Risk Factors for Progression of Chronic Kidney Disease With Glomerular Etiology in Hospitalized Children

Aim: To Identify association between risk factors to Chronic kidney disease (CKD) stage 5 in children with glomerular diseases in children in China.Methods: The Hospital Quality Monitoring System database was used to extract data for the study cohort. The primary outcome included progression to CKD stage 5 or dialysis. Cox regression was used to assess potential risk factors. Patients with lower stages (CKD stage 1 and 2) and higher stages (CKD stage 3 and 4) at baseline were analyzed separately.Results: Of 819 patients (4,089 hospitalization records), 172 (21.0%) patients reached the primary outcome during a median followed-up of 11.4 months. In the lower stages group, factors associated with the primary outcome included older age [Hazard Ratio (HR), 1.21; 95% confidence interval (CI), 1.10–1.34] and out-of-pocket payment (HR, 4.14; 95% CI, 1.57–10.95). In the higher stages group, factors associated with the primary outcome included CKD stage 4 (HR, 2.31; 95% CI, 1.48–3.62) and hypertension (HR, 1.99; 95% CI, 1.29–3.07). The medical migration rate was 38.2% in this study population.Conclusion: There are different risk factors for progression to the primary outcome in different stages in CKD with glomerular etiology. Further prospective studies are needed to assess these risk factors. The high medical migration rate reflected the regional disparities in the accessibility of pediatric kidney care between regions.

African Physician Migration to High-Income Nations: Diverse Motives to Emigrate ("We Are not Florence Nightingale") or Stay in Africa ("There Is No Place Like Home") Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

Research in assessing the global and asymmetric flows of health workers in general, and international medical graduates in particular, is fraught with controversy. The complex goal of improving health status of the citizens of home nations while ensuring the right of health workers to migrate generates policy discussions and decisions that often are not adequately informed by evidence. In times of global public health crises like the current coronavirus disease 2019 (COVID-19) global pandemic, the need for equitable distribution and adequate training of health workers globally becomes even more pressing. Brugha et al report suboptimal training and working conditions among Irish and foreign medical doctors practicing in Ireland, while predicting large-scale outward migration. We comment on health personnel migration and retention based on our own experience in this area of research. Drawing from our examination of medical migration dynamics from sub-Saharan Africa, we argue for greater consideration of health workforce retention in research and policy related to resource-limited settings. The right to health suggests the need to retain healthcare providers whose education was typically subsidized by the home nation. The right to migrate may conflict with the right to health. Hence, a deeper understanding is needed as to healthcare worker motives based on interactions of psychosocial processes, economic and material determinants, and quality of work environments.

Indian medical graduates in New Zealand: does anyone win?

Medical migration has become a global phenomenon, partly led by easier air travel, economic factors and the expansion of medical technology. New Zealand has gradually evolved from being ‘bicultural’ to a multicultural, multitextured society. The movement of the Indian people, particularly Indian physicians, will be the focus of this paper. In the last three decades, migration eligibility in New Zealand has changed from countries of origin or ability to speak English, to profession and skills. Despite struggling with its own issues, New Zealand has proven to be a preferred destination for Indian medical graduates (IMGs). India is widely recognised as the largest ‘donor country’ for doctors, many of whom go on to establish themselves as leaders and prominent figures in their field. This migration involves three parties: India as a donor country, New Zealand as a recipient country and IMGs as the drivers of this process. Factors behind this growing phenomenon are examined and recommendations are made so that all three parties can benefit from it.

Development of a Methodology for Hospital Beds Planning according to Population and Morbidity

Introduction: Most of the forecast methods for hospital beds estimate a total number of beds per region, based on demographic and utilization indicators, without allocation on specialty wards.Objectives: Develop a forecast methodology per specialty in a county, according to the population needs.Materials and methods: Literature review, demographic data and indicators of hospital morbidity analysis; hospitalization rates adjustment for medical migration; model the allocation of new cases according to the previous hospitalization models.Results: the excess of hospitalization between similar counties varies between -34.71 to 96.50%; adjustment of the hospital beds for patient migration leads to increase in the number of beds in 5 of 6 counties; the allocation of new cases, based on the previous model of hospitalization, triggers the reallocation between specialties.Conclusions: demographic indicators, hospital activity, family doctor records can be used successfully to design the number of beds at county level, according to the needs of the population.

Migration of Junior Doctors: The Case of Psychiatric Trainees in Portugal

Introduction: In the last few decades, the rates of international medical migration have continuously risen. In Psychiatry, there is great disparity in the workforce between high and low-income countries. Yet, little is known about the ‘push’ and ‘pull’ factors and the migratory intentions of trainees. This study aims to assess the factors impacting the decisions of psychiatric trainees in Portugal towards migration.Material and Methods: A questionnaire was developed in the Brain Drain study and was distributed to psychiatric trainees in Portugal.Results: The sample consists of 104 psychiatric trainees (60.6% female). Overall, 40.4% of the trainees had prior experience of living abroad and the majority (96.9%) felt that this experience influenced their attitude towards migration in a positive way. About 75% of trainees had ‘ever’ considered leaving the country, but the majority (70.0%) had not taken any ‘practical steps’ towards migration. The main reasons to stay in Portugal were personal, while the main reason to leave was financial. The majority of the trainees (55.7%) were dissatisfied or very dissatisfied with their income, working conditions and academic opportunities.Discussion: Working conditions, salaries and academic opportunities are the main triggers for the migration of psychiatric trainees from Portugal.Conclusion: These results may inform the decisions of stakeholders in the health and education sectors and point out the necessary investments required and the impact it may have on the workforce.

Emigração de médicos brasileiros para os Estados Unidos da América

Resumo Este artigo aborda a mobilidade de médicos pelo mundo a partir de levantamento bibliográfico em base de dados e identifica a escassez de informações referentes aos médicos brasileiros. O objetivo é analisar aspectos que determinam a emigração de médicos brasileiros para os EUA. A metodologia baseia-se em pesquisa bibliográfica, utilizando as palavras-chave “brain drain”, “medical migration”, “physicians migration”, “data migration physicians”; identificação de artigos relacionados à emigração de médicos pelo mundo; elaboração e validação do questionário “Motivos de Emigração”; identificação de médicos que emigraram utilizando a técnica “bola de neve” ; envio do questionário por e-mail aos médicos que emigraram para os EUA; tabulação das respostas encaminhadas; realização de entrevistas por Skype com a finalidade de corroborar e exemplificar os resultados obtidos nos questionários. Inicialmente, os médicos escolhem emigrar por motivos pessoais (família, oportunidades profissionais e, em geral, facilidade do idioma); ao se estabelecerem nos EUA vivenciam uma nova forma de vida, o que os faz permanecer (melhores condições de trabalho, qualidade de vida, família e oportunidades em geral); as causas do não retorno ao Brasil passam a ter motivos externos (insegurança, cenários profissional, político e econômico). Conclui-se que existe um processo emigratório de médicos brasileiros para os EUA e, a princípio, a motivação de emigrar não é bem determinada; o salário não é citado como questão primordial; a presença da família facilita a permanência no país; a fluência na língua inglesa é fundamental; e é necessário recomeçar a vida profissional como um recém-formado em medicina, pois não existe processo de validação de diploma ou de especialidades.

Changes in Highly Skilled Migration Policies: Turkish-German Medical Migration since the 1960s

Turkish physicians have been migrating to Germany since the 1960s to obtain professional experience. Therefore, this article takes a long-term perspective: How and why did the careers of physicians with medical degrees from Turkish universities change through time? This study is based on 29 semi-structured and three expert interviews. The results show that the migrant physicians can be classified as three generations, whose qualifications have been viewed variably through time: The first generation (migrated 1961-1974) was welcomed because of a lack of doctors. They got special permits to practice medicine, which was usually bound to German citizenship. The second generation (migrated 1979-1990) only got permission to treat Turkish immigrants – because of both an excessive amount on doctors and ethnicization. The third generation (migrated 1999-2012) was affected by Europeanization and the competition with immigrating physicians from Eastern Europe. The findings show how medical migration changes due to migration and healthcare policies, thus highlighting the context-dependent nature of skill valuation processes.

Migration and Environmental Crises in Africa

This chapter discusses the contributions of economic crises, disasters, medical migration—especially for maternal and child care, in particular among the privileged— and climate change to migration in Africa, within the context of embedded values of immigration for economic advantage for self, family, and friends. Embedded local constructions of the West as the land of incredible opportunities and limitless wealth propel migration and frame local economic and environmental challenges as insurmountable requiring a determined or ‘lucky’ escape to developed countries to be achieved. Hence, local environmental crises solidify the resolve to migrate to improve socioeconomics for present and future populations through chain migration and remittances, among other culturally defined and expected support from successful migrants.