关键词： COVID   Graduate medical education   Medical student   New generation   Surgery clerkship  

摘要： Background: The surgery clerkship has a powerful impact on medical students' attitudes toward surgery. The primary aim of this study was to identify factors that influence current medical student experiences during the surgery clerkship and discern if they have shifted following the COVID pandemic and with a new generation of "Zillennial" students. Materials and Methods: We conducted a qualitative content analysis of medical student surgery clerkship evaluations from 2018 to 2022 at three clinical training sites of our medical school (n = 596). The codes and themes that emerged from the data were then compared between the pre-COVID cohort (pre-March 2020) and post-COVID (post June 2020) cohorts. Results: Our analysis revealed four themes: clerkship factors, educator qualities, surgical culture, and student expectations. Clerkship factors included the overall clerkship organization, preparatory sessions, and having schedule flexibility. The clinical educators had a significant impact on medical student experience by setting expectations and providing actionable feedback. Surgical culture included the team dynamic and professionalism or diversity issues. Students were expected to have clear guidance for their roles, opportunities to shine, and sought meaningful learning. While the themes were consistent between both cohorts, the frequency of codes varied, with more students commenting on flexibility, neglect, and long work hours in the post-COVID cohort. Conclusions: Numerous previously unreported factors impact surgical clerkship experiences, revealing a generational shift in medical student attitudes. These results suggest that educators and their institutions must be proactive in tracking student evaluations to adapt their clerkship curriculum for an optimal educational experience and evolving student expectations. 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies

关键词： Adolescence   Depression   COVID-19 pandemic   Prospective   Sex differences   DEPRESSIVE SYMPTOMS   FEELINGS QUESTIONNAIRE   MAJOR DEPRESSION   COMMUNITY SAMPLE   CHILDHOOD   CHILDREN   TRAJECTORIES   VALIDITY   TRENDS   PREVALENCE  

摘要： Current prospective reports suggest a pandemic-related increase in adolescent mental health problems. We examine whether age-related change over 11-14 years accounts for this increase. Mothers and adolescents in a UK-based birth cohort (Wirral Child Health and Development Study; WCHADS; N = 737) reported on adolescent depression and behavioural problems pre-pandemic (December 2019-March 2020), mid-pandemic (June 2020-March 2021) and late pandemic (July 2021-March 2022). Analysis used repeated measures models for over-dispersed Poisson counts with an adolescent-specific intercept with age as a time-varying covariate. Maturational curves for girls, but not for boys, showed a significant increase in self-reported depression symptoms over ages 11-14 years. Behavioural problems decreased for both. After adjusting for age-related change, girls' depression increased by only 13% at mid-pandemic and returned to near pre-pandemic level at late pandemic (mid versus late - 12%), whereas boys' depression increased by 31% and remained elevated (mid versus late 1%). Age-adjusted behavioural problems increased for both (girls 40%, boys 41%) and worsened from mid- to late pandemic (girls 33%, boys 18%). Initial reports of a pandemic-related increase in depression in young adolescent girls could be explained by a natural maturational rise. In contrast, maturational decreases in boys' depression and both boys' and girls' behavioural problems may mask an effect of the pandemic.

关键词： telework   preferences   COVID-19   productivity   stress   health   ORGANIZATIONAL-CHANGE   SATISFACTION   UNCERTAINTY   PATTERNS   JOB  

摘要： This study of teleworking during the COVID-19 pandemic avoids a common self-selection bias by controlling for preferences and whether the introduction of teleworking was voluntary or mandatory. In a survey (n = 1,500) conducted in December 2020, we inquired about working arrangements and agent preferences in January, April, and December 2020. Productivity levels initially did not significantly differ for newly teleworking individuals after correcting for age, gender, marital status, breadwinner and management roles, childcare gap, area, job type, and general awareness, but were negatively affected by a preference mismatch (PM; around -3pp) and cognitive dissonance (not going with one's preference in spite of having a chance to do so, adding another -5pp). By December 2020, individuals with a PM lost as much as 9pp of their productivity levels, but the net effect for those in partially remote work was only about -2pp. Similarly, stress levels initially did not differ for newly teleworking individuals using largely the same controls as before. By December 2020, stress levels for individuals newly undertaking fully remote telework were significantly lower than for the control group of individuals with unchanged working arrangements, but the PM contributed significantly to higher stress levels.

关键词： COVID-19 deaths   Socioeconomic factors   Race   Counties   Partial least squares   Structural equation models   BURDEN  

摘要： A complex interplay of social, economic, and environmental factors drove the COVID-19 epidemic. Understanding these factors is crucial in explaining the racial disparities observed in COVID-19 deaths. This research investigated various hypotheses, including ecological, racial, demographic, economic, and political party factors, to determine their impact on COVID-19 deaths. The study utilized data from the National Center for Health Statistics (NCHS), specifically focusing on COVID-19 deaths categorized by race and Hispanic origin in US counties, with over 100 recorded deaths as of July 11, *** analyze the data, the study employed partial least squares (PLS) as the statistical approach, considering the presence of multicollinearity in the county-level socioeconomic data. SmartPLS4 software was utilized to illustrate paths depicting variance and covariance and to conduct significance tests. The analysis encompassed overall COVID-19 deaths and deaths among White, Black, and Hispanic Americans, utilizing the same latent variables and *** results revealed that the number of residents aged 65 years or older in a county was the most influential predictor of COVID-19 deaths, irrespective of race. Economic factors emerged as the second strongest predictors. However, when considering each racial group separately, distinct factors aligned with the five hypotheses emerged as significant contributors to COVID-19 deaths. Furthermore, the diagrams illustrating the relationships between these factors (covariates) varied among racial groups, indicating that the underlying social influences differed across *** light of these findings, it becomes evident that a "one-size-fits-all" approach to prevention strategies is suboptimal. Instead, targeted prevention efforts tailored to specific racial and social classes at high risk of COVID-19 death could have provided more precise messaging and necessitate direct engagement.

关键词： Pandemic   Students   Teaching and learning strategies   University   CLINICAL EDUCATORS  

摘要： BackgroundHealthcare education encountered unprecedented challenges during the COVID-19 pandemic, but the necessary responses have also provided learning opportunities for the *** aimed to evaluate the impact of COVID-19 on teaching and learning strategies and the perceptions of clinical educators and health sciences students on novel methods to improve online student engagement in Ireland's largest medical *** separate online surveys designed to gain insights into the perceived efficacy of online teaching strategies were distributed to clinical educators and health sciences students (medical and pharmacy) over 7 months via *** total of 86.4% of educators responded that rapport was more difficult to build online, and 90.5% reported less engagement from students online. The most popular methods that improved student engagement included using polls, a chat box function for questions, small group discussions and having student cameras turned on. Amongst educators surveyed, 81.8% felt a training course focused on teaching strategies at the start of every academic year would be beneficial. From the students' perspective, no difference was noted between the medicine and the pharmacy students. Seventy-five percent reported using quizzes/polls, and 63% reported using game-based platforms as techniques to improve online learning. Sixty-two percent of students described it as a positive outcome of learning during the *** pandemic poses unique challenges to the delivery of healthcare education. These surveys report educators' and students' views on online teaching and learning strategies, highlighting novel mechanisms to improve student engagement and ultimately impact on graduate outcomes.

关键词： COVID-19   vulnerabilities   lockdowns   Nepal   migrant workers   MIGRATION   HEALTH  

摘要： The global pandemic impacted Asian migrant workers disproportionately. During the first COVID-19 nationwide lockdown, Nepali migrant workers faced many challenges due to widespread misconceptions of them being vectors of COVID-19. This research examines COVID-19 impacts on international and internal Nepali migrant workers. A national survey on the social, economic, and psychological challenges of returning Nepali migrant workers was administered online from 10 May to 20 July 2020. A total of 672 responses were received. Using a binary logistic regression model, the research finds that the domestic migrant workers were less likely to get economic support, expect to borrow money during COVID-19, experience negative changes in their personal lives, and expect the COVID-19 contraction. In contrast, international migrant workers were less likely to return to their pre-pandemic employment. The research exposed long-standing vulnerabilities of migrant workers and identified immediate actions from Nepalese Central, Provincial, and Local governments to address their needs.

关键词： aging   COVID-19 perspectives   life-space mobility   COMMUNITY   HEALTH  

摘要： Background: The COVID-19 pandemic significantly affected the physical health of older adults around the world, causing day-to-day disruptions in routines and changes to usual patterns of mobility. Despite the passing of 2 years since vaccinations, older adults continue to experience detriments, including social isolation and reduced mobility. This study aims to understand how views of the COVID-19 pandemic are associated with life-space mobility-moving about the community. We hypothesize that endorsing stronger perspectives about the persistence of COVID-19 is correlated with reduced life-space mobility. Methods: Survey data were collected via online questionnaire in October and November of 2022. Linear regression models were used to examine the relationship between five perspectives on the COVID-19 pandemic (e.g., agreeing that "I wish people would take COVID-19 more seriously") and life-space mobility, measured using a modified version of the life space assessment, in older adults (n = 510). Analyses were adjusted for demographic factors and mental and physical health indicators, including depressive symptoms and number of chronic conditions. Results: In fully adjusted models, the study found that endorsing a stronger lingering impact of the COVID-19 pandemic across any of the five perspectives was associated with significantly lower life-space mobility. Conclusions: The results of this study show that endorsing a stronger lingering impact of the COVID-19 pandemic is associated with reduced life-space mobility, which underscores the importance of designing public health strategies that carefully balance the safety concerns of older adults with opportunities for physical activity and social interaction.

关键词： COVID-19   Suffering   Redemption   Salvifici Doloris   Pastoral care   DEATH  

摘要： The COVID-19 global pandemic has brought unprecedented physical and mental health challenges to many, making the exploration of the spiritual dimension of suffering increasingly meaningful and relevant. Pope John Paul II's theologico-pastoral approach in Salvifici Doloris (SD) sheds light on how spiritual reflections and pastoral care anchored on the theology of Jesus Christ's sufferings can be put together to contribute to post-COVID-19 reflections. Given this context, this paper explores the perceptions and coping mechanisms of COVID-19 patients as they navigate the challenges of their illness. By examining patient experiences gleaned from medical and scientific journals, the study underscores the necessity of supporting individuals suffering from various diseases. As John Paul II thoughtfully remarks in Salvifici Doloris, there is a profound need to address patients' inquiries about "the cause, the reason, and equally, the purpose of suffering, and, in brief, a question about its meaning." Taking this into account, this paper contextualizes the theology of suffering articulated by Pope John Paul II in SD within the experiences of patients who contracted COVID-19 during the global pandemic. To embark on this discussion, the following themes about suffering are expounded: First, Insights into the Weight of Suffering Among Persons who Contracted COVID-19. Second, Understanding of Suffering in Salvifici Doloris, and Third, The Salvific Meaning of Suffering in COVID-19 and its Transformative Experience.

关键词： evidence-based medicine   medical ethics   RECOMMENDATIONS   TRIALS  

摘要： RationaleThe GRADE system of clinical recommendations has deontic implications and can discriminate between mandatory, prohibited, and merely permitted medical *** and ObjectivesThe recommendation categories of the GRADE framework map onto deontological imperatives that can lead to a better understanding and management of allegations of imprudence and appropriateness of treatments. Allegations made during the worst phase of COVID-19 pandemic are used as a case study for exploring the deontic implications of *** theoretical analysis, case study analysis, and argumentation in defence of *** GRADE recommendations for or against treatment are justified by high-quality evidence and can be construed as ethical obligations and prohibitions. In contrast, when evidence for benefit or harm is of lower quality, GRADE yields weak, discretionary recommendations. In such grey area cases, the absence of a duty to prescribe or refuse to prescribe a requested treatment is compatible with the privilege of considering unproven but possibly beneficial options in a private setting. This privilege, however, does not extend to healthcare policymakers, who have a duty to promote actions that serve the public and whose recommendations should not be guided by personal or idiosyncratic preferences or *** there is no prima facie evidence that a proposed treatment is harmful, doctors are not negligent in considering it in shared doctor-patient decision-making. But these clinical decisions under uncertainty do not transfer obligations to health authorities, who are not part of the decision-making process in clinical settings. The clinical decision-making process concerns particulars and is guided by contextual and specific reasons that do not fall within the scope of a general policy. Thus, in the context of a serious epidemic in which patients need and demand treatments, if the body of evidence is still changing and fragile, an