Internationale Rekrutierung und Migration von Ärztinnen, Ärzten und Personal in Gesundheitsfachberufen: ein qualitatives Scoping Review der Public Health Literatur

Background

The international recruitment and migration of health workers has long been debated in the health policy literature. This study assesses to what extent the ethics of international recruitment are targeted in existing public health peer-reviewed literature, with a focus on concepts and in-depth consideration within articles. It further critically discusses hidden implications of this discourse regarding equity-creating health policy.

Methods

We conducted a qualitative scoping literature review searching the databases PubMed and Web of Science. Articles were assessed for quality using the Critical Appraisal Skills Program (CASP) checklist for qualitative research. Drawing on a thematic analysis approach, common themes across the sample were identified, coded and analyzed.

Results

A total of 17 articles were included in the analysis after searches and quality appraisal. These articles predominantly targeted nursing professions and physicians, and were written mainly by authors working in the Global North. Thematic analysis revealed that ethics are generally discussed in connection with overviews regarding the situation of health systems as well as regarding inequities between countries. Their focus lies more on migration between countries than between regions within a country. Proposed solutions are usually of an economic nature and range from global financial equalization between countries to national improvements in working conditions. Creative evaluation schemes for these solutions are rarely discussed in depth. Overall, the academic ethics discussion focuses predominantly on the health systems level, and views migration of health workers as problematic.

Conclusions

Our results suggest that academic research operates and aims to inform policy within the current system, without necessarily proposing fundamental changes to the status quo. Thus, an ethics discourse of health workforce recruitment may serve to increase awareness of inequalities without supporting radical change. Further research into intersectional aspects of health worker migration, including gender and ethnicity, may be useful for the discussion on inequities.

     

Die Relevanz einer institutionalisierten Ethik für eine professionelle Zahnmedizin

Definition of the problem

The concept of “ethics” has recently been incorporated into both the 2014 Model Professional Code for Dentists and the current version of the “National Competence-Based Catalog of Learning Objectives in Dental Medicine” (NKLZ, Nationaler Kompetenzbasierter Lernzielkatalog Zahnmedizin). The study presented here addresses the question which relevance this has for the relevance of the new concept accomplished for the dental profession and society.

Arguments

To this end, the societal processes that are related to the autonomous freedom of action of the dental profession are discussed. Therefore the sociological fields of discourse such as profession (and the effect of its constitutive antinomies), trust, education, expertise, practice of treatments and sanction are reviewed for their potential of having connections to each other and serving as a structural frame concerning an ethically reflected acting of the professional. The basis of the professional freedom of action is the trust of society and the individual patient in the professionally acting dentist.

Conclusion

The study arrives at the conclusion that it was a serious omission for many decades not to make young dentists aware of the ethical foundations of dental activity on an institutionally established basis and thus failing to encourage them to constantly reflect their professional expertise in relation to the problems to be solved. This deficit has now been identified. It is absolutely essential to implement an institutionalized structure dealing with ethical questions within the scope of dental medicine.

     

Psychological constructs in driving automation: a consensus model and critical comment on construct proliferation

As automation in vehicles becomes more prevalent, the call for understanding the behaviour of the driver while driving an automated vehicle becomes more salient. Although a variety of driver behaviour models exist, and various psychological constructs have been said to be influenced by automation, an empirically testable psychological model of automated driving has yet to be developed. Building upon Stanton and Young's model of driving automation, this article presents an updated model of interrelated psychological constructs. The proposed model was created based upon a systematic literature search of driving automation papers and a subsequent quantification of the number of reported links between a selected set of psychological constructs. A secondary aim of this article is to reach consensus in the use of psychological constructs regarding driving automation. Henceforth special attention is paid to resolving the issue of construct proliferation.     

Pleurotusostreatus and Agaricus subrufescens: investigation of chemical composition and antioxidant properties of these mushrooms cultivated with different handmade and commercial supplements

In this study, the chemical composition, total phenolic content and antioxidant activity (DPPH, ORAC and FRAP assays) of A. subrufescens and P. ostreatus, cultivated with handmade and commercials supplements, were compared. Additionally, the compounds ergosterol, saccharopine, and hexitol were identified in A. subrufescens by HPLC-MS/MS. The antioxidant compound p-coumaric acid and dihexoses was found in both mushroom species. A. subrufescens presented higher total phenolic content (73.8 ± 0.6 mg GAE 100 g⁻¹) and antioxidant activity than P. ostreatus (16.6 ± 0.5 mg GAE 100 g⁻¹). The handmade supplement based on the waste of noble grains presented statistically similar phenolic content to the mushrooms cultivated with commercial ones Spawn Mate II SE (86.1 ± 1.4 and 92.9 ± 0.3 mg GAE 100 g⁻¹, respectively). Therefore, the results support the use of handmade supplements based on agro-wastes as a viable alternative to the use of high-cost commercial ones.     

Influence of the gasket materials on the clamping pressure distribution in a PEM water electrolyzer: Bolt torques and operation mode in pre-conditioning

To keep optimally connected, all electrolysis cell elements is one of the most important design criteria. The optimal distribution of the clamping points is crucial to increasing cell performance. In this work, the compression pressure distribution inside of a 25 cm² PEM electrolysis cell was evaluated, using different materials: Teflon®, Viton®, ethylene propylene diene monomer rubber (EPDM), and nitrile rubber. Sealing material evaluation was performed taking as performance indicators: total compressed area (%) and compression pressure, for different torques applied. Pressure distribution was obtained by using pressure-sensitive films, analyzing the distribution of pressure points from three-dimensional plots (3D), and quantifying intensities of the images obtained. Results showed that pressure points distribution depends on the stiffness and thickness of the gasket materials. For a tightening torque of 3.70 N m, a pressure of 2.23 MPa is obtained with 85% of the membrane area compressed using nitrile rubber-EPDM gaskets.     

Autonomous indoor ultrasonic positioning system based on a low-cost conditioning circuit

This work presents a low cost 3-D location system based on ultrasonics and implemented with low-cost FPGAs. The mobile nodes of the system use distance estimation to several anchor points in order to trilaterate their positions with an accuracy of few centimeters. The ultrasonic transducers are handled with an ad hoc conditioning circuit based on instrumental amplifiers which provides high amplification keeping low noise. The proposed system is autonomous so there is no need of an external PC or other devices. A prototype of the system has been attached to a mobile robot to check the viability of the location system in a real scenario.     

Indoor air quality in Portuguese schools: levels and sources of pollutants

Indoor air quality (IAQ) parameters in 73 primary classrooms in Porto were examined for the purpose of assessing levels of volatile organic compounds (VOCs), aldehydes, particulate matter, ventilation rates and bioaerosols within and between schools, and potential sources. Levels of VOCs, aldehydes, PM_2.5, PM₁₀, bacteria and fungi, carbon dioxide (CO₂), carbon monoxide, temperature and relative humidity were measured indoors and outdoors and a walkthrough survey was performed concurrently. Ventilation rates were derived from CO₂ and occupancy data. Concentrations of CO₂ exceeding 1000 ppm were often encountered, indicating poor ventilation. Most VOCs had low concentrations (median of individual species <5 μg/m³) and were below the respective WHO guidelines. Concentrations of particulate matter and culturable bacteria were frequently higher than guidelines/reference values. The variability of VOCs, aldehydes, bioaerosol concentrations, and CO₂ levels between schools exceeded the variability within schools. These findings indicate that IAQ problems may persist in classrooms where pollutant sources exist and classrooms are poorly ventilated; source control strategies (related to building location, occupant behavior, maintenance/cleaning activities) are deemed to be the most reliable for the prevention of adverse health consequences in children in schools.