive policy strategies that address the root causes of health worker emigration and can inform global efforts to retain healthcare professionals and ensure sustainable healthcare systems.

War and women: An analysis of Ukrainian refugee women staying in the Czech Republic.

In addition to the loss of life, Russian aggression against Ukraine, which began in February 2022, also brings interpersonal losses resulting from the need to emigrate. Parallel to the fighting men, women bear most of the burden of caring for the family. Using in-depth interviews supplemented by questions about adverse childhood experiences and administration of The Centrality of Events Scale and the PTSD Checklist - PCL-5 with 43 Ukrainian women (18-60 years old), we analyzed adaptation to the situation of emigration and the association of their war and earlier experiences with the level of traumatization. Women were interviewed shortly after emigration to the Czech Republic (3-42 week afterward). High levels of adverse childhood experiences and post-traumatic stress symptoms were found. The war was perceived as a currently negative central event associated with traumatic stress symptoms, and 79% of the sample expressed the opinion that the war had changed them. The results of this study suggest an intertwining of previous life experiences with the current need and ability to adapt.

Investigating the emigration intention of health care workers: A cross-sectional study.

AIMS: To (1) explore the intramigration experience of HCWs within Nigeria, (2) explore the migration intention of health care workers (HCWs) in Nigeria and (3) identify the predictors of migration intention among HCWs in Nigeria. DESIGN: Cross-sectional study. METHODS: The online survey was used to collect data from 513 HCWs in Nigeria between May and June 2023. Crude and adjusted logistic regression were used to identify factors associated with emigration intention. Analyses were performed on SPSS version 26 at a 95% confidence interval. RESULTS: The study found that 34.4% had intramigration experience, and the rate of intention to emigrate to work in another country was 80.1%. The United Kingdom was the most preferred destination (109 HCWs), followed by Canada (92 HCWs) and the United States (82 HCWs). At the multivariate level, emigration intention was associated with the experience of burnout and duration of practice as a HCW. Nurses had higher emigration intentions than medical doctors. CONCLUSIONS: Many HCWs in Nigeria appear to have emigration intent, and nurses are more likely to be willing to migrate than doctors. The Nigerian government may want to explore strategies to reverse the emigration intent of the HCWs in Nigeria.

An overview of health workforce mobility in the European Union under the current supply challenges. SESPAS Report 2024.

OBJECTIVE: Providing a general overview of the European Union's health workforce mobility under the challenges facing health systems regarding the supply of health workers. METHOD: We use a descriptive method, based on the analysis of secondary data, qualitative and quantitative, concerning the European Semester from the European Union, complemented with statistical data from both the Union and some international organisations. RESULTS: The mobility of health professionals in the Union, associated to strong reliance on recruiting abroad and shortages due to emigration, was identified as a challenge in the European Semester process in a significant number of times during 2017-2023. The pandemic aggravated pre-existing shortages and the need to strike a balance between maintaining the resolution capacity of health systems while abiding by the free movement of health professionals. The information shows that Romania, Slovakia, Spain, Lithuania, Latvia, Portugal, Bulgaria, Greece, Croatia, Hungary, Italy, and Slovenia could be flagged with an "issuer profile". Luxembourg, Ireland, Malta, and Sweden could be flagged with a "recipient profile". We benefited from improvements in the information system concerning the Union's health workforce. Further advances regarding the harmonisation of health professions' definition are needed, especially for nurses. CONCLUSIONS: The European Union faces internal migrations of health professionals. Mobility is used as a solution to shortages. The pandemic aggravated pre-existing shortages bringing to the forefront the need to strike a balance between health objectives and internal market objectives. Member States are immersed in health reforms, some financed with European Funds. Promoting health workforce planning and forecasting would emerge as a necessary action, including improving harmonised information. Drawing in a systematic way on the available information from the European Semester reports may provide some clues to give answers to policymaking concerning health professionals' mobility.

Plasmodium vivax Infections among Immigrants from China Traveling to the United States.

Beginning in 2023, we observed increased Plasmodium vivax malaria cases at an institution in Los Angeles, California, USA. Most cases were among migrants from China who traveled to the United States through South and Central America. US clinicians should be aware of possible P. vivax malaria among immigrants from China.

Thymocyte migration and emigration.

Hematopoietic precursors (HPCs) entering into the thymus undergo a sequential process leading to the generation of a variety of T cell subsets. This developmental odyssey unfolds in distinct stages within the thymic cortex and medulla, shaping the landscape of T cell receptor (TCR) expression and guiding thymocytes through positive and negative selection. Initially, early thymic progenitors (ETPs) take residence in the thymic cortex, where thymocytes begin to express their TCR and undergo positive selection. Subsequently, thymocytes transition to the thymic medulla, where they undergo negative selection. Both murine and human thymocyte development can be broadly classified into distinct stages based on the expression of CD4 and CD8 coreceptors, resulting in categorizations as double negative (DN), double positive (DP) or single positive (SP) cells. Thymocyte migration to the appropriate thymic microenvironment at the right differentiation stage is pivotal for the development and the proper functioning of T cells, which is critical for adaptive immune responses. The journey of lymphoid progenitor cells into the T cell developmental pathway hinges on an ongoing dialogue between the differentiating cell and the signals emanating from the thymus niche. Herein, we review the contribution of the key factors mentioned above for the localization, migration and emigration of thymocytes.

[Shortage of nurses in Spain: from the global case to particular situation. SESPAS Report 2024]. / Escasez de enfermeras en España: del caso global a la situación particular. Informe SESPAS 2024.

The nursing shortage is a multi-causal phenomenon that affects all countries and currently a global concern. The shortage of nurses jeopardizes the sustainability of health systems and the population health outcomes. Spain has historically had no difficulties in attracting new generations of nurses. The shortage of nurses is caused by the precarious working conditions and lack of professional development that have led to episodes of high international migration and abandonment of the profession. In this paper we focus on the evolution of different indicators of the working conditions of non-specialist nurses, who make up the bulk of the profession. These indicators allow us to analyse the abandonment of the profession, the duration of contracts, their full-time or part-time dedication and the excessive hiring. We have analysed the effect of COVID-19 and the labour reform on these indicators. COVID-19 reduced the abandonment of the profession and is currently at its lowest level, it has also accelerated the need to improve working conditions by increasing the percentage of permanent contracts and reducing the multiplicity of contracts in the same month. The labour reform has helped reduce the percentage of temporary contracts until reaching around 80% of the total contracts, and has reduced the number of nurses in Spain with more than one contract in the same month to below 3000 nurses on a sustained basis.

Life history correlations and trade-offs resulting from selection for dispersal in Tribolium castaneum.

Dispersal is an important facet of the life history of many organisms and is, therefore, subject to selective pressure but does not evolve in isolation. Across nature, there are examples of dispersal syndromes and life history strategies in which suites of traits coevolve and covary with dispersal in combinations that serve to maximize fitness in a given ecological context. The red rust flour beetle, Tribolium castaneum, is a model organism and globally significant post-harvest pest that relies on dispersal to reach new patches of ephemeral habitat. Dispersal behaviour in Tribolium has a strong genetic basis. However, a robust understanding of the relationship between dispersal and other life-history components, which could elucidate evolutionary processes and allow pest managers to control their spread and reduce the impact of infestation, is currently lacking. Here, we use highly replicated lines of T. castaneum previously artificially selected for divergent small-scale dispersal propensity to robustly test several important life history components: reproductive strategy, development time, and longevity. As predicted, we find that a suite of important changes as a result of our selection on dispersal: high dispersal propensity is associated with a lower number of longer mating attempts by males, lower investment in early life reproduction by females, slower development of later-laid offspring, and longer female life span. These findings indicate that correlated intraspecific variation in dispersal and related traits may represent alternative life history strategies in T. castaneum. We therefore suggest that pest management efforts to mitigate the species' agro-economic impact should consider the eco-evolutionary dynamics within multiple life histories. The benefits of doing so could be felt both through improved targeting of efforts to reduce spread and also in forecasting how the selection pressures applied through pest management are likely to affect pest evolution.

An Analytic Hierarchy Process Contingency Analysis of Factors Affecting the Emigration Decision of Medical Doctors in Turkey.

While the importance of explicitly identifying and considering contingent factors such as decision content and context is widely accepted as a way to ensure the validity of the decision analysis for the specific task at hand, few studies include this. This research uses a contingency theoretical approach to study factors affecting the emigration decision of medical doctors (MDs) for the specific case of Turkey. The motivation for conducting this study arises from the observation that the growing trend in emigration among MDs from Turkey is having a significant impact on the country's healthcare system. Dealing with the emigration of MDs is crucial for ensuring an effective and sustainable healthcare system, especially in terms of the availability of services, satisfaction, and employment of the healthcare staff. Contextual factors were explicitly identified through consultation with experts, while the generic factors were retrieved from the specialized medical migration literature. The Analytic Hierarchy Process method was utilized to prioritize the factors. Seventy-three participants were surveyed about their intention to either study or work abroad. The findings reveal that low remuneration and anxiety about their future due to the political situation in the country constitute the two most important factors driving the decision to emigrate.

Emotional and behavioural problems of left behind children in Lithuania: a comparative analysis of youth self-reports and parent/caregiver reports using ASEBA.

BACKGROUND: Children being left behind (LBC) in their home countries due to parental emigration is a global issue. Research shows that parents' emigration negatively affects children's mental health and well-being. Despite a high number of LBC, there is a dearth of data from Eastern European countries. The present study aims to collect and analyse self-reported data on LBC emotional and behavioural problems and compare children's reports with those of parents/caregivers. METHODS: A cross-sectional study was conducted in 24 Lithuanian schools, involving parents/caregivers and their children aged 12 to 17. We employed self-reported measures, including the Achenbach System of Empirically Based Assessment (ASEBA) tools - Child Behaviour Checklist (CBCL 6/18) and Youth Self Report (YSR 11/18), to evaluate the emotional and behavioural problems of the children. These instruments had been translated, standardised, and validated for the Lithuanian population. Data collection took place between January 2022 and April 2023. In addition to descriptive analysis, multivariate regression was used to adjust for various sociodemographic factors. RESULTS: A total of 760 parents/caregivers and 728 of their children participated in the study. LBC exhibited higher total problem scores (57.7; 95% CI 52.0-63.4) compared to non-LBC (47.1; 95% CI 44.7-49.4). These differences were consistent across all YSR 11/18 problem scales. However, no significant differences were observed in CBCL 6/18 scores. Furthermore, LBC self-reported a higher total problem score (57.7; 95% CI 52.0-63.4) compared to their parents/caregivers (24.9; 95% CI 18.9-30.9), and this pattern persisted across all scales. Being female, having school-related problems and having LBC status were associated with higher YSR 11/18 scores in the multivariable regression, while female gender, living in rural areas, school-related problems, and having hobbies were associated with higher CBCL 6/18 scores. CONCLUSION: This study highlights that LBC report more emotional and behavioural challenges than their non-LBC peers, while parent/caregiver assessments show lower problem scores for LBC. Gender, living environment, school-related issues, and engagement in hobbies have influenced these outcomes. These findings underscore the multifaceted nature of the experiences of LBC and the importance of considering various contextual factors in understanding and addressing their emotional and behavioural well-being.

Foray movements are common and vary with natal habitat for a highly mobile bird.

Understanding dispersal is central to interpreting the effects of climate change, habitat loss and habitat fragmentation, and species invasions. Prior to dispersal, animals may gather information about the surrounding landscape via forays, or systematic, short-duration looping movements away from and back to the original location. Despite theory emphasizing that forays can be beneficial for dispersing organisms and that such behaviors are predicted to be common, relatively little is known about forays in wild populations. Theory predicts that individuals that use forays may delay dispersal and such behaviors should increase survival, yet empirical tests of these predictions remain scarce. We tested these predictions in a natural system using the critically endangered snail kite (Rostrhaumus sociabilis), a wetland-dependent raptor. We GPS tracked 104 snail kites from fledging through emigration from the natal site across their breeding range to understand the demographic consequences of movement. We found that forays were common (82.7% of individuals tracked), and natal habitat played an important role in the initiation, execution, and outcome of foray behavior. The effect of foraying on survival was indirect, where forayers emigrated later than non-forayers, and individuals that emigrated later had the highest survival. Poor hydrological conditions in the natal environment were especially important for eliciting forays. Finally, females responded more strongly to natal hydrology than males, making more forays and significantly longer, more distant trips. These results emphasize the fundamental role of natal habitat for determining behavioral patterns, strengthen links between individual movement decisions and their demographic consequences, and provide an important behavioral focal point for interpreting movement tracks that would not otherwise be captured by conventional movement models.

Evaluation of the impact of "speak out" and "human libraries" educational methodologies on nursing students' attitudes toward immigration.

Introduction: Measuring and understanding attitudes toward migrants is crucial in Health Sciences professionals. Nursing students, as future professionals in the healthcare system, must be comprehensively trained and prepared from the undergraduate level to effectively face the challenges of caring for health and disease processes in an increasingly globalized world. Our study aims to determine the level of attitudinal change in nursing students for immigrants, based on a training intervention with sessions of coexistence with immigrants in Spain. Methods: Quasi-experimental controlled and non-randomized study, carried out in 2019 in Nursing School La Fe, Valencia (Spain), with 201 participants (74 intervention group, 127 control group). Instrument: Attitudes toward Immigration Instrument (IAHI) questionnaire. Educational techniques of the training intervention: Speak outs and Human Libraries. Descriptive statistical analysis and comparison of results between groups was performed. Results: The participants in the intervention group showed significant changes in attitude modification, both in the total score of the questionnaire and in 4 of the 5 dimensions (pre-post intervention medition). When comparing the differences between the intervention group and the control group, we observed significant differences in 3 of the 5 dimensions: equality principles and policies, positive favorability, and negative favorability. Conclussion: Sessions involving coexistence, discussion, and reflection with immigrants, as educational intervention methods for nursing students (Speak outs and Human Libraries), are useful and effective tools to promote positive attitudinal changes toward immigrants within the healthcar context in nursing students.

High immigration rates critical for establishing emigration-driven diversity in microbial communities.

Unraveling the mechanisms governing the diversity of ecological communities is a central goal in ecology. Although microbial dispersal constitutes an important ecological process, the effect of dispersal on microbial diversity is poorly understood. Here, we sought to fill this gap by combining a generalized Lotka-Volterra model with experimental investigations. Our model showed that emigration increases the diversity of the community when the immigration rate crosses a defined threshold, which we identified as Ineutral. We also found that at high immigration rates, emigration weakens the relative abundance of fast-growing species and thus enhances the mass effect and increases the diversity. We experimentally confirmed this finding using co-cultures of 20 bacterial strains isolated from the soil. Our model further showed that Ineutral decreases with the increase of species pool size, growth rate, and interspecies interaction. Our work deepens the understanding of the effects of dispersal on the diversity of natural communities.

Differentiating spillover: an examination of cross-habitat movement in ecology spillover in ecology.

Organisms that immigrate into a recipient habitat generate a movement pattern that affects local population dynamics and the environment. Spillover is the pattern of unidirectional movement from a donor habitat to a different, adjacent recipient habitat. However, ecological definitions are often generalized to include any cross-habitat movement, which limits within- and cross-discipline collaboration. To assess spillover nomenclature, we reviewed 337 studies within the agriculture, disease, fisheries and habitat fragmentation disciplines. Each study's definition of spillover and the methods used were analysed. We identified four descriptors (movement, habitat type and arrangement, and effect) used that differentiate spillover from other cross-habitat movement patterns (dispersal, foray loops and edge movement). Studies often define spillover as movement (45%) but rarely measure it as such (4%), particularly in disease and habitat fragmentation disciplines. Consequently, 98% of studies could not distinguish linear from returning movement out of a donor habitat, which can overestimate movement distance. Overall, few studies (12%) included methods that matched their own definition, revealing a distinct mismatch. Because theory shows that long-term impacts of the different movement patterns can vary, differentiating spillover from other movement patterns is necessary for effective long-term and inter-disciplinary management of organisms that use heterogeneous landscapes.

Epidemiology of asylum seekers and refugees at the Mexico-US border: a cross-sectional analysis from the migrant settlement camp in Matamoros, Mexico.

BACKGROUND: The number of migrants and asylum seekers at the Mexico-US border has increased to historic levels. Our objective was to determine the medical diagnoses and treatments of migrating people seeking care in humanitarian clinics in Matamoros, Mexico. METHODS: We conducted a cross-sectional study of patient encounters by migrating people through a humanitarian clinic in Matamoros, Mexico, from November 22, 2019, to March 18, 2021. The clinics were operated by Global Response Medicine in concert with local non-governmental organizations. Clinical encounters were each coded to the appropriate ICD-10/CPT code and categorized according to organ system. We categorized medications using the WHO List of Essential Medicines and used multivariable logistic regression to determine associations between demographic variables and condition frequency. RESULTS: We found a total of 8,156 clinical encounters, which included 9,744 diagnoses encompassing 132 conditions (median age 26.8 years, female sex 58.2%). People originated from 24 countries, with the majority from Central America (n = 5598, 68.6%). The most common conditions were respiratory (n = 1466, 15.0%), musculoskeletal (n = 1081, 11.1%), and skin diseases (n = 473, 4.8%). Children were at higher risk for respiratory disease (aOR = 1.84, 95% CI: 1.61-2.10), while older adults had greater risk for joint disorders (aOR = 3.35, 95% CI: 1.73-6.02). Women had decreased risk for injury (aOR = 0.50, 95% CI: 0.40-0.63) and higher risk for genitourinary diseases (aOR = 4.99, 95% CI: 3.72-6.85) compared with men. Among 10,405 medications administered, analgesics were the most common (n = 3190, 30.7%) followed by anti-infectives (n = 2175, 21.1%). CONCLUSIONS: In this large study of a migrating population at the Mexico-US border, we found a variety of clinical conditions, with respiratory, musculoskeletal, and skin illnesses the most common in this study period which encompassed a period of restrictive immigration policy and the first year of the COVID-19 pandemic.

Predator-induced prey dispersal can cause hump-shaped density-area relationships in prey populations.

Predation can both reduce prey abundance directly (through density-dependent effects) and indirectly through prey trait-mediated effects. Over the years, many studies have focused on describing the density-area relationship (DAR). However, the mechanisms responsible for the DAR are not well understood. Loss and fragmentation of habitats, owing to human activities, creates landscape-level spatial heterogeneity wherein patches of varying size, isolation and quality are separated by a human-modified "matrix" of varying degrees of hostility and has been a primary driver of species extinctions and declining biodiversity. How matrix hostility in combination with trait-mediated effects influence DAR, minimum patch size, and species coexistence remains an open question. In this paper, we employ a theoretical spatially explicit predator-prey population model built upon the reaction-diffusion framework to explore effects of predator-induced emigration (trait-mediated emigration) and matrix hostility on DAR, minimum patch size, and species coexistence. Our results show that when trait-mediated response strength is sufficiently strong, ranges of patch size emerge where a nonlinear hump-shaped prey DAR is predicted and other ranges where coexistence is not possible. In a conservation perspective, DAR is crucial not only in deciding whether we should have one large habitat patch or several-small (SLOSS), but for understanding the minimum patch size that can support a viable population. Our study lends more credence to the possibility that predators can alter prey DAR through predator-induced prey dispersal.